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. 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] 11. 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] 12. 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] 13. 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] 14. 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] 15. 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] 16. 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] 17. 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] 18. 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] 19. 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] 20. 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] 21. 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] 22. Ugeskr Laeger. 2009 Nov 9;171(46):3350-4. [Herpes zoster-associated morbidity in children undergoing chemotherapy for acute lymphoblastic leukaemia] [Article in Danish] Sørensen GV, Helgestad J, Rosthøj 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] 23. Curr Pharm Des. 2009;15(31):3644-55. Insulin-degrading enzyme: structure-function relationship and its possible roles in health and disease. Fernández-Gamba A, Leal MC, Morelli L, Castaño EM. Fundación Instituto Leloir and Instituto de Investigaciones Bioquímicas de Buenos Aires, Consejo Nacional de Investigaciones Científicas y Técnicas (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] 24. 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] 25. 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] 26. 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] 27. 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] 28. Ned Tijdschr Geneeskd. 2009;153:A913. [Vaccination against chickenpox, shingles and rotavirus-infection] [Article in Dutch] Hartwig NG, Rümke HC, Visser HK. Erasmus Medisch Centrum-Sophia, Rotterdam, The Netherlands. The Dutch National Immunisation Programme (NIP) has been very successful over the past 50 years. In future, this programme shall not include all new vaccines. Such vaccines can, however, be individually administered. At present there are 3 vaccines available in the Netherlands that have not been included in the NIP to date: against varicella (chickenpox), herpes zoster (shingles) and rotavirus infections. These vaccines are safe and effective. Chickenpox is not always a harmless childhood disease. A chickenpox vaccine is now available as well as a combined vaccine against mumps, measles, rubella and chickenpox. Shingles (herpes zoster) is a common disease in the elderly people. For many patients it is a considerable burden with significant complications, mainly postherpetic neuralgia and herpes zoster ophthalmicus. Vaccination may be considered for people 60 years and older. Rotavirus is much more associated with severe symptoms of diarrhoea than other pathogens. More than 95% of children experience one or more episodes of rotavirus gastroenteritis before their 5th birthday. In the Netherlands about 3400 children are hospitalised each year for rehydration following rotavirus infection. The vaccine is given orally. PMID: 19900343 [PubMed - indexed for MEDLINE] 29. Am J Gastroenterol. 2009 Nov;104(11):2852; author reply 2852-3. Questions regarding use of infliximab and risk of certain viral infections. El-Matary W. Comment on: Am J Gastroenterol. 2009 Jun;104(6):1575-86. PMID: 19888241 [PubMed - indexed for MEDLINE] 30. JAMA. 2009 Nov 4;302(17):1862; author reply 1862-3. Postherpetic neuralgia in herpes zoster. Zhou M, Zhou D, He L. Erratum in: JAMA. 2010 Feb 24;303(8):734. Comment in: JAMA. 2010 Feb 24;303(8):733-4. Comment on: JAMA. 2009 Jul 1;302(1):73-80. PMID: 19887663 [PubMed - indexed for MEDLINE] 31. Clin Med. 2009 Oct;9(5):500-1. Herpes zoster brachial plexopathy with predominant radial nerve palsy. Jeevarethinam A, Ihuoma A, Ahmad N. Hammersmith Hospital, London. naeem.ahmad@bhrhospitals.nhs.uk Herpes zoster or shingles is the reactivation of dormant varicella zoster virus (VZV) in the dorsal root ganglia. Segmental motor paresis is rare and only few cases of brachial plexitis have been reported in the literature. This case reports herpes zoster resulting in unilateral brachial plexitis with predominant radial nerve palsy. The patient was treated successfully with aciclovir, gabapentin and physiotherapy with good recovery. Radial neuritis secondary to active herpes zoster has been rarely reported in the past. PMID: 19886118 [PubMed - indexed for MEDLINE] 32. Scand J Infect Dis. 2010;42(1):79-80. Case detection rates of herpes zoster by gender and age. Kyriakis KP, Kosma E, Rachioti E, Paltatzidou K, Tadros A, Kapitsini A. PMID: 19883152 [PubMed - indexed for MEDLINE] 33. Klin Med (Mosk). 2009;87(9):67-9. [A rare form of eczema in a patient with herpes zoster] [Article in Russian] Shishov AS, Gul'iants AA, Shandalin VA, Rusanova SA. A rare clinical condition, herpes Zoster duplex bilateralis, is described. Because the erroneous definition of the disease as a lichen is widespread even in the system of advanced medical training, the importance of differentiation between the notions of herpes and lichen is emphasized. PMID: 19882886 [PubMed - indexed for MEDLINE] 34. Nippon Jibiinkoka Gakkai Kaiho. 2009 Sep;112(9):656-9. [Ramsay Hunt syndrome with cranial polyneuropathy involving cranial nerves VII, VIII, IX, and X] [Article in Japanese] Sugita-Kitajima A, Sato S, Koizuka I. Department of Otolaryngology, St. Marianna University School of Medicine, Kawasaki. In addition to facial and vestibular nerve paralysis, patients with Ramsay Hunt syndrome may also show glossopharyngeal, vagal, and hypoglossal nerve paralysis. We report a case of Ramsay Hunt syndrome with cranial polyneuropathy including cranial nerves VII, VIII, IX, and X. A 58-year-old rheumatic woman suffering from vertigo, right earache, and sore throat suffered right-side facial palsy, hoarseness, and swallowing difficulty on day 5. Admitted on day 6, she was treated with antiviral medication and steroids. Although vertigo, facial palsy, and hearing loss gradually improved, hoarseness required over three months to recover. Of the 33 patients with Ramsay Hunt syndrome we have seen, 9 (27%) had cranial polyneuropathy, including cranial nerves IX and X in 4 years. Of these, 9% involved total paralysis of nerves IX and X. Physical symptoms of those with polyneuropathy, especially vagal nerve palsy, tended to worsen, making it important to observe other cranial nerve signs, such as for IX and X carefully, in addition to VII and VIII. PMID: 19860268 [PubMed - indexed for MEDLINE] 35. J Med Virol. 2009 Dec;81(12):2053-8. Epidemiology of herpes zoster and its relationship to varicella in Japan: A 10-year survey of 48,388 herpes zoster cases in Miyazaki prefecture. Toyama N, Shiraki K; Society of the Miyazaki Prefecture Dermatologists. Collaborators: Amano M, Anegawa S, Aoki Y, Chousa N, Era E, Era K, Hachisuka H, Hidaka M, Hiejima M, Higashi K, Horinouchi K, Idemori M, Inoue S, Ishii Y, Ito S, Kanda A, Kaneda R, Kawai S, Kawana N, Kikuchi I, Kikuchi T, Kinoshita M, Kitamura T, Kohashi M, Koketu H, Kurokawa M, Kuroki K, Kuroki Y, Kuromizu K, Kuwahara T, Maeda S, Miyagi T, Miyakuni H, Miyazaki Y, Nagamine H, Nakano H, Nakano S, Nakayama F, Nakayama K, Narahara S, Narita H, Nishida T, Nobe T, Numata T, Oda Y, Ogata K, Oumaru K, Ohtsuka K, Okamura H, Sakaguchi E, Sakai K, Setoyama M, Tada S, Tajima S, Tajiri A, Takasaki N, Taketomi I, Tateyama S, Tazaki T, Teruya N, Tsumori S, Yamaguchi K. Toyama Dermatologic Clinic, Nichinan City, Miyazaki, Japan. toyama@miyazaki.med.or.jp From 1997 to 2006, a total of 48,388 patients with herpes zoster, ranging from a 3-month-old girl to a 102-year-old woman, were monitored at the 46 dermatology clinics in the Miyazaki Prefecture, which has a population of about 1.2 million. The mean herpes zoster incidence was 4.15/1,000 person-years, ranging from 1.96 to 7.84/1,000 person-years among different age groups, and the herpes zoster incidence was significantly higher in females (4.58) than in males (3.67). The incidence by age group was 1.96-2.86/1,000 person-years below the age of 50 years, and it increased to 5.23-7.84/1,000 person-years in persons 50-59 and older, with a trough in the ages 30-39, forming the small and large peaks. Females showed a significantly higher incidence than males, and the difference between the sexes was small below age 40 but greater at 40-49, 50-59, and 60-69. The incidence of herpes zoster was highest in August and lowest in winter, mirroring the prevalence of varicella. The number of herpes zoster cases at 60 years and older increased more than in the population from 1997 to 2006, and this increased incidence of herpes zoster in the 60-69 years and older, especially in females, might have raised the rate in contrast to the stable incidence below the age of 60 years. This large-scale survey clarifies the epidemiology of herpes zoster by age, gender, and season in relation to the prevalence of varicella in the Miyazaki Prefecture in Japan. (c) 2009 Wiley-Liss, Inc. PMID: 19856466 [PubMed - indexed for MEDLINE] 36. Rev Clin Esp. 2009 Oct;209(9):454-5. [Abdominal muscle paralysis as a complication of herpes zoster] [Article in Spanish] Morera Montes J, Gómez García M, Muñoz Núñez A. PMID: 19852919 [PubMed - indexed for MEDLINE] 37. Jpn J Ophthalmol. 2009 Sep;53(5):548-9. Epub 2009 Oct 22. Two cases of varicella zoster virus keratitis with atypical extensive pseudodendrites. Kandori M, Inoue T, Takamatsu F, Hori Y, Maeda N, Tano Y. PMID: 19847615 [PubMed - indexed for MEDLINE] 38. Am J Ophthalmol. 2009 Dec;148(6):946-50. Epub 2009 Oct 17. Scleritis and systemic disease association in a community-based referral practice. Raiji VR, Palestine AG, Parver DL. Department of Ophthalmology, George Washington University, Washington, DC, USA. veena.raiji@gmail.com PURPOSE: To evaluate the association between scleritis and systemic disease in a non-university, non-tertiary referral practice and to describe our experience with scleritis treatment. DESIGN: Retrospective chart review. METHODS: The medical records of patients with scleritis between 2001 and 2007 were reviewed for associated systemic disease. RESULTS: In our series of 86 patients with scleritis, 55 patients (64.0%) had isolated scleritis while 31 patients (36.0%) had associated systemic-disease. Twenty-six patients (83.9%) with systemic disease had diagnosed systemic disease at the time of initial scleritis presentation, while 5 patients (16.1%) were diagnosed following systemic work-up. Those diagnosed after systemic work-up were more likely to have systemic vasculitic disease as opposed to a rheumatic or infectious disease. Patients with and without associated systemic disease were likely to require systemic therapy at similar rates (93.5% and 92.7%, respectively). Five patients with steroid-refractory scleritis were treated with infliximab (Remicade; Centocor Inc, Horsham, Pennsylvania, USA) and all responded without evidence of adverse effect. Seven patients were treated with mycophenolate mofetil (CellCept; Roche Laboratories, Nutley, New Jersey, USA), of which three improved. CONCLUSIONS: The association between scleritis and systemic disease in a community-based referral practice may be lower than in tertiary referral or university-based centers. Although thorough systemic disease evaluation is warranted in scleritis patients, most patients with associated systemic disease will have such a diagnosis prior to the development of scleritis. The need to institute aggressive systemic therapy cannot be predicted by the presence of an associated systemic disease. Infliximab and mycophenolate mofetil are useful additions to the scleritis practitioner's armamentarium for steroid-refractory scleritis. PMID: 19837380 [PubMed - indexed for MEDLINE] 39. Anasthesiol Intensivmed Notfallmed Schmerzther. 2009 Oct;44(10):644-50; quiz 651. Epub 2009 Oct 15. [Treatment of herpes zoster and postherpetic neuralgia] [Article in German] Schulzeck S, Gleim M. Klinik für Anästhesiologie und Operative Intensivmedizin des Universitätsklinikums Schleswig-Holstein. schulzeck@anaesthesie.uni-kiel.de Herpes zoster, a biphasic disease with different kinds of pain is a challenge for pain therapy. The acute illness with mixed pain (nociceptive - neuropathic) requires antivirals for risk patients and pain treatment according to rules of acute pain therapy. For treatment of postherpetic neuralgia (PHN) an example of neuropathic pain, antidepressants, anticonvulsants and topical lidocaine are today the first line therapeutics, further opioids are of a certain therapeutic value. Georg Thieme Verlag Stuttgart * New York. PMID: 19834828 [PubMed - indexed for MEDLINE] 40. J Clin Virol. 2009 Dec;46(4):349-53. Epub 2009 Oct 13. Genetic variation of Varicella-Zoster Virus strains circulating in Mexico City. Rodríguez-Castillo A, Vaughan G, Ramírez-González JE, González-Durán E, Gudiño-Rosales JC, Escobar-Gutiérrez A. Departamento de Genoma de Patógenos, Instituto de Diagnóstico y Referencia Epidemiológicos, Secretaría de Salud, Mexico City, Mexico. aracelirc2@yahoo.com.mx BACKGROUND: Different studies regarding VZV genotype distribution worldwide have demonstrated that genetic diversity and epidemiology of infection significantly vary from region to region. In Mexico, VZV genotype distribution is largely unknown mostly due to the lack of a surveillance system that monitors accurately the presence of viral strains circulating in the country. OBJECTIVE: To identify the main VZV genotypes circulating in the metropolitan area of Mexico City. STUDY DESIGN: In this study, 127 different VZV isolates, obtained from residents of the Mexico City Metropolitan area from 2005 to 2008, were identified and genotyped. Viral detection and preliminary genotyping was performed by amplification of the VZV ORF-38 and -54 and RFLP analysis using PstI and BglI endonuclease restriction patterns, respectively. Genotype was confirmed by nucleotide sequence variation along the ORF-22. RESULTS: RFLP analysis classified 121 viral strains as European and 6 as mosaic genotype. Genotyping scheme based on the ORF-22 sequence variation identified 120 viral strains belonging to the E genotype, 6 M1 and 1 M4 genotype strains. CONCLUSIONS: VZV European genotype appears to predominate in Mexico City. This is the first study addressing VZV genotype distribution in Mexico. The information reported in this paper may be useful for future epidemiological studies conducted in the country and also contributes to understand better the molecular epidemiology of VZV in the Americas. PMID: 19828367 [PubMed - indexed for MEDLINE] 41. Int J Environ Res Public Health. 2009 Sep;6(9):2344-53. Epub 2009 Sep 2. Herpes zoster associated hospital admissions in Italy: review of the hospital discharge forms. Gabutti G, Serenelli C, Cavallaro A, Ragni P. Department of Clinical and Experimental Medicine, Section of Hygiene and Occupational Health, University of Ferrara; 44100 Ferrara, Italy. giovanni.gabutti@unife.it In Italy a specific surveillance system for zoster does not exist, and thus updated and complete epidemiological data are lacking. The objective of this study was to retrospectively review the national hospital discharge forms database for the period 1999-2005 using the code ICD9-CM053. In the period 1999-2005, 35,328 hospital admissions have been registered with annual means of 4,503 hospitalizations and 543 day-hospital admissions. The great part of hospitalizations (61.9%) involved subjects older than 65 years; the mean duration of stay was 8 days. These data, even if restricted to hospitalizations registered at national level, confirm the epidemiological impact of shingles and of its complications. PMCID: PMC2760413 PMID: 19826547 [PubMed - indexed for MEDLINE] 42. Curr Neurol Neurosci Rep. 2009 Nov;9(6):430-4. Neurologic manifestations of varicella zoster virus infections. Amlie-Lefond C, Jubelt B. Department of Neurology, Medical College of Wisconsin and Children's Hospital of Wisconsin, Milwaukee, WI 53226, USA. Klefond@mcw.edu Varicella zoster virus (VZV) causes acute viral exanthema in childhood, becomes latent, and can reactivate years later to produce neurologic disease. Primary VZV infection is associated with acute cerebellitis and stroke, particularly in childhood. VZV reactivation may result in neuropathy, myelitis, stroke, and encephalitis, the latter two syndromes the result of small and large vessel vasculopathy. Prompt diagnosis and treatment are critical to minimize morbidity in herpes zoster as well as morbidity and death in VZV vasculitis and encephalitis. Detection of anti-VZV antibodies in cerebrospinal fluid is the most sensitive method of diagnosing varicella infection of the nervous system. Despite the advent of the VZV vaccine, varicella remains a significant cause of neurologic morbidity. PMID: 19818229 [PubMed - indexed for MEDLINE] 43. Stroke. 2009 Nov;40(11):3443-8. Epub 2009 Oct 8. Increased risk of stroke after a herpes zoster attack: a population-based follow-up study. Kang JH, Ho JD, Chen YH, Lin HC. Department of Physical Medicine and Rehabilitation, the Neuroscience Research Center, Taipei Medical University Hospital, Taipei, Taiwan. BACKGROUND AND PURPOSE: Varicella zoster virus-induced vasculopathy and postherpes zoster attack stroke syndromes have been reported previously; nevertheless, data regarding the exact prevalence and risk of stroke occurring postherpes zoster attack are still lacking. This study aims to investigate the frequency and risk of stroke after a herpes zoster attack using a nationwide, population-based study of a retrospective cohort design. Method- A total of 7760 patients who had received treatment for herpes zoster between 1997 and 2001 were included and matched with 23 280 randomly selected subjects. A 1-year stroke-free survival rate was then estimated using the Kaplan-Meier method. After adjusting for potential confounders, Cox proportional hazard regressions were carried out to compute the adjusted 1-year survival rate. RESULTS: Of the sampled patients, 439 patients (1.41%) developed strokes within the 1-year follow-up period, that is, 133 individuals (1.71% of the patients with herpes zoster) from the study cohort and 306 individuals (1.31% of patients in the comparison cohort) from the comparison cohort. The log rank test indicated that patients with herpes zoster had significantly lower 1-year stroke-free survival rates than the control (P<0.001). The adjusted hazard ratios of stroke after herpes zoster and herpes zoster ophthalmicus during the 1-year follow-up period were 1.31 and 4.28, respectively. CONCLUSIONS: The risk for stroke increased after a zoster attack. Although varicella zoster virus vasculopathy is a well-documented complication that may induce a stroke postherpes zoster attack, it does not fully account for the unexpectedly high risk of stroke in these patients. PMID: 19815828 [PubMed - indexed for MEDLINE] 44. Acta Paediatr. 2009 Nov;98(11):1706, 1855-6. Vesicular eruption located on sunburned areas in an 8-year-old girl. Zoller L, Shavit I, Sprecher E. Department of Dermatology, Rambam Health Care Campus, Haifa, Israel. PMID: 19807701 [PubMed - indexed for MEDLINE] 45. Pain Physician. 2009 Sep-Oct;12(5):851-3. Herpes zoster radiculopathy treated with fluoroscopically-guided selective nerve root injection. Conliffe TD, Dholakia M, Broyer Z. Rothman Institute of Orthopedics, Philadelphia, PA 19107, USA. TConliffemd@aol.com BACKGROUND: Varicella-zoster virus, a member of the herpes virus family, is a neurotrophic virus that primarily affects afferent sensory neurons. Reactivation of latent virus within the dorsal root ganglion and axoplasmic transport to epithelial nerve terminals causes the segmental cutaneous rash and neuralgic pain characteristic of herpes zoster. SETTING: Outpatient orthopedic practice. CASE DESCRIPTION: A 75-year-old male developed a herpetic rash followed by burning pain in the right L5 distribution. The pain was exacerbated by standing or walking. Six weeks later, the rash had improved, but the patient developed a right foot drop requiring use of a molded ankle-foot orthosis. MRI of the lumbar spine revealed mild degenerative changes without evidence of significant spinal stenosis or disc disease. Electrodiagnostic studies confirmed the diagnosis of right L5 radiculopathy. RESULTS: The patient had dramatic improvement of pain and weakness after undergoing a fluoroscopically guided right L5 selective nerve root block with Depo-Medrol and Lidocaine. He then began a course of physical therapy and, 6 weeks later, had only trace weakness of the ankle dorsiflexor group on the right side. The patient has continued without significant weakness or pain since the procedure and has returned to normal functioning. DISCUSSION: This case demonstrates apparent treatment of a relatively uncommon phenomenon, herpes zoster radiculopathy, using selective nerve root block. LIMITATIONS: There is a limited amount of data regarding this disorder presently available regarding Herpes Zoster Radiculopathy. A second limitation would be an inability to exclude spinal pathology as an alternative etiology of this patient's condition. CONCLUSION: Cases of herpes zoster-induced radiculopathy may become more frequent, as evidenced by the increasing number of cases of herpes zoster in the United States noted epidemiologically. PMID: 19787010 [PubMed - indexed for MEDLINE] 46. Antimicrob Agents Chemother. 2009 Dec;53(12):5095-101. Epub 2009 Sep 28. Susceptibilities of human cytomegalovirus clinical isolates and other herpesviruses to new acetylated, tetrahalogenated benzimidazole D-ribonucleosides. Hwang JS, Schilf R, Drach JC, Townsend LB, Bogner E. Institute of Virology, Charité Universitätsmedizin Berlin, Berlin, Germany. Recently we characterized two inhibitors targeting the human cytomegalovirus (HCMV) terminase, 2-bromo-4,5,6-trichloro-1-(2,3,5-tri-O-acetyl-beta-D-ribofuranosyl) benzimidazole (BTCRB) and 2,4,5,6-tetrachloro-1-(2,3,5-tri-O-acetyl-beta-D-ribofuranosyl) benzimidazole (Cl(4)RB). The terminase consists of the ATP-hydrolyzing subunit pUL56 and the subunit pUL89 required for duplex nicking. Because mammalian cell DNA replication does not involve cleavage of concatemeric DNA by a terminase, these compounds represent attractive alternative HCMV antivirals. We now have tested these previously identified benzimidazole ribonucleosides in order to determine if they are active against HCMV clinical isolates as well as those of herpes simplex virus type 1, mouse cytomegalovirus, rat cytomegalovirus (RCMV), and varicella-zoster virus (VZV). Antiviral activity was quantified by measurement of viral plaque formation (plaque reduction) and by viral growth kinetics. Interestingly, both BTCRB and Cl(4)RB had an inhibitory effect in ganciclovir (GCV)-sensitive and GCV-resistant clinical isolates, with the best effect produced by Cl(4)RB. Electron microscopy revealed that in cells infected with GCV-sensitive or GCV-resistant isolates, B capsids and dense bodies were formed mainly. Furthermore, pulsed-field gel electrophoresis showed that cleavage of concatenated DNA was inhibited in clinical isolates. In addition, the antiviral effect on other herpesviruses was determined. Interestingly, in plaque reduction assays, BTCRB was active against all tested herpesviruses. The best effects were observed on VZV- and RCMV-infected cells. These results demonstrate that the new compounds are highly active against GCV-resistant and GCV-sensitive clinical isolates and slightly active against other herpesviruses. PMCID: PMC2786319 [Available on 2010/6/1] PMID: 19786605 [PubMed - indexed for MEDLINE] 47. J Heart Lung Transplant. 2009 Nov;28(11):1215-6. Epub 2009 Sep 26. Fulminant hepatic failure due to varicella zoster in a heart transplant patient: successful liver transplant. Alvite-Canosa M, Paniagua-Martín MJ, Quintela-Fandiño J, Otero A, Crespo-Leiro MG. Liver Transplant Unit, Complejo Hospitalario Universitario A Coruña, C/As Xubias 84, A Coruña, Spain. marlenqx@hotmail.com Fulminant hepatic failure is a rare complication of infection by varicella zoster virus that is favored by immunosuppression. Within 1 week, a 43-year-old male heart transplant recipient who was admitted with epigastric pain successively developed a generalized vesicular rash, hepatitis, and secondary multiorganic failure involving encephalopathy, despite treatment with acyclovir (since Day 2) and varicella zoster virus immunoglobulin (since Day 6). Emergency liver transplantation was performed on Day 9, and 36 months later, his heart and liver function are normal. PMID: 19782606 [PubMed - indexed for MEDLINE] 48. Pediatr Infect Dis J. 2009 Dec;28(12):1069-72. Incidence of herpes zoster among children vaccinated with varicella vaccine in a prepaid health care plan in the United States, 2002-2008. Tseng HF, Smith N, Marcy SM, Sy LS, Jacobsen SJ. Department of Research and Evaluation, Southern California Permanente Medical Group, Kaiser Permanente, Pasadena, CA 91101, USA. hung-fu.x.tseng@kp.org BACKGROUND: Herpes zoster (HZ), or shingles, is caused by reactivation of latent varicella-zoster virus after a primary infection with either wild-type or vaccine-type varicella-zoster virus, the latter having been introduced in 1995 for children. Since then, few population-based data about the incidence of childhood HZ are available. METHODS: We identified children aged < or = 12 years who were vaccinated with 1 dose of varicella vaccine between 2002 and 2008 in a prepaid health plan and followed them through their electronic health records for a diagnosis of HZ. The medical records of these children were reviewed. Persistent and chronic conditions for these children before HZ were identified. RESULTS: There were 172,163 children vaccinated, with overall follow-up of 446,027 person-years (Incidence rate = 27.4 per 100,000 person-years, 95% confidence interval: 22.7-32.7). Children vaccinated after age 5 years had a higher but not statistically significant different rate than children vaccinated between 12 and 18 months (34.3 vs. 28.5 per 100,000 person-years). Among children vaccinated between 12 and 18 months, incidence rates gradually increased each year in the first 4 years after vaccination (P < 0.001). Among the HZ cases, there were 1 (0.7%) case of lymphoid leukemia, 1 (0.7%) case of drug abuse, 16 (11.1%) cases of asthma with 3 or more acute exacerbations, 12 (8.3%) cases of developmental disorders, and 3 (2.1%) cases of psychological or mental disorders. CONCLUSIONS: These data demonstrate that diagnosed HZ is rare among children following varicella vaccine. Despite the small numbers, the roles of delayed vaccination, severe asthma, and development disorders warrant further investigation. In the future, analyses of HZ isolates will be needed to identify the virus strains causing reactivation. PMID: 19773676 [PubMed - indexed for MEDLINE] 49. Del Med J. 2009 Jun;81(6):221-4. Case report: acute retinal necrosis. Reinhardt JF, Jain N, Ahmed S. Jefferson Medical College, Philadelphia, USA. PMID: 19772077 [PubMed - indexed for MEDLINE] 50. Duodecim. 2009;125(15):1608-14. [Management of herpes zoster infection.] [Article in Finnish] Lauhio A, Anttila VJ. HYKS/HUS, medisiininen tulosyksikkö, infektiosairauksien klinikka. Approximately 10 to 30% of the population will suffer from herpes zoster (HZ) during their lifetime. Prompt treatment of acute HZ with acyclovir, valacyclovir or famciclovir is recommend, if patients are over 50 years old or have severe or moderate pain or severe or moderate rash or they are immonocompromised or suffer from herpes zoster ophtalmicus. Zoster lesions contain high concentrations of Varicella zoster virus that can spread, and cause chicken pox. There is no universal recommendations for varicella vaccination. It has been shown that zoster vaccine markedly reduced morbidity from herpes zoster and postherpetic neuralgia among older adults. PMID: 19769176 [PubMed - indexed for MEDLINE] 51. Lancet. 2009 Sep 19;374(9694):1010. Distinctly different purpura on different arms. Gelber AC. Department of Medicine, Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland 21224, USA. agelber@jhmi.edu PMID: 19766882 [PubMed - indexed for MEDLINE] 52. J Infect. 2009 Dec;59(6):416-20. Epub 2009 Sep 17. A 9 year follow up of post herpetic neuralgia and predisposing factors in elderly patients following herpes zoster. McKendrick MW, Ogan P, Care CC. Department of Infection and Tropical Medicine, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, UK. mike.mckendrick@sth.nhs.uk To characterise predisposition to post herpetic neuralgia following herpes zoster. DESIGN: Late follow up of patients originally admitted with acute zoster to a double blind randomised placebo controlled study of oral acyclovir over 60 years of age. SETTING: Two UK cities of 1.5 million population. RESULTS: 158 of the 298 patients from the original study were available for evaluation at a mean follow up of 9 years. Thirty four (21%) described experiencing pain from the zoster within the previous 12 months. Pain at follow up was associated with characteristics at the time of acute zoster of: moderate or severe acute pain (p = 0.006), prodromal pain >72 h before rash (p = 0.006), severity of rash (p = 0.033) and female gender (p = 0.046). There was no association between pain at 9 year follow up and use of placebo or aciclovir nor with the presence or absence of pain at the point of discharge from the original study. Further analysis of 17 of the 34 patients with long term pain who have full data available, the median pain score was 4 out of 10 and more than 50% described persistent pain and interference with sleep. CONCLUSION: Long term pain in the elderly following zoster is associated with identifiable characteristics during the acute illness. PMID: 19766139 [PubMed - indexed for MEDLINE] 53. Pharmacoeconomics. 2009;27(9):781-92. doi: 10.2165/11317560-000000000-00000. Incremental 1-year medical resource utilization and costs for patients with herpes zoster from a set of US health plans. White RR, Lenhart G, Singhal PK, Insinga RP, Itzler RF, Pellissier JM, Segraves AW. Department of Global Outcomes Research, Global Human Health, West Point, Pennsylvania, USA. ron_white@merck.com BACKGROUND: Nearly 1 million new episodes of herpes zoster (HZ) occur annually in the US, yet little is known about the medical resource utilization (RU) and costs associated with HZ and its complications. OBJECTIVES: To describe the medical RU and cost burden of HZ in the first 90 days and the first year after diagnosis from the health insurer perspective and to stratify this burden for patients diagnosed with post-herpetic neuralgia (PHN) and those who are immunocompromised. In addition, this study explores costs from the societal perspective as a result of work loss in the first year after diagnosis. METHODS: The medical RU and cost data were obtained from the MarketScan Research Database for the years 1998-2003. This database contains inpatient, outpatient and prescription drug data for approximately 14 million individuals of all ages, covered under a variety of fee-for-service and capitated provider reimbursement arrangements, including those with Medicare and private insurance. The work loss estimates were based on the MarketScan Health and Productivity Management Database. Claims for services incurred between 1 January 1998 and 31 December 2003 were screened to identify a cohort of HZ patients based on the presence of at least one International Classification of Diseases, 9th Revision (ICD-9) diagnosis code 053.xx. Each patient was assigned an index date based on the earliest observed occurrence of an HZ diagnosis. A cohort of PHN patients was identified as a subset of the HZ cohort with ICD-9 codes 053.12, 053.13, 053.19 or 729.2x in the period of 90 days to 12 months after the index date. Multivariable regression was used to compare HZ cases with matched controls after adjusting for demographic characteristics, insurance status, co-morbidities and medical expenditure in the 6 months prior to diagnosis for each of the endpoints. Separate regression models were developed, in which age and immune status were stratified. All costs were adjusted to March 2008 values using the medical care component of the Consumer Price Index. The average per patient cost of all HZ cases was $US605 in the first 90 days after diagnosis and $US1052 at 1 year. For the subset with PHN, the average per patient cost of HZ at 1 year was $US3815. For the subset with an immunocompromising condition, the average HZ cost at 1 year was $US1745. The majority of the costs were the result of outpatient visits and prescription drugs. The subset of HZ cases that had both absence hour and short-term disability (STD) records available had 26.5 absence hours and 2.9 STD days. Healthcare utilization, medical care costs and work loss all increased with age for all HZ cases. Based on the results from the present study, the direct medical cost burden of HZ in the US is high, exceeding $US1000 per HZ patient. This direct medical cost may be nearly twice as high in immunocompromised patients and four times as high in the subset of HZ cases with PHN. The direct medical cost burden of HZ may exceed $US1 billion annually in the US. The majority of medical RU and cost burden is incurred by the elderly. Although many people with HZ may no longer be in the workforce, HZ does contribute to lost work time. PMID: 19757871 [PubMed - indexed for MEDLINE] 54. BMJ. 2009 Sep 14;339:b3621. doi: 10.1136/bmj.b3621. Herpes zoster ophthalmicus. Don't forget HIV. Yoganathan K. Comment on: BMJ. 2009;339:b2624. PMID: 19752050 [PubMed - indexed for MEDLINE] 55. J Virol. 2009 Nov;83(22):11502-13. Epub 2009 Sep 9. Histone deacetylases 1 and 2 are phosphorylated at novel sites during varicella-zoster virus infection. Walters MS, Erazo A, Kinchington PR, Silverstein S. Department of Microbiology, College of Physicians and Surgeons, Columbia University, 701 W. 168th St., New York, NY 10032, USA. ORF66p, a virion-associated varicella-zoster virus (VZV) protein, is a member of a conserved Alphaherpesvirinae kinase family with homology to herpes simplex virus US3 kinase. Expression of ORF66p in cells infected with VZV or an adenovirus expressing only ORF66p results in hyperphosphorylation of histone deacetylase 1 (HDAC1) and HDAC2. Mapping studies reveal that phosphorylation is at a unique conserved Ser residue in the C terminus of both HDACs. This modification requires an active kinase domain in ORF66p, as neither protein is phosphorylated in cells infected with VZV lacking kinase activity. However, hyperphosphorylation appears to occur indirectly, as within the context of in vitro kinase reactions, purified ORF66p phosphorylates a peptide derived from ORF62p, a known substrate, but does not phosphorylate HDAC. These results support a model where ORF66p is necessary but not sufficient to effect hyperphosphorylation of HDAC1 and HDAC2. PMCID: PMC2772673 [Available on 2010/5/1] PMID: 19740981 [PubMed - indexed for MEDLINE] 56. Mayo Clin Proc. 2009 Sep;84(9):787-94. Health care utilization and cost burden of herpes zoster in a community population. Yawn BP, Itzler RF, Wollan PC, Pellissier JM, Sy LS, Saddier P. Department of Research, Olmsted Medical Center, Rochester, MN 55904, USA. yawnx002@umn.edu Erratum in: Mayo Clin Proc. 2010 Jan;85(1):102. OBJECTIVE: To conduct a population-based study to assess health care utilization (HCU) and costs associated with herpes zoster (HZ) and its complications, including postherpetic neuralgia (PHN) and nonpain complications, in adults aged 22 years and older. PATIENTS AND METHODS: Medical record data on HCU were abstracted for all confirmed new cases of HZ from January 1, 1996, through December 31, 2001, among residents of Olmsted County, Minnesota. Herpes zoster-related costs were estimated by applying the Medicare Payment Fee Schedule to health care encounters and mean wholesale prices to medications. All costs were adjusted to 2006 US dollars using the medical care component of the Consumer Price Index. RESULTS: The HCU and cost of the 1669 incident HZ cases varied, depending on the complications involved. From 3 weeks before to 1 year after initial diagnosis, there were a mean of 1.8 outpatient visits and 3.1 prescribed medications at a cost of $720 for cases without PHN or nonpain complications compared with 7.5 outpatient visits and 14.7 prescribed medications at a cost of $3998 when complications, PHN, or nonpain complications were present. CONCLUSION: The annual medical care cost of treating incident HZ cases in the United States, extrapolated from the results of this study in Olmsted County, is estimated at $1.1 billion. Most of the costs are for the care of immunocompetent adults with HZ, especially among those 50 years and older. PMCID: PMC2735428 PMID: 19720776 [PubMed - indexed for MEDLINE] 57. Pain Res Manag. 2009 Jul-Aug;14(4):275-82. Herpes zoster and postherpetic neuralgia: past, present and future. Bennett GJ, Watson CP. Department of Anesthesia, Faculty of Dentistry, and The Alan Edwards Centre for Research on Pain, McGill University, Montreal, Quebec, Canada. gary.bennett@mcgill.ca OBJECTIVES: The history behind the current understanding of the varicella-zoster virus and its relationship to the pain conditions caused by shingles and postherpetic neuralgia are reviewed. The framework for the current conceptualization is Hope-Simpson's latency hypothesis. Data from recent work in virology, neuroanatomy and epidemiology are reviewed, as is work using varicella-zoster virus-infected animals. The recent data largely confirm Hope-Simpson's hypothesis and extend it significantly. PMCID: PMC2734513 [Available on 2010/7/1] PMID: 19714266 [PubMed - indexed for MEDLINE] 58. Anesth Analg. 2009 Nov;109(5):1651-5. Epub 2009 Aug 27. The effectiveness of repetitive paravertebral injections with local anesthetics and steroids for the prevention of postherpetic neuralgia in patients with acute herpes zoster. Ji G, Niu J, Shi Y, Hou L, Lu Y, Xiong L. Department of Anesthesiology, Pain Clinic, Xijing Hospital, The Fourth Military Medical University, Xi'an, China. BACKGROUND: The treatment of postherpetic neuralgia (PHN) continues to be a challenge in clinical pain management. In this randomized, controlled study, we assessed the effectiveness of repetitive paravertebral injections with local anesthetics and steroids for the prevention of PHN in patients with acute herpes zoster. METHODS: One hundred thirty-two patients with acute herpes zoster diagnosed 1-7 days after the onset of the rash were randomly assigned to receive either standard therapy (oral antivirals and analgesics) or standard therapy with additional repetitive paravertebral injections of a mixture of 10 mL 0.25% bupivacaine and 40 mg methylprednisolone acetate every 48 h for a week. Efficacy was evaluated at 1, 3, 6, and 12 mo after the end of the treatments. The primary end point was the proportion of patients with zoster-associated pain and/or allodynia 1 mo after inclusion. Statistical analysis was performed based on the intent-to-treat population. RESULTS: One hundred thirteen patients completed the 1-yr follow-up. At 1 mo posttherapy, 13% of patients in the paravertebral group reported zoster-related pain, compared with 45% in the standard group (P < 0.001). At 3, 6, and 12 mo posttherapy, the incidence of PHN was still significantly lower in the paravertebral group than in the standard group. The quality of life improved in both groups at each follow-up time point with no significant difference between groups. CONCLUSION: Repetitive paravertebral anesthetic block in combination with steroids plus standard treatment with acyclovir and analgesics significantly reduced the incidence of PHN than the standard treatment alone. PMID: 19713253 [PubMed - indexed for MEDLINE] 59. J Infect Dis. 2009 Oct 1;200(7):1068-77. Varicella-zoster virus-specific immune responses to herpes zoster in elderly participants in a trial of a clinically effective zoster vaccine. Weinberg A, Zhang JH, Oxman MN, Johnson GR, Hayward AR, Caulfield MJ, Irwin MR, Clair J, Smith JG, Stanley H, Marchese RD, Harbecke R, Williams HM, Chan IS, Arbeit RD, Gershon AA, Schödel F, Morrison VA, Kauffman CA, Straus SE, Schmader KE, Davis LE, Levin MJ; US Department of Veterans Affairs (VA) Cooperative Studies Program Shingles Prevention Study Investigators. Collaborators: Barry P, Beisel C, Boardman KD, Colling CL, Gelb L, Peduzzi PN, Simberkoff MS, Silber JL, Annunziato P, Chan CY, Keay SK, Marques AR, Soto NE, Brunell P, Gnann JW, Serrao R, Cotton DJ, Goodman RP, Pachucki CT, Keitel WA, Greenberg RN, Wright PF, Griffin MR, Simberkoff MS, Yeh SS, Lobo Z, Holodniy M, Loutit J, Betts RF, Gelb LD, Crawford GE, Guatelli J, Brooks PA, Neuzil KM, Toney JF. University of Colorado Denver, Denver, CO, USA. Adriana.Weinberg@ucdenver.edu BACKGROUND: The objectives of this study were to evaluate the association between varicella-zoster virus (VZV)-specific humoral and cell-mediated immunity (CMI) to herpes zoster (HZ) and protection against HZ morbidity and to compare immune responses to HZ and zoster vaccine. METHODS: In 981 elderly persons who developed HZ during a zoster vaccine efficacy trial (321 vaccinees and 660 placebo recipients) and 1362 without HZ (682 vaccinees and 680 placebo recipients), CMI was measured by VZV responder cell frequency and interferon-gamma enzyme-linked immunospot, and antibodies were measured by VZV enzyme-linked immunosorbent assay against affinity-purified VZV glycoproteins (gpELISA). RESULTS: Robust VZV CMI at HZ onset correlated with reduced HZ morbidity, whereas VZV gpELISA titers did not. Three weeks after HZ onset, gpELISA titers were highest in those with more severe HZ and were slightly increased in placebo recipients (compared with zoster vaccine recipients) and in older individuals. VZV CMI responses to HZ were similar in zoster vaccine and placebo recipients and were not affected by demographic characteristics or antiviral therapy, except for responder cell frequency at HZ onset, which decreased with age. When responses to zoster vaccine and HZ could be compared, VZV CMI values were similar, but antibody titers were lower. CONCLUSIONS: Higher VZV CMI at HZ onset was associated with reduced HZ severity and less postherpetic neuralgia. Higher antibody titers were associated with increased HZ severity and occurrence of postherpetic neuralgia. HZ and zoster vaccine generated comparable VZV CMI. PMID: 19712037 [PubMed - indexed for MEDLINE] 60. J Clin Microbiol. 2009 Nov;47(11):3717-20. Epub 2009 Aug 26. Variability of immediate-early gene 62 in german varicella-zoster virus wild-type strains. Sauerbrei A, Bohn K, Zell R, Wutzler P. Institute of Virology and Antiviral Therapy, Friedrich-Schiller University of Jena, Hans-Knoell-Strasse 2, 07745 Jena, Germany. andreas.sauerbrei@med.uni-jena.de Varicella-zoster virus strains of European genotypes have developed a high variability of open reading frame (ORF) 62 during their occurrence over many years in Germany. M1 strains in Germany display a uniform ORF 62 pattern, suggesting that these strains were introduced from Africa and/or Asia via few sources during the last years. PMCID: PMC2772622 [Available on 2010/5/1] PMID: 19710264 [PubMed - indexed for MEDLINE] 61. J Oral Pathol Med. 2009 Oct;38(9):673-88. Epub 2009 Aug 18. Varicella zoster virus: review of its management. Mustafa MB, Arduino PG, Porter SR. Oral Medicine Section, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Khartoum, Khartoum, Sudan. maysonmustafa@yahoo.com Varicella zoster virus (VZV) is one of eight herpes viruses known to infect humans. Primary infection causes varicella (chickenpox), after which virus becomes latent. Years later, VZV reactivates and causes a wide range of neurological diseases. The aim of the present report was to critically examine the published literature to evaluate advantages and limitations of therapy of VZV infection in both immunocompetent and immunocompromised patients. Aciclovir (ACV) has been the drug of choice for many years for the treatment of VZV infections. Recently, other antiviral agents have been developed to overcome the low oral bioavailability of ACV, as well as to provide a more flattering dosage regime. Chickenpox is a benign self-limiting disease in the majority of cases and usually no specific treatment is required. Treatment of shingles is indicated to reduce the acute symptoms of pain and malaise, to limit the spread and duration of the skin lesions and to prevent the development of post-herpetic neuralgia. Different classes of drugs have been used for the treatment of post-herpetic neuralgia. The first choice of any of these medications should be guided by the patient's medical health, the likely adverse effects of the drug and the patient's preference. PMID: 19691461 [PubMed - indexed for MEDLINE] 62. Dermatol Nurs. 2009 Jul-Aug;21(4):211-3. Three case studies of herpes zoster. Lesniak R, Mareno K. Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, FL, USA. PMID: 19691235 [PubMed - indexed for MEDLINE] 63. Arch Dermatol. 2009 Aug;145(8):954-5. Atypical herpes zoster infection preceded by sciatica and foot drop. Leo AM, Kasper DA, Saxena A. PMID: 19687441 [PubMed - indexed for MEDLINE] 64. Zhen Ci Yan Jiu. 2009 Apr;34(2):125-7, 135. [Observation on the therapeutic effect of electroacupuncture of Jiaji (EX-B 2) plus regional encircled needling for herpes zoster] [Article in Chinese] Li X, Zhang HX, Huang GF, Feng YF, Zou R. School of Acu-moxibustion. Hubei College of Chinese Medicine, Wuhan 430061, China. Lee-xuan@126.com OBJECTIVE: To observe the clinical therapeutic effect of electroacupuncture (EA) of Jiaji (EX-B 2) plus focus-encircled needling for promoting the crust formation of herpes zoster and analgesia. METHODS: Eighty cases of herpes zoster patients were equally randomized into EA group [treated with EA of Ashi-point, Jiaji (EX-B 2), Zhigou (SJ 6) and Houxi (SI 3), once daily for 10 times] and medication group (treated with valaciclovir hydrochloride 300 mg/time, b. i. d. and vitamin B1 10 mg/time, t.i.d., 10 days). The pain severity was evaluated by using visual analogous scale (VAS) method. The time when the cutaneous scabbing area was equal or over 50% was recorded. RESULTS: After the treatment, of the two 40 cases in EA and medication groups, 30 (75.0%) and 15 (37.5%) were cured, 7 (17.5%) and 12 (30.0%) improved, 3 (7.5%) and 13 (32.5%) failed, with the total effective rates being 92.5% and 67.5%, respectively. The therapeutic effect of EA was significantly superior to that of medication (P < 0.01). VAS scores of both groups reduced significantly (P < 0.01). Both the VAS score and the crust formation time of EA group were significantly lower than those of medication group (P < 0.01). CONCLUSION: EA of Jiaji (EX-B 2) in combination with focus-encircled needling is effective in facilitating the crust formation and pain relief in the treatment of herpes zoster, and the effect of acupuncture is superior to that of medication. PMID: 19685728 [PubMed - indexed for MEDLINE] 65. BMJ. 2009 Aug 13;339:b2624. doi: 10.1136/bmj.b2624. Herpes zoster ophthalmicus. Lam FC, Law A, Wykes W. Department of Ophthalmology, Southern General Hospital, Glasgow G51 4TF. fook_chang@hotmail.com Comment in: BMJ. 2009;339:b3621. PMID: 19679612 [PubMed - indexed for MEDLINE] 66. J Antimicrob Chemother. 2009 Oct;64(4):671-3. Epub 2009 Aug 13. FV100 as a new approach for the possible treatment of varicella-zoster virus infection. McGuigan C, Balzarini J. Welsh School of Pharmacy, Cardiff University, King Edward VII Avenue, Cardiff CF10 3NB, UK. mcguigan@cardiff.ac.uk FV100 is a promising new agent with extreme potency and specificity for varicella-zoster virus (VZV). It is the valyl ester pro-drug of Cf1743, the lead clinical candidate among the highly lipophilic bicyclic nucleoside analogue (BCNA) family discovered in Cardiff/Leuven. Cf1743 is unique amongst antivirals in terms of its structure and lipophilicity. It is exquisitely potent and selective for human VZV. FV100 has recently entered a randomized, controlled Phase II clinical trial for the treatment of shingles, sponsored by Inhibitex. PMID: 19679595 [PubMed - indexed for MEDLINE] 67. BMC Complement Altern Med. 2009 Aug 12;9:31. Acupuncture in acute herpes zoster pain therapy (ACUZoster) - design and protocol of a randomised controlled trial. Fleckenstein J, Kramer S, Hoffrogge P, Thoma S, Lang PM, Lehmeyer L, Schober GM, Pfab F, Ring J, Weisenseel P, Schotten KJ, Mansmann U, Irnich D. Multidisciplinary Pain Centre, Department of Anaesthesiology, University of Munich, Munich, Germany. johannes.fleckenstein@med.uni-muenchen.de BACKGROUND: Acute herpes zoster is a prevalent condition. One of its major symptoms is pain, which can highly influence patient's quality of life. Pain therapy is limited. Acupuncture is supposed to soften neuropathic pain conditions and might therefore act as a therapeutic alternative. Objective of the present study is to investigate whether a 4 week semi-standardised acupuncture is non-inferior to sham laser acupuncture and the anticonvulsive drug gabapentine in the treatment of pain associated with herpes zoster. METHODS/DESIGN: Three-armed, randomised, placebo-controlled trial with a total follow-up time of 6 months. Up to estimated 336 patients (interim analyses) with acute herpes zoster pain (VAS > 30 mm) will be randomised to one of three groups (a) semi-standardised acupuncture (168 patients); (b) gabapentine with individualised dosage between 900-3600 mg/d (84 patients); (c) sham laser acupuncture. Intervention takes place over 4 weeks, all patients will receive analgesic therapy (non-opioid analgesics: metamizol or paracetamol and opioids: tramadol or morphine). Therapy phase includes 4 weeks in which group (a) and (c) consist of 12 sessions per patient, (b) visits depend on patients needs. Main outcome measure is to assess the alteration of pain intensity before and 1 week after treatment sessions (visual analogue scale VAS 0-100 mm). Secondary outcome measure are: alteration of pain intensity and frequency of pain attacks; alteration of different aspects of pain evaluated by standardised pain questionnaires (NPI, PDI, SES); effects on quality of life (SF 36); analgesic demand; alteration of sensoric perception by systematic quantitative sensory testing (QST); incidence of postherpetic neuralgia; side effects and cost effectiveness. Credibility of treatments will be assessed. DISCUSSION: This study is the first large-scale randomised placebo controlled trial to evaluate the efficacy of acupuncture compared to gabapentine and sham treatment and will provide valuable new information about the clinical and physiological effects of acupuncture and gabapentine in the treatment of acute herpes zoster pain. The study has been pragmatically designed to ensure that the study findings can be implemented into clinical practice if acupuncture can be shown to be an effective treatment strategy in acute herpes zoster pain. TRIAL REGISTRATION: NCT00885586. PMCID: PMC2739152 PMID: 19674449 [PubMed - indexed for MEDLINE] 68. Int J Dermatol. 2009 Aug;48(8):834-9. Herpes zoster with progression to acute varicella zoster virus-meningoencephalitis. Braun-Falco M, Hoffmann M. Department of Dermatology, University Medical Center Freiburg, Freiburg, Germany. markus.braun-falco@uniklinik-freiburg.de BACKGROUND: Acute meningoencephalitis (ME) from varicella zoster virus (VZV) reactivation is a rare and serious complication of herpes zoster (HZ). Objectives and methods: As early diagnostic detection is mandatory to prevent long-term sequelae, any clinical indication is helpful to identify patients that are at higher risk of the development of VZV-ME. In order to find such risk factors, the clinical data of 38 patients consecutively hospitalized for the treatment of HZ over a 1-year period were analyzed. RESULTS: Four of the 38 patients with HZ developed ME. Of these, three had involvement of the trigeminal nerve branch, one including an ophthalmic affection, and one presented with disseminated HZ. All were women with an average age of 83.5 years, in comparison with patients with HZ but without ME who had an average age of 69.3 years and a female preponderance of 60%. The first clinical signs of ME were rapidly progressing somnolence and meningism. Patients with HZ-ME were treated with intravenous acyclovir, oral glucocorticosteroids, and antiseizure therapy, and recovered almost completely without major residual symptoms. CONCLUSION: Progression of HZ to ME seems to occur more often than normally believed. Female patients above 80 years of age with either ophthalmic involvement or disseminated HZ are at a potentially high risk of the development of ME. The general recommendation of starting oral glucocorticosteroids from day 1 of antiviral treatment in older patients must be questioned, as it may stimulate VZV replication and dissemination. PMID: 19673047 [PubMed - indexed for MEDLINE] 69. Ugeskr Laeger. 2009 Jun 22;171(26):2194-7. [Herpes zoster incidence in persons above 50 years of age] [Article in Danish] Østergaard K, Damgaard M, Kristiansen TB, Madsen KG. Danske Laegers Forsknings Center A/S, DK-2860 Søborg. KO@dlfc.dk Erratum in: Ugeskr Laeger. 2009 Aug 31;171(36):2576. Kristensen, Thomas Birk [corrected to Kristiansen, Thomas Birk]. INTRODUCTION: Following the development of herpes zoster vaccines and the potential socio-economic benefits hereof, it is relevant to conduct a study concerning epidemiological aspects of the disease based on a Danish population. MATERIAL AND METHODS: Structured telephone interviews with 1207 persons above 50 years of age were conducted in order to determine the cumulated incidence proportion of herpes zoster in the age groups 50-66 years, 66-70 years and 71+. RESULTS: The cumulated incidence proportion of herpes zoster was 8.9%, 12.5%, 16.0% in the age groups 50-65 years, 65-70 years and 71+, respectively. Herpes zoster was positively associated with female sex, hypertension, hypercholesterolemia and prescription medicine; however, only the former remained significant after test in a multiple logistic regression model. CONCLUSION: Herpes zoster is common among persons who are more than 50 years old and most frequent among women. PMID: 19671400 [PubMed - indexed for MEDLINE] 70. J Zhejiang Univ Sci B. 2009 Aug;10(8):625-30. Influence of systemic immune and cytokine responses during the acute phase of zoster on the development of postherpetic neuralgia. Zhu SM, Liu YM, An ED, Chen QL. Department of Anesthesiology, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China. Postherpetic neuralgia (PHN) is a severe sequela of herpes zoster (HZ). Until now, only age and pain severity were considered predisposing factors for the development of PHN. We evaluated 49 patients with acute phase HZ, 10 of whom developed PHN (Group A) and 39 of whom did not develop PHN (Group B). Twenty-five healthy volunteers similar in age and gender distribution to the study group were recruited as controls (Group C). Numbers of serum CD3(+) (pan-T lymphocytes), CD4(+) (helper/inducer), and CD8(+) (suppressor/cytotoxic) lymphocytes were decreased significantly in Groups A and B relative to the control group, but there were no statistical differences between Groups A and B. Interleukin (IL)-1beta, IL-6, tumor necrosis factor (TNF)-alpha, IL-8, and IL-10 were significantly elevated in Groups A and B relative to Group C. IL-6 was significantly higher in Group A than in Group B, and was significantly positively correlated with pain severity scored on a visual analog scale. Therefore, we suggest that the inflammatory response, especially that of IL-6, in the acute phase of HZ may be associated with hyperalgesia and the development of PHN. PMCID: PMC2722705 PMID: 19650202 [PubMed - indexed for MEDLINE] 71. Dermatology. 2009;219(4):347-9. Epub 2009 Aug 1. Disseminated herpes zoster mimicking rheumatoid vasculitis in a rheumatoid arthritis patient on etanercept. Tresch S, Trueb RM, Kamarachev J, French LE, Hofbauer GF. Dermatology Department, University Hospital Zürich, Züürich, Switzerland. Tumor necrosis factor-alpha (TNFalpha)-blocking agents are immunomodulating agents introduced for treatment of a variety of chronic inflammatory disease conditions. Adverse effects include an increased incidence of infections. Clinically, these infections often have atypical presentations that may hamper prompt diagnosis. In our report of a patient on etanercept therapy for rheumatoid arthritis, the correct diagnosis was delayed because disseminated herpes zoster was clinically mimicking vasculitis. Initially assuming rheumatoid vasculitis, immunosuppression was increased, resulting in worsening of skin lesions. Only an extended work-up, including a skin biopsy and viral cultures, established the correct diagnosis. Management of varicella zoster virus (VZV) infection primarily focuses on early initiation of antiviral therapy to control VZV replication. Therapy with intravenous acyclovir followed by oral valacyclovir allowed complete resolution of acute skin changes. In immunosuppressed patients, the possibility of infection with atypical presentation must always be kept in mind, and that this might mimic other disease conditions. Broad differential diagnosis and an extended diagnostic workup help in establishing the correct diagnosis. Copyright 2009 S. Karger AG, Basel. PMID: 19648728 [PubMed - indexed for MEDLINE] 72. J Pain. 2009 Aug;10(8):792-7. An insatiable itch. Wood GJ, Akiyama T, Carstens E, Oaklander AL, Yosipovitch G. Section of Palliative Care and Medical Ethics, Institute to Enhance Palliative Care, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. PMID: 19638326 [PubMed - indexed for MEDLINE] 73. Isr Med Assoc J. 2009 May;11(5):306-7. Varicella zoster infection in adults: a preventable disease. Megged O, Schlesinger Y. Comment on: Isr Med Assoc J. 2009 May;11(5):261-5. PMID: 19637510 [PubMed - indexed for MEDLINE] 74. Ig Sanita Pubbl. 2009 May-Jun;65(3):299-311. [Active immunoprophylaxis to reduce clinical impact of Herpes Zoster and its complications] [Article in Italian] Marino MG, Bagnato B, Torella I, Franco E. Dipartimento di Sanità Pubblica, Università di Roma Tor Vergata. m.marino@med.uniroma2.it Herpes Zoster is a painful cutaneous eruption caused by reactivation of Varicella Zoster Virus, years after primary infection. Approximately one third of the population, and more than 50% of persons older than 80, will present zoster in their lifetime. Zoster complications, particularly postherpetic neuralgia, are common and result in worsening health status and quality of life, with high direct and indirect costs. Licensed zoster vaccine, available in Italy in a next future, is efficacious in preventing virus reactivation and particularly in reducing complications. PMID: 19629155 [PubMed - indexed for MEDLINE] 75. Clin Experiment Ophthalmol. 2009 Jul;37(5):473-7. Acute retinal necrosis: a case series with clinical features and treatment outcomes. Sims JL, Yeoh J, Stawell RJ. Ocular Immunology Clinic, The Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia. josims98@yahoo.com PURPOSE: To determine clinical features, viral aetiology and treatment outcomes of eyes with acute retinal necrosis (ARN). METHODS: Retrospective, interventional, non-comparative case series. RESULTS: Twenty-two patients (23 eyes) were identified between 1996 and 2007. Varicella zoster virus was the causative agent in 12 patients (nine confirmed by polymerase chain reaction), herpes simplex virus type 1 in six (five polymerase chain reaction-confirmed) and unknown in three patients. Five patients had documented herpes zoster infection in the month prior to the onset of ARN. Twelve patients (55%) had identifiable (clinical or subclinical) immune dysfunction. At 6 months, 3 out of 15 eyes (20%) maintained vision 6/12 or better and 7 (47%) were 6/60 or worse. Median final VA was 6/60. Nine eyes developed retinal detachment and two-thirds of these had received prior barrier laser. Poor prognostic factors for severe visual loss by univariate analysis were male gender (P = 0.019), and the development of retinal detachment (P = 0.05). Delay between onset of symptoms and diagnosis was associated with moderate visual loss (P = 0.018). Barrier laser did not reduce the risk of retinal detachment. CONCLUSIONS: Acute retinal necrosis still has poor visual prognosis. Early diagnosis and initiation of treatment may improve outcome. PMID: 19624343 [PubMed - indexed for MEDLINE] 76. J Am Acad Dermatol. 2009 Aug;61(2):345-7. Disseminated herpes zoster with increased CD4 counts in 3 HIV-infected patients. Lidhoo P, Unemori P, Leslie KS, Maurer T. Department of Dermatology, University of California San Francisco, San Francisco, California 94110, USA. It has been reported that the diagnosis of multidermatomal herpes zoster in HIV-infected patients occurs at a lower CD4 level than zoster involving a single dermatome. Herein, we describe 3 cases of HIV-infected patients presenting with disseminated zoster at high CD4 counts and low HIV viral loads. PMID: 19615545 [PubMed - indexed for MEDLINE] 77. Can J Ophthalmol. 2009 Aug;44(4):379-84. Varicella zoster virus vaccines: effective, but concerns linger. Liesegang TJ. Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 3224, USA. tliesegang@mayo.edu Both varicella and herpes zoster (HZ) can cause severe disease in certain age groups. The cell-mediated immune (CMI) response to the varicella zoster virus (VZV) is critical in preventing a recurrence of VZV. The varicella vaccine has markedly decreased the morbidity and mortality associated with varicella, but concerns linger about the cost and frequency of vaccine administration and the long-term effects on both adult varicella and HZ epidemiology in the individual and in the population. Therapy for HZ with an antiviral is only partially effective. A zoster vaccine is now available that boosts the CMI immune reaction to VZV in individuals and has proven safe and partially effective in preventing both HZ and post-herpetic neuralgia. Concerns about the zoster vaccine include the costs of administration, the overall health-care costs to society, and the acceptance and implementation of the vaccine in the elderly. Because of altered immune responses to VZV as a result of universal varicella vaccination it becomes even more compelling in the future to have a zoster vaccine ready to boost the CMI response to a sufficient level to prevent HZ. The 2 vaccines are intertwined in the future epidemiology of VZV disease. PMID: 19606157 [PubMed - indexed for MEDLINE] 78. Ophthalmology. 2009 Oct;116(10):1971-5.e2. Epub 2009 Jul 9. Acute retinal necrosis: clinical features, early vitrectomy, and outcomes. Hillenkamp J, Nölle B, Bruns C, Rautenberg P, Fickenscher H, Roider J. Department of Ophthalmology, University Medical Center Schleswig-Holstein, Kiel, Germany. hillenka@hotmail.com OBJECTIVE: To determine the viral diagnosis and the outcome of eyes with acute retinal necrosis (ARN) treated with intravenous acyclovir and oral prednisolone alone or combined with early vitrectomy and intravitreal acyclovir lavage. DESIGN: Nonrandomized, retrospective, interventional, comparative, consecutive series. PARTICIPANTS: A cohort of 27 human immunodeficiency virus-negative patients with ARN comprising 24 unilateral and 3 bilateral cases. INTERVENTION: Vitreous biopsy for viral diagnosis. Twenty eyes were treated with intravenous acyclovir in combination with oral prednisolone (group A). Ten eyes were treated additionally with early vitrectomy, intravitreal acyclovir lavage, laser demarcation of necrotic retinal areas when feasible-with or without scleral buckling, and gas or silicone oil tamponade (group B). Vitrectomy was performed in all cases of secondary rhegmatogenous retinal detachment (RD). MAIN OUTCOME MEASURES: Results of vitreous biopsy, rate of RD, rate of phthisis bulbi, and course of best-corrected visual acuity (BCVA). RESULTS: Varicella zoster virus (VZV) was detected in 26 eyes, followed by herpes simplex virus (5 eyes), and Epstein-Barr virus (2 eyes, in conjunction with VZV). An RD developed in more eyes in group A (18 of 20 eyes) than in group B (4 of 10 eyes; P = 0.007). In 2 of 20 eyes in group A and in 0 of 10 eyes in group B, phthisis bulbi developed without a significant difference between groups A and B. Mean BCVA (logarithm of the minimum angle of resolution) at first visit was 1.09 (standard deviation [SD], 0.83), and mean final BCVA was 1.46 (SD, 0.88) without significant difference between groups A and B. CONCLUSIONS: Varicella zoster virus is the leading cause of ARN. Visual prognosis is guarded. Early vitrectomy with intravitreal acyclovir lavage was associated with a lower incidence of secondary RD; however, it did not improve mean final visual acuity. PMID: 19592111 [PubMed - indexed for MEDLINE] 79. Rev Neurol Dis. 2009 Spring;6(2):E81-4. Re: Multiple brain infarcts after orbital inflammation. Luneau K, Bruce BB, Newman NJ, Biousse V. Department of Ophthalmology, Emory University, School of Medicine, Atlanta, GA, USA. Comment on: Rev Neurol Dis. 2009 Spring;6(2):E75-6. PMID: 19587637 [PubMed - indexed for MEDLINE] 80. Rev Neurol Dis. 2009 Spring;6(2):E75-6. Multiple brain infarcts after orbital inflammation. Luneau K, Bruce BB, Newman NJ, Biousse V. Department of Ophthalmology, Emory University, School of Medicine, Atlanta, GA, USA. Comment in: Rev Neurol Dis. 2009 Spring;6(2):E81-4. A 75-year-old woman developed trigeminal varicella-zoster virus infection complicated by ophthalmoplegia, and visual loss followed by recurrent cerebral infarctions involving small and large intracranial arteries. Medical therapy improved her ophthalmoplegia, but she developed a right hemiparesis and aphasia. PMID: 19587635 [PubMed - indexed for MEDLINE] 81. J Am Osteopath Assoc. 2009 Jun;109(6 Suppl 2):ii-S1. Boosting immunity to herpes zoster. Clay SW, Carlsen WR. Ohio University College of Osteopathic Medicine in Athens, USA. PMID: 19585704 [PubMed - indexed for MEDLINE] 82. J Am Osteopath Assoc. 2009 Jun;109(6 Suppl 2):S7-12. Managing herpes zoster and postherpetic neuralgia. Galluzzi KE. Department of Geriatrics, Philadelphia College of Osteopathic Medicine, Rowland Hall, Philadelphia, PA 19131-1633, USA. katherineg@pcom.edu Treatment strategies for herpes zoster infection include limiting viral replication with anti-infective agents as well as limiting associated acute and chronic neuropathic pain with a variety of analgesics. The author outlines currently available pharmacotherapeutic options, from first-line (eg, anti-infective agents, tricyclic antidepressants, anticonvulsants, opioid analgesics, and topical agents) through adjuvant treatments (eg, oral corticosteroids). A summary of adverse event profiles is provided for each medication. Vaccination is recommended as a preventive measure. PMID: 19553635 [PubMed - indexed for MEDLINE] 83. J Am Osteopath Assoc. 2009 Jun;109(6 Suppl 2):S25-8. Overcoming barriers to adult immunization. High KP. Section of Infectious Diseases, Wake Forest University, Winston-Salem, NC 27157-1042, USA. khigh@wfubmc.edu The herpes zoster vaccine has proven to reduce the incidence of herpes zoster and postherpetic neuralgia, a debilitating condition that can remain for years after zoster rash has resolved. However, few eligible adults have received the vaccine. Findings from survey-based studies on patient uptake of influenza and pneumococcal polysaccharide vaccines suggest that physician recommendations and standing orders can increase vaccine uptake. However, certain barriers unique to zoster vaccination (eg, reimbursement concerns) will need to be addressed. PMID: 19553634 [PubMed - indexed for MEDLINE] 84. J Am Osteopath Assoc. 2009 Jun;109(6 Suppl 2):S22-4. Herpes zoster vaccination: benefits and barriers. Komara FA. Department of Family and Community Medicine, Michigan State University College of Osteopathic Medicine, East Lansing, MI 48824-1315, USA. komaraf@msu.edu The incidence and severity of herpes zoster increases with advancing age, as does its most common complication-postherpetic neuralgia (PHN). The most effective management strategy for herpes zoster and PHN is prevention of the disease through vaccination, particularly in the most vulnerable patient population (ie, individuals aged 70 years or older). The Shingles Prevention Study demonstrated that vaccination reduced the incidence and severity of herpes zoster, as well as the incidence of PHN. Despite the benefits of zoster immunization, administration of the vaccine may be met by certain barriers, including issues related to reimbursement, storage, and availability of the vaccine. Educating physicians and the public about the importance of herpes zoster prevention, while underscoring the pain associated with this disease and the challenges in managing it, will help to overcome these barriers. PMID: 19553633 [PubMed - indexed for MEDLINE] 85. J Am Osteopath Assoc. 2009 Jun;109(6 Suppl 2):S2-6. Herpes zoster overview: natural history and incidence. Weaver BA. Armor Correctional Health Services in Tampa, Fla., USA. bethanyg@u.washington.edu The varicella-zoster virus (VZV) causes two diseases. The primary VZV infection, known as chickenpox, typically occurs during childhood. Herpes zoster infection results later in life from reactivation of VZV in the dorsal root ganglia. Herpes zoster characteristically results in a rash with a unilateral dermatomal distribution, which usually resolves within 2 to 4 weeks. If the infection does not resolve after its acute phase, long-term complications, such as postherpetic neuralgia, may develop. The author discusses the natural history and incidence of primary VZV infection and herpes zoster and details the epidemiology, clinical manifestation, diagnosis, and complications of this disease. PMID: 19553632 [PubMed - indexed for MEDLINE] 86. J Am Osteopath Assoc. 2009 Jun;109(6 Suppl 2):S18-21. Reducing the incidence and severity of herpes zoster and PHN with zoster vaccination. Gelb LD. Washington University School of Medicine, Division of Infectious Diseases, St Louis, MO 63110-1010, USA. ldgelb@swbell.net The results of the Shingles Prevention Study, a Cooperative Studies Program conducted through the US Department of Veterans Affairs, are summarized. Also provided are general recommendations and contraindications for the use of zoster vaccine live among patients aged 60 years or older. PMID: 19553631 [PubMed - indexed for MEDLINE] 87. J Am Osteopath Assoc. 2009 Jun;109(6 Suppl 2):S13-7. Herpes zoster pathogenesis and cell-mediated immunity and immunosenescence. Oxman MN. University of California, San Diego, Staff Physician (Infectious Diseases), VA San Diego Healthcare System, San Diego, CA 92161-0001, USA. mnoxman@ucsd.edu Herpes zoster, or shingles, is a localized disease characterized by unilateral radicular pain and a vesicular rash limited to the area of skin innervated by a single dorsal root or cranial sensory ganglion. Whereas varicella, or chickenpox, results from primary exogenous varicella-zoster virus (VZV) infection, herpes zoster is caused by reactivation of endogenous VZV that has persisted in latent form within sensory ganglia following an earlier episode of chickenpox. In contrast to recurrent herpes simplex, herpes zoster is commonly associated with severe pain: prodromal pain often precedes the rash by several days; pain usually accompanies the dermatomal rash of herpes zoster; and clinically significant pain and allodynia may persist for weeks, months, or even years after the herpes zoster rash has healed, a debilitating complication known as postherpetic neuralgia (PHN). The incidence and severity of herpes zoster and PHN increase with age in association with an age-related decline in cell-mediated immunity to VZV. The Shingles Prevention Study-a randomized double-blinded placebo-controlled trial-sought to evaluate the capacity of a live attenuated VZV vaccine to protect older adults from herpes zoster and PHN by boosting their waning cell-mediated immunity to VZV. The study demonstrated that the zoster vaccine produced significant reductions in the incidence of herpes zoster, in the burden of illness caused by herpes zoster, and in the incidence of PHN. PMID: 19553630 [PubMed - indexed for MEDLINE] 88. Duke Med Health News. 2009 Jun;15(6):12. I have shingles and my doctor has prescribed a tricyclic antidepressant for me. I'm not at all depressed, so I don't understand why I should have to take this medication. Is depression connected to shingles? [No authors listed] PMID: 19579319 [PubMed - indexed for MEDLINE] 89. J Plast Reconstr Aesthet Surg. 2010 Feb;63(2):e195-6. Epub 2009 Jul 4. Herpes zoster in the median nerve distribution. Tahiri Y, Hamelin ND, Brutus JP. PMID: 19577970 [PubMed - indexed for MEDLINE] 90. Med Mal Infect. 2009 Sep;39(9):698-706. Epub 2009 Jul 1. [Impact of routine pediatric varicella vaccination on the epidemiology of herpes zoster] [Article in French] Alain S, Paccalin M, Larnaudie S, Perreaux F, Launay O. Service de bactériologie-virologie-hygiène, CHRU, Limoges, France. OBJECTIVE: This literature review addresses the following question: what elements point to an impact of routine chicken pox vaccination of children on the incidence of shingles? DESIGN: The search strategy involved an electronic search (Medline database via PubMed) and crossed references. Articles were selected by reading their abstracts. RESULTS: There were few published studies dealing with the question. A total of 13 publications reported seven longitudinal studies on the incidence of shingles and six mathematical models. The population studies were all American, and reported discordant results, four reporting an increase, and three, stability in the incidence of shingles. Four of the six mathematical models concerned the impact of routine chicken pox vaccination on shingles epidemiology. All showed a transitory short-term increase in the incidence of shingles (on condition that vaccine was effective and coverage high) and a long-term incidence of shingles lower than the current rate. CONCLUSIONS: The currently available data is insufficient for any conclusion to be drawn as to the impact of routine pediatric chicken pox vaccination on the incidence of shingles. Monitoring the incidence of shingles in countries either recommending or not such vaccination should be maintained. PMID: 19574007 [PubMed - indexed for MEDLINE] 91. Clin Transplant. 2009 Aug-Sep;23(4):484-9. Epub 2009 Jun 30. Incidence and clinical characteristics of ocular infections after heart transplantation: a retrospective cohort study. Del Pozo JL, van de Beek D, Daly RC, Pulido JS, McGregor CG, Patel R. Division of Infectious Diseases, Department of Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA. BACKGROUND: Ocular infections associated with organ transplantation are well documented following renal and liver transplantation; however, few studies have reported ocular infections following heart transplant. METHODS: We retrospectively studied patients who underwent heart transplantation in the Mayo Clinic Cardiac Transplant Program from January 1st 1988 through June 30th 2006. RESULTS: We report the frequency and type of ocular infections among 313 heart transplant recipients. There were eight patients (2.5%) diagnosed with ocular infections including three cases of ophthalmic zoster, one case of cytomegalovirus retinitis, one case of Aspergillus fumigatus endophthalmitis, one case of Haemophilus influenzae conjunctivitis, one case of blepharitis, and one case of preseptal orbital cellulitis. CONCLUSIONS: Ocular infections are rare after heart transplantation and usually present within the first year post-transplantation. The majority can be regarded as opportunistic infections which may be indicative of infections at other body sites. Ocular infections after heart transplantation may be associated with significant morbidity and visual loss if not promptly diagnosed. PMID: 19573087 [PubMed - indexed for MEDLINE] 92. Aging Clin Exp Res. 2009 Jun;21(3):236-43. Herpes Zoster and Postherpetic Neuralgia: a review of the effects of vaccination. Johnson RW. University of Bristol, Bristol, UK. r.w.johnson@bris.ac.uk Herpes zoster (HZ) results from reactivation of varicella zoster virus which has been persistent but clinically latent in dorsal root and cranial nerve ganglia since primary infection, usually as a child, with varicella (chicken pox). HZ affects 20-30% of individuals during their lifetime and up to 50% of those > or =80 years old. Although serious life- or sight-threatening complications occur rarely, postherpetic neuralgia (PHN) is the most common complication. Both HZ and PHN are most common in the elderly. Declining cell-mediated immunity resulting from immune senescence appears to be the cause. Incidence of HZ is also high in individuals who are immunocompromised as a result of disease or its treatment. HZ also occurs in younger and fit individuals but is usually mild and complications are rare. Current management of HZ with antiviral drugs and analgesics attains quite good control of acute pain and skin rash but offers only partial protection against PHN. Other strategies studied to prevent PHN such as nerve blocks are relatively ineffective and clinically impractical. Although several drug classes are used to manage PHN, numbers needed to treat to obtain 50% pain reduction range from approx. 2.5-5 and adverse effects are common. The elderly population is growing and thus the number of HZ and PHN susceptible individuals is increasing. HZ and PHN are expensive in terms of suffering, loss of independence and healthcare costs. Significant numbers of the elderly with HZ require hospitalization. Short-term illness in the elderly can lead to long-term loss of independence. A live attenuated herpes zoster vaccine has been studied in a large number of subjects and shown to reduce incidence of HZ as well as incidence and severity of PHN. The safety profile of the vaccine is good, local soreness at the injection site being the only common adverse event. Health economics studies suggest that vaccination of adults about 60 years of age would be cost effective. Duration of protection following vaccination is the subject of ongoing surveillance, as is the potential benefit of vaccinating younger and sicker members of the population. PMID: 19571648 [PubMed - indexed for MEDLINE] 93. Rinsho Ketsueki. 2009 Jun;50(6):488-94. [Prophylaxis with acyclovir for herpes zoster infection during bortezomib-dexamethasone combination therapy] [Article in Japanese] Hasegawa Y, Kawahara F, Nagai H, Hirose T, Imai Y, Ishiguro T, Chou T. Pharmaceutical Division, Niigata Cancer Center Hospital. A novel molecular targeting drug, a proteasome inhibitor, bortezomib (Bor), has been reported to be highly effective for relapsed/refractory, as well as for newly diagnosed multiple myeloma, but is also associated with a high frequency of herpes zoster (HZ) infection (13%). We conducted a retrospective survey on HZ infection (profile) after Bor therapy in our hospital. Six of 30 patients developed HZ infection during bortezomib-dexamethasone treatment (BD therapy). Age, performance status, and stem cell transplantation were not related risk factors for HZ infection. HZ developed when acyclovir (ACV) was not administrated to all six cases. Continuous administration of ACV decreased the incidence of HZ infection. Based on these results, we started an anti- HZ prophylaxis program using ACV for all patients receiving BD therapy. Further study is warranted to establish the optimal dose and duration of ACV for appropriate prophylaxis of HZ infection. PMID: 19571509 [PubMed - indexed for MEDLINE] 94. Cleve Clin J Med. 2009 Jul;76(7):410-2. Painful eye with a facial rash. Vallejo-García JL, Vañó-Galván S, Rayward O, Moreno-Martin P. Department of Ophthalmology, Hospital Universitario La Paz, Madrid, Spain. jvallejogarcia@gmail.com PMID: 19570973 [PubMed - indexed for MEDLINE] 95. Nat Rev Rheumatol. 2009 Jul;5(7):361-3. Therapy: The risk of herpes zoster: another cost of anti-TNF therapy? Bongartz T, Orenstein R. PMID: 19568250 [PubMed - indexed for MEDLINE] 96. Mayo Clin Proc. 2009 Jul;84(7):663; author reply 663-4. Herpes zoster: query and concern. Homler H. Comment on: Mayo Clin Proc. 2009 Mar;84(3):274-80. PMCID: PMC2704140 PMID: 19567720 [PubMed - indexed for MEDLINE] 97. JAMA. 2009 Jul 1;302(1):108. JAMA patient page. Shingles. Torpy JM, Burke AE, Glass RM. PMID: 19567448 [PubMed - indexed for MEDLINE] 98. Zhongguo Zhen Jiu. 2009 Apr;29(4):285-8. [Pricking blood therapy combined with ultraviolet irradiation for treatment of acute herpes zoster] [Article in Chinese] Ouyang Q, Wei ZJ, Hou YL. Beijing Army Region General Hospital, Beijing 100700, China. doctor_ouyang@sina.com OBJECTIVE: To evaluate clinical therapeutic effect and the safety of pricking blood therapy combined with ultraviolet irradiation for treatment of acute herpes zoster. METHODS: One hundred and thirty cases were randomly divided into an observation group and a control group, 65 cases in each group. The observation group was treated with pricking blood therapy combined with ultraviolet irradiation. Firstly, the affected parts were heavily taped with a plum-blossom needle and then cupping. After the cup was removed, with the body surface-dividing field method, ultraviolet irradiation was given at the skin injury area and the nerve root area corresponding to paraspinal vertebra, and the control group was treated with Aciclovir and other western medicine. Seven days constituted one course. Their therapeutic effects and adverse reactions were observed. RESULTS: After treatment of 7 days, the cured rate of 76.9% and the total effective rate of 90.8% in the observation group were significantly higher than 38.5% and 66.2% in the control group, respectively (both P < 0.01); the incidence rate of post herpetic neuralgia of 3.1% in the observation group was significantly lower than 12.3% in the control group (P < 0.05); after treatment, the scores for pain, rash and sleep decreased significantly in the two groups (all P < 0.01), more significantly decreased in the observation group than in the control group (P < 0.01 or P < 0.05); the pain-relieving time, herpes-stopping time, scab-forming time and the cured time in the cured patients of the observation group were significantly shorter than those in the control group (P < 0.01 or P < 0.05). CONCLUSION: The pricking blood therapy combined with ultraviolet irradiation has rapid therapeutic effect, effectively shortens duration of illness, decreases the incidence rate of post herpetic neuralgia and it is a safe remedy for treatment of herpes zoster. PMID: 19565736 [PubMed - indexed for MEDLINE] 99. Pediatr Infect Dis J. 2009 Jul;28(7):653-5. A phase I-II study of live attenuated varicella-zoster virus vaccine to boost immunity in human immunodeficiency virus-infected children with previous varicella. Gershon AA, Levin MJ, Weinberg A, Song LY, LaRussa PS, Steinberg SP, Bartlett P; Pediatric AIDS Clinical Trials Group 391 Team. Collaborators: Deveikis A, Batra J, Michalik DE, Chen T, Keller MA, Zangwill K, Mink C, Hayes J, Abrams E, Champion S, Frere M, Calo D, Borkowsky W, Kaul A, Chandwani S, Deygoo S, Rathore MH, Alvarez A, Mirza A, Thomas K, Rutstein RM, Douglas SD, Vincent CA, Puga AM, Inman A, Talero G, McNamara J, Read J, Ortiz A, Wang Y, Bouquin P, Rosenblatt HM, Kay L, Ferguson E, Chan CY. Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA. aag1@columbia.edu Herpes zoster, may be severe and recurrent in HIV-infected children. We determined the safety and immunogenicity of live attenuated varicella-zoster virus (VZV) vaccine in 46 HIV-infected children who had experienced varicella. There were no serious adverse events. Two years after vaccination 82% of subjects remained VZV-antibody positive and 60% had VZV-specific cell-mediated immunity. No child developed herpes zoster. PMID: 19561431 [PubMed - indexed for MEDLINE] 100. Psychiatry Res. 2009 Aug 15;168(3):265. Epub 2009 Jun 26. Two cases of herpes zoster, occurring 4 and 6 weeks after the initiation of citalopram treatment. Spyropoulou AC. PMID: 19560214 [PubMed - indexed for MEDLINE] 101. Dermatol Nurs. 2009 May-Jun;21(3):151-2. Disseminated zoster. Corigliano C, Wang SQ. Division of Dermatology, Memorial Sloan-Kettering Cancer Center, Basking Ridge, NJ, USA. PMID: 19554849 [PubMed - indexed for MEDLINE] 102. AIDS Read. 2009 May;19(5):187-8. Images in HIV/AIDS. Keloid after herpes zoster in an HIV-infected person. Castro JG, Espinoza L. Division of Infectious Diseases, Miller School of Medicine, University of Miami, USA. PMID: 19554738 [PubMed - indexed for MEDLINE] 103. Dermatol Surg. 2009 Sep;35(9):1439-40. Epub 2009 Jun 22. Successful treatment of depressed scars of the forehead secondary to herpes zoster using subdermal minimal surgery technology. Kim BJ, Yoo KH, Kim MN. Department of Dermatology, College of Medicine, Chung-Ang University, Seoul, Korea. beomjoon@unitel.co.kr PMID: 19549175 [PubMed - indexed for MEDLINE] 104. Trends Immunol. 2009 Jul;30(7):344-50. Epub 2009 Jun 21. Immune therapy for age-related diseases. Weksler ME, Pawelec G, Franceschi C. Department of Medicine, Weill-Cornell Medical College, NY 10065, USA. weksler@med.cornell.edu Human aging is reaching epidemic proportions as life expectancy increases and birth rate decreases. These demographic trends have led to a sharp increase in the diseases of aging, and an understanding of immune senescence promises to limit the development and progression of these diseases. In this review, we discuss three of the most important diseases of aging: shingles, Alzheimer's disease and atherosclerotic cardiovascular disease. All of these diseases have significant immunological components in either their etiology and/or progression, suggesting that appropriate immune intervention could be used in their prevention or treatment. Indeed, recent clinical studies have already demonstrated that vaccination can reduce the incidence of shingles and might prove effective in patients with Alzheimer's disease and artherosclerotic cardiovascular disease. PMID: 19541533 [PubMed - indexed for MEDLINE] 105. Pediatr Infect Dis J. 2009 Nov;28(11):954-9. The incidence and clinical characteristics of herpes zoster among children and adolescents after implementation of varicella vaccination. Civen R, Chaves SS, Jumaan A, Wu H, Mascola L, Gargiullo P, Seward JF. Los Angeles County Department of Public Health, Los Angeles, CA 90011, USA. rciven@la.publichealth.gov BACKGROUND: The varicella-zoster virus (VZV) vaccine strain may reactivate to cause herpes zoster. Limited data suggest that the risk of herpes zoster in vaccinated children could be lower than in children with naturally acquired varicella. We examine incidence trends, risk and epidemiologic and clinical features of herpes zoster disease among children and adolescents by vaccination status. METHODS: Population-based active surveillance was conducted among <20 years old residents in Antelope Valley, California, from 2000 through 2006. Structured telephone interviews collected demographic, varicella vaccination and disease histories, and clinical information. RESULTS: From 2000 to 2006, the incidence of herpes zoster among children<10 years of age declined by 55%, from 42 cases reported in 2000 (74.8/100,000 persons; 95% confidence interval [95% CI]: 55.3-101.2) to 18 reported in 2006 (33.3/100,000; 95% CI: 20.9-52.8; P<0.001). During the same period, the incidence of herpes zoster among 10- to 19-year-olds increased by 63%, from 35 cases reported in 2000 (59.5/100,000 persons; 95% CI: 42.7-82.9) to 64 reported in 2006 (96.7/100,000; 95% CI: 75.7-123.6; P<0.02). Among children aged<10 years, those with a history of varicella vaccination had a 4 to 12 times lower risk for developing herpes zoster compared with children with history of varicella disease. CONCLUSIONS: Varicella vaccine substantially decreases the risk of herpes zoster among vaccinated children and its widespread use will likely reduce overall herpes zoster burden in the United States. The increase in herpes zoster incidence among 10- to 19-year-olds could not be confidently explained and needs to be confirmed from other data sources. PMID: 19536039 [PubMed - indexed for MEDLINE] 106. J Neurol Sci. 2009 Oct 15;285(1-2):224-6. Epub 2009 Jun 13. Brachial plexopathy following herpes zoster infection: two cases with MRI findings. Choi JY, Kang CH, Kim BJ, Park KW, Yu SW. Department of Neurology, Korea University Medical Center, Korea University College of Medicine, Seoul, Republic of Korea. There are few reports of brachial plexopathy following the onset of a herpes zoster skin rash. Moreover, the MRI findings of zoster-induced brachial plexopathy have rarely been described. In the present study, we describe two cases of zoster brachial plexopathy and their MRI findings. MRI of the brachial plexus demonstrated T2 hyperintensity and contrast enhancement in the part of the brachial plexus that was compatible with both the clinical symptoms and the electrophysiological findings. Especially, MR imaging reflected the functional impairments more accurately than electrophysiological studies in the acute phase, during which MRI showed more extensive inflammatory involvement of the brachial plexus. MRI findings in the present cases suggest that, in addition to electrophysiological studies, MRI of the brachial plexus could provide valuable information for evaluating the location and extent of lesions and for understanding the pathophysiological mechanisms of zoster brachial plexopathy. PMID: 19524942 [PubMed - indexed for MEDLINE] 107. Neuroreport. 2009 Aug 5;20(12):1077-80. Modality-specific hyperexcitability of dorsal horn neurons to mechanical stimuli in herpetic mice. Nishikawa Y, Sasaki A, Andoh T, Nojima H, Shiraki K, Kuraishi Y. Department of Applied Pharmacology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan. Percutaneous inoculation of mice with herpes simplex virus type-1 produces marked dynamic allodynia in the zosteriform dermatome. In this study, we examined the electrophysiological excitability of the wide-dynamic range neuron in the spinal dorsal horn and the tibial nerve in response to mechanical (brush, punctum, and pinch) stimuli in mice with herpetic allodynia. The excitatory response of wide-dynamic range neurons to brush, but neither punctum nor pinch, stimulation of the zosteriform dermatome was increased in herpetic mice. The responses of the tibial nerve to all kinds of mechanical stimuli examined were decreased. These results suggest that dynamic allodynia in the affected dermatome is because of the increased excitability of wide-dynamic range neurons, but not primary afferents, to brush stimulation. PMID: 19512952 [PubMed - indexed for MEDLINE] 108. Dermatol Surg. 2009 Sep;35(9):1355-63. Epub 2009 Jun 5. Zosteriform cutaneous metastases: a literature meta-analysis and a clinical report of three melanoma cases. Savoia P, Fava P, Deboli T, Quaglino P, Bernengo MG. Department of Biomedical Sciences and Human Oncology, Section of Clinics and Oncological Dermatology, University of Turin, Turin, Italy. paola.savoia@unito.it BACKGROUND: Despite frequent skin involvement with solid tumors, zosteriform metastases are a rare, not well-defined entity, with only few cases published in literature. The unifying characteristic is merely topographic: cutaneous lesions were distributed along dermatomes, despite the variety of clinical features, including vesicobullous, papular, and nodular lesions. Several theories have been proposed to explain the pathogenetic mechanism of zosteriform dissemination, even if none was adequately proved. OBJECTIVE: In this article, we report three new cases of patients with melanoma with skin zosteriform metastases and present a meta-analysis of literature data. METHODS AND MATERIALS: We collected all Entrez-PubMed articles about zosteriform skin metastasis since 1970 and reviewed 56 cases, including our own taken from a 4,774-patient series. RESULTS: The histotypes mainly implicated were melanoma (18%); lymphoma (14%); breast cancer (12%); squamous cell carcinoma (12%); and digestive (10.7%), respiratory (10.7%), and urinary tumors (7%), with other histotypes accounting for 14%. In only one case in our series did we describe a typical herpetiform pattern, whereas in the others we found papulonodular lesions with a dermatomeric distribution. CONCLUSION: Cutaneous metastases with zosteriform pattern are rare and show a wide clinicopathologic spectrum that could affect the disease course. The authors have indicated no significant interest with commercial supporters. PMID: 19508408 [PubMed - indexed for MEDLINE] 109. J Clin Oncol. 2009 Aug 10;27(23):3830-5. Epub 2009 Jun 8. Primary therapy of Waldenström macroglobulinemia with bortezomib, dexamethasone, and rituximab: WMCTG clinical trial 05-180. Treon SP, Ioakimidis L, Soumerai JD, Patterson CJ, Sheehy P, Nelson M, Willen M, Matous J, Mattern J 2nd, Diener JG, Keogh GP, Myers TJ, Boral A, Birner A, Esseltine DL, Ghobrial IM. Bing Center for Waldenström's Macroglobulinemia, Dana-Farber Cancer Institute, Harvard Medical School, M547, 44 Binney St, Boston, MA 02115, USA. steven_treon@dfci.harvard.edu PURPOSE: We examined the activity of bortezomib, dexamethasone, and rituximab (BDR) in patients with symptomatic, untreated Waldenström macroglobulinemia (WM). PATIENTS AND METHODS: A cycle of therapy consisted of bortezomib 1.3 mg/m(2) intravenously; dexamethasone 40 mg on days 1, 4, 8, and 11; and rituximab 375 mg/m(2) on day 11. Patients received four consecutive cycles for induction therapy and then four more cycles, each given 3 months apart, for maintenance therapy. Twenty-three patients received a median of seven cycles of treatment. RESULTS: Median bone marrow disease involvement declined from 55% to 10% (P = .0004), serum immunoglobulin M levels declined from 4,830 to 1,115 mg/dL (P < .0001), and hematocrit increased from 29.8% to 38.2% (P = .0002) at best response. The overall response rates and major response rates were 96% and 83% with three complete responses, two near complete responses, three very good partial responses, 11 partial responses, and three minor responses. Responses occurred at a median of 1.4 months. With a median follow-up of 22.8 months, 18 of 23 patients remained free of disease progression. Peripheral neuropathy was the most common toxicity, and it resolved to grade < or = 1 in 13 of 16 patients at a median of 6.0 months. Four of the first seven treated patients developed herpes zoster, resulting in the institution of prophylactic antiviral therapy. CONCLUSION: The results demonstrate that BDR produces rapid and durable responses, along with high rates of response and complete remissions in WM. Herpes zoster prophylaxis is necessary with BDR, and reversible peripheral neuropathy was the most common toxicity leading to premature discontinuation of bortezomib in 61% of patients. Exploration of alternative schedules for bortezomib administration that includes weekly dosing should be pursued. PMCID: PMC2727288 [Available on 2010/8/10] PMID: 19506160 [PubMed - indexed for MEDLINE] 110. MMW Fortschr Med. 2009 Apr 2;151(14):122-3. [Infection induced pain. What should be considered in analgesia? (interview by Dr. Andreas Hackel)] [Article in German] Richter U. PMID: 19504853 [PubMed - indexed for MEDLINE] 111. Clin J Oncol Nurs. 2009 Jun;13(3):280-4. Disseminated varicella-zoster virus infection following azacitidine in a patient with myelodysplastic syndrome. Zhou G, Houldin AD. Vita Hematology Oncology, Bethlehem, PA, USA. guiyunzhou@hotmail.com PMID: 19502185 [PubMed - indexed for MEDLINE] 112. JAMA. 2009 Jul 1;302(1):73-80. Epub 2009 Jun 2. A 70-year-old woman with shingles: review of herpes zoster. Whitley RJ. Department of Pediatrics, University of Alabama at Birmingham, CHB 303, 1600 Seventh Ave S, Birmingham, AL 35294-0011, USA. rwhitley@peds.uab.edu Erratum in: JAMA. 2010 Feb 24;303(8):734. JAMA. 2009 Nov 4;302(17):1864. Comment in: JAMA. 2009 Nov 4;302(17):1862; author reply 1862-3. JAMA. 2010 Feb 24;303(8):733-4. Herpes zoster is a common late complication of varicella-zoster virus exposure and can be further complicated by postherpetic neuralgia. Ms A is a 70-year-old woman with shingles and Ramsay-Hunt syndrome who presented to the emergency department with a few days of earache followed by pain in the back of her head. Using her case as a springboard, the diagnosis, natural history, and treatment of herpes zoster and postherpetic neuralgia in immunocompetent older adults are reviewed, in addition to the effectiveness of the herpes zoster vaccine. PMID: 19491172 [PubMed - indexed for MEDLINE] 113. Cleve Clin J Med. 2009 Jun;76(6):329-30; author reply 330. Shingles vaccine (JANUARY 2009). Shaheen L. PMID: 19487551 [PubMed - indexed for MEDLINE] 114. Am J Nurs. 2009 Jun;109(6):63-5. Shingles and the vaccine to prevent it. Wielawski IM. imw@cloud9.net PMID: 19478611 [PubMed - indexed for MEDLINE] 115. J Infect Dis. 2009 Jul 1;200(1):11-9. Prevalence and clinical consequences of herpes simplex virus type 1 DNA in human cornea tissues. Remeijer L, Duan R, van Dun JM, Wefers Bettink MA, Osterhaus AD, Verjans GM. Rotterdam Eye Hospital, Rotterdam, The Netherlands. Comment in: J Infect Dis. 2009 Jul 1;200(1):1-4. BACKGROUND: We determined the prevalence and clinical consequences of herpes simplex virus (HSV) type 1 (HSV-1), HSV type 2 (HSV-2), and varicella-zoster virus (VZV) in cornea tissues obtained after penetrating keratoplasty (PKP) was performed. METHODS: The excised corneas of 83 patients with a history of herpetic keratitis (HK; hereafter referred to as "patients with HK") and 367 patients without a history of HK (hereafter referred to "patients without HK") were analyzed by real-time polymerase chain reaction (PCR) and virus culture for the presence of HSV-1, HSV-2, and VZV. In addition, 273 post-PKP donor corneoscleral rims were analyzed. The medical records of the transplant patients were reviewed to determine the risk factors influencing intracorneal viral load and graft survival. RESULTS: HSV-1 was the most prevalent herpesvirus. Both the prevalence of HSV-1 and the HSV-1 DNA load were higher in the corneas of patients with HK than in those of patients without HK. The HSV-1 DNA load in the corneas of patients with HK correlated with age, the recurrence-free interval, cornea neovascularization, steroid treatment before PKP, and disease severity. Herpesvirus DNA was detected in 2 of 273 corneoscleral rims. Graft survival was inversely correlated with the corneal HSV-1 DNA load in patients with HK. CONCLUSIONS: The data presented in this study argue for the implementation of real-time HSV-1 PCR to analyze the excised corneas of patients with HK, to improve post-PKP diagnosis and therapy. Screening of donor corneal tissues for herpesviruses is redundant to prevent newly acquired post-PKP HK. PMID: 19476433 [PubMed - indexed for MEDLINE] 116. J Infect Dis. 2009 Jul 1;200(1):1-4. Herpes simplex virus type 1 DNA in human corneas: what are the virological and clinical implications? Hill JM, Clement C. Comment on: J Infect Dis. 2009 Jul 1;200(1):11-9. PMID: 19476431 [PubMed - indexed for MEDLINE] 117. J Med Virol. 2009 Jul;81(7):1310-22. A real-time PCR assay to identify and discriminate among wild-type and vaccine strains of varicella-zoster virus and herpes simplex virus in clinical specimens, and comparison with the clinical diagnoses. Harbecke R, Oxman MN, Arnold BA, Ip C, Johnson GR, Levin MJ, Gelb LD, Schmader KE, Straus SE, Wang H, Wright PF, Pachucki CT, Gershon AA, Arbeit RD, Davis LE, Simberkoff MS, Weinberg A, Williams HM, Cheney C, Petrukhin L, Abraham KG, Shaw A, Manoff S, Antonello JM, Green T, Wang Y, Tan C, Keller PM; Shingles Prevention Study Group. Collaborators: Oxman MN, Arbeit RD, Barry P, Beisel CE, Boardman KD, Colling CL, Davis LE, Gelb LD, Gershon AA, Hayward AR, Irwin MR, Johnson GR, Levin MJ, Peduzzi PN, Schmader KE, Simberkoff MS, Straus SE, Weinberg A, Williams HM, Silber JL, Annunziato P, Chan CY, Chan IS, Davis LE, Kauffman CA, Keay SK, Marques AR, Soto NE, Brunell P, Gnann JW, Serrao R, Cotton DJ, Goodman RP, Arbeit RD, Pachucki CT, Levin MJ, Schmader KE, Keitel WA, Greenberg RN, Morrison VA, Wright PF, Griffin MR, Simberkoff MS, Yeh SS, Lobo Z, Holodniy M, Loutit J, Betts RF, Gelb LD, Crawford GE, Guatelli J, Brooks PA, Neuzil KM, Toney JF. Department of Veterans Affairs San Diego Healthcare System, San Diego, California, USA. A real-time PCR assay was developed to identify varicella-zoster virus (VZV) and herpes simplex virus (HSV) DNA in clinical specimens from subjects with suspected herpes zoster (HZ; shingles). Three sets of primers and probes were used in separate PCR reactions to detect and discriminate among wild-type VZV (VZV-WT), Oka vaccine strain VZV (VZV-Oka), and HSV DNA, and the reaction for each virus DNA was multiplexed with primers and probe specific for the human beta-globin gene to assess specimen adequacy. Discrimination of all VZV-WT strains, including Japanese isolates and the Oka parent strain, from VZV-Oka was based upon a single nucleotide polymorphism at position 106262 in ORF 62, resulting in preferential amplification by the homologous primer pair. The assay was highly sensitive and specific for the target virus DNA, and no cross-reactions were detected with any other infectious agent. With the PCR assay as the gold standard, the sensitivity of virus culture was 53% for VZV and 77% for HSV. There was 92% agreement between the clinical diagnosis of HZ by the Clinical Evaluation Committee and the PCR assay results. Published 2009 Wiley-Liss, Inc. PMID: 19475609 [PubMed - indexed for MEDLINE] 118. Neurology. 2009 May 26;72(21):1874. Varicella zoster infection of the brainstem followed by Brown-Séquard syndrome. Mathews MS, Sorkin GC, Brant-Zawadzki M. Department of Neurosurgery, SUNY Buffalo, 3 Gates Circle, Buffalo, NY 14209, USA. mmathews@buffns.com PMID: 19470972 [PubMed - indexed for MEDLINE] 119. J Infect Dis. 2009 Jul 1;200(1):26-32. Viremia in acute herpes zoster. Satyaprakash AK, Tremaine AM, Stelter AA, Creed R, Ravanfar P, Mendoza N, Mehta SK, Rady PL, Pierson DL, Tyring SK. Center for Clinical Studies, University of Texas Health Science Center, Houston, Texas, USA. BACKGROUND: A phase 2 trial was conducted to evaluate the efficacy of a topical antiviral, sorivudine, as an adjuvant to valacyclovir for the treatment of acute herpes zoster. METHODS: In this randomized, placebo-controlled, double-blind trial, 25 patients were treated with either sorivudine or placebo cream. All patients began 7 days of valacyclovir treatment on day 3. Zoster lesion swab samples and samples of peripheral blood mononuclear cells were collected periodically throughout the study and were analyzed for varicella-zoster virus (VZV) DNA by use of both qualitative and real-time polymerase chain reaction. Serum samples collected periodically throughout the study were analyzed for VZV DNA by use of real-time polymerase chain reaction. RESULTS: VZV DNA was detected in all 3 sample types, and the number of viral copies correlated with the progression of herpes zoster. No statistically significant differences were seen between the placebo- and sorivudine-treated groups with respect to clinical characteristics or laboratory test results. CONCLUSION: The detection of VZV DNA in the serum and peripheral blood mononuclear cells of all 25 zoster patients documents that viremia is a common manifestation of herpes zoster. Sorivudine cream appears to be a safe and well-tolerated adjuvant therapy; however, further phase 2 studies are needed to determine its clinical efficacy for the treatment of herpes zoster. Trials registration. ClinicalTrials.gov identifier: NCT00652184. PMID: 19469706 [PubMed - indexed for MEDLINE] 120. Eur J Dermatol. 2009 Jul-Aug;19(4):401-2. Epub 2009 May 25. Zosteriform metastasis of endometrial cancer. Werchau S, Hartschuh W, Hartmann M. PMID: 19467972 [PubMed - indexed for MEDLINE] 121. Pain Physician. 2009 May-Jun;12(3):629-32. Serial stellate ganglion blocks for intractable postherpetic itching in a pediatric patient: a case report. Peterson RC, Patel L, Cubert K, Gulati A. Weill Medical College, Cornell University, New York, NY, USA. BACKGROUND: While intractable itching may be rarely associated with postherpetic neuralgia, it can have catastrophic complications if present. METHOD: We highlight a severe case of postherpetic itching in a 10-year-old male with Fanconi's and aplastic anemia, refractory to conventional treatments and requiring intravenous sedation. RESULTS: Our use of 3 sequential stellate ganglion blocks with 5.5 mL of 0.25% bupivacaine provided significant improvement of the symptoms for 4 months after the last procedure. CONCLUSION: Although further evaluation is needed, we feel that novel use of sympathetic blockade may provide treatment for intractable itching. Highlighted is the possible influence of the sympathetic system in the pathophysiology of postherpetic itch. IMPLICATION: The use of serial stellate ganglion blocks may be a treatment option for patients with intractable itching and postherpertic neuralgia of the neck and arm region. This technique may lead to more permanent solutions such as pulse radiofrequency lesion or chemical neurolysis of sympathetic ganglions for postherpetic itch. PMID: 19461828 [PubMed - indexed for MEDLINE] 122. Arch Dermatol. 2009 May;145(5):589-94. Papules on the nape. Postherpetic granuloma annulare-like reaction (Wolf isotopic response). Watanabe T, Yoshida Y, Yamamoto O. Tottori University, Tottori, Japan. PMID: 19451508 [PubMed - indexed for MEDLINE] 123. Biol Blood Marrow Transplant. 2009 Jun;15(6):724-9. Incidence and risk of postherpetic neuralgia after varicella zoster virus infection in hematopoietic cell transplantation recipients: Hokkaido Hematology Study Group. Onozawa M, Hashino S, Haseyama Y, Hirayama Y, Iizuka S, Ishida T, Kaneda M, Kobayashi H, Kobayashi R, Koda K, Kurosawa M, Masauji N, Matsunaga T, Mori A, Mukai M, Nishio M, Noto S, Ota S, Sakai H, Suzuki N, Takahashi T, Tanaka J, Torimoto Y, Yoshida M, Fukuhara T. Stem Cell Transplantation Center, Hokkaido University Graduate School of Medicine, Sapporo, Japan. masahiro.onozawa@nifty.ne.jp). To assess the incidence of and risk factors associated with postherpetic neuralgia (PHN) after hematopoietic cell transplantation (HCT) varicella zoster virus (VZV) infection, we conducted a retrospective chart review of 418 consecutive patients who underwent HCT between April 2005 and March 2007. The male/female ratio was 221/197, median age at HCT was 47 years (range: 0-69 years), and autologous/allogeneic/syngeneic HCT ratio was 154/263/1. Seventy-eight patients developed VZV infection after HCT. Sixty-two patients had localized zoster, 11 patients had disseminated zoster (rash like chicken pox), and 4 patients had visceral zoster. All cases were treated with acyclovir (ACV) or valacyclovir (VACV), and there was no VZV infection-related death. Twenty-seven (35%) of the 78 patients with VZV infection suffered PHN after resolution of VZV infection. Multivariate analysis showed that advanced age is the only risk factor in autologous HCT (P = .0075; odds ratio [OR] = 1.14; 95% confidence interval [CI], 0.97-1.33). On the other hand, advanced age (P = .0097; OR = 1.06; 95% CI, 1.01-1.12), male gender (P = .0055; OR = 12.7; 95% CI, 1.61-100.1), and graft-versus-host disease (GVHD) prophylaxis with a tacrolimus-based regimen (P = .0092; OR = 9.56; 95% CI, 1.44-63.3) were associated with increased risk of PHN in allogeneic HCT. This study for the first time clarified the risk of PHN in HCT recipients. PMID: 19450757 [PubMed - indexed for MEDLINE] 124. Presse Med. 2010 Jan;39(1):34-41. Epub 2009 May 15. [Cytomegalovirus and other herpes virus infections in systemic diseases] [Article in French] Michaux C, Morlat P, Bonnet F. Service de médecine interne et maladies infectieuses, Hôpital Saint-André, CHU de Bordeaux, F-33075 Bordeaux, France. Reactivation of Herpesviridae is well known among transplant patients, but has not been sufficiently studied in patients who receive immunosuppressive treatment for systemic inflammatory diseases. CMV infection seems relatively rare; it is easily diagnosed by real-time PCR, a fast and reliable diagnostic tool. CMV disease is most often manifested in the form of lung disease, hepatitis, or colitis. The highest risks are associated with steroid or cyclophosphamide boluses and methotrexate. Prophylactic treatment cannot be recommended in clinical practice. The utility of monitoring viremia and of preemptive therapy must be evaluated. Herpes zoster is the most frequent viral infection in systemic diseases. Most immunosuppressive treatments, except methotrexate, promote its occurrence. Visceral involvement is quite rare, and outcome almost always favorable. Prophylactic treatment cannot be recommended. Copyright 2009 Elsevier Masson SAS. All rights reserved. PMID: 19446998 [PubMed - indexed for MEDLINE] 125. Actas Dermosifiliogr. 2009 Mar;100(2):155-7. [Blaschkoid, zosteriform linear lichen sclerosus et atrophicus] [Article in Spanish] Cabanillas González M, Monteagudo B, de las Heras C, Cacharrón JM. PMID: 19445886 [PubMed - indexed for MEDLINE] 126. J Neurol. 2009 Aug;256(8):1343-5. Epub 2009 May 12. Pure motor Herpes Zoster induced brachial plexopathy. Ismail A, Rao DG, Sharrack B. Department of Neurology, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, UK. azza.ismail@sth.nhs.uk Brachial plexus neuritis in the presence of herpes zoster infection is uncommon. Motor involvement is probably due to the spreading of inflammation from the dorsal root ganglia to the ventral roots and may be more extensive than the affected dermatomes. We present a case of herpes zoster brachial plexopathy with pure motor involvement both clinically and electrophysiologically. PMID: 19434442 [PubMed - indexed for MEDLINE] 127. Yonsei Med J. 2009 Apr 30;50(2):293-5. Topical glycopirrolate for the management of hyperhidrosis in herpetic neuralgia. Ladjevic NG, Likic-Ladjevic IS. Department of Anesthesia, Urology Clinic, Clinical Centre of Serbia, Belgrade, Serbia. nladjevic@yahoo.com Herpes zoster is a relapse of varicella. In certain cases, long-term pain and hyperhidrosis have been noted. Appearance of herpes zoster during pregnancy is infrequent. We described hyperhidrosis and pain treatment using glycopirrolate cream in a pregnant woman with herpetic neuralgia. A 32 year old woman, 21 weeks pregnant with second child, complained to her gynecologist of the appearance of a vesicular rash on the left half of the forehead that progressed toward her left eyelid, accompanied by lancinating pain, allodynia, hyperhidrosis and small edema, blepharitis and conjunctivitis. Following clinical and laboratory tests, she was diagnosed with herpes zoster ophtalmicus. Aciclovir therapy was administered 800 mg orally five times daily for seven days. Pain therapy was initiated with amitriptilline. We discontinued amitriptilline therapy after 10 days because of appearance of unwanted side effects. After skin changes ceased, we introduced Lidocaine patch into pain therapy which reduced the allodynia, but not the lancinating pain and hyperhidrosis. At that time we began using glycopirrolate cream which reduced pain intensity by 28.5% within 24 hours, and completely eliminated hyperhidrosis. After 48 hours of use, the pain completely disappeared. During the Glycopirrolate cream therapy, there were no side effects. This is a first report to document that a topical Glycopirrolate cream has a beneficial effect in a patient with hyperhidrosis and herpetic neuralgia. PMCID: PMC2678708 PMID: 19430567 [PubMed - indexed for MEDLINE] 128. Aten Primaria. 2009 Jul;41(7):424-5. Epub 2009 May 7. [Herpes zoster vaccination] [Article in Spanish] Rojas MA, Rodríguez FG, Rodríguez MR, Fernández JR. PMID: 19423192 [PubMed - indexed for MEDLINE] 129. BMC Infect Dis. 2009 May 7;9:55. Burden of herpes zoster requiring hospitalization in Spain during a seven-year period (1998-2004). Gil A, Gil R, Alvaro A, San Martín M, González A. Department of Health Sciences, Rey Juan Carlos University, Avda de Atenas s/n, 28922 Alcorcón, Madrid, Spain. angel.gil@urjc.es BACKGROUND: A thorough epidemiological surveillance and a good understanding of the burden of diseases associated to VZV are crucial to asses any potential impact of a prevention strategy. A population-based retrospective epidemiological study to estimate the burden of herpes zoster requiring hospitalization in Spain was conducted. METHODS: This study was conducted by using data from the national surveillance system for hospital data, Conjunto Mínimo Básico de Datos (CMBD). Records of all patients admitted to hospital with a diagnosis of herpes zoster (ICD-9-MC codes 053.0-053.9) during a 7-year period (1998-2004) were selected. RESULTS: A total of 23,584 hospitalizations with a primary or secondary diagnosis of herpes zoster in patients > or = 30 years of age were identified during the study period. Annually there were 13.4 hospitalizations for herpes zoster per 100,000 population in patients > or = 30 years of age. The rate increases with age reaching a maximum in persons > or = 80 years of age (54.3 admissions per 100,000 population >80 years of age). The mean cost of a hospitalization for herpes zoster in adult patients was 3,720 euro. The estimated annual cost of hospitalizations for herpes zoster in patients > or = 30 years of age in Spain was 12,731,954 euro. CONCLUSION: Herpes zoster imposes an important burden of hospitalizations and result in large cost expenses to the Spanish National Health System, especially in population older than 50 years of age. PMCID: PMC2685386 PMID: 19422687 [PubMed - indexed for MEDLINE] 130. Int J Dermatol. 2009 May;48(5):484-7. Eruption severity and characteristics in herpes zoster ophthalmicus: correlation with visual outcome, ocular complications, and postherpetic neuralgia. Nithyanandam S, Dabir S, Stephen J, Joseph M. Department of Ophthalmology, St John's Medical College Hospital, Bangalore, India. suneetha.n.lobo@gmail.com INTRODUCTION: Herpes zoster ophthalmicus (HZO) is characterized by a typical vesicular eruption affecting the distribution of the ophthalmic division of the trigeminal nerve which can be of varying severity. The correlation of eruption severity and ocular involvement and subsequent visual loss is still to be established. In this prospective longitudinal study we evaluated the correlation of eruption severity with ocular complications, visual outcome and postherpetic neuralgia. METHODS: Patients with HZO underwent detailed ophthalmological and dermatological examination at presentation and follow-up on 1(st) , 2(nd) and 4(th) week and 3(rd) and 6(th) month. Eruption severity was graded as mild, moderate and severe based on the number of vesicles. The correlation of eruption severity and distribution with ocular complications, visual outcome and postherpetic neuralgia was statistically evaluated. RESULTS: Severe eruption was seen in 14(28%), moderate eruption in 21(42%) and mild eruption in 15(30%). Severe eruption was significantly associated with increased incidence and severity of ocular involvement (p = 0.04 and p = 0.04 respectively), occurrence of uveitis (p = 0.004), reduced visual outcome (p = 0.002) and the occurrence of PHN (p = 0.05). Lacrimal nerve involvement was also associated with increased incidence (p = 0.03) and severity (p = 0.02) of ocular complications and visual loss (p = 0.01). CONCLUSION: Increasing eruption severity is a good predictor of occurrence of ocular complications and subsequent visual loss in HZO. Presence of a severe eruption is an indication for early ophthalmic intervention. Nasociliary nerve and lacrimal nerve involvement are also good predictors of ocular complications. PMID: 19416378 [PubMed - indexed for MEDLINE] 131. Clin Lymphoma Myeloma. 2009 Apr;9(2):151-3. Varicella-zoster virus prophylaxis with low-dose acyclovir in patients with multiple myeloma treated with bortezomib. Pour L, Adam Z, Buresova L, Krejci M, Krivanova A, Sandecka V, Zahradova L, Buchler T, Vorlicek J, Hajek R. Department of Internal Medicine-Hematooncology, University Hospital Brno, Masaryk University, Brno, Czech Republic. lpour@fnbrno.cz BACKGROUND: Varicella-zoster virus (VZV) reactivation is a common complication in patients with multiple myeloma (MM) treated with bortezomib, with an incidence rate of 10%-60%. The aim of our study was to analyze the effect of acyclovir prophylaxis in this patient population. PATIENTS AND METHODS: We studied 98 consecutive patients with relapsed MM treated with bortezomib. Bortezomib 1.3 mg/m2 was given on days 1, 4, 8, and 11 of a 21-day cycle. At first, patients did not receive any VZV prophylaxis, but because of the high incidence of VZV reactivation, VZV prophylaxis with acyclovir was implemented subsequently. RESULTS: A total of 11 patients treated with bortezomib did not have any VZV prophylaxis, and 4 of these 11 patients (36%) developed VZV reactivation in the form of herpes zoster. No VZV reactivations were observed in the 32 patients who received acyclovir 400 mg 3 times daily or the 55 patients who received acyclovir in a dose reduced to 400 mg once daily during bortezomib treatment. CONCLUSION: Varicellazoster virus reactivation is a common and serious adverse effect of bortezomib treatment. Acyclovir 400 mg once daily is sufficient to protect from VZV reactivation in patients with MM treated with bortezomib. PMID: 19406726 [PubMed - indexed for MEDLINE] 132. Praxis (Bern 1994). 2009 Apr 29;98(9):493-6. [Connection between hyponatriemia and local herpes in an old lady?] [Article in German] Osinga R, Hess-Sigrist F, Wegener D, Wiens M, Hess Ch. Medizinische Klinik, Bezirksspital Affoltern am Albis. We report the case of a 84 year old patient who developed a syndrome of inappropriate antidiuretic hormone secretion (SIADH) with severe hyponatremia in the context of a localized herpes zoster L1/2. This is a rare but known complication of localized varizella zoster infection. Under water restriction and salt administration the hyponatremia was corrected slowly. One month after hospital discharge the patient showed a normal sodium value without diet. PMID: 19404909 [PubMed - indexed for MEDLINE] 133. Acta Neurochir (Wien). 2009 Aug;151(8):1003-4; discussion 1004. Epub 2009 Apr 30. Atypic geniculate neuralgia: atypic anatomic correlation of cranial nerve roots and AICA. Ozer FD, Duransoy YK, Camlar M. Department of Neurosurgery, Izmir Training and Research Hospital, Arikent Sitesi C-7 Blok D:9 Narlidere, 35360 Izmir, Turkey. Geniculate neuralgia is a rare cause of craniofacial pains. The anterior inferior cerebellar artery is the offending vessel which compress nervus intermedius in the patients with typical geniculate neuralgia. We report a patient whose pain was atypical for either geniculate neuralgia and trigeminal neuralgia. At operation the anterior inferior cerebellar artery was coursing with the nerves and was separated. After the decompression the pain resolved immediately. PMID: 19404569 [PubMed - indexed for MEDLINE] 134. Clin Adv Hematol Oncol. 2009 Mar;7(3):159-61. The role of vaccination in prevention of VZV disease in the immunocompromised child. Hambleton S. Paediatric Immunology and Infectious Diseases, Institute of Cellular Medicine, Newcastle University Medical School, Newcastle upon Tyne, NE1 7RU, United Kingdom. PMID: 19398937 [PubMed - indexed for MEDLINE] 135. Int J Infect Dis. 2009 Nov;13(6):e498-500. Epub 2009 Apr 23. Thrombosis associated with varicella zoster in an adult. Limb J, Binning A. Department of Anesthesia, Gartnavel General Hospital, 1053 Great Western Road, Glasgow, G12 0YN, UK. jimjamlimb@doctors.org.uk The incidence of varicella zoster in adults is increasing, and may be associated with a number of significant complications. An adult male presented with varicella zoster complicated by pneumonitis and thrombosis, leading to a below-knee amputation. Thrombosis with varicella zoster has been associated with vasculitis and free protein S deficiency. Other microthrombotic complications, such as purpura fulminans, are more common in children. Current treatment recommendations include acetaminophen (paracetamol) and lotions for symptomatic treatment. Intravenous acyclovir is recommended in the treatment of complicated varicella zoster, although it has not been shown to reduce the incidence of complications. PMID: 19398362 [PubMed - indexed for MEDLINE] 136. Expert Rev Vaccines. 2009 May;8(5):593-606. Prevention of infectious diseases in older adults through immunization: the challenge of the senescent immune response. McElhaney JE. University of British Columbia, Vancouver, BC, Canada. janet.mcelhaney@ubc.ca A decline in immune function with aging increases the risk of different infectious diseases, many of which of can be prevented by vaccination. Influenza is foremost among these illnesses and remains a significant problem in older adults despite widespread influenza vaccination programs. There are major challenges to developing new or more effective vaccines against influenza and the many other virus and bacterial illnesses that commonly affect the population aged over 65 years. This article will provide a summary of the impact of vaccine-preventable diseases, including influenza, respiratory syncytial virus, pneumococcal disease and herpes zoster, strategies that are being used to develop or improve vaccines against these diseases and how this might alter the immune response to improve protection. PMID: 19397416 [PubMed - indexed for MEDLINE] 137. J Virol. 2009 Jul;83(14):7361-4. Epub 2009 Apr 22. Identification of varicella-zoster virus-specific CD8 T cells in patients after T-cell-depleted allogeneic stem cell transplantation. van der Heiden PL, de Boer R, van der Steen DM, Kester MG, van der Hoorn MW, Haarman WM, Barnby-Porritt HE, Fry JW, Napper CE, Marijt EW, Willemze R, Falkenburg JH, Heemskerk MH. Department of Hematology, Leiden University Medical Center, Leiden, The Netherlands. P.L.J.van_der_Heiden@lumc.nl To study the role of CD8 T cells in the control of varicella-zoster virus (VZV) reactivation, we developed multimeric major histocompatibility complexes to identify VZV-specific CD8 T cells. Potential HLA-A2 binding peptides from the putative immediate-early 62 protein (IE62) of VZV were tested for binding, and peptides with sufficient binding capacity were used to generate pentamers. Patients with VZV reactivation following stem cell transplantation were screened with these pentamers, leading to the identification of the first validated class I-restricted epitope of VZV. In 42% of HLA-A2 patients following VZV reactivation, these IE62-ALW-A2 T cells could be detected ex vivo. PMCID: PMC2704790 PMID: 19386715 [PubMed - indexed for MEDLINE] 138. Turk J Pediatr. 2009 Jan-Feb;51(1):86-8. Postherpetic pruritus in a child with retinoblastoma. Akgül S, Küpeli S, Yalçin B, Demir HA, Büyükpamukçu M. Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey. Herpes zoster is a painful neurocutaneous disease caused by the reactivation of the varicella zoster virus, and it can develop any time after a primary infection, which usually occurs during childhood. A variety of immunocompromised patient populations are known to be at increased risk for herpes zoster. Postherpetic pruritus is a serious complication, which may last after the infection, and has the potential to cause injury and disability. The medical literature on postherpetic pruritus is very limited. This is a case report of a six-year-old child who developed postherpetic pruritus lasting three months, which responded to topical urea treatment. PMID: 19378900 [PubMed - indexed for MEDLINE] 139. Clin Infect Dis. 2009 May 15;48(10):1372-4. Rheumatoid arthritis and the incidence of herpes zoster: risky business. Cohen JI. Comment on: Clin Infect Dis. 2009 May 15;48(10):1364-71. PMID: 19368500 [PubMed - indexed for MEDLINE] 140. Clin Infect Dis. 2009 May 15;48(10):1364-71. Herpes zoster risk factors in a national cohort of veterans with rheumatoid arthritis. McDonald JR, Zeringue AL, Caplan L, Ranganathan P, Xian H, Burroughs TE, Fraser VJ, Cunningham F, Eisen SA. St. Louis Veterans Affairs Medical Center, St. Louis, Missouri 63106, USA. Jay.McDonald1@va.gov Comment in: Clin Infect Dis. 2009 May 15;48(10):1372-4. BACKGROUND: Herpes zoster occurs more commonly in patients taking immunosuppressive medications, although the risk associated with different medications is poorly understood. METHODS: We conducted a retrospective cohort study involving 20,357 patients who were followed in the Veterans Affairs healthcare system and treated for rheumatoid arthritis from October 1998 through June 2005. Cox proportional hazards regression was used to determine risk factors for herpes zoster and herpes zoster-free survival. Chart review was performed to validate the diagnosis of herpes zoster. RESULTS: The incidence of herpes zoster was 9.96 episodes per 1000 patient-years. In time-to-event analysis, patients receiving medications used to treat mild rheumatoid arthritis were less likely to have an episode of herpes zoster than patients receiving medications used to treat moderate and severe rheumatoid arthritis (P < .001). Independent risk factors for herpes zoster included older age, prednisone use, medications used to treat moderate and severe rheumatoid arthritis, malignancy, chronic lung disease, renal failure, and liver disease. Among patients receiving tumor necrosis factor-alpha antagonists, etanercept (hazard ratio, 0.62) and adalimumab (hazard ratio, 0.53) were associated with a lower risk of herpes zoster. There was excellent agreement between the International Classification of Diseases, Version 9, Clinical Modification diagnosis of herpes zoster and diagnosis by chart review (kappa = 0.92). CONCLUSIONS: Risk factors for herpes zoster included older age, prednisone use, medications used to treat moderate and severe rheumatoid arthritis, and several comorbid medical conditions. These results demonstrate that the Department of Veterans Affairs' national administrative databases can be used to study rare adverse drug events. PMCID: PMC2743911 [Available on 2010/5/15] PMID: 19368499 [PubMed - indexed for MEDLINE] 141. Dtsch Med Wochenschr. 2009 Apr;134 Suppl 2:S90-4. Epub 2009 Apr 7. [Herpes zoster and postherpetic neuralgia - prevention by vaccination?] [Article in German] Wutzler P. Institut für Virologie und Antivirale Therapie, Universitätsklinikum Jena. Peter.Wutzler@med.uni-jena.de Herpes zoster is caused by reactivation of latent varicella-zoster virus (VZV), which had remained latent in the dorsal root or cranial nerve ganglia since the primary infection. The risk of developing zoster increases significantly with age, the vast majority of zoster cases occuring in persons over 50 years. The most frequent and debilitating complication of zoster in immunocompetent patients is postherpetic neuralgia (PHN). In the absence of antiviral therapy, clinical studies have found up to 30 - 45 % of persons over 60 years of age to experience pain persisting for more than 6 months. Systemic antiviral therapy is able to shorten the healing process of acute zoster and to prevent or alleviate pain and other complications, when given within 72 hours after appearance of the rash. About 20 % of patients older than 50 years continue to have pain six months after appearance of rash, despite antiviral treatment. A live attenuated VZV vaccine was licensed in Europe in 2006 for the prevention of zoster in individuals from the age of 60 years. Findings of a large clinical trial have shown that the zoster vaccine reduced the burden of illness caused by zoster among people 60 years of age or older by 61 % and the incidence of PHN by 67 %. Compared with controls, subjects who received the vaccine were 51 % less likely to develop zoster. PMID: 19353479 [PubMed - indexed for MEDLINE] 142. Pediatr Blood Cancer. 2009 Aug;53(2):226-8. Atypical varicella zoster infection associated with hemophagocytic lymphohistiocytosis. van der Werff ten Bosch JE, Kollen WJ, Ball LM, Brinkman DM, Vossen AC, Lankester AC, Egeler RM, Bredius RG. Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands. jvdwerff@uzbrussel.be Two adolescents, on immunosuppressive therapy for graft-versus-host disease, developed hemophagocytic lymphohistiocytosis (HLH) after varicella zoster virus (VZV) reactivation. In the absence of dermatome restricted characteristic skin lesions, VZV reactivation was not immediately recognized and treatment with acyclovir was delayed. The first patient developed optical neuritis and died 2 months after the VZV episode due to massive intracranial hemorrhage. The second patient presented with severe abdominal pain and pancreatitis, followed by atypical skin eruptions, which prompted a faster diagnosis. Both patients recovered from their HLH, the first patient being successfully treated with immunosuppressive agents and the second with VZV treatment only. These two cases demonstrate the difficulties in recognizing VZV reactivation, and in order to start adequate and timely treatment, the need to consider VZV as a possible cause of HLH in severely immunocompromised patients. (c) 2009 Wiley-Liss, Inc. PMID: 19353624 [PubMed - indexed for MEDLINE] 143. Expert Opin Pharmacother. 2009 Apr;10(5):797-812. The treatment of varicella-zoster virus infection and its complications. Partridge DG, McKendrick MW. Department of Infectious Diseases, Royal Hallamshire Hospital, Sheffield, UK. david.partridge@sth.nhs.uk BACKGROUND: Varicella, zoster and their complications remain important causes of morbidity and mortality in a population containing increasing numbers of elderly or immunocompromised individuals. OBJECTIVE: To review varicella-zoster virus pathogenesis and current therapeutic options. METHODS: The English-language literature related to varicella-zoster virus, its associated diseases, complications and treatments was identified using the Pubmed search engine, examination of reference lists of reviewed articles and the authors' personal knowledge. Focus was placed on those studies and meta-analyses performed within the past 5 years. RESULTS/CONCLUSIONS: Antiviral agents may be used to prevent or treat the complications of varicella or zoster in a variety of patient groups. The oral prodrugs valaciclovir and famciclovir have an expanding role in the management of disease. A stepwise approach to the management of post-herpetic neuralgia should be employed in affected patients with tricyclic antidepressants and alpha2delta ligands as first-line agents. PMID: 19351229 [PubMed - indexed for MEDLINE] 144. Clin Lab. 2009;55(1-2):1-7. Serological detection of specific IgG to varicella-zoster virus by novel ELISA based on viral glycoprotein antigen. Sauerbrei A, Wutzler P. Institute of Virology and Antiviral Therapy, Friedrich-Schiller University, Jena, Germany. Andreas.Sauerbrei@med.uni-jena.de The novel RIDASCREEN varicella-zoster virus (VZV) IgG enzyme immunoassay (EIA) based on viral envelope glycoproteins was evaluated using the fluorescent antibody to membrane antigen test as a reference. For the detection of VZV immunity in latently infected persons, the sensitivity of the RIDASCREEN assay was 94-100%. Thus, the novel EIA had comparable sensitivity as the SERION enzyme-linked immunosorbent assay (ELISA) classic VZV IgG and higher sensitivity than the ELISA Enzygnost Anti VZV/IgG. Sensitivity of the RIDASCREEN EIA for the determination of immunity following vaccination was 57-89% and not different from the sensitivity of the SERION and the Enzygnost assay. While the specificity of the RIDASCREEN EIA was calculated as 88-98%, SERION and Enzygnost ELISAs had 100% specificity. In conclusion, the novel RIDASCREEN EIA can be recommended for detection of VZV immunity after natural infection taking account of the reduced specificity. For determination of immunity post vaccination, a different approach for the interpretation of borderline results should be considered. PMID: 19350844 [PubMed - indexed for MEDLINE] 145. Acta Dermatovenerol Alp Panonica Adriat. 2009 Mar;18(1):28-30. Herpes zoster following intra-articular corticosteroid injection. Fernandes NF, Malliah R, Stitik TP, Rozdeba P, Lambert WC, Schwartz RA. Pathology, and Physical Medicine and Rehabilitation, New Jersey Medical School, 185 South Orange Avenue, Newark, NJ 07103, USA. Localized herpes zoster following intra-articular corticosteroid injection is remarkable. We describe an 80-year-old woman with severe osteoarthritis that received an intra-articular injection of 80 mg methylprednisolone in her knee, followed 1 day later by the appearance of linear unilateral vesicles and bullae on her leg in a dermatomal distribution adjacent to the injection site. The roofs of several blisters showed classic viral cytopathic effects for herpes including keratinocytes with multinucleation and margination of chromatin. Varicella zoster virus immunostaining revealed positive staining in the keratinocytes. One plausible explanation is herpes zoster virus reactivation secondary to localized immunosuppression from corticosteroid injection. PMID: 19350185 [PubMed - indexed for MEDLINE] 146. Infect Control Hosp Epidemiol. 2009 May;30(5):495-6; author reply 496-7. Trends in rates of herpes zoster-related hospitalizations: are they real, are they costly, and are they linked to varicella vaccination? Harpaz R, Yawn BP. Comment on: Infect Control Hosp Epidemiol. 2008 Dec;29(12):1157-63. PMID: 19344268 [PubMed - indexed for MEDLINE] 147. Cleve Clin J Med. 2009 Apr;76(4):221. The clinical picture: multiple huge bullae after renal transplant. Tsai MJ, Kuo HT, Chen HC. Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan. PMID: 19339637 [PubMed - indexed for MEDLINE] 148. Dermatol Online J. 2009 Feb 15;15(2):6. Darier disease complicated by disseminated zoster. Kandasamy R, Hecker M, Choi M, Pile J. Department of Medicine, Case Western Reserve University/MetroHealth Medical Center Cleveland, Ohio, USA. rkandasamy@metrohealth.org A 58-year-old man with Darier disease and end-stage renal failure on hemodialysis who developed disseminated Herpes Zoster is presented. He was cleared with intravenous acyclovir given at the time of dialysis. PMID: 19336023 [PubMed - indexed for MEDLINE] 149. Dermatol Ther. 2009 Mar-Apr;22(2):143-9. Varicella zoster vaccines. Creed R, Satyaprakash A, Ravanfar P. Center for Clinical Studies, Houston, Texas, USA. rcreed@ccstexas.com In the past, the varicella zoster virus affected virtually the entire population and had substantial morbidity and mortality associated with both primary varicella and herpes zoster reactivation. Since the varicella vaccine was first approved in 1995, there has been a significant decline in incidence, morbidity, and mortality caused by primary varicella. Breakthrough disease with the one-dose vaccine schedule led to the recommendation in 2006 that children receive a two-dose vaccine series. Older adults have also benefited from the development of the zoster vaccine. In 2006, the Food and Drug Administration approved the zoster vaccine, a higher concentration of the same live attenuated virus used in the primary varicella vaccine, for persons 60 years of age or older. It has the potential to help millions of people avoid the pain associated with reactivation of the varicella zoster virus by reducing the incidence and severity of herpes zoster and postherpetic neuralgia. PMID: 19335725 [PubMed - indexed for MEDLINE] 150. Urol Int. 2009;82(2):238-41. Epub 2009 Mar 19. Urinary retention, erectile dysfunction and meningitis due to sacral herpes zoster: a case report and review of the literature. Erol B, Avci A, Eken C, Ozgok Y. Zonguldak Karaelmas University, Zonguldak, Turkey. erolbulent@yahoo.com Zona zoster infection is often associated with painful erythematous vesicular eruptions of the skin or mucous membranes. Varicella zoster virus which stays latent in the sensorial root ganglia causes zona zoster infection. The most recognized feature of zona zoster is the dermatomal distribution of vesicular rashes. In the present case report, we state an unusual presentation of sacral zona zoster with urinary retention, erectile dysfunction and meningitis. Copyright 2009 S. Karger AG, Basel. PMID: 19322017 [PubMed - indexed for MEDLINE] 151. Lupus. 2009 Apr;18(5):476. Disseminated herpes zoster causing extensive skin necrosis. Appenzeller S, Vinet E, Clarke A. PMID: 19318405 [PubMed - indexed for MEDLINE] 152. Herpes. 2009 Jan;15(3):62-3. Varicella zoster virus redux. Gelb LD. Washington University School of Medicine, St Louis, MO 63110, USA. ldgelb@swbell.net In May 2008, the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention in the USA recommended the routine administration of a live-attenuated high-potency varicella zoster vaccine to all adults over 60 years of age without specific contraindications, for the prevention and attenuation of herpes zoster (HZ). Nevertheless, many physicians still consider this vaccine to be of marginal value. This is not a reasonable conclusion. This short article reviews available data. PMID: 19306605 [PubMed - indexed for MEDLINE] 153. Ocul Immunol Inflamm. 2009 Jan-Feb;17(1):33-5. Herpes zoster keratouveitis and inflammatory ocular hypertension 8 years after varicella vaccination. Lin P, Yoon MK, Chiu CS. Department of Ophthalmology, University of California San Francisco, San Francisco, California, USA. More than 8 years after varicella vaccination, a healthy 16 year-old boy presented with keratouveitis, severe inflammatory glaucoma in his left eye, and Hutchinson's sign. He was treated with systemic acyclovir, topical steroids, cycloplegics, and glaucoma medications for a full recovery two months after presentation. It is unclear whether the source of herpes zoster which reactivated in this patient represents wild type virus or his previous vaccine strain. Herpes zoster ophthalmicus is very rare in the pediatric population after varicella vaccination but can cause severe inflammatory glaucoma that requires aggressive therapy. PMID: 19294571 [PubMed - indexed for MEDLINE] 154. Neurology. 2009 Mar 17;72(11):1028-30; author reply 129-30. The varicella zoster virus vasculopathies: clinical, CSF, imaging, and virologic features. Elkind MS. Comment on: Neurology. 2008 Mar 11;70(11):853-60. PMID: 19289747 [PubMed - indexed for MEDLINE] 155. J Dermatol. 2009 Feb;36(2):95-7. Case of herpes zoster duplex bilateralis. Shin BS, Seo HD, Na CH, Choi KC. Department of Dermatology, College of Medicine, Chosun University, Gwangju, Korea. derm75@hanmail.net Non-contiguously simultaneous development of herpes zoster is very rare. It is named either herpes zoster duplex unilateralis or bilaterarlis, depending on whether one or both sides of the body are involved. Herein, we report a 21-year-old man, who had been treated for ulcerative colitis with prednisolone, and presented with painful grouped vesicles of the lower abdomen and back in a relatively symmetrical distribution. A Tzanck smear and punch biopsy were performed on the vesicles of the back. We report a rare case of symmetrical herpes zoster duplex bilateralis. PMID: 19284453 [PubMed - indexed for MEDLINE] 156. Presse Med. 2009 Jun;38(6):1013-5. Epub 2009 Mar 17. [Jugular foramen syndrome and cervical varicella zoster viral infection] [Article in French] Drouet A, Lemoigne F, Donnat A, Vincent E. Service de neurologie, HIA Desgenettes, F-69275 Lyon Cedex 03, France. drouetalain@yahoo.fr PMID: 19282132 [PubMed - indexed for MEDLINE] 157. J Hosp Infect. 2009 Jun;72(2):163-8. Epub 2009 Mar 17. Varicella zoster exposure on paediatric wards between 2000 and 2007: safe and effective post-exposure prophylaxis with oral aciclovir. Shinjoh M, Takahashi T. Department of Pediatrics, School of Medicine, Keio University, Shinjuku-ku, Tokyo, Japan. m-shinjo@z2.keio.jp Varicella zoster virus is highly contagious and can cause serious complications in immunocompromised patients. To prevent people exposed to the virus from developing secondary varicella we have used oral aciclovir as post-exposure prophylaxis (PEP) since 2000. Between 2000 and 2007, there were 11 unexpected occurrences of varicella and 11 unexpected occurrences of zoster in our paediatric wards. There were 174 contacts, 131 exposed to varicella and 43 exposed to zoster. A total of 163 (94%) received PEP and 11 (6%) did not. The rates of secondary infection among contacts given prophylaxis with aciclovir only were 2.1% (3/141) for all contacts and 1.3% (1/76) for immunocompetent contacts. The rate of secondary infection among contacts not given PEP was significantly higher (18%, 2/11) (P<0.05). No adverse events due to PEP were reported. We conclude that oral aciclovir PEP following exposure to VZV on paediatric wards is both safe and effective. PMID: 19282055 [PubMed - indexed for MEDLINE] 158. Eur Urol. 2009 Aug;56(2):392-4. Epub 2009 Feb 28. Reduction of serum prostate-specific antigen levels following varicella-zoster infection and valaciclovir treatment in prostate cancer. Jurhill RR, van der Veen H, van Leenders GJ, Verhagen PC. Department of Urology, Erasmus MC, Rotterdam, The Netherlands. We present two prostate cancer patients, including one with a castration-resistant cancer whose rising serum prostate-specific antigen (PSA) levels showed a remarkable drop after a reactivated varicella-zoster virus infection treated with valaciclovir. In one patient, we found a temporary decrease in serum PSA lasting for at least 4 mo. In the patient with castration-resistant prostate cancer, serum PSA decreased to <0.01 microg/l and has remained undetectable since. PMID: 19278776 [PubMed - indexed for MEDLINE] 159. Clin Experiment Ophthalmol. 2008 Dec;36(9):894-5. Acute retinal necrosis following steroid treatment for unrecognized Ramsay-Hunt syndrome. Sims JL, Zamir E. PMID: 19278487 [PubMed - indexed for MEDLINE] 160. Ann Acad Med Singapore. 2009 Feb;38(2):136-8. Herpes zoster as a useful clinical marker of underlying cell-mediated immune disorders. Soyuncu S, Berk Y, Eken C, Gulen B, Oktay C. Department of Emergency Medicine, Akdeniz University Faculty of Medicine, 07059 Antalya, Turkey. ssoyuncu@akdeniz.edu.tr INTRODUCTION: The objective of this study was to determine the necessity of further evaluation of patients presented with herpes zoster (HZ) to the Emergency Department for the underlying decreased cell-mediated immunity. MATERIALS AND METHODS: The data of 132 adult patients presenting with HZ to the Emergency Department were collected from the computerised database of Akdeniz University Hospital. The following data were recorded: demographic data and underlying diseases during onset of HZ and laboratory results (white blood cell counts, blood glucose levels). RESULTS: There were 132 patients with HZ in the study period. The mean age of patients was 52.98 +/- 18.91 years (range, 14 to 96) and 53% (70 patients) were male. Of the study patients, 70.5% (93 patients) were over 45 years old. Eight (6.1%) patients had been diagnosed to have a malignancy, 18 (13.6%) had diabetes mellitus and 3 (2.3%) patients had undergone organ transplantation during their admission. Malignancy, diabetes mellitus and organ transplantation prevalence in the HZ group was significantly higher than the whole Emergency Department population. CONCLUSIONS: Our results indicate a relationship between the presence of HZ and increasing age and cell-mediated immunosuppressive disorders in Emergency Department patients over the age of 45 years. HZ should be considered as a clinical marker of cell-mediated immunosuppressive disorders, particularly in elderly patients. PMID: 19271041 [PubMed - indexed for MEDLINE] 161. BMJ. 2009 Mar 6;338:b944. doi: 10.1136/bmj.b944. Shingles vaccination is likely to be cost effective at age 65 or 70. Dobson R. PMID: 19270023 [PubMed - indexed for MEDLINE] 162. Presse Med. 2009 Jul-Aug;38(7-8):1173-7. Epub 2009 Mar 9. [Cerebral vasculopathy as complication of zoster rash] [Article in French] Dufour-Gaume F, Guilloton LL, Estival JL, Vitry T, Felten D, Combemale P. Service de dermatologie, HIA Desgenettes, F-69275 Lyon Cedex 03, France. PMID: 19269775 [PubMed - indexed for MEDLINE] 163. J Clin Rheumatol. 2009 Mar;15(2):101. Herpes zoster infection followed by Henoch-Schönlein purpura in a girl receiving infliximab for ulcerative colitis. Nobile S, Catassi C, Felici L. Comment on: J Clin Rheumatol. 2006 Oct;12(5):249-51. PMID: 19265360 [PubMed - indexed for MEDLINE] 164. Auris Nasus Larynx. 2009 Oct;36(5):606-8. Epub 2009 Mar 4. Herpes zoster laryngitis with intractable hiccups. Morinaka S. Department of Otorhinolaryngology, Kobe Japanpost Hospital, Kamitsutsui-dori, Chuo-ku, Japan. smorinakaent@yahoo.co.jp A 73-year-old man presented to our hospital with a sore throat (left-sided) and hiccups. The patient had mucosal swelling and erosions affecting the left posterior pillar, base of tongue, epiglottis, arytenoid, and aryepiglottic fold. As the laryngeal mucosal edema became worse, herpetic vesicles and erosions developed on the left cavum conchae, external auditory canal, and palate. The patient was treated with acyclovir and a steroid. His hiccups were treated with metoclopramide, but it had little effect, and hiccups only subsided gradually after the disappearance of erosions. His hiccups relapsed transiently with vomiting, and then resolved completely. Elevation of the CF titer after 2 weeks confirmed the diagnosis of herpes zoster. This condition should be considered in patients with unilateral sore throat and intractable hiccups, and treatment with acyclovir should be provided. PMID: 19264432 [PubMed - indexed for MEDLINE] 165. Cleve Clin J Med. 2009 Mar;76(3):152; author reply 152. Shingles vaccine ((JANUARY 2009). Hirsch R. Comment on: Cleve Clin J Med. 2009 Jan;76(1):45-8. PMID: 19258459 [PubMed - indexed for MEDLINE] 166. Eur J Dermatol. 2009 May-Jun;19(3):283-5. Epub 2009 Mar 3. Herpes zoster occurring as a solitary vesicular in malignant lymphoma. Ishida N, Watanabe D, Kuhara T, Takama H, Tamada Y, Matsumoto Y. PMID: 19258238 [PubMed - indexed for MEDLINE] 167. Mayo Clin Proc. 2009 Mar;84(3):274-80. Herpes zoster (shingles) and postherpetic neuralgia. Sampathkumar P, Drage LA, Martin DP. Division of Infectious Diseases, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA. sampathkumar.priya@mayo.edu Comment in: Mayo Clin Proc. 2009 Jul;84(7):663; author reply 663-4. Herpes zoster (HZ), commonly called shingles, is a distinctive syndrome caused by reactivation of varicella zoster virus (VZV). This reactivation occurs when immunity to VZV declines because of aging or immunosuppression. Herpes zoster can occur at any age but most commonly affects the elderly population. Postherpetic neuralgia (PHN), defined as pain persisting more than 3 months after the rash has healed, is a debilitating and difficult to manage consequence of HZ. The diagnosis of HZ is usually made clinically on the basis of the characteristic appearance of the rash. Early recognition and treatment can reduce acute symptoms and may also reduce PHN. A live, attenuated vaccine aimed at boosting immunity to VZV and reducing the risk of HZ is now available and is recommended for adults older than 60 years. The vaccine has been shown to reduce significantly the incidence of both HZ and PHN. The vaccine is well tolerated, with minor local injection site reactions being the most common adverse event. This review focuses on the clinical manifestations and treatment of HZ and PHN, as well as the appropriate use of the HZ vaccine. PMCID: PMC2664599 PMID: 19252116 [PubMed - indexed for MEDLINE] 168. JAAPA. 2009 Jan;22(1):45-7. Hypertension; herpes zoster. Olsen ME, Klingler AM. Nephrology & Hypertension Associates, Middlebury, Connecticut, USA. PMID: 19248361 [PubMed - indexed for MEDLINE] 169. J Clin Microbiol. 2009 May;47(5):1418-23. Epub 2009 Feb 25. Genotyping of clinical varicella-zoster virus isolates collected in China. Liu J, Wang M, Gan L, Yang S, Chen J. Department of Microbiology, Anhui Medical University, Hefei, China. Varicella-zoster virus (VZV) is genetically stable; and various schemes for the genotyping of VZV based on restriction fragment length polymorphisms (RFLPs), PCR, and sequencing have been developed. At least three major genotypes have been recognized among VZV isolates or clinical samples from different locations around the world; however, few data were available for viral isolates from China. In the current study, a collection of 19 VZV isolates from patients with zoster or varicella in the middle eastern region of China was examined for genetic variations. RFLP analysis of DNA fragments of open reading frames (ORFs) 38, 54, and 62 showed that all 19 isolates were PstI and BglI positive and SmaI negative, and this may represent the major restriction pattern of wild-type VZV strains in China. Further analysis of the R5 variable-repeat region in those strains revealed that 9 (47.4%) were type R5A, while the remaining 10 strains (52.6%) were type R5B. On the basis of the sequencing data for ORFs 1, 21, 22, and 54, all 19 Chinese strains could be grouped into genotype J or J1. A novel in-frame 3-nucleotide insertion (CGG) in ORF1 was found in 4 (21%) of the 19 isolates. Additionally three new nucleotide substitutions were detected in two of the isolates. A varicella isolate from the United States, strain MLS, was included in this study as a control for American wild-type VZV, and was found to be type M1, which represents one of the minor genotypes in North America. PMCID: PMC2681844 PMID: 19244468 [PubMed - indexed for MEDLINE] 170. Indian J Ophthalmol. 2009 Mar-Apr;57(2):163-4; author reply 164. Herpes zoster ophthalmicus or Herpes zoster maxillaris? Chandravanshi SL, Rathore MK. Comment on: Indian J Ophthalmol. 2008 Sep-Oct;56(5):363-75. PMCID: PMC2684417 PMID: 19237800 [PubMed - indexed for MEDLINE] 171. Can J Neurol Sci. 2008 Nov;35(5):661-3. Herpes radiculitis following surgery for symptomatic cervical foraminal stenosis. Grauvogel J, Vougioukas VI. PMID: 19235455 [PubMed - indexed for MEDLINE] 172. Pain. 2009 Apr;142(3):175-6. Epub 2009 Feb 23. Controlled release oxycodone - an evidence-based treatment for pain in acute herpes zoster. Haanpää M. Comment on: Pain. 2009 Apr;142(3):209-17. PMID: 19233562 [PubMed - indexed for MEDLINE] 173. Masui. 2009 Feb;58(2):153-9. [The effects of early nerve blocks for prevention of postherpetic neuralgia and analysis of prognostic factors] [Article in Japanese] Tajima K, Iseki M, Inada E, Miyazaki T. Department of Anesthesiology and Pain Medicine, Juntendo University of Medicine, Tokyo 113-0033. BACKGROUND: Herpes zoster causes acute pain and sometimes leads to postherpetic neuralgia (PHN). The previously reported risk factors of PHN such as old age, allodynia, paresthesia and so on are not based on evidence. Although nerve block is useful to relieve acute pain and recommended for prevention of PHN, evidence is scanty. METHODS: The patients with herpes zoster within 3 months after the onset were studied. The patient underwent nerve blocks and proper medical treatment, and were followed for up to one year. The risk factors of PHN were assessed. We evaluated whether nerve block prevented PHN. RESULTS: A total of 144 consecutive patients were studied. Twenty seven % of patients suffered PHN. Old age (> 65 y. o) and hypesthesia were confirmed to be the risk factors of PHN, whereas the intensity of acute pain was not. Patients who underwent nerve block within 1 month after the onset were less likely to suffer from PHN compared with patients of delayed nerve blocks. CONCLUSIONS: Old age, hypesthesia and delayed nerve blocks were the risk factors of PHN. Nerve blocks in the early phase of herpes zoster may be useful to prevent PHN, particularly in the younger patients. PMID: 19227166 [PubMed - indexed for MEDLINE] 174. JAMA. 2009 Feb 18;301(7):774-5. Herpes zoster in the age of focused immunosuppressive therapy. Whitley RJ, Gnann JW Jr. Erratum in: JAMA. 2010 Feb 24;303(8):734. Comment in: JAMA. 2010 Feb 24;303(8):733-4. Comment on: JAMA. 2009 Feb 18;301(7):737-44. PMID: 19224757 [PubMed - indexed for MEDLINE] 175. JAMA. 2009 Feb 18;301(7):737-44. Risk of herpes zoster in patients with rheumatoid arthritis treated with anti-TNF-alpha agents. Strangfeld A, Listing J, Herzer P, Liebhaber A, Rockwitz K, Richter C, Zink A. Epidemiology Unit, German Rheumatism Research Center, Chariteplatz 1, 10117 Berlin, Germany. strangfeld@drfz.de Comment in: JAMA. 2009 Feb 18;301(7):774-5. CONTEXT: The risk of bacterial infection is increased in patients treated with drugs that inhibit tumor necrosis factor alpha (TNF-alpha). Little is known about the reactivation of latent viral infections during treatment with TNF-alpha inhibitors. OBJECTIVE: To investigate whether TNF-alpha inhibitors together as a class, or separately as either monoclonal anti-TNF-alpha antibodies (adalimumab, infliximab) or a fusion protein (etanercept), are related to higher rates of herpes zoster in patients with rheumatoid arthritis. DESIGN, SETTING, AND PATIENTS: Patients were enrolled in the German biologics register RABBIT, a prospective cohort, between May 2001 and December 2006 at the initiation of treatment with infliximab, etanercept, adalimumab, or anakinra, or when they changed conventional disease-modifying antirheumatic drug (DMARD). Treatment, clinical status, and adverse events were assessed by rheumatologists at fixed points during follow-up. MAIN OUTCOME MEASURES: Hazard ratio (HR) of herpes zoster episodes following anti-TNF-alpha treatment. Study aims were to detect a clinically significant difference (HR, 2.0) between TNF-alpha inhibitors as a class compared with DMARDs and to detect an HR of at least 2.5 for each of 2 types of TNF-alpha inhibitors, the monoclonal antibodies or the fusion protein, compared with conventional DMARDs. RESULTS: Among 5040 patients receiving TNF-alpha inhibitors or conventional DMARDs, 86 episodes of herpes zoster occurred in 82 patients. Thirty-nine occurrences could be attributed to treatment with anti-TNF-alpha antibodies, 23 to etanercept, and 24 to conventional DMARDs. The crude incidence rate per 1000 patient-years was 11.1 (95% confidence interval [CI], 7.9-15.1) for the monoclonal antibodies, 8.9 (95% CI, 5.6-13.3) for etanercept, and 5.6 (95% CI, 3.6-8.3) for conventional DMARDs. Adjusted for age, rheumatoid arthritis severity, and glucocorticoid use, a significantly increased risk was observed for treatment with the monoclonal antibodies (HR, 1.82 [95% CI, 1.05-3.15]), although this risk was lower than the threshold for clinical significance. No significant associations were found for etanercept use (HR, 1.36 [95% CI, 0.73-2.55]) or for anti-TNF-alpha treatment (HR, 1.63 [95% CI, 0.97-2.74]) as a class. CONCLUSION: Treatment with monoclonal anti-TNF-alpha antibodies may be associated with increased risk of herpes zoster, but this requires further study. PMID: 19224750 [PubMed - indexed for MEDLINE] 176. Am J Clin Dermatol. 2009;10(2):73-86. doi: 10.2165/00128071-200910020-00001. Clinical implications of aging skin: cutaneous disorders in the elderly. Farage MA, Miller KW, Berardesca E, Maibach HI. The Procter & Gamble Company, Winton Hill Business Center, Cincinnati, Ohio, USA. farage.m@pg.com Aging skin undergoes progressive degenerative change. Structural and physiologic changes that occur as a natural consequence of intrinsic aging combined with the effects of a lifetime of ongoing cumulative extrinsic damage and environment insult (e.g. overexposure to solar radiation) can produce a marked susceptibility to dermatologic disorders in the elderly. As skin ages, the vasculature progressively atrophies. The supporting dermis also deteriorates, with collagen and elastin fibers becoming sparse and increasingly disordered. These changes leave the elderly increasingly susceptible to both vascular disorders such as stasis dermatitis and skin injuries such as pressure ulcers and skin tears, with a steadily decreasing ability to effect skin repair. A parallel erosion of normal immune function produces higher levels of autoimmune skin disorders such as bullous pemphigoid, benign mucous membrane pemphigoid, paraneoplastic pemphigoid, and pemphigus vulgaris. Lichen sclerosus, an autoimmune disorder often occurring in the genital area in older women, is not common but is an important development because of the potential for substantial discomfort as well as serious complications. The prevalence of polypharmacy in this population increases the risk for autoimmune drug reactions, and diagnosis should be undertaken with an awareness that polypharmacy in this population creates a greatly increased susceptibility to drug eruptions that can mimic other cutaneous disorders. Immunologic senescence in the elderly also sets the stage for potential reactivation of the Varicella zoster virus, in which initial dermatologic involvement expands into the major sensory ganglia. Known as shingles, this disorder can be excruciatingly painful with the potential to cause blindness if the optic nerve becomes involved. Dermatoses such as xerosis, pruritus, and eczema are also widespread in the elderly, create substantial suffering in those afflicted, and often prove recalcitrant to treatment. Individual susceptibility to specific types of contact dermatitis changes over the lifetime, and seborrheic dermatitis is substantially more prevalent in the elderly. It is not uncommon for older patients to have multiple impairments, with the potential for cognitive dysfunction as well as impaired vision, hearing, or mobility. In addition, they may not have adequate housing or nutrition, or the financial resources necessary for adequate compliance. Physicians must take into consideration the patient's physical ability to comply with the recommended therapy as well as socioeconomic factors that may impact on compliance. Simple topical regimens are preferable wherever possible in order to maximize compliance and, therefore, efficacy. Extra effort may be necessary to ensure that instructions are accurately followed and that ongoing compliance with the regimen prescribed is actually achieved. Management of dermatologic disorders in the elderly is often less than optimal, due to the fact that the special needs and limitations of this population are not adequately considered. Treatments should consider the intrinsic differences between younger and older patients that may impact on diagnosis and therapy choice. The aged patient is often afflicted with numerous co-morbidities that can influence the choice of therapy. Skin integrity in the elderly is compromised, and safety concerns are increased with the long-term use of any medication prescribed. In addition, the prevalence of polypharmacy in the aged population substantially increases the risk of cutaneous drug reactions, which can profoundly complicate accurate diagnosis of dermatologic disorders. The aged population also needs to be more closely monitored because of increased fragility of the skin and the physical limitations that may hinder compliance with prescribed regimens. PMID: 19222248 [PubMed - indexed for MEDLINE] 177. Neurology. 2009 Feb 17;72(7):670-1. Brown-Séquard syndrome after herpes zoster. Young-Barbee C, Hall DA, LoPresti JJ, Schmid DS, Gilden DH. Department of Neurology, Mail Stop B182, University of Colorado Denver School of Medicine, 4200 E. 9th Ave., Denver, CO 80262, USA. PMCID: PMC2677537 PMID: 19221302 [PubMed - indexed for MEDLINE] 178. Arch Otolaryngol Head Neck Surg. 2009 Feb;135(2):211, 213-4. Radiology quiz case 2. Zoster sine herpete. Li CL, Chen CN, Young YH. Lo Tung Poh-Ai Hospital, I-lan, Taiwan. PMID: 19221253 [PubMed - indexed for MEDLINE] 179. Int J Infect Dis. 2009 Sep;13(5):e329-30. Epub 2009 Feb 12. Difficulties in the diagnosis of delayed contralateral hemiparesis due to varicella-zoster virus in an HIV-positive patient. Metta HA, Mammana L, Redini L, Bruggesser F, Bouzas MB. PMID: 19217334 [PubMed - indexed for MEDLINE] 180. Pediatr Med Chir. 2008 Jul-Aug;30(4):177-91. [Viral infections of the fetus and newborn infant] [Article in Italian] Tremolada S, Delbue S, Ferrante P. Center for Translational Research and Laboratory of Pathology, Saint Joseph Hospital, MilanoCuore, Milano. Viral infections may be vertically transmitted from mother to child at different times, ranging from in utero transmission, which occurs during pregnancy, perinatal transmission, which takes place during delivery and postnatal transmission, which is usually the consequence of breastfeeding. Mother-to-child transmission, which may occur after primary, recurrent or chronic maternal infection, is potentially harmful to the fetus or the newborn since it may result in miscarriage, fetal death, congenital anomalies, intrauterine growth restriction, or severe neonatal disease. Some risk factors are thought to affect the rate of mother-to-child transmission, such as the presence of other viral infections, maternal viral load, type of infection (primary versus recurrent), obstetrical procedures (prolonged rupture of membranes, mode of delivery), social-economical conditions and breastfeeding. For some of the vertically transmitted viruses, interventions are nowadays available to prevent mother-to-child transmission, such as vaccines, passive immunization, antiviral drugs. Moreover, perinatal and postnatal infections may be prevented by the use of elective caesarean delivery and avoidance of breastfeeding. PMCID: PMC2698175 PMID: 19216201 [PubMed - indexed for MEDLINE] 181. Semin Neurol. 2009 Feb;29(1):36-44. Epub 2009 Feb 12. Disorders of the trigeminal system. Gonella MC, Fischbein NJ, So YT. Department of Neurology, Stanford University Medical Center, Stanford, California, USA. The management of patients with trigeminal system dysfunction requires an understanding of the system's complex anatomy, which extends from peripheral nerve endings, through the skull base, cavernous sinus (V1, V2 only), and trigeminal ganglion, to the intraaxial nuclei, tracts, and cerebral cortex. The differential diagnosis is broad. Seemingly minor facial sensory loss may indicate an underlying malignancy (as in numb-chin syndrome). Painful syndromes of the trigeminal nerve are numerous and require careful categorization. Understanding trigeminal system anatomy and the appropriate use of imaging and electrodiagnostics should aid in the diagnosis and treatment of these disorders. PMID: 19214931 [PubMed - indexed for MEDLINE] 182. Semin Neurol. 2009 Feb;29(1):5-13. Epub 2009 Feb 12. Seventh cranial neuropathy. Gilchrist JM. Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island, USA. jgilchrist@lifespan.org Facial neuropathy, or seventh cranial neuropathy, is the most common cranial neuropathy. The anatomy of the facial nerve is rather complex for a cranial nerve, with a long intracranial course, in which the nerve takes three bends (or genu). Electrodiagnosis can be helpful in prognosis, but not before several days. Imaging is rarely indicated in Bell's palsy, but is often abnormal nonetheless, and can be very useful in other causes of facial neuropathy. The clinical presentation is of unilateral facial weakness of upper and lower face, hyperacusis, dysgeusia, and disordered lacrimation and salivation. Many different disease processes can result in facial neuropathy, but 70% of cases are idiopathic, or as it is best known, Bell's palsy. Ramsay Hunt syndrome, defined as facial neuropathy with herpes zoster oticus, is another common cause. Steroids given acutely are beneficial in improving outcome in Bell's palsy, and antiviral therapy seems helpful in more severe cases. Antiviral therapy is definitely helpful in Ramsay Hunt disease when given within 3 days of onset. Antibiotics are helpful in Lyme facial neuropathy, which has a very good prognosis. PMID: 19214928 [PubMed - indexed for MEDLINE] 183. Laryngoscope. 2009 Apr;119(4):628-30. Herpes zoster oticus associated with varicella zoster virus encephalitis. Eskiizmir G, Uz U, Taşkiran E, Unlü H. Department of Otorhinolaryngology, Celal Bayar University, Manisa, Turkey. gorkemeskiizmir@yahoo.com Ramsay-Hunt syndrome, herpes zoster oticus (HZO), derived its name from James Ramsay Hunt, who first described it in 1907. It is classically characterized by acute peripheral facial paralysis, herpetic eruptions on the auricle, and vestibulocochlear dysfunction due to the reactivation of varicella zoster virus (VZV). In this Case Report, the authors describe an HZO patient with simultaneous VZV encephalitis. To date, only eight cases of HZO associated with VZV encephalitis have been reported in the English literature. Therefore, the authors discuss all the aspects of this rare entity, including clinical examination, radiological evaluation, laboratory evaluation, and treatment options. PMID: 19213041 [PubMed - indexed for MEDLINE] 184. Arch Ophthalmol. 2009 Feb;127(2):222-3. Interstitial keratitis following varicella vaccination. Nagpal A, Vora R, Margolis TP, Acharya NR. Francis I. Proctor Foundation for Research in Ophthalmology, University of California, San Francisco, 95 Kirkham St, San Francisco, CA 94143-0944, USA. PMID: 19204247 [PubMed - indexed for MEDLINE] 185. Ann Clin Lab Sci. 2009 Winter;39(1):43-50. IgE anti-varicella zoster virus and other immune responses before, during, and after shingles. Smith-Norowitz TA, Josekutty J, Lev-Tov H, Kohlhoff S, Norowitz KB, Silverberg JI, Chice S, Durkin HG, Bluth MH. Departments of Pediatrics, SUNY Downstate Medical Center, Brooklyn, New York 11203, USA. tamar.smithnorowitz@downstate.edu Blood lymphocyte distributions, serum immunoglobulin and cytokine levels, and serum IgE and IgG anti-varicella zoster virus (VZV) levels were measured in an atopic girl (age 15 yr) who developed shingles 10 yr after infection with chicken pox. Before, during, and 5 months after the shingles episode, the child's distributions of blood lymphocytes (excluding CD23+) and serum immunoglobulin levels (excluding IgE) were within the normal ranges. Her blood level of CD23+ lymphocytes decreased >50% during the shingles episode and remained low thereafter. Her serum level of IgE was elevated before and during shingles (154 and 168 IU/ml, respectively), but was reduced after recovery from shingles (<100 IU/ml). Before, during, and after shingles, her serum contained IgE and IgG anti-VZV antibodies. Before, during, and after shingles, low levels of IFN-gamma were detected in serum, but neither IL-1beta nor IL-4 were detected. Before shingles, low levels of IL-10 were detected in serum; during shingles, the serum level of IL-10 was increased 30-fold; it subsequently diminished at 5 mo after shingles. The role of IgE in immunity against varicella zoster virus (VZV) has not previously been studied. Our observations in this patient suggest that immunomodulation of IgE and accessory proteins may play a role in VZV pathogenesis. PMID: 19201740 [PubMed - indexed for MEDLINE] 186. Int J Dermatol. 2009 Feb;48(2):212-4. A case of secondary cutaneous mucinosis following herpes zoster: Wolf's isotopic response. Kim MB, Jwa SW, Ko HC, Kim SJ, Kwon KS, Oh CK. PMID: 19200212 [PubMed - indexed for MEDLINE] 187. Bull Soc Belge Ophtalmol. 2008;(309-310):63. Unilateral panuveitis secondary to varicella zoster virus. Van Calster J. PMID: 19198557 [PubMed - indexed for MEDLINE] 188. J Am Pharm Assoc (2003). 2009 Jan-Feb;49(1):12-7. Retrospective financial analysis of a herpes zoster vaccination program from an independent community pharmacy perspective. Wood HM, McDonough RP, Doucette WR. College of Pharmacy, University of Iowa, Iowa City, IA 52242, USA. OBJECTIVE: To determine the net financial gain or loss for herpes zoster vaccination services provided to patients from the perspective of an independent community pharmacy. DESIGN: Retrospective review of pharmacy records over the program's initial 11-month period. SETTING: Independent community pharmacy in Iowa City, IA. PARTICIPANTS: Patients received immunization with the herpes zoster vaccine from a certified pharmacist. INTERVENTION: Herpes zoster vaccination services were provided to the patient and documented by the pharmacist. MAIN OUTCOME MEASURE: Net financial gains or losses were calculated for the herpes zoster vaccination program. Sensitivity analyses were based on costs that might be incurred during program start-up. RESULTS: 478 patients received zoster vaccination services over the initial 11-month period. A net financial gain for the herpes zoster vaccination program was achieved, with a net profit of $15.02, or 8.15%, per vaccination. CONCLUSION: Revenues for this vaccination program exceeded its costs from the independent community pharmacy perspective. PMID: 19196591 [PubMed - indexed for MEDLINE] 189. Pain. 2009 Apr;142(3):209-17. Epub 2009 Feb 4. A randomized, placebo-controlled trial of oxycodone and of gabapentin for acute pain in herpes zoster. Dworkin RH, Barbano RL, Tyring SK, Betts RF, McDermott MP, Pennella-Vaughan J, Bennett GJ, Berber E, Gnann JW, Irvine C, Kamp C, Kieburtz K, Max MB, Schmader KE. Department of Anesthesiology, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Box 604, Rochester, NY 14642, USA. robert_dworkin@urmc.rochester.edu Comment in: Pain. 2009 Apr;142(3):175-6. Although acute pain in patients with herpes zoster can be severe and has a substantial impact on health-related quality of life, there have been no randomized clinical trials of oral medications specifically for its ongoing treatment. A randomized clinical trial was conducted in which 87 subjects >or=50 years of age with herpes zoster within 6 calendar days of rash onset and with worst pain in the past 24h >or=3 on a 0-10 rating scale initiated 7 days of treatment with famciclovir in combination with 28 days of treatment with either controlled-release (CR) oxycodone, gabapentin, or placebo. Subjects were evaluated for adverse effects of treatment, acute pain, and health-related quality of life. The results showed that CR-oxycodone and gabapentin were generally safe and were associated with adverse events that reflect well-known effects of these medications. Discontinuing participation in the trial, primarily associated with constipation, occurred more frequently in subjects randomized to CR-oxycodone (27.6%) compared with placebo (6.9%). Treatment with CR-oxycodone reduced the mean worst pain over days 1-8 (p=0.01) and days 1-14 (p=0.02) relative to placebo but not throughout the entire 28-day treatment period as pain resolved in most subjects. Gabapentin did not provide significantly greater pain relief than placebo, although the data for the first week were consistent with a modest benefit. By demonstrating that CR-oxycodone is safe, generally adequately tolerated, and appears to have efficacy for relieving acute pain, the results of this clinical trial provide a foundation for evidence-based treatment for acute pain in herpes zoster. PMID: 19195785 [PubMed - indexed for MEDLINE] 190. Cochlear Implants Int. 2009 Dec;10(4):229-36. Cochlear implant and delayed facial palsy. Joseph ST, Vishwakarma R, Ramani MK, Aurora R. Department of Otorhinolaryngology, Head & Neck Surgery, Government Medical College & Sir T Hospital, Bhavnagar, Gujarat, India, PIN-364001. shawndr@gmail.com Delayed facial nerve palsy following cochlear implant surgery is less documented though it poses diagnostic and therapeutic challenges. Apart from the functional, aesthetic and emotional concerns, it can raise important medico legal issues. The objectives of this study were: to report a case of delayed facial palsy following cochlear implant surgery in a patient who had positive viral antibody markers pre operatively; and to review the literature on delayed onset facial paralysis following viral reactivation and its relation to cochlear implant surgery. An extensive literature review was done using internet and medical search engines and library facilities. Important articles on the topic were identified and summarised. Data on delayed facial palsy following cochlear implant surgery were collected, constructed in a coherent way and details discussed. Postulated mechanisms of delayed facial palsy include neural oedema, vasospasm and viral reactivation. Of these, reactivation of previous herpes simplex virus infection has special significance, as many of these patients are positive for viral antibody markers. Manipulation of sensory branches of the facial nerve and chorda tympani can be a mechanism in such cases. Correlation of clinical presentation and pre operative positive viral antibody markers with positive polymerase chain reaction can be strongly suggestive of viral reactivation. It is concluded that patients with positive viral antibody markers are more susceptible to facial palsy from viral reactivation. Corticosteroids, antiviral agents and physiotherapy can be useful in producing a quicker and complete recovery. An experienced cochlear implant surgery team and pre operative radiological evaluations are mandatory to decrease the chances of direct facial nerve trauma. Proper irrigation lowers the risk of neural oedema. (c) 2009 John Wiley & Sons, Ltd. PMID: 19194876 [PubMed - indexed for MEDLINE] 191. Rev Chilena Infectol. 2008 Dec;25(6):458-64. Epub 2009 Jan 29. [Ramsay Hunt syndrome in children: four cases and review] [Article in Spanish] Sandoval C C, Núñez F A, Lizama C M, Margarit S C, Abarca V K, Escobar H R. Pontificia Universidad Católica de Chile, Santiago, Departamento de Pediatría, Servicio de Pediatría. Ramsay-Hunt Syndrome (RHS) is a rare affection characterized by peripheral facial paralysis (PFP), skin eruption in the auricular canal and cochleovestibular symptoms. It is produced by varicella-zoster virus (VZV) reactivation at the geniculate ganglia. We report four patients between 3 and 17 years-old with RHS. Earache was the first symptom in two cases and three had cochleovestibular compromise. The direct immunofluorescence from the vesicular lesion was positive for VZV in two of them. All patients received treatment with aeyelovir and in three cases, this was associated with steroids. Three children had complete resolution of the PFP. RHS is an infrequent disease in the pediatric population and it should be suspected in children with PFP, erythema, vesicles and/or auricular pain. Early treatment with aeyelovir therapy could improve the recovery rate of facial nerve palsy. PMID: 19194612 [PubMed - indexed for MEDLINE] 192. Int J Colorectal Dis. 2009 Sep;24(9):1111-2. Epub 2009 Feb 3. The value of sacral nerve stimulation in the treatment of faecal incontinence after pelvic radiotherapy. Schiano di Visconte M, Munegato G. PMID: 19189111 [PubMed - indexed for MEDLINE] 193. Ophthalmology. 2009 Feb;116(2):361. Non-necrotizing herpetic vasculitis. Wickremasinghe SS, Stawell R, Lim L, Pakrou N, Zamir E. PMID: 19187825 [PubMed - indexed for MEDLINE] 194. Eur J Neurol. 2009 Apr;16(4):457-60. Valacyclovir neurotoxicity: clinical experience and review of the literature. Asahi T, Tsutsui M, Wakasugi M, Tange D, Takahashi C, Tokui K, Okazawa S, Okudera H. Department of Crisis Medicine, Graduate School of Medicine, University of Toyama, Sugitani, Toyama, Japan. takashi-tym@umin.ac.jp Valacyclovir (VACV) is used increasingly to treat herpes zoster, although neuropsychiatric symptoms [VACV neurotoxicity (VAN) or acyclovir neurotoxicity], may accompany use of this drug. To promote awareness of this rare condition, we describe here two clinical cases of VAN we previously reported and review 20 cases from the literature. In all cases, chronic or acute renal failure preceded VAN. The symptoms of VAN varied, but disturbances of consciousness and hallucination occurred most commonly. When acute renal failure was due to the drug, recovery from both the disturbance of consciousness and renal failure followed within several days after discontinuation of VACV. Early recognition and diagnosis will ensure effective treatment of VAN. PMID: 19187258 [PubMed - indexed for MEDLINE] 195. Clin Pediatr (Phila). 2009 May;48(4):435-7. Epub 2009 Jan 26. Varicella reactivation presenting as shingles and aseptic meningitis in an immunocompetent 11-year-old boy. Peña JA, Pirics ML, DiCaprio HS, Julapalli MR, Phelps BR, Castagnini LA, Tolle MA. Department of Pathology, Baylor College of Medicine, Houston, Texas 77030, USA. PMID: 19171911 [PubMed - indexed for MEDLINE] 196. Infection. 2009 Apr;37(2):179-80. Disseminated zoster in an elderly patient. Capron J, Steichen O. Internal Medicine Dept, Tenon Hospital, Paris University, France. A 97-year-old lady was hospitalized for left leg cellulitis. Comorbidity included hypertension and congestive heart failure. While in hospital, she developed a painless vesicular rash localized to the territory of the left trigeminal nerve (third branch), which evolved to pustules and crusts (Figure 1). A chickenpox-like disseminated eruption of vesicles followed within 4 days, with the same evolution pattern (Figure 2).The diagnosis of disseminated zoster was suspected. A PCR analysis confirmed the presence of varicella-zoster-virus (VZV) in an abdominal vesicle. The patient was treated with oral valacyclovir for 7 days. Clinical examination, laboratory tests (including HIV serology), and a chest radiograph revealed no evidence of underlying immunodeficiency or malignancy. PMID: 19169630 [PubMed - indexed for MEDLINE] 197. Acta Oncol. 2009;48(4):631-3. Fatal drug-drug interaction of brivudine and capecitabine. Rätz Bravo AE, Hofer S, Krähenbühl S, Ludwig C. PMID: 19165642 [PubMed - indexed for MEDLINE] 198. Ann Thorac Surg. 2009 Feb;87(2):423-6. Herpes zoster after lung transplantation: incidence, timing, and outcome. Fuks L, Shitrit D, Fox BD, Amital A, Raviv Y, Bakal I, Kramer MR. Pulmonary Institute, Rabin Medical Center, Beilinson Campus, Petah Tiqwa, Israel. BACKGROUND: Although herpes zoster is a common complication of lung transplantation, the epidemiologic data are limited. The aims of the present study were to determine the incidence and clinical manifestations of herpes zoster in a large cohort of lung transplant recipients and to identify risk factors associated with its development. METHODS: The files of all adult patients who underwent lung transplantation at a major tertiary medical center from January 2001 to December 2007 were reviewed. Data were extracted on background, transplant-related, and posttransplantation factors. The occurrence and clinical characteristics of all episodes of herpes zoster were recorded. RESULTS: Of the 198 lung transplant recipients, 23 had a herpes zoster infection, of whom 18 had herpes in a single dermatome. Disseminated cutaneous infection was documented in 4 cases (17%) and visceral involvement in 1. The median duration of follow-up was 34 months (range, 1 to 85 months). There were no recurrent infections. Postherpetic neuralgia was detected in 26% of cases. Antiviral prophylaxis, primarily for cytomegalovirus, was effective (during treatment) against herpes zoster. The incidence of herpes zoster was higher in patients treated with rabbit antithymocyte globulin. CONCLUSIONS: The occurrence of herpes zoster peaks between 12 and 36 months after lung transplantation. Additional immunosuppression may increase the risk. Further studies on preventive strategies against herpes zoster in this population are warranted. PMID: 19161751 [PubMed - indexed for MEDLINE] 199. J AAPOS. 2009 Apr;13(2):213-4. Epub 2009 Jan 20. Role of polymerase chain reaction in early diagnosis of herpes zoster ophthalmicus in children. Bhatnagar A, Tomlins P, Parulekar MV. Birmingham Children's Hospital, Steelhouse Lane, Birmingham, United Kingdom. bhatnagar_ajay@hotmail.com Herpes zoster ophthalmicus is uncommon in children, and diagnosis may be delayed until the typical skin lesions become apparent. Delay in appropriate treatment may result in sight-threatening complications. We report a case of an 18-month-old child in whom we promptly confirmed the clinical suspicion of herpes zoster ophthalmicus by the identification of viral DNA using polymerase chain reaction. This procedure enabled us to administer prompt antiviral treatment, preventing sight-threatening sequelae. We review the literature regarding the possible mechanism of herpes zoster ophthalmicus in immunocompetent children and discuss the role of polymerase chain reaction in its diagnosis. PMID: 19157933 [PubMed - indexed for MEDLINE] 200. J Drugs Dermatol. 2008 Dec;7(12):1173-6. Varicella virus and the herpes zoster vaccine. A review of Zostavax and the new AFIP recommendations. Ebede TL, Zippin JH. PMID: 19137773 [PubMed - indexed for MEDLINE] 201. Vaccine. 2009 Feb 25;27(9):1454-67. Epub 2009 Jan 9. Estimating the cost-effectiveness of vaccination against herpes zoster in England and Wales. van Hoek AJ, Gay N, Melegaro A, Opstelten W, Edmunds WJ. Modelling and Economics Unit, Health Protection Agency, Centre for Infections, London NW9 5EQ, UK. albertjan.vanhoek@hpa.org.uk A live-attenuated vaccine against herpes zoster (HZ) has been approved for use, on the basis of a large-scale clinical trial that suggests that the vaccine is safe and efficacious. This study uses a Markov cohort model to estimate whether routine vaccination of the elderly (60+) would be cost-effective, when compared with other uses of health care resources. Vaccine efficacy parameters are estimated by fitting a model to clinical trial data. Estimates of QALY losses due to acute HZ and post-herpetic neuralgia were derived by fitting models to data on the duration of pain by severity and the QoL detriment associated with different severity categories, as reported in a number of different studies. Other parameters (such as cost and incidence estimates) were based on the literature, or UK data sources. The results suggest that vaccination of 65 year olds is likely to be cost-effective (base-case ICER=pound20,400 per QALY gained). If the vaccine does offer additional protection against either the severity of disease or the likelihood of developing PHN (as suggested by the clinical trial), then vaccination of all elderly age groups is highly likely to be deemed cost-effective. Vaccination at either 65 or 70 years (depending on assumptions of the vaccine action) is most cost-effective. Including a booster dose at a later age is unlikely to be cost-effective. PMID: 19135492 [PubMed - indexed for MEDLINE] 202. J Acquir Immune Defic Syndr. 2009 Feb 1;50(2):182-91. Short-term and long-term effects of highly active antiretroviral therapy on the incidence of herpes zoster in HIV-infected children. Levin MJ, Anderson JP, Seage GR 3rd, Williams PL; PACTG/IMPAACT 219C Team. Pediatric Infectious Diseases Section, University of Colorado at Denver Health Sciences Center, Mailstop C227, Building 401, (Room R09-108), 1784 Racine Street, Aurora, CO 80045-0508, USA. myron.levin@uchsc.edu BACKGROUND: Highly active antiretroviral therapy (HAART) has reduced herpes zoster (HZ) incidence in HIV-infected children, yet it remains common. METHODS: We evaluated perinatally HIV-infected youth with varicella infection enrolled between 1993 and 2006 in a prospective cohort study. Incidence rates (IRs) and 95% confidence intervals of HZ were estimated by calendar year, age group, and HAART use. The effect of initiating HAART was also evaluated by fitting Cox survival models adjusted for potential confounders. RESULTS: Among 536 perinatally infected children with documented prior varicella (median follow-up = 6.8 years), 116 (22%) developed HZ (IR = 3.2 events/100 person-years, confidence interval: 2.6 to 3.8). IRs increased from 1993 to 1996 and then declined significantly through 2006 (P < 0.001). However, an IR of 1.4-3.1 HZ episodes per 100 person-years persisted from 2001 to 2006. The risk of HZ was higher for those with lower CD4% or in Centers for Disease Control and Prevention clinical class C. The IR of HZ was similar in the 90 days before or after initiation of HAART but declined significantly after more than 90 days of HAART. CONCLUSIONS: Although HAART has markedly reduced the IR of HZ, it remains a frequent complication in HIV-infected children. The risk of HZ is similar in the 90 days before and after initiating HAART. PMCID: PMC2748317 PMID: 19131890 [PubMed - indexed for MEDLINE] 203. J Pediatr Hematol Oncol. 2008 Dec;30(12):931-4. Visceral varicella zoster virus (VZV) after allogeneic hematopoietic stem cell transplant (HSCT) in pediatric patients with chronic graft-versus-host disease (cGVHD). Peritz DC, Duncan C, Kurek K, Perez-Atayde AR, Lehmann LE. Dana-Farber Cancer Institute, Children's Hospital, Boston, MA, USA. David_Peritz@dfci.harvard.edu Reactivation of latent varicella zoster virus is one infectious complication associated with the extensive immunosuppression necessary for hematopoietic stem cell transplant. Most cases are limited to skin and mortality is low. Isolated visceral zoster is rare, presenting with ileus/abdominal pain, hepatitis, and/or hyponatremia. We present 2 cases of visceral varicella zoster virus in adolescents with chronic graft-versus-host disease after hematopoietic stem cell transplant. Both presented with elevated liver enzymes, severe abdominal pain, and hyponatremia but lacked cutaneous involvement. Both received high-dose acyclovir and showed improvement, but eventually expired from hepatic failure. The diagnosis of visceral zoster can be difficult especially without cutaneous manifestations. Vigilance is necessary in patients with chronic graft-versus-host disease, abdominal pain, and/or hepatitis and antiviral therapy should be initiated promptly. PMID: 19131784 [PubMed - indexed for MEDLINE] 204. J Formos Med Assoc. 2008 Dec;107(12):958-60. Herpes zoster infection associated with poor peripheral blood hematopoietic stem cell mobilization. Liu YC, Lu PL, Hsiao HH, Tsai HJ, Liu TC, Lin SF. Division of Hematology-Oncology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan. The efficacy of peripheral blood hematopoietic stem cell (PBSC) harvest is important for successful autologous transplantation. The impact of viral infection on PBSC mobilization has rarely been reported. Here, we report a patient with relapsed diffuse large B-cell lymphoma who experienced disseminated cutaneous herpes zoster infection during the neutropenic phase of PBSC mobilization. A markedly reduced number of PBSCs was initially harvested (1.72 x 10(6)/kg, 77.2% reduction), followed by a sufficient number (7.55 x 10(6)/kg) during remobilization with the same mobilization regimen when herpes zoster infection had subsided. Because of the temporal association, we suggest that herpes zoster infection is a risk factor for poor PBSC mobilization, and remobilization with the same regimen is feasible. PMID: 19129057 [PubMed - indexed for MEDLINE] 205. Clin Infect Dis. 2009 Feb 1;48(3):372-3. Fatal acute varicella-zoster virus hemorrhagic meningomyelitis with necrotizing vasculitis in an HIV-infected patient. Chang CC, McLean C, Vujovic O, Jenney AJ, Short M, Lyon S, Storey E, Lewin SR. PMID: 19128163 [PubMed - indexed for MEDLINE] 206. Am J Hematol. 2009 Feb;84(2):127-8. Pseudo-bowel obstruction due to varicella zoster virus infection after autologous stem cell transplantation. Precupanu CM, Girodet J, Mariani P, Zanni M, Mathiot C, Escande MC, Brault P, Decaudin D. PMID: 19127592 [PubMed - indexed for MEDLINE] 207. Cleve Clin J Med. 2009 Jan;76(1):45-8. Q: Who should receive the shingles vaccine? Singh A, Englund K. Division of Hospital Medicine, University of California San Francisco, USA. Comment in: Cleve Clin J Med. 2009 Mar;76(3):152; author reply 152. PMID: 19122110 [PubMed - indexed for MEDLINE] 208. Clin Exp Dermatol. 2009 Jun;34(4):518-9. Epub 2008 Dec 22. Herpes zoster complicated by delayed intracranial haemorrhage. Song HJ, Hong WK, Lee HS, Choi GS, Shin JH. PMID: 19120386 [PubMed - indexed for MEDLINE] 209. Arthroscopy. 2009 Jan;25(1):106-8. Epub 2007 Nov 26. Monoarthritis of the knee with unusual lesions in adults associated with varicella-zoster virus infection. Luna-Pizarro D, Rodríguez-Castillo A, Pérez-Hernández E, Pérez-Hernández J, Hernández-Salgado A, Escobar-Gutiérrez A. Hospital de Ortopedia Victorio de la Fuente Narváez, Unidad de Medicina de Alta Especialidad Magdalena de las Salinas, Instituto Mexicano del Seguro Social, Mexico City, Mexico. daniello1965@hotmail.com Varicella-zoster virus-associated arthritis has not been well documented in adults. We present the case of a 27-year-old female patient with monoarthritis of the knee associated with clinical symptoms typical of varicella. Arthroscopic examination showed unusual oval and circular lesions in cartilage, some of which measured 5 +/- 3 mm in diameter in weight-supporting zones. Such lesions have not been described previously and were type III-A lesions on the Noyes scale or grade IV on the Outerbridge scale. On microscopic observation, synovial fluid cultures and hemocultures were negative for the presence of bacteria. A biopsy sample and synovial liquid from the affected knee produced a positive polymerase chain reaction for varicella-zoster virus, genotype E. These findings suggest a strong relation between clinical varicella infection and important lesion invasion in the knee articulation of such a young adult, probably related to the virus. However, it remains necessary to corroborate this relation between cartilage destruction and clinical symptoms of varicella associated with monoarthritis of an adult knee. Nevertheless, it is advisable to initiate the appropriate antiviral treatment in adults with varicella-related gonalgia because the lesions produce the most severe effects on exposure to the knee bone. PMID: 19111226 [PubMed - indexed for MEDLINE] 210. Br J Ophthalmol. 2009 Jan;93(1):119. Type I Boston keratoprosthesis with cataract extraction and intraocular lens placement for visual rehabilitation of herpes zoster ophthalmicus: the "KPro Triple". Todani A, Gupta P, Colby K. Massachusetts Eye & Ear Infirmary, Harvard Medical School, Boston, MA 02114, USA. INTRODUCTION: Management of corneal scarring following herpes zoster ophthalmicus (HZO) is challenging due to the dense corneal anesthesia that results from viral damage to the subepithelial nerve plexus. These patients have significant risk of graft failure following traditional corneal transplantation. We present a case of a 74-year-old white woman with counting fingers vision from HZO-associated corneal scarring and mature cataract where visual rehabilitation was accomplished with a Type I Boston keratoprosthesis (KPro) and concurrent extracapsular cataract extraction and posterior chamber intraocular lens placement (the "KPro Triple"). One month following surgery, the patient's uncorrected visual acuity improved to 20/25; this level of vision has been maintained for 7 months at present. SURGICAL TECHNIQUE (SEE VIDEO): The keratoprosthesis is assembled by creating a sandwich composed of the KPro front plate, the donor cornea, and the KPro backplate that is secured with a locking ring. The host cornea is then trephined and posterior synechiae lysed to allow access to the mature cataract. The cataract is manually expressed and a posterior chamber intraocular lens implanted. The assembled keratoprosthesis is then sutured into position with 9.0 nylon. A bandage contact lens is placed. COMMENT: In patients with severe neurotrophic keratopathy, traditional penetrating keratoplasty is fraught with problems, including poor epithelial healing and corneal ulceration. The Boston KPro can provide rapid visual rehabilitation, despite corneal anaesthesia in these patients, and is currently our treatment of choice as a primary procedure for HZO patients who need corneal transplantation. PMID: 19098045 [PubMed - indexed for MEDLINE] 211. Am J Emerg Med. 2008 Nov;26(9):1062-3. An unusual cause of abdominal pain: implications for infection control in the ED. Chan SS. PMID: 19091278 [PubMed - indexed for MEDLINE] 212. Cancer. 2009 Jan 1;115(1):229-32. Acyclovir to prevent reactivation of varicella zoster virus (herpes zoster) in multiple myeloma patients receiving bortezomib therapy. Vickrey E, Allen S, Mehta J, Singhal S. Division of Hematology/Oncology, Feinberg School of Medicine, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois 60611, USA. BACKGROUND: Humoral-mediated as well as cell-mediated immunity is compromised in myeloma patients receiving treatment. Immunocompromised patients are at risk of developing herpes zoster. There is evidence from clinical trials that bortezomib therapy is associated with a significant risk of herpes zoster. It is the authors' clinical policy to administer long-term acyclovir prophylactically to all symptomatic myeloma patients. METHODS: A retrospective review of the records of 125 myeloma patients who were treated with bortezomib and who also received routine acyclovir prophylaxis at the dose of 400 mg daily in >80% of patients was undertaken. Alternatives, used in <20% of patients, were 200 mg of acyclovir, 250/500 mg of valacyclovir, or 500 mg of famciclovir administered daily. This was accompanied by patient education regarding the importance of compliance with these prophylactic medications. RESULTS: The duration of bortezomib therapy was 1 to 164 weeks (median, 16 weeks). The total duration of exposure to bortezomib was 4150 weeks (80 patient-years). Except for the occasional missed dose, the self-reported compliance with antiviral prophylaxis was 100%. Not a single episode of herpes zoster was reported during this period. No adverse effects were noted that could be definitely attributed to acyclovir, valacyclovir, or famciclovir. CONCLUSIONS: Daily acyclovir (or a suitable alternative) appears to be effective at preventing herpes zoster virus in patients with myeloma who are receiving bortezomib, with or without corticosteroids. Copyright (c) 2008 American Cancer Society. PMID: 19090004 [PubMed - indexed for MEDLINE] 213. Hematology Am Soc Hematol Educ Program. 2008:450-6. Disease-specific complications of chronic lymphocytic leukemia. Dearden C. Department of Haemato-Oncology, The Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Sutton, Surrey, UK. The majority of disease-specific complications in chronic lymphocytic leukemia (CLL), notably infection and autoimmunity, relate to the underlying alterations in immune function. Both cellular and humoral immunity are impaired with qualitative and quantitative defects in B cells, T cells, NK cells, neutrophils and the monocyte/macrophage lineage. Virtually all patients have reduced immunoglobulin levels, even in early stages, and this is associated with an increased frequency and severity of infection. Although prophylactic intravenous immunoglobulin may be of clinical benefit in selected patients, it does not reduce mortality and is certainly not cost-effective. Autoimmune complications occur in up to a quarter of CLL patients and predominantly target blood cells. Autoimmune hemolytic anemia (AHA) is the most common manifestation; immune thrombocytopenia, pure red cell aplasia and autoimmune neutropenia are less common, while non-hematological autoimmunity is rare. The UK CLL4 trial is the largest prospective trial in CLL to examine the significance of both a positive direct antiglobulin test (DAT) and AHA. The study confirmed the usefulness of the DAT in predicting the development of AHA or not, demonstrated that AHA occurred more frequently in patients receiving treatment with chlorambucil or fludarabine alone compared with the combination of fludarabine and cyclophosphamide, and showed that a positive DAT and the development of AHA were poor prognostic markers. Management of CLL-associated autoimmunity rests on good supportive care and the use of immunosuppressive therapies such as steroids and cyclosporine. Splenectomy remains useful, and monoclonal antibodies (rituximab and alemtuzumab) have given promising results. PMID: 19074125 [PubMed - indexed for MEDLINE] 214. Vaccine. 2009 Feb 5;27(6):882-7. Epub 2008 Dec 9. Herpes zoster vaccination among adults aged 60 years or older in the United States, 2007: uptake of the first new vaccine to target seniors. Lu PJ, Euler GL, Jumaan AO, Harpaz R. National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. plu@cdc.gov BACKGROUND: Approximately one million new cases of shingles (herpes zoster [HZ]), a severely painful and debilitating disease caused by reactivation of varicella-zoster virus (VZV), occur in the United States each year. HZ incidence increases with age, especially after age 50. A vaccine to prevent HZ and its sequelae was licensed in May 2006 for those aged 60 years or older, making it the first new vaccine targeted to this age group in many years. In October 2006 the Advisory Committee on Immunization Practices (ACIP) recommended HZ vaccination of persons aged > or =60 years; these recommendations were published in 2008. We examined HZ vaccination coverage among persons aged > or =60 years in the U.S. in 2007, and evaluated factors affecting the uptake of HZ vaccine in this population. METHODS: Data from the 2007 National Immunization Survey-Adult (NIS-Adult) restricted to individuals aged > or =60 years were analyzed using SUDAAN software to estimate national HZ vaccination coverage, and reasons for not receiving the HZ vaccine. We used multivariable logistic regression analysis to identify factors independently associated with HZ vaccination. RESULTS: Of 3662 respondents, 1.9% (95% confidence interval=1.3%, 2.8%) reported having received the HZ vaccine. A total of 72.9% of respondents were unaware of the HZ vaccine but 77.8% stated that they would accept HZ vaccination if their doctor recommended it. Of the remaining 556 respondents, key reasons reported for not accepting HZ vaccine included 'vaccination not needed' (34.8%), 'not at risk' (12.5%), and 'don't trust in doctors or medicine' (9.5%). CONCLUSIONS: Soon after its availability in the United States, coverage among adults recommended to receive the HZ vaccine was low. Our data provide evidence that the lack of patient awareness and of physician recommendations were barriers to vaccine uptake. PMID: 19071175 [PubMed - indexed for MEDLINE] 215. Ann Dermatol Venereol. 2008 Nov;135(11 Suppl):F25-31. [Item no 84: herpes virus infections of immunocompetent children and adults: varicella and zona] [Article in French] CEDEF. PMID: 18984224 [PubMed - indexed for MEDLINE] 216. Eur J Dermatol. 2009 Jan-Feb;19(1):61-3. Epub 2008 Dec 5. Trigeminal trophic syndrome with extensive ulceration following herpes zoster. Kautz O, Bruckner-Tuderman L, Müller ML, Schempp CM. Department of Dermatology, University Medical Center Hauptstrasse 7, 79104 Freiburg, Germany. ocko.kautz@uniklinik-freiburg.de The trigeminal trophic syndrome is a rare complication following central or peripheral injury of the trigeminal nerve typically characterized by unilateral distribution of anaesthesia, paraesthesia and ulceration. In one third of cases it is preceded by an iatrogenic damage of the trigeminal nerve, in another third by a history of stroke. Other causes include head trauma, intracranial tumours, herpes virus infection, degenerative diseases of the CNS and idiopathic. Little is known about the pathogenesis. Contribution of neurotrophic factors and an altered sympathetic activity is assumed but a pivotal role of self-mutilation is generally accepted. We report a case of a patient who developed a strictly unilateral crescent ulcer of the ala nasi in addition to an extensive ulceration of the forehead and scalp following herpes zoster ophthalmicus. PMID: 19059825 [PubMed - indexed for MEDLINE] 217. Harv Health Lett. 2008 Oct;33(12):6-7. Should you get the shingles vaccine? If you're 60 or older, the official recommendations say yes. But pluses and minuses make for a complicated equation. [No authors listed] PMID: 19058405 [PubMed - indexed for MEDLINE] 218. Rev Med Suisse. 2008 Nov 5;4(178):2398-402, 2404. [Herpes zoster and post-herpetic neuralgia in older adults] [Article in French] Lang PO, Zarate-Lagunes M, Pautex S. Département de réhabilitation et gériatrie, Hôpital des Trois-Chêne, Ch. Pont-Bochet 3, 1226 Thônex. Pierre.O.Lang@hcuge.ch Varicella-Zoster virus is responsible for chickenpox and, after reactivation, herpes zoster. Herpes zoster causes a vesicular dermatomal rash, traditionally metameric. Old adults can present severe pain during the acute phase, and late complications, such as post-herpetic neuralgia that can trying and crippling. Initiated within the first 72 hours of the rash, antivirals accelerate rash healing, reducing both rash and acute pain severity but incompletely the onset of other complications. Complementary therapeutic drug is often necessary. However, their application in old, frail, co-morbid and often poly-medicated patients have to be carefully considered as their use may be contraindicated. A specific vaccine is enable to reduce herpes zoster-related morbidity. PMID: 19051627 [PubMed - indexed for MEDLINE] 219. Plast Reconstr Surg. 2008 Dec;122(6):211e-213e. Herpes zoster after reconstruction for head and neck cancer. Parikh PM, Davison SP. Department of Plastic Surgery, Georgetown University Hospital, Washington, DC 20007, USA. PMID: 19050493 [PubMed - indexed for MEDLINE] 220. Bone Marrow Transplant. 2009 May;43(10):757-70. Epub 2008 Dec 1. Management of HSV, VZV and EBV infections in patients with hematological malignancies and after SCT: guidelines from the Second European Conference on Infections in Leukemia. Styczynski J, Reusser P, Einsele H, de la Camara R, Cordonnier C, Ward KN, Ljungman P, Engelhard D; Second European Conference on Infections in Leukemia. Department of Pediatric Hematology and Oncology, Collegium Medicum UMK, Bydgoszcz, Poland. These guidelines on the management of HSV, VZV and EBV infection in patients with hematological malignancies and after SCT were prepared by the European Conference on Infections in Leukemia following a predefined methodology. A PubMed search was conducted using the appropriate key words to identify studies pertinent to management of HSV, VZV and EBV infections. References of relevant articles and abstracts from recent hematology and SCT scientific meetings were also reviewed. Prospective and retrospective studies identified from the data sources were evaluated, and all data deemed relevant were included in this analysis. The clinical and scientific background was described and discussed, and the quality of evidence and level of recommendation were graded according to the Centers for Disease Control criteria. PMID: 19043458 [PubMed - indexed for MEDLINE] 221. J Pain Palliat Care Pharmacother. 2008;22(3):235-8. European pain management discussion forum. Eisenberg E. Pain Relief Unit, Ramban Medical Centre, Israel. e_eisenberg@rambam.health.gov.il Queries from European physicians about analgesic pharmacotherapy and responses from the author are presented. The topics addressed are tolerance to opioid side-effects, use of botulinum toxin A in pain management, use of ketamine in pain management, opioid addicts' perception of pain, intra-articular injections following joint surgery, and opioid rescue doses for breakthrough pain. PMID: 19042856 [PubMed - indexed for MEDLINE] 222. Biol Blood Marrow Transplant. 2008 Dec;14(12):1417-24. Recovery of varicella-zoster virus-specific T cell immunity after T cell-depleted allogeneic transplantation requires symptomatic virus reactivation. Distler E, Schnürer E, Wagner E, von Auer C, Plachter B, Wehler D, Huber C, Kolbe K, Meyer RG, Herr W. Department of Medicine III, Hematology and Oncology, Johannes Gutenberg-University, Mainz, Germany. Reactivated varicella-zoster virus (VZV) infection causes herpes zoster and commonly occurs after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Because VZV-specific T cell immunity is essential to prevent virus reactivation, we developed an interferon-gamma enzyme-linked immunosorbent spot (ELISPOT) assay for the sensitive detection of VZV-reactive T cells at the single-cell level ex vivo. We used this assay to monitor the frequency of VZV-reactive T cells in 17 seropositive patients during the first year after T cell-depleted allo-HSCT. The patients did not receive anti-herpesvirus prophylaxis after stem cell engraftment. Independent of the magnitude of transferred donor immunity, VZV-reactive T cell numbers decreased to low levels (median, 2/mL; range, 0 to 35/mL) in peripheral blood early after transplantation. Only patients with subsequent zoster (n = 5) exhibited a dramatic boost in VZV-reactive T cells (median, 366/mL; range, 158 to 756/mL), which was induced by the reactivation event. The postzoster VZV-reactive T cell levels were similar to those seen in healthy virus carriers. In contrast, antiviral T cell levels remained low in patients without VZV disease. Our results demonstrate that VZV-specific T cell immunity recovered efficiently during zoster in T cell-depleted allo-HSCT recipients. It did not reconstitute spontaneously in nonzoster patients, even in the absence of antiviral prophylaxis. Prospective studies should investigate whether VZV vaccination can substitute for natural resensitization by virus disease. PMID: 19041065 [PubMed - indexed for MEDLINE] 223. Ann Hepatol. 2008 Oct-Dec;7(4):382-5. Multinodular fatty liver after herpes-zoster vaccine: case report and review of the literature. Shim M, Durazo F. North County Gastroenterology Medical Group, Oceanside, California 92056, USA. mshim@ncgastro.com Multinodular fatty liver (MNFL) is a pattern of fatty infiltration of the liver characterized by multiple well-circumscribed nodules on hepatic imaging, often raising the concern of metastatic malignancy. Here we describe a case of MNFL and review the published literature. There is likely some association between traditional risk factors for hepatic steatosis (e.g. alcohol, rapid weight change, metabolic syndrome, medications, TPN) and MNFL. Further study and reporting of cases of MNFL are needed to better characterize its pathogenesis and natural history. PMID: 19034241 [PubMed - indexed for MEDLINE] 224. Braz J Infect Dis. 2008 Aug;12(4):313-5. Differentiation of wild-type varicella-zoster strains from India and the Oka vaccine strain using a VZV open reading frame - 62 based PCR-RFLP technique. Kaushik KS, Lahiri KK, Kapila K, Kumar S, Gupta RM, Karade S. Department of Microbiology, Armed Forces Medical College, Pune, India. mahakaroo@yahoo.com Since the introduction of varicella vaccination in India, surveillance of circulating VZV strains has gained significance. Differentiating wild-type VZV strains from the Oka vaccine strain can be achieved only by molecular genotyping methods. The development of PCR methods for VZV strain differentiation has been hampered by the fact that the VZV genome is highly conserved. We used VZV ORF 62 PCR-RFLP analysis to identify and differentiate wild-type VZV strains in India from the Oka vaccine strain. Digestion of VZV ORF 62 amplicons with SmaI, enabled accurate strain differentiation; the Oka strain was positive for three SmaI sites, compared to two SmaI sites in the wild-type VZV strains that we tested. PMID: 19030732 [PubMed - indexed for MEDLINE] 225. Ann Emerg Med. 2009 Jun;53(6):792-5. Epub 2008 Nov 22. Herpes zoster and meningitis resulting from reactivation of varicella vaccine virus in an immunocompetent child. Iyer S, Mittal MK, Hodinka RL. The Children's Hospital of Philadelphia, PA 19104-4399, USA. iyers@email.chop.edu Herpes zoster complicated by meningitis has been mainly reported in immunocompromised patients after reactivation of wild-type varicella-zoster virus. We present one of the first cases of aseptic meningitis after herpes zoster caused by reactivation of vaccine-type varicella-zoster virus in an immunocompetent child. We also highlight the increasing role of both wild-type and vaccine strains of varicella-zoster virus as a cause of viral meningoencephalitis and the use of appropriate laboratory tools to rapidly and accurately identify the virus in order to provide prompt patient care and management. PMID: 19028409 [PubMed - indexed for MEDLINE] 226. Presse Med. 2009 Apr;38(4):571-83. Epub 2008 Nov 22. [Herpes zoster in old adults] [Article in French] Lang PO, Belmin J, Michel JP. Département de réhabilitation et gériatrie, Faculté de médecine et Hôpitaux universitaires de Genève, CH-1226 Thônex-Genève, Suisse. Pierre.O.Lang@hcuge.ch The varicella-zoster virus is an exclusively human herpesvirus, responsible for chickenpox. Its reactivation, after several decades, causes herpes zoster (shingles). Herpes zoster produces a rash, classically metameric, that causes acute pain and complications to elderly patients. The last, most painful, and disabling of these is postherpetic neuralgia. This neuralgia is defined as a painful syndrome lasting for more than 30 days after eruption of the rash. Today's systemic antiviral drugs can reduce the severity of the eruption, limit the pain, and diminish the incidence of postherpetic neuralgia. A recent advance in primary prevention is approval of a vaccine (Zostavax) to prevent herpes zoster and postherpetic neuralgia in subjects 60 years or older. PMID: 19028069 [PubMed - indexed for MEDLINE] 227. Vaccine. 2009 Jan 22;27(4):520-9. Epub 2008 Nov 21. Herpes zoster burden of illness and health care resource utilisation in the Australian population aged 50 years and older. Stein AN, Britt H, Harrison C, Conway EL, Cunningham A, Macintyre CR. CSL Limited, 45 Poplar Road, Parkville, Victoria 3052, Australia. alicia.stein@csl.com.au Incidence of zoster and post-herpetic neuralgia (PHN) and associated health care resource utilisation were investigated in the Australian population aged > or =50 years, using general practice data from 2000 to 2006, and pharmaceutical prescribing, hospital morbidity and emergency department data from 1998 to 2005. Zoster and PHN incidence rates were estimated as approximately 10/1000 and 1.45/1000 persons, respectively, with antivirals prescribed for 73.5% of zoster cases. Estimated hospitalisation and emergency department visit rates were 0.67/1000 and 0.38/1000 persons, respectively. Management of zoster (including PHN) involved approximately 2.4 general practitioner consultations. Total costs to the health care system were estimated as approximately 32.8 million per year. The substantial burden of zoster and PHN highlights the potential benefit of zoster vaccination. PMID: 19027048 [PubMed - indexed for MEDLINE] 228. Clin Infect Dis. 2009 Jan 1;48(1):e6-8. Transmission of atypical varicella-zoster virus infections involving palm and sole manifestations in an area with monkeypox endemicity. Macneil A, Reynolds MG, Braden Z, Carroll DS, Bostik V, Karem K, Smith SK, Davidson W, Li Y, Moundeli A, Mombouli JV, Jumaan AO, Schmid DS, Regnery RL, Damon IK. National Center for Zoonotic, Vector-Borne, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. aho3@cdc.gov During a suspected monkeypox outbreak in the Republic of Congo, we documented transmission of varicella-zoster virus (VZV) infection with palm and sole manifestations among 5 family members. Genotyping results confirmed the VZV strain European E2, a genotype not previously reported in Africa. VZV with palm and sole involvement should be considered when differentiating a monkeypox diagnosis. PMID: 19025497 [PubMed - indexed for MEDLINE] 229. Drugs Aging. 2008;25(12):991-1006. doi: 10.2165/0002512-200825120-00002. Herpes zoster and postherpetic neuralgia: optimizing management in the elderly patient. Johnson RW, Wasner G, Saddier P, Baron R. Bristol Royal Infirmary and University of Bristol, Bristol, United Kingdom. r.w.johnson@bris.ac.uk Herpes zoster (HZ) results from reactivation of varicella-zoster virus (VZV) that has been persistent and clinically dormant in spinal ganglia or cranial sensory nerves since primary infection with VZV. The most common reason for reactivation is a decline in zoster-specific cell mediated immunity as a result of aging (immunosenescence). More than two-thirds of HZ cases occur in people >or=60 years of age. HZ incidence is higher in persons who are immunocompromised as a result of disease (e.g. malignancies such as lymphoma, HIV/AIDS, diabetes mellitus) or treatments such as chemotherapy and radiotherapy. HZ incidence is also increased by therapeutic immune suppression following organ transplantation and in patients taking high-dose corticosteroids. However, HZ may occur in otherwise healthy young people. Although serious and life-threatening complications sometimes occur, the most common complication is postherpetic neuralgia (PHN), which may persist for months or years and is significantly resistant to treatment despite substantial advances in the understanding of its pathological mechanisms. The medical and social costs of HZ and PHN are high, particularly in older patients. Prevention of PHN in patients with HZ is unsatisfactory although antiviral drugs reduce the duration of pain after HZ. A live attenuated vaccine has been shown to reduce the incidence of HZ and PHN as well as the burden of illness in subjects aged >or=60 years. In view of the increasing numbers of elderly persons in the population and the poor outcomes of PHN treatment, vaccination against HZ at approximately 60 years of age appears to be an appropriate strategy. PMID: 19021299 [PubMed - indexed for MEDLINE] 230. Virology. 2009 Jan 20;383(2):216-25. Epub 2008 Nov 20. Distribution of varicella-zoster virus (VZV) wild-type genotypes in northern and southern Europe: evidence for high conservation of circulating genotypes. Loparev VN, Rubtcova EN, Bostik V, Tzaneva V, Sauerbrei A, Robo A, Sattler-Dornbacher E, Hanovcova I, Stepanova V, Splino M, Eremin V, Koskiniemi M, Vankova OE, Schmid DS. National VZV Laboratory, Centers for Disease Control and Prevention, Coordinating Center for Infectious Diseases, National Center for Preparedness, Detection, and Control of Infectious Diseases, Atlanta, GA, USA. Phylogenetic analysis of 19 complete VZV genomic sequences resolves wild-type strains into 5 genotypes (E1, E2, J, M1, and M2). Complete sequences for M3 and M4 strains are unavailable, but targeted analyses of representative strains suggest they are stable, circulating VZV genotypes. Sequence analysis of VZV isolates identified both shared and specific markers for every genotype and validated a unified VZV genotyping strategy. Despite high genotype diversity no evidence for intra-genotypic recombination was observed. Five of seven VZV genotypes were reliably discriminated using only four single nucleotide polymorphisms (SNP) present in ORF22, and the E1 and E2 genotypes were resolved using SNP located in ORF21, ORF22 or ORF50. Sequence analysis of 342 clinical varicella and zoster specimens from 18 European countries identified the following distribution of VZV genotypes: E1, 221 (65%); E2, 87 (25%); M1, 20 (6%); M2, 3 (1%); M4, 11 (3%). No M3 or J strains were observed. PMID: 19019403 [PubMed - indexed for MEDLINE] 231. CJEM. 2008 May;10(3):247-50. Ramsay Hunt syndrome presenting as simple otitis externa. Kim D, Bhimani M. Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada. dkim000@gmail.com Ramsay Hunt syndrome is a rare complication of herpes zoster in which reactivation of latent varicella zoster virus infection occurs in the geniculate ganglion, causing otalgia, auricular vesicles and peripheral facial paralysis. Because these symptoms do not always present at the onset, this syndrome can be misdiagnosed. We report the case of a patient who was diagnosed with simple otitis externa after presenting to the emergency department (ED) with a 3-day history of right-sided otalgia. Her condition subsequently evolved to include right-sided auricular vesicles and right-sided facial weakness. She presented to the ED again after 2 days and was correctly diagnosed with Ramsay Hunt syndrome. We describe the clinical presentation, diagnostic findings and management of this uncommon but important entity. PMID: 19019276 [PubMed - indexed for MEDLINE] 232. J Am Geriatr Soc. 2008 Nov;56(11):2160-2. A rare case of herpes zoster ophthalmicus with complete ophthalmoplegia. Ying XH, Wagle AM, Tan L, Sanjay S, Hedge SR, Chew YC, Yap P. PMID: 19016960 [PubMed - indexed for MEDLINE] 233. Turk J Pediatr. 2008 Jul-Aug;50(4):342-8. The evaluation of acquired aplastic anemia in children and unexpected frequency of varicella-zoster virus association: a single-center study. Yetgin S, Kuşkonmaz B, Aytaç S, Cetin M. Division of Pediatric Hematology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey. In this study, 32 patients under the age of 17 years with acquired aplastic anemia (AAA) were evaluated. Nine patients developed AAA associatedwith viral infection in which viral hepatitis and varicella infection were nearly equal. Four of the patients were administered drugs before developing AAA. Patients were treated as follows: combined immunosuppressive therapy (CIST) including anti-thymocyte or anti-lymphocyte globulin plus high-dose methylprednisolone (HDMP) and cyclosporin A and granulocyte colony-stimulating factor (G-CSF) (14 patients); mega-dose (30 mg/kg) methylprednisolone (8 patients); and HDMP combined with cyclosporin A or anapolon or cyclophosphamide (6 patients). Complete remission was seen in 10 patients and partial remission in 2 patients. The response rate was similar in the CIST and MDMP groups. The most striking findings of this study were the frequent association of AAA withvaricella infection and the low cure rate, which was due to patient non-compliance with the treatment and inadequate isolation conditions in the hospital. PMID: 19014047 [PubMed - indexed for MEDLINE] 234. Neurol Sci. 2008 Dec;29(6):497-8. Epub 2008 Nov 15. Ramsay-Hunt syndrome complicated by unilateral multiple cranial nerve palsies. Morelli N, Mancuso M, Cafforio G, Gallerini S, Pittiglio L, Tonelli S, Pozzetti N, Benedetti L, Tavarelli C, Capellini C, Tartaglione A. PMID: 19011738 [PubMed - indexed for MEDLINE] 235. Can J Public Health. 2008 Sep-Oct;99(5):383-6. Estimating the number needed to vaccinate to prevent herpes zoster-related disease, health care resource use and mortality. Brisson M. Départemente de médecine sociale et préventive, Université Laval, Québec, QC. marc.brisson@uresp.ulaval.ca BACKGROUND: A clinical trial has shown that a live-attenuated varicella-zoster virus vaccine is effective against herpes zoster (HZ) and post-herpetic neuralgia (PHN). The aim of the study was to estimate the number needed to vaccinate (NNV) to prevent HZ-related outcomes. METHODS: A cohort model of HZ associated disease, health care resource use and mortality was developed. Canadian population-based data were used to estimate age-specific incidence, hospitalization, quality-adjusted life-year (QALY) lost and mortality. NNV was calculated as the number of individuals needed to be vaccinated to prevent a specific HZ-related outcome during their lifetime. Different ages at vaccination were examined and probabilistic sensitivity analysis was performed. RESULTS: For 65 year olds, the NNV (HZ vaccine efficacy=63%, PHN vaccine efficacy=67%, no waning) to prevent a case of HZ, a case of PHN, a HZ death, a life-year lost and a QALY lost is estimated to be 11 (90% Crl: 10-13), 43 (90% Crl: 33-53), 23,319 (90% Crl: 15,312-33,139), 3762 (90% Crl: 1650-4629) and 165 (90% Crl: 105-197), respectively. Results were most sensitive to the duration of vaccine protection and the age at vaccination. DISCUSSION: The predicted NNV to prevent HZ and PHN are low even though vaccine efficacy is between 50-70%, which reflects the high incidence of these diseases among older adults. Results clearly show that the main benefit of HZ vaccination is prevention of morbidity caused by pain (as measured by QALYs lost) rather than mortality. PMID: 19009921 [PubMed - indexed for MEDLINE] 236. Transpl Infect Dis. 2009 Feb;11(1):72-4. Epub 2008 Oct 30. Unusual presentation of Ramsay Hunt syndrome in renal transplant patients: case report and literature review. Mortada RA, El Fakih RO, Assi M. Department of Medicine, Internal Medicine, University of Kansas School of Medicine-Wichita, Wichita, Kansas, USA. ramimortada@hotmail.com Ramsay Hunt syndrome (RHS) is a rare manifestation of varicella zoster virus (VZV) infection that accounts for around 12% of all cases of facial paralysis. Although it is more common in immunosuppressed individuals, it has not been yet reported in kidney transplant recipients. We describe the case of a 41-year-old man with a history of renal transplant for whom the diagnosis and treatment of RHS were delayed owing to an unusual presentation. We also review the literature on VZV infection in renal transplant patients. PMID: 19000154 [PubMed - indexed for MEDLINE] 237. Infect Control Hosp Epidemiol. 2008 Dec;29(12):1157-63. Herpes zoster-related hospitalizations and expenditures before and after introduction of the varicella vaccine in the United States. Patel MS, Gebremariam A, Davis MM. University of Michigan Medical School, University of Michigan, Ann Arbor, Michigan, USA. Comment in: Infect Control Hosp Epidemiol. 2009 May;30(5):495-6; author reply 496-7. OBJECTIVE: With childhood varicella vaccination in the United States have come concerns that the incidence of herpes zoster may increase, because of diminishing natural exposure to varicella and consequent reactivation of latent varicella zoster virus. We wanted to estimate the rate of herpes zoster-related hospitalizations and the associated hospital charges before and during the promotion of varicella vaccination in the United States. DESIGN: A retrospective study of patients from the Nationwide Inpatient Sample for the years 1993-2004 who were hospitalized due to herpes zoster infection. METHODS: We searched for diagnoses of herpes zoster (using the International Classification of Diseases, Ninth Revision, Clinical Modification codes starting with 053) in all 15 diagnostic-code fields included for hospital discharges in the Nationwide Inpatient Sample during 1993-2004. We designed our analysis to examine the rates of severe illness due to herpes zoster that resulted in hospitalization, as measured by the rates of herpes zoster-related hospital discharges (HZHDs). The annual population-adjusted rate of HZHDs (per 10,000 US population) and the annual inflation-adjusted total charges for HZHDs were the primary outcomes. Secondary outcomes included mean charges for HZHDs and the distribution of total charges for HZHDs by expected primary payer. Varicella-related hospital discharges (VRHDs) were identified by use of similar diagnosis-based methods, which were described in our previous study. RESULTS: Population-adjusted rates of HZHDs did not change significantly from the prevaccination years (1993-1995) through the initial 5 years of the varicella vaccination period. Beginning in 2001, however, the rate of HZHDs overall began to increase, and by 2004 the overall rate was 2.5 HZHDs (95% confidence interval, 2.38-2.62) per 10,000 US population, significantly higher than any of the rates calculated during the years prior to 2002. Hospital charges for HZHDs overall increased by more than $700 million annually by 2004; in particular, we found that the herpes zoster vaccine-eligible population (ie, persons aged 60 years or older) accounted for 74% of the total annual hospital charges in 2004. The annual rate of VRHDs and the associated hospital charges decreased significantly from 1993 through 2004, but the decrease in hospitalizations and charges for VRHDs was less than the increase in hospitalizations and charges for HZHDs. CONCLUSIONS: As the rates of VRHDs and the associated charges have decreased, there has been a significant increase in HZHDs and associated charges, disproportionately among older adults. Herpes zoster vaccine may mitigate these trends for HZHDs. PMID: 18999945 [PubMed - indexed for MEDLINE] 238. Vaccine. 2009 Jan 7;27(2):192-6. Epub 2008 Nov 7. Determinants of non-compliance with herpes zoster vaccination in the community-dwelling elderly. Opstelten W, van Essen GA, Hak E. University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands. As part of a series of studies on vaccine acceptance, we assessed determinants of compliance of the community-dwelling elderly with herpes zoster (HZ) vaccination in an existing influenza vaccination program. General practitioners (GPs) sent out a questionnaire to 1778 patients aged > or =65 years, and offered them free HZ vaccination simultaneously with the yearly influenza vaccination. In all, 690 patients (39%) were vaccinated against HZ; 1349 patients (76%) accepted influenza vaccination. Determinants of non-compliance with HZ vaccination were perceived lack of recommendation by the GP, unwillingness to comply with the doctor's advice, perception of low risk of contracting HZ, perception of short pain duration of HZ, and the opinion that vaccinations weaken one's natural defenses. The same determinants were associated with non-compliance with both vaccinations, but objections in general towards vaccination, a high education and difficulties to visit GPs were also important. Uptake of HZ vaccination was rather low and more data on (cost-)effectiveness might encourage GPs to offer HZ vaccination to their patients. PMID: 18996427 [PubMed - indexed for MEDLINE] 239. J Virol Methods. 2009 Feb;155(2):143-9. Epub 2008 Nov 28. Comparison of fifteen commercial assays for detecting Varicella Zoster virus IgG with reference to a time resolved fluorescence immunoassay (TRFIA) and the performance of two commercial assays for screening sera from immunocompromised individuals. Chris Maple PA, Gunn A, Sellwood J, Brown DW, Gray JJ. Virus Reference Department, Health Protection Agency Centre for Infections, Colindale, London NW9 5HT, UK. chris.maple@hpa.org.uk The performance of fifteen, commercially available, VZV IgG assays and an "in house" indirect immunofluorescence (IF) assay has been compared to a reference VZV IgG time resolved immunofluorescence assay (VZV TRFIA). A panel of 273 VZV TRFIA IgG positive serum samples and 136 VZV TRFIA IgG susceptible sera, collected from a number of UK hospitals was used. Irrespective of the interpretation of equivocal results the most sensitive assays were Dade Behring EIA (97.4%), "in house" IF (95.2%), Human EIA (92.3%) and Becton Dickinson latex agglutination (94.1%). The least sensitive assays were Virion EIA (69.6%), Diesse EIA (68.9%) and Diasys EIA (68.5%). The least sensitive (<70%) assays all had >99.0% specificity whereas the most sensitive assays had lower specificities; for example, Dade Behring EIA had a specificity of 69.9% when equivocals were treated as VZV IgG negative. For some assays e.g. Dade Behring EIA there were major discrepancies between our findings and those reported by the manufacturer which may reflect the constitution of the panel(s) of sera used for evaluation or the reference method adopted or the choice of cut-off criteria (particularly relevant to our findings for the Behring EIA). Care must be taken to choose an assay with high specificity in order to accurately assess the need for vaccination or immunoprophylaxis; however, high sensitivity is preferable to prevent inappropriate and expensive treatment. PMID: 18996415 [PubMed - indexed for MEDLINE] 240. Int J Dermatol. 2008 Oct;47(10):1087. Linear IgA dermatosis after herpes zoster; Wolf's isotopic response. Goksugur N. Comment on: Int J Dermatol. 2007 May;46(5):500-2. PMID: 18986367 [PubMed - indexed for MEDLINE] 241. MMW Fortschr Med. 2008 Sep 18;150(38):31-4. [Virus-induced diseases of the external genital region] [Article in German] Möhrenschlager M, Ring J, Köhn FM. Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein, Technische Universität München. moehrenschlager@lrz.tum.de PMID: 18985902 [PubMed - indexed for MEDLINE] 242. Ugeskr Laeger. 2008 Oct 20;170(43):3435. [Picture of the month: varicella zoster virus] [Article in Danish] Wejse C, Maier C. Arhus Universitetshospital, Skejby, Infektionsmedicinsk Afdeling. wej@sks.aaa.dk PMID: 18976602 [PubMed - indexed for MEDLINE] 243. Dermatology. 2009;218(1):60-2. Epub 2008 Oct 31. Symmetrical drug-related intertriginous and flexural exanthema caused by valacyclovir. Daito J, Hanada K, Katoh N, Katoh S, Sakamoto K, Asai J, Takenaka H, Kishimoto S. Department of Dermatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan. Drug-related eruptions that appear only on intertriginous or flexural folds and in gluteal areas have recently been termed symmetrical drug-related intertriginous and flexural exanthema (SDRIFE). We report a case of a 56-year-old woman with acute erythematous rash in the intertriginous areas after treatment with the L-valine ester of acyclovir, valacyclovir. Oral-challenge tests resulted in erythematous pruritic rash in the intertriginous area by valacyclovir. The patient was diagnosed as having SDRIFE due to valacyclovir. Copyright 2008 S. Karger AG, Basel. PMID: 18974630 [PubMed - indexed for MEDLINE] 244. Virology. 2008 Dec 20;382(2):171-81. Epub 2008 Oct 26. Discordant varicella-zoster virus glycoprotein C expression and localization between cultured cells and human skin vesicles. Storlie J, Carpenter JE, Jackson W, Grose C. Departments of Microbiology and Pediatrics, University of Iowa, Iowa City, IA 52242, USA. Because of its very low titer, varicella-zoster virus (VZV) infectivity is usually transferred by passage of trypsin dispersed infected cells. Previously, we observed that gC biosynthesis was markedly delayed in monolayers inoculated with cell free virus. In this report, we investigated the kinetics of gC expression in more detail and included studies of monolayers inoculated with trypsin dispersed infected cells, the more traditional method of VZV infection. Extensive imaging analyses disclosed that gC was detectable in some inoculum cells, but little gC biosynthesis occurred during the first 48 hpi in the newly infected underlying monolayer. In contrast, during the first 24-48 hpi, expression of VZV gE and gB was easily detectable. Using real-time RT-PCR, we found a delay in accumulation of VZV gC transcripts that paralleled the delay in expression of VZV gC protein. Treatment with hexamethylene bisacetamide (HMBA) increased expression of both gC protein and gC mRNA. HMBA treatment also increased virus titer by 4-fold, but paradoxically reduced plaque size in the titration assay. Finally, we examined skin vesicles from cases of chickenpox and zoster in humans and observed abundant amounts of gC expression. In short, this report documents an unexpected delay in both gC mRNA and protein production under all conditions of VZV infection of cultured cells. PMCID: PMC2754791 PMID: 18954885 [PubMed - indexed for MEDLINE] 245. Clin Exp Dermatol. 2008 Nov;33(6):808-10. A case of zosteriform metastatic skin cancer. Minakawa S, Nakajima K, Aizu T, Kaimori M, Nomura K. Department of Dermatology and Clinical Pathology, Aomori Prefectural Central Hospital, Hirosaki, Aomori, Japan. minakawas@yahoo.co.jp PMID: 18954423 [PubMed - indexed for MEDLINE] 246. Rev Epidemiol Sante Publique. 2008 Oct;56(5):323-31. Epub 2008 Oct 31. [Modelling the impact of vaccination on the epidemiology of varicella zoster virus] [Article in French] Bonmarin I, Santa-Olalla P, Lévy-Bruhl D. Département des maladies infectieuses, institut de veille sanitaire, 12, rue du Val-d'Osne, 94415 Saint-Maurice, France. i.bonmarin@invs.sante.fr BACKGROUND: The soon to come the availability of a combined MMR-varicella vaccine has re-stimulated the debate around universal infant vaccination against varicella. In France, the incidence of varicella is estimated at about 700,000 cases per year, with approximately 3500 hospitalisations and 15-25 deaths, the latter mainly occurring in those over 15years. Vaccination would certainly decrease the overall incidence of the disease but concerns about vaccination leading to a shift in the average age at infection followed by an increase in incidence of severe cases and congenital varicella, still remain. In order to provide support for decision-making, a dynamic mathematical model of varicella virus transmission was used to predict the effect of different vaccination strategies and coverages on the epidemiology of varicella and zoster. METHODS: A deterministic realistic age-structured model was adapted to the French situation. Epidemiological parameters were estimated from literature or surveillance data. Various vaccine coverages and vaccination strategies were investigated. A sensitivity analysis of varicella incidence predictions was performed to test the impact of changes in the vaccine parameters and age-specific mixing patterns. RESULTS: The model confirms that the overall incidence and morbidity of varicella would likely be reduced by mass vaccination of 12-month-old children. Whatever the coverage and the vaccine strategy, the vaccination will cause a shift in age distribution with, for vaccination coverage up to at least 80% in the base-case analysis, an increased morbidity among adults and pregnant women. However, the total number of deaths and hospitalisations from varicella is predicted to remain below that expected without vaccination. The model is very sensitive to the matrix of contacts used and to the parameters describing vaccine effectiveness. Zoster incidence will increase over a number of decades followed by a decline to below prevaccination levels. CONCLUSION: Mass varicella vaccination, in France, will result in an overall reduction of varicella incidence but will cause a shift in age distribution with an increase in adult cases. Due to the uncertainties in key parameters values, the exact magnitude of this shift is difficult to assess. PMID: 18951741 [PubMed - indexed for MEDLINE] 247. J Am Osteopath Assoc. 2008 Oct;108(10):615-21. Complete ophthalmoplegia with pupillary involvement as an initial clinical presentation of herpes zoster ophthalmicus. Delengocky T, Bui CM. South Texas Retina Consultants in Corpus Christi, McAllen, Tex., USA. drtd2002@hotmail.com Complete oculomotor nerve palsy with pupillary involvement is a neuro-ophthalmologic emergency because it is commonly caused by a compressive aneurysm at the junction of the posterior communicating artery and the internal carotid artery. If left untreated, this condition can be potentially fatal within days. The present report describes a 45-year-old African American woman with human immunodeficiency virus who presented with complaint of new-onset nonspecific headache, acute onset of complete oculomotor nerve palsy, and a dilated pupil of the right eye. Results of standard work-up for aneurysm and other etiologic factors were negative. Ten days after presentation, papulovesicular eruptions occurred over the V1 and V2 dermatomes, revealing herpes zoster ophthalmicus. The present case may be the first to identify a patient with complete ophthalmoplegia with pupil involvement as a pre-eruptive manifestation of herpes zoster. The literature on epidemiology, pathogenesis, clinical presentation, diagnosis, and current treatment options for this rare form of shingles are reviewed. PMID: 18948645 [PubMed - indexed for MEDLINE] 248. Clin Neurol Neurosurg. 2009 Jan;111(1):54-6. Epub 2008 Oct 22. Association of a history of varicella virus infection with multiple sclerosis. Rodríguez-Violante M, Ordoñez G, Bermudez JR, Sotelo J, Corona T. Neurodegenerative Diseases Clinical Research Unit, National Institute of Neurology and Neurosurgery, Mexico City, Mexico. OBJECTIVE: To analyze the association of a previous history of varicella virus infection with multiple sclerosis (MS) and its subtypes. MATERIAL AND METHODS: We performed a case-control study including 126 cases and 157 controls. Subjects were divided into subgroups according to MS subtype and the history of varicella virus infection along with other variables was assessed. RESULTS: History of varicella zoster virus (VZV) infection was positive in 42% of controls and 66% of MS cases (p1 variant strain may reactivate to cause herpes zoster. PMID: 18826373 [PubMed - indexed for MEDLINE] 263. J Clin Virol. 2009 Jan;44(1):9-14. Epub 2008 Sep 27. Comparison of the performance of the LIAISON VZV-IgG and VIDAS automated enzyme linked fluorescent immunoassays with reference to a VZV-IgG time-resolved fluorescence immunoassay and implications of choice of cut-off for LIAISON assay. Maple PA, Rathod P, Smit E, Gray J, Brown D, Boxall EH. Virus Reference Department, HPA Centre for Infections, Colindale, London, United Kingdom. BACKGROUND: Determination of Varicella Zoster virus (VZV) immune status in pregnant women without history of chickenpox is important in identifying those who genuinely need VZV immune globulin prophylaxis following significant exposure to chickenpox or shingles. Immune status testing requires highly sensitive and specific immunoassays for timely and accurate results. OBJECTIVES: To compare the performance of DiaSorin LIAISON and Biomerieux VIDAS VZV-IgG assays with reference to a VZV-IgG time-resolved fluorescence immunoassay (TRFIA). STUDY DESIGN: A panel of sera collected from 65 pregnant contacts of VZV and 62 individuals tested for VZV immunity was tested in all three assays. Dose-response curves were generated using International Standards W1044 and 90/690. RESULTS: Sensitivity and specificity of VIDAS compared to VZV-TRFIA was 54.5% and 97.9% respectively and for LIAISON compared to VZV-TRFIA was 67% and 100% respectively. Both assays correlated well with TRFIA with R2 correlation coefficients of 0.79 and 0.76 respectively. Dose-response curves showed both Standards behaved in a similar manner in each assay. For VIDAS, the test cut-off value of 0.9 correlated with 275-280mIU/ml and for LIAISON a cut-off value of 150mIU/ml correlated with 208-219mIU/ml. CONCLUSIONS: By dose-response data and in comparison with TRFIA, LIAISON is more sensitive and specific than VIDAS. PMID: 18823815 [PubMed - indexed for MEDLINE] 264. Arthritis Rheum. 2008 Oct;58(10):2949-57. Viral infection and reactivation in autoimmune disease. Chakravarty EF. Division fo Immunology and Rheumatology, Stanford University School of Medicine, Palo Alto, California 94304, USA. echakravarty@stanford.edu PMID: 18821704 [PubMed - indexed for MEDLINE] 265. Br J Dermatol. 2008 Nov;159(5):1212-3. Epub 2008 Sep 20. Risk of herpes zoster infection in patients with pemphigus on mycophenolate mofetil. Saha M, Black MM, Groves RW. PMID: 18811686 [PubMed - indexed for MEDLINE] 266. Gen Dent. 2008 Sep-Oct;56(6):563-6; quiz 567-8, 591-2. Prevention and management of trigeminal herpes zoster and postherpetic neuralgia. Closmann JJ, Fielding CG, Pogrel MA. Oral and Maxillofacial Surgery Residency, Tripler Army Medical Center, Tripler AMC, Hawaii, USA. Herpes zoster (HZ, also known as shingles) is caused by the reactivation of a dormant varicella zoster virus and can be a source of significant morbidity. Oral manifestations can include vesicular eruptions of the mucosa, osteonecrosis with tooth loss, and postherpetic neuralgia (PHN). This article discusses treatment for trigeminal nerve involvement with herpes zoster, as well as for the painful syndrome PHN. PMID: 18810918 [PubMed - indexed for MEDLINE] 267. Am J Phys Med Rehabil. 2008 Oct;87(10):859-61. Axillary mononeuropathy after herpes zoster infection mimicking subacromial impingement syndrome. Aktas I, Akgun K, Gunduz OH. Marmara University Institute of Neurological Sciences, Istanbul, Turkey. Subacromial impingement syndrome is a frequent cause of shoulder pain and it is readily confused with other shoulder problems. We present a patient with herpes zoster infection associated with axillary mononeuropathy that was initially misdiagnosed as subacromial impingement syndrome. A 75-yr-old female patient was admitted to the internal medicine clinic because of pain and weakness in her right shoulder. As she did not respond to medical treatment and local injection therapy, magnetic resonance imaging of the right shoulder was ordered. As the magnetic resonance imaging revealed subacromial impingement of the supraspinatus tendon, the patient was referred to the physical medicine and rehabilitation department for rehabilitation. In our initial physical examination, her shoulder abductor muscle strength was 2/5 and her shoulder external rotator muscle strength was 3/5. A subacromial injection test with 10 ml of 1% lidocain was negative and the magnetic resonance imaging did not show a complete rotator tendon rupture that could explain such a muscle strength loss. So, an electrodiagnostic evaluation was performed and the patient was diagnosed to have a right axillary neuropathy. A more detailed questioning of the patient disclosed a history of herpes zoster approximately 3 mos ago. Herpes zoster-associated axillary neuropathy can mimic subacromial impingement syndrome, and magnetic resonance imaging examination alone may lead to a misdiagnosis. Therefore, we imply that clinical and electrophysiological evaluations would be of great importance in relevant patients with shoulder problems. PMID: 18806513 [PubMed - indexed for MEDLINE] 268. Am J Phys Med Rehabil. 2008 Oct;87(10):853-8. Zoster sine herpete with thoracic motor paralysis temporally associated with thoracic epidural steroid injection. Schuchmann JA, McAllister RK, Armstrong CS, Puana R. Department of Physical Medicine and Rehabilitation, Scott & White Memorial Hospital, Texas A&M Health Sciences Center College of Medicine, Temple, Texas 76508, USA. Reactivation of latent varicella-zoster virus can occur when the immune system is weakened leading to the typical presentation seen with herpes zoster or shingles. In a small percentage of these patients, motor paralysis can be seen in the affected myotomal distribution. Zoster sine herpete, or shingles without the typical vesicular rash, is an uncommon variant of zoster. Systemic steroids are known to weaken the immune response. Two previous case reports have implicated epidural steroid injections as a precipitating cause of zoster. We present a case of serologically verified zoster sine herpete producing an abdominal wall bulge, which occurred 1 wk after thoracic epidural steroid injection. Electromyography documented the presence of abdominal wall denervation. Given the low incidence of serologically proven zoster sine herpete--especially with thoracic motor paralysis--and the equally rarely documented incidence of zoster related to epidural steroids, we present what we believe to be the first reported case of zoster sine herpete with a neuropathic abdominal wall bulge occurring in close temporal association to receiving epidural steroids. PMID: 18806512 [PubMed - indexed for MEDLINE] 269. Med J Aust. 2008 Sep 15;189(6):347. The prevention and management of herpes zoster. Senanayake SN. Comment on: Med J Aust. 2008 Feb 4;188(3):171-6. PMID: 18803546 [PubMed - indexed for MEDLINE] 270. Clin Exp Dermatol. 2008 Aug;33(5):677-8. Postherpetic abdominal-wall pseudohernia. Dobrev H, Atanassova P, Sirakov V. Department of Dermatology, Medical University, Plovdiv, Bulgaria. hristo_dobrev@hotmail.com PMID: 18801105 [PubMed - indexed for MEDLINE] 271. Eur J Clin Microbiol Infect Dis. 2009 Apr;28(4):331-7. Epub 2008 Sep 17. Risk factors for opportunistic infections in infliximab-treated patients: the importance of screening in prevention. Garcia-Vidal C, Rodríguez-Fernández S, Teijón S, Esteve M, Rodríguez-Carballeira M, Lacasa JM, Salvador G, Garau J. Hospital Mútua de Terrassa, University of Barcelona, Spain. carolgv75@hotmail.com We sought to determine factors associated with opportunistic infections (OI) in infliximab-treated patients. A retrospective study cohort (1999-2004) was examined. Nine OI were diagnosed in 94 infliximab-treated patients: tuberculosis (four), visceral leishmaniasis (one), pyogenic muscular abscess (one Salmonella spp. and one Streptococcus pneumoniae), and two viral infections (hepatitis B virus [HBV] and zoster ophthalmicus). The risk for OI was significantly higher in the first year of treatment (odds ratio [OR] 8; 95% confidence interval [CI] 2-50). Previous treatment with more than two immunosuppressive drugs was the only factor related to OI (OR 8.686; 95% CI 1.889-39.943). We identified the subset of patients treated with infliximab who had a higher risk for OI. The screening of latent infections is key to diminishing the incidence of these infections. PMID: 18797940 [PubMed - indexed for MEDLINE] 272. J Eur Acad Dermatol Venereol. 2009 Apr;23(4):475-7. Sarcoid tissue reaction on herpes zoster scars in a myelodysplastic syndrome patient: Wolf's isotopic response. Watanabe D, Kuhara T, Ishida N, Tamada Y, Matsumoto Y. PMID: 18793243 [PubMed - indexed for MEDLINE] 273. AAOHN J. 2008 Sep;56(9):404. Herpes zoster in the workplace. Chalupka S. Department of Nursing, University of Massachusetts, Lowell, MA, USA. PMID: 18792615 [PubMed - indexed for MEDLINE] 274. J Clin Neurosci. 2008 Nov;15(11):1246-52. Epub 2008 Sep 11. Differential diagnosis of intraspinal and extraspinal non-discogenic sciatica. Kulcu DG, Naderi S. Department of Physical Medicine and Rehabilitation, Yeditepe University School of Medicine, Yeditepe University Hospital, Devlet Yolu Ankara Caddesi No. 102/104 Kozyataği, Istanbul, Turkey. d_geler@yahoo.com.tr The aim of this study is to present a series of 11 patients with non-discogenic sciatica (NDS), and to review the diagnostic techniques of careful clinical and radiological examination. The cases include lumbar radicular herpes zoster, lumbar nerve root schwannoma, lumbar instability, facet hypertrophy, ankylosing spondylitis, sacroiliitis, sciatic neuritis, piriformis syndrome, intrapelvic mass and coxarthrosis. The pain pattern and accompanying symptoms were the major factors suggesting a non-discogenic etiology. Pelvic MRI and CT scans, and sciatic nerve magnetic resonance neurography were the main diagnostic tools for diagnosis of NDS. The treatment of choice depended on the primary diagnosis. Detailed physical examinations with special attention paid to the extraspinal causes of sciatica and to pain characteristics are the major components of differential diagnosis of NDS. PMID: 18789864 [PubMed - indexed for MEDLINE] 275. Eur J Gastroenterol Hepatol. 2008 Oct;20(10):1049. Pregabalin as a probable cause of acute liver injury. Einarsdottir S, Björnsson E. Department of Internal Medicine, Section of Haematology and Coagulation, Sahlgrenska University Hospital, Gothenburg, Sweden. einar.bjornsson@medic.gu.se PMID: 18787478 [PubMed - indexed for MEDLINE] 276. Expert Opin Pharmacother. 2008 Oct;9(14):2531-6. Valacyclovir for the treatment of Bell's palsy. Hato N, Sawai N, Teraoka M, Wakisaka H, Takahashi H, Hinohira Y, Gyo K. Ehime University School of Medicine, Department of Otolaryngology, Shitsukawa, Toon city, Ehime 791-0295, Japan. nhato@m.ehime-u.ac.jp Despite recent evidence suggesting that Bell's palsy is associated with reactivation of alfa-herpes viruses, the disease has been treated empirically, and the use of valacyclovir has not been definitively established. In 2007, two prospective, randomised, placebo-controlled trials evaluating valacyclovir were reported in patients with Bell's palsy. One demonstrated that valacyclovir/prednisolone therapy was statistically more effective than placebo/prednisolone therapy in improving the recovery of patients with Bell's palsy, excluding zoster sine herpete. However, considering the cost-benefit ratio of this treatment and the limitations of virological diagnoses, we recommend that valacyclovir should be used in cases of severe palsy within 3 days after the onset of Bell's palsy. PMID: 18778190 [PubMed - indexed for MEDLINE] 277. Manag Care. 2008 Aug;17(8):32-4. Plans feel pressure to vaccinate more adults. The cost-effectiveness of prevention is undeniable, yet vaccination rates for everything but influenza decline. Sipkoff M. PMID: 18777787 [PubMed - indexed for MEDLINE] 278. J Clin Virol. 2008 Oct;43(2):233-5. Epub 2008 Sep 3. A rare case of disseminated shingles in an immunocompetent patient following a 7-day treatment with oral valacyclovir. Burdett C, Mendoza N, Arora A, Bartlett B, Gewirtzman A, Tremaine AM, Tyring S. University of Texas Medical School at Houston, 7675 Phoenix Drive #1028, Houston, TX 77030, United States. Catherine.E.Burdett@uth.tmc.edu PMID: 18771948 [PubMed - indexed for MEDLINE] 279. Am J Perinatol. 2008 Oct;25(9):573-5. Epub 2008 Sep 3. Varicella zoster meningitis in a pregnant woman with acquired immunodeficiency syndrome. Jayakrishnan A, Vrees R, Anderson B. Department of Obstetrics and Gynecology, Brown Medical School/Women & Infants' Hospital of Rhode Island, Providence, Rhode Island 02905, USA. ajayakrishnan@WIHRI.org Between 6000 and 7000 women in the United States infected with human immunodeficiency virus (HIV) give birth annually. It is well known that HIV-related immunosuppression significantly increases the risk for acquiring opportunistic infections (OIs). However, there is limited information regarding the relationship of pregnancy in the setting of HIV/AIDS infection, subsequent development of OIs, and maternal and fetal outcomes. A pregnant 36-year-old woman with AIDS was diagnosed with varicella zoster meningitis. Weight-based therapy with acyclovir was initiated with clinical improvement in symptoms. Care of a pregnant HIV-infected patient with an OI poses a unique diagnostic and therapeutic challenge for clinicians. Early diagnosis and initiation of appropriate treatment may provide an opportunity to improve both maternal and fetal outcomes. PMID: 18770492 [PubMed - indexed for MEDLINE] 280. Clin Lymphoma Myeloma. 2008 Aug;8(4):237-40. Bortezomib and the increased incidence of herpes zoster in patients with multiple myeloma. Kim SJ, Kim K, Kim BS, Lee HJ, Kim H, Lee NR, Nam SH, Kwon JH, Kim HJ, Sohn SK, Won JH, Lee JH, Suh C, Yoon SS, Kim HJ, Kim I, Do YR, Lee WS, Joo YD, Shin HJ; Korean Multiple Myeloma Working Party. Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul. BACKGROUND: Bortezomib has significantly advanced the treatment of patients with multiple myeloma (MM). However, considering that most patients with MM are elderly, bortezomib-related morbidity should be thoroughly studied to ensure the safe use of this drug. Herpes zoster has been reported as a possible adverse event associated with bortezomib because a major target of bortezomib, nuclear factor-kappaB, is known to be involved with T-cell immunity. PATIENTS AND METHODS: We performed a retrospective analysis of the incidence of herpes zoster among 282 patients treated with a bortezomib-containing regimen. RESULTS: During the patients' pre-bortezomib treatment (median, 2.14 years), the incidence of herpes zoster was 11% (31 of 282 patients). However, after the patients were treated with bortezomib, the incidence increased to 22.3% (63 of 282 patients), of which almost all occurrences were within the first 3 cycles (median duration, 41 days). The time interval from diagnosis to bortezomib initiation date was shorter in herpes zoster-positive patients than in herpes zoster-negative patients (2.14 +/- 1.87 years vs. 3.38 +/- 2.95 years; P = .002). Disease duration, previous herpes zoster infection, disease stage and type of myeloma, and the type and intensity of previous treatments failed to show any relationship with herpes zoster. These findings suggest that longer history of disease and treatments did not affect the occurrence of herpes zoster, nor did the type of bortezomib regimens or their toxicities. CONCLUSION: Bortezomib can increase the incidence of herpes zoster regardless of disease duration, previous treatments, and concomitantly administered drugs. Thus, the occurrence of herpes zoster should be monitored during bortezomib treatment. PMID: 18765311 [PubMed - indexed for MEDLINE] 281. Ophthalmology. 2008 Sep;115(9):1632-3. Acute retinal necrosis in Japan. Usui Y, Takeuchi M, Goto H, Mori H, Kezuka T, Sakai J, Usui M. PMID: 18762074 [PubMed - indexed for MEDLINE] 282. J Eur Acad Dermatol Venereol. 2009 May;23(5):618-9. Epub 2008 Aug 27. Herpes zoster histopathologically mimicking CD30-positive anaplastic large cell lymphoma. Shiohara J, Koga H, Uhara H, Takata M, Saida T, Uehara T. PMID: 18759786 [PubMed - indexed for MEDLINE] 283. Am J Med. 2008 Sep;121(9):772-3. Inka dinka don't. Herpes zoster. German V, Sakagiannis G, Margaritis G, Falagas ME. Second Internal Medicine and Infectious Diseases Department, 401 Army General Hospital of Athens, Greece. PMID: 18724965 [PubMed - indexed for MEDLINE] 284. Muscle Nerve. 2008 Aug;38(2):1070-3. Unilateral diaphragmatic paralysis and segmental motor paresis following herpes zoster. Bahadir C, Kalpakcioglu AB, Kurtulus D. Haydarpasa Numune Training and Research Hospital, Physical Medicine and Rehabilitation Clinic, Istanbul, Turkey. delta2006@ttmail.com We report the case of a 73-year-old woman who complained of acute onset of pain and weakness of her left shoulder and proximal arm muscles 3 weeks after a diagnosis of herpes zoster. Electromyography revealed involvement of the C5-6 myotomes and the upper trunk of the brachial plexus. Chest X-ray and electromyographic studies documented paralysis of the left diaphragm. One year after onset, muscle strength returned to normal, but radiographic and electrophysiologic findings of diaphragm paralysis were unchanged. PMID: 18724399 [PubMed - indexed for MEDLINE] 285. Eur J Neurol. 2008 Oct;15(10):e90-1. Epub 2008 Jul 20. Stroke and multiple peripheral thrombotic events in an adult with varicella. Massano J, Ferreira D, Toledo T, Mansilha A, Azevedo E, Carvalho M. Comment in: Eur J Neurol. 2008 Oct;15(10):e88-9. PMID: 18717719 [PubMed - indexed for MEDLINE] 286. Orbit. 2008;27(4):325-7. Severe, permanent orbital disease in herpes zoster ophthalmicus. Dhingra S, Williams G, Pearson A. Eye Department, John Radcliffe Hospital, Oxford, United Kingdom. drsumitdhingra@hotmail.com A 63-year-old man with HZO presented with involvement of cranial nerves II, III, IV, V, and VI, with proptosis, raised intraocular pressure, and chemosis. With the aid of orbital imaging, a diagnosis of orbital apex inflammation secondary to HZO was confirmed, and he was treated with intravenous acyclovir and oral steroids. Despite this, he made a minimal recovery at eight months following presentation. Severe, irreversible orbital disease may develop following HZO, and an ischemic vasculitis may play a role in the pathogenesis of the disease. PMID: 18716975 [PubMed - indexed for MEDLINE] 287. BMJ. 2008 Aug 19;337:a1164. doi: 10.1136/bmj.a1164. Childhood immunisation against varicella zoster virus. Farlow A. PMID: 18713808 [PubMed - indexed for MEDLINE] 288. J Clin Oncol. 2008 Oct 10;26(29):4784-90. Epub 2008 Aug 18. Analysis of herpes zoster events among bortezomib-treated patients in the phase III APEX study. Chanan-Khan A, Sonneveld P, Schuster MW, Stadtmauer EA, Facon T, Harousseau JL, Ben-Yehuda D, Lonial S, Goldschmidt H, Reece D, Neuwirth R, Anderson KC, Richardson PG. Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263, USA. asher.chanan-khan@roswellpark.org Comment in: J Clin Oncol. 2009 May 1;27(13):2293-4; author reply 2294-6. PURPOSE: The aim of this subset analysis was to determine if bortezomib treatment is associated with increased incidence of varicella-zoster virus (VZV) reactivation in patients with relapsed multiple myeloma (MM). PATIENTS AND METHODS: Incidence of herpes zoster was evaluated in 663 patients with relapsed MM from the phase III APEX trial comparing single-agent bortezomib with high-dose dexamethasone. RESULTS: Bortezomib was associated with a significantly higher incidence of herpes zoster compared with dexamethasone treatment (13%, 42 of 331 v 5%, 15 of 332; P = .0002). Most herpes zoster infections were grade 1/2; incidences of grade 3/4 events (1.8% v 1.5%) and infections considered serious adverse events (1.5% v 0.9%) were similar between treatment arms, and no herpes zoster-related deaths occurred. Neither the time to onset of the herpes event nor the patients' absolute lymphocyte counts at baseline differed significantly between arms. VZV reactivation was the only herpes viral event noted to be significantly elevated in the bortezomib treatment group compared with the dexamethasone treatment group (P = .0002). The incidence of non-VZV-related herpes viral infections was comparable between arms. No additional risk factors for herpes zoster reactivation were identified. CONCLUSION: Further studies are needed to explain these observations and their implications; however, for patients treated with bortezomib or bortezomib-containing regimens, the risk of VZV reactivation should be monitored and routine use of antiviral prophylaxis considered. PMID: 18711175 [PubMed - indexed for MEDLINE] 289. Acta Med Croatica. 2008 May;62(2):163-72. [Craniofacial neuralgias] [Article in Croatian] Mikula I. Klinika za neurologiju, Referentni centar za neurovaskularne poremećaje Ministarstva zdravstva RH, Klinicka bolnica Sestre milosrdnice, Zagreb, Hrvatska. Craniofacial neuralgias are characterized by sudden paroxysmal pain along the distribution of one or more of the cranial or upper cervical spinal nerves. The most significant neuralgia of the craniofacial region is trigeminal neuralgia, while geniculate neuralgia, glossopharyngeal neuralgia and occipital neuralgia are less common. Trigeminal neuralgia may be primary or secondary. Idiopathic trigeminal neuralgia or tic douloureux has been recognized for centuries as an extremely painful disorder most commonly involving the maxillary nerve. Recurrent lancinating, shocklike unilateral pain lasting for seconds to minutes is provoked by non noxious stimulation of the skin at specific sites around the face and less frequently by movement of the tongue. The trigger zones are usually within the same dermatome as the painful sensation. After each episode, there is usually a refractive period during which stimulation of the trigger zone will not induce pain. Idiopathic trigeminal neuralgia occurs somewhat more frequently in women and usually begins in individuals 50 to 70 years of age. There is no pain between attacks, and the frequency of painful episodes can range from several per day to only a few per year. With time, the features may become more atypical, with greater areas of more enduring and dull pain and occasionally bilateral pain, rarely on both sides simultaneously. No sensory or reflex deficit is detectable by routine neurologic testing. Diagnostic local anesthetic blocks will identify the specific nerves involved and the trigger point distribution. Neurologic and neuroradiologic examination is advised in all cases to rule out diseases such as intracranical tumors, vascular malformations or multiple sclerosis. PMID: 18710080 [PubMed - indexed for MEDLINE] 290. Clin Transplant. 2008 Nov-Dec;22(6):770-9. Epub 2008 Aug 13. Clinical efficacy of prophylactic strategy of long-term low-dose acyclovir for Varicella-Zoster virus infection after allogeneic peripheral blood stem cell transplantation. Kim DH, Kumar D, Messner HA, Minden M, Gupta V, Kuruvilla J, Chae YS, Sohn SK, Lipton JH. Allogeneic Blood and Marrow Transplant Program, Princess Margaret Hospital, University of Toronto, Toronto, Canada. Varicella-Zoster virus infection (VZV) has a high incidence post-allogeneic peripheral blood stem cell transplant (PBSCT). However, data regarding long-term acyclovir prophylaxis for VZV prevention are limited. We evaluated the clinical efficacy of long-term low-dose acyclovir prophylaxis for VZV infection after allogeneic PBSCT at the Princess Margaret Hospital (PMH), Canada and the Kyungpook National University Hospital (KNUH), Korea. The acyclovir prophylaxis regimen at PMH was acyclovir 400 mg/d orally until engraftment, and at KNUH was acyclovir 800 mg/d orally until immunosuppression discontinuation. Long-term acyclovir prophylaxis was given to 26/193 (14%) patients in the PMH group and 73/79 (92%) patients in the KNUH group. In the PMH group, 42 cases (22%) developed VZV infection, while six cases (8%) had VZV infection in the KNUH group (p = 0.005). With a median of 26.5 months of follow-up, the incidences of VZV infection at one and two yr were 15.8% and 20.7% in the PMH group, and 2.5% and 5.8% in the KNUH group, respectively (p = 0.001). By controlling the other potential risk factors for VZV infection in multivariate analysis, the use of long-term acyclovir was the only protective factor for VZV infection after allogeneic PBSCT (p = 0.04, hazard ratio = 0.296). Long-term use of acyclovir appears to be protective for VZV infection after allogeneic PBSCT, especially during the period of immunosuppressive therapy. PMID: 18707605 [PubMed - indexed for MEDLINE] 291. J Clin Microbiol. 2008 Oct;46(10):3530-3. Epub 2008 Aug 13. Molecular analysis of varicella-zoster virus strains circulating in Tanzania demonstrating the presence of genotype M1. Schmidt-Chanasit J, Olschläger S, Günther S, Jaeger G, Bleymehl K, Schäd SG, Heckel G, Ulrich RG, Doerr HW. Bernhard-Nocht-Institute for Tropical Medicine, Diagnostic Virology Laboratory, Bernhard-Nocht-Strasse 74, D-20359 Hamburg, Germany. jonassi@gmx.de Based on analysis of 16,392 bp encompassing the complete open reading frames (ORFs) 1, 5, 31, 36, 37, 47, 60, 62, 67, and 68 of the genome of genotype M1 varicella-zoster virus (VZV) was found in swab samples originating from eight Tanzanian zoster patients. Moreover, sequence analysis suggests recombination events between different VZV genotypes within ORFs 1, 31, 60, and 67. PMCID: PMC2566121 PMID: 18701658 [PubMed - indexed for MEDLINE] 292. Dermatol Online J. 2008 Feb 28;14(2):24. Persistent varicella as the initial manifestation of systemic lymphoma. Ferreira M, Sanches M, Teixeira M, Guerra M, Selores M. Service of Dermatology, Hospital Geral de Santo António, Porto, Portugal. marcia_ferreira@hotmail.com Varicella is a common benign childhood disease that often presents in adolescents and adults in a more severe form. We report a previously healthy 50-year-old man who developed multiple necrotic cutaneous ulcers associated with fever, asthenia and anorexia. Physical examination revealed few tense hemorrhagic vesicles on the trunk and necrotic cutaneous ulcers scattered over the entire cutaneous surface. After the diagnosis of varicella with varicella pneumonia was established, treatment with acyclovir was instituted. His poor response to treatment was indicative of immune compromise; an underlying peripheral T-cell lymphoma was discovered. PMID: 18700127 [PubMed - indexed for MEDLINE] 293. J Orthop Sci. 2008 Jul;13(4):383-6. Epub 2008 Aug 13. Morphological changes of the dorsal root ganglion in a patient with herpes zoster seen by magnetic resonance imaging. Yoshimoto M, Kawaguchi S, Takebayashi T, Isogai S, Nonaka S, Kosukegawa I, Yamashita T. Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, S1 W16, Chuo-ku, Sapporo, 060-8543, Japan. PMID: 18696200 [PubMed - indexed for MEDLINE] 294. Vaccine. 2008 Nov 25;26(50):6487-90. Epub 2008 Aug 9. Clinicopathologic understanding and control of varicella-zoster virus infection. Asano Y. Department of Pediatrics, Fujita Health University, School of Medicine, Toyoake, Aichi 470-1192, Japan. yasano@fujita-hu.ac.jp As reflections by the recipient for the Japanese society for vaccinology Takahashi award, clinicopathologic understanding and control of varicella-zoster virus (VZV) infection was briefly reviewed. In 1974, a live varicella vaccine was developed by attenuating the Oka strain of VZV after the passages in non-human cells at a low temperature. The vaccine was immunogenic, well tolerated, and effective, and distributed worldwide so far. For post-exposure prophylaxis of varicella, the vaccine and acyclovir is effectively used in the incubation period of varicella. The delayed type hypersensitivity to VZV skin test antigen was applied for evaluation of cell-mediated immunity to VZV which is commercially available in Japan. The biphasic viremia during incubation period of varicella and airborne spread of VZV from varicella patients and from herpes zoster patients with localized lesions were shown by the virus isolation or by detection of the virus DNA. PMID: 18694794 [PubMed - indexed for MEDLINE] 295. Eur J Dermatol. 2008 Sep-Oct;18(5):499-503. Epub 2008 Aug 8. Tracing of the molecular remnants of herpes virus infections in necrotic skin tissue. Yamamoto T, Yamada A, Tsuji K, Iwatsuki K. Department of Dermatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan. go-yama@md.okayama-u.ac.jp We have established an assay system to detect herpesvirus-derived transcripts in lesional crusts. Fifteen patients with herpes simplex (HS), 21 with herpes zoster (HZ), 2 with varicella, and 20 with irrelevant diseases were enrolled in the present study. Total RNA was extracted from crusts or scales, and converted to cDNA. Virus-encoded transcripts were amplified using reverse transcriptase (RT)-PCR. Housekeeping gene transcripts such as beta2-microglobulin (beta2-MG) and beta-actin (beta-actin) mRNA were also examined, and an efficient preservative condition of the crusts was determined. With extracted RNAs, beta2-MG and beta-actin mRNA were successfully amplified in all crust samples. Herpes simplex virus (HSV)-specific, lytic cycle-related transcript, UL30 mRNA was detected in all 15 HS samples, including 13 samples of HSV-1- and 2 of HSV-2-encoded UL30 mRNA, respectively. Of 23 samples, including 21 HZ and 2 varicella cases, varicella zoster virus (VZV)-specific, lytic cycle-related transcript, ORF40 mRNA was detected in 22 samples. In a control group, no UL30 and ORF40 mRNA were detected. Crust samples that had been stored without any pretreatment or preservative for 6 months at room temperature (RT) were available for the present assay. When compared with the freshly obtained materials, the amount of beta2-MG mRNA was reduced to 51% in the stored samples covered with adhesive tape, to 48% in a sample left at R.T. without any treatment, and to 1.2% in the samples stocked in saline for 5 days. Herpes virus- and host-derived transcripts contained in crusts can be detected by RT-PCR amplification. Crusts or dry epidermal necrosis with inflammatory cells may provide beneficial diagnostic information. PMID: 18693150 [PubMed - indexed for MEDLINE] 296. Clin Exp Dermatol. 2009 Apr;34(3):409-10. Epub 2008 Aug 7. Haemorrhagic herpes zoster associated with clopidogrel treatment. Ghosh S, Bandyopadhyay D. PMID: 18691243 [PubMed - indexed for MEDLINE] 297. Zh Nevrol Psikhiatr Im S S Korsakova. 2007;107(2):76-9. [The current aspects of herpes-zoster infection. Post herpes neuralgia: clinical symptoms, treatment, prevention] [Article in Russian] Volkova AI. PMID: 18689003 [PubMed - indexed for MEDLINE] 298. Clin Interv Aging. 2008;3(2):241-50. Zoster vaccine live for the prevention of shingles in the elderly patient. Zussman J, Young L. Department of Medicine, Dermatology Division, David Geffen School of Medicine at the University of California, Los Angeles, California 90095-6957, USA. Shingles, also known as herpes zoster, is a common disease in the elderly population that is caused by reactivation of latent varicella zoster virus. Its manifestations and complications can lead to significant short- and long-term morbidity. In 2006, the United States Food and Drug Administration approved Zoster Vaccine Live (Zostavax) for the prevention of herpes zoster in immunocompetent adults age 60 and over. The approval was based on the results ofa large, multi-center clinical trial, the Shingles Prevention Study. This study showed that vaccination significantly decreased shingles incidence, burden of illness due to disease, and the development of, and severity of postherpetic neuralgia. This review offers an overview of varicella zoster virus infection and complications, a summary of the Shingles Prevention Study, and a critical analysis designed to aid the practicing physician who has questions about vaccine administration. PMCID: PMC2546469 PMID: 18686747 [PubMed - indexed for MEDLINE] 299. Clin Exp Dermatol. 2008 Nov;33(6):740-2. Epub 2008 Aug 2. Pseudozoster clinical presentation of Demodex infestation after prolonged topical steroid use. Karincaoglu Y, Tepe B, Kalayci B, Seyhan M. Department of Dermatology, Inonu University School of Medicine, Malatya, Turkey. ykarincaoglu@inonu.edu.tr A 60-year-old man presented with a plaque lesion on the upper right half of the face, which had developed after ophthalmic varicella zoster infection about 2 years previously. The lesion, which was burning and itchy, included a few tiny erythematous pustules, and was slightly squamous and infiltrated. The lesion covered the upper two-thirds of the right trigeminal nerve dermatome, involving half of the face with the forehead, the periorbital area, upper part of the cheek and the nose. The lesion became more marked after continuous topical anaesthetic and corticosteroid use. A standardized skin-surface biopsy was taken, and revealed a large number of Demodex folliculorum (38/cm(2)) in the lesion area. The lesions completely abated after topical 5% permethrin treatment, and no recurrence was observed during follow-up. Demodicosis may have atypical clinical presentations, other than the well-known classic forms. To our knowledge, this is the first unilateral trigeminal, pseudozoster presentation in the literature. PMID: 18684117 [PubMed - indexed for MEDLINE] 300. Clin Infect Dis. 2008 Sep 15;47(6):783-9. Clinical features of viral meningitis in adults: significant differences in cerebrospinal fluid findings among herpes simplex virus, varicella zoster virus, and enterovirus infections. Ihekwaba UK, Kudesia G, McKendrick MW. Department of Infection and Tropical Medicine, Sheffield Teaching Hospitals, National Health Service Foundation Trust, Sheffield, United Kingdom. BACKGROUND: In this retrospective study, our objective was to review the epidemiology of viral meningitis and to compare clinical features associated with enterovirus, herpes simplex virus (HSV), and varicella zoster virus (VZV) infections in immunocompetent adults. METHODS: Data on cerebrospinal fluid (CSF) samples submitted to the Trust Virology Laboratory (Sheffield, UK) from April 2004 through April 2007 were reviewed. Notes on immunocompetent adults who were polymerase chain reaction (PCR) positive for enterovirus, HSV type 2, or VZV and who had presented to local clinical departments were scrutinized (4 patients were positive for HSV type 1 and did not meet the inclusion criteria). RESULTS: A total of 2045 samples were analyzed for viral pathogens during the 3-year period. Of the 109 PCR-positive samples, 38 (35%) were from immunocompetent adults, of whom 22 were infected with enterovirus, 8 were infected with HSV type 2, and 8 were infected with VZV. The median ages were 32 years (range, 16-39 years), 39 years (range, 22-53 years), and 47.5 years (range, 26-80 years), respectively. Rash occurred after the meningitis symptoms in 5 patients infected with VZV (median time from meningitis symptoms to rash, 6 days). Protein levels were significantly higher in CSF samples from patients infected with HSV type 2 (median, 1205 mg/L) and in samples from those infected with VZV (median, 974 mg/L) than in samples from those infected with enterovirus (median, 640 mg/L; P = .001 and P = .01, respectively). White blood cell counts were significantly higher in CSF samples from patients infected with HSV type 2 (median, 240 x 10(6) cells/L) than in samples from those infected with enterovirus (median, 51 x 10(6) cells/L; P = .01). CONCLUSIONS: Enterovirus infection was the most common cause of viral meningitis in immunocompetent adults in this study. White blood cell counts and protein levels were significantly higher in CSF samples from patients infected with HSV type 2 than in samples from patients with enterovirus infection. Zoster rash often occurs after meningitis. PCR testing provides a rapid and specific etiological diagnosis. PMID: 18680414 [PubMed - indexed for MEDLINE] 301. Clin Infect Dis. 2008 Sep 15;47(6):754-9. Hospitalizations to treat herpes zoster in older adults: causes and validated rates. Jackson LA, Reynolds MA, Harpaz R. Group Health Center for Health Studies, Seattle, Washington 98101, USA. Jackson.L@ghc.org BACKGROUND: The availability of a vaccine for the prevention of herpes zoster has increased interest in methods to measure zoster disease burden. Hospitalizations assigned a zoster diagnosis code have been used as indicators of severe zoster in prior studies. However, a zoster diagnosis code may not be a specific indicator of severe zoster illness, because the code may be assigned to a hospitalization for another cause in a person with coincident zoster. METHODS: To assess the validity of a hospital diagnosis code of zoster as an indicator of hospitalizations that are attributable to zoster, we identified all hospitalizations with a zoster diagnosis code assigned in any position among members of a managed-care organization who were >or=50 years of age during 1992-2004. Of those, we selected a sample of 260 hospitalizations for chart review. RESULTS: Chart reviews were completed for 225 hospitalizations. Sixty-five (29%) were because of zoster or a complication of zoster treatment, and an additional 9 (4%) were because of postherpetic neuralgia or a complication of postherpetic neuralgia treatment. Although the overall age-adjusted rate of hospitalizations with a zoster diagnosis code was 42.5 hospitalizations per 100,000 population per year, the estimated rate of hospitalizations because of zoster, postherpetic neuralgia, or adverse effects of a medication used to treat zoster or postherpetic neuralgia was only 14.0 hospitalizations per 100,000 population per year. CONCLUSIONS: Rates of hospitalizations associated with a zoster diagnosis code will substantially overestimate the burden of hospitalizations attributable to zoster in older adults. PMID: 18680413 [PubMed - indexed for MEDLINE] 302. Reg Anesth Pain Med. 2008 Jul-Aug;33(4):320-5. Analgesic effect of lidocaine patch 5% in the treatment of acute herpes zoster: a double-blind and vehicle-controlled study. Lin PL, Fan SZ, Huang CH, Huang HH, Tsai MC, Lin CJ, Sun WZ. Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan. BACKGROUND AND OBJECTIVES: Although lidocaine patch 5% has been widely used for postherpetic neuralgia, its analgesic effect on the intense pain associated with acute herpes zoster has not been investigated because of its potential hazard to damaged skin. METHODS: Forty-six patients suffering from moderate to severe pain caused by acute herpes zoster infection (within 4 weeks of onset) were enrolled in a randomized, double-blind, vehicle-controlled, parallel study. Lidocaine patch 5% or vehicle patch were applied to the intact portion of the painful skin area without blisters at 12-hour intervals twice a day for 2 consecutive days. Analgesic efficacy and side effect profiles were assessed before and 48 hours after patch application. RESULTS: We found that both groups of patients experienced significant pain relief during rest and movement. Differences of mean reduction of pain intensity between the two groups were 14.7 (4.7-24.8, P = 0.005) during rest and 10.4 (1.6-19.3, P = 0.007) during movement, favoring the lidocaine patch. The lidocaine patch produced a greater percentage change in a patient's global impression than the vehicle patch. The incidence and severity of adverse events were low with both treatments. CONCLUSIONS: This study demonstrates that lidocaine patch 5%, applied twice a day, could serve as a well tolerated and effective modality to relieve moderate to severe pain associated with acute herpes zoster presumably through its pharmacological action and physical barrier effect on sensitized skin. PMID: 18675742 [PubMed - indexed for MEDLINE] 303. Joint Bone Spine. 2008 Oct;75(5):540-3. Epub 2008 Jul 31. Herpes zoster in patients taking TNFalpha antagonists for chronic inflammatory joint disease. Wendling D, Streit G, Toussirot E, Prati C. Service de Rhumatologie, CHU Minjoz et Université de Franche-Comté, 25030 Besançon, France. dwendling@chu-besancon.fr OBJECTIVE: To assess the rate of occurrence and outcomes of herpes zoster in patients taking TNFalpha antagonists. METHODS: Retrospective review of the medical records of 300 patients who received TNFalpha antagonists to treat chronic inflammatory joint disease. RESULTS: We identified 9 (9/300, 3%) patients who experienced herpes zoster, 6 women and 3 men, with rheumatoid arthritis (n=7) or ankylosing spondylitis (n=2). The drug was infliximab in 4 patients, adalimumab in 2 patients, and etanercept in 3 patients, including 2 patients with a prior history of infliximab therapy (for 12 and 36 months, respectively). Mean treatment duration at the occurrence of herpes zoster was 27 months (range, 6-42 months). DISCUSSION: Glucocorticoid therapy (n=7) and methotrexate therapy (n=6) were the only risk factors identified in our study. Mean follow-up was 26 months. All 9 patients achieved a full recovery with antiviral treatment and interruption of the TNFalpha antagonist. One patient experienced a recurrence after resuming TNFalpha antagonist therapy. CONCLUSION: The scant data in the literature suggest a higher risk of herpes zoster with anti-TNFalpha antibodies than with the soluble receptor. The role for concomitant treatments (glucocorticoids and methotrexate) should be taken into account. PMID: 18674945 [PubMed - indexed for MEDLINE] 304. Endoscopy. 2008 Sep;40 Suppl 2:E157-8. Herpes simplex virus esophagitis in an immunodeficient patient with non-small-cell lung cancer following a disseminated herpes zoster infection. Gundling F, Rohrbach H, Nerlich A, Schepp W. Second Department of Medicine, Bogenhausen Academic Teaching Hospital, Technical University of Munich, Munich, Germany. Gastroenterologie@kh-bogenhausen.de PMID: 18668447 [PubMed - indexed for MEDLINE] 305. Otol Neurotol. 2009 Apr;30(3):428-9. Ramsay hunt syndrome: a histopathologic observation of a facial sequelae. de Mendonca Vaz R, Linthicum FH Jr. State University of Campinas, UNICAMP, Sao Paulo, Brazil. PMCID: PMC2757922 PMID: 18665005 [PubMed - indexed for MEDLINE] 306. Pediatr Infect Dis J. 2008 Sep;27(9):847-8. Vaccine-strain varicella zoster virus causing recurrent herpes zoster in an immunocompetent 2-year-old. Ota K, Kim V, Lavi S, Ford-Jones EL, Tipples G, Scolnik D, Tellier R. The Hospital for Sick Children, Toronto, ON, Canada. Varivax III is a live attenuated vaccine against varicella zoster virus (VZV). We report a case of recurrent vaccine-strain herpes zoster in an immunocompetent 2-year-old child. Vaccine-strain VZV was identified through polymerase chain reaction. This report aims to alert physicians that recurrent vaccine-strain herpes zoster can be a rare complication of VZV vaccination in apparently immunocompetent hosts. PMID: 18664930 [PubMed - indexed for MEDLINE] 307. J Fam Pract. 2008 Apr;57(4 Suppl):S1-11; quiz S12. Update on vaccine-preventable diseases: are adults in your community adequately protected? Schaffner W. Department of Preventive Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA. Comment in: J Fam Pract. 2008 Jul;57(7):438. Vaccine-preventable diseases continue to be a significant cause of morbidity and premature death among adults. The Advisory Committee on Immunization Practices Recommended Adult Immunization Schedule provides recommendations for 14 vaccine-preventable diseases. This supplement reviews the benefits of immunization against 6 vaccine-preventable diseases that physicians frequently encounter among adult patients: influenza, pneumococcal infections, herpes zoster, human papillomavirus, and hepatitis B. PMID: 18655764 [PubMed - indexed for MEDLINE] 308. Clin Pediatr (Phila). 2009 Jan;48(1):116-8. Epub 2008 Jul 25. Severe headache. Tolbert C, Kamat R, Chhabra S. Inova Fairfax Hospital for Children, Fall Church, Virginia, USA. PMID: 18660456 [PubMed - indexed for MEDLINE] 309. Neurol Clin. 2008 Aug;26(3):675-97, viii. Varicella zoster virus infection: clinical features, molecular pathogenesis of disease, and latency. Mueller NH, Gilden DH, Cohrs RJ, Mahalingam R, Nagel MA. Department of Neurology, University of Colorado School of Medicine, 4200 East 9th Avenue, Mail Stop B182, Denver, CO 80262, USA. Varicella zoster virus (VZV) is an exclusively human neurotropic alphaherpesvirus. Primary infection causes varicella (chickenpox), after which virus becomes 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 elderly and immunocompromised individuals, VZV reactivates and causes a wide range of neurologic disease. This article discusses the clinical manifestations, treatment, and prevention of VZV infection and reactivation; pathogenesis of VZV infection; and current research focusing on VZV latency, reactivation, and animal models. PMCID: PMC2754837 PMID: 18657721 [PubMed - indexed for MEDLINE] 310. J Infect. 2008 Sep;57(3):266-8. Epub 2008 Jul 24. Famciclovir substitution for patients with acyclovir-associated renal toxicity. Htwe TH, Bergman S, Koirala J. Division of Infectious Diseases, Department of Medicine, Southern Illinois University School of Medicine, Springfield, P.O. Box-19636, IL 62794-9636, USA. Acyclovir-induced nephrotoxicity is well known, but published literature lacks information on the safety of substitution with other antiviral agents. We describe four patients with acyclovir-induced renal toxicity that were subsequently managed with hydration and famciclovir. All four patients subsequently had improvements in their symptoms with full recovery of their baseline renal function. PMID: 18656262 [PubMed - indexed for MEDLINE] 311. Masui. 2008 Jul;57(7):874-8. [Effective treatment of acute pain and related symptoms in elderly with herpes zoster] [Article in Japanese] Tajima K, Kawagoe I, Kanai M, Mitsuhata H. Department of Anesthesiology and Pain Medicine, Juntendo Tokyo Koto Geriatric Medical Center Tokyo 136-5632. BACKGROUND: The incidence of herpes zoster increases with age. Immediate pain relief is required for prevention of postherpetic neuralgia (PHN) and also its related symptoms that worsen the general condition because acute herpetic pain often interferes with sleep, mood, and general activities in elderly patients. Nerve block is useful to relief acute pain and recommended for prevention of PHN. Tricyclic antidepressant drugs have antinoticeptive effect in acute pain in experimental models, in addition to its antidepressant effect. METHODS: Forty elderly patients with herpes zoster within 3 months after the onset underwent nerve blocks and received tricyclic antidepressant drugs. We assessed the effect of treatments and adverse effects. RESULTS: No significant adverse effects were found in elderly patients who had received nerve blocks and/or tricyclic antidepressant drugs. Alleviation of acute pain was obtained in more than 80% of patients, and in all patients depressive state and/or disturbance of the general condition were significantly improved. CONCLUSIONS: With careful technique and assessment of patients, both nerve block and tricyclic antidepressant drugs were beneficial and safe treatments in elderly patients with herpes zoster. PMID: 18649643 [PubMed - indexed for MEDLINE] 312. Cochrane Database Syst Rev. 2008 Jul 16;(3):CD006852. Corticosteroids as adjuvant to antiviral treatment in Ramsay Hunt syndrome (herpes zoster oticus with facial palsy) in adults. Uscategui T, Doree C, Chamberlain IJ, Burton MJ. Department of Paediatrics, Basildon University Hospital, Nethermayne, Basildon, Essex, UK, SS16 5NL. tere_u@yahoo.com BACKGROUND: Inflammation and oedema of the facial nerve due to viral infection by the herpes zoster virus are implicated in the aetiology and clinical manifestation of Ramsay Hunt syndrome (herpes zoster oticus with facial palsy). Corticosteroids, with their powerful anti-inflammatory effect, have a potential role to play in the reduction or minimisation of nerve damage when administered together with antiviral therapy, and therefore may improve the outcome for patients with Ramsay Hunt syndrome. OBJECTIVES: To determine the effectiveness of corticosteroids as an adjuvant to antiviral therapy in adult patients with Ramsay Hunt syndrome (herpes zoster oticus with facial palsy). SEARCH STRATEGY: We searched the Cochrane ENT Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), (The Cochrane Library Issue 4, 2007), MEDLINE (1950 to December 2007) and EMBASE (1974 to December 2007), CINAHL (1982 to December 2007), LILACS, KoreaMed, IndMed, PakMediNet, ZETOC, Cambridge Scientific Abstracts (Conference Proceedings Database), ISI Proceedings (Web of Science), the National Research Register (NRR), the UK Clinical Research Network Portfolio Database (UKCRN), the World Health Organization International Clinical Trials Registry Platform (ICTRP), the Research Findings Register (ReFeR) and the metaRegister of Controlled Trials (mRCT). SELECTION CRITERIA: All randomised controlled trials in which corticosteroids (by any route of administration at any dosage) were given as an adjuvant to antiviral agents in the treatment of Ramsay Hunt syndrome. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed eligibility and trial quality of the available studies, whether they were published or unpublished. No trials were found and therefore no data were analysed. MAIN RESULTS: This is an empty review as no trials were found that fulfilled the inclusion criteria. AUTHORS' CONCLUSIONS: Since no randomised controlled trials investigating the use of corticosteroids as an adjuvant to antiviral treatment in Ramsay Hunt syndrome were identified, such studies are needed to assess the effects of such therapy. PMID: 18646170 [PubMed - indexed for MEDLINE] 313. Biol Blood Marrow Transplant. 2008 Aug;14(8):867-71. Varicella-zoster virus disease is more frequent after cord blood than after bone marrow transplantation. Vandenbosch K, Ovetchkine P, Champagne MA, Haddad E, Alexandrov L, Duval M. Groupe de Recherche en Immunologie et Transplantation de Sang de Cordon, Service d'Hématologie-Oncologie, Centre de Cancérologie Charles-Bruneau, Montréal, Québec, Canada. Immune reconstitution may differ following cord blood transplantation (CBT) and bone marrow transplantation (BMT), and this may lead to a difference in varicella zoster virus (VZV) disease rates. One hundred fourteen VZV seropositive children received a CBT (37 patients), or a T-replete BMT (77 patients) at our institution. Patients did not received specific VZV disease prophylaxis. VZV disease was diagnosed by immunofluorescence or culture in 41 (36%) patients. In multivariate analysis, VZV disease was more frequent in older children (relative risk [RR] 1.11 per year; 95% confidence interval [CI], 1.04-1.18; P = .002), and after CBT (RR 2.27; 95% CI, 1.18-4.34; P = .013). The cumulative incidence of VZV disease at 3 years posttransplant was 46% following CBT. VZV disease incidence was 71% in CBT patients over 10 years old at transplant. Visceral dissemination occurred in 7 patients (6 CBT and 1 BMT) (P = .005). VZV disease is thus more frequent and more severe after CBT than after BMT. PMID: 18640569 [PubMed - indexed for MEDLINE] 314. J Fam Pract. 2008 Jul;57(7):438. FluMist: refrigerated, never frozen. Susla GM. Comment on: J Fam Pract. 2008 Apr;57(4 Suppl):S1-11; quiz S12. PMID: 18634200 [PubMed - indexed for MEDLINE] 315. Intern Emerg Med. 2009 Feb;4(1):65-6. Epub 2008 Jul 16. Herpetic leg paralysis and abdominal ileus in a patient with idiopathic myelofibrosis. Nicoli P, Bosa M, Rotolo A, Cilloni D, Saglio G. PMID: 18629653 [PubMed - indexed for MEDLINE] 316. Ann Pharmacother. 2008 Sep;42(9):1323-6. Epub 2008 Jul 15. Famciclovir-induced leukocytoclastic vasculitis. Te CC, Le V, Allee M. Department of Internal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73190, USA. charles-te@ouhsc.edu OBJECTIVE: To report a case of famciclovir-induced leukocytoclastic vasculitis (LCV). CASE SUMMARY: A 67-year-old white female presented to the hospital for evaluation of large, bilateral palpable purpura; coalescing ulcers with central eschars; and small, red violaceous papules on her legs and groin. Approximately 2 months prior to this hospitalization, the woman was diagnosed with shingles of her left T1-T2 nerve distribution and was treated with famciclovir 500 mg 3 times daily, which was her first exposure to this medication. Her shingles resolved; however, on day 4 of treatment, she began to notice red spots on both of her legs that began to progressively blister and increase in size. She discontinued famciclovir at that time. The rash persisted and spread to her abdomen, groin, legs, feet, and toes. She underwent punch biopsy that revealed LCV. Workup was negative for antinuclear antibody, rheumatoid factor, hepatitis B and C virus, perinuclear-staining antineutrophil cytoplasmic antibodies, cytoplasmic-staining antineutrophil cytoplasmic antibodies, antibodies to extractable nuclear antigens, proteinase 3, and myeloperoxidase. The patient improved with daily oral steroids and local wound care. DISCUSSION: LCV has been reported only once before in the English literature as of January 2008. The most common cause of LCV is medication use, but it is a diagnosis of exclusion. It is hypothesized that drugs act as haptens, which cause an immune response. An objective causality assessment using the Naranjo probability scale suggested that famciclovir was the probable cause of LCV in this patient. CONCLUSIONS: Healthcare professionals should be aware of the possible development of famciclovir-induced LCV. PMID: 18628445 [PubMed - indexed for MEDLINE] 317. Clin Transplant. 2008 Jul-Aug;22(4):502-7. Epub 2008 Jul 8. Herpes zoster infection after liver transplantation in patients receiving induction therapy with alemtuzumab. Alcaide ML, Abbo L, Pano JR, Gaynor JJ, Tryphonopoulos P, Weppler D, Moon JI, Tzakis AG, Morris MI. Department of Infectious Diseases, Miller School of Medicine, Miami, FL 33136, USA. BACKGROUND: The incidence of herpes zoster (HZ) infection in liver transplant recipients prior to the use of induction therapy with monoclonal antibodies has been reported as being 1.2-18%. We studied the occurrence of HZ in liver transplant recipients that received induction therapy with alemtuzumab (Campath 1H). MATERIAL AND METHODS: This was a retrospective review of primary liver transplant recipients who received alemtuzumab as induction therapy at our center. HZ infection was diagnosed clinically as the presence of a characteristic vesicular rash in a dermatomal distribution without any further virological confirmation. RESULTS: A total of 118 liver transplant recipients were treated with alemtuzumab between August 2002 and August 2005. Twelve patients developed HZ infection, and the cumulative probability of a patient developing HZ infection by 36 months post-transplant +/-1 SE was estimated as 16.5 +/- 5.0%. The median time for onset of the infection was 10.2 months (range 4.7-30.7) after the transplant. All patients had only one dermatomal distribution, and none developed systemic infection or complications such as postherpetic neuropathy. All patients except one were treated with systemic intravenous acyclovir. One patient received famciclovir. All of the patients had received ganciclovir during the post-transplant period but were not receiving any other antiviral medication at the time of the infection. CONCLUSION: Herpes zoster infection has previously been reported as a frequent complication of liver transplantation. Our study suggests that it occurs in approximately 16% of patients receiving induction therapy with alemtuzumab. Although alemtuzumab is a powerful immunosuppressive agent and there is still little information regarding its long-term safety when used in liver transplantation, our data do not suggest any increase in the occurrence and complications of HZ. PMID: 18627401 [PubMed - indexed for MEDLINE] 318. Vaccine. 2008 Sep 26;26(41):5244; author reply 5245. Epub 2008 Jul 9. Interpretation of results of the cost-effectiveness analysis reported by Pellissier et al. on October 2007. Najafzadeh M, Sadatsafavi M, Marra CA. Comment on: Vaccine. 2007 Nov 28;25(49):8326-37. PMID: 18619510 [PubMed - indexed for MEDLINE] 319. Gastroenterology. 2008 Aug;135(2):362, 715. Epub 2008 Jul 9. Clinical challenges and images in GI. Colonic pseudo-obstruction as a rare complication of herpes zoster. Dedemadi G, Georgoulis G. Department of Surgery, "A. Fleming" Hospital, Athens, Greece. PMID: 18619453 [PubMed - indexed for MEDLINE] 320. J Clin Neurosci. 2008 Sep;15(9):1068-9. Epub 2008 Jul 9. Tuberculous myelitis diagnosed by elevated adenosine deaminase activity in cerebrospinal fluid. Suda S, Ueda M, Komaba Y, Yamazaki M, Katsumata T, Katayama Y. PMID: 18617398 [PubMed - indexed for MEDLINE] 321. J Dermatolog Treat. 2008;19(4):255-6. Perineal muco-cutaneous herpes zoster treated with brivudin. Correia O, Pereira MA, Pereira T, Santos A. Centro Dermatologia Epidermis, Faculty of Medicine University of Porto, Portugal. Herpes zoster results from the reactivation of latent varicella-zoster virus (VZV) from the dorsal root ganglion of sensory nerves. It is rarely described in the pediatric population. We report the case of an 8-year-old immunocompetent boy with a painful lumbosacral herpes zoster that was treated with brivudin and achieved rapid and sustained improvement in the absence of muco-cutaneous or pharmacological side effects. PMID: 18608718 [PubMed - indexed for MEDLINE] 322. Kathmandu Univ Med J (KUMJ). 2006 Apr-Jun;4(2):246-8. Hemidiaphragmatic paralysis: a rare complication of cervical herpes zoster. Paudyal BP, Karki A, Zimmerman M, Kayastha G, Acharya P. Department of Medicine, Patan Hospital, Lalitpur, Nepal. buddhipaudyal@yahoo.com Herpes zoster, a sequel of the reactivation of the varicella zoster virus, usually presents with cutaneous eruptions associated with intense pain and burning sensation in the affected dermatomes. Motor weakness, however, can sometimes complicate herpes zoster. In this report we present a case that had diaphragmatic motor weakness as a sequel of herpes zoster lesions in the neck. PMID: 18603908 [PubMed - indexed for MEDLINE] 323. Int J Infect Dis. 2009 Jan;13(1):e1-8. Epub 2008 Jul 3. Incidence of common opportunistic infections in HIV-infected individuals in Pune, India: analysis by stages of immunosuppression represented by CD4 counts. Ghate M, Deshpande S, Tripathy S, Nene M, Gedam P, Godbole S, Thakar M, Risbud A, Bollinger R, Mehendale S. National AIDS Research Institute, Pune, India. mghate@nariindia.org BACKGROUND: Opportunistic infections (OIs) influence the morbidity and mortality due to HIV infections. Data from India on the incidence of OIs among HIV-infected individuals by stages of immunodeficiency are scarce. METHODS: Between September 2002 and November 2004, HIV-infected individuals were enrolled in a prospective study in Pune. They were clinically and immunologically evaluated quarterly. Incidence rates of specific OIs were calculated. RESULTS: Median CD4 counts in HIV-infected male and female patients at baseline were 197/mm(3) and 413/mm(3), respectively. Tuberculosis was the most common OI with an incidence of 15.4 (95% CI 12.2-19.2) per 100 person-years, followed by oral candidiasis 11.3 (95% CI 8.6-14.5), herpes zoster 10.1 (95% CI 7.6-13.1), and cryptococcal meningitis 1.7 (95% CI 0.8-3.1) per 100 person-years. Patients with baseline CD4 counts of <200/mm(3) were six times more likely to develop OIs compared to those with CD4 counts of >350/mm(3) (p<0.001). CONCLUSIONS: The high incidence of commonly reported OIs in Indian HIV-infected individuals highlights the need for early screening and also the need to increase awareness in healthcare providers, in order to improve decisions regarding prophylaxis for prevention and appropriate therapeutic intervention. Emphasis needs to be given to the early diagnosis and management of tuberculosis in HIV-infected individuals. PMID: 18602329 [PubMed - indexed for MEDLINE] 324. Semin Ophthalmol. 2008 Jul-Aug;23(4):285-90. Therapy for acute retinal necrosis. Kawaguchi T, Spencer DB, Mochizuki M. Department of Ophthalmology & Visual Science, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan. Acute retinal necrosis is a progressive necrotizing retinopathy caused by herpes simplex virus (HSV) or varicella zoster virus (VZV). The mainstay of its treatment is antiviral therapy against these pathogenic organisms, such as intravenous acyclovir or oral valacyclovir. Systemic and topical corticosteroids together with antiviral therapy are used as an anti-inflammatory treatment to minimize damages to the optic nerve and retinal blood vessels. Because the majority of severe cases of the disease show occlusive retinal vasculitis, a low dosage of aspirin is used as anti-thrombotic treatment. Vitreo-retinal surgery is useful to repair rhegmatogenous retinal detachment, one of the main late-stage complications. Moreover, recent articles have reported some encouraging results of prophylactic vitrectomy before rhegmatogenous retinal detachment occurs. The efficacy of laser photocoagulation to prevent the development or extension of rhegmatogenous retinal detachment is controversial. Despite these treatments, the visual prognosis of acute retinal necrosis is still poor, in particular VZV-induced acute retinal necrosis. PMID: 18584565 [PubMed - indexed for MEDLINE] 325. Semin Ophthalmol. 2008 Jul-Aug;23(4):275-83. Overview and diagnosis of acute retinal necrosis syndrome. Usui Y, Goto H. Department of Ophthalmology, Tokyo Medical University Hospital, Tokyo, Japan. usuyoshi@aol.com Acute retinal necrosis (ARN) syndrome, also known as Kirisawa's uveitis, is one of the most serious ocular diseases, and is characterized by a combination of peripheral, confluent, necrotizing retinitis, retinal arteritis, and intraocular inflammation. ARN syndrome is caused by the herpesvirus family, including herpes simplex virus (HSV) and varicella-zoster virus (VZV). The diagnosis of ARN syndrome is fundamentally based on clinical appearance and the demonstration of viral infection. Recently, polymerase chain reaction techniques permit detection of very small amounts of viral DNA in intraocular specimens. This knowledge can help in both the diagnosis and design of therapeutic strategy for ARN syndrome. Here we review the clinical presentation and the current advances in the diagnosis of ARN syndrome. PMID: 18584564 [PubMed - indexed for MEDLINE] 326. Semin Ophthalmol. 2008 Jul-Aug;23(4):235-40. Corneal endotheliitis. Suzuki T, Ohashi Y. Department of Ophthalmology, Ehime University School of Medicine, Ehime, Japan. Corneal endotheliitis is an intriguing clinical entity manifested by corneal edema, keratic precipitates, and mild anterior chamber reaction, and can be defined as a spectrum of the disorder in which the corneal endothelium is the primary site of the inflammation. The disease etiology consists of accumulating evidence of various viral infections including herpes simplex virus, varicella zoster virus, and cytomegalovirus. Corneal endotheliitis can be classified clinically into four forms: linear, sectorial, disciform, and diffuse. Antiviral treatment in combination with topical corticosteroids is generally effective to suppress the inflammation; however, irreversible corneal endothelial dysfunction may develop in some cases. PMID: 18584561 [PubMed - indexed for MEDLINE] 327. MMW Fortschr Med. 2008 May 22;150(21):33-4. [Case report: again just an idiopathic facial nerve palsy?] [Article in German] Seidel BM, Pichler J, Grüne S. Discipline of General Practice, The University of Adelaide, Australien. bastian.seidel@adelaide.edu.au PMID: 18575251 [PubMed - indexed for MEDLINE] 328. Rinsho Ketsueki. 2008 May;49(5):331-4. [Aggravated post-herpetic neuralgia due to bortezomib] [Article in Japanese] Kirizume K, Imataki O, Shintani T, Fujihara S, Waki F, Ohue Y, Ohnishi H. Post-graduate Clinical Education Center, Kagawa University Hospital, Kagawa, Japan. Bortezomib, a proteasome inhibitor, has been used for patients with refractory multiple myeloma. We present a 58-year old man who had IgG-gamma-type multiple myeloma, refractory for MP (melphalan-predonisolone) and VAD (vincrisitine-doxorubicin-dexamethasone) therapy. He was complicated with reactivation of varicella-zoster virus (VZV) 4 weeks before bortezomib administration. Two weeks of consolidation treatment with standard dose valaciclovir caused VZV infection to settle down and, after a further 2 weeks, VZV remission was confirmed. Bortezomib was started at a dose of 1.3 mg/m2 with prophylactic use of valaciclovir for VZV reactivation, post-herpetic neuralgia exacerbated the following day and grade 3 neuralgia developed the following week without recurrence of skin eruption. Neuralgia improved after the cessation of bortezomib with various supportive treatments and interventions. Although the reactivation of VZV was suspicious, no apparent skin lesions were observed. Although the mechanisms of post-herpetic neuralgia and chemotherapy-induced neuropathy are different, bortezomib might enhance post-herpetic neuralgia independent of the manner of viral reactivation. PMID: 18572810 [PubMed - indexed for MEDLINE] 329. AJNR Am J Neuroradiol. 2008 Oct;29(9):1743-5. Epub 2008 Jun 19. A case of Varicella zoster virus polyneuropathy: involvement of the glossopharyngeal and vagus nerves mimicking a tumor. Adachi M. Department of Radiology, Ohshima Clinic, Yamagata, Japan. miadchi@beach.ocn.ne.jp A 36-year-old woman presented with glossopharyngeal and vagus nerve palsy, which proved to be herpes zoster based on the high titers of Varicella zoster virus antibody in her serum. Thin-section T1-weighted images with contrast media demonstrated swelling and distinct contrast enhancement of the glossopharyngeal and vagus complex, mimicking a tumor. Following MR imaging, the size of the nerve complex returned to normal; however, the contrast enhancement remained longer than the symptoms. PMID: 18566008 [PubMed - indexed for MEDLINE] 330. Acta Neurol Taiwan. 2008 Mar;17(1):47-9. Acute orbital myositis heralding herpes zoster ophthalmicus: report of a case. Tseng YH. From the Department of Neurology, Chia-Yi Yang-Ming Hospital, Taiwan. erwintseng@hotmail.com We report a rare case that developed orbital myositis before appearance of zoster rashes. A 54 year-old man came to our hospital with a 4-day history of left orbital shooting pain extending to left temporal area. Neurological examinations demonstrated mild left proptosis and hyperemic conjunctiva without ophthalmoplegia. Brain magnetic resonance imaging (MRI) revealed left orbital myositis and periorbital skin eruptions appeared two days after this MRI study. The symptoms were improved after antiviral therapy and a follow-up MRI showed resolution of orbital myositis. Herpes zoster ophthalmicus may present as acute orbital myositis preceding skin eruptions and the recovery of orbital myositis was excellent in these patients. Our patient had postherpetic neuralgia which did not develop in previously reported cases. We conclude that herpes zoster should be listed as a cause of orbital myositis even without skin rashes. PMID: 18564828 [PubMed - indexed for MEDLINE] 331. J Fr Ophtalmol. 2008 Apr;31(4):457-8. [Zona ophthalmica. Part I] [Article in French] Labetoulle M. Service d'Ophtalmologie, Hôpital de Bicêtre, Le Kremlin-Bicêtre. PMID: 18563049 [PubMed - indexed for MEDLINE] 332. J Virol. 2008 Sep;82(17):8673-86. Epub 2008 Jun 18. Nuclear import of the varicella-zoster virus latency-associated protein ORF63 in primary neurons requires expression of the lytic protein ORF61 and occurs in a proteasome-dependent manner. Walters MS, Kyratsous CA, Wan S, Silverstein S. Department of Microbiology, College of Physicians and Surgeons, Columbia University, New York, New York 10032, USA. Varicella-zoster virus (VZV) open reading frame (ORF) 63 protein (ORF63p) is one of six VZV ORFs shown to be transcribed and translated in latently infected human dorsal root ganglia. ORF63p accumulates exclusively in the cytoplasm of latently infected sensory neurons, whereas it is both nuclear and cytoplasmic during lytic infection and following reactivation from latency. Here, we demonstrate that infection of primary guinea pig enteric neurons (EN) with an adenovirus expressing ORF63p results in the exclusive cytoplasmic localization of the protein reminiscent of its distribution during latent VZV infection in humans. We show that the addition of the simian virus 40 large-T-antigen nuclear localization signal (NLS) results in the nuclear import of ORF63p in EN and that the ORF63p endogenous NLSs are functional in EN when fused to a heterologous protein. These data suggest that the cytoplasmic localization of ORF63p in EN results from the masking of the NLSs, thus blocking nuclear import. However, the coexpression of ORF61p, a strictly lytic VZV protein, and ORF63p in EN results in the nuclear import of ORF63p in a proteasome-dependent manner, and both ORF63p NLSs are required for this event. We propose that the cytoplasmic localization of ORF63p in neurons results from NLS masking and that the expression of ORF61p removes this block, allowing nuclear import to proceed. PMCID: PMC2519623 PMID: 18562514 [PubMed - indexed for MEDLINE] 333. SADJ. 2008 Mar;63(2):106-10. Alveolar bone necrosis and spontaneous tooth exfoliation in an HIV-seropositive subject with herpes zoster. Feller L, Wood NH, Raubenheimer EJ, Meyerov R, Lemmer J. Department of Periodontology and Oral Medicine, School of Dentistry, University of Limpopo, Medunsa Campus, South Africa. lfeller@medunsa.ac.za Herpes zoster in the distribution of the maxillary and mandibular divisions of the trigeminal nerve is characterized by painful vesicular eruptions of the skin and oral mucosa in the distribution of the affected nerves. Oral complications may occur, including post-herpetic neuralgia, devitalization of teeth, abnormal development of permanent teeth, root resorption and periapical lesions. In cases where necrosis of the alveolar bony process occur it may be preceded or accompanied by spontaneous exfoliation of teeth. This usually follows the resolution of the acute phase of HZ and is more prevalent in HIV-seropositive than in HIV-seronegative subjects. A case of HZ of the trigeminal nerve in an HIV-seropositive subject, with complications of necrosis of alveolar bony process, external root resorption and tooth exfoliation is presented and the literature of HIV-associated HZ is reviewed. PMID: 18561810 [PubMed - indexed for MEDLINE] 334. Internist (Berl). 2008 Jul;49(7):887-90. [Therapy of herpes zoster] [Article in German] Ullmann AJ. III. Medizinische Klinik und Poliklinik, Klinikum Johannes Gutenberg Universität, Mainz, Langenbeckstrasse 1, 55101 Mainz, Deutschland. ullmann@uni-mainz.de PMID: 18551263 [PubMed - indexed for MEDLINE] 335. Int J Prosthodont. 2008 May-Jun;21(3):253-8. Effect of a jig on EMG activity in different orofacial pain conditions. Bodere C, Woda A. Faculté d'Odontologie, Brest, France. cel.bodere@wanadoo.fr PURPOSE: The bite stop (jig) is commonly used in clinical practice. It has been recommended as a simple means to routinely record or provide centric relation closure and, more recently, to reduce migraines and tension-type headaches. However, the reason for the jig effect has yet to be explained. This study tested the hypothesis that it works through a decrease in masticatory muscle activity. MATERIALS AND METHODS: The effect of a jig placed on the maxillary anterior teeth was investigated by recording the electromyographic (EMG) activity of the superficial masseter and anterior temporal muscles at postural position and when swallowing on the jig. EMG recordings were obtained from 2 groups of pain patients (myofascial and neuropathic) and from 2 groups of pain-free patients (disc derangement and controls) unaware of the role of dental occlusion treatments. RESULTS: EMG activity in postural position was higher in pain groups than in pain-free groups. The jig strongly but temporarily decreased the postural EMG activity for masseter muscles in all groups except for the neuropathic group and for temporal muscles in the myofascial group. The EMG activity when swallowing with the jig was reduced in control, disc derangement, and myofascial groups; however, EMG "hyperactivity" in the neuropathic pain group seemed to be locked. CONCLUSIONS: The decrease of postural EMG activity, especially in the myofascial group, was short lasting and cannot be considered as evidence to support the hypothesis of a long-term muscle relaxation jig effect. However, the results may uphold certain short-term clinical approaches. PMID: 18548966 [PubMed - indexed for MEDLINE] 336. Int J Infect Dis. 2008 Nov;12(6):e159-60. Herpes zoster in healthy children. Teran CG, Villarroel P, Teran-Escalera CN. Pediatric Center Albina Patiño, Calle Jordan 886, Cochabamba, Bolivia. PMID: 18547857 [PubMed - indexed for MEDLINE] 337. Bull Soc Belge Ophtalmol. 2008;(307):39-43. [Orbital apex syndrome secondary to herpes zoster infection. A case report] [Article in French] Baha Ali T, Moutaouakil A, Ouaggag B, Khoumiri R, Aderdour L, Hassani R, Raji A, Jamali A. Service d'Ophtalmologie, CHU Mohammed VI, Marrakech, Maroc. tbahaali@yahoo.fr The orbital apex syndrome is defined by the association of visual loss, ophtalmoplegia, blepharoptosis, proptosis along with forehead and upper eyelid anesthesia. This syndrome is secondary to traumatism, malignancy or infection of orbital apex. Herpes zoster is an uncommon cause. We discuss the physiopathologic mechanism, evolution and management of this affection. PMID: 18546925 [PubMed - indexed for MEDLINE] 338. J Cutan Med Surg. 2008 May-Jun;12(3):126-32. Dermatologic immune restoration syndrome: report of five cases from a tertiary care center in north India. Handa S, Narang T, Wanchu A. Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India. handa_sanjeev@yahoo.com BACKGROUND: Dermatologic conditions are often an early clue to human immunodeficiency virus (HIV) infection. As the disease progresses and the host immunity fails, patients may develop a number of skin conditions. At this point, they have a dominant T helper 2 immunologic response. After the initiation of antiretroviral therapy, the T helper 1 response is restored, and some skin problems, paradoxically, make their appearance then. CONCLUSION: Herpes zoster, mucocutaneous herpes, eosinophilic folliculitis, and mycobacterial infections have been known to occur at this stage. This may be because immune restoration of a host's immunity causes recognition of silent or latent infection and results in development of the condition. We report five cases that were seen at our center during a 2-year period. PMID: 18544296 [PubMed - indexed for MEDLINE] 339. SADJ. 2008 Feb;63(1):048. General practitioner's radiology case 60. Herpes zoster infection. Nortjé CJ. Faculty of Dentistry, University of the Western Cape. cnortje@uwc.ac.za PMID: 18543744 [PubMed - indexed for MEDLINE] 340. Am Fam Physician. 2008 May 1;77(9):1307-9. Scalded mouth with headache. Herpes zoster (shingles). Grimard BH, Larson JM, Mcbrayer RH. Mayo Clinic, Jacksonville, Florida, USA. grimard.brian@mayo.edu PMID: 18540498 [PubMed - indexed for MEDLINE] 341. Am J Emerg Med. 2008 Jun;26(5):612-7. Ophthalmic diagnoses in the ED: herpes zoster ophthalmicus. Carter WP 3rd, Germann CA, Baumann MR. Emergency Medicine Department, Maine Medical Center, Portland, ME 04102, USA. cartew2@mmc.org The epidemiology, pathophysiology, and clinical presentation of herpes zoster ophthalmicus in the emergency department is discussed with an emphasis on the identification of the numerous potential ocular complications. Emergency physicians need to be able to recognize the clinical features of herpes zoster ophthalmicus and initiate appropriate therapy and referral. PMID: 18534294 [PubMed - indexed for MEDLINE] 342. MMWR Recomm Rep. 2008 Jun 6;57(RR-5):1-30; quiz CE2-4. Prevention of herpes zoster: recommendations of the Advisory Committee on Immunization Practices (ACIP). Harpaz R, Ortega-Sanchez IR, Seward JF; Advisory Committee on Immunization Practices (ACIP) Centers for Disease Control and Prevention (CDC). Collaborators: Treanor J, Atkinson WL, Cohen JI, Dworkin RH, Gargiullo PM, Gershon AA, Glasser JW, Güris D, Haber P, Harpaz R, Hibbs BF, Iskander JK, Katz SL, Krause PR, LaRussa PS, Levin MJ, Lieu TA, Marin ME, Neuzil KM, Nichol K, Ortega-Sánchez IR, Poland GA, Rosenbaum S, Santibanez TA, Schaffner W, Schmader KE, Schmid DS, Seward J, Stafford H, Strikas R, Wallace GS, Watson B, Abramson JS, Pickering LK, Allos BM, Baker C, Beck RL, Gilsdorf JR, Hull H, Lett S, Lieu T, Morse DL, Morita J, Neuzil K, Stinchfield P, Sumaya CV, Treanor JJ, Womeodu RJ, Cheek J, Hachey W, Evans GS, Gellin B, Murphy L, Curlin GT, Baylor N, Nichol KL, Temte J, Campos-Outcalt D, Powell K, Baker C, Gelzer A, Turner JC, Gall S, Neuzil KM, Tan L, Foster SL, McKinney WP, Lewin C, Naus M, Gordon S, Katz SL, Salisbury D, Bennett N, Duchin JS, Neumann DA, Schaffner W, Rodriquez RS, Whitley-Williams P, Freed G, Paradiso P, Middleman AB, Araga DA. Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, USA. Erratum in: MMWR Recomm Rep. 2008 Jul 18;57(28):779. These recommendations represent the first statement by the Advisory Committee on Immunization Practices (ACIP) on the use of a live attenuated vaccine for the prevention of herpes zoster (zoster) (i.e., shingles) and its sequelae, which was licensed by the U.S. Food and Drug Administration (FDA) on May 25, 2006. This report summarizes the epidemiology of zoster and its sequelae, describes the zoster vaccine, and provides recommendations for its use among adults aged > or =60 years in the United States. Zoster is a localized, generally painful cutaneous eruption that occurs most frequently among older adults and immunocompromised persons. It is caused by reactivation of latent varicella zoster virus (VZV) decades after initial VZV infection is established. Approximately one in three persons will develop zoster during their lifetime, resulting in an estimated 1 million episodes in the United States annually. A common complication of zoster is postherpetic neuralgia (PHN), a chronic, often debilitating pain condition that can last months or even years. The risk for PHN in patients with zoster is 10%-18%. Another complication of zoster is eye involvement, which occurs in 10%-25% of zoster episodes and can result in prolonged or permanent pain, facial scarring, and loss of vision. Approximately 3% of patients with zoster are hospitalized; many of these episodes involved persons with one or more immunocompromising conditions. Deaths attributable to zoster are uncommon among persons who are not immunocompromised. Prompt treatment with the oral antiviral agents acyclovir, valacyclovir, and famciclovir decreases the severity and duration of acute pain from zoster. Additional pain control can be achieved in certain patients by supplementing antiviral agents with corticosteroids and with analgesics. Established PHN can be managed in certain patients with analgesics, tricyclic antidepressants, and other agents. Licensed zoster vaccine is a lyophilized preparation of a live, attenuated strain of VZV, the same strain used in the varicella vaccines. However, its minimum potency is at least 14-times the potency of single-antigen varicella vaccine. In a large clinical trial, zoster vaccine was partially efficacious at preventing zoster. It also was partially efficacious at reducing the severity and duration of pain and at preventing PHN among those developing zoster. Zoster vaccine is recommended for all persons aged > or =60 years who have no contraindications, including persons who report a previous episode of zoster or who have chronic medical conditions. The vaccine should be offered at the patient's first clinical encounter with his or her health-care provider. It is administered as a single 0.65 mL dose subcutaneously in the deltoid region of the arm. A booster dose is not licensed for the vaccine. Zoster vaccination is not indicated to treat acute zoster, to prevent persons with acute zoster from developing PHN, or to treat ongoing PHN. Before administration of zoster vaccine, patients do not need to be asked about their history of varicella (chickenpox) or to have serologic testing conducted to determine varicella immunity. PMID: 18528318 [PubMed - indexed for MEDLINE] 343. J Clin Neuromuscul Dis. 2008 Jun;9(4):402-6. Brachial neuritis with bilateral diaphragmatic paralysis following herpes zoster: a case report. Hoque R, Schwendimann RN, Liendo C, Chesson AL Jr. Department of Neurology, Louisiana State University Health Sciences Center, Shreveport, LA 71130, USA. rhoque@lsuhsc.edu We present a case of supine respiratory failure due to a bilateral diaphragmatic paralysis associated with brachial neuritis secondary to thoracic herpes zoster. Fluoroscopy in both the standing and supine positions revealed bilateral diaphragmatic paralysis accentuated in the supine position. To our knowledge, this is the first case of thoracic herpes zoster associated with brachial neuritis and bilateral diaphragmatic paralysis. PMID: 18525424 [PubMed - indexed for MEDLINE] 344. Ophthal Plast Reconstr Surg. 2008 May-Jun;24(3):218-9. Radiesse-induced herpes zoster. Sires B, Laukaitis S, Whitehouse P. Allure Facial Laser and Medispa, Kirkland, Washington 98033, U.S.A. bryan@aeamail.com Radiesse is a filler material for deep nasolabial folds that was recently approved by the United States Food and Drug Administration. It is composed of calcium hydroxylapatite crystals measuring 25 mum to 45 mum. Few complications have been reported to date. We present a case of a woman who developed herpetic appearing skin lesions after the injection of Radiesse in the glabella. She noted tenderness and tingling along with redness and bumps. The vesicles were isolated to the right ophthalmic branch of the trigeminal nerve distribution and the skin was erythematous with associated pustules. After disease progression while on systemic antibiotics, she improved markedly when started on antivirals. Three days later the tingling resolved, the erythema was markedly improved, and the vesicles started to resolve. She had returned to baseline after a month. Physicians should be suspicious for herpetic infection or reactivation with facial injections of Radiesse or other fillers and should initiate immediate treatment with oral antivirals upon identifying the above signs and symptoms. PMID: 18520838 [PubMed - indexed for MEDLINE] 345. Verh K Acad Geneeskd Belg. 2008;70(1):47-65. [Immune evasion of alphaherpesviruses] [Article in Dutch] Favoreel HW. Vakgroep Virologie Parasitologie en Immunologie, Faculteit Diergeneeskunde, Universiteit Gent, Merelbeke. Alphaherpesviruses represent the largest subfamily of the herpesviruses and comprise many different, closely related pathogens of man and animal, including herpes simplex virus (cold sores, genital lesions) and varicella-zoster virus (chickenpox, shingles) in man, pseudorabies virus orAujeszky's disease virus in pigs (neurological and respiratory symptoms, abortion), equine herpesvirus type 1 (neurological and respiratory symptoms, abortion), and bovine herpesvirus type 1 (respiratory symptoms, abortion). Typical for alphaherpesviruses, and for herpesviruses in general, is their ability to persist in a non-replicative, latent state in their host during its entire lifetime. Specific stimuli can lead to reactivation of these viruses from their latent state, which can lead to renewed spread within and between hosts and recurrent symptoms. This recurrent replication and spread implies that herpesviruses have evolved techniques to delay and avoid recognition and elimination by the immune system, so-called immune evasion mechanisms. In the current manuscript, different alphaherpesvirus immune evasion mechanisms will be reviewed that have been discovered and elucidated at our research group based on pseudorabies virus and that interfere with the antiviral activity of virus-specific antibodies. Investigating immune evasion mechanisms leads to novel insights in the interactions between viruses, host cells, and the immunity, but can also lead to novel avenues in the design of strategies to interfere with viral infections. PMID: 18512358 [PubMed - indexed for MEDLINE] 346. Br J Clin Pharmacol. 2008 Aug;66(2):327-8. Epub 2008 Apr 10. Decompensation of chronic heart failure associated with pregabalin in a 73-year-old patient with postherpetic neuralgia: a case report. De Smedt RH, Jaarsma T, van den Broek SA, Haaijer-Ruskamp FM. PMCID: PMC2492923 PMID: 18507657 [PubMed - indexed for MEDLINE] 347. Mayo Clin Womens Healthsource. 2008 Jun;12(6):6. Mayo Clinic office visit. The shingles vaccine. An interview with Gregory Poland, M.D. Poland G. PMID: 18506118 [PubMed - indexed for MEDLINE] 348. J Drugs Dermatol. 2008 May;7(5):457-62. Herpes zoster in eastern Saudi Arabia: clinical presentation and management. Alakloby OM, AlJabre SH, Randhawa MA, Alzahrani AJ, AlWunais KM, Bukhari IA. Department of Dermatology, College of Medicine, King Faisal University, Dammam, Saudi Arabia. oakloby1@yahoo.com BACKGROUND: Herpes zoster (HZ), caused by varicella zoster virus (VZV), initially produces chicken-pox, then the virus lies dormant in the dorsal root ganglia. The virus can reactivate after many years and results in HZ along ganglion's distribution. Old age, trauma, stress, diabetes mellitus, and immune suppression are important risk factors for the reactivation. Herpes zoster is characterized by unilateral radicular pain and vesicular eruption that is generally limited to the dermatome innervated by the affected ganglion. In immunocompromised individuals, disseminated zoster may develop. The aims of therapy in HZ are to control pain or reduce its severity by the use of analgesics, reduce the duration and eruption of new lesions, and prevent complications, particularly postherpetic neuralgia (PHN) by appropriate antiviral therapy. METHODS: All cases of HZ seen in the dermatology clinic at King Fahd Hospital of the University (KFHU) from 1988 to 2006 were included in the study. Their diagnoses were based on the clinical presentation. The following parameters were collected and analyzed: age, sex, nationality, symptoms, dermatomal distribution, complications, coexisting diseases, and disease management. RESULTS: Of 22 749 new cases seen in the dermatology clinic over 18 years, 141 were HZ, with an occurrence of 0.62%. Male to female ratio was 2:1 and the age ranged from 14 months to 80 years. The thoracic dermatomes were the most commonly involved. The most frequent coexisting disease was diabetes mellitus, and the most common complication of HZ was PHN. Most patients with HZ ophthalmicus developed eye complications. CONCLUSION: The occurrence of HZ is 0.62% in patients reporting to the dermatology clinic of the hospital. Males are little more affected than females. The thoracic dermatomes are the most frequently involved. Diabetes mellitus is the most frequent coexisting disease. Postherpetic neuralgia is the most common complication of HZ. PMID: 18505138 [PubMed - indexed for MEDLINE] 349. Medicina (B Aires). 2008;68(2):125-8. [Clinical and epidemiological aspects of herpes zoster] [Article in Spanish] Vujacich C, Poggi E, Cecchini D, Luchetti P, Stamboulian D. Fundación del Centro de Estudios Infectológicos, Buenos Aires, Argentina. cvujacich@funcei.org.ar Herpes zoster (HZ) is a public health problem worldwide. Although, there is paucity of data of this disease from South American countries. The objective of this study was to evaluate clinical and epidemiological aspects of HZ in a population of patients from South America. We underwent a retrospective analysis of clinical charts of an infectious diseases reference center (period: 2000-2005). Univariate analysis was performed to assess variables related to post herpetic neuralgia (PHN). From a total of 302 cases, 62% were in women. The median age was 57 years: 16.1% of the patients had a predisposing condition for the development of HZ. Most frequent dermatomes involved were: thoracic, ophthalmic and lumbar; 93.5% of the patients received antiviral drugs and 94% complementary medications. The most frequent complication was PHN and was related with age over 50 years. Clinical and epidemiological aspects of HZ and the frequency of complications in our population were similar to data from developed countries. PMID: 18499960 [PubMed - indexed for MEDLINE] 350. An Sist Sanit Navar. 2008 Jan-Apr;31(1):71-80. [Varicella and herpes zoster incidence prior to the introduction of systematic child vaccination in Navarre, 2005-2006] [Article in Spanish] García Cenoz M, Castilla J, Montes Y, Morán J, Salaberri A, Elía F, Floristán Y, Rodrígo I, Irisarri F, Arriazu M, Zabala A, Barricarte A. Instituto de Salud Pública de Navarra, 31003 Pamplona, Spain. mgcenoz@cfnavarra.es Varicella is an acute and highly contagious disease produced by the varicella-zoster virus, which leaves lasting immunity. Herpes zoster is produced by reactivation of a latent infection of the same virus. The introduction of systematic and free vaccination against varicella in children of 15 months in Navarre from 2007 onwards can be expected to produce important epidemiological changes. For this reason we describe the previous epidemiological situation in the period from 2005 to 2006. We analysed all cases of varicella and herpes zoster registered in the electronic clinical files of primary care, in the database of hospital discharges and in the mortality register. Between 2005 and 2006, 9,908 cases of varicella were diagnosed (8.29 annually per 1,000 inhabitants), with 90% in children under 15 years old. There were 80 hospital admissions (8 for every 1,000 cases), complications in 2.5 out of every 1,000 cases, and there was one death due to this cause (0.1 per 1,000 cases). In the same period, 4,959 cases of herpes zoster were diagnosed (4.15 cases per 1,000 inhabitants), half in people over 55 years old. There were 179 hospital admissions (36 per 1,000 cases), whose average age was 77, and 83 presented complications (16.7 per 1,000 cases). This epidemiological pattern is similar to that found in other places before the introduction of the vaccine. PMID: 18496581 [PubMed - indexed for MEDLINE] 351. Clin Infect Dis. 2008 Jul 1;47(1):e4-6. Tularemia with vesicular skin lesions may be mistaken for infection with herpes viruses. Byington CL, Bender JM, Ampofo K, Pavia AT, Korgenski K, Daly J, Christenson JC, Adderson E. Department of Pediatrics, University of Utah, Salt Lake City, UT 84132, USA. Carrie.byington@hsc.utah.edu The original reports of human infection with Francisella tularensis noted vesicular skin rash as a manifestation. We present 2 cases of tularemia initially diagnosed as herpes simplex or varicella zoster infection. Clinicians must recognize the cutaneous manifestations of tularemia and be able to distinguish these from lesions seen with herpes viruses. PMID: 18491968 [PubMed - indexed for MEDLINE] 352. Clin Infect Dis. 2008 Jul 1;47(1):e1-3. Varicella-zoster virus and cerebral aneurysm: case report and review of the literature. Bhayani N, Ranade P, Clark NM, McGuinn M. Division of Infectious Diseases, University of Illinois at Chicago, Chicago, IL 60607, USA. We report a case of varicella-zoster vasculopathy that occurred in a 42-year-old renal transplant recipient with concurrent vertebral artery aneurysm and dissection. The patient was successfully treated with embolization and acyclovir therapy. Here, we review the English literature regarding the association of varicella-zoster virus infection with cerebral aneurysm. PMID: 18491962 [PubMed - indexed for MEDLINE] 353. Arch Dermatol. 2008 May;144(5):603-8. Family history as a risk factor for herpes zoster: a case-control study. Hicks LD, Cook-Norris RH, Mendoza N, Madkan V, Arora A, Tyring SK. University of Texas Medical School at Houston, USA. Lindsey.D.Hicks@uth.tmc.edu OBJECTIVE: To assess risk factors for herpes zoster beyond age and immunosuppression, especially the association with a family history of herpes zoster, since a preventative herpes zoster and postherpetic neuralgia vaccine is now available. DESIGN: We undertook a case-control study of herpes zoster, which represents reactivation of latent varicella zoster virus residing in dorsal root ganglia following primary infection, involving 504 patients and 523 controls. Interviews were conducted by trained medical investigators using a structured questionnaire. SETTING: The Center for Clinical Studies, an outpatient clinic and research center in Houston, Texas. PARTICIPANTS: Nonimmunocompromised patients with confirmed cases of herpes zoster were included in the study. Controls were nonimmunocompromised clinic patients with new diagnoses of skin diseases other than herpes zoster. RESULTS: Cases were more likely to report blood relatives with a history of zoster (39%) compared with controls (11%; P < .001). Risk was increased with multiple blood relatives (odds ratio, 13.77; 95% confidence interval, 5.85-32.39) compared with single blood relatives (odds ratio, 4.50; 95% confidence interval, 3.15-6.41). CONCLUSIONS: The results suggest an association between herpes zoster and family history of zoster. Future studies will be needed to investigate this association. PMID: 18490586 [PubMed - indexed for MEDLINE] 354. Int J Dermatol. 2008 Jun;47(6):640-1. Herpes zoster after varicella vaccination in a healthy young child. Obieta MP, Jacinto SS. PMID: 18477170 [PubMed - indexed for MEDLINE] 355. Rev Recent Clin Trials. 2007 Jan;2(1):1. Most recent prevention strategies. Weinberg JM. PMID: 18473982 [PubMed - indexed for MEDLINE] 356. Epidemiol Infect. 2009 Jan;137(1):38-47. Epub 2008 May 9. Epidemiology and cost of herpes zoster and post-herpetic neuralgia in the United Kingdom. Gauthier A, Breuer J, Carrington D, Martin M, Rémy V. i3 Innovus, Uxbridge, Middlesex, UK. aline.gauthier@i3nnovus.com Recent information on epidemiology and management of herpes zoster (HZ) and post-herpetic neuralgia (PHN), a painful complication of HZ, is scarce. The objective of this study was to document the burden of HZ and PHN in the United Kingdom. This retrospective analysis of the UK General Practice Research Database aimed to estimate HZ incidence and proportion of HZ patients developing PHN and to assess management costs in immunocompetent individuals aged 50 years. A cohort of 27 225 HZ patients was selected, corresponding to an incidence of 5.23/1000 person-years. Respectively 19.5% and 13.7% of patients developed PHN at least 1 and 3 months after HZ diagnosis. Mean direct cost was pound103 per HZ patient and pound341 and pound397 per PHN episode (1- and 3-month definition respectively). Both HZ and PHN costs increased markedly with pain severity. This study confirms that HZ and PHN are frequent and costly diseases in the United Kingdom. PMID: 18466661 [PubMed - indexed for MEDLINE] 357. Endocr Pract. 2008 Apr;14(3):392. Visual vignette. Postherpetic neuralgia and galactorrhea. Paul TV, Spurgeon R, Jebasingh F. Department of Endocrinology, Christian Medical College and Hospital, Vellore, Tamil, Nadu, India. PMID: 18463051 [PubMed - indexed for MEDLINE] 358. Cent Eur J Public Health. 2008 Mar;16(1):41-4. Seroprevalence of antibodies to varicella-zoster virus in Madrid (Spain) in the absence of vaccination. Perez-Farinos N, Garcia-Comas L, Ramirez-Fernandez R, Sanz JC, Barranco D, Garcia-Fernandez C, Ordobas M. Epidemiology Department, Madrid Public Health Institute, Madrid, Spain. napo@napo.jazztel.es OBJECTIVE: to ascertain the seroprevalence of antibodies to varicella-zoster virus in the Madrid population prior to the introduction of vaccination. STUDY DESIGN: Cross-sectional antibody seroprevalence study. METHODS: Population: persons aged 2 to 40 years in Madrid. Field work: September 1999 to April 2000. Data were collected on demographic and socio-economic variables and on a number of exposures. IgG antibodies were determined using Enzyme Linked ImmunoSorbent Assay (ELISA), and antibody prevalence broken down by age group. Logistic regression was used to analyse the association between the presence of antibodies and the respective study variables. The results were compared against those of an earlier seroprevalence survey in Madrid (1993). RESULTS: A total of 2,131 subjects were included, with a non-response rate of 20.4%. Antibody prevalence was estimated at 90.2%; the 90% mark was reached at 11 years of age and almost 100% of adults presented with antibodies. In the case of children, school attendance associated with the presence of antibodies. No significant differences were observed vis-à-vis the results of the earlier survey. CONCLUSIONS: The seroprevalence profile coincides with those of other Spanish regions and European countries, and remains stable over time. Antibody presence rises sharply in children from aged 2 years to adolescence. Further seroprevalence studies are called for to study the disease trend and assess preventive measures. PMID: 18459480 [PubMed - indexed for MEDLINE] 359. Ann Dermatol Venereol. 2008 May;135(5):429-31. Epub 2008 Apr 21. [Herpes, varicella and zona] [Article in French] Marinho E. Service d'anatomie et cytologie pathologiques, hôpital Bichat-Claude-Bernard, 46 rue Henri-Huchard, Paris, France. eduardo.marinho@bch.ap-hop-paris.fr PMID: 18457737 [PubMed - indexed for MEDLINE] 360. Infection. 2008 Jun;36(3):226-30. Epub 2008 May 3. Diabetes as a risk factor for herpes zoster infection: results of a population-based study in Israel. Heymann AD, Chodick G, Karpati T, Kamer L, Kremer E, Green MS, Kokia E, Shalev V. Medical Division, Maccabi Healthcare Services, 27 HaMered St, Tel Aviv, 68125, Israel. BACKGROUND: Studies showed that diabetes mellitus (DM) is often accompanied by impaired cell-mediated immunity, which potentially may increase the risk for infectious diseases, including herpes zoster (HZ). However, data on the relation between DM and HZ are scarce. This case-control study explored the association between DM and HZ. PATIENTS AND METHODS: This study was nested within a cohort of all members of a large health maintenance organization (HMO) in Israel. Cases totaled 22,294 members who were diagnosed with HZ between 2002 and 2006. Controls (n=88,895) were randomly selected from the remaining HMO population using frequency-matched age, sex, and duration of follow-up. Personal data on history of DM, lymphoma, leukemia, or AIDS, were obtained from computerized medical records. RESULTS: Adjusted analyses showed that the risk of HZ was associated with history of leukemia, lymphoma, use of steroids or antineoplastic medications, and AIDS, particularly among patients below 45 years of age. In a multivariate analysis, DM was associated with an increased risk of HZ (OR=1.53; 95% CI: 1.44-1.62). CONCLUSIONS: The data suggest that individuals with DM are at increased risk of HZ. Well-designed cohort studies may help to clarify the nature of this association. PMID: 18454342 [PubMed - indexed for MEDLINE] 361. J Infect Dis. 2008 Mar 1;197 Suppl 2:S61-5. A model of lytic, latent, and reactivating varicella-zoster virus infections in isolated enteric neurons. Gershon AA, Chen J, Gershon MD. Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, New York 10032, USA. aag1@columbia.Edu Because human primary afferent neurons are not readily obtained, we sought to develop a model in which the lytic, latent, and reactivating phases of varicella-zoster virus (VZV) infection were recapitulated in neurons from an animal source. Enteric neurons were obtained from the small intestine of adult guinea pigs and from the bowel of fetal mice. Latency was established when these neurons were infected by cell-free VZV in the absence of fibroblasts or other cells of mesodermal origin. In contrast, lytic infection ensued when fibroblasts were present or when the enteric neurons were infected by cell-associated VZV. Latency was associated with the expression of a limited subset of viral genes, the products of which were restricted to the cytoplasm. Lysis was associated with the expression of viral glycoproteins, nuclear translocation of latency-associated gene products, and rapid cell death. Reactivation was accomplished by expressing VZV open reading frame (ORF) 61p or herpes simplex virus ICP0 in latently infected neurons. Isolated enteric neurons from guinea pigs and mice recapitulate latent gene expression in human cranial nerve and dorsal root ganglia. Expression of latency-associated VZV gene products was detected in 88% of samples of adult human intestine, suggesting that VZV not only infects enteric neurons but also is latent in the human enteric nervous system. This in vitro model should facilitate further understanding of latency and reactivation of VZV. PMID: 18419411 [PubMed - indexed for MEDLINE] 362. J Infect Dis. 2008 Mar 1;197 Suppl 2:S58-60. Humoral and cellular immunity to varicella-zoster virus: an overview. Arvin AM. Department of Pediatrics, Stanford University School of Medicine, Stanford, California 94305, USA. aarvin@stanford.edu PMID: 18419410 [PubMed - indexed for MEDLINE] 363. J Infect Dis. 2008 Mar 1;197 Suppl 2:S54-7. Vaccine Oka variants and sequence variability in vaccine-related skin lesions. Breuer J, Schmid DS. Skin Virus Laboratory, Centre for Cutaneous Research, St. Bartholomew's and The Royal London School of Medicine and Dentistry, Queen Mary College, London, United Kingdom. As with most live attenuated viral vaccines, varicella vaccine comprises a mixture of variant strains. Knowledge about the pathogenic potential of individual strains in the varicella vaccine is limited. Vaccination against chickenpox causes a usually modified varicella-like rash in a small percentage of healthy children, and vaccine virus reactivates on rare occasions to cause herpes zoster (HZ). In several published studies, our respective laboratories have analyzed genomic variation among specimens from cases of postvaccination rash and HZ in vaccine recipients, focusing on polymorphisms between vaccine Oka strains and the parental Oka strain. In most respects, these studies were in close agreement, identifying the set of wild-type markers among vaccine adverse event isolates, each occurring at similar frequencies. The same 3 universally present vaccine markers, at positions 106262, 107252, and 108111, were also identified by both laboratories. One notable difference has been the observation of mostly clonal vaccine virus among isolates examined by one laboratory and mostly mixed viruses in isolates examined by the other. In addition to reviewing and comparing our combined observations, we propose possible explanations for our contrasting findings and propose future studies to reconcile them. PMID: 18419409 [PubMed - indexed for MEDLINE] 364. J Infect Dis. 2008 Mar 1;197 Suppl 2:S41-4. Development of varicella vaccine. Takahashi M, Asano Y, Kamiya H, Baba K, Ozaki T, Otsuka T, Yamanishi K. Department of Virology, Research Institute for Microbial Diseases, Osaka University, Suita, Osaka, Japan. mtakahashi@mail.biken.or.jp The Oka strain of varicella-zoster virus (VZV) was first isolated from vesicles of an otherwise healthy 3-year-old boy with typical varicella. The virus was passaged 11 times in human embryonic lung fibroblasts at 34 degrees C and 12 times in guinea pig embryo fibroblasts (GPEFs) at 37 degrees C. GPEFs were the only nonprimate cells tested in which some degree of viral replication occurred. The resultant virus was temperature sensitive and showed host dependency, measured as better replication in GPEFs than that shown by the parental virus. The passaged virus was used as a candidate varicella vaccine and proved safe and effective for healthy and immunocompromised children. During the follow-up of vaccinated children with acute lymphocytic leukemia, the incidence of herpes zoster (HZ) was significantly lower among children who did not have a rash after vaccination, compared with those who had a rash caused by VZV (6 [2.3%] of 260 vs. 12 [17.1%] of 70, respectively). Because of the pathogenesis of VZV, the incidence of latency and of HZ is predicted to be lower among vaccine recipients than among individuals who have experienced varicella. PMID: 18419406 [PubMed - indexed for MEDLINE] 365. J Infect Dis. 2008 Mar 1;197 Suppl 2:S39-40. Varicella vaccine in the United States: a decade of prevention and the way forward. Gershon AA, Arvin AM, Levin MJ, Seward JF, Schmid DS. Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, New York, USA. aag1@columbia.edu Erratum in: J Infect Dis. 2008 Jun 15;197(12):1783. PMID: 18419405 [PubMed - indexed for MEDLINE] 366. J Infect Dis. 2008 Mar 1;197 Suppl 2:S242-5. Perspective on live varicella vaccine. Gershon AA, Katz SL. Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, New York 10032, USA. aag1@columbia.edu The attenuation of varicella-zoster virus (VZV) by Takahashi in 1974 was a remarkable achievement. It swiftly led to development of a live vaccine against chickenpox, which was initially tested in Japan. With its successful employment in immunocompromised children to prevent morbidity and mortality due to varicella, the vaccine began to be tested in healthy children in Japan and elsewhere. In the United States, vaccine use progressed from extensive clinical trials that demonstrated safety and efficacy to universal immunization of healthy infants and children. In the past 10 years, >30 million healthy American individuals, mostly children, have been vaccinated. With increasing use of vaccine, there has been a concomitant decrease in the incidence of disease, along with decreases in hospitalizations and deaths due to VZV. To improve protection, however, a 2-dose schedule of immunization was recommended for routine use in all children by the Centers for Disease Control and Prevention in June 2006. At roughly the same time, licensure of the combined measles-mumps-rubella-varicella vaccine was completed, which allowed harmonization of immunization against these 4 viruses with 1 injection given twice in childhood. Concomitantly, a version of the varicella vaccine with 10 times the titer was developed for immunization of healthy individuals >60 years of age against herpes zoster (HZ). Although elimination of VZV from human populations may not yet be possible, the combined approach of immunization against both varicella in childhood and HZ in adulthood in the developed world are predicted to dramatically increase our control of this troublesome virus. PMID: 18419404 [PubMed - indexed for MEDLINE] 367. J Infect Dis. 2008 Mar 1;197 Suppl 2:S237-41. Strategies for herpes zoster vaccination of immunocompromised patients. Cohen JI. Medical Virology Section, Laboratory of Clinical Investigation, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland 20892, USA. jcohen@niaid.nih.gov A vaccine to prevent herpes zoster (HZ) in adults > or =60 years of age with healthy immune systems was recently approved by the US Food and Drug Administration. This vaccine is contraindicated in persons with certain immunodeficiency states or who are receiving immunosuppressive therapy. On the basis of studies of the varicella vaccine in healthy and immunosuppressed children and studies of HZ vaccine in healthy adults before its licensure, a series of strategies are proposed for evaluating the live HZ vaccine in immunosuppressed persons. In addition, the use of other vaccines, including heat-inactivated or replication-defective varicella-zoster virus to prevent HZ in immunocompromised persons, is also discussed. PMCID: PMC2679676 PMID: 18419403 [PubMed - indexed for MEDLINE] 368. J Infect Dis. 2008 Mar 1;197 Suppl 2:S228-36. Vaccination against Herpes Zoster and Postherpetic Neuralgia. Oxman MN, Levin MJ; Shingles Prevention Study Group. Collaborators: Oxman MN, Arbeit RD, Barry P, Beisel C, Boardman KD, Colling CL, Davis LE, Gelb LD, Gershon AA, Hayward AR, Irwin MR, Johnson GR, Levin MJ, Peduzzi PN, Schmader KE, Simberkoff MS, Straus SE, Weinberg A, Williams HM, Annunziato P, Chan CY, Chan IS, Silber JL. VA San Diego Healthcare System, San Diego, California, USA. mnoxman@ucsd.edu BACKGROUND: Herpes zoster (HZ) and postherpetic neuralgia (PHN) cause significant morbidity in older adults. The incidence and severity of HZ and PHN increase with age in association with an age-related decline in varicella-zoster virus (VZV)-specific cell-mediated immunity (VZV-CMI). VZV vaccines can boost VZV-CMI. Therefore, we tested the hypothesis that VZV vaccination would protect older adults against HZ and PHN. METHODS: We enrolled 38,546 adults > or =60 years of age in a randomized, double-blind, placebo-controlled trial of an investigational HZ vaccine and actively followed subjects for the development of HZ. The primary end point was the burden of illness due to HZ (HZ BOI), a composite measure of the incidence, severity, and duration of pain and discomfort caused by HZ. The secondary end point was the incidence of PHN. RESULTS: Subject retention was >95%. HZ vaccine reduced the HZ BOI by 61.1% (95% confidence interval [CI], 51.1%-69.1%; P<.001) and reduced the incidence of PHN by 66.5% (95% CI, 47.5%-79.2%; P<.001). The incidence of HZ was also reduced by 51.3% (95% CI, 44.2%-57.6%; P<.001). HZ vaccine was well tolerated; injection site reactions were generally mild. HZ vaccine neither caused nor induced HZ. CONCLUSION: The Shingles Prevention Study demonstrated that HZ vaccine significantly reduced the morbidity due to HZ and PHN in older adults. PMID: 18419402 [PubMed - indexed for MEDLINE] 369. J Infect Dis. 2008 Mar 1;197 Suppl 2:S224-7. The impact of the varicella vaccination program on herpes zoster epidemiology in the United States: a review. Reynolds MA, Chaves SS, Harpaz R, Lopez AS, Seward JF. Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. mtr6@cdc.gov Speculation that a universal varicella vaccination program might lead to an increase in herpes zoster (HZ) incidence has been supported by modeling studies that assume that exposure to varicella boosts immunity and protects against reactivation of varicella-zoster virus (VZV) as HZ. Such studies predict an increase in HZ incidence until the adult population becomes predominantly composed of individuals with vaccine-induced immunity who do not harbor wild-type VZV. In the United States, a varicella vaccination program was implemented in 1995. Since then, studies monitoring HZ incidence have shown inconsistent findings: 2 studies have shown no increase in overall incidence, whereas 1 study has shown an increase. Studies from Canada and the United Kingdom have shown increasing rates of HZ incidence in the absence of a varicella vaccination program. Data suggest that heretofore unidentified risk factors for HZ also are changing over time. Further studies are needed to identify these factors, to isolate possible additional effects from a varicella vaccination program. Untangling the contribution of these different factors on HZ epidemiology will be challenging. PMID: 18419401 [PubMed - indexed for MEDLINE] 370. J Infect Dis. 2008 Mar 1;197 Suppl 2:S216-23. National survey of primary care physicians regarding herpes zoster and the herpes zoster vaccine. Hurley LP, Harpaz R, Daley MF, Crane LA, Beaty BL, Barrow J, Babbel C, Marin M, Steiner JF, Davidson A, Dickinson LM, Kempe A. Department of General Internal Medicine, University of Colorado at Denver and Health Sciences Center, The Children's Hospital, Denver, Colorado, USA. Laura.Hurly@dhha.org BACKGROUND: This study describes physicians' perception of burden associated with herpes zoster (HZ) and postherpetic neuralgia (PHN), intentions for recommending the HZ vaccine, and perceived barriers to vaccination. METHODS: A national survey of 438 general internal medicine (GIM) and 433 family medicine (FM) physicians was conducted during November-December 2005. RESULTS: The survey response rate was 69%. Approximately 35% of GIM and FM physicians strongly agreed that HZ and PHN caused a significant burden of disease. For patients 60-79 years of age, > or =80% of GIM and FM physicians were somewhat or very likely to recommend HZ vaccine. In multivariate analyses, physicians who strongly agreed that HZ and PHN cause significant burden were more likely to recommend the vaccine to patients 60-79 years of age (odds ratio [OR], 2.75 [95% confidence interval [CI], 1.85-4.09]), whereas those who felt there was insufficient information about duration of protection (OR, 0.40 [CI, 0.24-0.67]), that the need to store HZ vaccine in a freezer was a definite barrier (OR, 0.31 [CI, 0.13-0.75]), or that their patients would not pay for the vaccine if it was not covered by insurance (OR, 0.57 [CI, 0.38-0.86]) were less likely to recommend it. CONCLUSIONS: Primary care physicians perceived a high level of burden from HZ and PHN and generally favored the HZ vaccine. PMID: 18419400 [PubMed - indexed for MEDLINE] 371. J Infect Dis. 2008 Mar 1;197 Suppl 2:S207-15. The epidemiological, clinical, and pathological rationale for the herpes zoster vaccine. Schmader K, Gnann JW Jr, Watson CP. Center for the Study of Aging and Human Development and Division of Geriatrics, Department of Medicine, Duke University Medical Center, North Carolina, USA. schma001@mc.duke.edu Worldwide, herpes zoster (HZ) affects millions of patients (particularly older adults) annually and causes significant suffering due to acute and chronic pain, or postherpetic neuralgia (PHN). The objective of this article is to explain the rationale for the HZ vaccine by summarizing data on the epidemiology of HZ in the immunocompetent host, with a focus on recent incidence and risk factor studies; to review information on the burden of HZ; and to discuss the challenges of lessening the morbidity of the disease. The incidence and severity of HZ and PHN are highest in older adults. Given the central nervous system damage caused by HZ, the difficulty of adequately treating HZ to prevent PHN, and the intractability of PHN, the advent of the HZ vaccine appears to be a crucial innovation for preventing HZ and PHN. PMID: 18419399 [PubMed - indexed for MEDLINE] 372. J Infect Dis. 2008 Mar 1;197 Suppl 2:S196-9. Risk of herpes zoster in adults immunized with varicella vaccine. Hambleton S, Steinberg SP, Larussa PS, Shapiro ED, Gershon AA. Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, New York, USA. shambleton@doctors.org.uk A program of routine varicella vaccination of children 12-18 months of age, begun in the United States in 1995, has been very successful in reducing the incidence of varicella. Varicella-zoster virus (VZV), in both wild-type and live attenuated forms, is notable for its ability to produce latent infection of sensory neurons from which it can later reactivate to cause herpes zoster (HZ). Therefore, the effects of vaccination on this secondary VZV-related disease are important to consider; in practice, however, such studies are complicated by the typically long delay between acquisition of the virus and its reactivation. Studies of immunocompromised children have shown that vaccination is relatively protective against HZ in this highly vulnerable group. We now present long-term follow-up data on a group of individuals who received varicella vaccine as healthy young adults 10-26 years ago and who have been followed prospectively by means of active surveillance. Among some 2000 person-years of follow-up, 2 cases of HZ have occurred, for a rate of 1.00 case/1000 person-years. Overall, the incidence of HZ in this cohort, therefore, is similar to published data for the US population in the prevaccine era. PMID: 18419397 [PubMed - indexed for MEDLINE] 373. J Infect Dis. 2008 Mar 1;197 Suppl 2:S170-7. Safety of varicella vaccine after licensure in the United States: experience from reports to the vaccine adverse event reporting system, 1995-2005. Chaves SS, Haber P, Walton K, Wise RP, Izurieta HS, Schmid DS, Seward JF. Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. schaves@cdc.gov Widespread use of varicella vaccine in the United States could enable detection of rare adverse events not identified previously. We reviewed data from 1995 to 2005 from the Vaccine Adverse Event Reporting System, including data from laboratory analyses, to distinguish adverse events associated with wild-type varicella-zoster virus (VZV) versus those associated with vaccine strain. Almost 48 million doses of varicella vaccine were distributed between 1995 and 2005. There were 25,306 adverse events reported (52.7/100,000 doses distributed); 5.0% were classified as serious (2.6/100,000 doses distributed). Adverse events associated with evidence of vaccine-strain VZV included meningitis in patients with concurrent herpes zoster. Patients with genetic predispositions may rarely have disease triggered by receipt of varicella vaccine. Overall, serious adverse events reported after varicella vaccination continue to be rare and must be considered relative to the substantial benefits of varicella vaccination. Ongoing safety surveillance and further studies may shed light on some of the hypothesized associations. PMID: 18419393 [PubMed - indexed for MEDLINE] 374. J Infect Dis. 2008 Mar 1;197 Suppl 2:S165-9. The safety profile of varicella vaccine: a 10-year review. Galea SA, Sweet A, Beninger P, Steinberg SP, Larussa PS, Gershon AA, Sharrar RG. Merck Research Laboratories, Clinical Risk Management and Safety Surveillance, North Wales, Pennsylvania 19454-1099, USA. susan_galea@merck.com Varivax (varicella virus vaccine live [Oka/Merck]; Merck), a live attenuated varicella vaccine, is indicated for vaccination against varicella in appropriate individuals > or =12 months of age. The 10-year safety profile for Varivax is described using data submitted to Merck from routine global postmarketing surveillance, combined with information from a Varicella Zoster Virus Identification Program, which uses polymerase chain reaction (PCR) analysis to identify the presence and strain of VZV in selected specimens. There were 16,683 reports worldwide voluntarily submitted to Merck, for an overall reporting rate of 3.4 reports/10,000 doses of vaccine distributed. PCR analysis of vesicular rashes that occurred within the first 2 weeks after vaccination was more likely to identify wild-type varicella-zoster virus (VZV), whereas the presence of Oka VZV was generally associated with vesicular rashes that occurred 15-42 days after vaccination. Reports of breakthrough varicella that occurred >42 days after vaccination were associated with wild-type VZV. Among 697 herpes zoster reports, PCR analysis identified Oka VZV in 57 reports and wild-type VZV in 38 reports. There were no primary neurologic adverse events associated with Oka VZV. Secondary transmission of Oka VZV from vaccine recipients with postvaccination vesicular rashes was identified in 3 susceptible household contacts. Disseminated Oka VZV was identified in 6 immunocompromised patients and 1 patient with Down syndrome. This review has shown that the vaccine is generally safe and well tolerated. PMID: 18419392 [PubMed - indexed for MEDLINE] 375. Kulak Burun Bogaz Ihtis Derg. 2008;18(1):40-3. [A case of herpetic facial paralysis in which cochleovestibular symptoms outweigh facial nerve symptoms] [Article in Turkish] Avci S, Kansu L, Akkuzu B, Ozgirgin N, Ozlüoğlu L. Department of Otolaryngology, Başkent University Alanya Hospital, Antalya, Turkey. suat_avci2002@yahoo.com A 42-year-old man presented with sensorineural hearing loss of acute onset, tinnitus, and vertigo. Physical examination revealed slight asymmetry in facial nerve functions and spontaneous nystagmus. Magnetic resonance imaging of the internal acoustic canal showed contrast enhancement consistent with edema-inflammation, being notable and diffuse in the seventh and eighth cranial nerve complex, and minimal in the cochlea. Non-hydropic cochleovestibular syndrome was considered and the patient was treated with antiviral and corticosteroid medications. A week later, facial paralysis improved and the acute hearing loss reversed. On the twelfth day of presentation, he had no complaints other than mild imbalance on abrupt changes in movement. In this type of herpetic facial paralysis in which cochleovestibular symptoms outweigh facial nerve symptoms, it might be argued that varicella zoster virus reactivation occurs in the spiral and/or vestibular ganglion. PMID: 18443402 [PubMed - indexed for MEDLINE] 376. MMW Fortschr Med. 2005 Feb 24;147(8):31-2, 34-5. [Varicella vaccination: who should be vaccinated these days?] [Article in German] Hügle B, Suchowerskyj P, Schuster V. Universitätsklinik für Kinder und Jugendliche, Leipzig. boris.huegle@medizin.uni-leipzig.de In July 2004 the STIKO (German National Commission for Vaccinations) recommended routine varicella vaccination (together with the first MMR vaccination) for all healthy infants. The previous recommendations for vaccination of adolescents with no history of varicella and patient groups at risk remain valid. In persons with severely depressed cellular immunity or pregnant women vaccination with live attenuated VZV vaccines is contraindicated. Experience gained in the United States show that widespread introduction of VZV vaccination results in a decrease in both the incidence of varicella and concomitant complications including herpes zoster. PMID: 18441563 [PubMed - indexed for MEDLINE] 377. Can J Public Health. 2008 Jan-Feb;99(1):41-5. Health disparities in chickenpox or shingles in Alberta? Russell ML, Schopflocher DP, Svenson LW. Department of Community Health Sciences, University of Calgary, Calgary, AB. mlrussel@ucalgary.ca OBJECTIVE: Exploring for evidence of socio-economic health disparities in chickenpox and shingles in Alberta, Canada. METHODS: Chickenpox and shingles cases were identified from administrative data from Alberta's universal health care insurance system for 1994-2002. Incident cases were those with the earliest dated utilization of a health service (chickenpox: ICD9-CM 052/ICD10-CA B01; shingles: ICD9-CM 053/ ICD10-CA B02). Crude and age-specific rates were estimated for each year by an indicator of socio-demographic status based upon the nature of the payer and eligibility for health care premium subsidy (SES-proxy) for the provincial health care insurance system. RESULTS: Among young children there is a gradient of disparity in chickenpox rates prior to the year in which publicly funded vaccination programs were implemented. After this point, disparities decline but less so for First Nations children than for others. There was no evidence of disparity by SES-proxy for shingles. CONCLUSION: Publicly funded vaccination programs may effectively contribute to reduction in disease disparities for vaccine-preventable diseases. Further study is required to ascertain why disparities continue for First Nations children. PMID: 18435390 [PubMed - indexed for MEDLINE] 378. J Med Virol. 2008 Jun;80(6):1123-30. Genotypes of varicella-zoster virus wild-type strains in Germany. Sauerbrei A, Zell R, Philipps A, Wutzler P. Institute of Virology and Antiviral Therapy, Friedrich-Schiller University of Jena, Jena, Germany. andreas.sauerbrei@med.uni-jena.de Surveillance of varicella-zoster virus (VZV) genotypes is indicated in Germany after implementation of universal varicella vaccination. This article reports genotyping data of 77 VZV strains obtained from 54 patients with varicella, 1 newborn with congenital varicella syndrome, 2 fetuses with intrauterine VZV infection and 20 cases with zoster. Fragments of the open reading frames (ORF) 1, 21, 22, 37, 50, 54, and 60 were analyzed by sequencing. In addition, the PstI polymorphism of the ORF 38 was characterized. Thirty strains, 22 from varicella and 8 from zoster, had the genetic markers of genotype E2, 2 of them carried new single nucleotide polymorphisms (SNP). Twenty-nine VZV isolates, 17 from varicella, and 12 from zoster, could be analyzed as E1 strains, 6 of them as E1 variants containing individual SNPs. Finally, 17 strains taken from primary VZV infection were classified as genotype M1, 13 of which belonged to the M1 subtype 1, 3 to the M1 subtype 2, and 1 to the M1 subtype 3. One strain was regarded as potential E2/J recombinant. In conclusion, VZV genotypes E2, E1, and M1 can be found in nearly equal incidence in varicella in Germany. The most frequent group is attributed to the genotype E2. Genotype M1 strains can only be detected after primary VZV infection and not in zoster cases. The possible recombinant could not be classified definitely by the scattered SNP method used and, therefore, has to be confirmed by full-genome sequencing studies. PMID: 18428135 [PubMed - indexed for MEDLINE] 379. Clin J Pain. 2008 May;24(4):366-8. Post herpetic itching--a treatment dilemma. Semionov V, Shvartzman P. Pain and Palliative Care Unit, Siaal Research Center for Family Medicine and Primary Care, Ben-Gurion University of the Negev, Clalit Health Services-Southern District, Beer-Sheva, Israel. valsem2002@yahoo.com OBJECTIVES: To present a case of severe disabling postherpetic itching (PHI) and discuss possible mechanisms and management. METHODS: We report on a 22-year-old male patient with a history of non-Hodgkin lymphoma, chronic renal failure peritoneal dialysis dependent, presented with a disabling pruritus around his left eye and forehead. Two months before, he was diagnosed with herpes zoster ophtalmicus. His itching intensity was 10/10 on a visual analog scale and he reported no pain. The neurologic examination showed a hyposensitivity to touch around his left eye. RESULTS: Our patient suffered of PHI who responded successfully to a combination of antihistamine and an antiepileptic agent. DISCUSSION: The mechanism of postherpetic neuralgia and PHI are not well understood and no single best treatment for postherpetic neuralgia and PHI is known. Clinical experience suggested that neuropathic itch may be more resistant to treatment than neuropathic pain. This immunocompromized patient with a severe disabling PHI responded to antihistaminic and anticonvulsant treatment. PMID: 18427235 [PubMed - indexed for MEDLINE] 380. Eur J Dermatol. 2008 Mar-Apr;18(2):205-6. Erythema annulare centrifugum associated with herpes zoster. Sugita K, Kabashima K, Tokura Y. PMID: 18424397 [PubMed - indexed for MEDLINE] 381. J Infect Dis. 2008 May 1;197(9):1289-95. Double-blind study comparing 2 dosages of valacyclovir hydrochloride for the treatment of uncomplicated herpes zoster in immunocompromised patients 18 years of age and older. Arora A, Mendoza N, Brantley J, Yates B, Dix L, Tyring S. Department of Dermatology, University of Texas-Houston School of Medicine, Houston, TX 77030, USA. aarora1979@gmail.com A dosage of 1 g of valacyclovir 3 times per day (TID) for 7 days has already been shown to be superior to an oral dosage of 800 mg acyclovir 5 times per day for 7 days in immunocompetent individuals. The objective of this study was to assess the safety and efficacy of an oral dosage of valacyclovir, 1 g TID versus 2 g TID, for the treatment of herpes zoster in immunocompromised patients > or =18 years of age. The oral dosage schedule of 2 g of valacyclovir TID reaches acyclovir plasma levels similar to those achieved with intravenous acyclovir therapy given to immunocompromised patients (10 mg/kg every 8 h for 7 days). In this double-blind study, 87 immunocompromised patients with clinical evidence of localized herpes zoster were randomized to receive oral valacyclovir therapy for 7 days, either 1 g TID or 2 g TID, within 72 h after onset of zoster rash. Patients were seen and assessed for cutaneous healing, zoster-associated pain (ZAP), and/or zoster-associated abnormal sensations (ZAAS), up to 24 weeks. Participants in both arms of the study demonstrated similar median times to full crusting of the rash (8 days), and both dosages were safe and effective therapies for reduction of ZAP and ZAAS in the immunocompromised patient population. PMID: 18422441 [PubMed - indexed for MEDLINE] 382. Clin Infect Dis. 2008 May 1;46(9):1452-4. Shingles (varicella zoster) outbreaks in patients with hyperparathyroidism and their relationship to hypercalcemia. Norman J, Politz D. Norman Parathyroid Clinic, Tampa, Florida 33613, USA. jnorman@parathyroid.com Comment in: Clin Infect Dis. 2008 Nov 1;47(9):1235-6; author reply 1236-7. Shingles (varicella zoster) can be a presenting symptom of hyperparathyroidism and occurs twice as often (rate, 3.7%) among patients with hypercalcemia than in age-matched cohorts of patients >40 years of age who have normal calcium levels. The incidence of shingles increased in a linear fashion, from an annual rate of 1.5% among patients with serum calcium levels <10.5 mg/dL to 11% among patients whose calcium levels reached 13 mg/dL (P<.05), a rate that is 6 times greater than that among age-matched historical control individuals (P<.05). PMID: 18419453 [PubMed - indexed for MEDLINE] 383. J Infect Dis. 2008 Mar 15;197(6):825-35. Varicella-zoster virus-specific immune responses in elderly recipients of a herpes zoster vaccine. Levin MJ, Oxman MN, Zhang JH, Johnson GR, Stanley H, Hayward AR, Caulfield MJ, Irwin MR, Smith JG, Clair J, Chan IS, Williams H, Harbecke R, Marchese R, Straus SE, Gershon A, Weinberg A; Veterans Affairs Cooperative Studies Program Shingles Prevention Study Investigators. Collaborators: Oxman MN, Arbeit R, Barry P, Beisel C, Boardman KD, Colling CL, Davis L, Gelb L, Gershon AA, Hayward AR, Irwin MR, Johnson GR, Levin MJ, Peduzzi PN, Schmader K, Simberkoff MS, Straus SE, Weinberg A, Williams HM, Silber JL, Annunziato P, Chan CY, Chan IS, Davis LE, Kauffman CA, Keay SK, Marques AR, Soto NE, Brunell P, Gnann JW, Serrao R, Cotton DJ, Goodman RP, Arbeit RD, Pachucki CT, Levin MJ, Schmader KE, Keitel WA, Greenberg RN, Morrison VA, Wright PF, Griffin MR, Simberkoff MS, Yeh SS, Lobo Z, Holodniy M, Loutit J, Betts RF, Gelb LD, Crawford GE, Guatelli J, Brooks PA, Neuzil KM, Toney JF. University of Colorado Health Sciences Center, Denver, Colorado, USA. myron.levin@uchsc.edu BACKGROUND: A double-blind, placebo-controlled trial that involved 38,546 subjects > or =60 years old demonstrated efficacy of a high-potency live-attenuated Oka/Merck varicella-zoster virus (VZV) vaccine. The trial included an immunology substudy to determine the relationship of VZV-specific immune responses to vaccination and clinical outcome. METHODS: The immunology substudy enrolled 1395 subjects at 2 sites where blood samples obtained prior to vaccination, at 6 weeks after vaccination, and at 1, 2, and 3 years thereafter were tested for VZV-specific cell-mediated immunity (VZV-CMI) by gamma-interferon ELISPOT and responder cell frequency assays and for VZV antibody by glycoprotein ELISA. RESULTS: VZV-CMI and VZV antibodies were significantly increased in vaccine recipients at 6 weeks after vaccination. The vaccine-induced increases in VZV-CMI persisted during the 3 years of follow-up, although their magnitude decreased over time. The magnitude of these VZV-specific immune responses was greater in subjects 60-69 years old than in subjects > or =70 years old. CONCLUSIONS: The zoster vaccine induced a significant increase in VZV-CMI and VZV antibody. The magnitude and duration of the boost in VZV-CMI in vaccine recipients and the relationship of this boost to age paralleled the clinical effects of the vaccine observed during the efficacy trial. These findings support the hypothesis that boosting VZV-CMI protects older adults against herpes zoster and postherpetic neuralgia. PMID: 18419349 [PubMed - indexed for MEDLINE] 384. Scand J Infect Dis. 2008;40(5):428-30. Breakthrough VZV infection after immunization, presenting as herpes zoster. Schade RP, Bakkers J, Cornelissen M, Koster-Kamphuis L, Melchers WJ, Galama JM. Department of Medical Microbiology, Nijmegen, The Netherlands. r.schade@mmb.umcn.nl An immunocompromized, VZV-vaccinated child had a breakthrough infection with VZV, acquired at a day-care centre during a chickenpox outbreak. Interestingly, the infection manifested as herpes zoster of 1 dermatome. Typing showed wild-type virus, which suggests that exogenous reinfection with a new strain may present as herpes zoster. PMID: 18418805 [PubMed - indexed for MEDLINE] 385. J Pain. 2008 Jul;9(7):658-65. Epub 2008 Apr 15. Widespread unilateral pain associated with herpes simplex virus infections. Kallio-Laine K, Seppänen M, Lokki ML, Lappalainen M, Notkola IL, Seppälä I, Koskinen M, Valtonen V, Kalso E. Pain Clinic, Department of Anesthesiology and Intensive Care Medicine, Helsinki University Central Hospital, HUS, Helsinki, Finland. katariina.kalliolaine@hus.fi We describe a patient group with unexplained widespread pain on one side of the body and pain exacerbations during active labial or genital herpes and during herpetic central nervous system infections. The patients had no visible lesion of the central nervous system on magnetic resonance imaging or abnormality in electrophysiological studies. To understand the nature of the pain and its possible relation to herpes simplex virus (HSV) infections, a clinical neurological examination was performed and quantitative sensory testing and skin biopsies were assessed in 17 patients. The levels of serum total immunoglobulins and IgG subclasses and the frequencies of the immune response genes at the IGH@, HLA-A, -B, -DRB1, C4A, and C4B loci were analyzed in the patients and in control subjects. The patients manifested a uniform clinical syndrome with unilateral pain that was best described as neuropathic and that was exacerbated by HSV reactivations. Low plasma IgG3 concentrations, the presence of either low plasma IgG1 or IgG3 or both, and high anti-HSV-2-IgG titers were more common in the patients than in the control subjects, which rendered the patients more vulnerable to HSV recurrences. PERSPECTIVE: We suggest that low immunoglobulin subclass levels and certain MHC alleles render the patients susceptible to recurring HSV infections. HSV reactivations and the accompanying inflammatory process cause dysfunction of the central nervous system that manifests as neuropathic pain. Studies using functional brain imaging are needed to clarify this syndrome. PMID: 18417422 [PubMed - indexed for MEDLINE] 386. Niger Postgrad Med J. 2008 Mar;15(1):24-7. HIV/AIDS in ophthalmic patients: The Guinness Eye Centre Onitsha experience. Nwosu NN. Guinness Eye Center Onitsha Nigeria. sabenwosu@yahoo.com OBJECTIVES: To determine the incidence and pattern of ocular problems of HIV/AIDS at the Guinness Eye Centre Onitsha, Nigeria. METHODS: The case files of all patients who had HIV test at the Guinness Eye Centre Onitsha over a 6-year period were examined. Those who tested positive for HIV were further analysed. Information obtained included patients' demographic characteristics, clinical diagnosis, ocular and systemic co-morbidity, visual acuity and follow-up. RESULTS: Of 1011 patients, 100 (9.9%), 51 males and 49 females, were confirmed HIV-positive. The age range was 21 - 80 years; median -31 years. Fifty-five patients (55%) were or had been married; 45 (45%) were single. Herpetic eye disease constituted 50% of the cases with herpes zoster ophthalmicus accounting for 48%. Bilateral ocular disease occurred in 19 patients (19%) viz: cytomegalovirus (CMV) retinitis (6%); corneal ulcers (6%); uveitis (4%); ocular motor palsy (2%) and ocular gunshot injury (1%). Non-HIV ocular lesions occurred in 20 patients (20%) as follows: bacterial corneal ulcer (8%); globe laceration (6%); non-CMV associated rhegmatogenous retinal detachment, cataract, and secondary orbital tumour (2% each). Systemic co-morbidities were present in 10 patients (10%), namely, emaciation (6%), pulmonary tuberculosis and abdominal malignancy with orbital metastases (2% each). Twenty three patients (23%) had bilateral blindness; 45 (45%) had uniocular blindness; 73.4% of the affected eyes were blind at presentation with 25% having no light perception (NPL). CONCLUSIONS: The incidence of HIV seropositivity doubled in the hospital over nearly 10-year period. Herpes zoster ophthalmicus remains the commonest ocular manifestation although CMV retinitis is becoming common. Since 20% of the patients had non-HIV ocular lesions, eye-health workers are advised to always take universal precautions in order to prevent the spread of the infection within and outside the hospital. PMID: 18408779 [PubMed - indexed for MEDLINE] 387. Rev Med Interne. 2008 Nov;29(11):932-5. Epub 2008 Apr 10. [Sciatica with motor loss revealing meningoradiculitis due to varicella-zoster virus] [Article in French] Abourazzak F, Couchouron T, Meadeb J, Perdriger A, Tattevin P, Moutel A, Le Goff B, Hajjaj-Hassouni N, Chalès G. Service de rhumatologie, CHU de Rabat-Salé, hôpital El-Ayachi, Maroc. abourazakf@yahoo.fr Herpes zoster is a disease which occurs secondary to the reactivation of varicella-zoster virus. Motor involvement in acute herpes zoster is rare. We report a case of sciatica L5 due to herpes zoster infection with motor loss. Typical skin lesions occurred one week before the sciatica. Radiological finding did not explain the paresis. The diagnosis of zoster sciatica with motor involvement was suspected. Serological tests and cerebrospinal fluid examination established the diagnosis. The antiviral and physical treatment was conducted in order to improve functional outcome. PMID: 18406019 [PubMed - indexed for MEDLINE] 388. Zhongguo Zhen Jiu. 2008 Feb;28(2):147-50. [Evaluation of literature quality of acupuncture for treatment of herpes zoster and approach to the laws of treatment] [Article in Chinese] Peng WN, Liu ZS, Deng YH, Mao M, Yu JN, Du Y. Section of Acupuncture, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, China. wnpeng@hotmail.com OBJECTIVE: To assess the quality of literature of clinical studies on acupuncture in treatment of herpes zoster. METHODS: The literatures between 1994-2006 were searched by means of electronic retrieval. Type and methodology, general condition, diagnosis of diseases and enrolled and excluded criteria, assessment of sample content, treatment condition, criteria for assessment of therapeutic effects, following-up, etc. in clinical studies are evaluated according to principles and methods of clinical epidemiology and evidence-based medicine. RESULTS: Of the 399 literatures enrolled, only 8 were authentic randomized controlled trials (RCTs), 20 quasi-randomized controlled trials, 66 non-randomized concurrent controlled trials and 277 narrative studies, 70 had clear diagnostic criteria, 16 mentioned enrolled or excluded criteria, 287 had clear criteria for therapeutic effects, 107 reported follow-up, 2 had the description of health economical index, 9 reported adverse reaction. CONCLUSION: At present, correct randomization, concealment, blinding and placebo-control, and the RCTs with generally accepted criteria for assessment of diagnosis and therapeutic effects, safety evaluation and rational design of follow-up are needed. It is indicated by preliminary study of the literatures that blood-letting puncture and cupping at Ashi points are main methods for treatment of herpes zoster. PMID: 18405162 [PubMed - indexed for MEDLINE] 389. J Pediatr Ophthalmol Strabismus. 2008 Mar-Apr;45(2):116-7. Ring corneal infiltrate and progressive ring thinning following primary varicella infection. Khan AO, Al-Assiri A, Wagoner MD. Division of Pediatric Ophthalmology, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia. Unilateral stromal keratitis is a known rare sequela of primary varicella infection. The authors describe a unique case of immunological (Wessely) ring formation and progressive ring thinning following primary varicella infection in a 6-year-old girl. PMID: 18404961 [PubMed - indexed for MEDLINE] 390. Bull Acad Natl Med. 2007 Jun;191(6):1051-64; discussion 1064-7. [Immunization against varicella and zoster] [Article in French] Floret D. Université Claude Bernard LYON 1, Service d'Urgence et de Réanimation Pédiatrique, Hôpital Edouard Herriot, Place d'Arsonval 69437 Lyon. Two vaccines against varicella-zoster virus are available in France. These live attenuated vaccines are derived from the Oka strain used in Japan since 1974. They are indicated for healthy subjects from 12 months of age, at a dose of one injection until 12 years of age, and two injections 4-8 weeks apart for older children and adults. Seroconversion occurs in 95% of cases and the antibodies persist beyond 5 years. Clinical efficacy is about 85% against all forms of varicella and nearly 100% against severe forms. Post-exposure vaccination within 3 days may also prevent the disease. A universal immunization program against varicella was implemented in the USA in 1995. Now, with vaccine coverage at about 80%, the incidence of the disease has been reduced by 85%, with the largest decrease in 1- to 4-year-olds. Tolerability is generally good, with only mild reactions at the injection site and moderate fever The length of protection is not yet known. A two-dose schedule seems advisable to avoid breakthrough varicella, which occurs in 4% of vaccinees each year. Insufficient coverage is expected to lead to later disease onset, with more severe cases in adolescents and adults. Universal immunization could also increase the incidence of zoster. These problems indeed seem to be emerging in the United States. France has adopted restrictive guidelines on VZV vaccination, but they are expected to be revised when the combined MMR-V vaccine becomes available. Zoster vaccine, prepared with the same strain but at a higher concentration, has moderate efficacy on zoster and on post-zoster neuralgia in patients over 70. This vaccine is not yet recommended in France, because the length of protection is not known and there is a potential risk of delaying the occurrence of zoster and, thus, of increasing the risk of post zoster neuralgia. PMID: 18402164 [PubMed - indexed for MEDLINE] 391. Otol Neurotol. 2008 Jun;29(4):470-4. Soluble intercellular adhesion molecule 1 and soluble vascular cell adhesion molecule 1 in sudden hearing loss. Quaranta N, Ramunni A, Brescia P, D'Elia A, Vacca A, Ria R. Otolaryngology G. Lugli, Otologic and Neurotologic Surgery, University of Bari, Bari, Italy. nicola.quaranta@orl.uniba.it HYPOTHESIS: The aim of the present study was to evaluate the concentration of soluble intercellular adhesion molecule 1 and soluble vascular cell adhesion molecule 1 in patients affected by sudden sensorineural hearing loss (SSHL). STUDY DESIGN: Prospective study. SETTING: Tertiary referral center. PATIENTS: Patients affected by SSHL were evaluated. Inclusion criteria for this study were hearing loss of more than 30 dB hearing level affecting at least 3 contiguous frequencies, normal hearing on the contralateral ear, negative history of hearing loss or ear surgery in the affected ear, and magnetic resonance with gadolinium negative for VIII cranial nerve pathologic findings. INTERVENTION: Circulating levels of soluble intercellular adhesion molecule 1 and soluble vascular cell adhesion molecule (VCAM) 1 were evaluated by means of enzyme-linked immunosorbent assay. MAIN OUTCOME MEASURES: The levels of adhesion molecules in SSHL patients were compared with those of a control group. RESULTS: Intercellular adhesion molecule 1 and VCAM-1 levels in sera of patients with SSHL were significantly higher than those of the matched control subjects (p < 0.001). Statistical analysis did not show significant differences between the 2 groups in terms of the known vascular risk factors such as total and fractionated cholesterol, triglycerides, fibrinogen, erythrocyte sedimentation rate smoking, and diabetes. CONCLUSION: The results of this study show that in SSHL patients, there is an increased expression of circulating adhesion molecules confirming the existence of an endothelial dysfunction and supporting the vascular involvement in the pathogenesis of the disease. The identification of high levels of adhesion molecules and of the endothelial dysfunction open the way to selective pharmacologic treatments able to correct the activation of endothelial cells. PMID: 18401280 [PubMed - indexed for MEDLINE] 392. Dtsch Med Wochenschr. 2008 Apr;133(16):831-2. [Dermatoma complicating Herpes zoster during immunosuppression] [Article in German] Dorsch O. Kfh Nierenzentrum Kronach, Friesener Str. 37a, 96317 Kronach. oliver.dorsch@kfh-dialyse.de PMID: 18398791 [PubMed - indexed for MEDLINE] 393. Hell J Nucl Med. 2008 Jan-Apr;11(1):51-2. Pitfall of 18F-FDG-PET imaging in oncology: herpes zoster with axillary lymphadenopathy. Sharma R, Jaimini A, Mondal A, Tripathi M. PMID: 18392232 [PubMed - indexed for MEDLINE] 394. Hong Kong Med J. 2008 Apr;14(2):142-4. Good's syndrome in a patient with cytomegalovirus retinitis. Yong DS, Tsang MK, Chan EY, Tse DM. Department of Medicine and Geriatrics, Caritas Medical Centre, Shamshuipo, Kowloon, Hong Kong. Comment in: Hong Kong Med J. 2008 Jun;14(3):246. Thymoma-related adult-onset immunodeficiency or Good's syndrome is an uncommon condition. This case, of a 50-year-old woman who was human immunodeficiency virus-negative and developed herpes zoster and severe cytomegalovirus retinitis 6 months after removal of a thymoma, is the first to be reported in Hong Kong. Immunological investigations revealed no B cells, hypogammaglobulinaemia, a low CD4 count, and a low CD4/CD8 ratio. We recommend that immunological investigations, including T-cell subsets, B cells, and quantitative immunoglobulins, should be part of the routine diagnostic evaluation of patients with thymoma and infections. PMID: 18382022 [PubMed - indexed for MEDLINE] 395. Ann Dermatol Venereol. 2008 Mar;135(3):187-93. Epub 2008 Mar 7. [Prevalence of skin disorders in HIV patients in Senegal and relationship to degree of immunosuppression] [Article in French] Monsel G, Ly F, Canestri A, Diousse P, Ndiaye B, Caumes E. Service des maladies infectieuses et tropicales, groupe hospitalier de la Pitié-Salpêtrière, Assistance publique-Hôpitaux de Paris, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France. BACKGROUND: The aim was to evaluate the association between dermatological findings in HIV-infected patients in Senegal and degree of immunosuppression and HIV stage. PATIENTS AND METHODS: All consecutive HIV infected patients followed up at three dermatology centres in Senegal from 01 January 2004 to 01 January 2006 were evaluated retrospectively regarding dermatological findings, CD4 cell count and HIV stage. PATIENTS AND METHODS: One hundred and forty-nine patients with 331 skin diseases were evaluated. The most common forms of dermatosis were oral candidiasis (53%), herpes zoster (24%), prurigo (24%) and dermatophytosis (16%). An increasing number of skin diseases was significantly associated with CD4 counts of below 200 per cubic millimeter and Aids diagnosis. A significant association (p<0.05) was found between two types of dermatosis (oral candidiasis and chromonychia) and CD4 counts of below 200 per cubic millimeter and between four types of dermatosis (straightened hair, herpes, oral candidiasis and xerosis) and Aids diagnosis. CONCLUSION: Dermatological findings are of great diagnostic and prognostic significance. We found some features specific to black skin: longitudinal melanonychia and blue ungueal pigmentation potentially related to immunosuppression and straightened hair, associated with Aids, probably resulting from denutrition. PMID: 18374849 [PubMed - indexed for MEDLINE] 396. Pain Med. 2008 Apr;9(3):348-53. Health care expenditure burden of persisting herpes zoster pain. Dworkin RH, White R, O'Connor AB, Hawkins K. Department of Anesthesiology, University of Rochester School of Medicine and Dentistry, Rochester, New York 14642, USA. robert_dworkin@urmc.rochester.edu OBJECTIVES: Pain can persist long after the resolution of herpes zoster, but little is known regarding its health care costs. The objective of this study was to determine the health care expenditures associated with persisting pain following herpes zoster by comparing expenditures for patients with postherpetic neuralgia or subacute herpetic neuralgia with a control group without these conditions. METHODS: Health care expenditures attributable to persisting pain in herpes zoster patients were calculated using Thomson-Medstat's MarketScan databases to examine commercial, Medicare, and Medicaid claims for inpatient and outpatient services and outpatient prescription drugs. RESULTS: Excess annualized costs were $4,917 for commercially insured patients, $2,696 for Medicare patients, and $9,310 for Medicaid patients. CONCLUSIONS: The substantial health care costs associated with persisting pain in herpes zoster have important public health implications given evidence that the incidence of herpes zoster is increasing and that the population is aging in the United States. The results provide a basis for evaluating the cost-effectiveness of existing treatments and emerging prevention strategies. PMID: 18366512 [PubMed - indexed for MEDLINE] 397. Fetal Pediatr Pathol. 2007 Sep-Dec;26(5-6):243-54. Inflammatory myofibroblastic tumor of the midesophagus. Goldin SB, Osborne D, Paidas C, Iannello J, Gilbert-Barness E, Karl R, Wilsey MJ Jr. Department of Surgery, University of South Florida College of Medicine, Tampa, Florida, USA. sgoldin@hsc.usf.edu An inflammatory myofibroblastic tumor (IMFT) is a rare entity that can arise in a multiplicity of organs including the lung, liver, and at any location within the gastrointestinal tract. Typically, an IMFT presents as a localized mass with clinical symptoms dependent upon its site of origin. IMFTs pathologically resemble a neoplastic process but are theorized to arise from an unknown inflammatory event. We present a case of a midesophageal IMFT in a 12-year-old female. PMID: 18363157 [PubMed - indexed for MEDLINE] 398. Neurology. 2008 Mar 25;70(13):1049-51. Ramsay hunt syndrome followed by multifocal vasculopathy and posterior circulation strokes. Ortiz GA, Koch S, Forteza A, Romano J. Jackson Memorial Hospital, University of Miami, Miller School of Medicine, Miami, FL 33136, USA. PMID: 18362285 [PubMed - indexed for MEDLINE] 399. Eur J Dermatol. 2008 Jan-Feb;18(1):108-11. Skin diseases with high public health impact. Herpes simplex and zoster. Díaz-Ramón JL, Dĺaz-Pérez JL. PMID: 18360933 [PubMed - indexed for MEDLINE] 400. Mod Rheumatol. 2008;18(3):301-5. Epub 2008 Mar 25. Varicella-zoster virus hepatitis in polymyositis. Mizoguchi F, Nakamura S, Iwai H, Kubota T, Miyasaka N. Department of Medicine and Rheumatology, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, Japan. A 31-year-old woman had recurrent mild flare-ups of polymyositis for years. Fourteen days after low-dose methotrexate was added in an attempt to taper the corticosteroid, she began to feel abdominal and lower back pain, followed by generalized pustulosis, severe liver dysfunction, and disseminated intravascular coagulation. On the diagnosis of varicella-zoster virus (VZV) hepatitis, acyclovir, immune globulin and plasmapheresis were given with a favorable outcome. Physicians should be aware that VZV infection could complicate severe hepatitis in immuno-suppressed patients. PMID: 18360803 [PubMed - indexed for MEDLINE] 401. Ophthal Plast Reconstr Surg. 2008 Mar-Apr;24(2):162-4. Palpebral subconjunctival hemorrhages in herpes zoster ophthalmicus. Najjar DM, Youssef OH, Flanagan JC. Department of Ophthalmology, Temple University Hospital, Philadelphia, PA 19140, USA. danynajjar@hotmail.com A 75-year-old previously healthy woman was referred for evaluation of pain and foreign body sensation in her left eye of 4 days' duration. Two weeks before presentation she was diagnosed with herpes zoster involving the left forehead and temple area and started on famciclovir treatment. Examination of her left cornea revealed inferior superficial punctate keratitis, but no dendrites or pseudodendrites. Upper eyelid eversion disclosed unusual raised palpebral subconjunctival hemorrhages on the left side. She was started on topical prednisolone eyedrops in the left eye, and her symptoms improved over the following week. Herpes zoster ophthalmicus can initially present in the eyelids. Careful follow-up with particular attention to the eyelids and eyelid eversion is recommended in any patient presenting with herpes zoster to detect early ocular involvement. PMID: 18356732 [PubMed - indexed for MEDLINE] 402. J Eur Acad Dermatol Venereol. 2009 Jan;23(1):90-2. Epub 2008 Mar 18. Wolf's isotopic response: zosteriform morphea appearing at the site of healed herpes zoster in a HIV patient. López N, Alcaraz I, Cid-Mañas J, Camacho E, Herrera-Acosta E, Matilla A, Herrera E. PMID: 18355190 [PubMed - indexed for MEDLINE] 403. Klin Monbl Augenheilkd. 2008 Mar;225(3):236-9. [Atypical ocular toxoplasmosis with concomitant ocular reactivation of varicella-zoster virus and cytomegalovirus in an immunocompromised host] [Article in German] Hasselbach HC, Fickenscher H, Nölle B, Roider J. Klinik für Ophthalmologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel. hhasselbach@ophthalmol.uni-kiel.de BACKGROUND: Necrotising retinopathy in immunocompromised hosts is characterised by an unfavourable course often with unspecific clinical features. Therefore, differential diagnosis can be critical. HISTORY AND SIGNS: A case of an initially therapy-resistant, necrotizing retinopathy is presented in a 65-year-old immunocompromised male patient suffering from chronic B-cell leukemia. THERAPY AND OUTCOME: Despite demonstration of cytomegalovirus and Varicella-Zoster-Virus DNA by polymerase chain reaction in vitreous, aqueous humour samples and from retinal biopsy with specific antiviral therapy, a progression of retinal necrosis was noted. Finally Toxoplasma gondii DNA was detected and retinal necrosis resolved after specific treatment. However, visual acuity remains poor because of optic nerve atrophy. CONCLUSIONS: The polymerase chain reaction is an important diagnostic tool for differential diagnosis in immunocompromised patients suffering from necrotising retinopathy. If resistance to therapy is noted atypical ocular toxoplasmosis should be considered. The presented case report shows that even multiple infections are possible in the same host. PMID: 18351539 [PubMed - indexed for MEDLINE] 404. Oral Maxillofac Surg Clin North Am. 2008 May;20(2):237-54, vii. Neuropathic orofacial pain. Benoliel R, Eliav E. Department of Oral Medicine, Hebrew University-Hadassah, POB 12272, Jerusalem, Israel 91120. benoliel@cc.huji.ac.il Neuropathic orofacial pain is a general term employed to describe a number of clinical syndromes, which may be spontaneous or triggered by local trauma or systemic disorders. Symptomatically these painful syndromes may be episodic or continuous and are often difficult to distinguish from dental pathology. In the present article, we review the diagnosis, pathophysiology and therapeutic approaches to trigeminal and glossopharyngeal neuralgias, orofacial pain associated with herpetic infection, persistent idiopathic facial pain (previously termed atypical facial pain), post-traumatic orofacial neuropathy and neuritis. PMID: 18343328 [PubMed - indexed for MEDLINE] 405. Can Fam Physician. 2008 Mar;54(3):373-7. Treatment of herpes zoster. Opstelten W, Eekhof J, Neven AK, Verheij T. Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands. W.Opstelten@umcutrecht.nl OBJECTIVE: To review the evidence regarding treatment of herpes zoster (HZ) in the short-term, focusing on the prevention of postherpetic neuralgia (PHN). QUALITY OF EVIDENCE: The evidence relating to treatment of HZ is derived mainly from randomized controlled trials (level I evidence). MAIN MESSAGE: Antiviral drugs might have some effect on the severity of acute pain and on the duration of skin lesions. Corticosteroids also alleviate acute pain. Oral antiviral medication reduces the risk of eye complications in patients with ophthalmic HZ. There is no convincing evidence that antiviral medication reduces the risk of PHN. Some studies, however, have shown that famciclovir and valacyclovir shorten the duration of PHN. The effectiveness of amitriptyline or cutaneous and percutaneous interventions in preventing PHN has not been proven. CONCLUSION: Oral antiviral drugs should be prescribed to elderly HZ patients with high risk of PHN. Moreover, these drugs should be prescribed to all patients at the first signs of ophthalmic HZ, irrespective of age or severity of symptoms. PMCID: PMC2278354 PMID: 18337531 [PubMed - indexed for MEDLINE] 406. Neurology. 2008 Mar 11;70(11):853-60. The varicella zoster virus vasculopathies: clinical, CSF, imaging, and virologic features. Nagel MA, Cohrs RJ, Mahalingam R, Wellish MC, Forghani B, Schiller A, Safdieh JE, Kamenkovich E, Ostrow LW, Levy M, Greenberg B, Russman AN, Katzan I, Gardner CJ, Häusler M, Nau R, Saraya T, Wada H, Goto H, de Martino M, Ueno M, Brown WD, Terborg C, Gilden DH. Department of Neurology, Mail Stop B182, University of Colorado Health Sciences Center, 4200 E. 9th Ave., Denver, CO 80262, USA. Comment in: Neurology. 2009 Mar 17;72(11):1028-30; author reply 129-30. BACKGROUND: Varicella zoster virus (VZV) vasculopathy produces stroke secondary to viral infection of cerebral arteries. Not all patients have rash before cerebral ischemia or stroke. Furthermore, other vasculitides produce similar clinical features and comparable imaging, angiographic, and CSF abnormalities. METHODS: We review our 23 published cases and 7 unpublished cases of VZV vasculopathy. All CSFs were tested for VZV DNA by PCR and anti-VZV IgG antibody and were positive for either or both. RESULTS: Among 30 patients, rash occurred in 19 (63%), CSF pleocytosis in 20 (67%), and imaging abnormalities in 29 (97%). Angiography in 23 patients revealed abnormalities in 16 (70%). Large and small arteries were involved in 15 (50%), small arteries in 11 (37%), and large arteries in only 4 (13%) of 30 patients. Average time from rash to neurologic symptoms and signs was 4.1 months, and from neurologic symptoms and signs to CSF virologic analysis was 4.2 months. CSF of 9 (30%) patients contained VZV DNA while 28 (93%) had anti-VZV IgG antibody in CSF; in each of these patients, reduced serum/CSF ratio of VZV IgG confirmed intrathecal synthesis. CONCLUSIONS: Rash or CSF pleocytosis is not required to diagnose varicella zoster virus (VZV) vasculopathy, whereas MRI/CT abnormalities are seen in almost all patients. Most patients had mixed large and small artery involvement. Detection of anti-VZV IgG antibody in CSF was a more sensitive indicator of VZV vasculopathy than detection of VZV DNA (p < 0.001). Determination of optimal antiviral treatment and benefit of concurrent steroid therapy awaits studies with larger case numbers. PMID: 18332343 [PubMed - indexed for MEDLINE] 407. Dermatol Online J. 2007 Jul 13;13(3):29. [Herpes zoster and polyradiculopathy: report of a case] [Article in Portuguese] Silva de Almeida KJ, Tavares CB, Campos-Sousa RN. Universidade Federal do Piauí - Departamento de Neurologia. Polyradiculopathy that develops as a result of herpes zoster is rare. When it does occur, it usually follows the cutaneous eruption. However, we present a case of nerve impairment (motor, sensatory, and autonomic) that occurred prior to the cutaneous herpes zoster eruption. PMID: 18328223 [PubMed - indexed for MEDLINE] 408. Int J Infect Dis. 2007 Nov;11 Suppl 2:S43-8. Prevention of herpes zoster and its painful and debilitating complications. Johnson R, McElhaney J, Pedalino B, Levin M. r.w.johnson@bris.ac.uk BACKGROUND: Reactivation of latent varicella-zoster virus in sensory neurons to cause herpes zoster (shingles) is common in adults 50 years of age and older; half of adults experience an episode by age 85 years. Herpes zoster is attributable to the progressive decline in the VZV-specific cell-mediated immunity that occurs with aging or other conditions that cause immune compromise. Herpes zoster and complications, such as postherpetic neuralgia (PHN), can have a substantial negative impact on quality of life. DISCUSSION: The incidence of herpes zoster and its associated morbidity is increasing worldwide as the population ages. Nevertheless, the severity and impact of this condition, and its painful sequelae, are often unrecognized. Many patients delay seeking medical attention, complicating both diagnosis and treatment. Prevention appears to be the best option. A new herpes zoster vaccine significantly reduced the burden of illness (61.1%), the incidence of PHN (66.5%), and the incidence of herpes zoster (51.3%) (p < 0.001). Vaccine tolerability was good, with minor local injection site reactions the most common adverse event. CONCLUSIONS: Herpes zoster and PHN represent a substantial burden in terms of suffering and associated costs. Immunization of older adults is a good option to prevent herpes zoster and PHN. PMID: 18162246 [PubMed - indexed for MEDLINE] 409. Internist (Berl). 2008 Jun;49(6):737-42. [A 52-year-old woman with acute shock and purpura fulminans. Pneumococcal sepsis] [Article in German] Jochum E, Perez-Bouza A, Baumanns S, vom Dahl J, Janssen U. Klinik für Kardiologie, Nephrologie und internistische Intensivmedizin, Krankenhaus St. Franziskus, Kliniken Maria Hilf GmbH, Viersener Strasse 450, 41063, Mönchengladbach, Germany. Eric.Jochum@mariahilf.de We report a 52-year-old female patient admitted with fever, chills, and myalgias since the previous day. On the day of admission she had a generalized seizure. The patient had no previous illnesses. Laboratory investigations showed consumptive coagulopathy with clinical manifestations of shock and development of multiple organ failure. Pneumococci were detected in blood cultures. Furthermore the skin showed purpura fulminans all over. The patient died within 24 h after admission in the intensive care unit. On autopsy, in addition to adrenal and myocardial hemorrhages, hypoplasia of the spleen was found. Fulminant pneumococcal sepsis is a life-threatening disease that occurs in patients with risk factors like splenic hypoplasia or asplenia. Sometimes a fulminant pneumococcal sepsis may be the first clinical manifestation of a hitherto unknown splenic hypoplasia. In this context the general recommendation of vaccination against pneumococci in patients with risk factors like splenic hypoplasia or asplenia, in patients older than 60, and in children from 2 months onward has to be emphasized. PMID: 18322667 [PubMed - indexed for MEDLINE] 410. Iran J Immunol. 2008 Mar;5(1):64-7. Co-existence of common variable immunodeficiency (CVID) with idiopathic thrombocytopenic purpura (ITP). Hegazi MO, Kumar R, Alajmi M, Ibrahim E. Department of Medicine, Al Adan Hospital, Kuwait. drosama02@gmail.com PMID: 18319527 [PubMed - indexed for MEDLINE] 411. J Natl Compr Canc Netw. 2008 Feb;6(2):191-201. Prevention and early treatment of opportunistic viral infections in patients with leukemia and allogeneic stem cell transplantation recipients. Angarone M, Ison MG. Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA. A leading complication of leukemia therapy and stem cell transplantation is opportunistic viral infections. Infections caused by cytomegalovirus, herpes simplex, varicella-zoster, Epstein-Barr, and the community respiratory viruses are associated with significant morbidity and mortality in this highly immunosuppressed population. Fortunately, a growing armamentarium is allowing more effective prophylaxis of these pathogens. This article reviews the epidemiology and prophylactic strategies available for these common opportunistic viral pathogens. PMID: 18319051 [PubMed - indexed for MEDLINE] 412. Dermatol Online J. 2008 Jan 15;14(1):1. Pattern of non-venereal dermatoses of female external genitalia in South India. Singh N, Thappa DM, Jaisankar TJ, Habeebullah S. Department of Dermatology and Sexually Transmitted Diseases, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India. Non-venereal dermatoses tend to be confused with venereal diseases, which may be responsible for mental distress and guilt feelings in patients. We conducted the study to find the pattern of non-venereal dermatoses of female external genitalia and to correlate non-venereal dermatoses with various clinical parameters. The study included 120 female patients with non-venereal dermatoses of female external genitalia presenting over a period of 22 months from September 2005 to June 2007. The demographic characteristics and clinical findings were recorded. Cases having venereal diseases were excluded from the study. A total of nineteen non-venereal dermatoses were noted in the study. The most common non-venereal dermatoses were lichen sclerosus (26 cases or 21.7%), vitiligo (19 cases or 15.8%), lichen simplex chronicus (16 cases or 13.3%), and vulval candidiasis (11 or 9.2%). Other dermatoses included lymphedema, invasive squamous cell carcinoma, tinea cruris, psoriasis, furuncle, folliculitis, lichen planus, epidermal inclusion cyst, herpes zoster, irritant contact dermatitis, acrochordon, Bartholin cyst, fibroepithelial stromal polyp, molluscum contagiosum (autoinoculated), and streptococcal vulvitis. This study highlights the importance of diagnosing non-venereal dermatoses and refutes the general misconception that all vulval itching is the result of fungal infection. The two most common causes of vulval itching observed in the study were lichen sclerosus and lichen simplex chronicus. PMID: 18319018 [PubMed - indexed for MEDLINE] 413. Epidemiol Infect. 2008 Apr;136(4):449; author reply 449-50. Re: secular trends in the epidemiology of shingles in Alberta. Gagliotti C. Comment on: Epidemiol Infect. 2007 Aug;135(6):908-13. PMID: 18318919 [PubMed - indexed for MEDLINE] 414. Nippon Ganka Gakkai Zasshi. 2008 Feb;112(2):136-40. [Clinical features of acute retinal necrosis at Hokkaido University Hospital] [Article in Japanese] Mizuuchi K, Namba K, Kotake S, Ohno S. Department of Ophthalmology and Visual Sciences, Hokkaido University Graduate School of Medicine, Sapporo, Japan. mizuuchi@peach.plala.or.jp PURPOSE: To study clinical features of acute retinal necrosis (ARN) at Hokkaido University Hospital. METHODS: Twenty-one eyes of 19 patients with ARN (10 male and 9 female patients) who were treated at Hokkaido University Hospital between 1992 and 2006 were retrospectively examined from clinical records. RESULTS: The average age of the patients was 53.4 years (range, 13 to 91 years). 17 cases were unilateral and 2 were bilateral. The pathogenic virus was herpes simplex virus-1 (HSV-1) in 2 patients, and varicella-zoster virus (VZV) in 17 patients. Clinical severity was assessed from spreading speed and area of the retinal exudation, and 5 eyes were judged as fulminant cases (4 VZV eyes, 1 HSV eye), 6 eyes as severe cases (6 VZV eyes), and 10 eyes as mild cases (9 VZV eyes, 1 HSV eye). The range of retinal exudation was 1 to 2 quadrants in 7 eyes, 3 to 4 quadrants in 3 eyes, and increased to all quadrants in 11 eyes. Retinal detachment (RD) was observed in 8 eyes (38%), and the final visual acuity was less than 0.1 in 9 eyes (43%). CONCLUSIONS: The leading cause of ARN at Hokkaido University Hospital was VZV, and no HSV-2 ARN was seen. Compared with other areas in Japan, ARN at Hokkaido University Hospital seems to show less frequent RD, but the same prognosis for final visual acuity. PMID: 18318274 [PubMed - indexed for MEDLINE] 415. Nippon Ganka Gakkai Zasshi. 2008 Feb;112(2):105-6. [Acute retinal necrosis--today, past and future] [Article in Japanese] Goto H. PMID: 18318270 [PubMed - indexed for MEDLINE] 416. J Eur Acad Dermatol Venereol. 2008 Jun;22(6):722-8. Epub 2008 Feb 25. Identification and characterization of 20 immunocompetent patients with simultaneous varicella zoster and herpes simplex virus infection. Giehl KA, Müller-Sander E, Rottenkolber M, Degitz K, Volkenandt M, Berking C. Department of Dermatology, Ludwig-Maximilian University of Munich, Munich, Germany. BACKGROUND: It has been shown that varicella zoster virus (VZV) and herpes simplex virus (HSV) can co-localize to the same sensory ganglion. However, only a few case reports on VZV/HSV co-infections exist. Objective To identify and characterize patients with concurrent VZV and HSV infection at the same body site. SUBJECTS/METHODS: In 1718 patients, the presence of VZV and HSV in suspicious skin lesions was investigated by polymerase chain reaction analysis. Clinical characteristics of co-infected patients were compared with matched control patients infected with either VZV or HSV. The data are discussed in the context of an extensive review of the literature. RESULTS: Twenty (1.2%) of 1718 patients were infected with both VZV and HSV at the same body site. The mean age was 54 years (range, 2-83). The clinical diagnosis was zoster in 65%, herpes simplex in 20%, varicella in 10% and erythema multiforme in 5% of cases. The trigeminus region was affected in 60% and the trunk in 25%. Involvement of the head was most commonly associated with a severe course of disease and with older age. CONCLUSION: Simultaneous VZV/HSV infection is rare but can occur in immunocompetent patients, which is often overlooked. The majority of cases is localized to the trigeminus region and affects elderly people. PMID: 18312326 [PubMed - indexed for MEDLINE] 417. Intern Med. 2008;47(5):463-5. Epub 2008 Mar 3. Herpes zoster ophthalmicus and syndrome of inappropriate antidiuretic hormone secretion. Kucukardali Y, Solmazgul E, Terekeci H, Oncul O, Turhan V. Department of Internal Medicine, Gulhane School of Medicine, Haydarpasa Training Hospital, Istanbul, Turkey. The syndrome of inappropriate antidiuretic hormone (SIADH) secretion is a common consequence of neurologic and pulmonary infections as well as drug intake and many other clinical situations. This report describes SIADH that developed in an elderly woman with single dermatomal herpes varicella zoster ophthalmicus without evidence of varicella zoster encephalitis or dissemination. A 76-year-old woman was admitted to our department for evaluation of left facial pain, confusion and disorientation. Further investigation revealed hyponatremia 112 mEq/L, low serum osmolality, high urine osmolality, normal renal function, normal adrenal and thyroid hormones, and high plasma vasopressin 40 pg/mL. These results indicate that the hyponatremia in this case was due to SIADH and that SIADH was caused by an increased release of vasopressin probably because of the antiviral drug (acyclovir) or infection of varicella zoster virus (VZV) in a single dermatome. PMID: 18310984 [PubMed - indexed for MEDLINE] 418. Cutis. 2008 Jan;81(1):71-2. Monodermatomal herpes zoster in a pseudodisseminated distribution following breast reconstruction surgery. Tuchman M, Weinberg JM. New York Medical College, New York, USA. A 45-year-old woman underwent a modified radical mastectomy with transverse rectus abdominis myocutaneous (TRAM) flap reconstruction for newly diagnosed stage III breast cancer. Three months after beginning chemotherapy, she developed an erythematous, vesicular, painful rash along the right side of her abdomen that extended to the right side of her chest. Although the rash had the qualities of herpes zoster, the distribution was not dermatomal in nature; instead, it crossed multiple dermatomes. The initial presentation was suspicious for disseminated herpes zoster because of its clinical presentation and her clinical history. A more extensive examination revealed the patient had monodermatomal herpes zoster masquerading as disseminated herpes zoster secondary to her TRAM flap procedure whereby the nerves were realigned and created this pseudodisseminated appearance of the rash. PMID: 18306852 [PubMed - indexed for MEDLINE] 419. Singapore Med J. 2008 Feb;49(2):e59-60. Zosteriform herpes simplex. Koh MJ, Seah PP, Teo RY. Department of Dermatology, Changi General Hospital, 2 Simei Street 3, Singapore 529889. docmark@pacific.net.sg Herpes simplex virus (HSV) infection, though most commonly seen in the oral, perioral and genital areas, can occur anywhere on the body. After primary infection, HSV then establishes latency in sensory nerve ganglia and reactivates intermittently, precipitated by various factors. These reactivations may be recurrent and appear in a dermatomal distribution, mimicking herpes zoster, often leading to misdiagnosis if no confirmatory laboratory tests are carried out. We report a 65-year-old man who presented with recurrent episodes of a "zosteriform eruption", who was initially clinically diagnosed and treated as for recurrent herpes zoster, but was subsequently found to have recurrent herpes simplex virus type 2 after laboratory investigations. PMID: 18301829 [PubMed - indexed for MEDLINE] 420. Nepal Med Coll J. 2007 Dec;9(4):281-3. Herpes zoster in a five month old infant subsequent to intrauterine exposure to varicella infection. Jha A, Kumar A, Paudel U, Neupane S, Pokhrel DB, Badal KP. Department of Pathology, Tribhuvan University Teaching Hospital, Maharajgunj Campus, Maharajgunj, Kathmandu, Nepal. jhaabhimanyu@yahoo.com Herpes zoster is characterized by painful vesicular eruption in a dermatomal distribution of sensory nerves as a result of reactivation of latent herpes zoster virus in posterior root ganglia. The primary varicella infection is usually acquired in childhood and reactivation usually is seen in elderly. In rare instances herpes zoster can also occur in infancy as a result of reactivation of primary varicella infection acquired in utero or in early infancy. Here, we report a rare case of herpes zoster in a 5 month baby who acquired primary infection in utero from mother who had varicella infection at 6 months of gestation. PMID: 18298022 [PubMed - indexed for MEDLINE] 421. Niger J Clin Pract. 2007 Dec;10(4):283-6. Ocular disorders in patients infected with the human immunodeficiency virus at the University of Benin Teaching Hospital, Benin City, Nigeria. Osahon AI, Onunu AN. Department of Ophthalmology, University of Benin Teaching Hospital, Benin City, Nigeria. osahonai@yahoo.com AIMS: Ocular diseases occur at all stages of HIV infection. Reports have documented that the prevalence of these diseases vary from region to region. Thus the objective of this study is to determine the prevalence of these ocular disorders among people infected with HIV at the University of Benin Teaching Hospital, Benin City, Nigeria METHODS: The study was prospective in design and all patients who tested positive for HIV antibodies over a 5-year period from September 1997 to August 2002 in Dermatology and Ophthalmology Units at the University of Benin Teaching Hospital (UBTH), Benin City, Nigeria, were examined for the presence of ocular disease. RESULTS: Twenty-one of the 526 HIV-positive patients had ocular disease, giving a prevalence rate of 4.0%. Their mean age was 39.5 +/- 10.5 years. Fourteen patients (2.7%) had Herpes zoster ophthalmicus, four (0.8%) had Squamuos cell carcinoma, two (0.4%) had Kaposi's sarcoma while one (0.2%) had Cytomegalovirus retinitis. The signs seen on ocular examination were vesicular rash (66.7%) diminished vision (57.1%) corneal ulcers (38.0%), conjunctival injection (38.0%), and eyelid nodules (28.6%), preauricular lymphadenopathy (28.6%), purulent eye discharge (19.0), conjunctival nodules (9.5%), papilledema (9.5%), ptosis (9.5%), sudden visual loss in both eyes (9.5%), pupillary dilatation (4.8%), chemosis (4.8%), uveitis (4.8%), and retinal hemorrhage (4.8%). CONCLUSIONS: In this study the prevalence of ocular disorders was 4.0% in the 526 HIV-positive patients studied. Herpes zoster ophthalmicus was the commonest ocular disease encountered, occurring in 2.7% of the study population. This is in keeping with reports from other parts of the world. We recommend that young patients presenting with Herpes zoster ophthalmicus, conjunctival Squamuos cell carcinoma and sudden onset bilateral blindness should be screened for HIV infection. PMID: 18293635 [PubMed - indexed for MEDLINE] 422. J Gen Intern Med. 2008 May;23(5):648-9. Epub 2008 Feb 20. Live, attenuated varicella zoster vaccination of an immunocompromised patient. Curtis KK, Connolly MK, Northfelt DW. Division of Hematology/Oncology, Mayo Clinic, Scottsdale, AZ, USA. A vaccine for the prevention of herpes zoster outbreaks in adults over the age of 60 years has recently been approved. A 76-year-old white female with a history of recurrent left axillary breast cancer undergoing chemotherapy was given a Zostavax injection by her primary care physician. Eight days later, the patient developed a rash. Given the recent administration of live, attenuated varicella zoster virus (VZV), a diagnosis of disseminated cutaneous herpes zoster was made. The patient was treated successfully with a course of famciclovir for 10 days and cephalexin for 7 days for a secondary bacterial infection. A review of the medical literature disclosed no reports of Zostavax given to adult cancer patients immunocompromised by systemic chemotherapy. Therefore, we believe this report is the first to describe the consequences of Zostavax administration to such a host. Clinicians should take care to review contraindications and precautions prior to administering the Zostavax vaccine. PMCID: PMC2324151 PMID: 18286341 [PubMed - indexed for MEDLINE] 423. Br J Dermatol. 2008 May;158(5):1145-6. Epub 2008 Feb 16. Primary manifestation of a zosteriform lichen planus: isotopic response following herpes zoster sine herpete? Möhrenschlager M, Engst R, Hein R, Ring J. PMID: 18284381 [PubMed - indexed for MEDLINE] 424. Pharmacoeconomics. 2008;26(3):235-49. Community and patient values for preventing herpes zoster. Lieu TA, Ortega-Sanchez I, Ray GT, Rusinak D, Yih WK, Choo PW, Shui I, Kleinman K, Harpaz R, Prosser LA. Department of Ambulatory Care and Prevention, Harvard Pilgrim Health Care and Harvard Medical School, Boston, MA 02215, USA. tracey.lieu@harvardpilgrim.org OBJECTIVES: The US Advisory Committee on Immunization Practices has recently recommended a new vaccine against herpes zoster (shingles) for routine use in adults aged > or =60 years. However, estimates of the cost effectiveness of this vaccine vary widely, in part because of gaps in the data on the value of preventing herpes zoster. Our aims were to (i) generate comprehensive information on the value of preventing a range of outcomes of herpes zoster; (ii) compare these values among community members and patients with shingles and post-herpetic neuralgia (PHN); and (iii) identify clinical and demographic characteristics that explain the variation in these values. METHODS: Community members drawn from a nationally representative survey research panel (n = 527) completed an Internet-based survey using time trade-off and willingness-to-pay questions to value a series of scenarios that described cases of herpes zoster with varying pain intensities (on a scale of 0 to 10, where 0 represents no pain and 10 represents the worst imaginable pain) and duration (30 days to 1 year). Patients with shingles (n = 382) or PHN (n = 137) [defined as having symptoms for > or =90 days] from two large healthcare systems completed telephone interviews with similar questions to the Internet-based survey and also answered questions about their current experience with herpes zoster. We constructed generalized linear mixed models to evaluate the associations between demographic and clinical characteristics, the length and intensity of the health states and time trade-off and willingness-to-pay values. RESULTS: In time trade-off questions, community members offered a mean of 89 (95% CI 24, 182) discounted days to avoid the least severe scenario (pain level of 3 for 1 month) and a mean of 162 (95% CI 88, 259) discounted days to avoid the most severe scenario (pain level of 8 for 12 months). Compared with patients with shingles, community members traded more days to avoid low-severity scenarios but similar numbers of days to avoid high-severity scenarios. Compared with patients with PHN, community members traded fewer days to avoid high-severity scenarios. In multivariate analyses, older age was the only characteristic significantly associated with higher time trade-off values. In willingness-to-pay questions, community members offered a mean of $US450 (95% CI 203, 893) to avoid pain of level 3 for 1 month and a mean of $US1384 (95% CI 873, 2050) [year 2005 values] to avoid pain of level 8 for 12 months. Community members traded less money than patients with either shingles or PHN to avoid both low- and high-severity scenarios (p-values <0.05 to <0.001). In multivariate models, male gender, higher income and having experienced shingles or PHN were associated with higher willingness to pay to avoid herpes zoster. When patients were asked to assign a value to avoiding their own case of herpes zoster, those with shingles assigned a mean of 67 days or $US2319, while those with PHN assigned a mean of 206 days or $US18 184. Both the time and monetary value traded were associated with the maximum intensity of the pain the individual had experienced, but neither was associated with the duration of the pain. CONCLUSIONS: We believe that this study provides the most comprehensive information to date on the value individuals place on preventing herpes zoster, and it includes the only such valuation from nationally representative community members as well as patients with herpes zoster. Community members would trade substantial amounts of time or money to avoid herpes zoster, even in the least severe scenarios. The time trade-off results in this study may differ from those in other studies because of important differences in methods of assessing health utilities. Consideration of both community and patient perspectives is crucial to help decision makers fully determine the implications of their policies now that a vaccine against herpes zoster is available. PMID: 18282017 [PubMed - indexed for MEDLINE] 425. J Am Acad Dermatol. 2008 Mar;58(3):361-70. New viral vaccines for dermatologic disease. Urman CO, Gottlieb AB. Tufts University School of Medicine, Boston, Massachusetts, USA. Christine.Orlova@tufts.edu Comment in: J Am Acad Dermatol. 2008 Dec;59(6):1090-1. Two new viral vaccines have recently been approved by the Food and Drug Administration. Human papillomavirus (HPV) vaccine is intended to reduce infection with the most common HPV types that cause anogenital disease, including cervical cancer and genital warts. Herpes zoster (HZ) vaccine is intended to prevent shingles and its complications. The use of these two vaccines will immediately begin to impact dermatologic practice throughout the world and will reduce the healthcare burden associated with the diseases caused by the two viruses. The following review summarizes the relevant pathophysiology and epidemiology of genital warts, cervical neoplasia, and herpes zoster and describes the recent trials that have demonstrated efficacy and safety of the HPV and HZ vaccines. LEARNING OBJECTIVES: Following the completion of this learning activity, the participant will be able to describe the mechanisms of HPV and varicella zoster virus infection as well as pathogenesis, identify key aspects of the immune system involved in clearing the infection, and prescribe HPV and HZ vaccines for prevention of disease. PMID: 18280332 [PubMed - indexed for MEDLINE] 426. Pediatr Infect Dis J. 2008 Mar;27(3):265-8. Triad of severe abdominal pain, inappropriate antidiuretic hormone secretion, and disseminated varicella-zoster virus infection preceding cutaneous manifestations after hematopoietic stem cell transplantation: utility of PCR for early recognition and therapy. Rau R, Fitzhugh CD, Baird K, Cortez KJ, Li L, Fischer SH, Cowen EW, Balow JE, Walsh TJ, Cohen JI, Wayne AS. Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892-1104, USA. A hematopoietic stem cell transplant recipient developed abdominal pain, pneumatosis intestinalis, hepatitis, pancreatitis, and inappropriate antidiuretic hormone secretion. Blood for varicella-zoster virus (VZV) DNA polymerase chain reaction was positive. She was treated with acyclovir and subsequently developed VZV antigen-positive zoster. Detection of VZV DNA in blood may be useful for early diagnosis in immunocompromised hosts who present with zoster without skin lesions. PMID: 18277922 [PubMed - indexed for MEDLINE] 427. Ophthalmology. 2008 Feb;115(2 Suppl):S35-8. Preventing herpes zoster through vaccination. Gelb LD. Division of Infectious Disease, Washington University School of Medicine, Department of Internal Medicine, Barnes-Jewish Medical Center, St. Louis, Missouri 63110, USA. ldgelb@swbell.net TOPIC: The role of the zoster vaccine in the prevention of herpes zoster and its sequelae, including postherpetic neuralgia (PHN) and herpes zoster ophthalmicus. CLINICAL RELEVANCE: Wide administration of the herpes zoster vaccine in accordance with the recommendations of the Centers for Disease Control and Prevention Advisory Committee on Immunization Practices (ACIP) will lead to a decline in the incidence and morbidity of herpes zoster and its complications, including PHN. METHODS: The key study leading to the approval of the zoster vaccine for use, the Centers for Disease Control and Prevention ACIP's recommendations for appropriate use of the zoster vaccine, and predictions regarding the cost efficacy of a zoster vaccination program are reviewed. RESULTS: The Shingles Prevention Study established that the zoster vaccine was safe, well tolerated, and effective in reducing the burden of illness due to herpes zoster and the incidence of PHN. The ACIP recommended that the zoster vaccine be given to adults 60 and older for the prevention of herpes zoster. Cost-efficacy analyses suggest that the greatest gain in quality-adjusted life-years can be gained by vaccinating individuals at the younger end of the ACIP-recommended age range. CONCLUSION: The zoster vaccine promises to reduce the morbidity and mortality of herpes zoster. Administering the vaccine at the younger end of the age range may offer a greater cost benefit. PMID: 18243932 [PubMed - indexed for MEDLINE] 428. Ophthalmology. 2008 Feb;115(2 Suppl):S33-4. Use of photorefractive keratectomy in a patient with a corneal scar secondary to herpes zoster ophthalmicus. Kaufman SC. Department of Ophthalmology, University of Minnesota, Minneapolis, Minnesota 55455, USA. corneamd2000@yahoo.com TOPIC: The use of LASIK surgery to correct vision in a patient with postzoster corneal scarring. CLINICAL RELEVANCE: The cornea is commonly involved in cases of herpes zoster ophthalmicus, and as a result, corneal scarring after a varicella-zoster virus corneal infection is common. Corneal scars can be treated by lamellar keratoplasty or keratectomy, which may be performed using a microkeratome or excimer laser phototherapeutic keratectomy (PTK). However, articles on studies concerning the treatment of postherpetic scars by PTK have been published, offering conflicting results. LASIK surgery may offer an additional therapeutic approach to corneal scarring. METHODS: A patient seeking corrective surgery to improve vision was found to have corneal scarring. RESULTS: The patient experienced successful vision correction. CONCLUSION: LASIK surgery can be conducted even in a patient with postzoster corneal scarring. No complications were apparent in this case. PMID: 18243931 [PubMed - indexed for MEDLINE] 429. Ophthalmology. 2008 Feb;115(2 Suppl):S3-12. Herpes zoster ophthalmicus natural history, risk factors, clinical presentation, and morbidity. Liesegang TJ. Mayo Clinic College of Medicine, Jacksonville, Florida 32224, USA. tliesegang@mayo.edu TOPIC: The incidence and morbidity of herpes zoster (HZ) and HZ ophthalmicus (HZO), and the potential impact of varicella vaccine on their epidemiology. CLINICAL RELEVANCE: Herpes zoster affects 20% to 30% of the population at some point in their lifetime; approximately 10% to 20% of these individuals will have HZO. METHODS: The peer-reviewed literature published from 1865 to the present was reviewed. RESULTS: Herpes zoster is the second clinical manifestation of varicella-zoster virus (VZV). The incidence and severity of HZ increase with advancing age. Varicella-zoster virus-specific cell-mediated immunity, which keeps latent VZV in check and is boosted by periodic reexposure to VZV, is an important mechanism in preventing VZV reactivation as zoster. Thus, widespread varicella vaccination may change the epidemiology of HZ. Herpes zoster ophthalmicus occurs when HZ presents in the ophthalmic division of the fifth cranial nerve. Ocular involvement occurs in approximately 50% of HZ patients without the use of antiviral therapy. There is a long list of complications from HZ, including those that involve the optic nerve and retina in HZO, but the most frequent and debilitating complication of HZ regardless of dermatomal distribution is postherpetic neuralgia (PHN), a neuropathic pain syndrome that persists or develops after the zoster rash has resolved. The main risk factor for PHN is advancing age; other risk factors include severe acute zoster pain and rash, a painful prodrome, and ocular involvement. Many cases of HZ, HZO, and PHN can be prevented with the zoster vaccine. CONCLUSION: Vaccination is key to preventing HZ, HZO, and PHN, but strategies for both varicella and HZ vaccines will need to be evaluated and adjusted periodically as changes in the epidemiology of these VZV diseases become more evident. PMID: 18243930 [PubMed - indexed for MEDLINE] 430. Ophthalmology. 2008 Feb;115(2 Suppl):S24-32. Anterior segment complications of herpes zoster ophthalmicus. Kaufman SC. Department of Ophthalmology, University of Minnesota, Minneapolis, Minnesota 55455, USA. corneamd2000@yahoo.com TOPIC: The clinical features and management strategies for varicella-zoster virus (VZV) infections of the cornea, lids, and adnexa. CLINICAL RELEVANCE: Herpes zoster ophthalmicus (HZO) can result in a myriad of chronic and recurrent complications that may be sight threatening. Surgical intervention is the mainstay of treatment, and advancements in this area may lessen the complications of HZO if correctly implemented. METHODS: Literature review of pertinent topics, authors, and journals utilizing the National Institutes of Health PubMed service. RESULTS: A higher rate of treatment success for VZV-related complications was obtained when any preexisting ocular inflammation, increased intraocular pressure, lagophthalmos, dry eye, exposure, or neurotrophic keratitis was treated and under control before attempting ocular surgery. CONCLUSION: Options are available to manage ophthalmic complications of HZO and reduce the risk of treatment failure. PMID: 18243929 [PubMed - indexed for MEDLINE] 431. Ophthalmology. 2008 Feb;115(2 Suppl):S21-3. Boston keratoprosthesis treatment of herpes zoster neurotrophic keratopathy. Pavan-Langston D, Dohlman CH. Massachusetts Eye And Ear Infirmary, Harvard Medical School, Boston, Massachusetts 02114, USA. deborah.langston@schepens.harvard.edu TOPIC: The successful use of the Boston keratoprosthesis in a severely inflamed ulcer in herpes zoster neurotrophic keratopathy. CLINICAL RELEVANCE: Approximately 10% to 20% of patients with herpes zoster will develop herpes zoster ophthalmicus (HZO). Antiviral medication forms the foundation of pharmacologic treatment for acute herpes zoster, but management of HZO is supplemented with topical and systemic antimicrobials and corticosteroid agents as well as surgical interventions. However, HZO is associated with poor healing, as evidenced by a high occurrence of ulceration, superinfection, and surgical failure. METHODS: A 95-year-old man was referred for corneal edema in the right eye. There was a history of acute herpes zoster in the right eye 10 months previously. Slit-lamp examination revealed lagophthalmos, ectropion, total corneal anesthesia, and marked inferior corneal edema. Despite surgical repair of all lid abnormalities and aggressive lubrication and management of rosacea blepharitis, the corneal surface remained unhealthy. Four months later, the patient presented with an inflamed hypopyon ulcer, culture positive for abundant Pseudomonas and Candida albicans. The ulcer progressed to descemetocele in the face of aggressive antimicrobial therapy, vision was light perception (LP), and perforation became imminent. A Boston keratoprosthesis was used to replace the severely damaged cornea, and extracapsular cataract extraction of a mature cataract was also performed. RESULTS: One week after surgery, the inflammation was almost entirely resolved, and cultures of the host button were negative for any organisms. Vision gradually increased from LP to 20/60 over the ensuing 4 months. CONCLUSION: The Boston keratoprosthesis procedure successfully salvaged and restored vision in this high-risk herpes zoster eye in which standard keratoplasty would almost certainly have failed. PMID: 18243928 [PubMed - indexed for MEDLINE] 432. Ophthalmology. 2008 Feb;115(2 Suppl):S13-20. Herpes zoster antivirals and pain management. Pavan-Langston D. Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts 02114, USA. deborah.langston@meei.harvard.edu TOPIC: Evaluation of evidence-based strategies for managing herpes zoster (HZ) and the pain of postherpetic neuralgia (PHN). CLINICAL RELEVANCE: Approximately 20% of the world's population suffers from herpes zoster at least once in a lifetime, with 10% to 20% having ophthalmic involvement. Treatment of the acute disease with oral antivirals may reduce the incidence and severity of complications but does not reliably prevent PHN or postherpetic itch (PHI). The acute pain abates as the acute phase resolves; the long-term pain of PHN or PHI may be severe and difficult to manage. Although many therapeutic agents have efficacy in the management of these complications, relief is frequently partial for months to the remainder of the lifetime. METHODS: Literature review was performed using the resources of the Harvard Medical School/Massachusetts Eye and Ear Infirmary Ophthalmic library as well as the National Library of Medicine and the National Institutes of Health PubMed service searching by pertinent topics, authors, and journals. RESULTS: If started within 72 hours of the onset of the acute HZ rash, the oral antiviral agents acyclovir, valacyclovir, and famciclovir significantly shorten the periods of acute pain, virus shedding, rash, acute and late-onset anterior segment complications, and, in the case of valacyclovir and famciclovir, the incidence and severity of PHN. However, these medications do not prevent PHN, which remains a common and debilitating complication of HZ in older patients, requiring assiduous pain management. Tricyclic antidepressants, antiseizure drugs, opioids, and topical analgesics all offer some pain relief, and may be combined. CONCLUSION: Options are available to manage HZ and reduce the pain of PHN. However, prevention, now possible with the HZ vaccine, is preferable to treatment. PMID: 18243927 [PubMed - indexed for MEDLINE] 433. Am J Hematol. 2008 Jun;83(6):472-6. Long-term ultra-low-dose acyclovir against varicella-zoster virus reactivation after allogeneic hematopoietic stem cell transplantation. Asano-Mori Y, Kanda Y, Oshima K, Kako S, Shinohara A, Nakasone H, Sato H, Watanabe T, Hosoya N, Izutsu K, Asai T, Hangaishi A, Motokura T, Chiba S, Kurokawa M. Department of Hematology and Oncology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan. To evaluate the efficacy of long-term prophylaxis with ultra-low-dose acyclovir against varicella-zoster virus (VZV) reactivation, we analyzed the records of 242 Japanese adult patients who underwent allogeneic hematopoietic stem cell transplantation for the first time from 1995 to 2006 at our hospital. We started long-term oral acyclovir at 200 mg/day in July 2001. Acyclovir was continued until the end of immunosuppressive therapy and at least 1 year after transplantation. Sixty-six patients developed VZV reactivation at a median of 248 days after HSCT, with a cumulative incidence of 34.7%. Only one breakthrough reactivation occurred during long-term acyclovir, which responded well to therapeutic dose of valacyclovir. The use of long-term acyclovir was the only independent determinant that significantly decreased the overall incidence of VZV reactivation (20% vs. 50%, P < 0.0001). With this prophylaxis, visceral dissemination and serious complications other than post-herpetic neuralgia was completely eliminated, and thereby need for hospitalization was significantly reduced (21% vs. 71%, P = 0.0034). Fifteen of the 57 patients who discontinued acyclovir developed VZV reactivation, with a cumulative incidence of 32.1%. VZV reactivation following discontinuation tended to occur in patients who were receiving immunosuppressive therapy at the cessation of acyclovir. These findings suggested that long-term prophylaxis of ultra-low-dose acyclovir resulted in a successful prevention of severe VZV-related symptoms and death, with a significantly decreased overall incidence of VZV reactivation. Prolongation of prophylactic acyclovir on profound immunosuppression might be important for thorough suppression of VZV reactivation. Copyright 2008 Wiley-Liss, Inc. PMID: 18266207 [PubMed - indexed for MEDLINE] 434. J Infect Dis. 2008 Mar 1;197(5):654-7. Varicella-zoster virus in the saliva of patients with herpes zoster. Mehta SK, Tyring SK, Gilden DH, Cohrs RJ, Leal MJ, Castro VA, Feiveson AH, Ott CM, Pierson DL. Enterprise Advisory Services, Inc., USA. Comment in: J Infect Dis. 2008 Mar 1;197(5):635-7. J Infect Dis. 2008 Mar 1;197(5):646-53. Fifty-four patients with herpes zoster were treated with valacyclovir. On treatment days 1, 8, and 15, pain was scored and saliva examined for varicella-zoster virus (VZV) DNA. VZV DNA was found in every patient the day treatment was started and later disappeared in 82%. There was a positive correlation between the presence of VZV DNA and pain and between VZV DNA copy number and pain (P <.0005). VZV DNA was present in 1 patient before rash and in 4 after pain resolved and was not present in any of 6 subjects with chronic pain or in 14 healthy subjects. Analysis of human saliva has potential usefulness in the diagnosis of neurological disease produced by VZV without rash. PMID: 18260763 [PubMed - indexed for MEDLINE] 435. J Infect Dis. 2008 Mar 1;197(5):635-7. Herpes zoster: new insights provide an important wake-up call for management of nosocomial transmission. Breuer J. Comment on: J Infect Dis. 2008 Mar 1;197(5):654-7. J Infect Dis. 2008 Mar 1;197(5):646-53. PMID: 18260760 [PubMed - indexed for MEDLINE] 436. J Infect Dis. 2008 Mar 1;197(5):646-53. Transmission of a newly characterized strain of varicella-zoster virus from a patient with herpes zoster in a long-term-care facility, West Virginia, 2004. Lopez AS, Burnett-Hartman A, Nambiar R, Ritz L, Owens P, Loparev VN, Guris D, Schmid DS. National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA. alopez@cdc.gov Comment in: J Infect Dis. 2008 Mar 1;197(5):635-7. Comment on: J Infect Dis. 2008 Mar 1;197(5):654-7. We investigated a small outbreak of varicella in a long-term-care facility after a case of herpes zoster. Clinical specimens and environmental samples were collected from all case patients and from surfaces in the case patients' rooms and other common-use areas. Wild-type varicella-zoster virus (VZV) DNA was identified in all 3 varicella case patients, and high concentrations of VZV DNA were detected in environmental samples from the room of the herpes zoster case patient. Genotypic analysis showed that the identical VZV strain was present in all samples; moreover, the strain was a unique Mosaic genotype isolate that included a stable Oka vaccine marker that had hitherto never been observed in a wild-type strain of VZV. This study provides evidence for the value of including environmental sampling during the investigation of varicella outbreaks and illustrates the importance of evaluating multiple vaccine-associated markers for the discrimination of vaccine virus from wild-type VZV. PMID: 18260757 [PubMed - indexed for MEDLINE] 437. Zhongguo Zhen Jiu. 2007 Oct;27(10):729-30. [Observation on therapeutic effect of pricking blood therapy combined with acupuncture on herpes zoster] [Article in Chinese] Huo HM, Yang XP. Department of Dermatology, Jimo Third People's Hospital, Shandong 266200, China. OBJECTIVE: To compare the therapeutic effects of pricking blood therapy combined with acupuncture and routine western medicine on herpes zoster. METHODS: Two hundred and forty cases were randomly divided into 2 groups, 120 cases in each group. The treatment group were treated with acupuncture combined with pricking blood therapy on the point with the most pain, and cupping and surround needling; the control group with external application and oral administration of Aciclovir plaster and Aciclovir tablets, respectively. Their therapeutic effects were compared. RESULTS: The total effective rate was 92.5% in the treatment group and 55.8% in the control group with a very significant difference between the two groups (P < 0.01). The time of producing killing pain, stopping vesication and scabbing in the treatment group was shorter than that in the control group. CONCLUSION: The pricking blood therapy combined with acupuncture is an effective therapy for herpes zoster. PMID: 18257346 [PubMed - indexed for MEDLINE] 438. J Virol. 2008 Apr;82(8):3971-83. Epub 2008 Feb 6. Mechanisms of varicella-zoster virus neuropathogenesis in human dorsal root ganglia. Reichelt M, Zerboni L, Arvin AM. Stanford University School of Medicine, 300 Pasteur Dr., Grant Bldg., Room S356, Stanford, CA 94305, USA. reichelt@stanford.edu Varicella-zoster virus (VZV) is a human alphaherpesvirus that infects sensory ganglia and reactivates from latency to cause herpes zoster. VZV replication was examined in human dorsal root ganglion (DRG) xenografts in mice with severe combined immunodeficiency using multiscale correlative immunofluorescence and electron microscopy. These experiments showed the presence of VZV genomic DNA, viral proteins, and virion production in both neurons and satellite cells within DRG. Furthermore, the multiscale analysis of VZV-host cell interactions revealed virus-induced cell-cell fusion and polykaryon formation between neurons and satellite cells during VZV replication in DRG in vivo. Satellite cell infection and polykaryon formation in neuron-satellite cell complexes provide mechanisms to amplify VZV entry into neuronal cell bodies, which is necessary for VZV transfer to skin in the affected dermatome during herpes zoster. These mechanisms of VZV neuropathogenesis help to account for the often severe neurologic consequences of herpes zoster. PMCID: PMC2292995 PMID: 18256143 [PubMed - indexed for MEDLINE] 439. Br J Clin Pharmacol. 2008 Feb;65(2):203-9. Nonsteroidal anti-inflammatory drug use and the risk of severe skin and soft tissue complications in patients with varicella or zoster disease. Mikaeloff Y, Kezouh A, Suissa S. Pediatric Department, Assistance publique-Hôpitaux de Paris, Bicêtre University Hospital, Le Kremlin Bicêtre, France. What is already known about this subject: Three previous epidemiological studies found an increased risk of severe skin and soft tissue infectious complications associated with exposure to NSAIDs in children with varicella. In vitro studies demonstrated that decreases in defences against infections induced by NSAIDs could be due to impairment of neutrophil blood cell function. What this study adds: The use of NSAIDs is associated with an increased risk of severe skin and soft tissue complication of varicella in children. The use of NSAIDs is also associated with a small increased risk of such complications in zoster disease in adults and the elderly. This study supports the limited prescription of NSAIDs in VZV infection. AIMS: To assess the risk of severe skin and soft tissue complications associated with the use of nonsteroidal anti-inflammatory drugs (NSAIDs) in treating patients with varicella zoster virus infection. METHODS: The design was a nested case-control study, with matching for age and practice. The setting was primary care in the United Kingdom (United Kingdom's General Practice Research Database). Two population-based cohorts of all patients with a primary varicella (n = 140,111) or zoster (n = 108,257) diagnosis during 1994-2005 were followed up for 2 months after diagnosis. Main outcome measures of severe skin or soft tissue complications (mostly cellulitis and abscess) associated with current NSAID or paracetamol use were estimated, and adjusted for potential confounding factors, including sex, drug use, and comorbidity. RESULTS: In patients with varicella, there were 386 cases of severe skin or soft tissue complications (rate 2.8 per 1000) during the 2 month follow-up period (mean age 10.7 years). The rate of complications associated with exposure to NSAIDs was increased (rate ratio 4.9; 95% CI 2.1, 11.4). In patients with zoster disease, there were 681 cases of severe skin or soft tissue complications (rate 6.3 per 1000) during the 2 month follow-up (mean age 60.9 years). The rate ratio of complications associated with exposure to NSAIDs was 1.6 (95% CI 1.1, 2.4). In both conditions, there was no increased risk of complication associated with a current exposure to paracetamol. CONCLUSIONS: The use of NSAIDs is associated with an elevated risk of severe skin and soft tissue complications of varicella zoster virus infection, mostly in children with varicella. PMCID: PMC2291221 PMID: 18251759 [PubMed - indexed for MEDLINE] 440. J Fam Pract. 2008 Feb;57(2):81. Diagnostic tips for ophthalmic zoster. Opstelten W, Zaal MJ. Comment on: J Fam Pract. 2007 Jul;56(7):551-3. PMID: 18248726 [PubMed - indexed for MEDLINE] 441. Br J Ophthalmol. 2008 Apr;92(4):505-8. Epub 2008 Feb 1. Association of varicella zoster virus load in the aqueous humor with clinical manifestations of anterior uveitis in herpes zoster ophthalmicus and zoster sine herpete. Kido S, Sugita S, Horie S, Miyanaga M, Miyata K, Shimizu N, Morio T, Mochizuki M. Department of Ophthalmology & Visual Science, Tokyo Medical and Dental University Graduate School of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan. AIM: To investigative whether clinical manifestations of anterior uveitis are associated with the viral load of varicella zoster virus (VZV) in the aqueous humor in patients with herpes zoster ophthalmicus (HZO) and zoster sine herpete (ZSH). METHODS: After informed consent was given, an aliquot of aqueous humor was collected from patients with VZV anterior uveitis (n = 8). Genomic DNA of the human herpes viruses was measured in the aqueous humor by two PCR assays: a qualitative multiplex PCR and a quantitative real-time PCR. RESULTS: All patients had unilateral acute anterior uveitis with high intraocular pressure, mutton fat keratic precipitates with some pigmentation, and trabecular meshwork pigmentation. Multiplex PCR demonstrated VZV genomic DNA in all of the samples, but not in other human herpes virus samples (human simplex virus types 1 and 2, Epstein-Barr virus, cytomegalovirus and human herpes virus types 6, 7 and 8). Real-time PCR revealed a high copy number of VZV DNA in the aqueous humor. After the initial onset of anterior uveitis, iris atrophy and distorted pupil with paralytic mydriasis developed. The intensity of iris atrophy and pupil distortion, but not ocular hypertension, correlated with the viral load of VZV in the aqueous humor. CONCLUSION: VZV viral load in the aqueous humor correlated significantly with damage to the iris (iris atrophy and pupil distortion) in patients with HZO and ZSH. PMID: 18245272 [PubMed - indexed for MEDLINE] 442. Med J Aust. 2008 Feb 4;188(3):171-6. The prevention and management of herpes zoster. Cunningham AL, Breuer J, Dwyer DE, Gronow DW, Helme RD, Litt JC, Levin MJ, Macintyre CR. University of Sydney, Sydney, NSW, Australia. tony_cunningham@wmi.usyd.edu.au Comment in: Med J Aust. 2008 Sep 15;189(6):347. The burden of illness from herpes zoster (HZ) and postherpetic neuralgia (PHN) in the Australian community is high. The incidence and severity of HZ and PHN increase with age in association with a progressive decline in cell-mediated immunity to varicella-zoster virus (VZV). Antiviral medications (valaciclovir, famciclovir, aciclovir) have been shown to be effective in reducing much but not all of the morbidity associated with HZ and PHN, but are consistently underprescribed in Australia. Zoster-associated pain should be treated early and aggressively, as it is more difficult to treat once established. Clinicians should be proactive in their follow-up of individuals at high risk of developing PHN, and refer patients to a specialist pain clinic earlier, rather than later. A live, attenuated VZV vaccine (Oka/Merck strain, Zostavax [Merck Sharp & Dohme]) has proven to be efficacious in reducing the incidence of and morbidity associated with HZ and PHN in older adults. The vaccine's efficacy has been shown to persist for at least 4 years, but is likely to last a lot longer. Ongoing surveillance will determine the duration of protection and whether a booster dose is required. Clinicians should consider recommending the vaccine, which can be safely administered at the same time as the inactivated influenza vaccine, to all immunocompetent patients aged 60 years or older. Clinicians should refer to the Australian immunisation handbook for advice on the use of the live vaccine in immunosuppressed individuals. PMID: 18241179 [PubMed - indexed for MEDLINE] 443. Harv Womens Health Watch. 2007 Oct;15(2):8. By the way, doctor. I'm 67 and had shingles four years ago. Am I immune to it now? If not, should I get the new shingles vaccine? Robb-Nicholson C. PMID: 18240445 [PubMed - indexed for MEDLINE] 444. Perspect Infirm. 2007 Nov-Dec;5(2):21; quiz 30-4. [Recognizing shingles in order to prevent postherpetic neuropathy] [Article in French] Bourgault P, Lacombe G. l'Ecole des sciences infirmières de l'Université de Sherbrooke. PMID: 18236882 [PubMed - indexed for MEDLINE] 445. Brain Nerve. 2008 Jan;60(1):79-83. [Case of varicella myelitis in nursing care worker] [Article in Japanese] Takei-Suzuki M, Hayashi Y, Kimura A, Nagasawa M, Koumura A, Sakurai T, Tanaka Y, Hozumi I, Inuzuka T. Department of Neurology and Geriatrics, Gifu University Graduate School of Medicine, Yanagido, Japan. Varicella myelitis is very rarely observed in healthy adult. We report the case of 25-year-old nursing care worker who suffered from chickenpox for the first time. Approximately 2 weeks prior to the development of the symptoms, she cared for an old man who suffered from herpes zoster. She was admitted to our hospital, and she complained of weakness and paresthesia in the lower limbs. Subsequently, she experienced vesicorectal disorders: this was followed 5 days later by the appearance of a rash. Spinal T2-weighted MR images showed a high-intensity lesion in the spinal cord at the level of Th9/10, and both IgM-type anti-VZV antibodies and VZV-DNA were present in her cerebrospinal fluid. Treatment comprising a combination of acyclovir at 1,500 mg/day for 14 days and gamma-globulin with high titer of IgG-type anti-VZV antibodies at 5 g/day for 5 days result in remarkable improvement. She was able to walk again. The high-intensity lesion in the spinal T2-weighted MR images disappeared. Urinary dysfunction disappeared completely after 5 months. Care persons without anti-IgG antibodies against VZV are at a high risk of contracting varicella infection. Guidelines for infection control in home care, as well as hospitals, are necessary for caregivers. PMID: 18232335 [PubMed - indexed for MEDLINE] 446. Comp Med. 2008 Feb;58(1):22-30. Simian varicella in old world monkeys. Gray WL. Department of Microbiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA. graywaynel@uams.edu Simian varicella virus (SVV) causes a natural erythematous disease in Old World monkeys and is responsible for simian varicella epizootics that occur sporadically in facilities housing nonhuman primates. This review summarizes the biology of SVV and simian varicella as a veterinary disease of nonhuman primates. SVV is closely related to varicella-zoster virus, the causative agent of human varicella and herpes zoster. Clinical signs of simian varicella include fever, vesicular skin rash, and hepatitis. Simian varicella may range from a mild infection to a severe and life-threatening disease, and epizootics may have high morbidity and mortality rates. SVV establishes a lifelong latent infection in neural ganglia of animals in which the primary disease resolves, and the virus may reactivate later in life to cause a secondary disease corresponding to herpes zoster. Prompt diagnosis is important for control and prevention of epizootics. Antiviral treatment for simian varicella may be effective if administered early in the course of infection. PMCID: PMC2703154 PMID: 19793453 [PubMed - indexed for MEDLINE] 447. Int Tinnitus J. 2007;13(2):90-3. Viral infection and serum antibodies to heat shock protein 70 in the acute phase of Ménière's disease. DiBerardino F, Cesarani A, Hahn A, Alpini D. Department of Audiology-Ear, Nose, and Throat, I.R.C.C.S. Fondazione Policlinico, Mangiagalli e Regina Elena, University of Milan, Italy. federica.diberardino@unimi.it Ménière's disease (MD) is an idiopathic inner-ear disorder characterized by fluctuating hearing loss, episodic vertigo, and tinnitus. Though MD's etiology is unknown, growing evidence suggests that autoimmunity may be involved in its development. The aim of this prospective study was to investigate the presence of anti-heat shock protein 70 (anti-HSP70) antibodies during the acute phase of MD and to relate its presence to the antibody pattern. We examined the sera of 13 patients by Western blot immunoassays for reactivity to bovine inner-ear antigen (anti-HSP70) antibodies. The presence of viral antibodies and autoantibodies (herpes simplex, types 1, 2; herpes zoster; cytomegalovirus; Epstein-Barr; IgM; IgG; cardiolipin; thyroglobulin and thyroperoxidase; and antinuclear, antimitochondrial, and anti-smooth-cell antibodies) were also tested. We found reactivity to HSP70 in only 1 of the 13 MD patients (7.7%), and it occurred during herpes zoster reactivation. We found no relationship between the presence of antibodies to HSP70 and immunological or viral testing. PMID: 18229786 [PubMed - indexed for MEDLINE] 448. Mayo Clin Health Lett. 2007 Oct;25(10):4. Vaccine cuts by half the risk of developing shingles. [No authors listed] PMID: 18229411 [PubMed - indexed for MEDLINE] 449. J Pain. 2008 Jan;9(1 Suppl 1):S37-44. Diagnosis and assessment of pain associated with herpes zoster and postherpetic neuralgia. Dworkin RH, Gnann JW Jr, Oaklander AL, Raja SN, Schmader KE, Whitley RJ. Department of Anesthesiology and Neurology, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Rochester, NY 14642, USA. robert_dworkin@urmc.rochester.edu Accurate evaluation of pain plays a critical role in identifying new interventions for the treatment and prevention of herpes zoster and postherpetic neuralgia (PHN). Different types of pain and other sensory symptoms are found in patients with herpes zoster, and these vary greatly with respect to their presence, location, duration, intensity, and quality. The results of recent studies of herpes zoster and PHN and the development of new methods for assessing neuropathic pain provide a foundation for diagnosing and assessing the pain associated with herpes zoster. We review the results of recent research to identify the essential components that must be considered in developing an evidence-based description of pain associated with herpes zoster and PHN. PERSPECTIVE: Comprehensive assessments of pain are necessary for clinical research on the epidemiology, natural history, pathophysiologic mechanisms, treatment, and prevention of pain in herpes zoster and PHN. PMID: 18166464 [PubMed - indexed for MEDLINE] 450. J Pain. 2008 Jan;9(1 Suppl 1):S31-6. Vaccination to prevent herpes zoster in older adults. Gnann JW Jr. Departments of Medicine, Pediatrics, and Microbiology, University of Alabama at Birmingham, 908 20th Street South, Birmingham, AL 35294, USA. jgnann@uab.edu Herpes zoster causes substantial morbidity, especially among older adults. Although the acute cutaneous manifestations can be painful and troublesome, the most important consequence of herpes zoster (shingles) is the chronic pain syndrome known as postherpetic neuralgia (PHN). Previous studies have suggested that declining varicella-zoster virus (VZV)-specific cell-mediated immune (CMI) responses account for the increased frequency of herpes zoster seen in older adults. This led to the idea that immunization designed to boost VZV-specific CMI responses might reduce the risk of herpes zoster. This hypothesis was tested in a large, randomized, placebo-controlled clinical trial called the Shingles Prevention Study (SPS). Compared with the placebo group, herpes zoster vaccine recipients had a 61.1% reduction in zoster "burden of illness" (an index incorporating incidence and severity of herpes zoster); a 66.5% reduction in the incidence of postherpetic neuralgia; and a 51.3% reduction in the incidence of herpes zoster. The incidence of serious adverse events was not different between the overall vaccine and placebo populations. The most frequently encountered adverse event among vaccine recipients was local reactogenicity, with self-limited and generally mild tenderness, warmth, or erythema occurring at the injection site in about one-half of vaccine recipients. The zoster vaccine was approved by the US Food and Drug Administration in 2006 and is indicated for prevention of herpes zoster in immunocompetent persons aged 60 years and older. PERSPECTIVE: The herpes zoster vaccine provides physicians with an effective means for reducing a patient's risk for developing shingles and its attendant complications. No significant safety concerns regarding the vaccine have been identified. Indications for use of the attenuated-virus vaccine in special subpopulations continue to evolve. PMID: 18166463 [PubMed - indexed for MEDLINE] 451. J Pain. 2008 Jan;9(1 Suppl 1):S19-30. An update on the treatment of postherpetic neuralgia. Wu CL, Raja SN. Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287, USA. Like other types of neuropathic pain, postherpetic neuralgia (PHN) can be resistant to many types of pharmacologic and interventional therapies. Although many analgesic agents have been used for the treatment of other types of neuropathic pain, tricyclic antidepressants, antiepileptic drugs, opioids, and lidocaine patch appear to demonstrate relative analgesic efficacy for the treatment of pain from PHN. There are fewer studies on the use of interventional options for the treatment of pain from PHN. The majority of interventional therapies show equivocal analgesic efficacy although some data indicate that intrathecal methylprednisolone may be effective. Further randomized, controlled trials will be needed to confirm the analgesic efficacy of analgesic and interventional therapies to determine their role in the overall treatment of patients with PHN. PERSPECTIVE: This article reviews the analgesic options for the treatment of PHN and suggests that tricyclic antidepressants, membrane stabilizers, opioids, and lidocaine patch may demonstrate analgesic efficacy in this group of patients. These data may potentially help clinicians who attempt to provide analgesia in patients with PHN. PMID: 18166462 [PubMed - indexed for MEDLINE] 452. J Pain. 2008 Jan;9(1 Suppl 1):S10-8. Mechanisms of pain and itch caused by herpes zoster (shingles). Oaklander AL. Departments of Neurology and Pathology, Massachusetts General Hospital, Harvard Medical School, 275 Charles Street, Boston, MA 02114, USA. aoaklander@partners.org Study of humans with shingles or postherpetic neuralgia (PHN) is providing insights into pain mechanisms. Shingles pain is a combination of normal and neuropathic pain that reflects acute tissue and neural injury. PHN pain, which lasts after tissues have healed, is caused by persistent neural injuries. Spontaneous C-nociceptor activity has been documented in painful polyneuropathies and probably occurs in shingles as well, although there are no microneurographic studies of either shingles or PHN. It is uncertain if this persists in PHN since pathological examination of PHN-affected nerves and ganglia show chronic neuronal loss and quiescent scarring without inflammation. Skin-biopsy study has correlated the presence of PHN with the severity of persistent distal nociceptive axon loss, and autopsy has correlated pain persistence with segmental atrophy of the spinal cord dorsal horn, highlighting the importance of central responses to nerve injury. Pathological studies of tissues from patients with trigeminal neuralgia suggest that brief lancinating pains reflect ephaptic neurotransmission between adjacent denuded axons. The mechanisms of chronic spontaneous pain and mechanical allodynia remain uncertain despite considerable indirect evidence from animal models. Postherpetic itch is presumably caused by unprovoked firing of the peripheral and/or central neurons that mediate itch. If it occurs in neurons innervating skin left severely deafferented from shingles ("numb"), patients can give themselves painless injuries from scratching. Further human study, by electrophysiological recording, by structural and functional imaging, and by autopsy, should continue to provide much-needed insights. PERSPECTIVE: Many patients continue to have chronic pain and/or itch after shingles that is unrelieved by current treatments. Many will gladly volunteer for clinical studies, including autopsy, to try and improve understanding of these common and disabling conditions. Their prevalence makes highly powered studies feasible. Funding and organization are the current bottlenecks. PMID: 18166461 [PubMed - indexed for MEDLINE] 453. J Pain. 2008 Jan;9(1 Suppl 1):S3-9. Natural history and treatment of herpes zoster. Schmader KE, Dworkin RH. Division of Geriatrics, Department of Medicine, Duke University Medical Center and Geriatric Research, Education and Clinical Center, Durham VA Medical Center, Durham, NC 27705, USA. schma001@mc.duke.edu The objective of this article is to provide an overview of the natural history and treatment of herpes zoster, with a focus on pain management. Herpes zoster has the highest incidence of all neurological diseases, occurring annually in approximately 1 million people in the United States. A basic feature of herpes zoster is a marked increase in incidence with aging and with diseases and drugs that impair cellular immunity. Herpes zoster begins with reactivation of varicella zoster virus in dorsal root or cranial nerve ganglia, which is often accompanied by a prodrome of dermatomal pain or abnormal sensations. Varicella zoster virus spreads in the affected primary afferent nerve to the skin and produces a characteristic dermatomal maculopapular and vesicular rash and pain. Herpes zoster acute pain lowers quality of life and interferes with activities of daily living. Antiviral therapy and scheduled analgesics form the pharmacotherapeutic foundation for herpes zoster acute pain reduction. If moderate to severe herpes zoster pain is not adequately relieved by antiviral agents in combination with oral analgesic medications, then corticosteroids, anticonvulsants (eg, gabapentin or pregabalin), tricyclic antidepressants (eg, nortriptyline or desipramine), or neural blockade can be considered. PERSPECTIVE: This article presents information on the clinical features and treatment of herpes zoster. This information will help clinicians diagnose and manage herpes zoster pain. PMID: 18166460 [PubMed - indexed for MEDLINE] 454. Ear Nose Throat J. 2007 Nov;86(11):649; author reply 649-50. Less common MRI findings in ramsay hunt syndrome type I. Antón E. Comment on: Ear Nose Throat J. 2007 Mar;86(3):138, 140. PMID: 18225616 [PubMed - indexed for MEDLINE] 455. Swiss Med Wkly. 2008 Jan 26;138(3-4):47-51. Serology and serum DNA detection in shingles. Dobec M, Bossart W, Kaeppeli F, Mueller-Schoop J. Medizinische Laboratorien Dr. F. Kaeppeli, Zürich, Switzerland. m.dobec@medica-labor.ch AIM: To investigate the sensitivity of various laboratory approaches in the diagnosis of herpes zoster from patient serum. METHODS: Paired sera from 53 consecutive adult patients with acute herpes zoster were tested for the presence of varicella-zoster virus (VZV) antibodies. All acute sera were tested subsequently by real-time polymerase chain reaction (PCR) for the presence of VZV DNA. In addition, convalescent sera of patients who tested initially positive for VZV DNA underwent PCR analysis. RESULTS: VZV IgM antibodies were found by enzyme immunoassay (EIA) in 5 acute (9%) and 20 convalescent (38%) zoster sera. VZV DNA was detected by PCR in 21 (40%) acute zoster sera and was no longer detectable in the convalescent samples. A seroconversion or a fourfold or greater titre increase was found by complement fixation (CF) test in 41 (77%), by IgG indirect fluorescent antibody assay (IgG IFA) in 43 (81%) and by CF and IgG IFA combined in 45 of 53 (85%) paired zoster sera. The combination of all serological methods detected 51 (96%) and PCR combined with serology identified 52 (98%) of 53 patients. CONCLUSIONS: Optimal laboratory sensitivity in the diagnosis of herpes zoster from serum can be achieved by the combination of PCR and serology of paired serum samples. Serological methods alone are of limited value for early diagnosis of zoster when therapy can be initiated, because CF and IgG IFA need convalescent serum and IgM test sensitivity is insufficient. Early diagnosis of VZV reactivation is possible from serum by PCR in the first days of illness and test sensitivity needs further improvement. The findings highlight the need for future studies into the usefulness of PCR and serology in atypical cases of VZV reactivation. PMID: 18224496 [PubMed - indexed for MEDLINE] 456. Acta Ophthalmol. 2008 Nov;86(7):806-9. Epub 2008 Jan 24. Central nervous system involvement after herpes zoster ophthalmicus. Haargaard B, Lund-Andersen H, Milea D. Department of Ophthalmology, Glostrup University Hospital, Copenhagen, Denmark. birgitte@haargaard.dk PURPOSE: To report central nervous system involvement after varicella zoster virus infection. METHODS: We evaluated the frequency and type of neurological complications in patients initially presenting with ophthalmic herpes zoster at an ophthalmological department in a Danish university hospital, over a 7-year period. RESULTS: Of the 110 immunocompetent patients who presented with initial ophthalmic zoster, six (5.5%) suffered from neurological complications other than post-herpetic neuralgia. Four experienced isolated cranial motor nerve palsies, one patient had meningitis with a favourable outcome and one patient had severe encephalitis with a poor clinical outcome. CONCLUSIONS: Central nervous system involvement after varicella zoster virus infection is an uncommon, but potentially life-threatening, complication. Early recognition of neurological complications prompts acute, appropriate antiviral treatment. PMID: 18221497 [PubMed - indexed for MEDLINE] 457. Can J Ophthalmol. 2008 Feb;43(1):124-5. Macular infarction after intravitreal ganciclovir injection in a patient with acute retinal necrosis. Kim SW, Oh J, Huh K. PMID: 18219358 [PubMed - indexed for MEDLINE] 458. Jpn J Infect Dis. 2008 Jan;61(1):65-7. Molecular characterization of clinical varicella-zoster strains from India and differentiation from the oka vaccine strain. Kaushik KS, Lahiri KK, Chumber SK, Gupta RM, Kumar S, Kapila K, Karade S. Department of Microbiology, Armed Forces Medical College, Pune, India. mahakaroo@yahoo.com With the introduction of varicella vaccination in India, surveillance of circulating varicella-zoster strains has gained significance. The aim of the present study was to achieve molecular characterization of circulating varicella-zoster virus (VZV) strains and differentiation from the Oka vaccine strain. In this study, the genotype of 100 clinical VZV strains was analyzed. Vesicle fluid was collected from patients with VZV infections (92 cases of varicella and 8 cases of herpes zoster). The PCR-RFLP analysis of two polymorphic loci--a PstI restriction site in ORF 38 and a BglI restriction site in ORF 54 was used to characterize and differentiate them from the vaccine strain. All the wild-type strains were positive for the PstI restriction site in ORF 38. This differentiated them from the Oka vaccine strain, which is PstI negative. The wild-type strains as well as the Oka vaccine strain were positive for the BglI restriction site in ORF 54. Thus, the genotype of all the VZV strains examined had the wild-type pattern represented as PstI(+) BglI(+). None of the strains had the PstI(-) BglI(+) genotype characteristic of the Oka strain or the PstI(+) BglI(-) wild-type pattern. To conclude, PstI and BglI serve as good reference markers in the genotyping of circulating varicella strains in India and serve to differentiate them from the vaccine strain as well as other wild-type strains. PMID: 18219137 [PubMed - indexed for MEDLINE] 459. Am Fam Physician. 2007 Dec 15;76(12):1757. Coping with the pain. Wellbery C. wellberc@georgetown.edu PMID: 18217515 [PubMed - indexed for MEDLINE] 460. Ann Emerg Med. 2008 Feb;51(2):211, 219. Images in emergency medicine. Herpes zoster ophthalmicus with ocular involvement. Hahn B, Arnold N, Roth N. Department of Emergency Medicine, Staten Island University Hospital, Staten Island, NY, USA. Erratum in: Ann Emerg Med. 2008 Sep;52(3):273. PMID: 18206556 [PubMed - indexed for MEDLINE] 461. N Engl J Med. 2008 Jan 17;358(3):306; author reply 307. Prednisolone or acyclovir in Bell's palsy. Leiner S. Comment on: N Engl J Med. 2007 Oct 18;357(16):1598-607. PMID: 18203331 [PubMed - indexed for MEDLINE] 462. N Engl J Med. 2008 Jan 17;358(3):306; author reply 307. Prednisolone or acyclovir in Bell's palsy. Beutner D. Comment on: N Engl J Med. 2007 Oct 18;357(16):1598-607. PMID: 18199872 [PubMed - indexed for MEDLINE] 463. Rev Neurol Dis. 2007 Fall;4(4):203-8. Management of acute shingles (herpes zoster). Tyler KL, Beckham JD. University of Colorado Health Sciences Center, Denver, CO, USA. Practical, evidence-based recommendations for the management of acute shingles (herpes zoster) were published this year in Clinical Infectious Diseases. These guidelines were the result of a consensus meeting of several groups with an interest in neuropathic pain and varicella-zoster virus research. This article summarizes the key findings and recommendations that were generated from this meeting and reviews some of the research on which these guidelines are based. PMID: 18195672 [PubMed - indexed for MEDLINE] 464. Neurologist. 2008 Jan;14(1):52-5. Transient facial palsy in two cases of benign, very rare middle ear tumors (carcinoid tumor and myxoma). Zehlicke T, Punke C, Boltze C, Pau HW. Department of Otorhinolaryngology, Head and Neck Surgery Otto Koerner, University of Rostock, Rostock, Germany. thorsten.zehlicke@med.uni-rostock.de OBJECTIVE: Presentation of the clinical features of 2 very rare middle ear tumors in which the guiding symptom was facial palsy. MATERIAL AND METHODS: Illustrative case reports about a myxoma and a carcinoid tumor of the middle ear associated with peripheral facial palsy. RESULTS: The facial palsy was transient in either case, and its pathomechanism is open for discussion. In both cases, the initial symptoms were typical for an inflammatory process. Moreover, both tumor entities are typically found in organs other than the ear; if located in the middle ear, those neoplasms grow rather superficially. In those cases, a surgical exposure of the middle ear is indicated. CONCLUSION: The etiopathology of an acute peripheral facial palsy is often hard to identify. If the facial weakness starts together with symptoms suggesting an inflammatory process, the differential diagnosis may be focused first on diseases like herpes zoster oticus and a severe course of acute purulent otitis media. We report the cases of 2 rare middle ear tumors causing facial palsy. Treatment of choice should be complete surgical excision. PMID: 18195660 [PubMed - indexed for MEDLINE] 465. Kulak Burun Bogaz Ihtis Derg. 2007;17(5):287-9. A case of herpes zoster presenting as orbital cellulitis. Al-Rikabi A, Trotter MI, Khan H, Raut VV. Head and Neck Department, Russells Hall Hospital, Dudley Group of Hospitals, Dudley, UK. alikamil30@yahoo.com We presented an unusual case of ophthalmic herpes zoster masquerading as orbital cellulitis, resulting in delay in appropriate treatment. A 65-year-old woman presented with left periorbital pain and swelling of a week duration. Examination revealed periorbital edema and inflammation but no proptosis. The erythema extended onto the brow. There was no change in visual acuity and cranial nerve function was normal. She was apyrexial and all other parameters were within normal limits. The patient was admitted with an initial diagnosis of sinusitis with orbital cellulitis/dacryocystitis and intravenous co-amoxiclav and a non-steroidal anti-inflammatory drug were administered. The following day, there was little change in her condition with the ocular movements being normal and vision remaining unaffected. She was apyrexial but the periorbital swelling persisted. Computed tomography of the sinuses did not show sinusitis or a periorbital collection. The third day after admission and 10 days after the initial appearance of pain, vesicles appeared on the left forehead, which enabled a diagnosis of herpes zoster of the ophthalmic branch of the trigeminal nerve. She was then treated with acyclovir with a good result. PMID: 18187989 [PubMed - indexed for MEDLINE] 466. J Heart Lung Transplant. 2008 Jan;27(1):11-6. Incidence and clinical characteristics of herpes zoster after lung transplantation. Manuel O, Kumar D, Singer LG, Cobos I, Humar A. Department of Transplant Infectious Diseases, University of Alberta, Edmonton, Alberta, Canada. o.manuel@provlab.ab.ca BACKGROUND: Solid-organ transplant recipients are at high risk for the development of herpes zoster. Epidemiologic data in lung transplant recipients are lacking. We determined the incidence and clinical characteristics of herpes zoster, and the risk factors for developing herpes zoster, after lung transplantation. METHODS: We retrospectively reviewed all adult (>18 years old) lung transplants performed at our institution between January 2001 and December 2005. Clinical characteristics of herpes zoster and potential risk factors associated with herpes zoster were assessed. RESULTS: Two hundred thirty-nine lung transplant recipients were included in the analysis. Median time of follow-up was 722 days (range 18 to 1,943 days). Thirty-five episodes of herpes zoster occurred in 29 patients, with a calculated incidence of 55.1 cases per 1,000 person-years of follow-up. The cumulative probability of herpes zoster was 5.8% at 1 year, 18.1% at 3 years and 20.2% at 5 years post-transplant. Only 2 of the 35 (5.7%) patients had disseminated cutaneous infection and none had visceral involvement. Recurrence of herpes zoster was seen in 13.8% of patients. Post-herpetic neuralgia was detected in 20% of cases. Anti-viral prophylaxis, primarily for cytomegalovirus (CMV), was protective against herpes zoster. No significant epidemiologic risk factors associated with herpes zoster could be identified. CONCLUSIONS: Herpes zoster is a common complication after lung transplantation with a peak incidence at between 1 and 4 years post-transplant. Preventive strategies would be beneficial for this population. PMID: 18187081 [PubMed - indexed for MEDLINE] 467. Pediatr Infect Dis J. 2008 Feb;27(2):112-8. The epidemiology of children hospitalized with herpes zoster in Canada: Immunization Monitoring Program, Active (IMPACT), 1991-2005. Wootton SH, Law B, Tan B, Mozel M, Scheifele DW, Halperin S; IMPACT Investigators. University of British Columbia, Vancouver, British Columbia, Canada. BACKGROUND: Varicella zoster virus causes varicella (chickenpox) and can reactivate to cause herpes zoster (HZ). In Canada, live attenuated varicella vaccine was recommended for routine use among healthy susceptible children age 1 year and older, in 1999. Varicella vaccine has had a profound impact on the incidence of varicella; however the impact on HZ remains uncertain. METHODS: Surveillance for HZ admissions was conducted by the Immunization Monitoring Program, Active (IMPACT) surveillance network comprising 12 centers representing over 90% of pediatric tertiary care beds in Canada. Active surveillance for HZ was undertaken in 1991-1996 and reintroduced in 1999. A clinical diagnosis was accepted, with or without laboratory confirmation. For each case, a detailed case report form was completed. RESULTS: In total, 648 children were admitted with HZ; 342 (52.8%) were boys and the mean age was 9.9 +/- 4.4 years. Five hundred seventy-seven (89.0%) were immunocompromised and 71 immunocompetent (10.8%). Five hundred seventy-one (88.1%) had a history of varicella zoster virus infection. Varicella vaccination was documented in 4 children before admission. Most (85.5%) presented with localized disease. Immunocompetent children were more likely than immunocompromised children to be hospitalized with ophthalmic disease (odds ratio 5.1, P < 0.001) or with at least 1 complication (odds ratio 3.0, P < 0.001). Only 1 death was attributable to HZ. CONCLUSIONS: Immunocompromised children represented the overwhelming majority of IMPACT hospitalized cases. Complications directly resulting from HZ were common in immunocompetent children. As varicella vaccine use becomes more widespread, the IMPACT network will continue to play an important role in monitoring the changing epidemiology of HZ in children. PMID: 18174867 [PubMed - indexed for MEDLINE] 468. Int J Dermatol. 2008 Jan;47(1):36-9. Herpes zoster-associated voiding dysfunction in hematopoietic malignancy patients. Imafuku S, Takahara M, Uenotsuchi T, Iwato K, Furue M. Division of Dermatology and Hematology, Hiroshima Red Cross and Atomic Bomb Survivor's Hospital, and Department of Dermatology, Graduate School of Medical Sciences, Kyushu University. dermatologist@mac.com BACKGROUND: Voiding dysfunction is a rare but important complication of lumbo-sacral herpes zoster. Although the symptoms are transient, the clinical impact on immunocompromised patients cannot be overlooked. METHODS: To clarify the time course of voiding dysfunction in herpes zoster, 13 herpes zoster patients with voiding dysfunction were retrospectively analyzed. RESULTS: Of 13 patients, 12 had background disease, and six of these were hematopoietic malignancies; four of these patients were hematopoietic stem cell transplant (HSCT) recipients. Ten patients had sacral lesions, two had lumbar, and one had thoracic lesions. Interestingly, patients with severe rash, or with hematopoietic malignancy had later onset of urinary retention than did patients with mild skin symptoms (Mann-Whitney U analysis, P = 0.053) or with other background disease (P = 0.0082). Patients with severe skin rash also had longer durations (P = 0.035). In one case, acute urinary retention occurred as late as 19 days after the onset of skin rash. CONCLUSIONS: In immune compromised subjects, attention should be paid to patients with herpes zoster in the lumbo-sacral area for late onset of acute urinary retention even after the resolution of skin symptoms. PMID: 18173598 [PubMed - indexed for MEDLINE] 469. Pediatr Rev. 2008 Jan;29(1):5-10; quiz 11. Varicella-zoster virus infections. Gershon AA. Columbia University College of Physicians and Surgeons, New York, NY, USA. PMID: 18166616 [PubMed - indexed for MEDLINE] 470. Pain. 2008 Aug 15;138(1):61-9. Epub 2007 Dec 31. Novel histamine H3 receptor antagonists GSK189254 and GSK334429 are efficacious in surgically-induced and virally-induced rat models of neuropathic pain. Medhurst SJ, Collins SD, Billinton A, Bingham S, Dalziel RG, Brass A, Roberts JC, Medhurst AD, Chessell IP. Neurology and GI Centre of Excellence for Drug Discovery, GlaxoSmithKline, Third Avenue, Harlow, Essex CM19 5AW, UK. stephen.j.medhurst@gsk.com Several studies have implicated a potential role for histamine H(3) receptors in pain processing, although the data are somewhat conflicting. In the present study we investigated the effects of the novel potent and highly selective H(3) receptor antagonists GSK189254 (6-[(3-cyclobutyl-2,3,4,5-tetrahydro-1H-3-benzazepin-7-yl)oxy]-N-methyl-3-pyridin ecarboxamide hydrochloride) and GSK334429 (1-(1-methylethyl)-4-([1-[6-(trifluoromethyl)-3-pyridinyl]-4-piperidinyl]carbonyl )hexahydro-1H-1,4-diazepine) in two rat models of neuropathic pain, namely the chronic constriction injury (CCI) model and the varicella-zoster virus (VZV) model. Both GSK189254 (0.3, 3 and/or 10mg/kg p.o.) and GSK334429 (1, 3 and 10mg/kg p.o.) significantly reversed the CCI-induced decrease in paw withdrawal threshold (PWT) measured using an analgesymeter and/or von Frey hairs. In addition, GSK189254 (3mg/kg p.o.) and GSK334429 (10mg/kg p.o.) both reversed the VZV-induced decrease in PWT using von Frey hairs. We also investigated the potential site of action of this analgesic effect of H(3) antagonists using autoradiography. Specific binding to H(3) receptors was demonstrated with [(3)H]-GSK189254 in the dorsal horn of the human and rat spinal cord, and in human dorsal root ganglion (DRG), consistent with the potential involvement of H(3) receptors in pain processing. In conclusion, we have shown for the first time that chronic oral administration of selective H(3) antagonists is effective in reversing neuropathic hypersensitivity in disease-related models, and that specific H(3) receptor binding sites are present in the human DRG and dorsal horn of the spinal cord. These data suggest that H(3) antagonists such as GSK189254 and GSK334429 may be useful for the treatment of neuropathic pain. PMID: 18164820 [PubMed - indexed for MEDLINE] 471. Can Commun Dis Rep. 2007 Nov 1;33(11):1-15. The burden of varicella and zoster in British Columbia 1994-2003: baseline assessment prior to universal vaccination. [Article in English, French] Edgar BL, Galanis E, Kay C, Skowronski D, Naus M, Patrick D. Epidemiology Services, BC Centre for Disease Control, Vancouver, British Columbia, Canada. PMID: 18163240 [PubMed - indexed for MEDLINE] 472. MMW Fortschr Med. 2007 Nov 29;149(48):60. [Chickenpox misjudged for a long time. No real pustules, but still very dangerous ] [Article in German] Gerardy KF. PMID: 18161440 [PubMed - indexed for MEDLINE] 473. Yonsei Med J. 2007 Dec 31;48(6):963-8. Correlation between MRI and operative findings in Bell's palsy and Ramsay Hunt syndrome. Kim IS, Shin SH, Kim J, Lee WS, Lee HK. Department of Otorhinolaryngology, Yonsei University College of Medicine, 612 Eonjuro, Gangnam-gu, Seoul, Korea. hoki@yuhs.ac. PURPOSE: To investigate the correlation between gadolinium enhanced magnetic resonance image (MRI) results and surgical findings of facial nerves in Bell's palsy and Ramsay Hunt syndrome. MATERIALS AND METHODS: From 1995 to 2004, MRI was performed on 13 patients with Bell's palsy or Ramsay Hunt syndrome, who were offered with surgical decompression of the facial nerve through the middle cranial fossa approach. Gadolinium enhanced MRI was performed on all patients and the enhancement of the facial nerve was evaluated by radiology specialists. Operative findings including the degree of the facial nerve segment swelling were examined. Furthermore, the time interval from the onset of palsy to surgery was evaluated. RESULTS: Swelling of facial nerve segments was found in patients with enhanced facial nerves from MRI. The swelling of the facial nerve in the labyrinthine segment in particular was identified in all patients with enhanced labyrinthine segments in MRI. The intraoperative swelling of geniculate ganglion of facial nerve was found in 78% of patients with enhanced facial segment in MRI (p=0.01). The intraoperative swelling of tympanic segment was observed from fourth to ninth weeks after the onset of palsy. CONCLUSION: MRI enhancement of facial nerves in Bell's palsy and Ramsay Hunt syndrome is associated with the extent of intratemporal lesions of facial nerves, especially in the labyrinthine segment. PMCID: PMC2628199 PMID: 18159587 [PubMed - indexed for MEDLINE] 474. Arq Bras Oftalmol. 2007 Sep-Oct;70(5):767-70. [Ophthalmologic findings in cardiac transplant recipients] [Article in Portuguese] Pires CS, Remígio MC, Aguiar MI, Tenório D, Moraes CR, Cavalcanti HD. Fundação Altino Ventura, Recife, PE, Brazil. fav@fundacaoaltinoventura.org.br PURPOSE: To evaluate findings of ophthalmologic examinations in cardiac transplant recipients, searching especially for changes in the retinal nerve fiber layer by means of Scanning Laser Polarimetry. METHODS: Fifteen cardiac transplant recipients were examined from September 2003 to July 2004. All of them underwent ophthalmologic examination, which consisted of visual acuity (VA), biomicroscopy, tonometry and fundoscopy. Fiber layer analyzer-GDx-examination was performed in eleven patients. Twelve patients were men. The mean age was 55.0+/-13.5 years. The follow-up since transplantation lasted from 3 to 74 months; mean value 29.7+/-20.8 months. RESULTS: VA with best correction in all patients attained at least 20/40. Subcapsular posterior cataract was seen in one patient; another presented corneal nubeculae secondary to herpes zoster. In one case a scar suggesting retinocoroiditis was seen at fundoscopy. Biomicroscopic and the fundoscopic findings were expected because of immunosuppressive treatment, following transplantation. GDx examination disclosed loss of fibers in the superior retinal fiber layer in 12 of the 22 examined eyes. CONCLUSION: These results support the hypothesis that reduction of oxygen inflow in retinal circulation before or during heart transplantation could lead to loss of fibers in the retinal nerve fiber layer. PMID: 18157299 [PubMed - indexed for MEDLINE] 475. Adv Skin Wound Care. 2008 Jan;21(1):13; author reply 13. Expanding the rationale for occlusion? Bolton LL. Comment on: Adv Skin Wound Care. 2007 Jul;20(7):408-12. PMID: 18156819 [PubMed - indexed for MEDLINE] 476. BMJ. 2007 Dec 22;335(7633):1305. Death delusion. Helldén A, Odar-Cederlöf I, Larsson K, Fehrman-Ekholm I, Lindén T. Division of Clinical Pharmacology/Pharmacovigilance, Department of Laboratory Medicine, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden. anders.hellden@ki.se PMID: 18156240 [PubMed - indexed for MEDLINE] 477. Dent Clin North Am. 2008 Jan;52(1):203-30, x. Oral manifestations of internal malignancy and paraneoplastic syndromes. Woo VL, Abdelsayed R. Columbia University College of Dental Medicine, 630 West 168th Street, PH 1562 West, New York, NY 10032, USA. vlw2104@columbia.edu Malignant tumors of visceral organs are a fundamental feature of familial cancer and paraneoplastic syndromes. In many instances, the presence of an internal and often occult malignancy may be forewarned by various external manifestations. Several of these findings are preferentially localized to the head and neck region, including the oral cavity proper. This places the dental practitioner in a unique position to detect these "markers" of occult neoplastic involvement. Because these markers may present before an established syndrome or cancer diagnosis, even representing the first expression of disease in some cases, early recognition by a dentist may lead to timely diagnosis and management of these cancer-associated syndromes. PMID: 18154871 [PubMed - indexed for MEDLINE] 478. Rev Iberoam Micol. 2007 Dec 31;24(4):330-1. [Clinical cases in Medical Mycology. Case No. 30] [Article in Spanish] Maiolo E, Arechavala AI, Santiso G, Bianchi MH, Troglio F, Orduna T, Negroni R. Unidad Micología, Hospital de Infecciosas Francisco Javier Muñiz, Buenos Aires, Argentina. PMID: 18095773 [PubMed - indexed for MEDLINE] 479. J Ark Med Soc. 2007 Dec;104(6):139. An unusual case of shingles. Dildy DW Jr, McLeane LR. PMID: 18092499 [PubMed - indexed for MEDLINE] 480. Arch Dermatol. 2007 Dec;143(12):1599-600. A case of zosteriform pigmented purpuric dermatosis. Hamada T, Inoue Y, Nakama T, Hashimoto T. PMID: 18087025 [PubMed - indexed for MEDLINE] 481. Pediatrics. 2008 Jan;121(1):e150-6. Epub 2007 Dec 17. Primary varicella and herpes zoster among HIV-infected children from 1989 to 2006. Wood SM, Shah SS, Steenhoff AP, Rutstein RM. Special Immunology Service, Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, USA. OBJECTIVES: The primary objective of this study was to determine the incidence of herpes zoster in perinatally HIV-infected children. Secondary objectives included assessing the impact of highly active antiretroviral therapy and varicella zoster virus immunization on primary varicella and herpes zoster incidence and identifying risk factors for herpes zoster. We hypothesized that the incidence of herpes zoster has decreased in this population as a result of highly active antiretroviral therapy and routine varicella zoster virus immunization. PATIENTS AND METHODS: This retrospective cohort study included HIV-infected children at a pediatric HIV clinic from 1989 to 2006. Incidence rates for 3 intervals (1989-1996, 1997-1999, and 2000-2006) were compared on the basis of introduction of highly active antiretroviral therapy (1996) and varicella zoster virus vaccination (1999). A Cox proportional-hazards regression model was developed for the time to herpes zoster among the subset of patients with primary varicella infection. RESULTS: In 356 patients followed for 1721 person-years, the incidence of herpes zoster according to period was 30.0 per 1000 person-years in 1989-1996, 31.9 per 1000 person-years in 1997-1999, and 6.5 per 1000 person-years in 2000-2006. There was no difference in incidence-rate ratio between 1989-1996 and 1997-1999. However, there was a significant difference in herpes zoster incidence when comparing 1989-1999 with 2000-2006. The incidence of primary varicella zoster virus infection and herpes zoster in the 57 patients who received the varicella zoster virus vaccine was 22.3 per 1000 and 4.5 per 1000 person-years, respectively. Highly active antiretroviral therapy at the time of primary varicella zoster virus infection was protective against herpes zoster and increased herpes zoster-free survival. CONCLUSIONS: The incidence of herpes zoster has decreased since 1989. The decline occurred after 2000, likely representing the combined effect of immunization and highly active antiretroviral therapy. The use of highly active antiretroviral therapy at the time of primary varicella zoster virus infection decreased the risk of herpes zoster and increased herpes zoster-free survival. Varicella zoster virus immunization was effective in preventing both primary varicella zoster virus and herpes zoster in this cohort. PMID: 18086820 [PubMed - indexed for MEDLINE] 482. Eur J Dermatol. 2008 Jan-Feb;18(1):101-2. Epub 2007 Dec 18. Zosteriform cutaneous localizations of B-cell chronic lymphocytic leukaemia. Claeys A, Pouaha J, Christian B, Froment N, Truchetet F. PMID: 18086615 [PubMed - indexed for MEDLINE] 483. Transpl Infect Dis. 2008 Jul;10(4):260-8. Epub 2007 Dec 11. Varicella zoster virus-associated disease in adult kidney transplant recipients: incidence and risk-factor analysis. Arness T, Pedersen R, Dierkhising R, Kremers W, Patel R. Mayo Medical School, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA. Varicella zoster virus (VZV)-related disease, particularly herpes zoster, is a complication of organ transplantation due to long-term immunosuppression. We determined the incidence and risk factors for post-transplant VZV infection by retrospectively reviewing the medical records of a cohort of 612 adult renal transplant recipients transplanted at Mayo Clinic Rochester between October 1, 2001 and October 1, 2004. Thirty-seven subjects developed herpes zoster, corresponding to a follow-up time-adjusted incidence of 11.2% at 4 years post transplant. The incidence rate of zoster was relatively constant between 6 months and 4 years, yielding an average incidence of approximately 28 per 1000 person-years. The risk of developing post-transplant zoster increased with increasing age at transplant, with each decade conferring a 1.42-fold (P=0.009) increase in risk of zoster development. Seronegativity at time of transplant conferred over 3 times the risk of development of post-transplant zoster (hazard ratio 3.4; P=0.04) compared with seropositivity. Adult kidney transplant recipients are at high risk for the development of post-transplant zoster. PMID: 18086277 [PubMed - indexed for MEDLINE] 484. Ocul Immunol Inflamm. 2007 Nov-Dec;15(6):425-7. Long-term preservation of vision in progressive outer retinal necrosis treated with combination antiviral drugs and highly active antiretroviral therapy. Kim SJ, Equi R, Belair ML, Fine HF, Dunn JP. The Johns Hopkins Hospital, The Wilmer Eye Institute, Ophthalmology, Baltimore 21205, USA. PURPOSE: To report the successful long-term treatment of varicella zoster virus-associated progressive outer retinal necrosis (VZV-PORN) with aggressive antiviral combination drugs along with highly active antiretroviral therapy (HAART). DESIGN: Interventional case report. METHODS: Combined treatment of progressive outer retinal necrosis in a university-based tertiary eye hospital with ganciclovir implant, intravenous acyclovir (10 mg/kg every 8 h), intravitreal foscarnet (2.4 mg), and HAART. RESULTS: Successful treatment of progressive outer retinal necrosis with disease remission and preservation of 20/20 visual acuity out to 1 year. CONCLUSIONS: Combination antiviral therapy and HAART may improve long-term visual outcomes for VZV-PORN. PMID: 18085485 [PubMed - indexed for MEDLINE] 485. Clin Vaccine Immunol. 2008 Feb;15(2):314-9. Epub 2007 Dec 12. A double-blind, randomized, controlled, multicenter safety and immunogenicity study of a refrigerator-stable formulation of Zostavax. Gilderman LI, Lawless JF, Nolen TM, Sterling T, Rutledge RZ, Fernsler DA, Azrolan N, Sutradhar SC, Wang WW, Chan IS, Schlienger K, Schödel F, Silber JL; Zostavax Protocol 010 Study Group. University Clinical Research, Pembroke Pines, Florida, USA. Comment in: Clin Vaccine Immunol. 2009 Sep;16(9):1381; author reply 1381-2. The vaccine Zostavax has been shown to prevent herpes zoster (HZ) and postherpetic neuralgia and is recommended for individuals > or =60 years of age. This study compared the safety and the immunogenicity of a refrigerator-stable formulation (Zostavax refrigerated) with those of the current formulation (Zostavax frozen) in subjects > or =50 years of age. Subjects with a negative history for HZ were randomized 1:1 to receive one dose of either formulation. Enrollment was stratified 1:2 by age (50 to 59 years and > or =60 years). Safety was evaluated for 28 days postvaccination. Varicella-zoster virus (VZV) antibody responses were measured by a glycoprotein enzyme-linked immunosorbent assay (gpELISA). The primary endpoints were the VZV antibody geometric mean titer (GMT; day 28), the VZV antibody geometric mean rise (GMR; days 1 to 28), and the incidence of vaccine-related serious adverse experiences (AEs) over 28 days. The refrigerated (n = 182) and frozen (n = 185) formulations induced similar GMTs (727.4 and 834.4 gpELISA units/ml, respectively); the estimated GMT ratio (refrigerated formulation/frozen formulation) was 0.87 (95% confidence interval, 0.71 to 1.07). The GMRs were 2.6- and 2.9-fold, respectively. No vaccine-related serious AEs were reported in either group, and the safety profiles of the formulations were generally similar. The frequencies of injection-site AEs during follow-up were 35.6% and 46.4% in the refrigerated and the frozen formulation groups, respectively, and were generally mild. The frequencies of systemic AEs were similar in the two groups, and those of vaccine-related AEs were approximately 6% in both groups. The refrigerator-stable formulation of Zostavax has an acceptable safety profile and is as immunogenic as the frozen formulation; thus, the vaccine may be used in clinical settings where freezer availability is limited. PMCID: PMC2238040 PMID: 18077611 [PubMed - indexed for MEDLINE] 486. Nippon Rinsho. 2007 Oct 28;65 Suppl 8:233-41. [Adverse effects of antiviral agents] [Article in Japanese] Moriuchi M, Moriuchi H. Department of Molecular Microbiology and Immunology, Nagasaki University Graduate School of Biomedical Sciences. PMID: 18074544 [PubMed - indexed for MEDLINE] 487. Can J Ophthalmol. 2007 Dec;42(6):881. Macular optical coherence tomography findings in progressive outer retinal necrosis. Almony A, Dhalla MS, Feiner L, Shah GK. PMID: 18059519 [PubMed - indexed for MEDLINE] 488. Ophthalmology. 2007 Dec;114(12):2367; author reply 2367-8. Oral drugs for viral retinitis. Garner HR, Latkany P. Comment on: Ophthalmology. 2007 Feb;114(2):307-12. PMID: 18054655 [PubMed - indexed for MEDLINE] 489. Mayo Clin Proc. 2007 Dec;82(12):1562-5. 66-year-old man with inarticulate speech. Curtis KK, Vikram HR. Internal Medicine, Mayo School of Graduate Medical Education, Mayo Clinic, Scottsdale, AZ, USA. PMID: 18053466 [PubMed - indexed for MEDLINE] 490. Virol J. 2007 Dec 3;4:130. Determination of suitable housekeeping genes for normalisation of quantitative real time PCR analysis of cells infected with human immunodeficiency virus and herpes viruses. Watson S, Mercier S, Bye C, Wilkinson J, Cunningham AL, Harman AN. Centre for Virus Research, Westmead Millennium Institute, Sydney, Australia. sarahlouise53@hotmail.com The choice of an appropriate housekeeping gene for normalisation purposes has now become an essential requirement when designing QPCR experiments. This is of particular importance when using QPCR to measure viral and cellular gene transcription levels in the context of viral infections as viruses can significantly interfere with host cell pathways, the components of which traditional housekeeping genes often encode. In this study we have determined the reliability of 10 housekeeping genes in context of four heavily studied viral infections; human immunodeficiency virus type 1, herpes simplex virus type 1, cytomegalovirus and varicella zoster virus infections using a variety of cell types and virus strains. This provides researchers of these viruses with a shortlist of potential housekeeping genes to use as normalisers for QPCR experiments. PMCID: PMC2216015 PMID: 18053162 [PubMed - indexed for MEDLINE] 491. MMW Fortschr Med. 2007 Nov 8;149(45):5. [Unexpected diagnosis in a child. Herpes zoster] [Article in German] Escher W. PMID: 18050590 [PubMed - indexed for MEDLINE] 492. Ann Otolaryngol Chir Cervicofac. 2007 Oct;124 Suppl 1:S74-83. [Pain associated with craniofacial and cervical herpes zoster] [Article in French] George B, Lory C. Service d'anesthésie-réanimation chirurgicale, unité d'évaluation et de traitement de la douleur, hôpital Saint-Louis, 75010 Paris, France. Ophthalmological and cervical involvement of herpes zoster virus ranks second and third, respectively, in terms of localization frequency. Involvement of the cranial nerves is a particular sign of complications, notably ocular complications, possibly compromising the visual or facial prognosis through involvement of the VIIth nerve, which is responsible for facial paralysis. These types of involvement should be rapidly diagnosed and treated so as to limit these complications. The pain associated with herpes zoster remains frequent and difficult to treat, even if today the criteria for defining postzoster pain is increasingly refined. Antalgic and antiviral treatment should be initiated early, from the very first signs, to attempt to reduce the incidence of this postzoster pain. The risk factors, associated with the development of postzoster pain are age over 50 years, the severity of the skin rash and the intensity of the acute pain, and the existence of a prodromic pain phase before onset. The European Federation of Neurological Societies has recently published guidelines on the pharmacological treatments for postzoster pain. Nerve block treatments remain at a limited evidence level. Patients with postzoster pain should be managed by teams specializing in pain management as soon as conventional treatments fail. PMID: 18047868 [PubMed - indexed for MEDLINE] 493. J Am Acad Dermatol. 2007 Dec;57(6 Suppl):S143-7. Vaccination strategies for the prevention of herpes zoster and postherpetic neuralgia. Betts RF. Infectious Diseases Unit, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA. robert_betts@urmc.rochester.edu Herpes zoster disease and its most common complication, postherpetic neuralgia, are associated with significant morbidity in the elderly. The zoster vaccine boosts cell-mediated immunity to varicella-zoster virus, the virus that causes both varicella and herpes zoster. This vaccine has demonstrated the ability to reduce the zoster-related burden of illness and the incidence of both zoster and postherpetic neuralgia in a randomized, controlled trial conducted in individuals aged 60 years and older, an age group at increased risk of herpes zoster. Widespread use of this vaccine could prevent as many as a quarter of a million cases of zoster disease each year. The design and outcomes of the Shingles Prevention Study, which examined the efficacy and safety of the vaccine, and the rationale for widespread immunization against varicella-zoster virus, are presented here. PMID: 18021866 [PubMed - indexed for MEDLINE] 494. J Am Acad Dermatol. 2007 Dec;57(6 Suppl):S136-42. Management of herpes zoster and postherpetic neuralgia. Tyring SK. Department of Dermatology, The University of Texas, Houston, Texas, USA. styring@ccstexas.com Patients with herpes zoster experience severe pain and potential lasting complications such as postherpetic neuralgia, ophthalmic disease/damage, and, rarely, skin complications (eg, infection of rash area). Treatment for acute zoster aims to accelerate healing, control pain, and, when possible, reduce the risk of complications. Early intervention with antivirals can accelerate rash healing, reduce rash severity, and reduce the risk of some complications. The addition of corticosteroids to antiviral medication may further alleviate short-term zoster pain, but is associated with an increased risk of serious adverse effects, especially among older adults. If a patient does develop postherpetic neuralgia, gabapentin, pregabalin, opioids, tricyclic antidepressants, lidocaine patch 5%, and capsaicin may all be considered as palliative treatments. For individuals with treatment-refractory postherpetic neuralgia, nonpharmacologic approaches may be considered and a pain-management specialist should be consulted. There is a need for more effective agents to treat herpes zoster and postherpetic neuralgia. PMID: 18021865 [PubMed - indexed for MEDLINE] 495. J Am Acad Dermatol. 2007 Dec;57(6 Suppl):S130-5. Herpes zoster: epidemiology, natural history, and common complications. Weinberg JM. Clinical Research Center, Department of Dermatology, St. Luke's-Roosevelt Hospital Center, and Columbia University College of Physicians and Surgeons, New York, New York 10025, USA. jmw27@columbia.edu Herpes zoster is a disease associated with aging that can significantly impair quality of life for affected individuals. Anyone infected with varicella (chickenpox) virus in childhood is at risk for reactivation of dormant virus and the onset of zoster disease, although it occurs with increasing frequency in the elderly as a result of waning of cell-mediated immunity. The most common complication of herpes zoster is postherpetic neuralgia, which can cause chronic and debilitating pain. Current treatments can decrease the severity of zoster rash and pain but cannot prevent disease onset or completely eliminate the most frequent symptoms. The zoster vaccine may help prevent the onset of herpes zoster in the target population of those age 60 years and older. This summary reviews the epidemiology, pathogenesis, natural history, and common symptoms of zoster disease. PMID: 18021864 [PubMed - indexed for MEDLINE] 496. Arthritis Rheum. 2007 Dec 15;57(8):1431-8. The risk of herpes zoster in patients with rheumatoid arthritis in the United States and the United Kingdom. Smitten AL, Choi HK, Hochberg MC, Suissa S, Simon TA, Testa MA, Chan KA. Harvard School of Public Health, Boston, Massachusetts 02115, USA. OBJECTIVE: To determine whether the incidence of herpes zoster is elevated in patients with rheumatoid arthritis (RA) and whether herpes zoster is associated with use of disease-modifying antirheumatic drugs (DMARDs) in patients with RA. METHODS: Two retrospective cohort studies were conducted using data from a US integrated managed care database (PharMetrics claims database) from 1998-2002 and the UK General Practice Research Database (GPRD) between 1990-2001. Rates of herpes zoster among patients with RA and randomly sampled non-RA patients were compared. A nested case-control analysis was performed within each RA cohort to examine the effect of current treatment on herpes zoster risk. RESULTS: A total of 122,272 patients with RA from the PharMetrics database and 38,621 from the GPRD were included. The adjusted hazard ratios of herpes zoster for patients with RA compared with non-RA patients were 1.91 (95% confidence interval [95% CI] 1.80-2.03) in the PharMetrics database and 1.65 (95% CI 1.57-1.75) in the GPRD. In the PharMetrics database, current use of biologic DMARDs alone was associated with herpes zoster (odds ratio [OR] 1.54, 95% CI 1.04-2.29), as was current use of traditional DMARDs alone (OR 1.37, 95% CI 1.18-1.59). In the GPRD, current use of traditional DMARDs was associated with herpes zoster (OR 1.27, 95% CI 1.10-1.48). In both data sources, use of oral corticosteroids was associated with herpes zoster regardless of concomitant therapies. CONCLUSION: Data from 2 large databases suggested that patients with RA are at increased risk of herpes zoster. Among patients with RA, DMARDs and/or use of oral corticosteroids appeared to be associated with herpes zoster. PMID: 18050184 [PubMed - indexed for MEDLINE] 497. Arch Phys Med Rehabil. 2007 Dec;88(12):1742-3; author reply 1743-4. Safety of cervical transforaminal steroid injections. Shankar H. Comment on: Arch Phys Med Rehabil. 2007 Feb;88(2):255-8. PMID: 18047902 [PubMed - indexed for MEDLINE] 498. Retina. 2007 Nov-Dec;27(9):1313-4. Optical coherence tomography of progressive outer retinal necrosis. Blair MP, Goldstein DA, Shapiro MJ. Department of Ophthalmology and Visual Science, University of Illinois at Chicago, USA. mblair2@uic.edu PMID: 18046245 [PubMed - indexed for MEDLINE] 499. Herpes. 2007 Sep;14 Suppl 2:52-5. Factors affecting an economic model for zoster vaccination. Fattore G. Centre for Research on Healthcare Management (CERGAS), Bocconi University, Milan, Italy. giovanni.fattore@unibocconi.it Results from the recent Shingles Prevention Study indicate that zoster vaccination can reduce the incidence and severity of herpes zoster and post-herpetic neuralgia (PHN), raising the possibility of a widespread vaccination programme. Such a programme would incur substantial costs, mandating the need for rigorous cost-effectiveness analyses prior to implementation. Suitably robust analyses of the cost benefits of zoster vaccination, capturing the duration of benefits and impact on quality of life resulting from vaccination, are lacking. Any economic model would need to consider current estimates of the economic burden of zoster and PHN in unvaccinated populations, as well the predicted effects of zoster vaccination on health improvements (e.g. reductions in zoster and PHN morbidity, improved quality of life, incidence of adverse effects), and costs for the health system and society at large (e.g. reductions in healthcare costs, variations in the costs of administering the vaccine) in different regions. Economic estimates of the burden of zoster and PHN in unvaccinated populations are scarce, and further studies are needed to measure the impact of these prevention strategies in different regions of the world. PMID: 17939898 [PubMed - indexed for MEDLINE] 500. Herpes. 2007 Sep;14 Suppl 2:48-51. Prevention strategies: experience of varicella vaccination programmes. Patrick D. University of British Columbia, Centre for Disease Control, Vancouver, BC, Canada. david.patrick@bccdc.ca Widespread immunization programmes have had a dramatic effect on the morbidity associated with varicella in the USA; mortality has declined by 66% (from 0.41 to 0.14 deaths / million population) and the reduction in hospitalizations is at least 4-fold (from 2.7 to 0.6/100,000 population) compared with the pre-vaccination era. Although varicella outbreaks have occurred in vaccination areas, these data may underestimate the true efficacy of the varicella vaccine, and there is still the potential for two-dose programmes, which have not yet been fully explored in the USA or Canada. Catch-up vaccination programmes have also been regarded as an important approach in susceptible individuals, including women of childbearing potential. Periodic exposure (boosts) to vaccines may potentially help prevent the reactivation of herpes zoster and accumulation of susceptibility in these at-risk groups. Pregnant women may also benefit from prophylaxis with varicella zoster immunoglobulin (VZIG) or possibly with aciclovir. Ongoing surveillance for the reactivation of herpes zoster and safety programmes are also highlighted as key recommendations. PMID: 17939897 [PubMed - indexed for MEDLINE] 501. Herpes. 2007 Sep;14 Suppl 2:45-7. Prevention strategies: herpes zoster, post-herpetic neuralgia and immunogenicity. Levin MJ, Schmader K. Section of Pediatric Infectious Diseases, Department of Pediatrics, University of Colorado School of Medicine, Denver, CO 80262, USA. myron.levin@uchsc.edu Herpes zoster is a common condition that can have a significant impact on quality of life among older adults. A significant proportion of older subjects with herpes zoster develop post-herpetic neuralgia (PHN), a chronic condition that is difficult to treat. The Shingles Prevention Study was a large-scale clinical trial to determine the efficacy of a live, attenuated varicella zoster virus (VZV) vaccine ('zoster vaccine') for preventing or attenuating herpes zoster in subjects aged > or =60 years. A total of 38 546 subjects were given either zoster vaccine or placebo. The burden of illness (pain severity-by-duration), incidence of herpes zoster, and PHN decreased by 61.1%, 51.3% and 66.5% (all P<0.001), respectively, following vaccination. Vaccine efficacy was maintained for a 4-year follow-up period. A sub-study of the vaccine trial evaluated VZV-specific immunity in approximately 1200 vaccine or placebo recipients prior to vaccination, at 3 months and annually for 3 years. VZV-specific cell-mediated immunity (CMI) was boosted significantly by the zoster vaccine. This boost remained substantially intact for the 3 years of follow-up. It is likely that the vaccine-induced boost in VZV-specific CMI reversed the natural decline in these responses that occurs as part of the ageing process, thereby protecting vaccine recipients against herpes zoster and its complications. PMID: 17939896 [PubMed - indexed for MEDLINE] 502. Herpes. 2007 Sep;14 Suppl 2:40-4. Epidemiology and burden of herpes zoster and post-herpetic neuralgia in Australia, Asia and South America. Araújo LQ, Macintyre CR, Vujacich C. Federal University of São Paulo, UNIFESP, São Paulo, SP, Brazil. lara.mqaraujo@gmail.com Following the development of a herpes zoster vaccine and the successful introduction of widespread varicella vaccination in the USA, many countries are considering similar vaccination programmes. However, before implementing such programmes, it is important to describe the regional baselines of varicella and herpes zoster epidemiology, both to aid the design of vaccination strategies and to observe trends after the introduction of vaccination. In many areas of the world, this information is difficult to gather, and the epidemiology of herpes zoster and post-herpetic neuralgia in these regions is poorly understood. In Australia, available national data sources of varicella and herpes zoster, including serological data, provide reliable estimates of disease and reveal similar rates of incidence and complications to those in Europe and the USA. However, the average age of infection in Australia is higher than in Europe and in the USA. Epidemiological data from Asia and South America are scarce. Unexpectedly for tropical countries, the incidences of herpes zoster in Asia and South America also appear to be comparable with those in Europe and the USA, despite the delayed acquisition of varicella-zoster virus infection in Asia. In Brazil, there is some evidence for higher than expected incidence rates for herpes zoster in young adults. The epidemiology of herpes zoster in Asia and South America suggests that recommendations on treatment and prevention from Europe and the USA may be relevant to these countries. PMID: 17939895 [PubMed - indexed for MEDLINE] 503. Herpes. 2007 Sep;14 Suppl 2:35-9. Severe complications of herpes zoster. Volpi A. Department of Public Health, University of Rome Tor Vergata, Rome, Italy. volpi@med.uniroma2.it The usual presentation of herpes zoster is as a self-limiting vesicular rash, often accompanied by post-herpetic neuralgia (PHN), its most common complication. However, herpes zoster can give rise to other complications, many of which have unusual presentations and serious sequelae. The incidence and burden of many of these less common complications are poorly understood. Ocular complications of ophthalmic zoster are relatively frequent but, with early antiviral therapy, need not be sight-threatening. Delayed contralateral hemiparesis is a rare complication of ophthalmic zoster that may present as stroke, temporally remote from the zoster episode. Ramsay Hunt syndrome is caused by reactivation of varicella zoster virus (VZV) involving the facial nerve; facial paralysis, ear pain and vesicles in the ear are diagnostic. Facial paralysis in the absence of vesicles may indicate zoster sine herpete, which can be mistaken for Bell's palsy. Herpetic facial palsies may respond to combination therapy with an antiviral plus steroid, but further research is needed to determine the benefit of such treatments. PMID: 17939894 [PubMed - indexed for MEDLINE] 504. Herpes. 2007 Sep;14 Suppl 2:30-4. Zoster-associated pain: what is known, who is at risk and how can it be managed? Johnson RW. University of Bristol, Bristol, UK. r.w.johnson@bris.ac.uk Herpes zoster episodes commence with a prodromal period of about 4 days with symptoms including pain and malaise. This is followed by a rash lasting approximately 2-4 weeks, with possible subacute herpetic neuralgia for up to 3 months, followed, in some patients, by a period of post-herpetic neuralgia (PHN) lasting months or possibly years. Severe acute pain is more likely in older females and those with a prodrome or severe rash. Two separate mechanisms of PHN have been proposed: the first is that the excitability of primary afferent neurons is increased after nerve damage, causing irritable nociceptors and central sensitization, resulting in pain and allodynia; the second involves the degeneration of nociceptive neurons, which leads to deafferentation with central hyperactivity, causing pain but without allodynia. Both mechanisms may co-exist in an individual patient. Treatments for acute herpes zoster and PHN include established antivirals, alone or in combination with steroids, analgesics and neural blockade with local anaesthetics. Commonly used pain relief includes acetaminophen/paracetamol, non-steroidal anti-inflammatory drugs (NSAIDs), opioid analgesics, tricyclic antidepressants, gabapentin, pregabalin and topical analgesics. Effective and long-lasting pain relief in herpes zoster and PHN remains a largely unmet medical need. PMID: 17939893 [PubMed - indexed for MEDLINE] 505. Herpes. 2007 Sep;14 Suppl 2:25-9. Varicella zoster virus: natural history and current therapies of varicella and herpes zoster. Breuer J, Whitley R. Centre for Infectious Disease, Institute of Cell and Molecular Science, Barts, UK. j.breuer@qmul.ac.uk Erratum in: Herpes. 2007 Dec;14(3):74. The natural history of varicella zoster virus (VZV) infection and the molecular mechanisms of viral pathogenesis are incompletely understood. Although no animal model yet reproduces all aspects of VZV infection, recently developed models of VZV infection, and the creation of genetically altered VZV recombinants, are yielding new information about primary viraemia and latency. During viraemia, T-cells transport VZV to the skin, where cell-free viral replication facilitates person-to-person spread and transmission to the neurons where latency is established. The alternate viral pathways of lytic infection or latency appear to be cell-type determined and involve both host and viral components. Antiviral therapy for varicella is safe and efficacious, and as varicella in children is usually mild, treatment is generally recommended only for adolescents and adults with varicella. Treatment is recommended for all individuals with herpes zoster, especially those aged over 50 years. For some varicella and zoster cases, aciclovir, the original standard, is being replaced by valaciclovir and famciclovir as preferred therapies. For herpes zoster, bromovinyl deoxyuridine (brivudin) has been added to the list of treatment options for immunocompetent individuals, but is contraindicated in patients with cancer. Antiviral therapy will still have a role in the treatment of disease caused by VZV even after the widespread implementation of vaccination programmes for both chickenpox and herpes zoster. PMID: 17939892 [PubMed - indexed for MEDLINE] 506. Herpes. 2007 Sep;14 Suppl 2:24. Global strategies to prevent herpes zoster and its associated complications. Johnson RW, Griffiths P. PMID: 17939891 [PubMed - indexed for MEDLINE] 507. JAAPA. 2007 Nov;20(11):21-5. Herpes zoster in 2007: treatment and prevention. Friel FJ. Idaho Army National Guard, USA. PMID: 18035759 [PubMed - indexed for MEDLINE] 508. Reg Anesth Pain Med. 2007 Nov-Dec;32(6):533-5. Bee stings--a remedy for postherpetic neuralgia? A case report. Janik JE, Wania-Galicia L, Kalauokalani D. Department of Anesthesiology and Pain, University of California Davis Medical Center, Sacramento, CA, USA. james.janik@chw.edu OBJECTIVE: This case report describes the effects of bee stings on painful postherpetic neuralgia in a 51-year-old man. CASE REPORT: The patient was stung by 3 bees in the distribution in which he had been experiencing postherpetic neuralgia. One day after the bee stings, the patient's painful postherpetic neuralgia was completely relieved, and the relief lasted for 1 and a half months. Subsequently, the patient's pain returned, but at significantly less intensity and frequency than what he had experienced prior to the bee stings. CONCLUSIONS: Bee venom and bee sting therapy have been shown to have both antinociceptive and anti-inflammatory properties, which may explain why the bee stings relieved the patient's postherpetic neuralgia. Bee sting or bee venom therapy should be further investigated as a potential treatment modality for postherpetic neuralgia. PMID: 18035302 [PubMed - indexed for MEDLINE] 509. J Clin Microbiol. 2008 Jan;46(1):325-7. Epub 2007 Nov 21. Novel varicella-zoster virus glycoprotein E gene mutations associated with genotypes A and D. Schmidt-Chanasit J, Bleymehl K, Schäd SG, Gross G, Ulrich RG, Doerr HW. Institute of Medical Virology, Hospital of the Johann Wolfgang Goethe University, D-60596 Frankfurt am Main, Germany. jonassi@gmx.de Here, we describe the association of certain varicella-zoster virus (VZV) genotypes with unique glycoprotein E (gE) gene mutations. Within 45 analyzed VZV wild-type strains of genotypes A and D, five novel gE mutations were discovered. A statistically significant (P < 0.0001) association of certain gE mutations with VZV genotype D was found. PMCID: PMC2224269 PMID: 18032615 [PubMed - indexed for MEDLINE] 510. J Am Acad Dermatol. 2007 Dec;57(6):1102-3. Ramsay Hunt syndrome: a case report with cranial nerve XII involvement. Izumi AK, Kitagawa K. PMID: 18021862 [PubMed - indexed for MEDLINE] 511. J Infect Dis. 2007 Nov 15;196(10):1455-8. Immunocompetent children account for the majority of complications in childhood herpes zoster. Grote V, von Kries R, Rosenfeld E, Belohradsky BH, Liese J. Institute of Social Pediatrics and Adolescent Medicine, Ludwig-Maximilian University, Heiglhofstrasse 63, Munich, Germany. veit.grote@med.uni-muenchen.de In a 2-year-long active surveillance conducted in all German pediatric hospitals, the incidence of hospitalization because of herpes zoster and the clinical picture of complications in children were assessed. Herpes zoster resulted in hospitalization of 244 children, 78 of whom were considered to be immunocompromised. Zoster ophthalmicus (n=29), meningoencephalitis (n=22), and zoster oticus (n=23) (11 cases had Ramsay Hunt syndrome) accounted for 59% of all complications (n=115). The incidence of hospitalization suggests that at least 1 in every 100 children with herpes zoster is hospitalized and that at least 1 in every 250 immunocompetent children with herpes zoster is hospitalized with complications. PMID: 18008223 [PubMed - indexed for MEDLINE] 512. J Laryngol Otol. 2008 Feb;122(2):170-6. Epub 2007 Nov 16. Unilateral associated laryngeal paralysis due to varicella-zoster virus: virus antibody testing and videofluoroscopic findings. Chitose SI, Umeno H, Hamakawa S, Nakashima T, Shoji H. Department of Otolaryngology-Head and Neck Surgery, Kurume University School of Medicine, Fukuoka, Japan. yonekawa@med.kurume-u.ac.jp The relationship between varicella-zoster virus and idiopathic associated laryngeal paralysis was examined in five patients, using complement fixation or enzyme immunoassay testing. In all cases, significant changes in serum levels of varicella-zoster virus antibody were observed. Videofluoroscopy was useful in assessing the severity of the dysphagia and in making an accurate diagnosis; both laryngeal elevation and weakness of pharyngeal wall contraction were also observed. In two cases in which antiviral therapy was delayed, the outcome was poor, with increased levels of varicella-zoster virus immunoglobulin M found on enzyme immunoassay. The outcome of the condition may thus depend both on the speed of antiviral therapy commencement following onset of symptoms, and on the levels of varicella-zoster virus immunoglobulin M antibody (measured by enzyme immunoassay). Our study suggests that varicella-zoster virus should be considered in the differential diagnosis of patients with idiopathic associated laryngeal paralysis, and rapid antiviral therapy should be initiated when necessary. PMID: 18005500 [PubMed - indexed for MEDLINE] 513. Aten Primaria. 2007 Nov;39(11):622. [Parsonage-Turner syndrome] [Article in Spanish] Valdivieso EF, Sanz SM, Lázaro CD. PMID: 18001648 [PubMed - indexed for MEDLINE] 514. Expert Rev Neurother. 2007 Nov;7(11):1581-95. Postherpetic neuralgia: epidemiology, pathophysiology and management. Johnson RW, Wasner G, Saddier P, Baron R. Bristol Royal Infirmary, University of Bristol, Bristol, UK. r.w.johnson@bris.ac.uk Postherpetic neuralgia (PHN) is a neuropathic pain syndrome and is the most common complication of herpes zoster (HZ; shingles). PHN occurs mainly in HZ patients 60 years of age and older, in particular in those suffering from more severe acute pain and rash. Administration of antiviral drugs reduces the duration of pain associated with HZ. The pathophysiology of PHN may be distinctly different between patients with either reduced or increased skin sensitivity. Therapy is with tricyclic drugs (e.g., nortriptyline), alpha 2 delta-ligands (e.g., gabapentin) or opiates with adjunctive topical lidocaine or capsaicin. Mechanism-based therapy is a desirable goal but so far proves elusive. The incidence of HZ, and therefore that of PHN, is likely to increase as a result of greater longevity and increasing numbers of patients receiving treatment that compromises cell-mediated immunity. A zoster vaccine for administration to adults reduces the incidence of HZ and PHN, as well as the burden of illness associated with these conditions. PMID: 17997705 [PubMed - indexed for MEDLINE] 515. Clin Infect Dis. 2007 Dec 1;45(11):1527-9. Cost-effectiveness of herpes zoster vaccine: flawed assumptions regarding efficacy against postherpetic neuralgia. Brisson M, Pellissier JM, Levin MJ. Comment on: Clin Infect Dis. 2007 May 15;44(10):1280-8. PMID: 17990240 [PubMed - indexed for MEDLINE] 516. J Neurol. 2007 Dec;254(12):1750-1. Epub 2007 Nov 9. Vagus nerve palsy caused by varicella zoster virus infection without rash. Irioka T, Ohta K, Machida A, Kawashima M, Ishikawa K, Mizusawa H. PMID: 17990059 [PubMed - indexed for MEDLINE] 517. Int J Dermatol. 2007 Nov;46(11):1177-9. Comparison of the Tzanck test and polymerase chain reaction in the diagnosis of cutaneous herpes simplex and varicella zoster virus infections. Ozcan A, Senol M, Saglam H, Seyhan M, Durmaz R, Aktas E, Ozerol IH. Department of Dermatology, Inonu University School of Medicine, Malatya, Turkey. Background: Although the diagnosis of herpes simplex virus (HSV) and varicella zoster virus (VZV) infections is usually made clinically, the Tzanck test, electron microscopy, viral culture, polymerase chain reaction (PCR), and serologic tests can be utilized to verify the diagnosis. METHODS: We conducted a study on a total of 98 patients (77 patients with recurrent herpes simplex and 21 patients with herpes zoster) to evaluate the reliability and reproducibility of the Tzanck test in comparison with PCR. RESULTS: In herpes virus infections, the general positivity rates of the Tzanck test and PCR were 61.2% and 79.6%, respectively. The difference between the positivity rates of the two tests was statistically significant. The positivity rates of the tests differed according to the type and duration of the lesions. CONCLUSIONS: Although PCR was superior to the Tzanck test, the Tzanck test has also been proven to be a reliable diagnostic method, with a sensitivity of 76.9% and a specificity of 100%. We recommend the use of this easy, quick, reproducible, and inexpensive diagnostic test more often in dermatologic practice, especially in cutaneous herpes virus infections. PMID: 17988338 [PubMed - indexed for MEDLINE] 518. Int J Dermatol. 2007 Nov;46(11):1141-5. Isotopic response of fungal granuloma following facial herpes zoster infections - report of three cases. Huang CW, Tu ME, Wu YH, Lin YC. Department of Dermatology, Mackay Memorial Hospital, Taipei, Taiwan. BACKGROUND: An isotopic response is the occurrence of a new skin disease at the site of another unrelated, healed skin disorder. METHODS: We report three cases of unilateral granulomatous fungal infection in immunocompetent patients at sites of resolved herpes zoster on the face. Diagnoses were made by potassium hydroxide preparation, histopathologic findings, and fungal culture. Two patients had Candida albicans folliculitis, and the other was infected with both Epidermophyton floccosum and Trichophyton mentagrophytes. RESULTS: The patients responded well to antifungal therapy. CONCLUSIONS: Localized isotopic fungal infections, although rare, can occur in immunocompetent patients. PMID: 17988332 [PubMed - indexed for MEDLINE] 519. Afr J Reprod Health. 2007 Apr;11(1):133-6. Maxillary herpes zoster with corneal involvement in a HIV positive pregnant woman. Omoti AE, Omoti CE. Department of Opthalmology, University of Benin Teaching Hospital, Benin City. Afeomoti@Yahoo.com Corneal involvement in maxillary herpes zoster is very rare. This report presents the case of a 32 years old 7 months pregnant para2+1 female, who presented with vesiculopapular rashes with hyperpigmented crusts over the maxillary area of the face on the left side with periocular oedema, conjunctivitis and mild punctate keratitis in the left eye. She was HIV positive and was on treatment with the highly active antiretroviral therapy. She was treated with topical and systemic acyclovir with rapid resolution of the ocular features. PMCID: PMC2367144 PMID: 17982956 [PubMed - indexed for MEDLINE] 520. J Korean Med Sci. 2007 Oct;22(5):905-7. A case of herpes zoster with abducens palsy. Shin MK, Choi CP, Lee MH. Department of Dermatology, College of Medicine, Kyunghee University, Seoul, Korea. Only a few reports have focused on ocular motor paralysis in herpes zoster ophthalmicus. We report a case of ocular motor paralysis resulting from herpes zoster. The patient, an 80-yr-old woman, presented with grouped vesicles, papules, and crusting in the left temporal area and scalp, with diplopia, impaired gaze, and severe pain. Her cerebrospinal fluid analysis was positive for varicellar zoster virus IgM. Magnetic resonance imaging was performed to rule out other diseases causing diplopia; there were no specific findings other than old infarctions in the pons and basal ganglia. Therefore, she was diagnosed of abducens nerve palsy caused by herpes zoster ophthalmicus. After 5 days of systemic antiviral therapy, the skin lesions improved markedly, and the paralysis was cleared 7 weeks later without extra treatment. PMCID: PMC2693861 PMID: 17982243 [PubMed - indexed for MEDLINE] 521. Vaccine. 2007 Nov 28;25(49):8326-37. Epub 2007 Oct 17. Evaluation of the cost-effectiveness in the United States of a vaccine to prevent herpes zoster and postherpetic neuralgia in older adults. Pellissier JM, Brisson M, Levin MJ. Merck Research Laboratories, Blue Bell, PA, United States. james_pellissier@merck.com Comment in: Vaccine. 2008 Sep 26;26(41):5244; author reply 5245. CONTEXT: A live-attenuated varicella-zoster virus vaccine, demonstrated to reduce the incidence of herpes zoster (HZ) and postherpetic neuralgia (PHN) and the morbidity associated with incident HZ and its sequelae, has recently been approved for use in the United States (U.S.). OBJECTIVE: To examine the potential value of zoster vaccine for society and payers. DESIGN, SETTING AND POPULATION: An age-specific decision analytic model was designed to estimate the lifetime costs and outcomes associated with HZ, PHN and other HZ-related complications for vaccinated and non-vaccinated cohorts aged >or=60 years. Clinical trial data, published literature and other primary studies were used to inform the model. Robustness of results to key model parameters was explored through a series of one-way, multivariate and probabilistic sensitivity analyses. Both societal and payer perspectives were considered. MAIN OUTCOME MEASURE: Incremental cost per quality-adjusted life year (QALY) gained. RESULTS: For a representative cohort of 1,000,000 U.S. vaccine recipients aged >or=60 years, use of the zoster vaccine was projected to eliminate 75,548-88,928HZ cases and over 20,000 PHN cases. Over 300,000 outpatient visits, 375,000 prescriptions, 9,700 ER visits and 10,000 hospitalizations were projected to be eliminated with the vaccine translating into savings of US$ 82 million to US$ 103 million in healthcare costs associated with the diagnosis and treatment of HZ, PHN and other HZ-related complications. Cost-effectiveness ratios range from US$ 16,229 to US$ 27,609 per QALY gained, depending on the input data source and analytic perspective. Results were most sensitive to PHN costs, duration of vaccine efficacy, vaccine efficacy against PHN and HZ, QALY loss associated with pain states and complication costs. CONCLUSIONS: The zoster vaccine at a price of US$ 150 is likely to be cost-effective for a cohort of immunocompetent U.S. vaccine recipients aged >or=60 years using commonly cited thresholds for judging cost-effectiveness. Conclusions are robust over plausible ranges of input parameter values and a broad range of scenarios and age cohorts. PMID: 17980938 [PubMed - indexed for MEDLINE] 522. Rev Med Interne. 2008 Feb;29(2):152-4. Epub 2007 Sep 21. [Should we care about pregabalin for elderly patients with a history of cardiac dysrhythmia?] [Article in French] Laville MA, de la Gastine B, Husson B, Le Boisselier R, Mosquet B, Coquerel A. Centre régional de pharmacovigilance de Basse-Normandie, CHRU Côte-de-Nacre, 14033 Caen cedex, France. lavillema@yahoo.fr Pregabalin is similar in structure to gamma-aminobutyric acid. It is used for neuropathic pain, generalized anxiety disorders and as an adjunct therapy for partial seizures. Tachycardia is a rare side-effect. A 92-year-old patient with a history of paroxystic fibrillation was hospitalised for zoster. She developed a sinusal tachycardia followed by atrial fibrillation and congestive heart failure 15 h after a first dose of pregabalin. The imputation was considered as plausible. Even though the mechanism remains unclear, pregabalin might induce tachycardia in predisposed old patients. PMID: 17976866 [PubMed - indexed for MEDLINE] 523. Mayo Clin Proc. 2007 Nov;82(11):1341-9. A population-based study of the incidence and complication rates of herpes zoster before zoster vaccine introduction. Yawn BP, Saddier P, Wollan PC, St Sauver JL, Kurland MJ, Sy LS. Department of Research, Olmsted Medical Center, 210 Ninth St SE, Rochester, MN, USA. yawnx002@umn.edu Erratum in: Mayo Clin Proc. 2008 Feb;83(2):255. OBJECTIVE: To establish accurate, up-to-date, baseline epidemiological data for herpes zoster (HZ) before the introduction of the recently licensed HZ vaccine. METHODS: Using data from January 1, 1996, to October 15, 2005, we conducted a population-based study of adult residents (Greater than or equal to 22 years) of Olmsted County, MN, to determine (by medical record review) the incidence of HZ and the rate of HZ-related complications. Incidence rates were determined by age and sex and adjusted to the US population. RESULTS: A total of 1669 adult residents with a confirmed diagnosis of HZ were identified between January 1, 1996, and December 31, 2001. Most (92%) of these patients were immunocompetent and 60% were women. When adjusted to the US adult population, the incidence of HZ was 3.6 per 1000 person-years (95% confidence interval, 3.4-3.7), with a temporal increase from 3.2 to 4.1 per 1000 person-years from 1996 to 2001. The incidence of HZ and the rate of HZ-associated complications increased with age, with 68% of cases occurring in those aged 50 years and older. Postherpetic neuralgia occurred in 18% of adult patients with HZ and in 33% of those aged 79 years and older. Overall, 10% of all patients with HZ experienced 1 or more nonpain complications. CONCLUSIONS: Our population-based data suggest that HZ primarily affects immunocompetent adults older than 50 years; 1 in 4 experiences some type of HZ-related complication. PMID: 17976353 [PubMed - indexed for MEDLINE] 524. Eye (Lond). 2009 Feb;23(2):376-81. Epub 2007 Nov 2. Course and complications of varicella zoster ophthalmicus in a high HIV seroprevalence population (Cape Town, South Africa). Richards JC, Maartens G, Davidse AJ. Department of Surgery, University of Cape Town, South Africa. diastella@iinet.net.au AIM: To describe the course and complications of varicella zoster ophthalmicus (VZO) in patients attending an eye clinic in a community with a high HIV seroprevalence. STUDY DESIGN: Prospective cohort study of consecutive patients presenting to a tertiary hospital eye clinic with VZO. METHOD: Patients recruited in 2001 and 2002 received standardized initial topical and systemic management, which was then modified according to complications. Information on the course and complications of the disease was entered in a database prior to statistical analysis. RESULTS: Information on 102 patients who had 250 visits to the eye clinic was collected. HIV serology was positive, negative, and unknown in 66, 22, and 14 patients, respectively. The most common complication was uveitis (40/102). Median delay from onset of rash to starting acyclovir was 5 days. Complications were present in 33 patients at the first visit. Complications were commoner in patients with positive Hutchinson's sign and were less common at CD4 counts <200. At CD4 counts, > or =200 HIV infection had little effect on the course and complications of VZO. Timing of commencement of Acyclovir therapy within or after 72 h had no demonstrable effect on the incidence of new complications. CONCLUSION: In a resource-limited setting, patients with the following characteristics should have immediate ophthalmic assessment: symptoms suggesting ocular complications or the presence of Hutchinson's sign. All VZO patients should receive antiviral therapy at the first doctor's visit even if they present >72 h after onset of the rash. PMID: 17975560 [PubMed - indexed for MEDLINE] 525. Zhonghua Shi Yan He Lin Chuang Bing Du Xue Za Zhi. 2007 Sep;21(3):285-7. [Zoster Chinese medicine treatment] [Article in Chinese] Chen HM. Beijing Friendship Hospital, Capital University of Medical Sciences, Beijing, China. OBJECTIVE: Clinical diagnosis will clear any part of the human herpes zoster, patients as soon as possible to alleviate the pain and suffering chinese soups with oral treatment. METHODS: Will be advised by the People's Republic of China Chinese medicine industry standards, TCM diagnosis of dermatological diseases efficacy standards, Herpes Zoster State Administration of Traditional Chinese Medicine 1994-06-28 approved, 1995-01-01 implementation Randomly divided into two groups. Treatment and control groups, Treatment groups treated with Chinese herbs. The control group were treated with WM. Since the proposed unification formula, tell patients with customized soups boiling method. Add inguisitor first slices, just cold water soaking, four hours after the use of force opened five, slow fire just 10 minutes after each bowl, when oral temperature, twice good, morning fasting drink, a throw into before falling asleep after serving temperature. Treatment for a week, clinical observation. RESULTS: The group of Chinese medicine is better than western medicine. CONCLUSION: Although Chinese medicine in the diagnosis and treatment of the current lack of scientific and quantitative criteria, but Chinese medicine in the treatment of skin diseases are effectual, we will be in the modernization of Chinese medicine to do more exploration. PMID: 17971948 [PubMed - indexed for MEDLINE] 526. J Cataract Refract Surg. 2007 Nov;33(11):1855-9. Laser in situ keratomileusis in patients with a history of ocular herpes. de Rojas Silva V, Rodríguez-Conde R, Cobo-Soriano R, Beltrán J, Llovet F, Baviera J. Clínica Baviera, Instituto Oftalmológico Europeo, Madrid, Spain. vderojas@terra.es Comment in: J Cataract Refract Surg. 2008 May;34(5):718; author reply 718-9. PURPOSE: To report the outcomes of laser in situ keratomileusis (LASIK) in patients with a history of ocular herpes simplex virus (HSV) or herpes zoster ophthalmicus (HZO). SETTING: Clínica Baviera, Instituto Oftalmológico Europeo, Madrid, Spain. METHODS: In this retrospective case series, the records of eyes with a history of ocular herpes that had LASIK from 2003 through 2005 were reviewed. The main outcome measure was postoperative recurrence of ocular herpes. RESULTS: Forty-nine eyes (48 patients) with a history of ocular herpes (HSV keratitis, 28 eyes; HSV eyelid lesions, 17 eyes; HZO, 4 eyes) were identified. All LASIK procedures were uneventful. Herpetic disease was inactive at the time of surgery in all eyes and for more than 1 year in 31 eyes. Perioperative antiviral systemic prophylaxis was used in 13 patients with a history of HSV keratitis. No eye developed reactivation of herpetic keratitis during the follow-up (range 1 to 28 months). CONCLUSIONS: Laser in situ keratomileusis was safe in patients with a history of ocular herpes; no recurrences occurred during the follow-up period. However, candidates should be selected with caution and surgery performed only in eyes in which the herpes has been inactive for 1 year before surgery, without stromal disease, and with regular topography and pachymetry maps and normal corneal sensitivity. The most reasonable clinical strategy is perioperative systemic antiviral prophylaxis. PMID: 17964388 [PubMed - indexed for MEDLINE] 527. Pediatr Dermatol. 2007 Sep-Oct;24(5):557-8. Zosteriform connective tissue nevus in a pediatric patient. Brazzelli V, Muzio F, Barbagallo T, Fornara L, Donadini F, Guerci B, Mancini L, Calcaterra V, Larizza D, Borroni G. Department of Human and Hereditary Pathology, Institute of Dermatology, University of Pavia, Fondazione, IRCCS Policlinico S. Matteo, Pavia, Italy. vbrazzelli@libero.it We report an 8-year-old girl affected by hypochromic, asymptomatic, acquired lesions with a paving-stone aspect on the right lumbosacral area and proximal right leg. The results of serum and urine biochemical screening were normal, as was the bone survey A biopsy was performed. The clinical and histologic aspects led to the diagnosis of connective tissue nevus with zosteriform distribution. PMID: 17958812 [PubMed - indexed for MEDLINE] 528. Clin Microbiol Infect. 2007 Dec;13(12):1217-9. Epub 2007 Oct 22. High variability in viral load in cerebrospinal fluid from patients with herpes simplex and varicella-zoster infections of the central nervous system. Růzek D, Piskunova N, Zampachová E. Institute of Parasitology, Biology Centre of the Academy of Sciences of the Czech Republic and Faculty of Biological Sciences, University of South Bohemia, Ceské Budejovice, Czech Republic. ruzekd@paru.cas.cz Infections of the central nervous system (CNS) caused by herpes viruses can result in severe diseases, often with a fatal outcome. In this study, the viral load in the cerebrospinal fluid (CSF) of patients with herpes simplex or varicella-zoster infections of the CNS was measured using a quantitative real-time PCR. The results suggest a high variability in viral load, with relatively mild disease associated with a high viral load in CSF and vice versa. Determination of the viral load in CSF does not therefore seem to be useful in assessing the prognosis of disease caused by these viruses. PMID: 17953699 [PubMed - indexed for MEDLINE] 529. Int J Infect Dis. 2008 May;12(3):245-7. Epub 2007 Oct 18. Incidence of herpes zoster and seroprevalence of varicella-zoster virus in young adults of South Korea. Kang CI, Choi CM, Park TS, Lee DJ, Oh MD, Choe KW. Department of Internal Medicine, Armed Forces Capital Hospital, San 13-4 Yul-dong, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-040, Republic of Korea. collacin@hotmail.com OBJECTIVES: This study was performed to determine the incidence of herpes zoster and seroprevalence of varicella-zoster virus (VZV) in young adults of South Korea, where VZV seroprevalence remains relatively high. METHODS: In South Korea, military service is compulsory for all healthy young men and hence those in military service might provide a reflection of the general population. The computerized database of the Armed Forces Medical Command was examined to identify the number of reported herpes zoster cases. In order to evaluate VZV seroprevalence, serum samples were obtained from randomly selected subjects among those who had been admitted to the Armed Forces Capital Hospital. RESULTS: A total of 705 cases of herpes zoster were reported between June 2004 and May 2005. The annual incidence rate of herpes zoster was 141 (95% CI 131.0-151.8) per 100000 population. A total of 192 subjects were enrolled for the analysis of VZV seroprevalence. All subjects were male and their median age was 21 (range 19-24) years. The overall anti-VZV IgG seropositivity prevalence was 92.7% (178/192, 95% CI 88.0-95.7%). CONCLUSION: We have described a population-based study of the epidemiology of VZV infections in the military personnel of South Korea. PMID: 17950022 [PubMed - indexed for MEDLINE] 530. J Fam Pract. 2007 Oct;56(10 Suppl A):51A-57A; quiz 58A. Preventing herpes zoster and postherpetic neuralgia through vaccination. High KP. Section on Infectious Diseases, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA. PMID: 17949604 [PubMed - indexed for MEDLINE] 531. Lancet Neurol. 2007 Nov;6(11):1015-28. The neurotropic herpes viruses: herpes simplex and varicella-zoster. Steiner I, Kennedy PG, Pachner AR. Neurological Sciences Unit, Hadassah University Hospital, Mount Scopus, Jerusalem, Israel. isteiner@md2.huji.ac.il Herpes simplex viruses types 1 and 2 (HSV1 and HSV2) and varicella-zoster virus (VZV) establish latent infection in dorsal root ganglia for the entire life of the host. From this reservoir they can reactivate to cause human morbidity and mortality. Although the viruses vary in the clinical disorders they cause and in their molecular structure, they share several features that affect the course of infection of the human nervous system. HSV1 is the causative agent of encephalitis, corneal blindness, and several disorders of the peripheral nervous system; HSV2 is responsible for meningoencephalitis in neonates and meningitis in adults. Reactivation of VZV, the pathogen of varicella (chickenpox), is associated with herpes zoster (shingles) and central nervous system complications such as myelitis and focal vasculopathies. We review the biological, medical, and neurological aspects of acute, latent, and reactivated infections with the neurotropic herpes viruses. PMID: 17945155 [PubMed - indexed for MEDLINE] 532. Herpes. 2007 Sep;14(2):45-7. Case reports: zoster pain in haematological malignancies: effective pain relief with oxycodone in patients unresponsive to other analgesic measures. Niscola P, Perrotti AP, del Poeta G, Romani C, Palombi M, Piccioni D, Scaramucci L, Tolu B, Tendas A, Cupelli L, Abruzzese E, D'Elia GM, Brunetti GA, Maurillo L, Giovannini M, Cartoni C, de Fabritiis P. Haematology Division, Sant'Eugenio Hospital, Tor Vergata University, Rome, Italy. pasquale.niscola@uniroma2.it Varicella zoster virus (VZV) outbreak is a significant cause of morbidity in patients suffering from blood-related malignancies, occurring mostly among those affected by lymphoproliferative disorders and in those receiving haematopoietic stem-cell transplantation. The elucidated pathological mechanisms of VZV-related painful complications have provided the rationale for acute zoster pain (AZP) and post-herpetic neuralgia (PHN) treatment with antiviral therapy combined with neuroactive agents, such as tricyclic or anticonvulsant agents. The role of opioids in this setting is less clearly established. We successfully treated (with oxycodone) 12 consecutive patients suffering from AZP and long-lasting PHN resistant to several agents, including anticonvulsants and analgesics. Our experience is reported together with a brief overview of the management of these often distressing and intractable complications. PMID: 17939903 [PubMed - indexed for MEDLINE] 533. Herpes. 2007 Sep;14(2):32-6. Managing herpes zoster in immunocompromised patients. Ahmed AM, Brantley JS, Madkan V, Mendoza N, Tyring SK. Baylor College of Medicine, Houston, TX, USA. Herpes zoster infections are more common and often more complicated in immunocompromised patients. The key clinical objective in these patients is to reduce the incidence of cutaneous and visceral dissemination that can lead to life-threatening complications. This is best achieved with prompt antiviral therapy, which should be instituted in all immunosuppressed zoster patients if presentation occurs within 1 week of rash onset or any time before full crusting of lesions. For localized disease, most patients can be treated with oral valaciclovir, famciclovir or aciclovir, with close outpatient follow-up. Intravenous aciclovir therapy is reserved for those with disseminated varicella zoster virus infection, ophthalmic involvement, very severe immunosuppression or the inability to take oral medications. Foscarnet is the drug of choice to treat aciclovir-resistant herpes zoster. Appropriate analgesic therapy should be combined with early antiviral treatment to reduce the incidence and severity of acute zoster pain and post-herpetic neuralgia. PMID: 17939900 [PubMed - indexed for MEDLINE] 534. Herpes. 2007 Sep;14(2):31. Herpes zoster in immunocompromised patients. Volpi A, Stanberry L. PMID: 17939899 [PubMed - indexed for MEDLINE] 535. Rev Med Suisse. 2007 Sep 19;3(125):2116-22, 2124-9. [Swiss recommendations for the management of varicella-zoster virus infections] [Article in French] Meylan P, Gerber S, Kempf W, Nadal D; Swiss Herpes Management Forum. Institut de microbiologie et Division des maladies infectieuses, CHUV, Lausanne. pascal.meylan@chuv.ch Infections with varicella zoster virus (VZV) are common viral infections associated with significant morbidity. Diagnosis and management are complex, particularly in immunocompromised patients and during pregnancy. The present recommendations have been established by a multidisciplinary panel of specialists and endorsed by numerous Swiss medical societies involved in the medical care of such patients (Appendix). The aim is to improve the care of affected patients and to reduce complications. PMID: 17939531 [PubMed - indexed for MEDLINE] 536. Indian J Dermatol Venereol Leprol. 2007 Sep-Oct;73(5):352-3. Persistent hiccups: a rare prodromal manifestation of herpes zoster. Reddy BV, Sethi G, Aggarwal A. PMID: 17921622 [PubMed - indexed for MEDLINE] 537. Lancet. 2007 Oct 6;370(9594):1240. How shingles can be beached. Ludwig RJ, Kaufmann R. Department of Dermatology, Johann Wolfgang Goethe-Universität, Frankfurt, Germany. r.ludwig@em.uni-frankfurt.de PMID: 17920919 [PubMed - indexed for MEDLINE] 538. Vaccine. 2007 Nov 7;25(45):7866-72. Epub 2007 Aug 8. The comparative sero-epidemiology of varicella zoster virus in 11 countries in the European region. Nardone A, de Ory F, Carton M, Cohen D, van Damme P, Davidkin I, Rota MC, de Melker H, Mossong J, Slacikova M, Tischer A, Andrews N, Berbers G, Gabutti G, Gay N, Jones L, Jokinen S, Kafatos G, de Aragón MV, Schneider F, Smetana Z, Vargova B, Vranckx R, Miller E. Health Protection Agency, Centre for Infections, London, UK. a.nardone@invs.sante.fr The European sero-epidemiology network (ESEN2) aims to standardise serological surveillance of varicella zoster virus (VZV) in 11 participant countries. In each country, serum banks were collected between 1996 and 2003 and tested for VZV antibodies. Assay results were standardised so that international comparisons could be made. Age-specific forces of infection were calculated for three age groups (<5, 5-9 and >or=10 years of age) and used to estimate the base reproduction number (R(0)) and the herd immunity threshold (H). Most VZV infection occurred in childhood, but there was a wide variation in transmissibility, with R(0) ranging from 16.9 in the Netherlands to 3.3 in Italy. Herd immunity thresholds varied from 70% in Italy to 94% in the Netherlands. There are substantial differences in VZV sero-epidemiology within the European region, which will need to be taken into account in designing national policies regarding VZV vaccination. PMID: 17919788 [PubMed - indexed for MEDLINE] 539. Actas Dermosifiliogr. 2007 Oct;98(8):576-8. [Psoriasis at the site of healed herpes zoster: Wolf's isotopic response] [Article in Spanish] Allegue F, Fachal C, Romo M, López-Miragaya MI, Pérez S. PMID: 17919439 [PubMed - indexed for MEDLINE] 540. J Am Coll Surg. 2007 Oct;205(4):625. Epub 2007 Jul 20. Metastatic colon adenocarcinoma mimicking herpes zoster. Goodwin TL, Wren SM. Stanford University School of Medicine, Stanford, CA, USA. PMID: 17903740 [PubMed - indexed for MEDLINE] 541. Med Sci Monit. 2007 Oct;13(10):CS128-31. Varicella zoster-associated severe aplastic anemia in a child and its successful treatment with peripheral blood stem cell transplantation from HLA-5/6-identical donor. Kuskonmaz B, Cetin M, Uckan D, Yetgin S. Division of Pediatric Hematology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Sihhiye, Ankara, Turkey. BACKGROUND: Varicella zoster virus is very rarely associated with aplastic anemia. Bone marrow transplantation from an HLA-identical sibling is the treatment of choice. CASE REPORT: A seven-year-old boy presented with aplastic anemia (AA) following chicken pox infection. No clinical improvement was observed with pharmaceutical therapy and peripheral blood stem cell transplantation (PBSCT) was performed from his HLA 5/6 identical mother. Since the transplantation, the patient has had a durable, trilineage hematological response for 12 months. CONCLUSIONS: The present case with varicella zoster-associated aplastic anemia was non-responsive to conventional therapies (ATG protocol, ALG protocol, oxymethalone, and cyclosporine A) and successfully treated with bone marrow transplantation from his 5/6 identical mother. PMID: 17901857 [PubMed - indexed for MEDLINE] 542. Anesth Analg. 2007 Oct;105(4):1127-9, table of contents. A unique case of recurrent asystole secondary to paroxysmal pain of acute herpetic ophthalmicus. Cheung MY, Viney M. Geelong Hospital, Victoria, Australia. manyiucheung@yahoo.com Postherpetic neuralgia is considered to be the most common and debilitating complication of acute herpes zoster and its incidence and duration of symptoms increase with age. We describe an unusual, but life-threatening complication of postherpetic neuralgia. The following case report is the first to describe a patient who developed unexpected asystolic episodes as a result of complicating pain secondary to acute herpetic ophthalmicus. The underlying pathogenesis of her cardiovascular disturbance coinciding with her painful paroxysms is unclear. This uncommon phenomenon may be explained by an exaggerated vasovagal response or even by the oculocardiac reflex rarely observed outside ocular or maxillofacial surgery. Her severe paroxysmal pain and asystole were eventually managed with oxycontin, amitriptyline, gabapentin, and intranasal fentanyl spray. PMID: 17898398 [PubMed - indexed for MEDLINE] 543. J Virol. 2007 Dec;81(23):12758-65. Epub 2007 Sep 26. Identification of five major and two minor genotypes of varicella-zoster virus strains: a practical two-amplicon approach used to genotype clinical isolates in Australia and New Zealand. Loparev VN, Rubtcova EN, Bostik V, Govil D, Birch CJ, Druce JD, Schmid DS, Croxson MC. Centers for Disease Control and Prevention, National Center for Preparedness, Detection, and Control of Infectious Diseases, Atlanta, Georgia 30333, USA. Whole genome phylogenetic analysis in this study resolved a total of five major genotypes among the 22 varicella-zoster virus (VZV) strains or isolates for which complete genomic sequences are available. Consistent with earlier publications we have designated these genotypes European 1 (E1), European 2 (E2), Japanese (J), mosaic 1 (M1), and mosaic 2 (M2). Single nucleotide polymorphism (SNP) analysis performed in a whole-genome alignment revealed that VZV isolates of all five genotypes can be accurately genotyped using SNPs from two amplicons: open reading frame 22 (ORF22) and either ORF21 or ORF50. This modified approach identifies all of the genotypes observed using any of the published genotyping protocols. Of 165 clinical varicella and zoster isolates from Australia and New Zealand typed using this approach, 67 of 127 eastern Australian isolates were E1, 30 were E2, 16 were J, 10 were M1, and 4 were M2; 25 of 38 New Zealand isolates were E1, 8 were E2, and 5 were M1. VZV strain diversity in eastern Australia is thus broader than has been described for any other region, including Europe, Africa, and North America. J strains were far more prevalent than previously observed in countries other than Japan. Two-amplicon typing was in complete accord with genotypes derived using SNP in multiple ORFs (ORFs 1, 21, 22, 38, 50, 54, and 62). Two additional minor genotypes, M3 and M4, could also be resolved using two-amplicon typing. PMCID: PMC2169114 PMID: 17898056 [PubMed - indexed for MEDLINE] 544. Bull Soc Belge Ophtalmol. 2007;(303):23-6. Herpes zoster ophthalmicus complicated by complete ophthalmoplegia and signs of pilocarpine hypersensitivity. A case report and literature review. Pion B, Salu P. Dept. of Ophthalmology, Academic Hospital of the Free University of Brussels, Laarbeeklaan 101, B-1090 Jette. bartpion@hotmail.com We report a case of zona ophthalmica complicated with a complete ophthalmoplegia. In the literature only 19 cases have been reported the last 30 years, with a variety of possible pathophysiological mechanisms. Our patient's mydriasis reacted to diluted pilocarpine 0.125% which is a sign of Adie's pupil and is not supposed to occur in mydriasis caused by a third nerve palsy. We review the literature on the possible pathogenesis of this hypersensitivity. PMID: 17894283 [PubMed - indexed for MEDLINE] 545. Anesthesiology. 2007 Oct;107(4):678-9. Cost effectiveness of epidural injection of steroids and local anesthetics for relief of zoster-associated pain. Opstelten W, van Wijck AJ, van Essen GA, Moons KG, Verheij TJ, Kalkman CJ, van Hout BA. PMID: 17893478 [PubMed - indexed for MEDLINE] 546. Vaccine. 2007 Oct 23;25(43):7598-604. Epub 2007 Aug 15. Epidemiology and costs of herpes zoster: background data to estimate the impact of vaccination. Di Legami V, Gianino MM, Atti MC, Massari M, Migliardi A, Tomba GS, Zotti C; Zoster Study Group. Dipartimento di Sanità Pubblica e di Microbiologia, Università degli Studi di Torino, via Santena 5 bis, 10126 Torino, Italy. valeria.dilegami@unito.it In 2004, we conducted a study in Piemonte (Italy), in order to describe incidence, treatment, hospitalizations and costs of herpes zoster (HZ), in population over 14 years of age. Twenty-four regional general practitioners, with 26,394 patients >14 years in charge (0.71% of the regional population), reported prospectively all diagnosed HZ cases. In addition, all regional hospital discharge records were reviewed. Forty-six HZ cases treated at home were reported, accounting for a total incidence of 1.74 cases/1000 population >14 years per year. HZ rate standardized by age on regional population 14 years older is 1.59/1000. The cost per observed home case was 136.06 euros. The incidence of hospital admissions was 0.12/1000 inhabitants. The mean cost of hospitalized cases was 4082.59 euros. These results contribute to depict the impact of HZ in the general population, and to provide background data for setting-up either mathematical models aimed to estimate the impact of vaccination on HZ, and the cost-benefit analyses of various preventive and therapeutic scenarios. PMID: 17889410 [PubMed - indexed for MEDLINE] 547. Ophthal Plast Reconstr Surg. 2007 Sep-Oct;23(5):411-3. Orbital myositis involving the oblique muscles associated with herpes zoster ophthalmicus. Badilla J, Dolman PJ. Department of Ophthalmology, University of British Columbia, Vancouver, Canada. An 81-year-old woman with right orbital inflammation and acute retinal necrosis following Herpes zoster ophthalmicus was evaluated and treated. CT showed right massive superior and inferior oblique enlargement and moderate enlargement of the remaining extraocular muscles with tendon sparing. The myositis and acute retinal necrosis dramatically improved following prednisone and intravenous acyclovir therapy. PMID: 17881997 [PubMed - indexed for MEDLINE] 548. Bull Math Biol. 1999 Nov;61(6):1031-64. Modeling the effects of varicella vaccination programs on the incidence of chickenpox and shingles. Schuette MC, Hethcote HW. Applied Mathematical and Computational Sciences, University of Iowa, Iowa City, IA 52242, USA. Two possible dangers of an extensive varicella vaccination program are more varicella (chickenpox) cases in adults, when the complication rates are higher, and an increase in cases of zoster (shingles). Here an age-structured epidemiologic-demographic model with vaccination is developed for varicella and zoster. Parameters are estimated from epidemiological data. This mathematical and computer simulation model is used to evaluate the effects of varicella vaccination programs. Although the age distribution of varicella cases does shift in the simulations, this does not seem to be a danger because many of the adult cases occur after vaccine-induced immunity wanes, so they are mild varicella cases with fewer complications. In the simulations, zoster incidence increases in the first three decades after initiation of a vaccination program, because people who had varicella in childhood age without boosting, but then it decreases. Thus the simulations validate the second danger of more zoster cases. PMID: 17879870 [PubMed - indexed for MEDLINE] 549. Pol Merkur Lekarski. 2005 Feb;18(104):229-32. [Prophylaxis and treatment of viral infections. Part I--infections caused by DNA viruses] [Article in Polish] Strycharz M, Bartecka K, Polz-Dacewicz M. Zakład Wirusologii AM w Lublinie. The amount of antiviral drugs have increased recently. Many viruses treated as a mild pathogens has turned out to cause different complications and severe diseaseses in elderly people and immunocomprised patients. The authors have made an attempt of presenting on the basis of scientific reports the principles of antiviral prophylaxis and treatment. The first part is focused on infections caused by DNA viruses. PMID: 17877138 [PubMed - indexed for MEDLINE] 550. Curr Med Res Opin. 2007 Oct;23(10):2585-96. Cost-effectiveness analysis of pregabalin versus gabapentin in the management of neuropathic pain due to diabetic polyneuropathy or post-herpetic neuralgia. Rodríguez MJ, Díaz S, Vera-Llonch M, Dukes E, Rejas J. Pain and Palliative Care Unit, Carlos Haya University Hospital, Málaga, Spain. maje1946@yahoo.es OBJECTIVE: To estimate the cost-effectiveness of branded pregabalin (PGB) versus generic gabapentin (GBP) in patients with neuropathic pain (NeP) due to painful diabetic polyneuropathy (DPN) or post-herpetic neuralgia (PHN) in Spain. METHODS: Using stochastic simulation, we estimated the cost-effectiveness of PGB 150-600 mg/d vs. GBP 900-3600 mg/d in a hypothetical cohort of 1000 patients. The model used data from three randomized controlled clinical trials. Pain was evaluated using a 0-10 scale. Mean baseline pain was 6.9 in both treatment groups. The model assigned untreated pain scores over 84 days. Treated scores were calculated using weekly changes in pain scores from trials. Outcomes included the numbers of days with no or mild pain (score < 4), days with >or= 30% and >or= 50% reductions in pain intensity, quality-adjusted life-years (QALYs), and estimated health costs. RESULTS: Compared with GBP, PGB yielded an estimated mean of 8 (standard error, 0.4) additional days with no or mild pain, 6 (0.4) days with >or= 30% reduction in pain intensity, 9 (0.5) days with >or= 50% reduction in pain intensity, and a gain of 0.1186 (0.0002) QALYs for 12 weeks. The estimated total health costs of therapies were euro 1049 (euro 35) for PGB and euro 951 (euro 38) for GBP, respectively. Incremental cost-effectiveness ratio (ICER) for PGB versus GBP were a mean of euro 12 (95% confidence interval, euro 1-24) per additional day with no or mild pain, euro 431 (dominant-euro 876) per additional patient with no or mild pain, and euro 20 535 (euro 1607-40 345) per QALY gained. CONCLUSIONS: According with data used in this modeling in patients with NeP due to DPN and/or PHN, PGB was shown to be more cost-effective than generic gabapentin in Spain. PMID: 17875242 [PubMed - indexed for MEDLINE] 551. J Clin Microbiol. 2007 Dec;45(12):3909-14. Epub 2007 Sep 12. Effect of viral load on the outcome of herpes zoster. Quinlivan ML, Ayres K, Ran H, McElwaine S, Leedham-Green M, Scott FT, Johnson RW, Breuer J. Centre for Infectious Disease, Institute of Cell and Molecular Science, Barts, and the London School of Medicine and Dentistry, Queen Mary College, London, UK. Varicella-zoster virus (VZV) is a member of the Herpesviridae family, primary infection with which causes varicella, more commonly known as chicken pox. Characteristic of members of the alphaherpesvirus subfamily, VZV is neurotropic and establishes latency in sensory neurons. Reactivation of VZV causes herpes zoster, also known as shingles. The most frequent complication following zoster is chronic and often debilitating pain called postherpetic neuralgia (PHN), which can last for months after the disappearance of a rash. During episodes of acute zoster, VZV viremia occurs in some, but not all, patients; however, the effect of the viral load on the disease outcome is not known. Here we describe the development of a highly specific, sensitive, and reproducible real-time PCR assay to investigate the factors that may contribute to the presence and levels of baseline viremia in patients with zoster and to determine the relationship between viremia and the development and persistence of PHN. VZV DNA was detected in the peripheral blood mononuclear cells (PBMCs) of 78% of patients with acute zoster and in 9% of healthy asymptomatic blood donors. The presence of VZV in the PBMCs of patients with acute zoster was independently associated with age and being on antivirals but not with gender, immune status, extent of rash, the age of the rash at the time of blood sampling, having a history of prodromal pain, or the extent of acute pain. Prodromal pain was significantly associated with higher baseline viral loads. Viral load levels were not associated with the development or persistence of PHN at 6, 12, or 26 weeks. PMCID: PMC2168564 PMID: 17855575 [PubMed - indexed for MEDLINE] 552. J Paediatr Child Health. 2007 Oct;43(10):713-5. Herpes zoster due to Oka vaccine strain of varicella zoster virus in an immunosuppressed child post cord blood transplant. Chan Y, Smith D, Sadlon T, Scott JX, Goldwater PN. Department of Infectious Diseases and Microbiology, Women's and Children's Hospital, 72 King William Road, North Adelaide, SA 5006, Australia. A 5-year-old boy was vaccinated with the Oka strain of varicella zoster virus vaccine before cord blood transplant for chronic granulomatous disease in 2005. In 2006, he developed herpes zoster on his left arm. DNA from the vesicular rash confirmed the Oka vaccine strain of varicella zoster virus caused this complication. He responded well to 10 days of aciclovir treatment. PMID: 17854459 [PubMed - indexed for MEDLINE] 553. Eur Arch Otorhinolaryngol. 2008 Mar;265(3):365-7. Epub 2007 Sep 12. Laryngeal zoster with multiple cranial nerve palsies. Van Den Bossche P, Van Den Bossche K, Vanpoucke H. Department of Internal Medicine, H Hartziekenhuis Roeselare Menen vzw, Rijselse straat, 71, 8930 Menen, Belgium. paul-vandenbossche@skynet.be A young immunocompetent patient is presented with a very rare presentation of a common viral illness: herpes zoster of the left hemilarynx with sensorial and motoric neuropathy of three ipsilateral lower cranial nerves: IX, X and XI. The mucosal lesions were discovered during upper gastrointestinal endoscopy. PCR of erosional exsudate confirmed the clinical diagnosis. Antiviral therapy and corticosteroids possibly contributed to the prosperous evolution with complete healing. PMID: 17849136 [PubMed - indexed for MEDLINE] 554. Neurologist. 2007 Sep;13(5):313-7. Segmental zoster paresis of limbs: report of three cases and review of literature. Kawajiri S, Tani M, Noda K, Fujishima K, Hattori N, Okuma Y. Department of Neurology, Juntendo University Shizuoka Hospital, Shizuoka, Japan. OBJECTIVES: Segmental zoster paresis is a relatively rare complication characterized by focal motor weakness, which may occur in limbs affected by herpes zoster. We demonstrate the clinical characteristics of segmental zoster paresis by reviewing the cases of 138 patients, including 3 of our patients. CASE REPORT AND REVIEW SUMMARY: We report 3 patients with zoster paresis of the limbs. Patients 1 and 3 showed motor weakness in the left shoulder and arm after developing a herpetic rash in the left C5-C6 dermatomes. Patient 2 showed weakness in the right thigh and groin after a right L2-L3 herpetic eruption. The electromyograms of all 3 patients showed abnormal spontaneous activity in the affected muscles. Intravenous acyclovir and corticosteroid pulse therapy were added to oral antiviral drugs for patients 1 and 2. All 3 patients recovered favorably. Our review of the literature revealed that antiviral treatment may prevent the occurrence of zoster paresis; however, there is insufficient evidence to show what treatment hastens recovery from zoster paresis. CONCLUSIONS: Segmental zoster paresis is still underrecognized by neurologists. Awareness of this disorder is important because it may eliminate unnecessary invasive investigations and lead to appropriate treatment. Further studies on the treatment are necessary. PMID: 17848871 [PubMed - indexed for MEDLINE] 555. Herpes. 2007 Jun;14(1):4-10. Herpetic retinitis. Cordero-Coma M, Anzaar F, Yilmaz T, Foster CS. Massachusetts Eye Research and Surgery Institute, Cambridge, MA 02142, USA. This paper provides an appreciation of the various forms and consequences of retinal inflammation caused by human herpesviruses. Herpes simplex virus types 1 and 2, varicella zoster virus, cytomegalovirus and Epstein-Barr virus are known to cause retinitis. The prognosis of herpetic retinitis remains poor because it is associated with a high incidence of complications, both during and after the acute disease phase. On diagnosis of retinal necrosis, antiviral treatment must be started promptly to limit disease progression; following this, prophylactic maintenance therapy may be required. PMID: 17848212 [PubMed - indexed for MEDLINE] 556. J Am Med Dir Assoc. 2007 Sep;8(7):419-20. How should nursing homes use vaccine to prevent zoster? Drinka PJ. PMID: 17845943 [PubMed - indexed for MEDLINE] 557. Intern Med. 2007;46(17):1487-8. Epub 2007 Sep 3. Constipation and segmental abdominal paresis followed by herpes zoster. Maeda K, Furukawa K, Sanada M, Kawai H, Yasuda H. Division of Neurology, Department of Medicine, Shiga University of Medical Science. kengo@belle.shiga-med.ac.jp PMID: 17827858 [PubMed - indexed for MEDLINE] 558. J Indian Med Assoc. 2007 Apr;105(4):216-7. Human immunodeficiency virus infection in a child presenting as herpes zoster ophthalmicus. Pandey N, Chandrakar AK, Adile SL, Garg ML, Patel S. Department of Ophthalmology, Pt JNM Medical College, Raipur 492009. Herpes zoster is mainly a disease of the elderly. Its occurrence in younger age should be viewed with suspicion. A 9-year-old boy presented with herpes zoster ophthalmicus. He had a history of abdominal surgery one and half years back during which he had received blood transfusion. A year following the surgery he developed general malaise and fever with progressive weight loss. He was treated by local doctors. Subsequently he developed eruptions of blisters around right eye for a duration of 8 days, with which he presented to the department of ophthalmology, Pt JNM Medical College, Raipur. On investigations he was found to have infected with human immunodeficiency virus. Systemic acyclovir along with antiretroviral treatment was started, to which he showed favourable response. PMID: 17822193 [PubMed - indexed for MEDLINE] 559. Pediatr Rev. 2007 Sep;28(9):343-51. Index of suspicion. Rapson A, Rappaport DI, Holman L, Michaud L, Doyne E, Durrani A, Lanuza K, Ang J, Kamat D, Silver ES. Jefferson Medical College, Philadelphia, PA, USA. PMID: 17766593 [PubMed - indexed for MEDLINE] 560. J Infect Dis. 2007 Oct 1;196(7):1014-20. Epub 2007 Aug 29. Varicella-zoster-virus genotypes in East London: a prospective study in patients with herpes zoster. Sengupta N, Taha Y, Scott FT, Leedham-Green ME, Quinlivan M, Breuer J. Department of Virology, Centre for Infectious Diseases, Institute of Cell Molecular Sciences, Queen Mary School of Medicine and Dentistry, Barts, Whitechapel, London, E1 2AT, United Kingdom. n.sengupta@qmul.ac.uk A total of 298 patients with herpes zoster were recruited as part of 2 community-based studies in East London between 1998 and 2003. Single nucleotide-polymorphism analysis of 4 regions (genes 1, 21, 37, and 60) found that most genotypes were European strains C and B, representing 58% and 21% of all samples collected. No change in the proportion of these European clades has occurred during the past 80 years, strongly supporting the hypothesis that these strains are indigenous to the United Kingdom. White patients almost exclusively had reactivation of genotypes C (66%) and B (21%), whereas patients from Africa, Asia, or the Caribbean mainly had reactivation of genotypes A and J. An increase in BglI-positive A and J genotypes in UK cases of zoster is only partly explained by immigration from endemic regions. The data presented provide a baseline against which to evaluate changes in the molecular epidemiology of varicella-zoster virus and the effect of immunization with the Japanese Oka vaccine strain. PMID: 17763323 [PubMed - indexed for MEDLINE] 561. J Clin Virol. 2007 Oct;40(2):129-34. Epub 2007 Aug 28. Detection and differentiation of wild-type and vaccine mutant varicella-zoster viruses using an Invader Plus method. Tang YW, Allawi HT, DeLeon-Carnes M, Li H, Day SP, Schmid DS. Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN 37232, USA. yiwei.tang@vanderbilt.edu We report the use of a prototype Invader Plus method (Third Wave Technologies, Inc., Madison, WI) for the qualitative detection of varicella-zoster virus (VZV) and differentiation of wild-type and Oka vaccine VZV. The analytical sensitivity of the VZV Invader Plus reagents is at 10 copies per reaction. A total of 174 skin and mucous swab specimens were used to validate the assay's performance. The sensitivity and specificity were 98.3% and 98.1%, respectively, in comparison to a PCR-EIA assay. A perfect 100% agreement was obtained when VZV wild-type and vaccine differentiation was performed on 54 VZV-positive swab specimens against an allele-specific FRET real-time assay. The Invader Plus method provides another reliable tool for qualitative detection of VZV and differentiation of wild-type and vaccine virus. PMID: 17728179 [PubMed - indexed for MEDLINE] 562. Cardiology. 2008;109(3):193-5. Epub 2007 Aug 28. When an MI is not an MI: a case of varicella zoster myocarditis. Kelly E, Cullen G, McGurk C. St. Luke's Hospital, Kilkenny, Ireland. emerkelly@rcsi.ie A sixteen-year-old male presented with symptoms and investigations suggestive of acute myocardial infarction. The patient had suffered from a varicella zoster infection 5 days prior to presentation. Varicella myocarditis was suspected and diagnosed following treatment and positive varicella serology. This case highlights a rare but serious cardiac presentation of a common condition. Copyright 2007 S. Karger AG, Basel. PMID: 17726320 [PubMed - indexed for MEDLINE] 563. Zhongguo Zhen Jiu. 2007 Jul;27(7):536-40. [Systematic assessment of acupuncture for treatment of herpes zoster in domestic clinical studies] [Article in Chinese] Yu XM, Zhu GM, Chen YL, Fang M, Chen YN. Acupuncture Department, Yueyang Hospital of Integrated TCM and Western Medicine Affiliated to Shanghai University of TCM, China. OBJECTIVE: To assess the effectiveness of acupuncture for treatment of herpes zoster. METHODS: According to the requirement of evidence-based medicine, acupuncture, body acupuncture, electroacupuncture, head acupuncture, three edged needle, plum-blossom needle, fire needle, elongated needle, encircling needling, herpes zoster, etc. were selected as subject words to retrieve the relative medical database at home, and clinically randomized controlled trials were used as enrolled criteria, the treatment group were treated with acupuncture or acupuncture plus other therapies, and the control group with medicine, the cured rate and the time of killing pain for herpes zoster were used as assessment indexes. Altogether 43 papers were enrolled. Among them 10 papers were conducted for Meta-analysis by RevMan 4.2.9. RESULTS: The total OR was 4.27 with 95% CI [2.90, 6.29] of the clinically cured rate in the 10 studies, and the total OR was -7.64 with 95% CI [-8.12, -7.15] of the time of killing pain in the 4 studies. The therapeutic effect in the treatment group on herpes zoster was superior to that of the western medicine (P < 0.01). CONCLUSION: Acupuncture therapy for herpes zoster is effective, but more high-quality studies are required to prove this view point. PMID: 17722838 [PubMed - indexed for MEDLINE] 564. J Infect Chemother. 2007 Aug;13(4):270-2. Epub 2007 Aug 27. Varicella zoster virus meningoencephalitis accompanied by sporadic skin lesions in an older immunocompetent adult. Sugisaki K, Yoshida H. Department of Internal Medicine, Jusendo General Hospital, 1-8-16 Ekimae, Koriyama, Fukushima 963-8585, Japan. kota_sugisaki@ryumachi-jp.com A previously healthy 75-year-old man complained of persistent fever, headache, nausea, mild gait disturbance, memory disorder, and sporadic vesicular skin lesions. Viral meningoencephalitis was diagnosed, based on cerebrospinal fluid (CSF) analysis. Intensive CSF analysis suggested that the patient's illness was caused by varicella zoster virus (VZV). The patient recovered completely after treatment with intravenous acyclovir. VZV infection should be considered as a possible cause of central nervous system disease, even in an immunocompetent patient. VZV reactivation was strongly suspected because of the results of anti-VZV antibody evaluations in serum and CSF, although the skin lesions were not similar to those of herpes zoster. PMID: 17721692 [PubMed - indexed for MEDLINE] 565. Nurse Pract. 2007 Sep;32(9):19-24, quiz, 24-5. Herpes zoster: prevention, diagnosis, and treatment. Wilson DD. Mennonite College of Nursing, Illinois State University, Normal, IL, USA. Republished in: Adv Skin Wound Care. 2008 Dec;21(12):582-8; quiz 589-90. PMID: 17721355 [PubMed - indexed for MEDLINE] 566. Harv Health Lett. 2007 Aug;32(10):1-2. The shingles vaccine. Why hasn't it caught on? The cost and other factors are to blame. [No authors listed] PMID: 17717891 [PubMed - indexed for MEDLINE] 567. Epidemiol Infect. 2007 Aug;135(6):883-6. Vaccination to prevent zoster in the elderly. Gershon AA. PMID: 17717853 [PubMed - indexed for MEDLINE] 568. J Eur Acad Dermatol Venereol. 2007 Sep;21(8):1112-4. Postzoster cutaneous pseudolymphoma in a patient with B-cell chronic lymphocytic leukaemia. Moreira E, Lisboa C, Azevedo F, Príncipe F, Lima M. PMID: 17714139 [PubMed - indexed for MEDLINE] 569. Consult Pharm. 2007 Jul;22(7):593-8. Postherpetic neuralgia in an elderly patient. Cappuzzo KA, Krogsund RR. Virginia Commonwealth University School of Pharmacy, Richmond, Virginia 23298-0533, USA. kacappuzzo@vcu.edu A 67-year-old patient presented to the community pharmacy with poorly controlled postherpetic neuralgia (PHN) pain following an episode of herpes zoster. The clinical pharmacist did a medication review and found that, although the patient was receiving medications proven effective in the treatment of PHN, she was not receiving optimal therapy. Additionally, the patient was experiencing intolerable side effects. The pharmacist provided recommendations to the patient's primary care physician that ultimately improved the patient's pain control. Managing PHN pain requires practitioners to be vigilant in titrating pain regimens and trying various combinations of therapies with different mechanisms of action. Such an approach is one that tailors medication therapy to each individual patient, provides the most relief, and restores a patient's quality of life. PMID: 17714004 [PubMed - indexed for MEDLINE] 570. J Tradit Chin Med. 2007 Jun;27(2):124-7. Dr. Long Wenjun's experience in auriculo-acupuncture. Tian Y, Hou C. Department of Acupuncture and Moxibustion, The Hospital Affiliated to Gansu College of Traditional Chinese Medicine, Lanzhou 730020, China. PMID: 17710810 [PubMed - indexed for MEDLINE] 571. Mymensingh Med J. 2007 Jul;16(2):221-4. Herpes zoster ophthalmicus in an otherwise healthy 7 years child. Akhanda AH, Quayum MA, Uddin A, Ahmed N, Uddin T, Ahmed T. Department of Ophthalmology, Mymensingh Medical College, Mymensingh, Bangladesh. Erratum in: Mymensingh Med J. 2008 Jan;17(1):111. A 07 years otherwise healthy child, non vaccinated for chickenpox and with a history of chickenpox infection at 02 years of age presented with red colored lesions in right upper lid, right side of forehead, vertex and right side of nose and defective vision in right eye in Mymensingh Medical College Hospital, 20 days after the appearance of blister in the same region. On examination granulation tissue was present on the same area. There was no hair and skin over that area. Lesion was strictly limited to right side of midline. Eyelashes of right upper lid were absent and there was defective closure of eyelids. Best corrected visual acuity of right eye was 3/60 and of left eye was 6/6. There was ciliary congestion of right eye with haziness of cornea at interpalpebral region of right eye. Corneal sensitivity was reduced and there was uniform fluorescein staining at central part of cornea. Mild flare and cells were present in anterior chamber. Fundus examination revealed no abnormality. He was treated with systemic acyclovir, antibiotics, topical acyclovir, antibiotic and atropine. Corneal ulcer and skin lesions were healed, but the patient developed cicatricial ectropion of right upper lid and best corrected visual acuity of right eye was reduced to 6/60 due to corneal opacity. So early diagnosis and treatment of herpes zoster ophthalmicus is mandatory to prevent sight threatening complications. PMID: 17703164 [PubMed - indexed for MEDLINE] 572. JAAPA. 2007 Jul;20(7):56. Patient information. Should I get the shingles vaccine? [No authors listed] PMID: 17695100 [PubMed - indexed for MEDLINE] 573. JAAPA. 2007 Jul;20(7):55. Should I get the shingles vaccine? Iverson K. Emergency Treatment Center, University of Iowa Hospitals and Clinics, Iowa City, USA. PMID: 17695099 [PubMed - indexed for MEDLINE] 574. J Assoc Physicians India. 2007 Apr;55:308-9. Ramsay Hunt syndrome presenting as cranial polyneuropathy. Padhiary KN, Mishra A, Routray P. PMID: 17695066 [PubMed - indexed for MEDLINE] 575. Transpl Infect Dis. 2007 Sep;9(3):237-40. Unusual presentation of central nervous system manifestations of Varicella zoster virus vasculopathy in renal transplant recipients. Hovens MM, Vaessen N, Sijpkens YW, de Fijter JW. Department of General Internal Medicine, Leiden University Medical Centre, Leiden, The Netherlands. m.m.c.hovens@lumc.nl We describe 2 renal transplant recipients with severe but reversible neurological manifestations related to Varicella zoster virus (VZV) cerebral vasculopathy. To the best of our knowledge, this is the first description of cerebral VZV vasculopathy in solid organ transplant recipients. We review the published literature on the clinical presentation, diagnosis and treatment. In solid organ transplant recipients presenting with neurological signs and symptoms, a diagnosis of VZV-associated vasculopathy should be considered. PMID: 17692072 [PubMed - indexed for MEDLINE] 576. Harv Mens Health Watch. 2007 Jul;11(12):8. On call. Your article on new immunizations for adults was very helpful. I already got my booster for tetanus, diphtheria, and whooping cough, but even though I'm 61, my doctor didn't want to give me the shingles because I've already had shingles. Should I get the vaccine? Simon HB. PMID: 17687797 [PubMed - indexed for MEDLINE] 577. Acta Otorrinolaringol Esp. 2007 Aug-Sep;58(7):311-5. [Viral infection of herpes simplex, Epstein-Barr, varicela zoster, human papilloma, cytomegalovirus, or adenovirus are not related to sinonasal adenocarcinomas] [Article in Spanish] Pérez Escuredo J, Llorente JL, Melón S, de Oña M, García Martínez J, Alvarez Marcos C, Hermsen M. Departamento de Otorrinolaringología, IUOPA, Hospital Universitario Central de Asturias, Oviedo, Asturias, España. OBJECTIVE: Several types of virus have been implicated in the development of head and neck tumors. However, until now sinonasal adenocarcinomas (ACN) have not been studied. The aim of this study is to screen a series of ACN for the presence of a number of viruses known to play a role in cancer. MATERIAL AND METHOD: Viral DNA sequences of herpes simplex virus, Epstein-Barr, varicela zoster, human papilloma, cytomegalovirus, and adenovirus were analysed by PCR in 37 primary ACN. RESULTS: Three tumors (8.1%) were positive for Epstein-Barr virus and 1 case (2.7%) for cytomegalovirus. CONCLUSIONS: Viral infections do not seem to play a role in the etiology of ACN. PMID: 17683698 [PubMed - indexed for MEDLINE] 578. Cleve Clin J Med. 2007 Jul;74(7):489-94, 496, 498-9 passim. The protean neurologic manifestations of varicella-zoster virus infection. Nagel MA, Gilden DH. Department of Neurology, University of Colorado Health Sciences Center, Denver 80262, USA. Comment in: Cleve Clin J Med. 2007 Jul;74(7):472. Multiple neurologic complications may follow the reactivation of varicella-zoster virus (VZV), including herpes zoster (also known as zoster or shingles), postherpetic neuralgia, vasculopathy, myelitis, necrotizing retinitis, and zoster sine herpete (pain without rash). These conditions can be difficult to recognize, especially as several can occur without rash. PMID: 17682626 [PubMed - indexed for MEDLINE] 579. Cleve Clin J Med. 2007 Jul;74(7):472. Zoster is more than 'just' a viral infection. Mandell BF. Comment on: Cleve Clin J Med. 2007 Jul;74(7):489-94, 496, 498-9 passim. PMID: 17682624 [PubMed - indexed for MEDLINE] 580. Lakartidningen. 2007 Jun 13-26;104(24-25):1916-20. [Risk of CNS adverse effects of aciclovir and valaciclovir. Watch the renal function in treatment of herpes simplex and herpes zoster] [Article in Swedish] Helldén A, Bergman U, Dwyer R, Medin C, Molanaei H, Ståhle L, Thylén P, Odar-Cederlöf I. Institutionen för laboratoriemedicin, Karolinska institutet. anders.hellden@karolinska.se PMID: 17674672 [PubMed - indexed for MEDLINE] 581. Eur J Ophthalmol. 2007 Jul-Aug;17(4):683-4. Herpetic optic neuritis associated with herpetic keratitis. Sáenz-Francés F, Calvo-González C, Jiménez-Santos M, Méndez-Hernández C, Fernandez-Vidal AM, Martínez-de-la-Casa JM, García-Sánchez J, García-Feijoó J. Department of Ophthalmology, Hospital Clinico Universitario San Carlos-Universidad Complutense, 28003 Madrid, Spain. federicosaenzfrancessb@gmail.com PURPOSE: To report a case of herpetic optic neuritis associated with herpetic keratitis. METHODS: A 65 year old woman presented with oedema in the nasal sector of his right papilla. Blood biochemistry, a haemogram, erythrocyte sedimentation rate and C-reactive protein were all normal. The patient was diagnosed as having a non-arteritic anterior ischaemic optic neuropathy. One week later slit lamp examination showed diffuse stromal corneal oedema and a dendritic lesion in the nasal zone of the corneal epithelium. RESULTS: Serology for varicela-zoster virus was positive. Treatment was started with valacyclovir given orally and topical acyclovir ointment. A week later, the optic disc swelling and corneal lesions had resolved. CONCLUSIONS: The precise mechanism through which the papilla and cornea were successively affected in our patient is unclear but the sensitive innervation of both these structures is provided by the nasal branch of the nasociliary nerve and the spread of herpes via this nerve could affect both sites. PMID: 17671953 [PubMed - indexed for MEDLINE] 582. J Dermatolog Treat. 2007;18(4):255. Herpes zoster, bacterial superinfections and antibiotics. Veraldi S, Schianchi R. PMID: 17671888 [PubMed - indexed for MEDLINE] 583. Actas Dermosifiliogr. 2007 Sep;98(7):494-6. [Zosteriform cutaneous leiomyoma. Satisfactory treatment with oral doxazosin] [Article in Spanish] Chaves AJ, Fernández-Recio JM, de Argila D, Rodríguez-Nevado I, Catalina M. Unidad de Dermatología, Hospital Universitario Infanta Cristina, Badajoz, España. antoniojchaves@yahoo.es We report a 50-year-old man that presented a zosteriform cutaneous leiomyoma in the left facial region, intensely painful, that showed great improvement after the administration of a daily dose of 4 mg of oral doxasozin. The therapy was well tolerated and did not present any associated adverse effect. In the English medical literature only two cases successfully treated with doxasozin have been reported. PMID: 17669306 [PubMed - indexed for MEDLINE] 584. Ann Fam Med. 2007 Jul-Aug;5(4):305-9. Clinical diagnosis of herpes zoster in family practice. Opstelten W, van Loon AM, Schuller M, van Wijck AJ, van Essen GA, Moons KG, Verheij TJ. Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands. w.opstelten@umcutrecht.nl PURPOSE: Family physicians usually diagnose herpes zoster on clinical grounds only, possibly resulting in false-positive diagnoses and unnecessary treatment. We wanted to determine the positive predictive value of the physicians' judgment in diagnosing herpes zoster and to assess the applicability of dried blood spot analysis for diagnosis of herpes zoster in family practice. METHODS: Our study population consisted of 272 patients older than 50 years with herpes zoster (rash for less than 7 days). Dried blood spot samples were collected from all patients and sent by mail to the laboratory. Baseline measurements included clinical signs (localization, severity, and duration of rash) and symptoms (duration and severity of pain). Varicella-zoster virus antibodies were determined at baseline and 5 to 10 days later. Multivariate logistic regression was used to assess independent associations between clinical variables and serological confirmation of herpes zoster. RESULTS: Dried blood spot analysis was possible in 260 patients (96%). In 236 the diagnosis of herpes zoster was confirmed serologically (positive predictive value of clinical judgment 90.8%; 95% confidence interval, 87.3%-94.3%). Independent clinical variables for serologically confirmed herpes zoster were severity and duration of rash at first examination. CONCLUSION: Family physicians have good clinical judgment when diagnosing herpes zoster in older patients. Dried blood spot analysis is a logistically convenient method for serological investigation of patients in family practice, but it is rarely needed for diagnosing herpes zoster. PMCID: PMC1934966 PMID: 17664496 [PubMed - indexed for MEDLINE] 585. J Neurol Sci. 2007 Nov 15;262(1-2):113-6. Epub 2007 Jul 30. On the viral hypothesis of multiple sclerosis: participation of varicella-zoster virus. Sotelo J. Neuroimmunology Unit, National Institute of Neurology and Neurosurgery, Mexico City, Mexico. jsotelo@servidor.unam.mx Recent studies, including our own, have accumulated evidence suggesting the etiological participation of varicella-zoster virus in multiple sclerosis. If confirmed, complex issues of individual susceptibility and immunopathogenesis would have to be unveiled. PMID: 17663004 [PubMed - indexed for MEDLINE] 586. Arch Pediatr. 2007 Sep;14(9):1092-3. Epub 2007 Jul 26. [Infantile herpes zoster] [Article in French] Atmani S, Elouardi M, Bouharrou A, Hida M. Département de pédiatrie, hôpital universitaire de Fès, faculté de médecine et de pharmacie de Fès, route Sidi-Hrazem, km 2,200, BP 1893, 30000 Fès, Maroc. samir.atmani8@caramail.com Herpes zoster occurs seldom in infants, especially in the absence of exposure to maternal varicella either intrauterine or postnatal. We report on a case in a 3-month-old infant admitted for herpes zoster in the sciatic nerve territory. No cutaneous eruption was found in the mother or in people who were in contact with the patient. This rare clinical situation is here reviewed, showing that the absence of antenatal or postnatal exposure to herpes viruses does not preclude the occurrence of herpes zoster infection in early infancy. PMID: 17662580 [PubMed - indexed for MEDLINE] 587. J Am Geriatr Soc. 2007 Aug;55(8):1168-75. Healthcare costs of acute and chronic pain associated with a diagnosis of herpes zoster. Dworkin RH, White R, O'Connor AB, Baser O, Hawkins K. Department of Anesthesiology, School of Medicine and Dentistry, University of Rochester, Rochester, New York 14642, USA. robert_dworkin@urmc.rochester.edu OBJECTIVES: To determine the healthcare costs of acute and chronic pain associated with herpes zoster. DESIGN: Retrospective cohort analysis. SETTING: Inpatient and outpatient care. PARTICIPANTS: Patients were selected from Medicare, commercial insurance, and Medicaid claims databases if they had a diagnosis of herpes zoster or postherpetic neuralgia (PHN) or were prescribed analgesics after a diagnosis of herpes zoster (possible PHN) and were matched to controls for demographic and clinical factors using propensity scores. MEASUREMENTS: One-year excess healthcare expenditures attributable to herpes zoster pain or PHN were calculated for inpatient, outpatient, and prescription drug services. RESULTS: For the Medicare cohort, the average excess cost per patient was $1,300 in the year after a diagnosis of herpes zoster with 30 days or fewer of analgesic use and ranged from $2,200 to $2,300 per patient with PHN or possible PHN. Patients with possible PHN were 53% more prevalent than patients with PHN in the Medicare cohort and accounted for half of all excess expenditures. Findings were similar in the younger cohorts with commercial insurance and Medicaid except that costs attributable to PHN and possible PHN were higher, and patients with possible PHN were three to five times as prevalent as patients with PHN. CONCLUSION: Healthcare costs associated with PHN were substantially greater than those associated with herpes zoster pain that resolved within 30 days. The data suggest that as many as 80% of patients with PHN may not be diagnosed with PHN and that these patients account for at least half of PHN expenditures. PMID: 17661954 [PubMed - indexed for MEDLINE] 588. Invest Ophthalmol Vis Sci. 2007 Aug;48(8):3689-97. Identification of viral antigens recognized by ocular infiltrating T cells from patients with varicella zoster virus-induced uveitis. Milikan JC, Kinchington PR, Baarsma GS, Kuijpers RW, Osterhaus AD, Verjans GM. Institute of Virology, Erasmus Medical Center, Rotterdam. PURPOSE: Varicella zoster virus (VZV) is a common cause of infectious uveitis associated with an intraocular inflammatory response involving virus-specific T cells. In the current study, the functional characteristics and the antigen specificity of VZV-reactive T cells recovered from intraocular fluid (IOF) samples of five patients with VZV were determined. METHODS: B-cell lines were infected with a comprehensive panel of recombinant vaccinia viruses expressing 11 individual VZV open reading frames (ORFs), or alternatively pulsed with the corresponding peptides to generate antigen-presenting cells (APCs). T-cell responsiveness of the IOF-derived VZV-specific T cells toward APCs was monitored by interferon (IFN)-gamma enzyme-linked immunosorbent spot-forming assays on bulk T-cell cultures and subsequently T-cell clones (TCCs). The cytokine-secretion profile and cytotoxicity of the VZV-specific TCCs was determined by ELISA and flow cytometry, respectively. RESULTS: T-cell reactivity to VZV proteins encoded by ORF4, -10, -14, -18, -29, -31, -61, -62, -63, -67, and -68 was demonstrated, but specificity varied individually. T-cell epitopes on ORF62 and -68 were delineated. The TCCs secreted IFNgamma, but relatively low levels of interleukin-4 and -5, in response to VZV antigen-expressing APCs. The TCCs induced antigen-specific cytotoxic T-cell activity. CONCLUSIONS: The results suggest that the intraocular VZV-specific T-cell response in the patients with VZV analyzed is directed to a broad spectrum of VZV antigens, including the latency-associated VZV proteins from ORFs 4, 29, 63, and particularly ORF62. This local T-cell response was in part mediated by cytotoxic CD4(+) T cells with a Th1/0-like effector memory phenotype. PMID: 17652740 [PubMed - indexed for MEDLINE] 589. Int J Dermatol. 2007 Aug;46(8):883-4. Acyclovir-induced neuropsychosis successfully recovered after immediate hemodialysis in an end-stage renal disease patient. Yang HH, Hsiao YP, Shih HC, Yang JH. Department of Dermatology, Chung Shan Medical University Hospital, Taichung, Taiwan 402. A 70-year-old man developed herpes zoster over the right L5-S2 region for 3 days and was admitted for acyclovir therapy. He had a medical history of rectal cancer status post-colostomy and end-stage renal disease undergoing thrice weekly hemodialysis. Without a prior loading dose, acyclovir 500 mg (7.7 mg/kg) daily was given intravenously in two divided doses. On the third dosage, the patient became confused and agitated and developed insomnia. Within the following 24 h, delirium, visual and auditory hallucinations, disorientation to place and time, as well as impaired recent memory occurred. At the same time, a transient low grade fever (38 degrees C) was noted but resolved spontaneously after ice pillow (Fig. 1). The etiology was vigorously explored. He had no history of any neurological or psychiatric disorders. Drug history was reviewed, but no other medications besides acyclovir were currently being used. Physical examination revealed neither meningeal signs nor focal neurological deficits. Serum blood urea nitrogen, glucose, and electrolytes were within normal limits except for an elevated creatinine level at 6.2 and 5.7 mg/dl (before and after neuropsychotic symptoms, respectively). Complete blood count with differentiation was also unremarkable. Cerebrospinal fluid examination was not possible as the patient's family refused the lumbar puncture. Moreover, an electroencephalograph study and head computed tomography scan disclosed no abnormalities. Acyclovir-induced neurotoxicity was suspected. Therefore, acyclovir was discontinued. Subsequently, serum acyclovir and CMMG were checked by enzyme-linked immunosorbent assay. Serum acyclovir level was 1.6 mg/l (normal therapeutic level, 0.12-10.8 mg/l) and CMMG level was 5 mg/l. Emergent hemodialysis (4-h/session) was given; the neuropsychotic symptoms, including agitation, delirium, and visual and auditory hallucinations, greatly abated after the second session. The patient fully recovered after three consecutive days of hemodialysis; the serum was rechecked and revealed that the acyclovir level was below 0.5 mg/l and the CMMG level was undetectable. At the same time, his herpetic skin lesions resolved well. PMID: 17651180 [PubMed - indexed for MEDLINE] 590. Neurology. 2007 Jul 24;69(4):398-400. VZV spinal cord infarction identified by diffusion-weighted MRI (DWI). Orme HT, Smith AG, Nagel MA, Bert RJ, Mickelson TS, Gilden DH. Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA. PMID: 17646633 [PubMed - indexed for MEDLINE] 591. Am J Clin Dermatol. 2007;8(4):221-33. Dermatologic adverse effects of antiretroviral therapy: recognition and management. Luther J, Glesby MJ. Upstate Medical School, State University of New York, Syracuse, New York, USA. Despite the decrease in opportunistic infections associated with HIV in the highly active antiretroviral treatment (HAART) era, a significant number of patients still present with skin pathology, some of which can be attributed directly or indirectly to antiretroviral therapy. The non-nucleoside reverse transcriptase inhibitors exhibit a class effect with regard to skin adverse manifestations, and the spectrum of disease can vary from a mild morbilliform rash to Stevens-Johnson syndrome. Certain protease inhibitors are associated with rash, and indinavir causes retinoid-like manifestations such as paronychia, alopecia, ingrown toe-nails, and curling of straight hair. Abacavir, a nucleoside reverse transcriptase inhibitor, is notorious for causing a hypersensitivity reaction in select patients. The fusion inhibitor enfuvirtide causes injection-site reactions in the overwhelming majority of patients, although a new method of delivery has decreased the rate and severity of these reactions. A syndrome of lipoatrophy with or without lipohypertrophy, often termed lipodystrophy, has been described in patients receiving HAART. Potential management of lipoatrophy includes switching antiretrovirals and surgical treatment with facial fillers. Lastly, skin manifestations of the immune reconstitution inflammatory syndrome, including herpes zoster and warts, must be recognized and treated accordingly. In the evaluation of the individual HIV-infected patient receiving antiretroviral therapy who presents with a skin disorder, clinicians should consider the CD4 cell count as a marker of the degree of immunodeficiency, the specific antiretrovirals used, and the timing of the initiation of antiretroviral therapy in order to formulate a rational differential diagnosis. Management should be individualized based on the specific drug that is implicated and the severity of the reaction. PMID: 17645377 [PubMed - indexed for MEDLINE] 592. Oncology. 2006;71(3-4):164-7. Epub 2007 Jul 18. Herpes infections in breast cancer patients treated with adjuvant chemotherapy. Masci G, Magagnoli M, Gullo G, Morenghi E, Garassino I, Simonelli M, Santoro A. Department of Medical Oncology and Hematology, Istituto Clinico Humanitas, Milan, Italy. giovanna.masci@humanitas.it OBJECTIVE: There is little information on Herpes zoster infection in breast cancer patients as a complication during adjuvant chemotherapy. The aim of this study is to evaluate the incidence of Herpes zoster and simplex infections in this patients setting. METHODS: We analyzed 623 early-stage breast cancer patients in our Institute over a period of 7 years (1998-2005). Four-hundred and sixty-one patients were treated with anthracycline-based chemotherapy, 116 with CMF and 46 with taxane-containing regimens. RESULTS: Twelve (1.9%) developed herpes zoster; 9 patients, receiving anthracycline-based chemotherapy, two taxane-containing regimens, and one CMF regimen. Herpes zoster infection required treatment delay in 6 patients. Adjuvant chemotherapy was delayed for 1 week in 2 patients, while in 4 patients with more severe symptoms chemotherapy was delayed for 2 weeks. One patient, despite i.v. acyclovir, had severe postherpetic motor neuropathy with a permanent ambulation impairment, and chemotherapy was stopped. In our study, herpes zoster occurred in 55/1,000 cases/year. The reported incidence in the general population varies between 2.2 and 4.1 per 1,000 patients/year; therefore, the risk of developing herpes zoster in these patients may be 13- to 25-fold higher compared to the incidence in the general population. In addition, 13 of 623 patients developed herpes simplex. CONCLUSION: Our findings suggest that adjuvant chemotherapy can facilitate reactivation of herpes infection. PMID: 17641534 [PubMed - indexed for MEDLINE] 593. J Neurol Neurosurg Psychiatry. 2007 Aug;78(8):818. Neurological picture. Herpes zoster duplex bilateralis. Peretz A, Nowatzky J, Steiner I. Department of Internal Medicine, Hadassah University Hospital Mount Scopus, Jerusalem 91240, Israel. asafp@bgu.ac.il PMID: 17635977 [PubMed - indexed for MEDLINE] 594. J Neurooncol. 2008 Jan;86(1):55-6. Epub 2007 Jul 19. Ramsay Hunt syndrome in a patient with metastatic lung cancer to brain. Alcalay RN, Shulman JM, Plotkin SR. Department of Neurology, Massachusetts General Hospital, Boston, MA, 02114, USA. royalcalay@gmail.com PMID: 17634859 [PubMed - indexed for MEDLINE] 595. Clin Geriatr Med. 2007 Aug;23(3):615-32, vii-viii. Herpes zoster and postherpetic neuralgia in older adults. Schmader K. Center for the Study of Aging and Human Development and Division of Geriatrics, Department of Medicine, Duke University Medical Center, Box 3469, Durham, NC 27710, USA. schma001@mc.duke.edu Herpes zoster (HZ) afflicts millions of older adults annually and causes significant suffering from acute and chronic pain, or postherpetic neuralgia (PHN). HZ is caused by the reactivation of varicella-zoster virus (VZV) in sensory ganglia in the setting of age, disease, and drug-related decline in cellular immunity. VZV-induced neuronal destruction and inflammation cause the pain, interference with activities of daily living, and reduced quality of life. The optimal treatment of HZ requires early antiviral therapy and pain management. For PHN, evidence-based pharmacotherapy can reduce pain burden. The zoster vaccine is effective in reducing pain burden and preventing HZ and PHN in older adults. PMID: 17631237 [PubMed - indexed for MEDLINE] 596. Med Arh. 2007;61(2):128-30. [Retrobulbar optic neuritis as first sign of HIV infection] [Article in Bosnian] Alimanović-Halilović E, Ibisević M. Klinika za ocne bolesti, KCU Sarajevo. ilda@bih.net.ba This case is about a unilateral retrobulbar optic neuritis, as rare and first sing of HIV infection. A young woman had came at Eye Clinic because suddenly she lost her sight on the right eye completely. At the visual field, we found anopsia, but at the stereoscopic fundus examination the situation was almost normal. After complete clinical examination we conclude that she is immunodeficiency person, HIV-positive, with clinical manifestation retrobulbar neuritis and with skin manifestation varicella zoster infection in region of the left arm. PMID: 17629153 [PubMed - indexed for MEDLINE] 597. RN. 2007 Jun;70(6):27-31; quiz 32. Shingles: what you should know. Novatnack E, Schweon S. St. Luke's Hospital, Bethlehem, PA, USA. PMID: 17624059 [PubMed - indexed for MEDLINE] 598. MMW Fortschr Med. 2006 Oct 26;148(43):41-3. [Stepped analgesic approach to herpes zoster pain] [Article in German] Ludwig J, Baron R. Klinik für Neurologie, Universitätsklinikum Schleswig-Holstein, Kiel. PMID: 17619424 [PubMed - indexed for MEDLINE] 599. N Engl J Med. 2007 Jul 5;357(1):89-90. Varicella-zoster vaccine. Senanayake SN. Comment on: N Engl J Med. 2007 Mar 29;356(13):1338-43. PMID: 17615639 [PubMed - indexed for MEDLINE] 600. N Engl J Med. 2007 Jul 5;357(1):89. Varicella-zoster vaccine. Lang PO, Herrmann F, Michel JP. Comment on: N Engl J Med. 2007 Mar 29;356(13):1338-43. PMID: 17615638 [PubMed - indexed for MEDLINE] 601. N Engl J Med. 2007 Jul 5;357(1):89. Varicella-zoster vaccine. Good CB. Comment on: N Engl J Med. 2007 Mar 29;356(13):1338-43. N Engl J Med. 2005 Jun 2;352(22):2271-84. PMID: 17615637 [PubMed - indexed for MEDLINE] 602. N Engl J Med. 2007 Jul 5;357(1):89. Varicella-zoster vaccine. Keller DL. Comment on: N Engl J Med. 2007 Mar 29;356(13):1338-43. PMID: 17615636 [PubMed - indexed for MEDLINE] 603. Ocul Immunol Inflamm. 2007 May-Jun;15(3):241-8. Evidence for antigen-specific immune deviation in patients with acute retinal necrosis. 2001. Kezuka T, Sakai JI, Usui N, Streilein JW, Usui M. PMID: 17613838 [PubMed - indexed for MEDLINE] 604. Cancer Invest. 2007 Jun;25(4):249-55. Selective lymphopenia and opportunistic infections in neuroendocrine tumor patients receiving temozolomide. Schwarzberg AB, Stover EH, Sengupta T, Michelini A, Vincitore M, Baden LR, Kulke MH. Harvard Medical School, Boston, Massachusetts, USA. aschwarzberg@partners.org Temozolomide is utilized as a treatment for a variety of solid tumors and has been associated with the development of selective lymphopenia. We evaluated the incidence of lymphopenia and opportunistic infections during treatment and up to 12 months following treatment discontinuation in a cohort of 39 patients receiving temozolomide for advanced neuroendocrine tumors. The incidence of Grade 3-4 lymphopenia was 46 percent after 4 months of therapy and remained at 30 percent or greater for 12 months following treatment discontinuation. The overall incidence of opportunistic infections was 10 percent, while among patients receiving therapy for > or =7 months, the incidence was 20 percent. Prophylaxis for Pneumocystis jiroveci pneumonia and varicella-zoster, as well as cytomegalovirus monitoring, should be considered in patients receiving temozolomide-based treatment. PMID: 17612935 [PubMed - indexed for MEDLINE] 605. MMW Fortschr Med. 2007 Mar 1;149(9):10-2. [Properly managing leg pain] [Article in German] Wepner U. PMID: 17612241 [PubMed - indexed for MEDLINE] 606. N Engl J Med. 2007 Jul 5;357(1):88. Varicella-zoster vaccine. Woo EJ, Ball R, Braun MM. Comment on: N Engl J Med. 2007 Mar 29;356(13):1338-43. PMID: 17611214 [PubMed - indexed for MEDLINE] 607. J Fam Pract. 2007 Jul;56(7):551-3. A young girl with blisters on her forehead. Sarabi K, Selim A, Khachemoune A. Loma Linda University Medical School, Loma Linda, CA, USA. Comment in: J Fam Pract. 2008 Feb;57(2):81. PMID: 17605947 [PubMed - indexed for MEDLINE] 608. Transpl Infect Dis. 2008 Apr;10(2):90-8. Epub 2007 Jul 1. Factors influencing varicella zoster virus infection after allogeneic peripheral blood stem cell transplantation: low-dose acyclovir prophylaxis and pre-transplant diagnosis of lymphoproliferative disorders. Kim DH, Messner H, Minden M, Gupta V, Kuruvilla J, Wright J, Lipton J. Blood and Marrow Transplant Program, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada. Varicella zoster virus (VZV) infection is one of the frequent opportunistic infections after allogeneic bone marrow transplantation, with a high incidence of 30-50%. However, no data have been reported on VZV infection after allogeneic peripheral blood stem cell transplantation (PBSCT). PATIENTS AND METHODS: We report a retrospective analysis of VZV infection in 192 allogeneic PBSCT recipients. Twenty-seven patients (14%) received long-term prophylaxis of low-dose acyclovir (200 mg twice daily orally > or =3 months) for recurrent oral (n=21) or genital herpes simplex virus infection (n=5) or for a previous history of recurrent VZV infection (n=1). RESULTS: Forty-two patients (22%) developed VZV infections: localized (n=37) and disseminated infection (n=5). The incidence of VZV infection at 1 and 3 years was 19.3+/-3.3% and 36.8+/-5.2%, respectively. Complications included post-herpetic neuralgia (n=18, 43%), secondary bacterial infections (n=3), and intracranial hemorrhage (n=1) with 2 deaths. A higher risk factor for VZV infection was pre-transplant diagnosis of a lymphoproliferative disorder (LPD): chronic lymphocytic leukemia, Hodgkin's disease, or non-Hodgkin's lymphoma (P=0.021, 52.5% in LPD vs. 32.6% in non-LPD group). The use of low-dose acyclovir prophylaxis (P=0.043, 14.7% in acyclovir vs. 41.6% in nonacyclovir group) was found to be protective. Although no VZV infection episodes were noted during the period of acyclovir prophylaxis, 3 episodes of VZV infection were noted after acyclovir cessation. CONCLUSION: The incidence of VZV infection after PBSCT was high at 36.8%, with patients transplanted for LPDs at higher risk. The long-term use of low-dose acyclovir may be protective for VZV infection, although it does not completely prevent rebound of late VZV infection. PMID: 17605742 [PubMed - indexed for MEDLINE] 609. J Clin Virol. 2007 Aug;39(4):322-5. Epub 2007 Jun 28. Ramsay Hunt syndrome complicated by a brainstem lesion. Kim JH, Chung PW, Oh S, Hong SB, Chung CS, Jung CW, Kim ST, Hong SD, Seo DW. Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Gangnam-Gu, Seoul 135-710, Republic of Korea. PMID: 17604687 [PubMed - indexed for MEDLINE] 610. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007 Oct;104(4):455-60. Epub 2007 Jun 29. Herpes zoster infection as an immune reconstitution inflammatory syndrome in HIV-seropositive subjects: a review. Feller L, Wood NH, Lemmer J. Department of Periodontology and Oral Medicine, School of Dentistry, Faculty of Health Sciences, University of Limpopo, Medunsa Campus, South Africa. lfeller@medunsa.ac.za The use of highly active antiretroviral therapy (HAART) in the management of human immunodeficiency virus (HIV) infection has resulted paradoxically in the worsening of clinical symptoms of previously subclinical infections, such as herpes zoster (HZ), herpes simplex, angular cheilitis, warts, tuberculosis, hepatitis B and C, cytomegalovirus retinitis, and others, as a result of substantial reconstitution of the host's immune responses. This phenomenon is referred to as immune reconstitution inflammatory syndrome (IRIS). It may affect up to 32% of HIV-seropositive subjects within a wide range of time after the initiation of HAART, but mainly after 8-12 weeks. Mucocutaneous HZ accounts for 7%-12% of the diseases associated with HIV infection that become worse again when the subject's immunity improves from the administration of HAART. It usually occurs after 4 weeks from the initiation of HAART, and under these circumstances the clinical symptoms and natural course of mucocutaneous HZ are similar to those in HIV-seropositive subjects who do not manifest IRIS. PMID: 17604657 [PubMed - indexed for MEDLINE] 611. Nursing. 2007 Jul;37(7):29. Myths and facts...about shingles. Quillen TF. PMID: 17603352 [PubMed - indexed for MEDLINE] 612. Pharmacotherapy. 2007 Jul;27(7):1013-9. Zoster vaccine live. Kockler DR, McCarthy MW. Drug Information Services, Virginia Commonwealth University Health System-Medical College of Virginia Hospitals, and the Virginia Commonwealth University School of Pharmacy, Charlottesville, Virginia 23298-0042, USA. dkockler@mcvh-vcu.edu Herpes zoster is a neurocutaneous disease caused by the varicella-zoster virus and is associated with significant morbidity and long-term sequelae in older adults. Until recently, treatment options for these complications have been primarily targeted at disease state management and symptom relief. Zoster vaccine live is the first vaccine approved for the prevention of herpes zoster. The vaccine was approved by the United States Food and Drug Administration for adults aged 60 years or older. Results of the Shingles Prevention Study demonstrated that in older individuals, administration of zoster vaccine live reduces the burden of illness associated with herpes zoster by 61.1%, the frequency of herpes zoster pain and discomfort by 51.3%, and the frequency of postherpetic neuralgia by 66.5%. Overall, adverse events reported in clinical trials of zoster vaccine live were classified as mild. Events that occurred more frequently in zoster vaccine live recipients than in placebo recipients included injection site reactions, headache, respiratory infections, fever, flu syndrome, diarrhea, rhinitis, skin disorders, respiratory disorders, and asthenia. The Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices recently recommended universal vaccination for those 60 years of age and older, including those who have experienced previous episodes of shingles. PMID: 17594207 [PubMed - indexed for MEDLINE] 613. Arq Bras Oftalmol. 2007 Mar-Apr;70(2):189-94. Laboratory results in ocular viral diseases: implications in clinical-laboratory correlation. Marangon FB, Miller D, Alfonso E. Universidade Federal de São Paulo, São Paulo, SP, Brasil. fbmarangon@yahoo.com.br PURPOSE: To document etiology and predictive value of clinical diagnosis in laboratory confirmed viral diseases. METHODS: Reports of culture-positive cases of samples collected from patients presenting from January 1987 - December 2001 were evaluated. RESULTS: One thousand nine hundred and sixty-four (1964) cultures were submitted during 1987-2001. Twenty-six percent were positive (514). Human herpesvirus 1 was the most frequent agent isolated from all positive culture (56%). Adenovirus was the most common virus isolated from conjunctiva (66%), human herpesvirus 1 from lid and cornea (76%, 88%) and cytomegalovirus from vitreous (27%). Some unusual pathogens were recovered from conjunctiva as cytomegalovirus and from cornea as adenovirus, enterovirus and cytomegalovirus. Recognition of common viral syndromes was human herpesvirus 1 (88%), epidemic keratoconjunctivitis (88%), acute hemorrhagic conjunctivitis (70%) and varicella zoster virus (100%). However, some misdiagnosed cases were observed. Thirteen percent of conjunctivitis thought to be caused by herpes were due to adenovirus, 3.2% to Enterovirus, 3.2% to varicella zoster virus and 3.2% to human cytomegalovirus. Also, 5% of cases with a clinical diagnosis of herpes keratitis were caused by adenovirus and 2.7% by enterovirus. Finally, 4.8% of cases thought to be adenovirus conjunctivitis were herpes conjunctivitis. CONCLUSIONS: Human herpesvirus 1 remains the most frequently isolated virus from ocular sites in general (56%). Nonherpetic corneal isolates were in decreasing order: adenovirus, enterovirus and cytomegalovirus. Clinical and laboratory correlation was less than 90%. The most misdiagnosed cases were herpes conjunctivitis and keratitis, some cases of adenovirus conjunctivitis some cases of acute hemorrhagic conjunctivitis. It is essential that a rapid and specific diagnosis is offered under atypical viral presentation for the institution of specific antiviral therapy and to avoid complications that can be a result of misdiagnosis and inappropriate treatment. Also it is important to do viral testing in order to confirm clinical diagnosis, report emerging infections, resistance and change in the epidemiology. PMID: 17589685 [PubMed - indexed for MEDLINE] 614. MMWR Recomm Rep. 2007 Jun 22;56(RR-4):1-40. Prevention of varicella: recommendations of the Advisory Committee on Immunization Practices (ACIP). Marin M, Güris D, Chaves SS, Schmid S, Seward JF; Advisory Committee on Immunization Practices, Centers for Disease Control and Prevention (CDC). Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, GA 30333, USA. mmarin@cdc.gov Two live, attenuated varicella zoster virus-containing vaccines are available in the United States for prevention of varicella: 1) a single-antigen varicella vaccine (VARIVAX, Merck & Co., Inc., Whitehouse Station, New Jersey), which was licensed in the United States in 1995 for use among healthy children aged > or = 12 months, adolescents, and adults; and 2) a combination measles, mumps, rubella, and varicella vaccine (ProQuad, Merck & Co., Inc., Whitehouse Station, New Jersey), which was licensed in the United States in 2005 for use among healthy children aged 12 months-12 years. Initial Advisory Committee on Immunization Practices (ACIP) recommendations for prevention of varicella issued in 1995 (CDC. Prevention of varicella: recommendations of the Advisory Committee on Immunization Practices [ACIP]. MMWR 1996;45 [No. RR-11]) included routine vaccination of children aged 12-18 months, catch-up vaccination of susceptible children aged 19 months-12 years, and vaccination of susceptible persons who have close contact with persons at high risk for serious complications (e.g., health-care personnel and family contacts of immunocompromised persons). One dose of vaccine was recommended for children aged 12 months-12 years and 2 doses, 4-8 weeks apart, for persons aged > or = 13 years. In 1999, ACIP updated the recommendations (CDC. Prevention of varicella: updated recommendations of the Advisory Committee on Immunization Practices [ACIP]. MMWR 1999;48 [No. RR-6]) to include establishing child care and school entry requirements, use of the vaccine following exposure and for outbreak control, use of the vaccine for certain children infected with human immunodeficiency virus, and vaccination of adolescents and adults at high risk for exposure or transmission. In June 2005 and June 2006, ACIP adopted new recommendations regarding the use of live, attenuated varicella vaccines for prevention of varicella. This report revises, updates, and replaces the 1996 and 1999 ACIP statements for prevention of varicella. The new recommendations include 1) implementation of a routine 2-dose varicella vaccination program for children, with the first dose administered at age 12-15 months and the second dose at age 4-6 years; 2) a second dose catch-up varicella vaccination for children, adolescents, and adults who previously had received 1 dose; 3) routine vaccination of all healthy persons aged > or = 13 years without evidence of immunity; 4) prenatal assessment and postpartum vaccination; 5) expanding the use of the varicella vaccine for HIV-infected children with age-specific CD4+ T lymphocyte percentages of 15%-24% and adolescents and adults with CD4+ T lymphocyte counts > or = 200 cells/microL; and 6) establishing middle school, high school, and college entry vaccination requirements. ACIP also approved criteria for evidence of immunity to varicella. PMID: 17585291 [PubMed - indexed for MEDLINE] 615. J Virol. 2007 Sep;81(17):9024-33. Epub 2007 Jun 20. Genetic analysis of varicella-zoster virus ORF0 to ORF4 by use of a novel luciferase bacterial artificial chromosome system. Zhang Z, Rowe J, Wang W, Sommer M, Arvin A, Moffat J, Zhu H. Department of Microbiology and Molecular Genetics, UMDNJ-New Jersey Medical School, 225 Warren Street, Newark, NJ 07101-1709, USA. To efficiently generate varicella-zoster virus (VZV) mutants, we inserted a bacterial artificial chromosome (BAC) vector in the pOka genome. We showed that the recombinant VZV (VZV(BAC)) strain was produced efficiently from the BAC DNA and behaved indistinguishably from wild-type virus. Moreover, VZV's cell-associated nature makes characterizing VZV mutant growth kinetics difficult, especially when attempts are made to monitor viral replication in vivo. To overcome this problem, we then created a VZV strain carrying the luciferase gene (VZV(Luc)). This virus grew like the wild-type virus, and the resulting luciferase activity could be quantified both in vitro and in vivo. Using PCR-based mutagenesis, open reading frames (ORF) 0 to 4 were individually deleted from VZV(Luc) genomes. The deletion mutant viruses appeared after transfection into MeWo cells, except for ORF4, which was essential. Growth curve analysis using MeWo cells and SCID-hu mice indicated that ORF1, ORF2, and ORF3 were dispensable for VZV replication both in vitro and in vivo. Interestingly, the ORF0 deletion virus showed severely retarded growth both in vitro and in vivo. The growth defects of the ORF0 and ORF4 mutants could be fully rescued by introducing wild-type copies of these genes back into their native genome loci. This work has validated and justified the use of the novel luciferase VZV BAC system to efficiently generate recombinant VZV variants and ease subsequent viral growth kinetic analysis both in vitro and in vivo. PMCID: PMC1951468 PMID: 17581997 [PubMed - indexed for MEDLINE] 616. Clin Pediatr (Phila). 2007 Sep;46(7):646-9. Epub 2007 Jun 19. Herpes zoster in an infant. Dent AE, Baetz-Greenwalt BA. Rainbow Babies and Children's Hospital, Department of Pediatrics, Division of Pediatric Infectious Diseases and Rheumatology, Cleveland, Ohio 44106, USA. arlene.dent@case.edu PMID: 17579095 [PubMed - indexed for MEDLINE] 617. Acta Paediatr. 2007 Jul;96(7):1099-100. Consequences of varicella in pregnancy: a report of four cases. Narkeviciute I. Clinic of Children's Diseases of Vilnius University, Vilnius, Lithuania. irena.narkeviciute@vuvl.lt Four infants are reported with varicella-Zoster virus (VZV) infection, whose mothers had varicella during the second-third trimester of pregnancy. Two newborns had neonatal varicella. One of them, whose mother contracted varicella 5 days before delivery, had a severe and complicated form of the disease. The infants who had herpes zoster did not have specific VZV-IgG antibodies at the onset of the disease. CONCLUSION: These cases showed that varicella during the second-third trimester of pregnancy may have serious consequence for infants. PMID: 17577346 [PubMed - indexed for MEDLINE] 618. Clin J Pain. 2007 Jul-Aug;23(6):490-6. The impact of acute herpes zoster pain and discomfort on functional status and quality of life in older adults. Schmader KE, Sloane R, Pieper C, Coplan PM, Nikas A, Saddier P, Chan IS, Choo P, Levin MJ, Johnson G, Williams HM, Oxman MN. Duke University, Durham, NC, USA. schma001@mc.duke.edu OBJECTIVES: To describe the interference of herpes zoster (HZ) pain and discomfort with activities of daily living (ADLs) and health-related quality of life (HRQL) during the acute rash phase, and to quantify the relationship between acute HZ pain and discomfort and impaired ADLs and HRQL in older persons. METHODS: Prospective, observational study of 160 HZ outpatients age > or =60 at 4 US study sites who completed the Zoster Brief Pain Inventory (ZBPI), Zoster Impact Questionnaire (ZIQ), McGill Pain Questionnaire, EuroQol, and SF-12 questionnaires on a predetermined schedule. Patients rated interference on a 0 to 10 scale for ADL items in the ZBPI and the ZIQ. Interference scores were averaged to create summary measures for the ZBPI items (ZBPI ADLI) and ZIQ items (ZIQ ADLI). A composite pain score was used in mixed-effects models analyses of the association between pain and discomfort and ADLI and HRQL measures during the first 35 days after HZ rash onset. RESULTS: HZ pain interfered with all ADLs but interference was greatest for enjoyment of life, sleep, general activity, leisure activities, getting out of the house, and shopping. For every 1.0 point increase in pain and discomfort intensity, there was a 0.69 and 0.53 point increase in ZBPI and ZIQ interference, respectively, and a 2.81 point, 1.57 point, and 1.95 point decrease in EuroQol, SF-12 physical, and SF-12 mental scales, respectively. DISCUSSION: Acute zoster pain and discomfort has a significant negative impact on functional status and HRQL in older adults. The magnitude of interference increases with increasing pain and discomfort intensity. PMID: 17575488 [PubMed - indexed for MEDLINE] 619. BMC Infect Dis. 2007 Jun 15;7:59. Varicella and herpes zoster in Madrid, based on the Sentinel General Practitioner Network: 1997-2004. Pérez-Farinós N, Ordobás M, García-Fernández C, García-Comas L, Cañellas S, Rodero I, Gutiérrez-Rodríguez A, García-Gutiérrez J, Ramírez R. Department of Epidemiology, Madrid Public Health Institute, Julián Camarillo 4B, Madrid, Spain. napoleon.perez@salud.madrid.org BACKGROUND: Varicella (chickenpox) is the primary disease caused by varicella-zoster virus. It is extremely contagious and is frequent in children. Indeed, in the absence of vaccination, a high proportion of the population is liable to contract it. Herpes zoster -more frequent among adults- is caused by reactivation of the latent virus. The objective of this study is to describe the status of and time trend for varicella and herpes zoster in the Madrid Autonomous Region prior to the introduction of the vaccine to the general population. METHODS: Data source: individualised varicella and herpes zoster case records kept by the Madrid Autonomous Region Sentinel General Practitioner Network for the period 1997-2004. Cumulative incidences, crude and standardised incidence rates, and age-specific rates of varicella and herpes zoster were calculated for each year. Kendall's Tau-b correlation coefficient was calculated to evaluate whether incidence displayed a time trend. Spectral density in the time series of weekly incidences was estimated using a periodogram. RESULTS: Standardised annual varicella incidence rates ranged from 742.5 (95% CI: 687.2-797.7) to 1239.6 (95% CI: 1164.5-1313.4) cases per 100 000 person-years. Most cases affected children, though complications were more frequent in adults. Varicella incidence displayed an annual periodicity but no trend over time. Most herpes zoster cases occurred at advanced ages, with incidence registering a rising annual trend but no seasonality factor. CONCLUSION: In the absence of vaccination, no significant changes in varicella incidence were in evidence recent years, though these were observed in the incidence of herpes zoster. Sentinel general practitioner networks are a valid instrument for surveillance of diseases such as varicella. Further varicella vaccination-coverage and vaccine-efficacy studies are called for. PMCID: PMC1913920 PMID: 17570859 [PubMed - indexed for MEDLINE] 620. Rev Soc Bras Med Trop. 2007 Mar-Apr;40(2):234-5. Abdominal wall protrusion following herpes zoster. Ruiz Junior FB, Shinosaki JS, Marques Junior W, Ferreira MS. Serviço de Neurologia, Hospital das Clínicas, Universidade Federal de Uberlândia, Uberlândia, MG. facundo_burgos@uol.com.br We present the case of a 62-year-old woman with abdominal segmental paresis consequent to radiculopathy caused by zoster, which was confirmed by electroneuromyography. The paresis resolved completely within three months. Recognition of this complication caused by zoster, which is easily misdiagnosed as abdominal herniation, is important for diagnosing this self-limited condition and avoiding unnecessary procedures. PMID: 17568896 [PubMed - indexed for MEDLINE] 621. Swiss Med Wkly. 2007 May 5;137(17-18):239-51. Swiss recommendations for the management of varicella zoster virus infections. Kempf W, Meylan P, Gerber S, Aebi C, Agosti R, Büchner S, Coradi B, Garweg J, Hirsch H, Kind C, Lauper U, Lautenschlager S, Reusser P, Ruef C, Wunderli W, Nadal D. Dermatologische Klinik, Universitätsspital Zürich, CH-8091 Zürich, Switzerland. kempf@derm.unizh.ch Infections with varicella zoster virus (VZV) are common viral infections associated with significant morbidity. Diagnosis and management are complex, particularly in immunocompromised patients and during pregnancy. The present recommendations have been established by a multidisciplinary panel of specialists and endorsed by numerous Swiss medical societies involved in the medical care of such patients (Appendix). The aim was to improve the care of affected patients and to reduce complications. PMID: 17557214 [PubMed - indexed for MEDLINE] 622. Nurse Pract. 2007 Jun;32(6):6-7. Prevent shingles with Zostavax. Laustsen G, Neilson T. Oregon Health and Science University, School of Nursing, La Grande, OR, USA. PMID: 17557014 [PubMed - indexed for MEDLINE] 623. BMJ. 2007 Jun 9;334(7605):1211-5. Herpes zoster. Wareham DW, Breuer J. Centre for Infectious Disease, Institute of Cell and Molecular Science, Barts and the London, Queen Mary's School of Medicine and Dentistry. d.w.wareham@qmul.ac.uk PMID: 17556477 [PubMed - indexed for MEDLINE] 624. J Clin Virol. 2007 Jul;39(3):238-9. Epub 2007 Jun 6. Correlates of acute pain in herpes zoster. Opstelten W, van Loon AM, van Wijck AJ, Moons KG. Comment on: J Clin Virol. 2007 Apr;38(4):275-9. PMID: 17556015 [PubMed - indexed for MEDLINE] 625. Ophthalmologe. 2008 May;105(5):480-4. [Scleromalacia associated with varicella-zoster virus] [Article in German] Yoeruek E, Deuter CM, Szurman P, Tatar O, Zierhut M. Abteilung I, Universitätsaugenklinik der Eberhard-Karls-Universität Tübingen, Schleichstrasse 12, 72076 Tübingen. Efdal.Yoeruek@med.uni-tuebingen.de BACKGROUND: Scleromalacia usually appears following vasculitis in systemic rheumatoid diseases, especially as a late symptom of rheumatoid arthritis. CASE REPORT: A 67-year-old woman was referred to our hospital for further evaluation with the diagnosis of a "fast-growing tumor" of the left eye. Sixteen months ago she had suffered from herpes zoster ophthalmicus-associated keratouveitis and trabeculitis in the same eye. Scleromalacia associated with varicella-zoster virus (VZV) was diagnosed after the biomicroscopic and gonioscopic examination of the eye was completed and a systemic disease had been ruled out. One week after beginning systemic application of acyclovir (5 x 800 mg daily) and prednisolone (30 mg daily), the anterior chamber inflammation regressed and a fibrosis seemed to appear in the atrophic scleral area. CONCLUSION: Although scleral atrophy mostly appears as a late sign of systemic rheumatoid diseases, it might also develop secondary to infectious diseases. Scleromalacia associated with varicella-zoster virus has been previously described only in a few cases. Scleromalacia is a vision-threatening complication of zoster ophthalmicus which responds well to combination therapy with systemic antiviral and anti-inflammatory agents. PMID: 17549494 [PubMed - indexed for MEDLINE] 626. Otolaryngol Head Neck Surg. 2007 Jun;136(6):1027. Hutchinson sign and herpes zoster. Opstelten W, Zaal MJ. Comment on: Otolaryngol Head Neck Surg. 2007 Feb;136(2):313-4. PMID: 17548004 [PubMed - indexed for MEDLINE] 627. J Vestib Res. 2006;16(4-5):217-22. The lesion site of vestibular dysfunction in Ramsay Hunt syndrome: a study by click and galvanic VEMP. Ozeki H, Iwasaki S, Ushio M, Takeuchi N, Murofushi T. Department of Otolaryngology and Head and Neck Surgery, University of Tokyo, Tokyo, Japan. Ramsay Hunt syndrome (RHS) is characterized by vestibulocochlear dysfunction in addition to facial paralysis and auricular vesicles. The present study investigated the lesion site of vestibular dysfunction in a group of 10 RHS patients. Caloric testing, vestibular evoked myogenic potentials by click sound (cVEMP) and by galvanic stimulation (gVEMP) were used to assess the function of the lateral semicircular canal, saccule, and their afferents. The results of caloric testing (all 10 cases showed canal paresis) mean the existence of lesion sites in lateral semicircular canal and/or superior vestibular nerve (SVN). Abnormal cVEMPs in 7 patients mean the existence of lesions in saccule and/or inferior vestibular nerve (IVN). Four of the 6 patients with absent cVEMP also underwent gVEMP. The results of gVEMP (2 absent and 2 normal) mean that the former 2 have lesions of the vestibular nerve, and the latter 2 have only saccular lesions concerning the pathway of VEMPs. Thus, our study suggested that lesion sites of vestibular symptoms in RHS could be in the vestibular nerve and/or labyrinth, and in SVN and/or IVN. In other words, in the light of vestibular symptoms, there is the diversity of lesion sites. PMID: 17538211 [PubMed - indexed for MEDLINE] 628. Acta Paediatr. 2007 Jun;96(6):794-5. General vaccination of children against varicella?--Yes! Trollfors B. Birger East Hospital, Göteborg 41685, Sweden. birger.trollfors@vgregion.se Comment on: Acta Paediatr. 2007 Jun;96(6):861-3. PMID: 17537004 [PubMed - indexed for MEDLINE] 629. Community Pract. 2007 May;80(5):9. Shingles. Wyndham M. PMID: 17536461 [PubMed - indexed for MEDLINE] 630. Eur J Epidemiol. 2007;22(6):405-9. Epub 2007 May 30. Seroprevalence of varicella antibodies among pregnant women in Lyon-France. Saadatian-Elahi M, Mekki Y, Del Signore C, Lina B, Derrough T, Caulin E, Thierry J, Vanhems P. Laboratoire d'Epidémiologie et de Santé Publique, Université de Lyon, F-69003, Lyon, France. The purpose of the study was to calculate the seroprevalence of immunity to the varicella-zoster virus (VZV) infection and to evaluate the positive predictive value (PPV) and the negative predictive value (NPV) of the self-reported history of VZV infection in pregnant women. A cross sectional study was conducted in 18 private medical analysis laboratories. Information on socio-demographic characteristics and past history of varicella or zoster were collected using a questionnaire. Blood samples were obtained to determine the serological levels of past exposure to VZV. Overall, 486 pregnant women were recruited. The seroprevalence of VZV antibodies was 98.8%. Six women were seronegative, of whom four were primiparous. The PPV was high (99.5%) while the NPV was only 10.3%. The PPV is a reliable marker of prior VZV infection. In contrast, a negative history does not predict lack of immunity and should be completed by serological analysis which might be introduced to routine antenatal blood tests. PMID: 17534728 [PubMed - indexed for MEDLINE] 631. Sex Health. 2007 Jun;4(2):141-2. Famciclovir or valaciclovir in the management of herpes simplex and varicella zoster infections: an attitudinal survey of clinician perceptions of differential activity. Smith DE, Gold J. PMID: 17524295 [PubMed - indexed for MEDLINE] 632. Am J Dermatopathol. 2007 Jun;29(3):303-5. Zosteriform connective tissue nevus: a case report. Amjadi M, Khorrami-Arani N, Mashman G, Allen PW. School of Medicine, Flinders University of South Australia, South Australia, Australia. amja0002@flinders.edu.au Zosteriform connective tissue nevus is a rare form of connective tissue hamartomas, which arises from cells of mesodermal origin. Despite similar clinical appearance of many connective tissue nevi, they can be differentiated histochemically and/or biochemically on the basis of the primary connective tissue element present. There are only 3 reported cases of zosteriform connective tissue nevi in the worldwide literature. We report a case occurring in a 25-year-old male with approximately 40 nodules and smaller papules distributed in a zosteriform fashion on the right lower lumbar region and upper gluteal region. The identification of the lesion by deep biopsy excluded the important differential diagnosis of segmental neurofibromatosis. PMID: 17519633 [PubMed - indexed for MEDLINE] 633. J Med Virol. 2007 Jul;79(7):1025-31. Different genotype pattern of varicella-zoster virus obtained from patients with varicella and zoster in Germany. Sauerbrei A, Wutzler P. Institute of Virology and Antiviral Therapy, Friedrich-Schiller University of Jena, Jena, Germany. Andreas.Sauerbrei@med.uni-jena.de The general use of the varicella vaccine requires the surveillance of varicella-zoster virus (VZV) strains in patients infected with VZV. This paper reports the data achieved from a prospective study of genotyping VZV in Germany, analyzing the restriction fragment length polymorphism (RFLP) of the open reading frames (ORF) 38, 54, and 62 as well as the polymorphism of the R5 repeat region. The study included 177 patients with varicella. Seventy-eight patients with zoster served as controls. Results revealed that 78% of VZV strains in patients with varicella had the genetic profile of the dominant wild-genotype occurring in Europe and 22% had the markers of African or Asian strains. Varicella patients with the profile of African or Asian strains were significantly younger than patients with varicella caused by the dominant genotype. By contrast, all zoster patients exhibited strains representing the majority of wild-type strains in Europe. In conclusion, VZV strains from patients with varicella have a significantly higher genetic variability than viral strains from zoster patients. Since variants with the markers of African or Asian strains could only be found in young children with chickenpox, the results suggest a changing scene of VZV genotypes in Germany. As reasons, the spread of viruses, which may be imported originally by persons immigrating from warmer climates, or the recombination between wild-and vaccine-type viruses have to be considered. PMID: 17516537 [PubMed - indexed for MEDLINE] 634. Pract Neurol. 2007 Jun;7(3):182-5. Some syndromes of James Ramsay Hunt. Pearce JM. Emeritus Department of Neurology, Hull Royal Infirmary, Hull, UK. jmsp@freenet.co.uk PMID: 17515597 [PubMed - indexed for MEDLINE] 635. Blood. 2007 Oct 15;110(8):3071-7. Epub 2007 May 21. One-year acyclovir prophylaxis for preventing varicella-zoster virus disease after hematopoietic cell transplantation: no evidence of rebound varicella-zoster virus disease after drug discontinuation. Erard V, Guthrie KA, Varley C, Heugel J, Wald A, Flowers ME, Corey L, Boeckh M. Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, WA 98109-1024, USA. No consensus exists on whether acyclovir prophylaxis should be given for varicella-zoster virus (VZV) prophylaxis after hematopoietic cell transplantation because of the concern of "rebound" VZV disease after discontinuation of prophylaxis. To determine whether rebound VZV disease is an important clinical problem and whether prolonging prophylaxis beyond 1 year is beneficial, we examined 3 sequential cohorts receiving acyclovir from day of transplantation until engraftment for prevention of herpes simplex virus reactivation (n = 932); acyclovir or valacyclovir 1 year (n = 1117); or acyclovir/valacyclovir for at least 1 year or longer if patients remained on immunosuppressive drugs (n = 586). In multivariable statistical models, prophylaxis given for 1 year significantly reduced VZV disease (P < .001) without evidence of rebound VZV disease. Continuation of prophylaxis beyond 1 year in allogeneic recipients who remained on immunosuppressive drugs led to a further reduction in VZV disease (P = .01) but VZV disease developed in 6.1% during the second year while receiving this strategy. In conclusion, acyclovir/valacyclovir prophylaxis given for 1 year led to a persistent benefit after drug discontinuation and no evidence of a rebound effect. To effectively prevent VZV disease in long-term hematopoietic cell transplantation survivors, additional approaches such as vaccination will probably be required. PMID: 17515400 [PubMed - indexed for MEDLINE] 636. J Cutan Med Surg. 2007 May-Jun;11(3):89-98. Open-label study of valacyclovir 1.5 g twice daily for the treatment of uncomplicated herpes zoster in immunocompetent patients 18 years of age or older. Madkan VK, Arora A, Babb-Tarbox M, Aboutlabeti S, Tyring S. Department of Dermatology, University of Texas School of Medicine, Center for Clinical Studies, Houston, TX 77030, USA. BACKGROUND: Herpes zoster (shingles) is a common disease caused by a reactivation of the latent varicella-zoster virus (chickenpox), which resides in the dorsal root ganglia. Valacyclovir HCl, the L-valyl ester of acyclovir, is an antiviral drug that is used to accelerate the resolution of the herpes zoster rash and associated pain and reduce the duration of postherpetic neuralgia. OBJECTIVE: To demonstrate the safety and efficacy of oral valacyclovir 1.5 g twice daily (bid) for the treatment of uncomplicated herpes zoster in immunocompetent patients over 18 years of age. The dosing schedule of bid versus three times daily is desirable for enhancing patient compliance and to subsequently reduce the incidence of viral resistance. METHODS: One treatment group of 125 patients was administered oral valacyclovir 1.5 g bid for 7 days. Administration of the first dose occurred within 72 hours after onset of rash. Patients were seen and assessed for cutaneous healing, zoster-associated pain (ZAP), and/or zoster-associated abnormal sensations (ZAAS). Patients under 50 years of age were followed for 4 weeks and patients 50 years of age and older were followed for a total of 24 weeks. Patients >or= 50 years were also asked to record a daily diary on pain and abnormal sensations throughout the 24-week study period. Responses to resource use and quality of life questions were also collected. Safety was monitored by means of routine hematologic and biochemical assessments and reporting of adverse experiences. RESULTS: Data from this study were compared with historical control groups both for three times daily antiviral therapy and for placebo. The results showed that twice-daily dosing was as safe and effective as three times daily dosing for the reduction of ZAP and ZAAS. Adverse-effect profiles were similar between the two different regimens, and both treatment groups showed better outcomes than the historical placebo group. Because it is standard of care to administer antivirals for the treatment of acute herpes zoster, a placebo-controlled trial is not possible, necessitating the use of historical controls. CONCLUSION: Oral valacyclovir 1.5 g bid is safe and effective for the treatment of uncomplicated herpes zoster in immunocompetent patients over 18 years of age. Twice-daily dosing may help increase patient compliance and therefore increase the effectiveness of treatment of the acute herpes zoster rash and the prevention of ZAP. PMID: 17511925 [PubMed - indexed for MEDLINE] 637. Rinsho Shinkeigaku. 2007 Feb-Mar;47(2-3):105-8. [Case of Horner's syndrome associated with ophthalmic herpes zoster] [Article in Japanese] Kobayashi Y, Yamamoto T. Department of Rehabilitation, Fukui General Hospital. We reported a 74-year-old man with right Horner's syndrome associated with ophthalmic herpes zoster. He presented acute onset of pain, swelling, vesicular cutaneous eruption around the right eyelid. A diagnosis of herpes zoster ophthalmicus was made and he was started on acyclovir 750 mg/day. Seven days later he manifested right abduction deficit On admission nine days later, the right eyelid became ptotic and the right pupil was smaller than the left There was gradual improvement over the next 10 days in ptosis and miosis, and over the next 3 weeks in the right abduction deficit. As the sympathetic nerve runs with the carotid artery, it partially joins the sixth nerve within the cavernous sinus. We have identified a patient in whom herpes zoster ophthalmicus has resulted in a syndrome involving the sympathetic nerves, the sixth nerve, and the first division of the fifth cranial nerve. As the Horner's syndrome was transient, we might miss the symptom in the early stage, so we should carefully examine the patients. PMID: 17511278 [PubMed - indexed for MEDLINE] 638. Minerva Ginecol. 2007 Apr;59(2):159-74. Viral infections in pregnancy. Haun L, Kwan N, Hollier LM. Division of Maternal-Fetal Medicine, Department of Obstetrics, University of Texas-Houston Medical School, Lyndon Baines Johnson General Hospital, 5656 Kelley Street, Houston, TX 77026, USA. Viral infections are a common complication of pregnancy and in some cases, can have profound effects for the unborn fetus. The human herpesvirus family is composed of large, enveloped DNA viruses that have close structural similarity. The family includes the herpes simplex viruses types 1 and 2, varicella zoster virus, Epstein Barr virus, cytomegalovirus (CMV), and human herpes viruses types 6, 7 and 8. These viruses all share the ability to establish latency and reactivate at a later time. Structural fetal abnormalities can result from intrauterine infection and transmission of the infection during the pregnancy or at the time of delivery can result in important neonatal disease. Human parvovirus B19 is a DNA virus with strong tropism for erythroid precursors and infection during pregnancy can result in fetal hydrops and stillbirth. The causative agents of hepatitis are hepatotropic viruses termed hepatitis A, B, C, D (deltavirus) and E. All except hepatitis B virus are RNA viruses. Vertical transmission of maternal infection with hepatitis B and C can result in significant long term sequelae. PMID: 17505458 [PubMed - indexed for MEDLINE] 639. Br J Ophthalmol. 2007 Nov;91(11):1452-5. Epub 2007 May 15. Acute retinal necrosis: a national population-based study to assess the incidence, methods of diagnosis, treatment strategies and outcomes in the UK. Muthiah MN, Michaelides M, Child CS, Mitchell SM. The Western Eye Hospital, Marylebone Road, London NW1 5YE, UK. AIM: To determine the incidence, methods of diagnosis, treatment strategies and outcomes for acute retinal necrosis (ARN) in the UK. METHODS: A 12-month active case ascertainment study was carried out between March 2001 and March 2002 to record cases of ARN presenting to ophthalmologists via the British Ophthalmological Surveillance Unit (BOSU) reporting system. Questionnaires were sent to the reporting consultants, requesting data on patient characteristics, presentation, clinical findings, investigations and treatment. Diagnosis was made using the American Uveitis Society diagnostic criteria. Further questionnaires were sent at 2 weeks and 6 months to assess outcome and therapies. RESULTS: 74 cases of ARN were reported by 58 consultants between March 2001 and March 2002. Questionnaires were returned for 49 cases (66.2%), of which 18 (36.7%) were excluded. Of the 31 cases included, 22 (71.0%) were male and 9 (29.0%) were female. The age range was 13 to 85 years (mean 54.3 years). 28 cases (90.3%) were unilateral, with 3 patients (9.7%) presenting with bilateral ARN. An aqueous or vitreous biopsy was performed in only 18 patients, with one patient having both. Herpes viral DNA analysis was performed on all 19 biopsies, with identification of the viral DNA in 16; results from 3 biopsies were not documented. Varicella zoster virus (VZV) was the commonest cause identified in 10 patients (56%). Of the 31 subjects, 27 (87.1%) were treated for ARN with systemic antiviral treatment: with intravenous antiviral in 23 cases (85.2%) and oral antiviral in 4 cases (14.8%). 21 of these patients went on to receive oral antiviral maintenance therapy. In addition to antiviral treatment, systemic steroids were given to 16 subjects (51.6%). Surgical intervention for retinal detachment was performed on 5 patients. CONCLUSIONS: During the 12-month study period, 31 cases of ARN met the diagnostic criteria set by the American Uveitis Society. The incidence in the UK based on this study is approximately 1 case per 1.6 to 2.0 million population per year. We have ascertained that the management of ARN throughout the UK is variable, suggesting that national guidelines would be of benefit. PMID: 17504853 [PubMed - indexed for MEDLINE] 640. Headache. 2007 May;47(5):728-30. Sympathetic nerve blocks in mandibular herpes zoster and postherpetic neuralgia. Gomes RT, de Nazareth Pedras RB, da Silva JF, de Aguiar MC. Pain Clinic, Hospital das Clínicas Federal, University of Minas Gerais, Belo Horizonte, MG, Brazil. Sympathetic blocks have been indicated for the diagnosis and treatment of painful neuropathic conditions, such as herpes zoster (HZ) and postherpetic neuralgia (PHN). The purpose of this article is to report a case of mandibular HZ and PHN in an HIV-positive patient, and discuss the efficacy of sympathetic nerve blocks for pain relief and prevention of PHN. PMID: 17501858 [PubMed - indexed for MEDLINE] 641. Dermatol Online J. 2007 May 1;13(2):2. Why do so many clinicians believe that recurrent zoster is common? Chien AJ, Olerud JE. The University of Washington Department of Medicine, Division of Dermatology, Seattle, USA. andchien@u.washington.edu PMID: 17498421 [PubMed - indexed for MEDLINE] 642. Nippon Rinsho. 2007 Mar 28;65 Suppl 3:326-30. [Varicella-zoster virus infection] [Article in Japanese] Suzuki K, Suga S, Asano Y. Department of Pediatrics, Toyokawa City Hospital. PMID: 17494161 [PubMed - indexed for MEDLINE] 643. Wien Klin Wochenschr. 2007;119(7-8):217. Hemorrhagic herpes zoster. Steininger C, Huber J, Hauswirth A. Department of Medicine I, Medical University Vienna, Vienna, Austria. christoph.steininger@meduniwien.ac.at PMID: 17492347 [PubMed - indexed for MEDLINE] 644. J Am Osteopath Assoc. 2007 Mar;107(3 Suppl 1):S8-S13. Management strategies for herpes zoster and postherpetic neuralgia. Galluzzi KE. Philadelphia College of Osteopathic Medicine, 4190 City Avenue, Philadelphia, PA 19131-1633, USA. katherineg@pcom.edu Evidence-based strategies for the management of herpes zoster and postherpetic neuralgia (PHN) include the use of antiviral agents in acute zoster and specific analgesics in PHN. Antiviral agents are effective in reducing the severity and duration of acute herpes zoster when given within 72 hours of rash onset, but they do not prevent PHN. Anticonvulsants, tricyclic antidepressants, opioids, and topical treatment modalities such as lidocaine-containing patches and capsaicin cream offer moderate pain relief to some patients with PHN, but they may be associated with adverse events that limit their use. Therefore, prevention of herpes zoster and PHN with prophylactic vaccination using the zoster virus vaccine is an effective strategy to reduce the morbidity of these conditions. Treatment modalities are available, however, that may shorten the duration of acute herpes zoster and alleviate the pain of PHN. PMID: 17488885 [PubMed - indexed for MEDLINE] 645. J Am Osteopath Assoc. 2007 Mar;107(3 Suppl 1):S2-7. The burden of herpes zoster and postherpetic neuralgia in the United States. Weaver BA. Armor Correctional Health Services, Hillsborough County Jail Medical Clinic, 520 Falkenburg Road, Tampa, FL 33619, USA. bethanyg@myuw.net Herpes zoster (shingles), a painful and disabling disease, affects an estimated 1 million individuals in the United States annually and results in significant morbidity, lost productivity, and diminished quality of life. Herpes zoster constitutes the reactivation of varicella-zoster virus (VZV), the same virus that causes chickenpox. After resolution of chickenpox, VZV remains dormant in dorsal root ganglia. Varicella-zoster-specific cell-mediated immunity wanes naturally with advancing age or earlier in the setting of an altered immune status, which can result in the reactivation of VZV as herpes zoster. The pain associated with the rash caused by herpes zoster is often described as burning, stabbing, itching, or aching. Postherpetic neuralgia, the most common complication of herpes zoster, occurs after the zoster rash has resolved, affecting up to a third of patients. Herpes zoster is associated with significant morbidity, especially in the elderly. Herpes zoster is both more common and more severe among older adults. In both acute herpes zoster and postherpetic neuralgia, pain is the primary cause of morbidity. PMID: 17488884 [PubMed - indexed for MEDLINE] 646. J Am Osteopath Assoc. 2007 Mar;107(3 Suppl 1):S14-8. Herpes zoster vaccine: clinical trial evidence and implications for medical practice. Burke MS. Internal Medicine Clinical Care Center, Lankenau Hospital, 100 Lancaster Avenue, Area B15, Wynnewood, PA 19096-3450, USA. burkes@mlhs.org This review of the data from the Shingles Prevention Study (SPS) highlights the efficacy and safety of a high-titer live attenuated herpes zoster virus vaccine in preventing herpes zoster and postherpetic neuralgia (PHN) in adults aged 60 years or older. In the SPS, the vaccine reduced the burden of illness due to herpes zoster disease by 61.1% and the incidence of its most common and debilitating sequela, PHN, by 66.5%. In addition, vaccination was associated with a 51.3% reduction in the overall incidence of herpes zoster. Also, subjects in whom herpes zoster did develop had decreased pain and discomfort. The vaccine was safe in the SPS population, with little differentiation from the safety profile of placebo other than an increased risk for reactions at the injection site. Rates of serious adverse events, systemic adverse events, hospitalization, and death were low and similar to those observed in the group that received placebo. PMID: 17488883 [PubMed - indexed for MEDLINE] 647. JAAPA. 2007 Apr;20(4):16. New drug information. Product: Zostavax. [No authors listed] PMID: 17484325 [PubMed - indexed for MEDLINE] 648. Int J Hematol. 2007 Apr;85(3):242-5. Quantification of circulating varicella-zoster virus DNA for follow-up in a case of visceral varicella-zoster infection ameliorated with intravenous acyclovir. Ishizawa J, Fujita H, Iguchi M, Tachibana T, Taguchi J, Ishigatsubo Y. Department of Hematology, Shizuoka Red Cross Hospital, Shizuoka, Japan. We describe a patient with acute lymphocytic leukemia (ALL) who developed visceral varicella-zoster virus (VZV) infection following cord blood stem cell transplantation (CBSCT) and was successfully treated with intravenous acyclovir (ACV). A 24-year-old woman with ALL developed severe epigastric pain 168 days after CBSCT, followed by blistering eruptions 2 days later. A diagnosis of visceral varicella-zoster disease was made, and early intravenous ACV therapy successfully alleviated the epigastric pain and skin lesions within 2 weeks. Polymerase chain reaction analysis of the serum showed dramatic decreases in the viral DNA copy number and revealed large viral concentrations prior to the skin manifestations. The viral DNA copy number in whole blood remained positive, however, but was reduced. Further treatment with intravenous ACV led to VZV DNA becoming undetectable in whole blood, a result not achieved with oral valacyclovir. PMID: 17483062 [PubMed - indexed for MEDLINE] 649. Int J Dermatol. 2007 May;46(5):500-2. Localized linear IgA dermatosis induced by UV light-treatment for herpes zoster. He C, Xu H, Xiao T, Geng L, Chen HD. Department of Dermatology, No. 1 Hospital of China Medical University, Shenyang, China. Comment in: Int J Dermatol. 2008 Oct;47(10):1087. We report a case of localized linear IgA dermatosis (LID). The patient suffered from herpes zoster on the right waist and received three localized ultraviolet (UV) light treatments. One month later he presented with bullae on the same site. Direct immunofluorescence showed deposition of linear IgA and weak C3 along the basement membrane zone. Indirect immunofluorescence on the salt-split human skin demonstrated that IgA antibodies were bound to the epidermal side. To our knowledge, this is the first case of localized LID induced by UV light treatment for herpes zoster. It is also the third case of LID induced by UV light. PMID: 17472682 [PubMed - indexed for MEDLINE] 650. Holist Nurs Pract. 2007 May-Jun;21(3):124-34. Postherpetic neuralgia in older adults: culture, quality of life, and the use of alternative/complementary therapies. Young MK, Wood M, Jean-Noel N. Christine E. Lynn College of Nursing, Florida Atlantic University, 777 Glades Road, Boca Raton, FL 33431, USA. myoung@pbiho.net The purpose of this article is to describe current knowledge and standards of care for postherpetic neuralgia (PHN) among older persons. Three influencing factors are considered: cultural implications, quality of life (QOL), and current practice of alternative/complementary therapy. A review of literature published between 2001 and 2006 was conducted. The findings indicate that PHN has debilitating effects on older adults regardless of culture. The impact of PHN on culture and ethnicity, particularly on the relationship between culture and patient's self-report of herpes zoster and/or PHN, has not been well investigated as evidenced in the literature. PHN is found to be associated with decreased health-related QOL among the elderly, with the most affected domains being sleep, mood, and general activity. Alternative and complementary therapy offers many advantages such as ease of use, availability, and low cost. However, due to lack of controlled trials and insufficient evidence, alternative therapy is not currently used widely and recommended. As the US population ages, the incidence of herpes zoster and PHN is expected to rise. Clinical trials that explore the response of the culturally diverse older adults to current treatment guidelines, strategies for prevention of PHN and its corresponding decrease in QOL, as well as controlled trials of alternative/complementary remedies should be considered. PMID: 17471050 [PubMed - indexed for MEDLINE] 651. J Cataract Refract Surg. 2007 May;33(5):925-6. Spontaneous intraocular lens extrusion in a patient with scleromalacia secondary to herpes zoster ophthalmicus. Ahmed TY, Carrim ZI, Diaper CJ, Wykes WN. Department of Ophthalmology, Southern General Hospital, Glasgow, Scotland. tahaahmed@doctors.org.uk We report a case of spontaneous intraocular lens (IOL) extrusion in association with scleromalacia 10 years after uneventful endocapsular surgery. The patient had a history of iridocyclitis secondary to herpes zoster ophthalmicus in the affected eye. A minimally invasive approach involving repositioning the IOL and closure with a conjunctival flap resulted in restoration of visual acuity. PMID: 17466876 [PubMed - indexed for MEDLINE] 652. J Pediatr Gastroenterol Nutr. 2007 May;44(5):637-9. Varicella recurrence complicated by pneumonia after liver transplantation for APECED. Batra A, Davison S, Rajwal S, Hale A, Stringer MD, McClean P. Children's Liver & GI Unit, St James's University Hospital, Leeds, UK. PMID: 17460500 [PubMed - indexed for MEDLINE] 653. Korean J Ophthalmol. 2007 Mar;21(1):51-4. Progressive outer retinal necrosis combined with vitreous hemorrhage in a patient with acquired immunodeficiency syndrome. You YS, Lee SJ, Lee SH, Park CH, Kwon OW. NUNE Eye Hospital, Seoul, Korea. PURPOSE: To describe an unusual case of rapidly progressive outer retinal necrosis (PORN) with vitreous hemorrhage in a 41-year-old woman with acquired immunodeficiency syndrome (AIDS), who had retinitis developed from what was probably varicellar-zoster virus combined with cytomegalovirus (CMV) and herpes simplex type 1,2, as proven by the polymerase chain reaction restriction fragment length polymorphism method (PCR-RFLP). METHODS: This study is a case report detailing clinical follow-up and an aqueous humor test by PCR-RFLP. RESULTS: The deep, white retinal lesions coalesced and progressively expanded in a circumferential manner, with sparing of the perivascular retina. However, retinal and vitreous hemorrhages, unusual findings for PORN, could be noted around the optic nerve. Varicellar-zoster virus (VZV), cytomegalovirus (CMV), and herpes simplex types 1,2 (HSV-1,2) were detected in the aqueous humor by PCR. CONCLUSIONS: PORN has been described as a variant of necrotizing herpetic retinopathy, occurring particularly in patients with AIDS. Although the etiologic agent has been reported to be VZV, concurrent or combined etiologic agents can include HSV-1, HSV-2, and CMV in AIDS patients. Therefore, combined antiviral therapy with acyclovir and ganciclovir could be more reasonable as an initial therapy. PMCID: PMC2629688 PMID: 17460434 [PubMed - indexed for MEDLINE] 654. Nippon Rinsho. 2007 Feb 28;65 Suppl 2 Pt. 1:480-6. [Antiviral resistance of herpes simplex virus and varicella-zoster virus] [Article in Japanese] Daikoku T, Shiraki K. Department of Virology, University of Toyama. PMID: 17455667 [PubMed - indexed for MEDLINE] 655. Rev Chilena Infectol. 2007 Apr;24(2):106-10. Epub 2007 Apr 12. [Erroneous prescriptions of aciclovir and valaciclovir in herpes zoster treatment] [Article in Spanish] Fica C A, Jadue A C, Donaire R L. Sección de Infectología, Hospital Clínico, Universidad de Chile, Departamento de Medicina, Santiago, Chile. afica@redclinicauchile.cl Medical prescription errors are frequent in community settings and information exploring its magnitude during antiviral treatment of herpes zoster is scarce. A questionnaire was applied to 31 physicians working in hospital- or community-based settings in Santiago, Chile in order to characterize their dosing and timing preferences for aciclovir or valaciclovir prescriptions. Aciclovir was more often prescribed than valaciclovir (71.9 and 28.1%, respectively), but less than a third of prescription (27.3%) fulfilled the minimal aciclovir dosing and timing criteria for clinical efficacy (4 gr per day and <72 hours since rash initiation). The limited size of the simple prevented exploring factors linked to a misleading prescription. Appropriate knowledge on dosing and timing of aciclovir/valaciclovir therapy for herpes zoster was infrequent in a sample of physicians working in various clinical settings in Chile. PMID: 17453067 [PubMed - indexed for MEDLINE] 656. Pain. 2007 Sep;131(1-2):214-8. Epub 2007 Apr 23. Relief of post-herpetic neuralgia by surgical removal of painful skin: 5 years later. Petersen KL, Rowbotham MC. UCSF Pain Clinical Research Center, Department of Neurology, University of California, San Francisco, CA 94115, USA. karin.petersen@ucsf.edu Surgical removal of painful skin was first attempted as a treatment for chronic intractable post-herpetic neuralgia (PHN) more than a century ago, but long-term follow-up has rarely been reported. A patient who underwent surgical excision of 294cm(2) of thoracic skin comprising the entire area of pain and allodynia in October 2000 has been followed for 5.5years post-surgery. Our initial report presented evidence of benefit in the form of reduced pain, elimination of allodynia, and reduced medication consumption during the first post-operative year. Unfortunately, pain steadily increased and now exceeds pre-surgery levels despite increased medication use. Pain topography and characteristics are different from pre-surgery and may relate to the pathophysiology of PHN. Skin resection cannot be recommended as a treatment for PHN. PMCID: PMC2020855 PMID: 17451877 [PubMed - indexed for MEDLINE] 657. J Eur Acad Dermatol Venereol. 2007 May;21(5):712-3. Ambilateral reactivation of herpes zoster V2 following cataract operation of both eyes. Korber A, Franckson T, Grabbe S, Dissemond J. PMID: 17448008 [PubMed - indexed for MEDLINE] 658. J Eur Acad Dermatol Venereol. 2007 May;21(5):711-2. Prurigo nodularis in healed herpes zoster scar: an isotopic response. De D, Dogra S, Kanwar AJ. PMID: 17448007 [PubMed - indexed for MEDLINE] 659. J Microbiol Immunol Infect. 2007 Apr;40(2):116-22. Coinfection and clinical manifestations of tuberculosis in human immunodeficiency virus-infected and -uninfected adults at a teaching hospital, northwest Ethiopia. Kassu A, Mengistu G, Ayele B, Diro E, Mekonnen F, Ketema D, Moges F, Mesfin T, Getachew A, Ergicho B, Elias D, Aseffa A, Wondmikun Y, Ota F. Department of Microbiology and Parasitology, University of Gondar, Gondar, Ethiopia. afeworkkassu@yahoo.com BACKGROUND AND PURPOSE: The pattern of clinical presentations of tuberculosis (TB) is reflected in the microbiological, radiological, and histological characteristics of the disease. However, coinfection with human immunodeficiency virus (HIV) poses special diagnostic and therapeutic challenges. This study was aimed at assessing the clinical manifestations of TB in patients with or without HIV coinfection in a hospital-based cross-sectional study in Gondar, Ethiopia. METHODS: TB was diagnosed following standard clinical, bacteriological, radiological, and histological procedures. HIV serostatus was checked by enzyme-linked immunosorbent assay. RESULTS: This study included 257 TB patients, of whom 52.1% were coinfected with HIV. Pulmonary TB and extrapulmonary TB were diagnosed in 64.2% and 35.8% of the patients, respectively. No significant association was found between sputum smear positivity and HIV serostatus. One-fifth of the patients reported hemoptysis. More than one-third had chest pain, and >90% reported fever and weight loss. Night sweats and cough were reported by 86% and 82.5%, respectively. Coarse crepitations were the most frequent auscultatory finding (33.9%). Sputum smear positivity rate was 26.8%. Cavitation was significantly associated with sputum smear positivity (odds ratio = 9.0, 95% confidence interval = 2.4-34.1). Wasting, cough of 60 years. Outcomes included cost in 2005 US dollars and quality-adjusted life expectancy. Costs and natural history data were drawn from the published literature; vaccine efficacy was assumed to persist for 10 years. RESULTS: For the base case analysis, compared with usual care, vaccination increased quality-adjusted life expectancy by 0.0007-0.0024 quality-adjusted life years per person, depending on age at vaccination and sex. These increases came almost exclusively as a result of prevention of acute pain associated with herpes zoster and postherpetic neuralgia. Vaccination also increased costs by $94-$135 per person, compared with no vaccination. The incremental cost-effectiveness ranged from $44,000 per quality-adjusted life year saved for a 70-year-old woman to $191,000 per quality-adjusted life year saved for an 80-year-old man. For the sensitivity analysis, the decision was most sensitive to vaccine cost. At a cost of $46 per dose, vaccination cost <$50,000 per quality-adjusted life year saved for all adults >60 years of age. Other variables related to the vaccine (duration, efficacy, and adverse effects), postherpetic neuralgia (incidence, duration, and utility), herpes zoster (incidence and severity), and the discount rate all affected the cost-effectiveness ratio by >20%. CONCLUSIONS: The cost-effectiveness of the varicella zoster vaccine varies substantially with patient age and often exceeds $100,000 per quality-adjusted life year saved. Age should be considered in vaccine recommendations. PMID: 17443464 [PubMed - indexed for MEDLINE] 661. Intern Med. 2007;46(8):535-6. Epub 2007 Apr 17. Isolated trochlear nerve palsy in herpes zoster ophthalmicus. Tsuda H, Ito T, Yoshioka M, Ishihara N, Sekine Y. The Department of Internal Medicine, National Health Insurance Minamitama Hospital, Tokyo. tsuda@minamitama.jp PMID: 17443053 [PubMed - indexed for MEDLINE] 662. Br J Dermatol. 2007 Jun;156(6):1369-71. Epub 2007 Apr 17. Multiple dermatomal daughter lesions of postzoster granuloma. Araki E, Kambe N, Takahashi K, Miyachi Y, Utani A. PMID: 17441956 [PubMed - indexed for MEDLINE] 663. Br J Neurosurg. 2006 Dec;20(6):423-6. Herpes zoster of the trigeminal nerve following microvascular decompression. Simms HN, Dunn LT. Department of Neurosurgery, Institute of Neurological Science, Southern General Hospital, Glasgow, UK. A patient developed herpes zoster of the maxillary division of the trigeminal nerve after microvascular decompression. Varicella zoster virus lies dormant in the Gasserian ganglion until reactivation and can cause herpes zoster ophthalmicus. This can result in serious ocular complications including blindness. Antiviral agents are effective if commenced promptly. PMID: 17439097 [PubMed - indexed for MEDLINE] 664. Rev Med Chir Soc Med Nat Iasi. 2006 Oct-Dec;110(4):852-5. [Varicella-zoster infection--extreme clinical aspects] [Article in Romanian] Maniciuc C, Dorobaţ C, Hurmuzache M, Mihalache D, Luca V. Facultatea de Medicina, Universitatea de Medicina "Gr.T. Popa", Iaşi. Infections with the varicella-zoster (VZ) virus are a constant of our everyday practice. The aim of the present study is that of underlining unusual aspects of the infection with the VZ virus--primary infection in adults and herpes zoster in children. If varicella, or chickenpox, has been traditionally considered a childhood disease, nowadays, an increased number of adults are affected by primary infections. On the contrary, more and more children present the secondary form of the infection, which appears as herpes zoster, a disease usually diagnosed in adults. MATERIAL AND METHODS: We studied the observation papers of adult patients with varicella, hospitalized in our clinic during 2004-2005 and we analyzed the herpes zoster manifestations in non-HIV children, diagnosed with the disease during the same period of time. RESULTS: During 2004-2005, 34 adult patients were diagnosed with varicella, while 10 children presented herpes zoster. 16 of the adults with varicella were 25-34 years old. One of the children with herpes zoster was less than one year old. All the adults with varicella were treated with acyclovir; in 14 cases, the therapy was supplemented with rifampicin. All the children with herpes zoster came from rural areas. The pathology that determined the decrease of general immunity was represented by neoplasia (3 cases), malnutrition and rickets (2 cases), associated infectious pathologies--bronchopneumonia (3 cases). CONCLUSIONS: Varicella in adults has an increased incidence, which is underestimated, in our opinion. Its loud clinical manifestations impose the therapy with acyclovir. Herpes zoster in children reveals significant subsidiary pathologies and a depressed immune system that impose special medical care and many days of hospitalization. PMID: 17438887 [PubMed - indexed for MEDLINE] 665. Medicine (Baltimore). 2007 Mar;86(2):78-92. Cryptococcosis and idiopathic CD4 lymphocytopenia. Zonios DI, Falloon J, Huang CY, Chaitt D, Bennett JE. Clinical Mycology Section, Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland 20892, USA. zoniosd@niaid.nih.gov We reviewed the cases of 11 patients with cryptococcosis and idiopathic CD4 lymphocytopenia (ICL) referred to our institution in the previous 12 years, as well as 42 similar cases reported in the literature, to assess the characteristics of the infection in this population. Cryptococcosis in 53 patients with ICL had features in common with cryptococcosis in previously normal patients. ICL patients had a slight male predominance (1.2:1) and a median age of presentation of 41 years (range, 4.5-85 yr). Initial cerebrospinal fluid findings showed glucose below 40 mg/dL in 60% of the patients, a median pleocytosis of 59 white blood cells/mm (range, 0-884), and protein of 156 mg/dL (range, 25-402 mg/dL). The median CD4 count at diagnosis of ICL and at the last available measurement was 82 (range, 7-292) and 132 (range, 13-892) cells/mm, respectively, for an average follow-up of 32 months in 46 patients. Unlike previously normal patients with cryptococcosis, those with ICL had an excess incidence of dermatomal zoster (7 episodes in 46 ICL cases). Pneumocystis pneumonia was rare (1 case), casting doubt on the need for prophylaxis in patients with ICL. A favorable outcome (cured or improved) may be more common in ICL patients than in previously normal patients with cryptococcal meningitis and no predisposing factors. Identification of ICL in patients who were apparently normal before the onset of cryptococcosis appears to be useful because it predicts a favorable outcome. Patients with cryptococcal infection and ICL have an increased likelihood of developing dermatomal zoster. The long-term follow-up of these patients offers some reassurance regarding favorable prognosis. PMID: 17435588 [PubMed - indexed for MEDLINE] 666. Am J Ophthalmol. 2007 Jun;143(6):1003-1008. Epub 2007 Apr 16. Multifocal posterior necrotizing retinitis. Margolis R, Brasil OF, Lowder CY, Smith SD, Moshfeghi DM, Sears JE, Kaiser PK. Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA. PURPOSE: To describe the clinical features of an acute, inflammatory, and progressive retinal necrosis that affects primarily the posterior pole. DESIGN: Retrospective, interventional case series. METHODS: Twenty-seven eyes of 24 patients diagnosed with and treated for acute retinal necrosis (ARN) were categorized into two groups according to the predominant location of retinitis at presentation: either in the peripheral retina or in the posterior pole. Clinical features, disease progression, visual outcomes, and complications of these two groups were compared. RESULTS: Fifteen eyes demonstrated the known peripheral retinitis pattern, and 12 eyes exhibited a pattern of retinitis that affected mainly the posterior pole. Eyes with peripheral retinitis showed focal, well-demarcated areas of retinal necrosis in the periphery with rapid circumferential progression and rare involvement of the posterior pole. All eyes with posterior pole retinitis had multifocal deep lesions posterior to the vortex veins at presentation, and half of these eyes had lesions in the macula. These lesions progressed to patches of confluent retinitis in both the periphery and the posterior pole. There was no significant difference between the two groups in the incidence of anterior chamber and vitreous cells, vascular sheathing, retinal hemorrhages, or optic disk edema. Patients with posterior retinitis involvement seemed to have a worse visual outcome during the first two years after diagnosis. The Cox proportional hazards model suggested a higher incidence of retinal detachment in patients with posterior retinitis (P = .07). CONCLUSIONS: The authors report a pattern of herpetic retinitis that affects predominantly the posterior pole and may have a worse visual prognosis and a higher rate of retinal detachment. PMID: 17434436 [PubMed - indexed for MEDLINE] 667. Bioorg Med Chem Lett. 2007 Jun 15;17(12):3349-53. Epub 2007 Apr 5. 2-Aryl-2-hydroxyethylamine substituted 4-oxo-4,7-dihydrothieno[2,3-b]pyridines as broad-spectrum inhibitors of human herpesvirus polymerases. Schnute ME, Anderson DJ, Brideau RJ, Ciske FL, Collier SA, Cudahy MM, Eggen M, Genin MJ, Hopkins TA, Judge TM, Kim EJ, Knechtel ML, Nair SK, Nieman JA, Oien NL, Scott A, Tanis SP, Vaillancourt VA, Wathen MW, Wieber JL. Global Research and Development, Pfizer Inc., 700 Chesterfield Parkway West, St. Louis, MO 63017, USA. mark.e.schnute@pfizer.com A novel series of 2-aryl-2-hydroxyethylamine substituted 4-oxo-4,7-dihydrothieno[2,3-b]pyridine-5-carboxamides have been identified as potent antivirals against human herpesviruses. These compounds demonstrate broad-spectrum inhibition of the herpesvirus polymerases HCMV, HSV-1, EBV, and VZV with high specificity compared to human DNA polymerases. PMID: 17434304 [PubMed - indexed for MEDLINE] 668. Med Sci (Paris). 2007 Apr;23(4):423-7. [Preventing papillomavirus infectious and herpes zoster: new vaccines] [Article in French] Silbermann B, Launay O. CIC de vaccinologie Cochin-Pasteur, Pôle de médecine interne, Hôpital Cochin 27, rue du Faubourg Saint-Jacques, 75014 Paris, France. Two new vaccines have been recently licensed : a quadrivalent vaccine against Human papillomavirus infections (HPV) 6, 11, 16 and 18, recommended to children from 9 years old and to young adults under the age of 26 years, and a vaccine against herpes zoster for adults from 60 years old onwards. A bivalent vaccine against HPV 16 and 18 will be shortly available. HPV vaccines are composed of the L1 structural proteins of 2 or 4 HPV genotypes, produced by genetic engineering and self-assembled. These inert vaccines are devoid of genetic materials and mimic the viral particle (virus-like particle, VLP). They allow, as suggested by the 4.5 to 5 years follow-up, to prevent HPV infections and the onset of pre-cancerous lesions associated with genotypes contained within the vaccine. They represent a major overhang in the vaccinology field, and, as anti-hepatitis B vaccine, will probably be effective in cancer prevention. Their use must be associated with the continued detection of cervix cancer by smears and also with the prevention of other sexually transmitted diseases. The herpes zoster vaccine is a living attenuated vaccine produced from the OKA/Merck strain already used in the vaccine against varicella. Its safety is good among persons 50 years old and over and its efficiency on lowering herpes zoster incidence, on the burden of illness and on post-herpetic neuralgia has been demonstrated in persons over 60 years old. PMID: 17433234 [PubMed - indexed for MEDLINE] 669. Ear Nose Throat J. 2007 Mar;86(3):138, 140. Ramsay Hunt syndrome, type I. Gupta J, Hutchins T, Palacios E. Department of Radiology, Tulane University Hospital and Clinics, New Orleans, USA. Comment in: Ear Nose Throat J. 2007 Nov;86(11):649; author reply 649-50. PMID: 17427772 [PubMed - indexed for MEDLINE] 670. Cont Lens Anterior Eye. 2007 Jul;30(3):204-6. Epub 2007 Apr 8. Neurotrophic ulcer after extra-capsular cataract operation. Yülek F, Cakmak HB, Cağil N, Orhan N, Altintaş AG, Simşek S. SB Atatürk Eğitim ve Araştirma Hastanesi, Ankara, Turkey. fatmayulek@yahoo.com.tr Although neurotrophic ulcers due to herpes zoster are seldom, there may be challenging cases. Especially neurotrophic corneal ulcers after cataract operations should arise the possibility of a previous herpes zoster attack and the treatment plan should be prepared accordingly. This case highlights the importance of thorough evaluation of cataract patients in order not to miss a previous diagnosis of herpes. PMID: 17420151 [PubMed - indexed for MEDLINE] 671. Bone Marrow Transplant. 2007 Jun;39(11):661-5. Epub 2007 Apr 9. Safety of vaccinating sibling donors with live-attenuated varicella zoster vaccine before hematopoietic stem cell transplantation. Leung AY, Chow HC, Kwok JS, Lui CK, Cheng VC, Yuen KY, Lie AK, Liang R. Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China. ayhleung@hku.hk Reactivation of varicella zoster virus (VZV), clinically manifested as herpes zoster (HZ) is a common complication after hematopoietic stem cell transplantation (HSCT). The optimum prophylaxis for this disease has not been defined. In this study, we examined the effects of vaccinating donors with a live-attenuated vaccine with particular reference to their immune responses and the outcome of HSCT patients. Forty prospective HLA-matched sibling donors were vaccinated before HSCT. There were humoral immune responses in both sero-positive (P<0.01) and sero-negative (P=0.058) donors. Cellular immune response was assayed in 26 donors. Significant correlation was observed between cellular immune responses as enumerated by thymidine incorporation and interferon gamma secretion (P<0.001) and the latter was used in subsequent analyses. Significant response was observed in sero-negative (6/26) and a group of sero-positive (13/26) donors while 7/26 sero-positive donors showed no response. Thirty-four HSCT were performed. These patients have a lower, albeit insignificant, risk of HZ compared with historical controls and only 3/34 patients developed single dermatomal HZ at 6, 9 and 28 months after HSCT. No patients developed VZV-related mortality. Vaccinating donors with live-attenuated VZV vaccine was safe, but whether it confers a significant protection to the patients would require further study. PMID: 17417658 [PubMed - indexed for MEDLINE] 672. J Virol. 2007 Jun;81(12):6752-6. Epub 2007 Apr 4. Productive varicella-zoster virus infection of cultured intact human ganglia. Gowrishankar K, Slobedman B, Cunningham AL, Miranda-Saksena M, Boadle RA, Abendroth A. Center for Virus Research, Westmead Millenium Institute, and Department of Infectious Diseases and Immunology, University of Sydney, Blackburn Building, 2006 NSW, Australia. Varicella-zoster virus (VZV) is a species-specific herpesvirus which infects sensory ganglia. We have developed a model of infection of human intact explant dorsal root ganglia (DRG). Following exposure of DRG to VZV, viral antigens were detected in neurons and nonneuronal cells. Enveloped virions were visualized by transmission electron microscopy in neurons and nonneuronal cells and within the extracellular space. Moreover, rather than remaining highly cell associated during infection of cultured cells, such as fibroblasts, cell-free VZV was released from infected DRG. This model enables VZV infection of ganglionic cells to be studied in the context of intact DRG. PMCID: PMC1900131 PMID: 17409155 [PubMed - indexed for MEDLINE] 673. J Dermatol. 2007 May;34(5):349-52. Isolated double herpes zoster paresis involving the left facial nerve and the right peroneal nerve following disseminated herpes zoster. Takahama H, Tsukahara N, Hirayama M, Ito S, Sakuramoto C. Department of Dermatology, Machida Municipal Hospital, Machida, Tokyo, Japan. hdt2taka@rose.ocn.ne.jp A 72-year-old Japanese male developed disseminated herpes zoster and could not easily walk due to right drop foot and pain. He soon developed numbness and pain on the left side of his face, and noticed difficulty closing his left eye. The left angle of his mouth dropped. The patient was diagnosed as having a double mononeuropathy (a left facial nerve paresis and a right peroneal nerve paresis) following disseminated herpes zoster. Given that the patient was elderly and had diabetes mellitus, the patient appeared to be an immunocompromised host. We also describe other rare complications of herpes zoster from the published work. PMID: 17408447 [PubMed - indexed for MEDLINE] 674. J Heart Lung Transplant. 2007 Apr;26(4):399-402. Varicella infection after heart and lung transplantation: a single-center experience. Carby M, Jones A, Burke M, Hall A, Banner N. Department of Transplantation, Harefield Hospital, Harefield, Middlesex, United Kingdom. m.carby@rbht.nhs.uk Disseminated varicella-zoster virus infection after organ transplantation in adults is a rare but serious event causing significant morbidity and mortality. We describe our 10-year experience of 13 cases in a single center, including risk factors for infection, lack of protection from pre-existing anti-varicella-zoster virus antibodies, and unusual modes of presentation, including disseminated intravascular coagulation. We also report our preliminary observation of resolution of infection without sequelae in 4 patients with severe disseminated varicella-zoster virus infection who were treated with the combination of intravenous acyclovir and polyspecific intravenous immunoglobulin. PMID: 17403483 [PubMed - indexed for MEDLINE] 675. J Am Geriatr Soc. 2007 Apr;55(4):511-7. Augmenting immune responses to varicella zoster virus in older adults: a randomized, controlled trial of Tai Chi. Irwin MR, Olmstead R, Oxman MN. Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience, University of California at Los Angeles, Los Angeles, California, USA. mirwin1@ucla.edu OBJECTIVES: To evaluate the effects of a behavioral intervention, Tai Chi, on resting and vaccine-stimulated levels of cell-mediated immunity (CMI) to varicella zoster virus (VZV) and on health functioning in older adults. DESIGN: A prospective, randomized, controlled trial with allocation to two arms (Tai Chi and health education) for 25 weeks. After 16 weeks of intervention, subjects were vaccinated with VARIVAX, the live attenuated Oka/Merck VZV vaccine licensed to prevent varicella. SETTING: Two urban U.S. communities between 2001 and 2005. PARTICIPANTS: A total of 112 healthy older adults aged 59 to 86. MEASUREMENTS: The primary endpoint was a quantitative measure of VZV-CMI. Secondary outcomes were scores on the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36). RESULTS: The Tai Chi group showed higher levels of VZV-CMI than the health education group (P<.05), with a significant rate of increase (P<.001) that was nearly twice that found in the health education group. Tai Chi alone induced an increase in VZV-CMI that was comparable in magnitude with that induced by varicella vaccine, and the two were additive; Tai Chi, together with vaccine, produced a substantially higher level of VZV-CMI than vaccine alone. The Tai Chi group also showed significant improvements in SF-36 scores for physical functioning, bodily pain, vitality, and mental health (P<.05). CONCLUSION: Tai Chi augments resting levels of VZV-specific CMI and boosts VZV-CMI of the varicella vaccine. PMID: 17397428 [PubMed - indexed for MEDLINE] 676. N Engl J Med. 2007 Mar 29;356(13):1338-43. Varicella-zoster vaccine for the prevention of herpes zoster. Kimberlin DW, Whitley RJ. Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL 35233, USA. dkimberlin@peds.uab.edu Comment in: N Engl J Med. 2007 Jul 5;357(1):89-90. N Engl J Med. 2007 Jul 5;357(1):89. N Engl J Med. 2007 Jul 5;357(1):88. N Engl J Med. 2007 Jul 5;357(1):89. N Engl J Med. 2007 Jul 5;357(1):89. PMID: 17392303 [PubMed - indexed for MEDLINE] 677. Am J Transplant. 2007 Apr;7(4):741-7. Herpes simplex and varicella zoster viruses: forgotten but not gone. Miller GG, Dummer JS. Department of Medicine, Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, USA. geraldine.miller@vanderbilt.edu Herpesvirus infections are common complications of organ transplantation. The most frequent herpesvirus infections are caused by cytomegalovirus (CMV), herpes simplex (HSV) and varicella zoster (VZV). Despite expansion of the therapeutic armamentarium, HSV and VZV continue to cause morbidity and occasional mortality in transplant recipients. Here we review the incidence and risk factors for HSV and VZV disease, their clinical presentation, effects of newer immunosuppressive regimens and prophylaxis for HSV and VZV in solid organ transplant recipients. PMID: 17391119 [PubMed - indexed for MEDLINE] 678. Eur J Neurol. 2007 Apr;14(4):e7-8. Acquired prothrombotic state due to protein-losing enteropathy as a rare cause for ischemic stroke? Amtage F, Marouf W, Hetzel A, Schubert M. PMID: 17388979 [PubMed - indexed for MEDLINE] 679. Pain Physician. 2007 Mar;10(2):301-4. Seven zoster reactivations in an immune competent patient: how many is too many? Rashid RM, Candido KD, Ibrahim S. Loyola University Medical Center, Maywood, IL, USA. RashidRashid.MDPhD@yahoo.com Herpes zoster virus (HZV) reactivation is commonly reported in elderly or immune compromised patients. However, certain presentations are rarely reported in immune competent patients. Here we report a rare case of recalcitrant HZV infection, including 7 reactivations over 3 years, in an immune competent patient. Due to the pain experienced, this patient self-referred to our clinic, and thus bypassed other specialties. As pain management specialists, it is critical to be aware of such presentations, the clinical implications involved, and management options to consider. PMID: 17387352 [PubMed - indexed for MEDLINE] 680. Br J Dermatol. 2007 May;156(5):1084-6. Epub 2007 Mar 23. A case of herpes zoster in a child with congenital insensitivity to pain with anhidrosis. Ogata M, Misago N, Suzuki Y, Hirashima N, Inoue T, Yamasaki M, Narisawa Y. PMID: 17381455 [PubMed - indexed for MEDLINE] 681. Tex Dent J. 2007 Jan;124(1):132, 136-8. Oral and maxillofacial pathology case of the month. Herpes zoster (shingles). Bouquot JE, Horn N, Wan SF. Department of Diagnostic Sciences, University of Texas Dental Branch at Houston, USA. PMID: 17380914 [PubMed - indexed for MEDLINE] 682. Pain. 2007 Nov;132 Suppl 1:S52-9. Epub 2007 Mar 26. Predicting postherpetic neuralgia in elderly primary care patients with herpes zoster: prospective prognostic study. Opstelten W, Zuithoff NP, van Essen GA, van Loon AM, van Wijck AJ, Kalkman CJ, Verheij TJ, Moons KG. Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, P.O. Box 85060, 3500 AB Utrecht, The Netherlands. w.opstelten@umcutrecht.nl Postherpetic neuralgia (PHN) is the most frequent complication of herpes zoster (HZ) and difficult to treat. Timely identification of high-risk HZ-patients enables physicians to focus on PHN prevention. To assess which simple to measure factors are independent predictors of PHN, and whether psychosocial and serological/virological parameters have additional predictive value, a prospective cohort study in primary care was conducted. We included 598 elderly (>50 years) consecutive patients with acute HZ (rash <7 days) below sixth cervical dermatome. At baseline demographic, clinical (e.g., duration and severity of pain and rash), psychological (Pain Cognition List [PCL] and Spielberger's Anxiety Inventory), serological (VZV-antibodies) and virological (viremia presence) variables were measured. Blood tests were performed in a random subset of 218 patients. Primary outcome was significant pain (VAS >30 on 0-100 scale) after three months. The final prediction model obtained from multivariable logistic regression was (internally) validated using bootstrapping techniques, and adjusted for optimism. Forty-six (7.7%) patients developed PHN. Independent predictors were age (odds ratio [OR]=1.08 per year), acute pain severity (OR=1.02 per unit), presence of severe rash (OR=2.31), and rash duration before consultation (OR=0.78 per day): area under receiver-operating-characteristic curve [ROC area]=0.77 (95% CI: 0.71-0.82). Of the five PCL scores, only factor V ('trust in healthcare') was an additional predictor (OR=1.01 per unit), though it increased the ROC area with only 0.01 to 0.78. The Spielberger's anxiety scores and serological and virological variables were no additional predictors. Thus, four simple variables can help physicians to timely identify elderly HZ-patients at risk of PHN. PMID: 17379412 [PubMed - indexed for MEDLINE] 683. Mich Med. 2007 Jan-Feb;106(1):12-3. ACIP recommends vaccine to prevent shingles. [No authors listed] PMID: 17375694 [PubMed - indexed for MEDLINE] 684. An Med Interna. 2007 Jan;24(1):31-4. [Ramsay-Hunt syndrome] [Article in Spanish] Martínez Oviedo A, Lahoz Zamarro MT, Uroz del Hoyo JJ. Medicina Familiar y Comunitaria, Hospital General Obispo Polanco, C/Jaca 4, 44002 Teruel. amoviedo25@yahoo.es Ramsay-Hunt syndrome is a peripheral facial nerve palsy accompanied by an erythematous vesicular rash on the ear or in the mouth; it is caused by varicella zoster virus that affects the geniculate ganglion. The zoster oticus is the second most common cause of atraumatic peripheral facial paralysis. We present a review of zoster oticus identified in our hospital among 2001-2005. We show various atypical cases with multiple cranial nerve involvement; cerebellum and spinal cord was affected in one patient. 3/10 cases were complicated with pneumonia. So, we think that some grade of immunodeficiency may be present in these cases. Treatment with acyclovir and prednisone has been successfully to improve the outcome in the most of patients. Compared with Bell s palsy, patients with zoster oticus often have more severe paralysis at onset and are less likely to recover completely. PMID: 17373867 [PubMed - indexed for MEDLINE] 685. J Drugs Dermatol. 2006 Nov-Dec;5(10):938-41. Post-herpetic neuralgia: a review of advances in treatment and prevention. Young L. Department of Medicine, Dermatology Division, David Geffen School of Medicine at the University of California, Los Angeles, CA 90095, USA. lcyoung@mednet.ucla.edu Post-herpetic neuralgia (PHN) is primarily a disease of the elderly and often refractory to treatment. Randomized and controlled trials have yielded several significant advances in the treatment and prevention of this disease. Treatment advances include the lidocaine patch, opioid analgesics, nortriptyline, amitriptyline, and gabapentin. However, no treatment regimen fully eliminates the pain. Improvements in prevention include prompt recognition and treatment of high-risk herpes zoster (HZ) patients with antiviral and analgesic therapies. Even with these advances, PHN remains a debilitating and painful disease. Vaccines offer the greatest promise of relief. The childhood vaccine against varicella zoster virus offers long-lasting immunity, largely preventing HZ and PHN. But most adults have already had varicella and are at risk for HZ and PHN as they age. Therefore, a more potent vaccine against varicella has been developed for use in adults. This vaccine offers a new and significant advance in the prevention of HZ and its most noteworthy complication, PHN. PMID: 17373141 [PubMed - indexed for MEDLINE] 686. Zhongguo Zhen Jiu. 2007 Feb;27(2):123-5. [Observation on therapeutic effect of surround needling plus surround moxibustion on herpes zoster] [Article in Chinese] Zhang M, Qiu L, Zhang J. Chengdu Hospital of Integrated Chinese and Western Medicine, Chengdu First People's Hospital, Sichuan 610016, China. zm859@163.com OBJECTIVE: To search for a better therapy for herpes zoster. METHODS: Seventy-two cases of herpes zoster were randomly divided into a treatment group of 38 cases treated with surround needling plus surround moxibustion (direct moxibustion at the area of surround needling), and a control group of 34 cases treated with surround needling the margin of the herpes zoster from "the head" to "the tail" of the herpes zoster respectively. RESULTS: The 38 cases in the treatment group were cured within 3 days with an effective rate of 97.4%, which was better than 85.3% in the control group (P<0.05), with the herpes stopping and scab time shorten, and incidence of residual neuralgia reduced. CONCLUSION: Surround needling plus surround moxibustion has obvious therapeutic effect on herpes zoster. PMID: 17370497 [PubMed - indexed for MEDLINE] 687. Ethiop Med J. 2006 Oct;44(4):401-4. Ramsay Hunt syndrome. T/Selasic H, Zenebe G. Tikur Anbessa Specialized Hospital, Addis Ababa University P.O.Box 5657, Addis Ababa, Ethiopia. Ramsay Hunt Syndrome was described in a 58 years old woman from Addis Ababa. The woman presented with vesicular eruptions in the right ear which was followed by weakness of the same side of face & otalgia. The objective of this case report is to address herpes zoster & its complications with the treatment modalities & an uncommon clinical entity, Ramsay hunt syndrome. PMID: 17370442 [PubMed - indexed for MEDLINE] 688. J Am Acad Dermatol. 2007 Apr;56(4):675-6. New opportunities in preventative dermatology: how far should we go? Zhang AY, Elmets CA, Camp WL, Elewski BE. Skin Diseases Research Center and the Department of Dermatology, University of Alabama at Birmingham, USA. PMID: 17367617 [PubMed - indexed for MEDLINE] 689. Int J Clin Pract. 2007 Jul;61(7):1223-9. Epub 2007 Mar 16. The change in zoster-associated pain treated with oral valaciclovir in immunocompetent patients with acute herpes zoster. Kurokawa I, Murakawa K, Kumano K. Department of Dermatology, Mie University Graduate School of Medicine, Tsu, Mie, Japan. kuroichi@clin.medic.mie-u.ac.jp We have analysed zoster-associated pain treated with valaciclovir (VCV) in immunocompetent patients with acute herpes zoster over 6 months, and evaluated the safety of VCV. We know of no reports that evaluate postherpetic neuralgia (PHN) treated with VCV for 6 months. Predisposing factors that influence PHN were age (over 60 years), clustered vesicles, severity of eruption, sleep disturbance, and hypesthesia. Timing of the administration of VCV before or after the onset of rash did not influence the incidence of PHN. No serious adverse reactions were observed during the administration of VCV. PMID: 17362479 [PubMed - indexed for MEDLINE] 690. Ned Tijdschr Tandheelkd. 2007 Feb;114(2):98-103. [An unusual skin disorder after tooth extraction] [Article in Dutch] van Gemert JT, Koole R. Tandheelkunde van het Universitair Medisch Centrum Utrecht. J.T.M.vanGemert@umcutrecht.nl A 72-year-old woman was referred to a department of oral and maxillofacial surgery because of a unilateral skin eruption of the face after extraction of the right first upper molar, a few days earlier. She had been diagnosed with chronic lymphocytic leukaemia some years before. It appeared to be herpes zoster or'shingles'from the second branch of the trigeminal nerve. Treatment included hospital admission with intravenous antiviral therapy and analgetics. Herpes zoster of the face is a severe infection and requires early treatment. Post herpetic neuralgia is a serious complication of herpes zoster and may adversely affect the quality of life. PMID: 17361787 [PubMed - indexed for MEDLINE] 691. Can J Ophthalmol. 2007 Feb;42(1):152-3. Herpes zoster ophthalmicus and sixth nerve palsy in a pediatric patient. Liao W, Chu G, Hutnik CM. PMID: 17361269 [PubMed - indexed for MEDLINE] 692. Public Health Rep. 2007 Mar-Apr;122(2):155-9. Chickenpox exposure and herpes zoster disease incidence in older adults in the U.S. Chaves SS, Santibanez TA, Gargiullo P, Guris D. Viral Diseases Division, Centers for Disease Control and Prevention,1600 Clifton Rd., NE; MS-A-47, Atlanta, GA, 30333, USA. schaves@cdc.gov OBJECTIVES: Exposure to varicella zoster virus through close contact with people with chickenpox was suggested to boost specific immunity, reducing the risk of herpes zoster (HZ). Since the introduction of the varicella immunization program in the US in 1995, varicella morbidity has decreased substantially. This article examines incidence and risk factors associated with self-reported HZ disease and whether exposure to chickenpox within the previous decade reduces the risk of shingles in this age group. METHODS: In 2004, a national random-digit dial telephone survey was used to obtain information on self-reported HZ disease, demographic characteristics, and exposure to children with chickenpox in the past decade. National estimates of the incidence of shingles disease were calculated. RESULTS: Incidence rate of self-reported HZ was 19 per 1,000 population per year. White individuals were 3.5 times more likely to report shingles than Hispanic individuals (p<0.01). Previous exposure to chickenpox did not protect against HZ disease in this population. Seven percent of adults > or =65 years of age reported exposure to children with chickenpox in the past decade. CONCLUSIONS: Incidence of HZ among individuals > or =65 years of age in the U.S. may be higher than previously described in the literature, with whites being at higher risk for the disease. Currently, the potential contribution of exposure to chickenpox as a mechanism for maintaining cell-mediated immunity against HZ may be limited to a small percentage of the population. Vaccination against HZ may represent the best means of decreasing this disease burden. PMCID: PMC1820439 PMID: 17357357 [PubMed - indexed for MEDLINE] 693. Eur J Hum Genet. 2007 Jun;15(6):672-8. Epub 2007 Mar 14. Does apolipoprotein E determine outcome of infection by varicella zoster virus and by Epstein Barr virus? Wozniak MA, Shipley SJ, Dobson CB, Parker SP, Scott FT, Leedham-Green M, Breuer J, Itzhaki RF. Faculty of Life Sciences, The University of Manchester, Manchester, UK. Over 90% of the population are infected with varicella zoster virus (VZV) but only some develop shingles - caused when the virus reactivates from latency, and only some shingles patients develop post-herpetic neuralgia (PHN), defined as pain continuing for more than about 4 months. Epstein Barr virus (EBV) similarly infects over 90% of the population; some of those infected during teenage or young adult years develop infectious mononucleosis (IM). The reason for these disparities between numbers infected and numbers affected by illness is unknown, but presumably reflects host factor(s). Our previous results showed that apolipoprotein E (APOE) genotype determines susceptibility to, or outcome of, infection in the case of several diseases of known infectious cause. Therefore, we investigated APOE genotypes of shingles, PHN, and IM patients. Our rationale for the previous studies and for investigating VZV was that these micro-organisms use for cell binding and entry the same sites in the cell surface as does the protein apoE, and that consequently, competition with apoE could affect the pathogen's extent of entry and hence extent of the damage caused. The APOE genotypes of shingles and PHN sufferers, and of IM sufferers were determined using restriction fragment length polymorphism. In females, epsilon4 homozygosity confers a risk of shingles and also of IM, and the APOE-epsilon4 allele is protective against PHN whereas APOE-epsilon3 allele is a risk. Our results showing that a host genetic factor influences the development of shingles and PHN in females have clinical significance: they could lead to identification of those (female) patients at greater risk of PHN, thus enabling these people to be targeted for treatment with the most effective drugs. PMID: 17356546 [PubMed - indexed for MEDLINE] 694. Rev Med Suisse. 2007 Jan 10;3(93):14-7. [Geriatrics] [Article in French] Büla C, Gold G. Service de gériatrie et readaptation gériatrique, Centre universitaire de traitements et de readaptation (CUTR) Sylvana, Département de médecine, CHUV CUTR Sylvana, 1066 Epalinges. christophe.bula@chuv.ch A new vaccine reduces the incidence and severity of zoster and its complications in older persons. A cost-effectiveness analysis highlights the implication of CDC's recent recommendation to vaccinate all persons aged 60 years and over. A meta-analysis confirms that the chronic use of sedatives in older persons provides modest benefits and important risks. Unfortunately, melatonin does not seem to be a useful alternative. A systematic review of interventions to prevent pressure ulcers provides scientific support to measures empirically used in most institutions. Finally, a randomized controlled trial questions the clinical benefit of atypical neuroleptics in Alzheimer's disease and a comprehensive review of pharmacological trials in mild cognitive impairment reports no benefit of any of the tested drugs on conversion rate to Alzheimer's disease. PMID: 17354654 [PubMed - indexed for MEDLINE] 695. Harefuah. 2007 Feb;146(2):89-91, 167. [Varicella zoster virus infection involving the maxillary branch of the trigeminal nerve] [Article in Hebrew] Warman M, Halperin D. Department of Otolaryngology Head and Neck Surgery, Kaplan Medical Center, Rehovot. meirwa@clalit.org.il Herpes zoster is an infection caused by reactivation of the latent varicella virus in the sensory ganglia. The mechanisms responsible for Varicella zoster virus (VZV) reactivation are poorly understood. Yet, it is believed that decreased cellular immunity can be a trigger for it's reactivation. The occurrence of herpes zoster in young people may point to an underlying immunodeficiency. Therefore, the possibility of concomitant HIV infection must be eliminated. Herpes zoster manifests as a vesicular rash along a sensory dermatome, usually preceded by pain or paresthesia of the involved cutaneous area. The most commonly affected dermatomes are those of the thorax and abdomen, followed by the cranial nerves, especially the trigeminal nerve. The maxillary nerve is the least frequently affected branch of the trigeminal nerve and only rarely causes ocular injury. This is a case history of a young patient infected with VZV involving the maxillary branch of the trigeminal nerve, complicated by secondary bacterial infection of the ipsilateral hemiface. The literature regarding the epidemiology, pathogenesis, complications and the proper treatment of herpes zoster is reviewed with an emphasis on the involvement of cranial nerves. PMID: 17352273 [PubMed - indexed for MEDLINE] 696. Nihon Kokyuki Gakkai Zasshi. 2007 Feb;45(2):166-9. [A case of diaphragmatic paralysis caused by herpes zoster after anticancer chemotherapy] [Article in Japanese] Morinaga R, Matsunaga N, Iwata A, Kishi K, Tokimatsu I, Nagai H, Kadota J. Second Department of Internal Medicine, Oita University Faculty of Medicine. A 61-year-old woman who had been followed up after resection of lung cancer (adenosquamous cell carcinoma), was admitted to our hospital because of recurrence. She received systemic anticancer chemotherapy and the chief adverse event was leukopenia (Grade 3). Nineteen days after initiating chemotherapy, she suffered painful vesicular eruption on the right upper limb and the right upper hemithorax which was diagnosed as herpes zoster. After treatment with anti-viral drugs the vesicular eruption disappeared, but chest X-ray film revealed a right diaphragmatic relaxation. Although herpes zoster virus usually affects sensory nerves and causes painful vesicular eruption, it can also damage motor nerves. Herpes zoster virus almost affects cranial nerves, but it should be considered as the cause of diaphragmatic paralysis in this case. PMID: 17352174 [PubMed - indexed for MEDLINE] 697. J Neurol. 2007 Mar;254(3):400-1. Epub 2007 Mar 7. Posterior horn varicella-zoster virus myelitis. Toledano R, López-Sendón J, Gilo F, Riva E, Martínez-San Millán J, Masjuán J. PMID: 17345034 [PubMed - indexed for MEDLINE] 698. Mov Disord. 2007 May 15;22(7):1024-6. PRKCG mutation (SCA-14) causing a Ramsay Hunt phenotype. Visser JE, Bloem BR, van de Warrenburg BP. Department of Neurology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands. j.visser@neuro.umcn.nl Progressive myoclonic ataxia, also referred to as Ramsay Hunt syndrome, is characterized by a combination of myoclonus and cerebellar ataxia, infrequently accompanied by tonic-clonic seizures. Its differential diagnosis overlaps with progressive myoclonic epilepsy, a syndrome with myoclonus, tonic-clonic seizures, progressive ataxia and dementia. In patients with progressive myoclonic epilepsy, specific diseases can frequently be recognized, but the diagnostic yield in progressive myoclonic ataxia is much lower. We describe a patient who presented with multifocal myoclonus in his thirties and who later developed cerebellar ataxia and focal dystonia. His father was similarly affected. Genetic studies revealed a mutation in the protein kinase C gamma (PRKCG) gene, known to cause spinocerebellar ataxia type 14 (SCA-14). This case illustrates that both myoclonus and dystonia are part of the clinical spectrum in SCA-14 and that myoclonus can even be the presenting symptom. We suggest that SCA-14 should be considered in the differential diagnosis of progressive myoclonic ataxia. (c) 2007 Movement Disorder Society. PMID: 17343273 [PubMed - indexed for MEDLINE] 699. Rev Med Liege. 2007 Jan;62(1):44-7. [How I prevent...herpes zoster by vaccination] [Article in French] Nikkels AF, Piérard GE. Service de Dermatopathologie, CHU Sart Tilman, Liège, Belgique. Herpes zoster (HZ) results from reactivation of the varicella-zoster virus (VZV), which remains latent in the dorsal root ganglia after varicella. HZ predominantly affects people over 50 years of age without gender distinction, and its incidence increases with age. The most feared complication of HZ is the zoster-associated pains (ZAP), which encompasses the prodromal, concomitant and post-zoster persistent pains. The latter neuralgias are particularly invalidating and notoriously difficult, or even impossible to abate with current therapies. Until now, the best ZAP prevention was achieved by antiviral treatment given during the earliest phase of the eruption. This treatment certainly reduces the duration and intensity of ZAP, but exerts little influence on post-zoster persistent pains. A vaccination boosting the specific anti-VZV immunity in order to decrease the HZ incidence and post-zoster pains appears promising. A recent study performed on 38.546 immunocompetent patients aged over 60 years assessed the efficacy of a single injection of an anti-zoster vaccine (Zostavax). The incidence of HZ and post-zoster pain was decreased by 50% and 66%, respectively. Vaccination could be considered as a valuable option to alleviate the feared complications of HZ. PMID: 17343129 [PubMed - indexed for MEDLINE] 700. J Clin Virol. 2007 Apr;38(4):275-9. Epub 2007 Mar 6. Clinical and psychosocial correlates of acute pain in herpes zoster. Volpi A, Gatti A, Serafini G, Costa B, Suligoi B, Pica F, Marsella LT, Sabato E, Sabato AF. Department of Public Health, University of Rome Tor Vergata, Italy. volpi@med.uniroma2.it Comment in: J Clin Virol. 2007 Jul;39(3):238-9. BACKGROUND: Acute and persistent pain are the most significant clinical manifestations of herpes zoster (HZ), but the characteristics of acute pain in HZ patients have been inadequately investigated. OBJECTIVES: To correlate the severity of acute pain with clinical, demographic and psychosocial characteristics of HZ patients. STUDY DESIGN: Five hundred thirty-three patients with acute HZ were recruited by 119 dermatologists who collected medical and demographic data at diagnosis, provided counselling and therapy where appropriate and asked the patients to complete the Short Italian Questionnaire designed for comprehensive evaluation of HZ patients. RESULTS: In a univariate analysis, greater acute pain severity was significantly associated with female gender, number of dermatomes affected, presence of prodromal pain, abnormal sensations (dysesthesia), education level, anxiety and depression. Quality of life, even if greatly reduced, did not correlate with the intensity of pain. In a multivariate model, the intensity of pain was independently associated with the extent of rash (p=0.042), presence of prodromal pain (p=0.005), dysesthesia, education level (p=0.040), and depression (p<0.001), but not with gender, anxiety or quality of life. CONCLUSIONS: This study suggests that in patients with acute HZ the severity of the disease and depression at presentation are the main correlates of pain intensity. PMID: 17339131 [PubMed - indexed for MEDLINE] 701. FDA Consum. 2006 Sep-Oct;40(5):38-9. Vaccine approved for shingles in older people. [No authors listed] A new vaccine called Zostavax is available to reduce the risk of shingles (herpes zoster) in people ages 60 and older. PMID: 17326312 [PubMed - indexed for MEDLINE] 702. Adv Nurse Pract. 2007 Mar;15(3):73-4, 76. Advances in adult immunization. Time to renew vaccination efforts. Stinchfield P. Children's Hospital and Clinics of Minnesota, St. Paul, USA. PMID: 19998947 [PubMed - indexed for MEDLINE] 703. Neurologia. 2007 Jan-Feb;22(1):46. [Trigeminal herpes zoster. Pons hypersignal in magnetic resonance imaging] [Article in Spanish] Pérez Navarro JM, Escamilla Sevilla F, Pastor Rull J. Servicio de Neurología, Hospital Universitario Virgen de las Nieves, Granada. majosepn@fundacionhvn.org PMID: 17315102 [PubMed - indexed for MEDLINE] 704. J Med Virol. 2007 Apr;79(4):413-25. Infection and direct injury in human hepatocyte explants and a hepatoblastoma cell line due to hepatiticomimetic (non-hepatitis) viruses. Phromjai J, Aiba N, Suzuki M, Sato H, Takahara T, Kondo S, Shiraki K. Department of Virology, University of Toyama, Sugitani, Toyama, Japan. Hepatitis is caused by hepatitis viruses, but hepatitis or hepatocellular enzyme abnormalities is sometimes associated with infection by the hepatiticomimetic viruses. The direct and indirect effects of infection with hepatiticomimetic viruses were examined in two human hepatocyte systems. Poliovirus, adenovirus, and herpes simplex virus (HSV) induced cytopathology in Hep G2 cells. Measles virus caused no change in hepatocytes. Poliovirus infection did not affect cellular protein synthesis, and the peak of hepatocellular enzyme release coincided with the peak of virus release. The increase in adenovirus protein synthesis correlated with the decrease of transferrin synthesis, and enzyme release was not prominent. HSV induced viral protein synthesis with enhanced processing and inhibition of synthesis of alpha1-antitrypsin. The peak of enzyme release was later than the peak of virus release. In primary hepatocytes, poliovirus, adenovirus, and induced extensive cytopathology and enzyme release, and VZV caused cytopathology and significant but minute enzyme release. The ratio of lactate dehydrogenase to aspartate aminotransferase release was larger in poliovirus infection in both hepatocytes than in HSV or VZV infection. Although poliovirus and adenovirus are released by cytolysis and HSV and VZV are secreted by exocytosis of cytoplasmic vacuoles, enzyme release was independent of the type of virus release. Adenovirus showed strong cytotoxicity but did not modify the membrane nor cause enzyme release. Enzyme release was associated with modification of the surface membrane due to apoptosis with poliovirus and necrosis with HSV. Consequently hepatocellular injury by viral infection did not reflect the amount or pattern of hepatocellular enzyme release. (c) 2007 Wiley-Liss, Inc. PMID: 17311334 [PubMed - indexed for MEDLINE] 705. J Eur Acad Dermatol Venereol. 2007 Mar;21(3):431-2. Occurrence of acne comedones over healed linear scar of herpes zoster: a neurogenic perception. Sardana K, Relhan V, Sehgal VN, Garg VK, Kochhar AM. PMID: 17309494 [PubMed - indexed for MEDLINE] 706. Rev Neurol (Paris). 2007 Jan;163(1):89-92. [VZV-related myelitis: a pathophysiological hypothesis] [Article in French] Outteryck O, Deramecourt V, Bombois S, Mackowiak-Cordoliani MA, Pasquier F. Clinique Neurologique, Hôpital Roger Salengro, CHRU de Lille, 59037 Lille Cedex. INTRODUCTION: Complications of VZV infection in the central nervous system are multiple. VZV-related myelitis is an uncommon complication of herpes zoster. OBSERVATION: We report the case of a 55-year old man with intercostal herpes zoster who presented a subacute medullar syndrome. MRI demonstrated an extended cervico-thoracic medullar hyperintensity on the T2-weighted images. Cerebrospinal fluid (CSF) analysis showed 100 leukocytes/mm3, 0.94 g/L protein, negative VZV PCR, elevated rate of anti-VZV IgG and no oligoclonal bands. Clinical, biological and radiological presentations were compatible with the diagnosis of VZV-related myelitis with three potential pathophysiological mechanisms: infectious, immune post-infectious, vascular. The course was partially favorable after a 3-day regimen of corticosteroid and 3 weeks of acyclovir infusions. DISCUSSION: Parainfectious myelitis is often the consequence of a viral infection with a post-infectious pathogenesis. Most often, the clinical outcome is good. In this case report, we highlight the VZV vascular tropism and its more severe outcome. CONCLUSION: VZV-related myelitis should be diagnosed early. The combination of aciclovir and corticoids infusions seems to be beneficial. PMID: 17304177 [PubMed - indexed for MEDLINE] 707. Pediatr Dermatol. 2007 Jan-Feb;24(1):34-7. Ramsay Hunt syndrome in a 3-month-old infant. Balatsouras DG, Rallis E, Homsioglou E, Fiska A, Korres SG. ENT Department, Tzanion General Hospital, Piraeus, Greece. balats@panafonet.gr Ramsay Hunt syndrome is a disorder characterized by herpetic eruptions on the auricle, facial paralysis, and vestibulocochlear dysfunction, and is attributed to varicella zoster virus infection in the geniculate ganglion. Although it is a common cause of acute peripheral facial paralysis, children are not usually affected. We describe Ramsay Hunt syndrome in a 3-month-old infant who was referred because of a 2-day-old appearance of herpetic blisters on the right auricle and along the distribution of the right facial nerve. His mother had been infected with chickenpox during the second trimester of pregnancy. The infant presented with right facial palsy and was anxious, but had no fever. Otoscopy revealed herpetic eruptions in the right ear canal. Otoacoustic emissions were absent in the right ear and auditory brainstem responses confirmed moderate sensorineural hearing loss. Appropriate treatment resulted in slight improvement after the first week and complete recovery within 4 months. Infection with varicella zoster virus was proved by a significant increase in the serum anti-varicella zoster virus antibody titer during the convalescent phase of the disease. PMID: 17300646 [PubMed - indexed for MEDLINE] 708. Hum Vaccin. 2007 Mar-Apr;3(2):64-8. Epub 2007 Mar 23. Vaccination to prevent herpes zoster and postherpetic neuralgia. Oxman MN. University of California San Diego, VA San Diego Healthcare System, San Diego, California, USA. mnoxman@ucsd.edu PMID: 17299270 [PubMed - indexed for MEDLINE] 709. J Hum Lact. 2007 Feb;23(1):70-1. Herpes zoster in the T4 dermatome: a possible cause of breastfeeding strike. Mathers LJ, Mathers RA, Brotherton DR. University of Pittsburgh School of Medicine, Waukesha Family Practice Residency Program, Pittsburgh, PA, USA. The authors report a case of breastfeeding strike temporally related to the onset of a herpes zoster prodrome involving the left breast. PMID: 17293553 [PubMed - indexed for MEDLINE] 710. Epidemiol Infect. 2007 Aug;135(6):908-13. Epub 2007 Feb 12. Secular trends in the epidemiology of shingles in Alberta. Russell ML, Schopflocher DP, Svenson L, Virani SN. Department of Community Health Sciences, University of Calgary, Calgary, Canada. mlrussel@ucalgary.ca Comment in: Epidemiol Infect. 2008 Apr;136(4):449; author reply 449-50. Varicella vaccine was licensed in Canada in 1998, and a publicly funded vaccination programme introduced in the province of Alberta in 2001. In theory the vaccination programme might increase the burden of disease from shingles, making it important to develop baseline data against which future comparisons can be made. The study's aim was to describe the epidemiology of non-fatal cases of shingles for which publicly funded health services were utilized for the period 1986-2002. Shingles cases were identified from the records of Alberta's universal, publicly funded health-care insurance system for 1986-2002. The earliest dated health service utilizations for ICD-9-CM codes of 053 or ICD-10-CA codes of B02 were classified as incident. Diagnostic codes at least 180 days after the first were classified as recurrent episodes. Denominators for rates were estimated using mid-year population estimates from the Alberta Health Care Insurance Plan Registry. Annual age- and sex-specific rates were estimated. We explored the pattern of rates for sex, age and year effects and their interactions. Shingles rates increased between 1986 and 2002. There was a sex effect and evidence of an age-sex interaction. Females had higher rates than males at every age; however, the difference between females and males was greatest for the 50-54 years age group and declined for older age groups. The increased rate of shingles in Alberta began before varicella vaccine was licensed or publicly funded in Alberta, and thus cannot be attributed to vaccination. PMID: 17291380 [PubMed - indexed for MEDLINE] 711. Dermatol Nurs. 2006 Dec;18(6):529. More advances for dermatology patients. Hill MJ. PMID: 17286153 [PubMed - indexed for MEDLINE] 712. Am J Dermatopathol. 2007 Feb;29(1):109-11. The many faces of alpha-herpesviridae infections. Nikkels AF, Piérard GE. Comment on: Am J Dermatopathol. 2006 Apr;28(2):181-6. PMID: 17284977 [PubMed - indexed for MEDLINE] 713. J Clin Virol. 2007 Mar;38(3):254-9. Epub 2007 Feb 5. Progressive outer retinal necrosis in the era of highly active antiretroviral therapy: successful management with intravitreal injections and monitoring with quantitative PCR. Yin PD, Kurup SK, Fischer SH, Rhee HH, Byrnes GA, Levy-Clarke GA, Buggage RR, Nussenblatt RB, Mican JM, Wright ME. National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA. pdyin@mail.nih.gov BACKGROUND: Progressive outer retinal necrosis (PORN) is an ocular disease in individuals with AIDS and is associated with substantial morbidity. The optimal management of PORN and its clinical course in the HAART era is unclear. OBJECTIVE: We report a case of successfully managed PORN that provides insight into the monitoring and treatment of this disease. STUDY DESIGN: Intravitreal injections and intravenous therapy targeted towards varicella zoster virus (VZV) were used to treat PORN. HAART was initiated for HIV-1 therapy. Serial PCR for VZV was performed on aqueous humor to monitor the clinical course. RESULTS: The presence of VZV DNA from aqueous humor correlated with clinical exacerbations of disease. Initiation of twice weekly intravitreal injections with dual antiviral drugs appeared to be an important therapeutic intervention that resulted in remission of PORN. Secondary prophylaxis against VZV was successfully withdrawn after HAART induced partial immune recovery. CONCLUSION: In addition to aggressive therapy with intravitreal injections, HAART and quantitative measurements of VZV DNA from aqueous humor have important roles in the management of PORN. A multidisciplinary approach involving specialists in infectious diseases, ophthalmology, and clinical microbiology will improve the chances for successful long-term outcomes. PMID: 17280866 [PubMed - indexed for MEDLINE] 714. Otolaryngol Head Neck Surg. 2007 Feb;136(2):313-4. Hutchinson sign and herpes zoster. Murrell GL, Hayes BH. Naval Hospital Camp Pendleton California, Camp Pendleton, CA, and Uniformed Services University of the Health Sciences, Bethesda, MD, USA. glmurrell@cpen.med.navy.mil Comment in: Otolaryngol Head Neck Surg. 2007 Jun;136(6):1027. PMID: 17275563 [PubMed - indexed for MEDLINE] 715. Rev Med Interne. 2007 Mar;28(3):166-72. Epub 2007 Jan 17. [Immunization of adults against varicella and herpes zoster] [Article in French] Hanslik T, Blanchon T, Alvarez FP. Service de Médecine Interne, Hôpital Ambroise-Paré, Université Versailles-Saint-Quentin-en-Yvelines, Assistance publique-Hôpitaux de Paris, 9, avenue Charles-de-Gaulle, 92104 Boulogne Billancourt cedex, France. thomas.hanslik@apr.aphp.fr PURPOSE: Following the commercialisation in France of the varicella vaccine and the European marketing authorization for a vaccine against zoster, this article intends to review the epidemiology of varicella and herpes zoster, to expose the characteristics of the available vaccines, and to consider the advantages and caveats of the different immunisation strategies. CURRENT KNOWLEDGE AND KEY POINTS: In France, from 550.000 to 750.000 cases of varicella are reported each year, which result in more than 3.500 hospitalizations and about 20 deaths. Subjects>or=15 years old represent 8.3% of the total number of cases of varicella, 26% of varicella-related hospitalisations and 69% of all varicella-related deaths. The susceptibility rate for the 15 years old is 10,3 and 79% of these non-immune subjects are expected to contract varicella. The vaccines currently marketed against varicella are safe, have a good immunogenicity and remain effective over the evaluated periods. Two vaccination strategies are considered: a generalized vaccination of the infants and children, or a vaccination targeted against high-risk populations and non-immune teenagers and adults. The incidence of herpes zoster is estimated in France at 235.000 new cases per year, from which 1% is hospitalized. A live attenuated vaccine using the same strain as the varicella vaccine, but at a much higher dose, proved its efficacy in terms of reducing shingles and postherpetic neuralgia incidences, of 51 and 67% respectively. This vaccine received a marketing authorisation in France, for adults>or=60 years old. FUTURE PROSPECTS: Uncertainties about the impact of vaccination on varicella and herpes zoster epidemiology have yet to be solved, such as the potential increase in herpes zoster incidence or in the absolute number of diagnosed varicella cases in older age groups, or the loss of vaccination-induced immunity with time. These questions demonstrate the need for an operational real-time surveillance network to monitor varicella and herpes zoster incidence in the setting of general population immunisation. PMID: 17270316 [PubMed - indexed for MEDLINE] 716. Pediatr Ann. 2007 Jan;36(1):21-9. Childhood viral exanthems. Dyer JA. Department of Dermatology, University of Missorui, Columbia, MO, USA. dyerja@health.missouri.edu Many viral infections exhibit cutaneous lesions. Recognition of the exanthems associated with these infections and the broader clinical scenarios in which they occur can lead to more rapid diagnosis and appropriate treatment for affected patients. PMID: 17269280 [PubMed - indexed for MEDLINE] 717. Georgian Med News. 2006 Dec;(141):50-3. Peculiarities of herpes zoster in immunocompetent and immunocompromised hosts. Sharvadze L, Tsertsvadze T, Gochitashvili N, Bolokadze N, Dolmazashvili E. Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia. The aim of five years (2000-2005) study was to investigate the peculiarities of Herpes Zoster in immunocompromised and immunocompetent patients. For this purpose we have investigated the clinical course of Herpes Zoster, disease duration, complications of disease, as in acute phase as well as postherpetic neuralgia in 74 HIV positive (1st group) and 74 HIV negative (2nd group) groups of patients. In both group of patients we have studied the prevalence of the following complications: 1. Acute complications of Herpes Zoster: a) Neurological: motor neuropathy, cranial neuritis, meningoencephalitis, transverse myelitis. b) Ophthalmic: keratitis, iritis, retinitis, visual impairment c) Cutaneous: bacterial superinfection, scarring, disfigurement. d) Visceral: pneumonitis, hepatitis. e) Multidermatomal. 2. The complications of after resolution of infection: a) Postherpetic neuralgia and various duration of pain associated with postherpetic neuralgia such as : < month, 1-6 months, 6-12 months and >1 year durations. b) Recurrent herpes zoster. Herpes Zoster infection was diagnosed based on clinical symptoms and by detection of VZV specific IgM and IgG by ELISA. HIV infection was diagnosed by ELISA method and was confirmed by Western Blot. We found that Herpes Zoster may develop as in HIV positive as well as HIV negative population. Study showed that severe cases of disease (Herpes Zoster), long duration and rate of complications are much higher in HIV/AIDS than in HIV negative group patients. Rate of hospitalization is also higher in HIV/AIDS patients with Herpes Zoster than in HIV negative patients with Herpes Zoster. Frequency of recurrent Herpes Zoster is much higher in HIV/AIDS patients than in HIV negative patients. The postherpetic neuralgia is very frequent complication for both group (HIV positive and HIV negative) Herpes Zoster patients, but its duration longer in HIV/AIDS patients in comparison HIV negative group. There were no significant difference in disease severity, duration and complications among male and female patients. PMID: 17261887 [PubMed - indexed for MEDLINE] 718. Neurology. 2007 Jan 30;68(5):E4. Spinal myoclonus following herpes zoster radiculitis. Estraneo A, Saltalamacchia AM, Loreto V. Salvatore Maugeri Foundation, IRCCS Via Bagni Vecchi, 82037 Telese Terme (BN), Italy. aestraneo@fsm.it PMID: 17261675 [PubMed - indexed for MEDLINE] 719. Enferm Infecc Microbiol Clin. 2007 Jan;25(1):69-70. [Ramsay-Hunt syndrome complicated with cerebral venous thrombosis in an HIV-1-infected patient] [Article in Spanish] Pazos-Añón R, Machado-Costa C, Farto E Abreu J. PMID: 17261251 [PubMed - indexed for MEDLINE] 720. Manag Care. 2006 Dec;15(12):57-8. Herpes zoster vaccine brings relief for the elderly. Morrow T. Genentech Inc. PMID: 17260848 [PubMed - indexed for MEDLINE] 721. Rinsho Shinkeigaku. 2006 Sep;46(9):668-70. [Case of zoster sine herpete presenting with dysphagia diagnosed by PCR analysis of VZV DNA in auricular skin exudates] [Article in Japanese] Yaguchi H, Hisatomi M, Sekine T, Matsui K, Nagatomo M, Inoue K. Department of Neurology, The Jikei University Kashiwa Hospital. A 66-year-old woman was admitted to our hospital because of hoarseness and dysphagia after right earache and pharyngalgia. She showed right glossopharyngeal nerve and vagus nerve palsies, but no other neurological deficits. There was no skin rash within the regions of her ear, oral cavity, pharynx and larynx. Slight increase of mononuclear cells was noted in the cerebrospinal fluid. MR brain imaging was normal. We diagnosed her as zoster sine herpete (ZSH) and treated her with acyclovir, after which she almost completely recovered. The examination of antibodies and DNA of varicella zoster virus (VZV) in the serum and cerebrospinal fluid revealed a pattern of previous zoster infection without evidences of reactivation. However, VZV DNA was detected in auricular skin exudates with PCR. We conclude that PCR analysis of VZV DNA in auricular skin exudates can be a useful diagnostic tool for the diagnosis of zoster sine herpete presenting with painful glossopharyngeal nerve and vagus nerve palsies. PMID: 17260814 [PubMed - indexed for MEDLINE] 722. Rinsho Shinkeigaku. 2006 Sep;46(9):664-7. [Case of herpes zoster associated Guillain-Barré syndrome with a relapse of eruptions after intravenous immunoglobulin therapy] [Article in Japanese] Nagane Y, Utsugisawa K, Obara D. Department of Neurology, Hanamaki General Hospital. A 77-year-old woman developed progressive dysesthesia, hypesthesia and weakness in four extremities immediately after improvement of herpes zoster in the left Th10 dermatome area. Examination of the cerebrospinal fluid (CSF) showed an increase in protein concentrations. Evidence of demyelinating polyneuropathy was demonstrated by nerve conduction studies. Her hypesthesia and weakness in the extremities were gradually improved following intravenous immunoglobulin therapy (IVIg). Varicella zoster virus (VZV) titer levels in CSF well correlated both with neurological symptoms and CSF protein concentrations. VZV DNA in the CSF was not detectable. These findings suggested autoimmune Guillain-Barré syndrome (GBS) associated with herpes zoster. An interesting finding in the present patient is that one day after the completion of IVIg, when the neurological symptoms in the extremities were apparently ameliorating, the herpes zoster eruptions again emerged in the left L3 dermatome area. By treatment with intravenous acyclovir, the vesicular eruptions were improved. We assume that IVIg might suppress the immune response against VZV and promote the recurrence of eruptions. PMID: 17260813 [PubMed - indexed for MEDLINE] 723. Vaccine. 2007 Mar 1;25(11):2139-44. Epub 2006 Nov 27. Safety and immunogenicity of a zoster vaccine in varicella-zoster virus seronegative and low-seropositive healthy adults. Macaladad N, Marcano T, Guzman M, Moya J, Jurado F, Thompson M, Meechan C, Li D, Schlienger K, Chan I, Sadoff J, Schödel F, Silber JL. De la Salle University Medical Center, Cavite, Philippines. OBJECTIVE: To evaluate immunogenicity and tolerability of a live attenuated zoster vaccine in varicella-zoster virus (VZV) seronegative or low-seropositive adults > or = 30 years of age. STUDY DESIGN: Double-blind, placebo-controlled, randomized, multicenter study. Subjects were enrolled in two stages by prescreened serostatus. Subjects with a low VZV antibody titer (< or = 5 gpELISA units/mL) were enrolled in Stage 1. Subjects with undetecable VZV antibodies and no safety issues identified during Stage 1 were enrolled in Stage 2. All enrolled subjects were randomized 4:1 to receive one dose (approximately 50,000 PFU) of zoster vaccine or placebo and were followed for safety for 42 days postvaccination. Primary objectives/hypotheses: (1) no vaccine-related serious adverse experiences (AE); (2) < or = 1 laboratory-confirmed varicella-like rash with > 50 lesions within 42 days postvaccination. Secondary objective: summarize the VZV antibody response postvaccination. RESULTS: Twenty-one subjects (age 27 to 69 years; median 34) enrolled (1148 prescreened); 18 (including 4 seronegative subjects) received vaccine and 3 (including 1 seronegative subject) received placebo. Twenty subjects completed the study; one subject withdrew for reasons unrelated to safety. No serious vaccine-related AE or laboratory-confirmed varicella-like rashes with > 50 lesions were reported. In the zoster vaccine group, all 4 of the initially seronegative subjects (age 32 to 36 years; median 33.5) seroconverted and 6 of the 13 (46.2%) initially seropositive subjects had a > or = 4-fold rise in VZV-specific antibody titer at 6 weeks postvaccination. CONCLUSIONS: The zoster vaccine appears to be immunogenic and generally well tolerated in healthy adults > or = 30 years of age, regardless of initial VZV antibody serostatus. PMID: 17250932 [PubMed - indexed for MEDLINE] 724. Pharmacoeconomics. 2007;25(2):155-69. Acute/subacute herpes zoster: healthcare resource utilisation and costs in a group of US health plans. Insinga RP, Itzler RF, Pellissier JM. Department of Health Economic Statistics, Merck Research Laboratories, North Wales, Pennsylvania 19454-1099, USA. ralph_insinga@merck.com BACKGROUND: Although there are estimated to be nearly 1 million cases of herpes zoster diagnosed in the US each year, the economic costs associated with herpes zoster in the US have not been well described. OBJECTIVE: To describe the healthcare resource utilisation and costs associated with physician-diagnosed acute/subacute herpes zoster, from a payer perspective, using a large US healthcare claims database. METHODS: Data for the period 2000-1 were obtained from the Medstat Marketscan healthcare claims database. The duration of acute/subacute herpes zoster was considered to include the 21 days preceding, and 90 days following, the initial herpes zoster diagnosis. Resource utilisation was examined for individuals with newly diagnosed acute/subacute herpes zoster (n = 8741) and compared, through regression analyses, with that observed for control individuals from the same population (n = 50,000). Similar analyses were conducted for costs; the costs included reflected healthcare payments from patients, insurers and other sources. Regression analyses controlled for demographics (age, gender), conditions that have been observed with greater frequency among patients with acute/subacute herpes zoster in prior studies (cancer, HIV infection, organ transplantation, other immunosuppressive conditions and therapies) and the number of billed services within each of seven categories of care that were potentially related to acute/subacute herpes zoster and that were utilised within the 30-180 days prior to the diagnosis for affected patients, and over an analogous period for controls. RESULTS: The acute/subacute phase of herpes zoster was estimated to result in an average of 1.7 (standard error [SE] 0.02) additional physician and hospital outpatient visits, 0.05 (SE 0.003) additional emergency room visits, 0.03 (SE 0.003) additional inpatient hospital admissions, 2.1 (SE 0.03) additional prescriptions filled and $US431 (SE 17.60) in additional healthcare costs per patient. Among patients with acute/subacute herpes zoster, 21.1% had a diagnosis code with a designation for a herpes zoster-related complication, and 9.4% had three or more outpatient visits with a diagnosis code for herpes zoster. The average estimated incremental costs per patient with acute/subacute disease increased with age, ranging from $US258 (SE 37.70) among patients aged < or =19 years to $US805 (SE 106.30) among those aged > or =80 years. The numbers of additional outpatient visits, inpatient admissions, prescriptions filled for pain medications and coded complications were also substantially higher among older than younger patients with acute/subacute herpes zoster. CONCLUSIONS: The management of acute/subacute herpes zoster was found to result in substantial healthcare costs, with outpatient care and prescription drugs comprising the majority of the cost burden. To more fully understand the overall cost of herpes zoster disease to society, future studies should examine the healthcare costs associated with post-herpetic neuralgia and productivity losses due to herpes zoster and post-herpetic neuralgia. PMID: 17249857 [PubMed - indexed for MEDLINE] 725. Singapore Med J. 2007 Jan;48(1):e16-8. Herpes zoster complicating imatinib mesylate for gastrointestinal stromal tumour. Durosinmi MA, Ogbe PO, Salawu L, Oyekunle AA. Departments of Haematology and Blood Transfusion, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria. mdurosin@yahoo.com Varicella zoster virus (VZV) infection is uncommon in patients with gastrointestinal stromal tumour (GIST) and who have not been exposed to extensive radiotherapy and/or high-dose chemotherapy. We report a 56-year-old Nigerian man with GIST who developed VZV infection while on imatinib mesylate therapy. From August 2003 to November 2005, 64 patients (GIST/CML = 6/58) were enrolled into an ongoing Glivec (imatinib mesylate) international patient-assistance programme therapy for Philadelphia/bcr-abl-positive chronic myeloid leukaemia (CML) and CD117-positive GIST patients at Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria. The patient developed herpes zoster (HZ) infection 23 months into therapy with Glivec. With his absolute lymphocyte count at 2,774 cells per microlitre and CD4 count at 950 cells per microlitre, no obvious immunological defect was observed. Prompt resolution of symptoms without sequelae was achieved by treating with acyclovir, analgesic and dressing of lesions with desiccant. To our knowledge, this is the first reported case of HZ infection in a patient with GIST on Glivec therapy, and the response is similar to that of CML patients who developed VZV while on similar therapy. PMID: 17245498 [PubMed - indexed for MEDLINE] 726. Pain Med. 2007 Jan-Feb;8(1):36-40. Effectiveness of prostaglandin E1 for the treatment of patients with neuropathic pain following herpes zoster. Kanai A, Osawa S, Suzuki A, Ishimaru R, Hoka S. Department of Anesthesiology, Kitasato University School of Medicine, Japan. Kanaiakifumi@aol.com OBJECTIVE: Postherpetic neuralgia (PHN) is one of the most painful neuropathic conditions, the mechanism of which remains unclear. There is no universally accepted treatment. The pain in PHN is often relieved by bathing, heating, or sympathetic blockade, suggesting a circulation-dependent property of the pain. Therefore, we examined the effectiveness of prostaglandin E(1) (PGE(1)), which has an analgesic effect via improvement of peripheral blood circulation, for patients with PHN. DESIGN: A total of 27 patients with PHN underwent intravenous administration of 60 microg of PGE(1) dissolved in 100 mL of physiological saline and 5 mL of 8.4% sodium bicarbonate solution at an infusion rate of 0.02 microg/kg/min. Oral administration of PGE(1), limaprost alfadex, was followed at doses of 30 microg/day for 2 weeks. Pain at rest and tactile allodynia before and after the treatment was evaluated with visual analog scale (VAS). RESULTS: Intravenous PGE(1) significantly decreased VAS in rest pain and tactile allodynia without severe adverse effects. The analgesic effect of PGE(1) continued during the 2 weeks of oral administration of PGE(1). Oral PGE(1) caused nausea in seven cases, diarrhea in three, and abdominal distention in one subject. All subjects, except for two cases of nausea, continued the treatment until the end of the study, although some required a decrease in the dose to 15 microg/day. During the 2-week oral administration, the VAS did not change remarkably in the three patients whose VAS were not decreased by at least 80% during the initial infusion. CONCLUSIONS: The results of the present study indicate that oral PGE(1) following the intravenous administration produces prompt and continuous analgesia in patients with PHN. Moreover, the intravenous treatment using PGE(1) appears useful for predicting the analgesic effect of PGE(1) in the patients. PMID: 17244102 [PubMed - indexed for MEDLINE] 727. J Travel Med. 2007 Jan-Feb;14(1):65-6. Herpes zoster after yellow fever vaccination. Bayas JM, González-Alvarez R, Guinovart C. Preventive Medicine Service, International Vaccination Centre, Hospital Clínic-IDIBAPS, Barcelona, Spain. jmbayas@cliic.ub.es An immunocompetent 64-year-old women presented with brachial herpes zoster (HZ) infection 3 days after vaccination against yellow fever (YF). The lesions disappeared after antiviral treatment. There are very few reports of a possible association between YF vaccination and HZ infection. This case supports the importance of continuing surveillance of vaccine adverse events. PMID: 17241257 [PubMed - indexed for MEDLINE] 728. Pain. 2007 Mar;128(1-2):189-90; author reply 190-2. Epub 2007 Jan 19. Inadequate evidence for a revised definition of postherpetic neuralgia (PHN). Dworkin RH. Comment on: Pain. 2007 Mar;128(1-2):148-56. PMID: 17240068 [PubMed - indexed for MEDLINE] 729. Top HIV Med. 2006 Dec-2007 Jan;14(5):154-8. Immunizations for HIV-infected adults: indications, timing, and response. Spach DH. University of Washington, Seattle, WA, USA. Vaccines routinely recommended for HIV-infected adults include those for influenza, hepatitis A virus, hepatitis B virus, pneumococcal infection, and tetanus. Responses to vaccination may be affected by CD4+ cell count and viral load. A number of live vaccines are contraindicated in the HIV-infected population. This article summarizes a presentation on immunization in HIV-infected adults made by David H. Spach, MD, at the 9th Annual Ryan White CARE Act Clinical Update in Washington, DC, in August 2006. The original presentation is available as a Webcast at www.iasusa.org. PMID: 17237556 [PubMed - indexed for MEDLINE] 730. J Infect Dis. 2007 Feb 15;195(4):502-10. Epub 2007 Jan 10. DNA sequence variability in isolates recovered from patients with postvaccination rash or herpes zoster caused by Oka varicella vaccine. Loparev VN, Rubtcova E, Seward JF, Levin MJ, Schmid DS. National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. Comment in: J Infect Dis. 2007 Sep 1;196(5):801-2; author reply 802-3. Little is known about the pathogenic potential of individual strains in the varicella vaccine. We analyzed genomic variation among specimens obtained from vaccine recipients with postvaccination rash or herpes zoster (HZ), focusing on polymorphisms between live attenuated varicella vaccine virus and wild-type varicella-zoster virus. Eleven of 18 postvaccination HZ specimens contained >1 strain, and 7 of 18 appeared to be clonal. All 21 postvaccination rash specimens contained mixtures of vaccine strains. Four single-nucleotide polymorphisms (SNPs) consistently occurred in every isolate; all were polymorphisms in open-reading frame (ORF) 62, and 2 confer amino acid substitutions in the immediate-early protein 62. Four wild-type SNPs occurred in every isolate: one each occurred in ORF 10, ORF 21, ORF 62, and a noncoding region upstream of ORF 64. The frequencies of the remaining wild-type SNPs were variable, with the SNPs uniformly expressed (even in mixtures) in 20.5%-97.4% of isolates (mean frequency, 67.7%). No 2 clinical isolates had identical SNP profiles; as such, vaccine latency usually involves >1 strain. PMID: 17230409 [PubMed - indexed for MEDLINE] 731. Duke Med Health News. 2006 Nov;12(11):12. I've had one bout with shingles. Can I get it again? Can I prevent it? [No authors listed] PMID: 17228401 [PubMed - indexed for MEDLINE] 732. Vaccine. 2007 Feb 26;25(10):1877-83. Epub 2006 Oct 30. Safety and tolerability of a high-potency zoster vaccine in adults >/= 50 or years of age. Tyring SK, Diaz-Mitoma F, Padget LG, Nunez M, Poland G, Cassidy WM, Bundick ND, Li J, Chan IS, Stek JE, Annunziato PW; Protocol 009 Study Group. University of Texas Health Science Center, Houston, TX, USA. BACKGROUND: Herpes zoster (HZ) incidence rises with age, especially after 50 years of age, probably due to waning varicella-zoster virus (VZV)-specific immunity. The Shingles Prevention Study [Oxman MN, Levin MJ, Johnson GR, Schmader KE, Straus SE, Gelb LD, et al. A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults, N Engl J Med 2005;352:2271-84], enrolled people >/= 60 or years of age and showed that zoster vaccine prevents HZ and postherpetic neuralgia (PHN), presumably through boosting VZV-specific immunity. This study of people >/= 50 or years of age compared the safety and tolerability of two zoster vaccine potencies. METHODS: Adults >/= 50 or years old enrolled in a randomized, double-blind, multicenter study to compare the safety and tolerability of one dose of two zoster vaccine potencies, approximately 58,000 and approximately 207,000 plaque-forming units/dose. Adverse experiences (AEs) were recorded on a standardized Vaccination Report Card for 42 days postvaccination. For assessment of injection-site AEs, clinically acceptable tolerability was predefined based on experience with PNEUMOVAX 23, a licensed vaccine recommended for use in older people. RESULTS: Six hundred and ninety-eight subjects (age 50-90 years, median 64 years) were enrolled. No serious vaccine-related AEs were reported. Similar AE rates were observed in the higher and lower potency groups (overall systemic AEs: 37.5 and 39.3%, vaccine-related systemic AEs: 10.9 and 13.2%, injection-site AEs: 63.0 and 59.8%). Rates for a combined endpoint of moderate or severe injection-site pain/tenderness/soreness and swelling were 17.2% (95% CI 13.9, 21.0) and 9.0% (95% CI 5.6, 13.4), respectively. Most combined endpoint events were reported as moderate in intensity. CONCLUSIONS: Both vaccine potencies were generally well tolerated in this study of people > or years of age. Although rates of some moderate or severe injection-site AEs were greater in the higher potency group, all rates met the prespecified criteria for clinically acceptable tolerability. PMID: 17227688 [PubMed - indexed for MEDLINE] 733. Am J Med Sci. 2007 Jan;333(1):56-7. Herpes zoster ophthalmicus and syndrome of inappropriate antidiuretic hormone secretion. Dhawan SS. Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, Tennessee 38103, USA. csaurabh@gmail.com Presented here is a case of syndrome of inappropriate antidiuretic hormone secretion (SIADH) that developed in an elderly woman with single dermatomal herpes varicella zoster ophthalmicus without evidence of varicella-zoster encephalitis or dissemination. This is only the third such case reported in the English language literature to date, and it affirms that SIADH can develop in patients with herpetic involvement of just a single dermatome and corrects with resolution of the herpetic lesions. PMID: 17220695 [PubMed - indexed for MEDLINE] 734. Ostomy Wound Manage. 2006 Dec;52(12):14-6. Use of an atraumatic dressing in the treatment of a painful wound resulting from herpes zoster. Serena TE. PMID: 17219697 [PubMed - indexed for MEDLINE] 735. Dtsch Med Wochenschr. 2007 Jan 19;132(3):95-6. [Reactivation of varicella-zoster-virus in the area of the left vagus nerve (herpes zoster)] [Article in German] Helmstaedter V, Preuss SF. PMID: 17219343 [PubMed - indexed for MEDLINE] 736. Neurologist. 2007 Jan;13(1):43-4. Shingles. Kernich CA. Department of Medicine, University Hospitals Medical Group, University Hospitals, Cleveland, Ohio, USA. PMID: 17215727 [PubMed - indexed for MEDLINE] 737. Lakartidningen. 2006 Nov 22-28;103(47):3702-3. [Sensory innervation of the back incorrectly described in dermatomal maps] [Article in Swedish] Dahlgren N. Onkologiska kliniken, Universitetssjukhuset i Lund. helgonavagen18@msn.com PMID: 17212317 [PubMed - indexed for MEDLINE] 738. Saudi Med J. 2007 Jan;28(1):125-7. Sudden onset of herpes zoster following chemotherapy for orbital lymphoma in a HIV positive patient. Omoti AE, Omoti CE. Department of Ophthalmology, University of Benin Teaching Hospital, Benin City, Nigeria. ediomoti@yahoo.com We report a 38-year-old HIV positive female, who developed an acute attack of herpes zoster HZ involving the mandibular, C2, C3, C4, T1, and T2 dermatomes, 9 days after the commencement of the first cycle of chemotherapy regimen for non-Hodgkin's lymphoma NHL. She had developed NHL of the ovary approximately 6 months earlier, followed by metastasis to the left orbit resulting in proptosis of the left eye. A combination of a positive HIV status, lymphoma, and chemotherapy can predispose a patient to an attack of HZ involving many dermatomes. PMID: 17206304 [PubMed - indexed for MEDLINE] 739. J Dermatol Sci. 2007 Mar;45(3):213-5. Epub 2007 Jan 3. Polymorphism of the IL-10 gene is associated with susceptibility to herpes zoster in Korea. Cho JW, Shin DH, Lee KS. PMID: 17204399 [PubMed - indexed for MEDLINE] 740. J Dermatol. 2007 Jan;34(1):68-73. Zosteriform skin involvement of nodal T-cell lymphoma: a review of the published work of cutaneous malignancies mimicking herpes zoster. Niiyama S, Satoh K, Kaneko S, Aiba S, Takahashi M, Mukai H. Department of Dermatology, Yokohama Rosai Hospital, and Kitasato University, Kanagawa, Japan. sniiyama@aol.com A 77-year-old Japanese woman initially presented with non-Hodgkin's lymphoma involving her neck, axillary and inguen lymph nodes. She had edematous erythema and nodules limited to the skin in zosteriform distribution on the left side chest wall along the T4-5 dermatome. In addition, since 1970, we have mainly been collecting English-language articles on malignant skin tumors and skin metastasis described as zosteriform in the title, and we have reviewed a total of 29 cases, including our own. It should be mentioned that 59% of the cases reported had been diagnosed with herpes zoster at the time of the initial examination and that many of them had received drug therapy (e.g. acyclovir). We wish to add the dermatomic eruption mimicking zoster sine herpete to the list of possible presentations of cutaneous malignancies. PMID: 17204106 [PubMed - indexed for MEDLINE] 741. Dakar Med. 2007;52(3):236-43. [Herpes zoster and human imunodeficiency virus in the medical centers of Ouagadougou] [Article in French] Barro-Traoré F, Traoré A, Ilboudo L, Ouédraogo LT, Kaboré J. Service de Dermatologie du Centre Hospitalier Universitaire Yalgado Ouédraogo de Ouagadougou. fatou_barro@yahoo.fr Herpes zoster is an acute posterior ganglio-radiculitis related to the reactivation of the chicken pox-herpes zoster virus remained quiescent in the neurons of the nerve-knots. It usually occurs at the subject after 60 years old. For young patient, it is closely related to the infection by the HIV. Our exploratory descriptive and analytical study was carried out from 1 October 2002 to 30 September 2003, in order to describe the epidemiological, clinical aspects of the herpes zoster in the medical formations of the town of Ouagadougou (Burkina Faso) and to determine the prevalence of the infection by the HIV in the patients. We have collected 118 patients who have a herpes zoster through 6500 consultants. There were 79 women and 39 men. The average age was 34.4 years. The age bracket from 20 to 40 years was the most touched. The blistered eruption was the first reason for consultation; the light with type of burn, intermittent pain prevailed. The lesions healed in one month but there were 28 ulcerated necrotic cases. Post zoster pains have been observed in 33 cases. The localizations were the members in 44 cases (37.29%), the head in 35 cases (29.66%) and the trunk in 40 cases (33.90%). We have observed a case with double localization of herpes zoster. On 65 patients tested for the HIV, 58 (89.2%) were infected. The age bracket from 20 to 40 was the most concerned. A case of corneal necrosis isolated, with blindness and another with an opposed, spasmodic and total hemi paresis were notified. Fourteen patients having an antecedent of herpes zoster were all infected by HIV. Since the pandemic infection by the HIV, the incidence of the herpes zoster increases within the young population. The high frequency of HIV infection among our patients (89.2%) showed that the herpes zoster is closely related to this disease. PMID: 19097409 [PubMed - indexed for MEDLINE] 742. Z Orthop Ihre Grenzgeb. 2006 Nov-Dec;144(6):583-6. [Rare differential diagnosis of a radicular spine syndrome: herpes zoster radiculitis] [Article in German] Koch P, Diedrich O, Pennekamp PH, Schmitz A. Klinik und Poliklinik für Orthopädie, Universitätsklinikum Bonn, Germany. peter.koch@ukb.uni-bonn.de We report on the case of a 66-year-old patient who was hospitalized because of intractable low back pain radiating into the right leg. Leg pain was accompanied by a numbness and muscle weakness which was clearly assigned to the L5 dermatome. Concerning the patient's medical history a nucleotomy L4/5 and a osteomyelofibrosis were known. MRI of the lumbar spine revealed a multisegmental stenosis which was pronounced on the level L4/5. One day after admission of the patient to the hospital a typical zoster exanthema involving the L5 dermatome appeared. Varicella-zoster virus (VZV) was detected in the fluid of the vesicular skin lesions by polymerase chain reaction. Intravenous administration of aciclovir lead to rapid decrease of pain and exanthema. A few months later the patient died because of an acute myeloid leukemia as a complication of the known osteomyelofibrosis. This case report shows that a herpes zoster infection can imitate a radicular spine syndrome usually caused by degenerative changes. Especially in immunocompromised patients, a zoster radiculitis should be included in the differential diagnosis of radiculopathy. VZV infection might also occur without skin lesions (zoster sine herpete) so that serological assays for the early detection of virus DNA can be useful. PMID: 17187332 [PubMed - indexed for MEDLINE] 743. Ophthalmology. 2007 Apr;114(4):756-62. Epub 2006 Dec 20. Acute retinal necrosis features, management, and outcomes. Lau CH, Missotten T, Salzmann J, Lightman SL. Department of Clinical Ophthalmology, Institute of Ophthalmology and Moorfields Eye Hospital, London, United Kingdom. Comment in: Ophthalmology. 2008 Jun;115(6):1104-5; author reply 1105-6. OBJECTIVE: To determine the viral diagnosis and factors affecting the visual outcome of eyes with acute retinal necrosis. DESIGN: Nonrandomized, retrospective, interventional, noncomparative series. PARTICIPANTS: A cohort of 22 human immunodeficiency virus-negative patients with acute retinal necrosis (ARN). There were 17 unilateral and 5 bilateral cases. INTERVENTION: Diagnostic vitreous biopsy for polymerase chain reaction (PCR) viral DNA analysis, prophylactic barrier laser posterior to necrotic retina to try to prevent rhegmatogenous retinal detachment (RD), intravenous acyclovir in combination with oral, and vitrectomy for RD repair. MAIN OUTCOME MEASURES: Results of PCR viral DNA analysis, relationship between prophylactic barrier argon laser photocoagulation and occurrence of RD, and visual acuities at presentation and follow-up. RESULTS: Varicella-zoster virus (VZV) was detected in 66.7% (12/18) of eyes (66.7% of patients [10/15]) with vitreous biopsy and herpes simplex virus (HSV) in 22.2% (4/18) of eyes (20% of patients [3/15]). Epstein-Barr virus (EBV) was detected in 16.7% (3/18) of eyes (20% of patients [3/15]), and all the EBV-positive eyes were also positive for VZV. Polymerase chain reaction results were identical in both eyes of bilateral cases (5 patients) and were negative in 11.1% (2/18) of eyes (13.3% of patients [2/15]) biopsied. Systemic corticosteroid treatment given before ARN diagnosis did not appear to increase the risk of developing RD (P = 0.69). Rhegmatogenous RD occurred in 35.3% (6/17) of eyes given prophylactic argon laser treatment and in 80% (8/10) of eyes that could not be lasered prohylactically. Of RDs, 96.3% (13/14) occurred after the third week and up to 5 months from onset of symptoms. The VA after surgical repair of RD improved relative to the presentation acuity in 33.3% (4/12) of eyes. CONCLUSION: Varicella-zoster virus is the leading cause of ARN. We recommend the management of ARN to include prompt diagnosis; prophylactic argon laser retinopexy, preferably within the first 2 weeks to reduce risk of RD; systemic acyclovir; and corticosteroids to control the severe inflammation associated with ARN. Despite the guarded visual prognosis, RD repair may result in improved visual outcomes. PMID: 17184841 [PubMed - indexed for MEDLINE] 744. J Pain Palliat Care Pharmacother. 2006;20(4):41-2. Zoster vaccine to prevent postherpetic neuralgia. Sederholm B, Peterson D. Drug Information Service, University of Utah, Salt Lake City, UT 84108, USA. In 2006, the U.S. Food and Drug Administration approved the first vaccine for the prevention of acute herpes zoster neuralgia (shingles). This vaccine has important implications in reducing the incidence and severity of the common neuropathic pain condition postherpetic neuralgia. The new vaccine is described. PMID: 17182505 [PubMed - indexed for MEDLINE] 745. Drugs. 2006;66(18):2397-416. Famciclovir: a review of its use in herpes zoster and genital and orolabial herpes. Simpson D, Lyseng-Williamson KA. Wolters Kluwer Health | Adis, Auckland, New Zealand. demail@adis.co.nz Famciclovir (Famvir) is the oral prodrug of penciclovir, an agent that has demonstrated antiviral activity against herpes simplex viruses, type 1 (HSV-1) and 2 (HSV-2) [which cause orolabial and/or genital herpes simplex], and against varicella zoster virus (VZV) [a reactivation of which leads to herpes zoster]. Famciclovir has efficacy similar to that of aciclovir (in immunocompetent or immunocompromised patients) or valaciclovir (in immunocompetent patients) in the treatment of herpes zoster, and efficacy similar to aciclovir in the treatment of first or recurrent episodes of genital herpes (in immunocompetent or immunocompromised patients). Famciclovir also has efficacy in the suppression of recurrent episodes of genital herpes, and in the treatment of orolabial herpes, in immunocompetent patients. As such, famciclovir is a well tolerated first-line option for the treatment of herpes zoster and the treatment and suppression of genital herpes, and is approved for the treatment of recurrent orolabial herpes. Convenient patient-initiated single-day (for recurrent genital herpes) and single-dose (for orolabial herpes) dosage regimens may contribute to treatment compliance, patient acceptability and subsequent treatment outcomes. PMID: 17181386 [PubMed - indexed for MEDLINE] 746. Infection. 2006 Dec;34(6):352-4. Coexistence of Ramsay Hunt syndrome and varicella-zoster virus encephalitis. Kin T, Hirano M, Tonomura Y, Ueno S. Dept. of Neurology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan. We describe a patient with Ramsay Hunt syndrome and varicella-zoster virus encephalitis. The coexistence of these conditions is rare and to our knowledge has not been clearly documented in the English-language literature. We summarize the clinical characteristics of our patient and seven similar patients described in previous reports, including those published in Japanese. Although concomitant diseases such as diabetes and chronic renal failure may lead to an aggressive course, all patients described in detail have had good outcomes. PMID: 17180593 [PubMed - indexed for MEDLINE] 747. J Med Virol. 2007 Feb;79(2):192-9. Increased prevalence of varicella zoster virus DNA in cerebrospinal fluid from patients with multiple sclerosis. Mancuso R, Delbue S, Borghi E, Pagani E, Calvo MG, Caputo D, Granieri E, Ferrante P. Laboratory of Molecular Medicine and Biotechnology, Don C. Gnocchi Foundation, IRCCS, Milan, Italy. In order to investigate the possible involvement of viruses in Multiple Sclerosis (MS), the study evaluated the presence of viral genomic sequences in cerebrospinal fluid (CSF), as markers of viral replication within the central nervous system (CNS). A total of 85 CSF samples were collected from 38 MS patients, 28 patients with other neurological diseases and 19 subjects without neurological diseases. Using nested-PCR, the investigation focused on the presence of human herpes virus DNA, including herpes simplex virus 1 (HSV-1) and 2 (HSV-2), the Epstein-Barr virus (EBV), varicella zoster virus (VZV), human cytomegalovirus (HCMV), human herpes virus 6 (HHV-6) and JC virus (JCV). All the CSF samples from the individuals without neurological diseases were negative for viral DNA. Genomic sequences of HSV-1, HCMV, EBV, HHV6, and JCV were found in patients with MS and other neurological diseases without significant differences between the two groups. VZV DNA was detected more frequently (P < 0.05) in the MS group (31.6%), particularly among the relapsing-remitting MS patients (43.5%), compared with patients with other neurological diseases (10.7%). In addition, the results indicated that JCV and HHV-6 were replicating actively in the CNS of a small, but significant number of patients with MS and other neurological diseases. Most importantly, the study revealed a high frequency of VZV DNA in the CSF of patients with MS, suggesting a possible role of this virus in the pathogenesis of MS. PMID: 17177306 [PubMed - indexed for MEDLINE] 748. Mayo Clin Health Lett. 2006 Oct;24(10):8. My granddaughter was recently visiting and she had chickenpox. I've already had chickenpox, but I'm concerned about getting shingles because I know the two diseases are related. Can I catch shingles from her? [No authors listed] PMID: 17176523 [PubMed - indexed for MEDLINE] 749. Intervirology. 2007;50(1):40-4. Epub 2006 Nov 24. Analysis of repeat units in the R2 region among different Oka varicella-zoster virus vaccine strains and wild-type strains in Germany. Sauerbrei A, Zell R, Wutzler P. Institute of Virology and Antiviral Therapy, Friedrich Schiller University of Jena, Jena, Germany. Andreas.Sauerbrei@med.uni-jena.de OBJECTIVE: The present study compared the number of R2 repeat units in six different Oka strains and in 54 varicella-zoster virus (VZV) wild-type strains isolated from patients with varicella or zoster in Germany. METHODS: The R2 genomic region was characterized by polymerase chain reaction and sequencing methods. RESULTS: Five VZV Oka vaccine strains showed a number of seven 42-bp units and, in one, eight repeats were found. In 11 VZV wild-type strains isolated from patients with varicella, the copy number ranged between four and eight, and in 43 strains from zoster a similar range between four and nine copies was observed. About 80% of all strains showed between five and seven repeated units. More than one third of strains revealed seven repeats like Oka. CONCLUSIONS: The size of the R2 repeat region can also be different in single Oka vaccine strains. In German VZV wild-type strains, the R2 fragment seems to be not as variable as in Japanese wild-type strains. Copyright 2007 S. Karger AG, Basel. PMID: 17164556 [PubMed - indexed for MEDLINE] 750. Clin Gastroenterol Hepatol. 2006 Dec;4(12):1483-90. Incidence and risk factors for herpes zoster among patients with inflammatory bowel disease. Gupta G, Lautenbach E, Lewis JD. Center for Clinical Epidemiology and Biostatistics, Department of Internal Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104-6021, USA. Comment in: Inflamm Bowel Dis. 2007 Sep;13(9):1178-9. BACKGROUND & AIMS: An increased risk of herpes zoster in patients with inflammatory bowel disease (IBD) is hypothesized based on altered immune function, especially among patients receiving immunosuppressive medications. METHODS: We performed a retrospective cohort study and a retrospective nested case-control study using 1988-1997 data from the General Practice Research Database. In the cohort study, 7823 Crohn's disease (CD) and 11,930 ulcerative colitis (UC) patients were matched on age, sex, and primary care practice to 79,563 randomly selected controls without CD or UC. In the nested case-control study, 185 CD patients with zoster and 266 UC patients with zoster were matched on sex and year of birth to 1787 IBD patients without zoster. RESULTS: In the cohort study, the incidence of zoster was higher in patients with CD and UC compared with their matched controls (UC incidence rate ratio, 1.21; 95% confidence interval [CI], 1.05-1.40; CD incidence rate ratio, 1.61; 95% CI, 1.35-1.92). In the nested case-control study, receipt of a prescription for corticosteroids (adjusted odds ratio, 1.5; 95% CI, 1.1-2.2) or azathioprine/6-mercaptopurine (adjusted odds ratio, 3.1; 95% CI, 1.7-5.6) were both associated with zoster. CONCLUSIONS: Patients with IBD, especially those on immunosuppressive medications, are at higher risk for herpes zoster compared with the general population. Future studies should clarify the relative risk associated with anti-tumor necrosis factor alpha therapies and determine the use of the new zoster vaccine for patients with IBD. PMID: 17162240 [PubMed - indexed for MEDLINE] 751. Biol Blood Marrow Transplant. 2006 Dec;12(12):1335-42. Antigen-specific T-lymphocyte function after cord blood transplantation. Cohen G, Carter SL, Weinberg KI, Masinsin B, Guinan E, Kurtzberg J, Wagner JE, Kernan NA, Parkman R. The EMMES Corporation, Rockville, Maryland, USA. It has not been possible to determine the singular contribution of naive T lymphocytes to antigen-specific immunity after hematopoietic stem cell transplantation (HSCT), because of the confounding effects of donor-derived antigen-specific T lymphocytes present in most hematopoietic stem cell (HSC) products. Because umbilical cord blood contains only naive T lymphocytes, we longitudinally evaluated the recipients of unrelated cord blood transplantation (UCBT) for the presence of T lymphocytes with specificity for herpesviruses, to determine the contribution of the naive T lymphocytes to antigen-specific immune reconstitution after HSCT. Antigen-specific T lymphocytes were detected early after UCBT (herpes simplex virus on day 29; cytomegalovirus on day 44; varicella zoster virus on day 94). Overall, 66 of 153 UCBT recipients developed antigen-specific T lymphocytes to 1 or more herpesviruses during the evaluation period. The likelihood of developing antigen-specific T lymphocyte function was not associated with immunophenotypic T lymphocyte reconstitution, transplant cell dose, primary disease, or acute and chronic graft-versus-host disease. These results indicate that naive T lymphocytes present in the HSC inoculum can contribute to the generation of antigen-specific T-lymphocyte immunity early after transplantation. PMCID: PMC1794680 PMID: 17162216 [PubMed - indexed for MEDLINE] 752. Eur J Paediatr Neurol. 2007 Mar;11(2):104-7. Epub 2006 Dec 11. Anti-basal ganglia antibodies and acute movement disorder following herpes zoster and streptococcal infections. Basheer SN, Wadsworth LD, Bjornson BH. Division of Neurology, British Columbia Children's Hospital and the University of British Columbia, Vancouver, British Columbia, Canada. sn.basheer@hey.nhs.uk Anti-basal ganglia antibodies (ABGA) have been associated with poststreptococcal encephalitis similar to encephalitis lethargica (EL). We report two children with parainfectious encephalitis of similar phenotype and IgG ABGA. However, the associated pathogens in the two cases differed; beta-hemolytic streptococcus and herpes zoster. ABGA may not be specific to poststreptococcal encephalitis, but rather a surrogate marker of an inflammatory mediated movement disorder, which may respond to immunotherapy. PMID: 17161966 [PubMed - indexed for MEDLINE] 753. Pain. 2007 Mar;128(1-2):3-5. Epub 2006 Dec 11. Pain following herpes zoster: the influence of changing population characteristics and medical developments. Johnson RW, Rice AS. Comment in: Pain. 2007 Jul;130(1-2):195-6. PMID: 17161531 [PubMed - indexed for MEDLINE] 754. Harv Mens Health Watch. 2006 Oct;11(3):5-6. New immunizations for adults. [No authors listed] PMID: 17153759 [PubMed - indexed for MEDLINE] 755. Otolaryngol Pol. 2006;60(4):611-4. [Paresis of the vagus and accessory nerve in the course of the herpes zoster] [Article in Polish] Dabrowska A, Tarnowska C, Jałowiński R, Amernik K, Stankiewicz J, Grzelec H. Katedra i Klinika otolaryngologii i Onkologii Laryngologicznej Pomorskiej AM anna.d@wp.pl INTRODUCTION: The cephalic zoster is a cranial neuritis, with great tendency to diffusion along the nerves. The objective of this article is both to report a case of cranial polineuritis due to herpes zoster infection with laryngeal involvement and review of the relevant literature. MATERIAL AND METHODS: The case of 57-years-old man with unilateral laryngeal mucosal eruptions and complete left vocal paralysis is reported. Laryngeal symptoms, diagnostic criteria and therapeutic result are described. CONCLUSION: 1. In cases of head and neck herpes zoster, the investigations of all cranial nerves should be carried out, and the larynx must always be examinated; 2. Co-occurrence of the neuralgic pain (radiating especially to the ear or the occipital region) with unilateral laryngeal palsy should raise a suspicion that herpes zoster infection may by the causative factor; 3. The explanation of the etiologic cause of a vocal fold paralysis in idiopathic cases, may yield not only diagnostic, but also therapeutic value. PMID: 17152819 [PubMed - indexed for MEDLINE] 756. Herpes. 2006 Nov;13(3):75-80. Investigations of the pathogenesis of Varicella zoster virus infection in the SCIDhu mouse model. Arvin AM. Departments of Pediatrics, and Microbiology and Immunology, Stanford University School of Medicine, Stanford, CA 94305, USA. aarvin@stanford.edu Varicella zoster virus (VZV) is a medically important human herpesvirus that causes varicella, establishes latency in sensory ganglia and may reactivate to cause herpes zoster in healthy and immunocompromised patients. Experiments in the severe combined immunodeficiency (SCID) mouse model have provided new insights about VZV pathogenesis. In addition, the evaluation of VZV recombinant viruses, with targeted mutations of viral genes or their promoters in SCIDhu skin, T-cell and dorsal root ganglia xenografts, has the potential to identify options for the design of a recombinant 'second-generation' VZV vaccine. This would be characterized by the retention of infectivity in skin combined with a restricted tropism for T-cells and neurons within sensory ganglia. PMID: 17147912 [PubMed - indexed for MEDLINE] 757. Herpes. 2006 Nov;13(3):59. Varicella Pathogenesis: from Hox to Mutated gE glycoproteins. Grose C. PMID: 17147909 [PubMed - indexed for MEDLINE] 758. Herpes. 2006 Nov;13(3):60-5. Prevention of VZV infection in immunosuppressed patients using antiviral agents. Boeckh M. Fred Hutchinson Cancer Research Center, Program in Infectious Diseases, University of Washington, Seattle, WA 98109, USA. mboeckh@fhcrc.org Antiviral agents play a key role in the prevention and treatment of varicella zoster virus (VZV) disease in immunosuppressed patients. Randomized trials show that aciclovir is effective in preventing VZV reactivation disease; however, no consensus exists on dose, duration and patient population for its use. The recent shortage of VZV-specific immunoglobulin has generated renewed interest in the use of antiviral agents as post-exposure prophylaxis. The use of antiviral agents for post-exposure prophylaxis is not supported by randomized trials, but uncontrolled experience suggests that it might be a reasonable alternative if varicella-specific immunoglobulin is not available. Current evidence on the use of antiviral agents in the prevention of reactivation disease and management of exposure to VZV is discussed. PMID: 17147908 [PubMed - indexed for MEDLINE] 759. Clin Infect Dis. 2007 Jan 1;44 Suppl 1:S1-26. Recommendations for the management of herpes zoster. Dworkin RH, Johnson RW, Breuer J, Gnann JW, Levin MJ, Backonja M, Betts RF, Gershon AA, Haanpaa ML, McKendrick MW, Nurmikko TJ, Oaklander AL, Oxman MN, Pavan-Langston D, Petersen KL, Rowbotham MC, Schmader KE, Stacey BR, Tyring SK, van Wijck AJ, Wallace MS, Wassilew SW, Whitley RJ. Department of Anesthesiology, University of Rochester School of Medicine and Dentistry, Rochester, NY, 14642, USA. robert_dworkin@urmc.rochester.edu. The objective of this article is to provide evidence-based recommendations for the management of patients with herpes zoster (HZ) that take into account clinical efficacy, adverse effects, impact on quality of life, and costs of treatment. Systematic literature reviews, published randomized clinical trials, existing guidelines, and the authors' clinical and research experience relevant to the management of patients with HZ were reviewed at a consensus meeting. The results of controlled trials and the clinical experience of the authors support the use of acyclovir, brivudin (where available), famciclovir, and valacyclovir as first-line antiviral therapy for the treatment of patients with HZ. Specific recommendations for the use of these medications are provided. In addition, suggestions are made for treatments that, when used in combination with antiviral therapy, may further reduce pain and other complications of HZ. PMID: 17143845 [PubMed - indexed for MEDLINE] 760. J Clin Pathol. 2006 Dec;59(12):1331-3. Herpetiform cutaneous metastases from transitional cell carcinoma of the urinary bladder: immunohistochemical analysis. Somani BK, Prita D, Grant S, Nabi G, N'dow J. Department of Urology, Aberdeen Royal Infirmary Hospital, Aberdeen, Scotland, UK. The case of an 83-year-old woman with an uncommon presentation of cutaneous metastases from muscle-invasive transitional cell carcinoma of the urinary bladder is reported. The band-like eruption of the metastatic lesion can often be misdiagnosed and treated initially as herpes zoster. A detailed immunohistochemical analysis is also described to differentiate metastatic lesions from other sources. PMCID: PMC1860531 PMID: 17142578 [PubMed - indexed for MEDLINE] 761. Arch Phys Med Rehabil. 2006 Dec;87(12):1653-5. Monoparesis with complex regional pain syndrome-like symptoms due to brachial plexopathy caused by the varicella zoster virus: a case report. Eyigor S, Durmaz B, Karapolat H. Department of Physical Medicine and Rehabilitation, University of Ege, Medical Faculty, Bornova, Izmir, Turkey. eyigor@hotmail.com Viral invasion of the motoneurons and the subsequent inflammation in the anterior horn cells by the varicella zoster virus results in a weakness in the area of the cutaneous eruption. The exact mechanism of zoster paresis is uncertain. The occurrence of symptoms resembling complex regional pain syndrome (CRPS) is common in subjects where the herpes zoster (HZ) outbreak affects an extremity, particularly if it is the distal extremity that is involved. We report the case of a 54-year-old man with monoparesis, hyperalgesia, allodynia, edema, and both color and skin-temperature changes in his left arm after a skin eruption. Electrophysiologic examination revealed the partial degeneration of the superior, middle, and inferior truncus in the brachial plexus, with evidence of HZ infection. Magnetic resonance imaging of the cervical spine and brachial plexus showed degenerative changes without any evidence of nerve root compression. Brachial plexopathy may be the direct cause of the reversible upper-limb paresis resulting from HZ with CRPS-like symptoms. PMID: 17141648 [PubMed - indexed for MEDLINE] 762. Magn Reson Med Sci. 2006 Oct;5(3):151-5. Prompt contrast enhancement of cerebrospinal fluid space in the fundus of the internal auditory canal: observations in patients with meningeal diseases on 3D-FLAIR images at 3 Tesla. Naganawa S, Sugiura M, Kawamura M, Fukatsu H, Nakashima T, Maruyama K. Department of Radiology, Nagoya University Graduate School of Medicine, Japan. naganawa@med.nagoya-u.ac.jp We speculated that meningeal pathologies might facilitate the permeability of cranial nerves at the fundus of the internal auditory canal (IAC), causing prompt enhancement after administration of Gd-DTPA. Using a 3D- fluid-attenuated inversion recovery (FLAIR) sequence, we evaluated the enhancement of the cerebrospinal fluid (CSF) space in the IAC fundus 10 min after Gd-DTPA administration in patients with meningeal diseases. Twenty patients (aged 22 to 79 years) were divided into 2 groups, a group with meningeal disease comprising 9 patients with meningeal abnormalities (6, tumor dissemination; 3, infection) and a control group of 11 patients with unilateral IAC pathology whose healthy sides were included as controls. Six of the 9 patients in the group with meningeal disease showed bilateral enhancement; one showed unilateral enhancement. None of the control group showed enhancement in the healthy side. One patient with Ramsay-Hunt syndrome showed only ipsilateral enhancement. Enhancement in the IAC fundus was frequently observed in patients with meningeal disease, even just 10 min after administration of contrast agent. This enhancement in the IAC fundus was never visible on T1-weighted 3D-FLASH images. PMID: 17139141 [PubMed - indexed for MEDLINE] 763. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006 Dec;102(6):e37-9. Epub 2006 Oct 2. Ramsay-Hunt syndrome with vesicular stomatitis in a 4-year-old infant. Koga C, Iwamoto O, Aoki M, Nakamura C, Kusukawa J, Matsuishi T. Kurume University School of Medicine, Kurume, Japan. ckoga@med.kurume-u.ac.jp Ramsay-Hunt syndrome (RHS) usually affects adults, but rare cases of preschool children with RHS have been reported. We report a case of RHS in a healthy 4-year-old girl. At the age of 4 years and 5 months, she complained of pain in her mouth and herpes zoster vesicles were noted on the left soft palate and tongue without left pinna, and complete left facial paralysis subsequently developed. She was treated with acyclovir and steroids. Six months later, her facial paralysis had almost fully resolved. PMID: 17138164 [PubMed - indexed for MEDLINE] 764. Clin Exp Dermatol. 2007 Mar;32(2):162-4. Epub 2006 Nov 27. Complete ophthalmoplegia after herpes zoster. Im M, Kim BJ, Seo YJ, Park JK, Lee JH. Department of Dermatology, College of Medicine, Chungnam National University, Daejeon, Korea. Motor loss caused by herpes zoster is infrequent, and only a few studies have focused on ocular motor paralysis in ophthalmic herpes zoster. We report a case of complete ophthalmoplegia resulting from ophthalmic herpes zoster. A 69-year-old man presented with complete left-side ptosis with total ophthalmoplegia 7 days after the onset of left ophthalmic herpes zoster. The patient was treated with aciclovir and prednisolone. Five months later, the ptosis had resolved and the extraocular motility had almost returned to normal. PMID: 17137485 [PubMed - indexed for MEDLINE] 765. J Clin Microbiol. 2007 Feb;45(2):559-63. Epub 2006 Nov 29. Toward universal varicella-zoster virus (VZV) genotyping: diversity of VZV strains from France and Spain. Loparev V, Martro E, Rubtcova E, Rodrigo C, Piette JC, Caumes E, Vernant JP, Schmid DS, Fillet AM. Biotechnology Core Facility, Coordinating Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. Thirty-one isolates from France and Spain were genotyped using a published method analyzing DNA sequence variation in open reading frame (ORF) 22, together with an evaluation of three well-characterized single nucleotide polymorphisms (SNP) in ORF 38, 54, and 62. Nineteen were allocated to the European (E) genotype, six were mosaic-1 (M1), and two were mosaic-2 (M2). Four strains were assigned to a new genotype, mosaic-4 (M4). All isolates were wild type, with no Oka vaccine-associated markers. No isolates of the mosaic-3 (M3) or Japanese (J) genotype were observed. We also evaluated 13 selected isolates of E, J, M1, and M2 strains (9 of the 31 described above) using an alternative genotyping method based on the assessment of multiple SNP located in ORF 1, 9, 10, 21, 31, 50, 54, 62, and 68. This method assigns wild-type varicella-zoster virus (VZV) strains to seven genotypes: A1, A2, J1, B1, B2, C, and C1. VZV isolates identified as E (ORF22 method) had the genetic signature of genotype C VZV strains, M1 strains were A1, and M2 were A2. No J strains were detected, but parental Oka and vaccine Oka (genotype J) corresponded to genotype J1. M4 isolates (B) share the SNP array observed for M1 and E viruses, and probably represent recombinants between African-Asian (M1) and European (E) viruses. The two genotyping methods, using entirely different genomic targets, produced identical clusters for the strains examined, suggesting robust phylogenetic linkages among VZV strains circulating in Europe. PMCID: PMC1829061 PMID: 17135433 [PubMed - indexed for MEDLINE] 766. J Virol Methods. 2007 Feb;139(2):227-9. Epub 2006 Nov 28. Different real-time PCR assays could lead to a different result of detection of varicella-zoster virus in facial palsy. Yamakawa K, Hamada M, Takeda T. Department of Otolaryngology, Kochi Medical School, Kohasu, Oko-chou, Kochi 783-8505, Japan. yamakawk@med.kochi-u.ac.jp Real-time PCR is a useful tool for rapid detection of viral genomic DNA. However, there are many types of real-time PCR, and this variation may induce different results. The sensitivity of two different real-time PCR assays was evaluated for the detection of the varicella-zoster virus (VZV) genome: LightCycler PCR and TaqMan PCR. Auricular skin cells and saliva were sampled from 201 patients with facial nerve paralysis. A hundred and seventy-one of these patients were diagnosed clinically with Bell's palsy, and the remaining 30 with Ramsay Hunt syndrome. In 30 specimens obtained from Ramsay Hunt syndrome patients, VZV DNA was detected in 26 skin and 3 saliva specimens using the LightCycler PCR, while 28 skin and 9 saliva specimens were positive using the TaqMan PCR. None of the patients with Bell's palsy were positive for VZV by the LightCycler PCR, whereas five of these patients were positive by the TaqMan PCR. The TaqMan PCR assay has a better sensitivity compared to the LightCycler PCR for the detection of VZV genome from patients with facial palsy. Further study is required to develop a more sensitive real-time PCR. PMID: 17134766 [PubMed - indexed for MEDLINE] 767. Ann Hematol. 2007 Apr;86(4):301-2. Epub 2006 Nov 25. Late onset of bortezomib-associated cutaneous reaction following herpes zoster. Varettoni M, Vassallo C, Borroni G, Mangiacavalli S, Zappasodi P, Rosso R, Lazzarino M, Corso A. PMID: 17131123 [PubMed - indexed for MEDLINE] 768. Eur Arch Otorhinolaryngol. 2007 May;264(5):505-7. Epub 2006 Nov 24. Herpes zoster laryngitis: case report and serological profile. Watelet JB, Evrard AS, Lawson G, Bonte K, Remacle M, Van Cauwenberge P, Vermeersch H. Department of Otorhinolaryngology and Head & Neck Surgery, Ghent University Hospital, Ghent, Belgium. jeanbaptiste.watelet@ugent.be Compared to herpes zoster oticus, varicella zoster virus (VZV) reactivations in immunocompetent patients are rare in laryngeal region. Usually, associated vocal cord paralyses are reported. Herein is a case report of a patient with laryngeal zoster without any associated motor disorders. An attempt is made to assign the distribution of mucosal eruptions to the appropriate neuroanatomical structures. A description of the serological course of VZV IgM and IgG are provided. Vesicles were found on the left sensory distribution areas of the superior laryngeal nerve. VZV IgM and IgG antibodies reached their peak 1 month after initial symptoms. Attentive follow-up and no antiviral therapy were advocated because of the absence of any immune deficiency or endoscopic suspicion of malignancy. In this case of VZV reactivation in the sensitive area of the superior laryngeal nerve, serological profiles of VZV IgM and IgG were profoundly modified up to the fourth month. PMID: 17124598 [PubMed - indexed for MEDLINE] 769. Ophthalmology. 2007 Feb;114(2):307-12. Epub 2006 Nov 21. Treatment of acute retinal necrosis syndrome with oral antiviral medications. Aizman A, Johnson MW, Elner SG. W. K. Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan School of Medicine, Ann Arbor, Michigan 48105, USA. Comment in: Ophthalmology. 2007 Dec;114(12):2367; author reply 2367-8. OBJECTIVE: Acute retinal necrosis (ARN) is a distinct ocular viral syndrome traditionally treated with intravenous acyclovir followed by oral acyclovir. We investigated the use of the oral antiviral medications valacyclovir and famciclovir as the sole treatment for patients with newly diagnosed ARN syndrome. DESIGN: Retrospective, uncontrolled, interventional case series. PARTICIPANTS: Eight consecutive patients with newly diagnosed ARN treated solely with oral antiviral medications. INTERVENTION: All patients received famciclovir or valacyclovir without antecedent intravenous therapy. One patient with bilateral ARN treated with famciclovir received a single intravitreal injection of foscarnet in the more severely involved eye. MAIN OUTCOME MEASURES: Clinically and photographically documented complete resolution of retinitis and best-corrected visual acuity on final follow-up. RESULTS: Active retinitis resolved completely in 10/10 (100%) affected eyes. Initial response to treatment was seen as early as 4 days (in 5 eyes), with a median time to complete resolution of 14 days. At the last examination, visual acuity was improved (> or = 2 Snellen lines) in 6 (60%) eyes, stable in 2 (20%) eyes, and worse in 2 (20%) eyes. Over a mean follow-up of 36 weeks (range, 7-72 weeks), 3 eyes developed rhegmatogenous retinal detachment that was successfully repaired with 1 vitrectomy surgery. No patient with initially unilateral involvement developed disease in the contralateral eye. CONCLUSIONS: In this pilot study, the use of the oral drugs valacyclovir and famciclovir resulted in complete regression of herpetic necrotizing retinitis. Additional studies are necessary to evaluate the role of these antiherpetic medications in the treatment of the ARN syndrome. PMID: 17123607 [PubMed - indexed for MEDLINE] 770. Cephalalgia. 2006 Dec;26(12):1483-4. Secondary intermedius neuralgia-like pain in a young child. da Silva HM, Boullosa JL, Arruda MA. Instituto de Neurologia e Cefaléia, Rua Casemiro de Abreu 544, Ribeirão Preto, CEP 14030-060 São Paulo, RP, Brazil. PMID: 17116099 [PubMed - indexed for MEDLINE] 771. Headache. 2006 Nov-Dec;46(10):1590-1. Occipital neuralgia evoked by facial herpes zoster infection. Kihara T, Shimohama S. Department of Neuroscience for Drug Discovery, Graduate School of Pharmaceutical Sciences, Kyoto University, Yoshida-Shimoadachi-cho 46-29, Sakyo-ku, Kyoto 606-8501, Japan. Occipital neuralgia is a pain syndrome which may usually be induced by spasms of the cervical muscles or trauma to the greater or lesser occipital nerves. We report a patient with occipital neuralgia followed by facial herpes lesion. A 74-year-old male experienced sudden-onset severe headache in the occipital area. The pain was localized to the distribution of the right side of the greater occipital nerve, and palpation of the right greater occipital nerve reproduces the pain. He was diagnosed with occipital neuralgia according to ICHD-II criteria. A few days later, the occipital pain was followed by reddening of the skin and the appearance, of varying size, of vesicles on the right side of his face (the maxillary nerve and the mandibular nerve region). This was diagnosed as herpes zoster. This case represents a combination of facial herpes lesions and pain in the C2 and C3 regions. The pain syndromes can be confusing, and the classic herpes zoster infection should be considered even when no skin lesions are established. PMID: 17115995 [PubMed - indexed for MEDLINE] 772. HNO. 2008 Feb;56(2):165-8. [Myxoma of the middle ear-a rare cause of facial palsy] [Article in German] Zehlicke T, Punke C, Haase K, Boltze C, Pau HW. Universitätsklinik und Poliklinik für Hals-, Nasen-, Ohrenheilkunde, Kopf- und Halschirurgie Otto Körner, Doberaner Strasse 137-139, 18057 Rostock. thorsten.zehlicke@web.de In case of the co-occurrence of facial palsy and inflammation-like symptoms of the same ear, the differential diagnosis is focused on viral (herpes zoster) or bacterial diseases. We report a patient for whom the surgical exploration of the middle ear revealed a benign tumor: a myxoma. These neoplasias are rare tumors in the head and neck region. The typical tumor site is the atrium of heart. In the ear, the tumor grows slowly and remains asymptomatic unless it irritates structures such as the facial nerve or the vestibular organ. Histologically, the tumor presents a "myxoid" matrix that is rich in acid mucopolysaccarides. The treatment of choice is complete surgical resection. Using the case presented, we discuss the causality between the tumor and the facial palsy, although during the operation the bony canal of the nerve was found to be intact. In any cases with clinically and radiologically unclear findings of the ear in connection with facial palsy, surgical exposure should be considered. PMID: 17115088 [PubMed - indexed for MEDLINE] 773. J Pediatr Hematol Oncol. 2006 Nov;28(11):757-9. Concomitant Candida epiglottitis and disseminated Varicella zoster virus infection associated with acute lymphoblastic leukemia. Chiou CC, Seibel NL, Derito FA, Bulas D, Walsh TJ, Groll AH. Immunocompromised Host Section, Pediatric Oncology Branch, National Cancer Institute, Bethesda, MD 20892, USA. Acute epiglottitis by nonbacterial pathogens is an uncommon but life-threatening clinical entity. Herein, we report the concomitant occurrence of Candida epiglottitis and mucosal and visceral Varicella zoster virus infection in a child with acute lymphoblastic leukemia. Both infections were atypical in their presentation, occurred in a severely immunocompromised host, and required invasive procedures for diagnosis. PMID: 17114965 [PubMed - indexed for MEDLINE] 774. J Can Dent Assoc. 2006 Nov;72(9):829-32. Unilateral facial swelling caused by Ramsay Hunt syndrome resembles odontogenic infection. Jan AM, McGuire TP, Clokie CM, Sándor GK. Division of oral and maxillofacial surgery, University of Toronto, Toronto, Ontario, Canada. Facial cellulitis and swellings of the head and neck are worrisome signs of odontogenic infection, which can be life threatening. Most head and neck infections are caused by bacterial pathogens. When treating such infections, dentists must also be aware of possible viral or fungal causes and their associated presentations. This report documents a case of viral infection that initially resembled a bacterial odontogenic infection. It is intended to familiarize dentists with the Ramsay Hunt syndrome and the need for prompt recognition and early definitive treatment. PMID: 17109804 [PubMed - indexed for MEDLINE] 775. Dev Med Child Neurol. 2006 Dec;48(12):991-3. Recurrent hemiplegia associated with cerebral vasculopathy following third trimester maternal herpes zoster infection. West SL, Newton RW, Baildam EM, Turner AJ, Arkwright PD. Royal Manchester Children's Hospital, Manchester, UK. Siobhan.wykes@doctors.org.uk The chickenpox virus (varicella zoster virus; VZV) is known to cause large and small vessel central nervous system vasculopathies that may be associated with strokes in both adults and children. We present the case of a female aged 2 years 6 months who developed a chronic progressive small-vessel vasculopathy with radiological features of moyamoya disease as a manifestation of congenital varicella syndrome. Clinically, the condition was characterized by recurrent ischaemic strokes, which were brought under control using intravenous acyclovir. The case is unique in that it is the first report of congenital varicella syndrome to occur after a maternal herpes zoster infection. Furthermore, it is the first case of symptomatic VZV infection in a child to occur after a maternal infection occurring in the third trimester of pregnancy. PMID: 17109789 [PubMed - indexed for MEDLINE] 776. J Int Assoc Physicians AIDS Care (Chic Ill). 2006 Dec;5(4):157-60. Immune reconstitution syndrome presenting with cerebral varicella zoster vasculitis in HIV-1-infected patient: a case report. Patel AK, Patel KK, Shah SD, Desai J. Infectious Diseases Clinic, Ahmedabad, India. atulpatel65@gmail.com Neurologic dysfunction complicating HIV infection may occur in up to 70% of AIDS patients. The advent of highly active antiretroviral therapy has reduced central nervous system opportunistic infections. Immune reconstitutions after highly active antiretroviral therapy also lead to atypical presentations of neurologic opportunistic infections. We report a man who developed an encephalitic illness 10 months after institution of highly active antiretroviral therapy and improvement in his CD4 count. Varicella zoster vasculitis involving the brain was suspected. Acyclovir therapy resulted in complete clinical and radiologic recovery. Symptomatic reactivation of varicella zoster infection within the encephalon during therapeutic immunologic reconstitution is rare and should be suspected, especially in patients with neurologic syndrome consistent with encephalitis with recent history of herpes zoster and multiple, discrete areas of infarct or demyelination on brain magnetic resonance imaging. The clinical and neuroradiologic features of this condition and its relevance to the immune reconstitution syndrome are discussed. PMID: 17101808 [PubMed - indexed for MEDLINE] 777. Transplant Proc. 2006 Oct;38(8):2416-8. Varicella infection in adult renal allograft recipients: experience at one center. Rodriguez-Moreno A, Sanchez-Fructuoso AI, Calvo N, Ridao N, Conesa J, Marques M, Prats D, Barrientos A. Department of Nephrology, Hospital Clínico San Carlos, Madrid, Spain. arodriguez@friat.es Disseminated varicella-zoster virus (VZV) infection in adult renal allograft recipients is a rare but potentially fatal illness. We retrospectively collected the cases of VZV infection that occurred in 812 adult renal transplant recipients, performed between 1995 and 2004 at our institution. Eight patients developed varicella (1%), seven men and one woman. The overall median age was 38 years (range = 31 to 64). The median time from transplantation to infection was 32 months (range = 2 to 92). Four cases were primary infections and four disseminated VZV reactivations. Immunosuppression consisted of prednisone (PDN) + cyclosporine (CSA) + mycophenolate (MF; n = 4); PDN + CSA + azathioprine (n = 1); PDN + tacrolimus (FK) + MF (n = 1); FK + MF (n = 1); PDN + rapamycin + MF (n = 1). Seven patients (87%) required hospital admission for a median duration of 11 days (range = 3 to 21). Four patients were previously diagnosed with chronic hepatitis virus infection: two type B (HBV) and two type C (HCV). The last cohort required longer admission than the negative patients (11.5 +/- 3 vs 7.5 +/- 9 days; P = .1). The only clinical manifestation in four patients was general malaise, fever, and a disseminated vesicular rash; the other four patients also showed visceral involvement: two pneumonitis, one hepatitis, and thrombotic microangiopathy, and one developed multiorgan failure and died due to a delayed diagnosis in a patient positive for HBVs. The diagnosis was established according to the symptoms, IgG-IgM seroconversion and VZV polymerase chain reaction quantification in vesicle contents. Treatment consisted of reduced immunosuppression, antiviral drugs (acyclovir or gancyclovir), and in six patients, a varicella-zoster immunoglobulin dose. We concluded that varicella infection in adult renal allograft recipients is unusual but highly morbid. A vaccination program in seronegative pretransplant candidates should be attempted. Early diagnosis and treatment may improve the prognosis. Although further studies are required, chronic HBV or HCV infection seemed to be a risk factor for the disease. PMID: 17097954 [PubMed - indexed for MEDLINE] 778. An Otorrinolaringol Ibero Am. 2006;33(5):489-94. [Ramsay-Hunt syndrome associated to unilateral recurrential paralysis] [Article in Spanish] Pino Rivero V, González Palomino A, Pantoja Hernández CG, Mora Santos ME, Trinidad Ramos G, Blasco Huelva A. Complejo Hospitalario Infanta Cristina, Facultativo Especialista de Otorrinolaringología, Badajoz. vicentepinorivero@terra.com Varicella herpes zoster (VZV) virus reactivaction can produce multiple neuropathies of the cranial and cervical region being the peripheral facial paralysys the most common one. We report one case of Ramsay-Hunt syndrome with eruption of vesicles on left auricular pinna and face besides facial palsy which associated to ipsilateral laryngeal or recurrential paralysis nonexisting previously. Our patient was treated by oral aciclovir (800 mg, 5 times daily) for 1 week. 3 months later she returned to Emergencies due to another cause and the ENT exploration showed a recovery in the mobility of the left cord but it persisted the affectation of VII pair, specially the inferior branch or cervicofacial. It is advised that the larynx should be examined in all cases of herpes zoster that involve the head and neck. PMID: 17091862 [PubMed - indexed for MEDLINE] 779. J Burn Care Res. 2006 Nov-Dec;27(6):914-6. Misdiagnosis of burns: herpes zoster ophthalmicus. Sawyer AR, Williams G. Burns Unit, Chelsea and Westminster Hospital, London, United Kingdom. Many conditions can mimic the presentation of burns. We present an interesting case in which the initial diagnosis of a chemical burn was later confirmed to be herpes zoster ophthalmicus. PMID: 17091093 [PubMed - indexed for MEDLINE] 780. Biol Blood Marrow Transplant. 2006 Oct;12(10):1096-7. Postexposure prophylaxis against varicella zoster virus infection among hematopoietic stem cell transplant recipients. Weinstock DM, Boeckh M, Sepkowitz KA. PMID: 17084374 [PubMed - indexed for MEDLINE] 781. Cornea. 2006 Jul;25(6):742-4. "Steel wool keratopathy": a clinical sign of chronic inflammation. Seitzman GD, Strauss EC, Margolis TP. Francis I Proctor Foundation and Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA. PURPOSE: To introduce into the clinical nomenclature a sign frequently observed in our patients with persistent corneal inflammation associated with herpetic stromal keratitis. METHODS: Case reports and review of the literature. RESULTS: Four representative patients with herpesvirus stromal keratitis are presented. Herpes simplex virus-1 (HSV-1) was confirmed by culture in 1 case and by polymerase chain reaction in a second case. In the remaining 2 cases, the diagnosis was made based on characteristic clinical findings for herpes simplex virus and varicella zoster virus (VZV). On clinical examination, all 4 representative cases of stromal keratitis revealed a well-defined, localized region of intertwined, metallic-like, polychromatic material in the corneal stroma, a sign we have termed steel wool keratopathy. We have only rarely observed this finding in patients with stromal keratitis not caused by a herpesvirus. CONCLUSION: Steel wool keratopathy seems to represent a focal region of stromal degeneration or deposition associated with chronic inflammation. Although we most often observe this finding in patients with stromal keratitis secondary to HSV or VZV, we cannot exclude the possibility that this sign represents the sequelae of chronic/recurrent inflammation rather than a specific pathologic response to herpetic antigens. PMID: 17077672 [PubMed - indexed for MEDLINE] 782. Pain. 2007 Mar;128(1-2):148-56. Epub 2006 Oct 27. Natural history of pain following herpes zoster. Thyregod HG, Rowbotham MC, Peters M, Possehn J, Berro M, Petersen KL. UCSF Pain Clinical Research Center, Department of Neurology, University of California, San Francisco, CA 94115, USA. Comment in: Pain. 2007 Mar;128(1-2):189-90; author reply 190-2. In a longitudinal observational study of 94 patients (39 M:55 F, mean age 69) at elevated risk for developing post herpetic neuralgia (PHN), the natural history of pain during the first 6 months after herpes zoster (HZ) rash onset was determined. Pain severity and impact were rated using pain-VAS, SF-MPQ, and MPI. Applying a definition of PHN of average daily pain >0/100 on the pain VAS during the last 48 h, 30 subjects had PHN at 6 months. These 30 subjects reported more pain and a higher SF-MPQ score (p<0.01) at study inclusion than the 64 subjects whose pain completely resolved by 6 months. At 6 months, mean daily pain in the PHN group was 11/100 (95% CI 5,16) and only nine of these subjects were still taking prescription medication for HZ pain. The rate of recovery (pain severity over time) was the same in the PHN and no-pain groups. At study inclusion, the SF-MPQ and MPI scores in our PHN group were similar to historical controls with chronic severe PHN enrolled in clinical trials, but by 6 months the scores in our PHN subjects were significantly lower than historic controls. Only two subjects met the more stringent criteria for 'clinically meaningful' PHN at 6 months (> or = 30/100 on the pain VAS). Defining PHN as average daily pain >0/100 at 6 months after rash onset appears to substantially overestimate the number of HZ patients negatively impacted by ongoing pain and disability. PMCID: PMC1905461 PMID: 17070998 [PubMed - indexed for MEDLINE] 783. J Med Virol. 2006 Dec;78(12):1679-87. The optimization and validation of the glycoprotein ELISA assay for quantitative varicella-zoster virus (VZV) antibody detection. Hammond O, Wang Y, Green T, Antonello J, Kuhn R, Motley C, Stump P, Rich B, Chirmule N, Marchese RD. Vaccine and Biologics Research, Merck Research Laboratories, Wayne, Pennsylvania, USA. Varicella is a highly contagious viral disease found throughout the world. A live-attenuated Varicella-Zoster virus (VZV) vaccine (Oka/Merck strain), VARIVAXtrade mark, was licensed in the United States (US) in 1995 and was made a part of the US recommended childhood vaccination schedule in 1996. The immune response to VZV-containing vaccines has been measured using an enzyme-linked immunosorbent assay (ELISA) to detect antibodies to glycoproteins from VZV. A correlate for protective immunity has been established between anti-VZV glycoprotein antibody levels and protection against breakthrough varicella in children, and this correlate is used as the primary immunogenicity endpoint in clinical trials with VZV-containing vaccines. The performance of the "first generation" validated version of the assay was recently reevaluated in order to identify areas for improvement. Specific format and reagent changes were implemented, with the goal of improving assay consistency by maintaining tighter control over assay processes and reagents. An extensive validation of the "second generation" gpELISA was undertaken in order to characterize the updated assay. In this article, we describe the gpELISA method, detail the procedures used to evaluate assay performance, and present the operating characteristics of the second generation gpELISA. (c) 2006 Wiley-Liss, Inc. PMID: 17063506 [PubMed - indexed for MEDLINE] 784. J Laryngol Otol. 2007 Feb;121(2):163-5. Epub 2006 Oct 24. A case of glossopharyngeal zoster diagnosed by detecting viral specific antigen in the pharyngeal mucous membrane. Nakagawa H, Nagasao M, Kusuyama T, Fukuda H, Ogawa K. Department of Otolaryngology, Seibo International Catholic Hospital, Tokyo, Japan. hnakagawa@seibokai.or.jp Glossopharyngeal nerve paralysis caused by varicella zoster virus reactivation is rare. We present a case of glossopharyngeal zoster confirmed by direct immunofluorescence staining for virus antigens. A 35-year-old man presented with right-sided, severe swallowing pain and dysgeusia. Physical examination showed a loss of ipsilateral gag reflex. White spots on the posterior wall of the right pyriform sinus were seen by laryngofibroscopy, and a loss of taste on the right posterior part of the tongue was confirmed by gustometry using the filter paper disc method. The varicella zoster virus antigen was revealed by direct immunofluorescence staining by fluorescein isothiocyanate labelled mouse monoclonal antibody specific for varicella zoster virus glycoprotein, using samples obtained from the mucosal lesion by abrasion with a cotton swab. The patient was treated by intravenous administration of acyclovir. His throat pain and dysgeusia completely resolved. We discuss the advantages of direct immunofluorescence staining for varicella zoster virus antigen for the diagnosis of glossopharyngeal zoster. PMID: 17059621 [PubMed - indexed for MEDLINE] 785. MMW Fortschr Med. 2006 Sep 28;148(39):48-9. [Burning pain on one side of the body and blisters filled with clear fluid. Tentative diagnosis: shingles] [Article in German] Möhrenschlager M, Ring J, Hofmann H. Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein, Technische Universität München. moehrenschlager@lrz.tum.de PMID: 17059198 [PubMed - indexed for MEDLINE] 786. Ocul Immunol Inflamm. 2006 Oct;14(5):317-9. Necrotizing scleritis due to varicella zoster infection: a case report. Gungor IU, Ariturk N, Beden U, Darka O. Department of Ophthalmology, School of Medicine, Ondokuz Mayis University, Samsun, Turkey. ligungor@omu.edu.tr PURPOSE: To report a case with necrotizing scleritis due to varicella-zoster infection. METHODS: The patient records were evaluated. The present literature was investigated using MEDLINE. A six-year-old boy with varicella infection was admitted to our clinic with redness, pain, and lid edema on the right eye. Slit lamp examination revealed lid edema, purulent secretion, conjunctival injection and chemosis, and inferotemporal scleral necrosis. Sclera was avascular and the conjunctiva was spontaneously detached from sclera in the necrotic region. RESULTS: Systemic and topical acyclovir treatment was started and a rapid improvement achieved in signs and symptoms. CONCLUSIONS: Ophthalmic manifestations of varicella infection are potentially blinding especially in the absence of appropriate diagnosis and medical intervention. Distinctive skin eruptions are specifically helpful in the early diagnosis of the disease. PMID: 17056468 [PubMed - indexed for MEDLINE] 787. Cell. 2006 Oct 20;127(2):305-16. Insulin degrading enzyme is a cellular receptor mediating varicella-zoster virus infection and cell-to-cell spread. Li Q, Ali MA, Cohen JI. Laboratory of Clinical Infectious Diseases, Medical Virology Section, National Institutes of Health, Bethesda, MD, 20892 USA. Varicella-zoster virus (VZV) causes chickenpox and shingles. While varicella is likely spread as cell-free virus to susceptible hosts, the virus is transmitted by cell-to-cell spread in the body and in vitro. Since VZV glycoprotein E (gE) is essential for virus infection, we postulated that gE binds to a cellular receptor. We found that insulin-degrading enzyme (IDE) interacts with gE through its extracellular domain. Downregulation of IDE by siRNA, or blocking of IDE with antibody, with soluble IDE protein extracted from liver, or with bacitracin inhibited VZV infection. Cell-to-cell spread of virus was also impaired by blocking IDE. Transfection of cell lines impaired for VZV infection with a plasmid expressing human IDE resulted in increased entry and enhanced infection with cell-free and cell-associated virus. These studies indicate that IDE is a cellular receptor for both cell-free and cell-associated VZV. PMID: 17055432 [PubMed - indexed for MEDLINE] 788. Auris Nasus Larynx. 2007 Jun;34(2):159-64. Epub 2006 Oct 19. Analysis of prognostic factors in Bell's palsy and Ramsay Hunt syndrome. Yeo SW, Lee DH, Jun BC, Chang KH, Park YS. Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, 505 Banpo-dong, Secho-gu, Seoul 137-701, Republic of Korea. OBJECTIVE: This study evaluated the prognostic factors in Bell's palsy and Ramsay Hunt syndrome (HZO). METHODS: A retrospective, institutional review board-approved study at a university-based hospital. A total of 81 patients consisting of 55 Bell's palsy patients and 26 HZO patients were enrolled in this study. The treatment consisted uniformly in all cases, and acyclovir was administered in the case of Ramsay Hunt syndrome. All patients were followed up until they recovered or for least up 6 months. RESULTS: The recovery rates to House-Brackmann grade II or better were 96.3% in those with Bell's palsy and 84.6% in those with HZO. In the HZO cases, older patients had a poorer initial and final status, and less chance of making a complete recovery than the younger patients. The HZO patients without diabetes mellitus had a higher chance of recovery, a higher chance of complete recovery, and a better final status. In addition, HZO patients without essential hypertension had a higher degree of recovery. HZO patients not suffering from vertigo had a higher chance of recovery. CONCLUSION: There was no prognostic factor found in the Bell's palsy patients in this study. The prognostic factors of HZO were age, diabetus mellitus, essential hypertension and vertigo. PMID: 17055202 [PubMed - indexed for MEDLINE] 789. Clin Infect Dis. 2006 Nov 15;43(10):1301-3. Epub 2006 Oct 11. Reactivation of 2 genetically distinct varicella-zoster viruses in the same individual. Taha Y, Scott FT, Parker SP, Syndercombe Court D, Quinlivan ML, Breuer J. Skin Virus Laboratory, Centre for Infectious Diseases Research, Barts and the London School of Medicine and Dentistry, London, E1 2AT, United Kingdom. Varicella-zoster viruses recovered from 2 episodes of herpes zoster in an immunocompetent man were found to be different genotypes. The fact that the 2 isolates came from the same individual was confirmed by DNA fingerprinting. Immunity following chickenpox may not always protect against systemic reinfection. This finding raises questions about varicella-zoster virus pathogenesis and may have an impact on public health policy. PMID: 17051496 [PubMed - indexed for MEDLINE] 790. Vaccine. 2006 Nov 17;24(47-48):6875-85. Epub 2006 Jul 7. Safety, tolerability, and immunogenicity of a two-dose regimen of high-titer varicella vaccine in subjects > or =13 years of age. Diaz C, Dentico P, Gonzalez R, Mendez RG, Cinquetti S, Barben JL, Harmon A, Chalikonda I, Smith JG, Stek JE, Robertson A, Caulfield MJ, Biasio LR, Silber JL, Chan CY, Vessey R, Sadoff J, Chan IS, Matthews H, Wang W, Schlienger K, Schödel FP; Protocol 049 Study Group. University of Puerto Rico School of Medicine, San Juan, Puerto Rico. A new manufacturing process, known as process upgrade varicella vaccine (PUVV) was developed for a refrigerated formulation of varicella vaccine and for an investigational zoster vaccine. Safety and tolerability of a two-dose regimen of high-titered (approximately 50,000 PFU) PUVV were compared to a lower-titer formulation (approximately 5400 PFU) of VARIVAX; in 1366 healthy subjects > or =13 years old. Only one vaccine-related clinical serious adverse experience (pruritus; no hospitalization) was reported, in the VARIVAX group. Injection-site adverse experiences following any dose were higher in the PUVV group, 70.0%, than in the VARIVAX group, 56.2%, but generally were mild. Immunogenicity were similar in both groups in seronegative subjects. PUVV was generally well tolerated, and elicited an immune response similar to that induced by the marketed formulation of VARIVAX. PMID: 17050042 [PubMed - indexed for MEDLINE] 791. Nurs Older People. 2006 Oct;18(9):20-2. Shingles: relief at last. Dinsdale P. PMID: 17042348 [PubMed - indexed for MEDLINE] 792. J Dermatol. 2006 Oct;33(10):705-8. Drug eruption caused by the nonionic contrast medium iohexol. "Recall-like phenomenon" appearing on an area previously affected by herpes zoster. Matsumura T, Watanabe H, Batchelor J, Sueki H, Iijima M. Department of Dermatology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan. We report a case of "recall-like phenomenon" caused by nonionic contrast medium. A 62-year-old woman suffering from postherpetic neuralgia developed erythematous plaques 12 h after an intercostal nerve block under X-ray guidance using iohexol (Omnipaque) as contrast medium. The erythematous plaques were preferentially located in the sites where she had experienced herpes zoster 4 months previously. The lesions cleared spontaneously leaving no pigmentation. Both patch testing and intradermal testing with iohexol and ioversol were positive. We postulate that local immunological changes in the skin, such as an increased number and/or accelerated activity of Langerhans cells and mast cells in the herpes zoster lesions, were responsible for this phenomenon. This "recall-like phenomenon", occurring preferentially in skin previously affected by herpes zoster, could facilitate understanding of the pathology of drug eruptions. PMID: 17040501 [PubMed - indexed for MEDLINE] 793. J Drugs Dermatol. 2006 Oct;5(9):863-6. A novel vaccine (Zostavax) to prevent herpes zoster and postherpetic neuralgia. Holcomb K, Weinberg JM. Department of Dermatology, St. Luke's-Roosevelt Hospital Center and Beth Israel Medical Center, New York, NY 10025, USA. Varicella-zoster virus is the causal agent of varicella and herpes zoster in humans. Herpes zoster results from reactivation of latent varicella-zoster virus (VZV) within the sensory ganglia. The incidence and severity of herpes zoster increase with advancing age. More than half of all persons in whom herpes zoster develops are older than 60 years. The most frequent debilitating complication is postherpetic neuralgia, a neuropathic pain syndrome that persists or develops after the dermatomal rash has healed and can be prolonged and disabling. There are many limitations of current therapies for herpes zoster and postherpetic neuralgia. A live attenuated VZV vaccine has been developed and recently approved by the FDA for the prevention of herpes zoster in individuals 60 years of age and older. In a randomized, double-blind, placebo-controlled trial with 38,546 patients 60 years of age or older, the use of the zoster vaccine reduced the burden of illness due to herpes zoster by 61.1% (P < .001), reduced the incidence of postherpetic neuralgia by 66.5% (P < .001), and reduced the incidence of herpes zoster by 51.3% (P < .001). In this review, we will discuss the history of the use of the varicella vaccine in children, and the subsequent development of the new zoster vaccine. PMID: 17039651 [PubMed - indexed for MEDLINE] 794. J Am Pharm Assoc (2003). 2006 Sep-Oct;46(5):647-9. Shingles prevention: vaccine presents opportunity to pharmacists. Hayney MS. School of Pharmacy, University of Wisconsin, Madsion, USA. mshayney@pharmacy.wisc.edu PMID: 17036653 [PubMed - indexed for MEDLINE] 795. Paediatr Respir Rev. 2006;7 Suppl 1:S328. CR8-194--A case of fulminated fatal disseminated Varicella Zoster virus infection with severe pulmonary damage. Kobayashi Y, Watanabe T, Inoue Y, Arakawa H, Mochizuki H, Tokuyama K, Morikawa A. Gunma University Graduate School of Medicine, Pediatrics and Developmental Medicine, Maebashi, Gunma, Japan. PMID: 17036409 [PubMed - indexed for MEDLINE] 796. J Clin Microbiol. 2006 Dec;44(12):4441-3. Epub 2006 Oct 11. Relationship between preexisting anti-varicella-zoster virus (VZV) antibody and clinical VZV reactivation in hematopoietic stem cell transplantation recipients. Onozawa M, Hashino S, Takahata M, Fujisawa F, Kawamura T, Nakagawa M, Kahata K, Kondo T, Ota S, Tanaka J, Imamura M, Asaka M. Department of Gastroenterology and Hematology, Hokkaido University Graduate School of Medicine, Kita-15, Nishi-7, Kita-ku, Sapporo, Hokkaido 060-8638, Japan. masahiro.onozawa@nifty.ne.jp Reactivation of latent varicella-zoster virus (VZV), presenting as localized zoster or as disseminated infection, is a common and potentially serious complication in hematopoietic stem cell transplantation (HSCT) recipients. We retrospectively studied anti-VZV immunoglobulin G titers by the immune adherence hemagglutination method after HSCT and also studied VZV DNA by real-time PCR during clinical VZV reactivation using cryopreserved serum samples. No significant difference was found between anti-VZV titers in 13 patients with VZV infection (localized zoster in 11 patients and disseminated zoster in 2 patients) and in 13 subjects without VZV infection at each time point after HSCT. Preexisting anti-VZV titers of disseminated zoster cases tended to be lower than those of localized zoster cases (P=0.10). Serum VZV DNA copy numbers at the onset of disseminated zoster cases tended to be higher than those of localized zoster cases (P=0.09). A strong inverse correlation was found between preexisting anti-VZV titer and serum VZV DNA at onset (r=-0.90, P=0.006). In HSCT recipients, preexisting antibody does not prevent the development of VZV reactivation but may contribute to decreased viral load at onset, resulting in a mild clinical course. PMCID: PMC1698415 PMID: 17035500 [PubMed - indexed for MEDLINE] 797. J Med Microbiol. 2006 Nov;55(Pt 11):1587-90. Intractable colitis associated with chronic granulomatous disease. Arimura Y, Goto A, Yamashita K, Endo T, Ikeda H, Tanaka K, Tsutsumi H, Shinomura Y, Imai K. First Department of Internal Medicine, Sapporo Medical University, S-1, W-16, Chuo-ku, Sapporo 060-8543, Japan. arimura@sapmed.ac.jp Comment in: J Med Microbiol. 2007 Sep;56(Pt 9):1253; author reply 1254. The case of a 20-year-old Japanese man, diagnosed as having autosomal recessive chronic granulomatous disease (CGD), who was being treated with corticosteroids for intractable unclassified colitis, is described. He died from multiple organ failure following disseminated intravascular coagulation secondary to disseminated varicella-zoster virus (VZV) infection. He was diagnosed as an index case of CGD when 2 years old, was inoculated against VZV at the age of 5 years and had had an unremarkable course for 19 years. He was admitted to hospital because of a third episode of recurrent bloody diarrhoea. Clinical remission for each episode was achieved by intravenous corticosteroid therapy. Unclassified colitis associated with CGD was diagnosed based on a colonic biopsy demonstrating characteristic macrophages with lipofuscin deposits. From a treatment viewpoint, idiopathic inflammatory bowel disease (IBD) should be differentiated from secondary IBD occurring in CGD, in which immunosuppressive drugs including corticosteroids, still the mainstay of IBD treatment, should be avoided. PMID: 17030921 [PubMed - indexed for MEDLINE] 798. Rev Neurol (Paris). 2006 Sep;162(8-9):879-87. [Neurological complications of Herpes zoster] [Article in French] Mathis S, Gil R, Neau JP. Clinique Neurologique, CHU La Milétrie, Poitiers. INTRODUCTION: Herpes zoster is a disease which occurs secondary to the reactivation of varicella-zoster virus (VZV). Its frequency is high in the general population. STATE OF ART: Herpes zoster leads to numerous complications, among which there were neurological peripheral or central lesions. Antiviral treatment must be instituted, particularly if neurological complications develop, as soon as possible. Corticosteroid therapy can be used, especially in Ramsay-Hunt syndrome or central nervous system involvement. CONCLUSION: Herpes-zoster is a frequent disease which can lead to serious neurological complications. Early treatment is necessary in order to improve functional outcome. PMID: 17028554 [PubMed - indexed for MEDLINE] 799. J Neuropathol Exp Neurol. 2006 Oct;65(10):1022-30. Latency of alpha-herpes viruses is accompanied by a chronic inflammation in human trigeminal ganglia but not in dorsal root ganglia. Hüfner K, Derfuss T, Herberger S, Sunami K, Russell S, Sinicina I, Arbusow V, Strupp M, Brandt T, Theil D. Department of Neurology, Klinikum Grosshadern, Ludwig-Maximilians University, Munich, Germany. The immune response to latent herpesvirus infections was compared in human trigeminal ganglia (TG) and dorsal root ganglia (DRG) of 15 dead individuals. On the basis of our previous findings, we hypothesized that T-cells would be attracted to sensory neurons latently infected with herpes simplex virus type 1 (HSV-1), but not to those harboring latent varicella zoster virus (VZV). We showed that the TG contain a positive hybridization signal for HSV-1 latency-associated transcript (LAT), whereas the DRG from the same individuals lack detectable LAT. In contrast, immunohistochemistry revealed that latent VZV protein 62 stained positive in the vast majority of all tested TG and DRG. T-cell infiltrates prominently surrounded individual neurons in the TG but not in the DRG. TaqMan polymerase chain reaction also showed higher expression of CD8 and RANTES transcripts in the TG versus DRG. Only the infiltrates in the TG, but not in the DRG, produced RANTES at the protein level. Because it has been shown that RANTES protein is produced only after T-cell receptor stimulation, we assume that T-cell infiltration is associated with antigen recognition in the TG but not in the DRG. PMID: 17021407 [PubMed - indexed for MEDLINE] 800. Aust Fam Physician. 2006 Oct;35(10):789-90. Localised herpes zoster infection and SIADH. O'Rourke F, Chilov M. Aged Care and Rehabilitation, Bankstown- Lidcombe Hospital, New South Wales, Australia. fintan.o'rourke@swsahs.nsw.gov.au Localised herpes zoster infection ('shingles') in older patients is a common presentation to primary, and sometimes secondary, care physicians. However, symptoms of hyponatraemia, caused by the rare complication of 'syndrome of inappropriate antidiuretic hormone secretion' (SIADH), may be mistaken for constitutional symptoms of the infection itself. Such patients may require closer monitoring or hospitalisation. PMID: 17019453 [PubMed - indexed for MEDLINE] 801. J Dtsch Dermatol Ges. 2006 Oct;4(10):871-9; quiz 880-1. Zoster-associated neuralgias. [Article in English, German] Wassilew SW. Dermatology Clinic, Krefeld, Germany. dermatologie@klinikum-krefeld.de PMID: 17010178 [PubMed - indexed for MEDLINE] 802. Int Wound J. 2006 Jun;3(2):145-6. Nocturnal sedation in a child with facial ulceration. Patel GK, Motley RJ. Welsh Institute of Dermatology, University Hospital of Wales, Heath Park, Cardiff, UK. patelgk@cf.ac.uk Mostly, herpes zoster affects adults and therefore childhood presentation can represent a diagnostic challenge. Childhood herpes zoster, when it occurs, can also be associated with peripheral nerve complications, as illustrated by this case. A 3-year-old child who had herpes zoster developed a nasolabial scar resulting in a shallow non-healing ulcer from being repeatedly picked. Healing was only achieved after nocturnal sedation, with chloral hydrate. PMID: 17007345 [PubMed - indexed for MEDLINE] 803. Pancreas. 2006 Oct;33(3):314-5. Shingles-associated Pancreatitis. Famularo G, Minisola G, Nicotra GC. PMID: 17003657 [PubMed - indexed for MEDLINE] 804. Rheumatology (Oxford). 2006 Nov;45(11):1370-5. Epub 2006 Sep 26. Rates and predictors of herpes zoster in patients with rheumatoid arthritis and non-inflammatory musculoskeletal disorders. Wolfe F, Michaud K, Chakravarty EF. National Data Bank for Rheumatic Diseases, Arthritis Research Center Foundation, 1035 N. Emporia, Suite 230 Wichita, KS 67214, USA. fwolfe@arthritis-research.org OBJECTIVES: Herpes zoster (HZ) is a common disorder that causes substantial pain and morbidity. We examined its rate and predictors in rheumatoid arthritis (RA) and non-inflammatory musculoskeletal (MSK) disorders to determine if HZ was increased in RA and whether treatment contributed to the risk of HZ. METHODS: After excluding patients witzh prior HZ, we assessed 10 614 RA and 1721 MSK patients by semi-annual questionnaires during 33 825 patient-years of follow-up. Predictors of HZ were determined by Cox regression and expressed as hazard ratios (HR) and 95% confidence intervals (CI). RESULTS: The annualized incidence rate per 1000 patient-years was 13.2 (95% CI 11.9-14.5) in RA and 14.6 (95% CI 11.2-18.1) in MSK, and did not differ significantly after adjustment for age and sex. HZ was predicted by impaired functional status, as measured by the Health Assessment Questionnaire (HAQ), [HR 1.3 (95% CI 1.1-1.5)] and by the use of COX-2-specific non-steroidal anti-inflammatory drugs (NSAIDs) [HR 1.3 (95% CI 1.1-1.6)] in RA and MSK. In multivariable analyses in patients with RA, cyclophosphamide HR 4.2 (95% CI 1.6-11.5), azathioprine HR 2.0 (1.2-3.3), prednisone HR 1.5 (1.2-1.8), leflunomide HR 1.4 (1.1-1.8) and COX-2 NSAIDs HR 1.3 (95% CI 1.1-1.6) were significant predictors of HZ. CONCLUSION: The incidence of HZ is increased in RA and MSK compared with population-based rates. However, the rate of HZ in RA is not increased compared with MSK. After adjustment for severity, various treatments, but not methotrexate or biologics, were risk factors for HZ. PMID: 17003175 [PubMed - indexed for MEDLINE] 805. Ophthalmology. 2006 Dec;113(12):2259-61. Epub 2006 Sep 25. Primary treatment of acute retinal necrosis with oral antiviral therapy. Emerson GG, Smith JR, Wilson DJ, Rosenbaum JT, Flaxel CJ. Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA. PURPOSE: To explore the possibility of oral antiviral therapy in lieu of intravenous acyclovir for treating acute retinal necrosis (ARN), a necrotizing retinopathy caused by herpes simplex virus type 1 or 2 or by varicella zoster virus. DESIGN: Retrospective, interventional, small case series. PARTICIPANTS: Four patients (6 eyes). METHODS: Patients were treated with oral antiviral therapy. Medications included valacyclovir (1 g 3 times daily), oral famciclovir (500 mg 3 times daily), and topical and oral corticosteroids. MAIN OUTCOME MEASURES: Improvement of symptoms, including photophobia, blurred vision, ocular discomfort, and floaters; increase in visual acuity; and resolution of vitreitis, retinitis, and retinal vasculitis, where present. RESULTS: Symptoms and visual acuity improved within 2 weeks to 1 month in 3 of 4 patients (75%) treated with oral antiviral medication. One patient required surgical treatment for asymptomatic retinal detachment after 3 weeks of treatment; retinal detachment in the fellow eye was repaired 2 months later. Duration of antiviral therapy ranged from 5 weeks to 3 months. CONCLUSIONS: For 4 patients with relatively indolent cases of ARN, oral antiviral therapy alone was effective in eliminating signs and symptoms of the disease. In particular, oral valacyclovir and famciclovir appeared to be effective, although further study is necessary to determine whether these drugs are as effective as intravenous acyclovir for initial treatment of ARN. PMID: 16996614 [PubMed - indexed for MEDLINE] 806. Expert Rev Vaccines. 2006 Aug;5(4):431-43. Prevention of shingles by varicella zoster virus vaccination. Holodniy M. VA Palo Alto Health Care System, 3801 Miranda Ave. (132), Palo Alto, CA 94306, USA. mark.holodniy@va.gov Herpes zoster is caused by reactivation from previous varicella zoster virus (VZV) infection, and affects millions of people worldwide. It primarily affects older adults and those with immune system dysfunction, most likely as a result of reduced or lost VZV-specific cell-mediated immunity. Complications include post-herpetic neuralgia, a potentially debilitating and chronic pain syndrome. Current treatment of herpes zoster and post-herpetic neuralgia involves antiviral agents and analgesics, and is associated with significant economic cost. Results from several clinical trials have determined that a live, attenuated VZV vaccine using the Oka/Merck strain (Zostavax) is safe, elevates VZV-specific cell-mediated immunity, and significantly reduces the incidence of herpes zoster and post-herpetic neuralgia in people over 60 years of age. Regulatory approval has recently been obtained and once launched, it is expected that this vaccine will significantly reduce the morbidity and financial costs associated with herpes zoster. Durability of vaccine response and possible booster vaccination will still need to be determined. PMID: 16989624 [PubMed - indexed for MEDLINE] 807. Consum Rep. 2006 Oct;71(10):62. Vaccines: more reasons to immunize. [No authors listed] PMID: 16981311 [PubMed - indexed for MEDLINE] 808. Med Lett Drugs Ther. 2006 Sep 11;48(1243):73-4. Herpes zoster vaccine (Zostavax). [No authors listed] A live attenuated varicella-zoster vaccine (Zostavax--Merck) has been approved by the FDA for prevention of herpes zoster (HZ; zoster; shingles) in persons > or = 60 years old. Each dose of Zostavax contains about 14 times as much varicella-zoster virus (VZV) as Varivax, which has been used in the US since 1995 to vaccinate against varicella (chicken pox). PMID: 16977285 [PubMed - indexed for MEDLINE] 809. J Virol. 2006 Dec;80(23):11806-16. Epub 2006 Sep 13. ORF66 protein kinase function is required for T-cell tropism of varicella-zoster virus in vivo. Schaap-Nutt A, Sommer M, Che X, Zerboni L, Arvin AM. Department of Pediatrics, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305-5208, USA. anne.s.nutt@gmail.com Several functions have been attributed to the serine/threonine protein kinase encoded by open reading frame 66 (ORF66) of varicella-zoster virus (VZV), including modulation of the apoptosis and interferon pathways, down-regulation of major histocompatibility complex class I cell surface expression, and regulation of IE62 localization. The amino acid sequence of the ORF66 protein contains a recognizable conserved kinase domain. Point mutations were introduced into conserved protein kinase motifs to evaluate their importance to ORF66 protein functions. Two substitution mutants were generated, including a G102A substitution, which blocked autophosphorylation and altered IE62 localization, and an S250P substitution, which had no effect on either autophosphorylation or IE62 localization. Both kinase domain mutants grew to titers equivalent to recombinant parent Oka (pOka) in vitro. pOka66G102A had slightly reduced growth in skin, which was comparable to the reduction observed when ORF66 translation was prevented by stop codon insertions in pOka66S. In contrast, infection of T-cell xenografts with pOka66G102A was associated with a significant decrease in infectious virus production equivalent to the impaired T-cell tropism found with pOka66S infection of T-cell xenografts in vivo. Disrupting kinase activity with the G102A mutation did not alter IE62 cytoplasmic localization in VZV-infected T cells, suggesting that decreased T-cell tropism is due to other ORF66 protein functions. The G102A mutation reduced the antiapoptotic effects of VZV infection of T cells. These experiments indicate that the T-cell tropism of VZV depends upon intact ORF66 protein kinase function. PMCID: PMC1642581 PMID: 16971426 [PubMed - indexed for MEDLINE] 810. Arch Neurol. 2006 Sep;63(9):1327. Abdominal pseudohernia caused by herpes zoster truncal D12 radiculoneuropathy. Mancuso M, Virgili MP, Pizzanelli C, Chiari A, Geri G, Michelassi MC, Galli R. Unit of Neurophysiopathology, Hospital Lotti, 56126 Pontedera, Italy. mmancuso@inwind.it PMID: 16966515 [PubMed - indexed for MEDLINE] 811. J Pediatr Health Care. 2006 Sep-Oct;20(5):300-3. Herpes zoster in childhood. Leung AK, Robson WL, Leong AG. Department of Pediatrics, University of Calgary, Alberta, Canada. Herpes zoster is caused by reactivation of latent varicella-zoster virus that resides in a dorsal root ganglion. Herpes zoster can develop any time after a primary infection. Because varicella vaccine is a live attenuated virus, herpes zoster can develop in a vaccine recipient. The incidence of herpes zoster among vaccine recipients is about 14 cases per 100,000 person-years. In young children, herpes zoster has a predilection for areas supplied by the cervical and sacral dermatomes. The most common complications are secondary bacterial infection, depigmentation, and scarring. Although the diagnosis of herpes zoster is based on a distinct clinical appearance, viral DNA analysis of the lesion by polymerase chain reaction or restriction fragment length polymorphism is necessary to differentiate wild from vaccine-type viruses. Acyclovir is the treatment of choice for herpes zoster. PMID: 16962434 [PubMed - indexed for MEDLINE] 812. Dermatol Online J. 2006 Sep 8;12(5):3. Zosteriform lichen planus. Perry D, Fazel N. University of California Davis, Department of Dermatology, USA. A 95-year-old woman presented with a 4-month history of a pruritic eruption involving her trunk, medial thighs, and lesions limited to the C5 dermatome of the left upper extremity. Punch biopsy supported a clinical diagnosis of zosteriform lichen planus. Linear lichen planus refers to lichen planus with a unilateral linear distribution. This variant may present as an example of the Wolf isotopic response, or more rarely, a de novo eruption on previously-normal skin. In very rare instances linear lichen planus presents in a segmental fashion corresponding to a dermatome and is termed zosteriform lichen planus. PMID: 16962018 [PubMed - indexed for MEDLINE] 813. Ann Intern Med. 2006 Sep 5;145(5):386-7. Shingles vaccine: effective and costly or cost-effective? Koplan JP, Harpaz R. Comment on: Ann Intern Med. 2006 Sep 5;145(5):317-25. PMID: 16954362 [PubMed - indexed for MEDLINE] 814. Ann Intern Med. 2006 Sep 5;145(5):317-25. Cost-effectiveness of a vaccine to prevent herpes zoster and postherpetic neuralgia in older adults. Hornberger J, Robertus K. SPHERE Institute and Acumen LLC, Burlingame, California 94010, USA. jhornberger@acumen-llc.com Comment in: Ann Intern Med. 2006 Sep 5;145(5):386-7. Summary for patients in: Ann Intern Med. 2006 Sep 5;145(5):I14. BACKGROUND: The Shingles Prevention Study showed that a varicella-zoster virus (VZV) vaccine administered to adults 60 years of age or older reduced the incidence of herpes zoster from 11.12 to 5.42 cases per 1000 person-years. Median follow-up was 3.1 years, and relative risk reduction was 51.3% (95% CI, 44.2% to 57.6%). OBJECTIVE: To assess the extent to which clinical and cost variables influence the cost-effectiveness of VZV vaccination for preventing herpes zoster in immunocompetent older adults. DESIGN: Decision theoretical model. DATA SOURCES: English-language data published to March 2006 identified from MEDLINE on herpes zoster rates, vaccine effectiveness, quality of life, medical resource use, and unit costs. Target Population: Immunocompetent adults 60 years of age or older with a history of VZV infection. Time Horizon: Lifetime. Perspective: U.S. societal. Interventions: Varicella-zoster virus vaccination versus no vaccination. Outcome Measures: Incremental quality-adjusted survival and cost per quality-adjusted life-year (QALY) gained. Results of Base-Case Analysis: By reducing incidence and severity of herpes zoster, vaccination can increase quality-adjusted survival by 0.6 day compared with no vaccination. One scenario in which vaccination costs less than 100,000 dollars per QALY gained is when 1) the unit cost of vaccination is less than 200 dollars, 2) the age at vaccination is less than 70 years, and 3) the duration of vaccine efficacy is more than 30 years. Results of Sensitivity Analysis: Vaccination would be more cost-effective in "younger" older adults (age 60 to 64 years) than in "older" older adults (age > or =80 years). Longer life expectancy and a higher level of vaccine efficacy offset a lower risk for herpes zoster in the younger group. Other factors influencing cost-effectiveness include quality-of-life adjustments for acute zoster, unit cost of the vaccine, risk for herpes zoster, and duration of vaccine efficacy. LIMITATIONS: The effectiveness of VZV vaccination remains uncertain beyond the median 3.1-year duration of follow-up in the Shingles Prevention Study. CONCLUSIONS: Varicella-zoster virus vaccination to prevent herpes zoster in older adults would increase QALYs compared with no vaccination. Resolution of uncertainties about the average quality-of-life effects of acute zoster and the duration of vaccine efficacy is needed to better determine the cost-effectiveness of zoster vaccination in older adults. PMID: 16954357 [PubMed - indexed for MEDLINE] 815. Ann Intern Med. 2006 Sep 5;145(5):I14. Summaries for patients. Cost-effectiveness of a vaccine to prevent herpes zoster (shingles) in older adults. [No authors listed] Original report in: Ann Intern Med. 2006 Sep 5;145(5):317-25. PMID: 16954354 [PubMed - indexed for MEDLINE] 816. J Clin Microbiol. 2006 Sep;44(9):3094-7. Serological detection of varicella-zoster virus-specific immunoglobulin G by an enzyme-linked immunosorbent assay using glycoprotein antigen. Sauerbrei A, Wutzler P. Institute of Virology and Antiviral Therapy, University Clinic of Jena, Postfach, Hans-Knoell-Strasse 2, D-07745 Jena, Germany. Andreas.Sauerbrei@med.uni-jena.de Since the introduction of varicella vaccination in several countries, there has been an urgent need for commercially available test procedures that allow highly sensitive and specific quantitative determination of the varicella-zoster virus (VZV)-specific immune status, including immunity postimmunization. This study compared the performance of two enzyme-linked immunosorbent assays (ELISAs) for the sensitive and specific determination of VZV-specific immunoglobulin G (IgG) in seronegative and latently infected persons, as well as in vaccinees. One ELISA is based on the detection of antibody to VZV-specific envelope glycoproteins (gp), and the other comprises the whole antigen extract prepared from VZV-infected cells. A modified standard fluorescent-antibody-to-membrane-antigen (FAMA) assay was used as a reference. An excellent sensitivity (100%) in relation to FAMA was demonstrated for the gpELISA (Virion\Serion), while the non-gpELISA (Dade Behring) had a lower sensitivity (83%) when sera from latently infected persons were tested. After postvaccinal immunity was measured, a sensitivity of 87% was achieved with gpELISA, whereas the ELISA incorporating antigen extract of VZV-infected cells had a sensitivity of 78%. Excellent specificity (100%) was calculated for both the gpELISA and the non-gpELISA. In conclusion, SERION ELISA classic VZV IgG is useful for the sensitive and specific quantitative determination of VZV immune status after natural infection. The test can also be recommended for measuring antibody response after varicella vaccination, particularly after the cutoff value was optimized. PMCID: PMC1594709 PMID: 16954232 [PubMed - indexed for MEDLINE] 817. Nursing. 2006 Sep;36(9):25-6. Heading off the pain of postherpetic neuralgia. D'Arcy Y. Pain Management and Palliative Care, Suburban Hospital, Bethesda, MD, USA. PMID: 16951600 [PubMed - indexed for MEDLINE] 818. Photodermatol Photoimmunol Photomed. 2006 Oct;22(5):232-7. Broad-band ultraviolet B phototherapy in zoster patients may reduce the incidence and severity of postherpetic neuralgia. Jalali MH, Ansarin H, Soltani-Arabshahi R. Department of Dermatology, Hazrat-e Rasool University Hospital, Iran University of Medical Sciences, Tehran, Iran. BACKGROUND: Postherpetic neuralgia (PHN) is one of the common complications of herpes zoster infection, particularly in the elderly. Current therapeutic measures are only partially effective in the affected patients. As inflammatory mediators released by different cells play an important role in the pathogenesis of this neuropathic pain and with regard to the immunomodulatory effects of ultraviolet B (UVB) spectrum, we presumed that UVB phototherapy might be effective in the prevention of PHN. METHOD: This study was performed in two phases. Phase I was a prospective open controlled trial. Twenty-five patients with severe pain in the first 7 days of zoster rash were divided into two groups: the prevention group (n=12) received oral acyclovir (800 mg five times a day for 10 days) plus broad-band UVB to the affected dermatomes, starting with 20 mJ/cm(2) and gradually increasing the dose by 10 mJ/cm(2) each session to a maximum dose of 100 mJ/cm(2). Treatment sessions were repeated three times a week until pain relief or to a maximum of 15 sessions. The control group (n=13), who had disease characteristics similar to the prevention group, received only oral acyclovir with the same dose. All patients reported their severity of pain on a verbal rating scale (VRS, score 0-4) before treatment and at 1 and 3 months' follow-up. In phase II of the study, five patients with established PHN (more than 3 months after rash onset) received UVB with the above-mentioned protocol. RESULTS: A total of 17 patients older than 40 (10 females, seven males; mean age, 65.5 years; range: 47-82 years) who had intractable pain due to zoster infection received UVB in two phases of the study. In patients who received phototherapy in the first 7 days of rash, 58.33% and 83.33% were completely pain free at 1-and 3-month follow-up, respectively. The corresponding figure in the control group was significantly lower (38.46% at 1 month and 53.85% at 3 months). The severity of pain was also lower in the phototherapy group than the control group (mean VRS 2.50 vs. 3.28 at 3 months). None of the patients who were treated more than 3 months after rash onset (established PHN) experienced significant (more than 50%) pain relief. CONCLUSION: UVB phototherapy in the acute stage of zoster rash might reduce the incidence and severity of PHN. Treatment after 3 months does not seem to have a significant beneficial effect. PMID: 16948824 [PubMed - indexed for MEDLINE] 819. S D Med. 2006 Aug;59(8):349-50. Shingles vaccine: who should get it? Johnson AM. South Dakota State University, VA Medical Center, Sioux Falls, USA. PMID: 16941852 [PubMed - indexed for MEDLINE] 820. Int J Toxicol. 2006 Sep-Oct;25(5):313-7. The case against universal varicella vaccination. Goldman GS. Medical Veritas International Inc., Pearblossom, California 93553, USA. pearblossominc@aol.com In 1995, the United States became the first country to implement a Universal Varicella Vaccination Program. Several questions remain: Is the varicella (chickenpox) vaccine needed? Is it cost effective as a routine immunization for all susceptible children? Or is it more beneficial for the disease to remain endemic so that adults may receive periodic exogenous exposures (boosts) that help suppress the reactivation of herpes zoster (shingles). In addition, as vaccination coverage becomes widespread, does loss of immunologic boosting cause a decline in vaccine efficacy and result in a reduced period of immunity? Scientific literature regarding safety of the varicella vaccine and its associated cost-benefit analysis have often reported optimistic evaluations based on ideal assumptions. Deleterious outcomes and their associated costs must be included when making a circumspect assessment of the Universal Varicella Vaccination Program. PMID: 16940003 [PubMed - indexed for MEDLINE] 821. J Laryngol Otol. 2006 Sep;120(9):745-8. Delayed facial nerve palsy following tympano-mastoid surgery: incidence, aetiology and prognosis. Safdar A, Gendy S, Hilal A, Walshe P, Burns H. Department of Otolaryngology, Royal Victoria Eye and Ear Hospital, Dublin, Republic of Ireland. adnan_safdar@hotmail.com OBJECTIVE: To establish the frequency of occurrence of delayed facial nerve paralysis following tympano-mastoid surgery in our department and to determine the aetiological factors and long term prognosis. SETTING: Tertiary care academic centre. MATERIALS AND METHODS: A retrospective review of all patients who had undergone tympano-mastoid surgery in our department over the previous five years was carried out. A total of 219 patients were included in the study. Only two patients were identified as having delayed onset facial nerve palsy over this period of time. The patients' medical records were reviewed and the patients clinically assessed. RESULTS: The frequency of delayed onset facial nerve palsy following tympano-mastoid surgery in our series was 0.91 per cent. Facial weakness set in on day eight and day 14 in the two patients. Serological investigations in both patients revealed raised titres of immunoglobulin (Ig) M and IgG to varicella-zoster virus, confirming the presence of varicella-zoster infection. In our experience, the combined use of prednisone and acyclovir was an effective form of treatment for both patients, whose facial nerve function fully recovered within six months of onset. CONCLUSION: The incidence of delayed facial nerve palsy following tympano-mastoid surgery is low. It can occur up to two weeks after the surgery. Our two cases confirm viral reactivation to be an important aetiological factor in the development of delayed onset facial nerve palsy. The overall prognosis for delayed facial nerve palsy following tympano-mastoid surgery appears to be good. PMID: 16939665 [PubMed - indexed for MEDLINE] 822. Br J Nurs. 2006 Aug 10-Sep 13;15(15):814-8. Managing pain after shingles: a nursing perspective. Hawksley H. Chronic Pain Management Services, Chronic Pain Management Department, Ashford and St Peter's Hospitals NHS Trust, Chertsey, Surrey. Post-herpetic neuralgia (PHN) is the neuropathic pain syndrome that may develop following an attack of shingles. While for many the symptoms subside, there can be long-term pain problems for up to 40% of those affected with PHN, and for 3% of these, symptoms can be severe (Dworkin and Portenoy, 1996). Knowledge and understanding of the symptoms and various treatments and approaches available is important to enable nurses and patients to work together in partnership to achieve the best outcomes. Realizing that more than one approach may be needed can allow for treatments which are complementary and for optimization of both biomedical and self-care approaches. PMID: 16936604 [PubMed - indexed for MEDLINE] 823. Ann Rheum Dis. 2007 Feb;66(2):228-34. Epub 2006 Aug 25. Selective costimulation modulation using abatacept in patients with active rheumatoid arthritis while receiving etanercept: a randomised clinical trial. Weinblatt M, Schiff M, Goldman A, Kremer J, Luggen M, Li T, Chen D, Becker JC. Rheumatology and Immunology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA. mweinblatt@partners.org OBJECTIVE: To investigate the efficacy and safety of abatacept in combination with etanercept in patients with active rheumatoid arthritis during a 1-year, randomised, placebo-controlled, double-blind phase, followed by an open-label, long-term extension (LTE). METHODS: Patients continued etanercept (25 mg twice weekly) and were randomised to receive abatacept 2 mg/kg (n = 85) or placebo (n = 36). As the effective dose of abatacept was established as 10 mg/kg in a separate trial, all patients received abatacept 10 mg/kg and etanercept during the LTE. RESULTS: A total of 121 patients were randomised; 80 completed double-blind treatment and entered the LTE. During double-blind treatment, the difference in the percentage of patients achieving the primary end point (modified American College of Rheumatology (ACR) 20 response at 6 months) was not significant between groups (48.2% v 30.6%; p = 0.072). At 1 year, no notable changes in modified ACR responses were observed. Subsequent to the dosing change, similar modified ACR responses were seen during the LTE. Significant improvements in quality of life were observed with abatacept and etanercept versus placebo and etanercept in five of the eight short-form 36 subscales at 1 year. More abatacept and etanercept-treated patients experienced serious adverse events (SAEs) at 1 year than patients receiving placebo and etanercept (16.5% v 2.8%), with 3.5% v 0% experiencing serious infections. CONCLUSION: The combination of abatacept (at a dose of 2 mg/kg during the double-blind phase and 10 mg/kg during the LTE) and etanercept was associated with an increase in SAEs, including serious infections, with limited clinical effect. On the basis of the limited efficacy findings and safety concerns, abatacept in combination with etanercept should not be used for rheumatoid arthritis treatment. PMCID: PMC1798511 PMID: 16935912 [PubMed - indexed for MEDLINE] 824. Am J Ophthalmol. 2006 Sep;142(3):393-9. Herpes zoster ophthalmicus in otherwise healthy children. De Freitas D, Martins EN, Adan C, Alvarenga LS, Pavan-Langston D. Department of Ophthalmology, Federal University of São Paulo, SP, Rua Botucatu, São Paulo, Brazil. PURPOSE: To evaluate the complications of herpes zoster ophthalmicus (HZO) in children. DESIGN: Prospective-observational case series. METHODS: Ten healthy patients (five boys, five girls) with HZO were prospectively followed. Data regarding best-corrected visual acuity, biomicroscopy, intraocular pressure, corneal sensitivity, and funduscopy were collected. The median duration of follow-up was 19 months (range eight to 78 months). RESULTS: The mean age at presentation was 8.7 years (range two to 14 years +/-3.95). At last visit, two patients (20%) had decreased visual acuity and nine (90%) had some degree of abnormal corneal sensitivity and corneal opacity despite good final visual acuity. CONCLUSION: In general, HZO seems to have a good prognosis in healthy children; nonetheless, some cases can present severe eye complications causing visual loss. PMID: 16935582 [PubMed - indexed for MEDLINE] 825. Nat Clin Pract Neurol. 2006 Jun;2(6):298-9. Does acute pain associated with herpes zoster respond to treatment with gabapentin? Moulin D. Department of Clinical Neurological Sciences, University of Western Ontario, London, ON, Canada. dwight.moulin@lhsc.on.ca PMID: 16932569 [PubMed - indexed for MEDLINE] 826. Clin J Oncol Nurs. 2006 Aug;10(4):463-4. Rash: is it shingles? Marrs JA. Hematology and Oncology Associates, Dayton, Ohio, USA. joycemrn@sbcglobal.net CASE PRESENTATION: Mrs. Smith, a 56-year-old Caucasian woman, was seen in the office for complaints of a rash at her waist. She completed three cycles of dose-dense cyclophosphamide and doxorubicin chemotherapy for stage III breast cancer. The third cycle was 10 days prior. Grade III neutropenia was the only complete blood count abnormality. PMID: 16927898 [PubMed - indexed for MEDLINE] 827. Dent Update. 2006 Jul-Aug;33(6):378. Physical signs for the general dental practitioner: case 34, Herpes zoster (Dent Update 2006; 33: 252). Hodges S. Comment on: Dent Update. 2006 May;33(4):252. PMID: 16924733 [PubMed - indexed for MEDLINE] 828. Arch Dermatol. 2006 Aug;142(8):1069. A unique pattern of hyperhidrosis and herpes zoster. Wu JJ, Murase JE, Huang DB, Tyring SK. Comment on: Arch Dermatol. 2006 Feb;142(2):264. PMID: 16924065 [PubMed - indexed for MEDLINE] 829. Health News. 2006 Aug;12(8):2. Shingles vaccine gets the FDA nod. [No authors listed] PMID: 16917965 [PubMed - indexed for MEDLINE] 830. An Med Interna. 2006 May;23(5):249-50. [Acute cerebellar ataxia in an adult] [Article in Spanish] Campos Franco J, Rodríguez Framil M, Martínez Rey C, Pose Reino A. PMID: 16913074 [PubMed - indexed for MEDLINE] 831. Oral Dis. 2006 Sep;12(5):500-5. Herpes zoster in HIV infection with osteonecrosis of the jaw and tooth exfoliation. Siwamogstham P, Kuansuwan C, Reichart PA. Faculty of Dentistry, Chiang Mai University, Chiang Mai, Thailand. BACKGROUND: Herpes zoster (HZ) infection of the trigeminal nerve is associated with complications such as postherpetic neuralgia, facial scarring, loss of hearing ability and conjunctivitis. Until 2005, postherpetic alveolar necrosis and spontaneous tooth exfoliation have been described in 20 cases unrelated to HIV infection. OBJECTIVE: The aim of this study was to describe HIV infection in patients (two women, two men, average age 30 years) who suffered from HZ attacks to their trigeminal nerves. MAIN OUTCOME MEASURES: None of the patients had received antiherpetic medications or antiretroviral therapy. HIV infection was only diagnosed after the development of HZ. Facial scarring with depigmentation and hyperesthesia (postherpetic neuralgia) was diagnosed in all four patients. Oral findings consisted of spontaneous loss of both maxillary or mandibular teeth. Osteonecrosis of varying extent was also found. Treatment consisted of extractions of teeth and administration of antibiotics and analgesics. Healing of alveolar wounds was unremarkable. CONCLUSION: Complications affecting the alveolar bone and teeth seem to be rare in HIV-infected patients. PMID: 16910922 [PubMed - indexed for MEDLINE] 832. Clin Exp Dermatol. 2006 Sep;31(5):714-5. Tufted angioma in site of healed herpes zoster: isotopic response. Kim CY, Nam YH, Kim GD, Oh CW. PMID: 16901320 [PubMed - indexed for MEDLINE] 833. Lakartidningen. 2006 Jul 12-25;103(28-29):2164. [An unusual case] [Article in Swedish] Blixt L. PMID: 16897847 [PubMed - indexed for MEDLINE] 834. Herpes. 2006 Aug;13(2):32-6. Varicella zoster virus: out of Africa and into the research laboratory. Grose C. Department of Pediatrics, Children's Hospital of Iowa, University of Iowa, Iowa City, IA 52242, USA. This review updates on numerous topics relating to the evolutionary origins of varicella zoster virus (VZV), the replication cycle, virion assembly and the recent genomic analyses. VZV is one of eight human herpesviruses that have existed for at least 400 million years. It has co-evolved with humankind and is present in all nationalities globally. The pathogenesis of varicella (chickenpox) is dependent on viral replication and dispersion through the body in T-lymphocytes. VZV replication is similar to that of herpes simplex virus. A complete analysis of VZV transcripts has identified their relative abundance, with transcripts for the regulatory proteins (open reading frame) ORF62 and ORF63 among the greatest. Studies of virion assembly have shown that endocytosis pathways are involved in the envelopment process by the viral glycoproteins. The complete sequencing of five VZV strains has identified numerous single nucleotide polymorphisms, and in turn, VZV strains have been segregated into European/North American and Asian clades. Furthermore, a small number of mutant VZV strains have been identified. These results suggest more diversity between VZV strains than previously recognized. PMID: 16895651 [PubMed - indexed for MEDLINE] 835. J Travel Med. 2006 Jul-Aug;13(4):244-7. Extensive cutaneous larva migrans with folliculitis mimicking multimetameric herpes zoster presentation in an adult traveler returning from Thailand. Malvy D, Ezzedine K, Pistone T, Receveur MC, Longy-Boursier M. Travel Clinics and Tropical Disease Unit, Department of Internal Medicine, Infectious Diseases and Tropical Medicine, University Hospital Center, Bordeaux, France. Hookworm-related cutaneous larva migrans (CLM) is a frequent cutaneous disease among travelers returning from the tropics. It can be misdiagnosed or treated incorrectly. We present a 42-year-old French patient who contracted the disease during a holiday in Thailand and who experienced an extensive CLM syndrome with a less frequent abdominal localization and a pseudo-multimetameric homolateral topography. The condition was late diagnosed and secondarily efficiently cured by a unique administration of ivermectin. Simple anamnestic information--often revealing beach activities--and clinical aspect of the creeping eruption allow to prevent diagnosis delay and to avoid aggressive or inadequate intervention. PMID: 16884408 [PubMed - indexed for MEDLINE] 836. An Otorrinolaringol Ibero Am. 2006;33(3):225-9. [Bogorad syndrome or crocodile tears after Ramsay-Hunt] [Article in Spanish] Pino Rivero V, González Palomino A, Trinidad Ramos G, Pantoja Hernández CG, Marcos García M, Keituqwa Yáñez T, Blasco Huelva A. Complejo Hospitalario Infanta Cristina, Badajoz. vicentepinorivero@terra.com Crocodile tears or Bogorad Syndrome describes a complication or sequel after facial palsy with incomplete recovery characterized by an excessive hyperlacrimation during the food ingestion. We report the case of a 50 years old female with that pathology associated to facial syncinesias secondary to suffer a right Ramsay-Hunt syndrome. Its pathogenesis and different treatment modalities are analysed. PMID: 16881549 [PubMed - indexed for MEDLINE] 837. Indian J Dermatol Venereol Leprol. 2006 Jul-Aug;72(4):270-5. Refining criteria for diagnosis of cutaneous infections caused by herpes viruses through correlation of morphology with molecular pathology. Böer A, Herder N, Blödorn-Schlicht N, Steinkraus V, Falk TM. Division of Dermatopathology, Dermatologikum, Hamburg, Germany. boer@dermatologikum.de BACKGROUND: Infections of the skin by herpes viruses do not always present themselves in typical fashion. Early diagnosis, however, is crucial for appropriate treatment. Polymerase chain reaction (PCR) allows diagnosis and differential diagnosis of herpes virus infections, but the method is not yet available in large parts of the world, where diagnosis is made based on morphology alone. AIM: To refine criteria for the diagnosis of herpes virus infections of the skin by way of correlation of clinical and histopathologic findings with results of PCR studies. METHODS: We studied 75 clinically diagnosed patients of "zoster," "varicella," and "herpes simplex", to correlate clinical and histopathological findings with results of PCR studies on paraffin embedded biopsy specimens. RESULTS: Clinical suspicion of infection by herpes viruses was confirmed by histopathology in 37% of the cases and by PCR studies in 65% of the cases. Zoster was frequently misdiagnosed as infection with herpes simplex viruses (30%). When diagnostic signs of herpes virus infection were encountered histopathologically, PCR confirmed the diagnosis in 94%. By way of correlation with results of PCR studies, initial lesions of herpes virus infections could be identified to have a distinctive histopathological pattern. Herpetic folliculitis appeared to be a rather common finding in zoster, it occurring in 28% of the cases. CONCLUSION: We conclude that correlation of clinical and histopathological features with results of PCR studies on one and the same paraffin embedded specimen permits identification of characteristic morphologic patterns and helps to refine criteria for diagnosis both clinically and histopathologically. PMID: 16880572 [PubMed - indexed for MEDLINE] 838. Pediatr Infect Dis J. 2006 Aug;25(8):728-32. Herpes zoster in juvenile-onset systemic lupus erythematosus: incidence, clinical characteristics and risk factors. Lee PP, Lee TL, Ho MH, Wong WH, Lau YL. Department of Paediatrics and Adolescent Medicine, University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong, China. BACKGROUND: Herpes zoster (HZ) is common in systemic lupus erythematosus (SLE) patients, but its clinical features and risk factors in juvenile-onset SLE have not been well described before. METHODS: A retrospective review of the clinical course and infections in pediatric SLE patients managed in our institution from 1988-2004 was performed. Clinical characteristics and potential risk factors for HZ were analyzed. RESULTS: Forty-nine children with SLE were identified. Nineteen episodes of HZ were recorded in 15 patients, and 2 of them had recurrent HZ. The incidence rate was 58.7 episodes/1000 patient-years. No patient had disseminated HZ, postherpetic neuralgia, or cutaneous scarring, and no death was attributed to HZ. Most (63.2%) HZ occurred within 6 months from onset of SLE or disease flare-up. There was no significant difference in age of onset of SLE, gender, disease duration, use of high dose steroid, or other immunosuppressive agents in patients with and without HZ. Patients with HZ were more likely to have prior or concurrent lupus nephritis (86.7%) than those without HZ (58.5%) (P = 0.096). Occurrence of other major infections was also significantly more common in those who had HZ (80.0%) than those without (32.3%) (P = 0.006). CONCLUSIONS: Herpes zoster was common in juvenile-onset SLE patients. Most were benign, without systemic dissemination and postherpetic neuralgia. SLE patients with renal involvement and heightened lupus activity were at greater risk of having HZ. Those with HZ were also more likely to have other major infections during their disease course. PMID: 16874173 [PubMed - indexed for MEDLINE] 839. Drugs Aging. 2006;23(6):525-31; discussion 532-3. Zoster vaccine live (Oka/Merck). Robinson DM, Perry CM. Adis International Limited, Auckland, New Zealand. demail@adis.co.nz A subcutaneously administered, live, high-titre (18,700-60,000 plaque-forming units per dose) varicella zoster virus (VZV) vaccine (zoster vaccine) of the Oka/Merck strain has been evaluated for the prevention of herpes zoster and the reduction of zoster-associated pain in adults aged > or =60 years. Zoster vaccine, when compared with placebo, reduced the burden of herpes zoster illness by 61%, the incidence of herpes zoster by 51% and the incidence of postherpetic neuralgia by 67% during more than 3 years of surveillance. The zoster vaccine caused an initial 1.7-fold rise in VZV antibody titre after 6 weeks that declined progressively over 3 years. Increases in gamma-interferon-secreting peripheral blood mononuclear cells were 2.2-fold greater with the zoster vaccine than with placebo 6 weeks after vaccination. Zoster vaccine was generally well tolerated. The most frequently reported adverse reactions following vaccination were injection-site reactions; the only systemic adverse event with zoster vaccine that differed significantly in incidence from that with placebo was headache. PMID: 16872235 [PubMed - indexed for MEDLINE] 840. MMW Fortschr Med. 2006;Spec no.1:16. [Two U.S. experts discuss the consequences of the "Shingles Prevention Study". Is senior vaccination worthwhile in the practice?] [Article in German] [No authors listed] PMID: 16872128 [PubMed - indexed for MEDLINE] 841. MMW Fortschr Med. 2006;Spec no.1:14-5. [Study tests Varicella-Zoster vaccine for over 60-years-old persons. Protection from Herpes zoster and postherpetic neuralgia] [Article in German] [No authors listed] PMID: 16872127 [PubMed - indexed for MEDLINE] 842. MMW Fortschr Med. 2006;Spec no.1:7-12; quiz 13. [Varicella-zoster virus infections--2: Zoster pain -- therapy and prevention] [Article in German] Wassilew SW. Dermatologische Klinik, Klinikum Krefeld. SWassilew.Dermatologie@klinikum-krefeld.de PMID: 16872126 [PubMed - indexed for MEDLINE] 843. MMW Fortschr Med. 2006;Spec no.1:1-5; quiz 6. [Varicella-zoster virus infections. 1: Chickenpox and shingles. Treatment and prevention] [Article in German] Wassilew SW. Dermatologische Klinik, Klinikum Krefeld. SWassilew.Dermatologie@klinikum-krefeld.de PMID: 16872125 [PubMed - indexed for MEDLINE] 844. Forsch Komplementmed. 2006 Jun;13(3):184-6. Epub 2006 Jun 26. [Recurrent herpes zoster with neuralgia] [Article in German] Schwickert M, Saha J. Klinik für Innere Medizin V / Naturheilkunde und Integrative Medizin, Kliniken Essen-Mitte/ Knappschaftskrankenhaus, Essen, Deutschland. myriam.schwickert@kliniken-essen-mitte.de We present the case of a 40-year-old female patient suffering from recurrent herpes zoster and postherpetic neuralgia. Herpes zoster has recurred several times per year for more than 15 years. At admission, rash localised on the right sacral region and accompanied by neuralgia had lasted for 3 months. Standard out-patient treatment remained unsuccessful. A multimodal integrative therapy regimen including fasting, hydrotherapy, leech application and treatment with autologous blood led to rapid healing of herpetic lesions and persistent pain relief. The case is discussed. PMID: 16868364 [PubMed - indexed for MEDLINE] 845. Int J Hematol. 2006 Jul;84(1):79-82. Varicella-zoster virus encephalitis in a patient undergoing unrelated cord blood transplantation for myelodysplastic syndrome-overt leukemia. Fukuno K, Tomonari A, Takahashi S, Ooi J, Takasugi K, Tsukada N, Konuma T, Iseki T, Moriwaki H, Tojo A, Asano S. Department of Hematology/Oncology, The Institute of Medical Science, The University of Tokyo, Shirokanidae, Tokyo. Varicella-zoster virus (VZV) infection of the central nervous system (CNS) is rare after hematopoietic stem cell transplantation (SCT). Here, we describe the first patient who developed VZV encephalitis after cord blood transplantation (CBT). A 35-year-old man with myelodysplastic syndrome-overt leukemia underwent CBT. On day +23, a neutrophil count consistently greater than 0.5 x 10(9)/L was achieved. On day +42, 1 mg/kg per day of prednisolone therapy was initiated for grade III acute graft-versus-host disease (GVHD). Then, the dose of prednisolone was slowly reduced. For exacerbation of chronic GVHD, the dose of prednisolone was again increased to 1 mg/kg per day on day +231. On day +265, localized cutaneous zoster in the left thoracic region occurred, but soon resolved after acyclovir therapy. On day +309, he suddenly developed diplopia. Subsequently, right facial palsy and hearing impairment occurred. No skin rash was observed. Magnetic resonance imaging (MRI) scans revealed multifocal abnormal high-signal intensity in the CNS. A high level of VZV DNA was detected in a cerebrospinal fluid specimen. He was diagnosed with VZV encephalitis. Acyclovir was given intravenously for 40 days. Four months after the onset, the neurologic symptoms had incompletely resolved. MRI scans showed substantial resolution but with mild residual lesions. The present report indicates that VZV should be considered as a possible causative agent in patients who develop multifocal neurologic symptoms of the CNS after SCT. PMID: 16867908 [PubMed - indexed for MEDLINE] 846. Australas J Dermatol. 2006 Aug;47(3):189-91. Wolf's isotopic response: rosacea appearing at the site of healed herpes zoster. Sezer E, Koseoglu RD, Filiz N. Department of Dermatology, Gaziosmanpasa University Scholn of Medicine, Tokat, Turkey. eseze@yahoo.com A 40-year-old man developed an erythematous rash on the right side of his face 3 weeks after a herpes zoster infection at the same location. Examination revealed an erythematous papular eruption and telangiectasias along the ophthalmic and maxillary divisions of the right trigeminal nerve, exactly at the site of the consistent with previous herpes zoster infection, Wolf's isotopic response. Histological examination showed vascular ectatic dilatation and perivascular and perifollicular infiltration of lymphocytes and histiocytes consistent with rosacea. The rash was resistant to oral doxycycline and topical metronidazole 1% cream and resolved with oral isotretinoin therapy. PMID: 16867001 [PubMed - indexed for MEDLINE] 847. Breast J. 2006 Jul-Aug;12(4):385. Ulcerative carcinoma of the breast with zosteriform skin metastases. Torchia D, Palleschi GM, Terranova M, Antiga E, Melani L, Caproni M, Fabbri P. Department of Dermatological Sciences, University of Florence, Florence, Italy. PMID: 16848856 [PubMed - indexed for MEDLINE] 848. J Neurol Neurosurg Psychiatry. 2006 Aug;77(8):938-42. Epub 2006 Apr 25. Polymerase chain reaction analysis and oligoclonal antibody in the cerebrospinal fluid from 34 patients with varicella-zoster virus infection of the nervous system. Gregoire SM, van Pesch V, Goffette S, Peeters A, Sindic CJ. Department of Neurology, Université catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium. Comment in: J Neurol Neurosurg Psychiatry. 2006 Aug;77(8):901. OBJECTIVE: To study cerebrospinal fluid (CSF) and serum samples from 34 consecutive patients suspected of having varicella-zoster virus (VZV) infection of the central nervous system (CNS). Population and METHODS: The patients were divided into three groups. The first group consisted of 27 patients with a rash in one to three dermatomes and clinical suspicion of meningitis and radiculitis; among them, three subgroups were distinguished according to the affected dermatome: ophthalmicus (n = 9), oticus (n = 11) and cervico-thoraco-lumbar zoster (n = 7). Four cases of zoster sine herpete (ZSH) were included in the second group: these patients presented with either radiculitis (n = 2) or meningoencephalitis (n = 2), without cutaneous eruption. The third group consisted of three patients with a generalised rash and encephalitis. A polymerase chain reaction (PCR) for VZV DNA and antigen-driven immunoblots for oligoclonal anti-VZV antibodies were carried out on all CSF samples. RESULTS: PCR of the CSF was positive in 44% of the patients from the first group, mainly within the first 7 days after eruption. In addition, intrathecal synthesis of anti-VZV antibodies was detected in 37% of patients, always after an interval of 7 days (p<0.0001). Among the four patients with ZSH, a positive VZV PCR was detected in three patients and CSF-specific oligoclonal anti-VZV antibodies in two. PCR was also positive in the CSF of two of the three patients with generalised rash and encephalitis; local production of anti-VZV antibodies was seen in a second CSF sample in one patient, and was also present in the third patient. CONCLUSION: Amplification of VZV DNA by PCR in the CSF and antigen-driven immunoblots have important diagnostic value in suspected VZV infection, although their presence depends on the timing of the CSF sampling. VZV is thought to be a causative agent in unexplained cases of meningitis associated with radiculitis or focal CNS symptoms, even in the absence of skin manifestations. In such patients, rapid diagnosis by this combined approach permits early antiviral treatment. PMCID: PMC2077607 PMID: 16844949 [PubMed - indexed for MEDLINE] 849. Prim Dent Care. 2006 Jul;13(3):114-6. Spontaneous tooth exfoliation, maxillary osteomyelitis and facial scarring following trigeminal herpes zoster infection. Pillai KG, Nayar K, Rawal YB. SDM College of Dental Sciences and Hospital, Sattur, Dharwad, Karnataka, India. gopal@trinidad.net A case of trigeminal herpes zoster (HZ) infection affecting the left maxillary and ophthalmic divisions of the fifth cranial nerve in an immuno-competent patient is presented. Extremely rare complications such as osteonecrosis, spontaneous tooth exfoliation, secondary osteomyelitis and facial scarring were observed. Sequestrectomy, aciclovir and erythromycin stearate were effectively used in managing the case. PMID: 16836817 [PubMed - indexed for MEDLINE] 850. JAMA. 2006 Jul 12;296(2):157-8. FDA approves shingles vaccine: herpes zoster vaccine targets older adults. Mitka M. PMID: 16835412 [PubMed - indexed for MEDLINE] 851. N Engl J Med. 2006 Jul 6;355(1):e1. Images in clinical medicine. Abdominal pseudohernia due to herpes zoster. Tagg NT, Tsao JW. Walter Reed Army Medical Center, Washington, DC 20307, USA. PMID: 16822989 [PubMed - indexed for MEDLINE] 852. MMW Fortschr Med. 2006 Jun 1;148(22):53. [Painful vesicles of the ear] [Article in German] Leunig A. Oberarzt, Klinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde der Ludwig-Maximilians-Universität München. PMID: 16821584 [PubMed - indexed for MEDLINE] 853. Altern Med Rev. 2006 Jun;11(2):102-13. Herpes zoster and postherpetic neuralgia: diagnosis and therapeutic considerations. Roxas M. Thorne Research, PO Box 25, Dover, ID 83825, USA. m.roxas@comcast.net. Herpes zoster (HZ), also known as shingles, is a painful vesicular rash resulting from reactivation of the virus that also causes chickenpox - Varicella zoster virus (VZV). Typically, the rash runs its course in a matter of 4-5 weeks. The pain, however, may persist months, even years, after the skin heals. This phenomenon is known as postherpetic neuralgia (PHN). Often described as an intense burning, itching sensation, this pain can be significant to the point of being debilitating, and as such can greatly affect quality of life. Although shingles is generally regarded as a self-limited condition, the fact it can take several weeks to resolve and has the potential for development of complications such as PHN presents a challenge to clinicians. Many treatment options are available, each offering variable levels of efficacy. Conventional therapies include prescription antivirals, corticosteroids, and analgesics, both oral and topical. Other considerations include use of over-the-counter anti-inflammatory agents, physiotherapy, and nerve block injections. This article reviews herpes zoster and postherpetic neuralgia, and presents the most effective conventional treatment options currently available, as well as select botanical, nutritional, and other considerations that may be beneficial in the management of this condition. PMID: 16813460 [PubMed - indexed for MEDLINE] 854. Acta Haematol. 2006;116(1):58-61. Acute abdomen by varicella zoster virus induced gastritis after autologous peripheral blood stem cell transplantation in a patient with non-Hodgkin's lymphoma. Scholl S, Hocke M, Hoffken K, Sayer HG. Department of Internal Medicine II (Oncology/Hematology/Gastroenterology/Infectious Disease), Medical Faculty, Friedrich Schiller University, Jena, Germany. sebastian.scholl@med.uni-jena.de We report on a 54-year-old male patient with an aggressive T cell non-Hodgkin's lymphoma with abdominal manifestation undergoing autologous peripheral blood stem cell transplantation after high-dose chemotherapy in April 2003. About 4 months after transplantation, he developed severe upper abdominal pain. Ultrasound examination, X-ray, computed tomography of the abdomen and cardiac diagnostics could not explain the symptoms. While empiric therapy with high-dose acyclovir was started, we could document herpetic lesions in the gastric antrum by endoscopy. The epigastric pain rapidly decreased within several days after the start of acyclovir therapy. No herpetic skin lesions were observed at any time during the disease. This report demonstrates the importance of viral-induced gastritis in the differential diagnosis of severe abdominal pain in patients receiving autologous peripheral blood stem cell transplantation. PMID: 16809891 [PubMed - indexed for MEDLINE] 855. Acta Virol. 2006;50(2):121-8. JC polyomavirus reactivation is not associated with herpes zoster. Jeong BH, Park SJ, Koo DW, Kim YS. Ilsong Institute of Life Science, Hallym University, Kyonggi-do, South Korea. Herpes zoster (HZ) is a neurocutaneous disease caused by Varicella-zoster virus (VZV) as a consequence of declined cell-mediated immunity, immune suppression and immunodeficiency. As reactivation of JC polyomavirus (JCPyV) might be linked with immunodeficiency or immunosuppressive therapy, the relationship between HZ and JCPyV reactivation was investigated. The incidence of JCPyV in urine samples from 102 patients with HZ and 100 healthy individuals from South Korea was determined by PCR. The incidence values for HZ patients and control individuals did not differ significantly (24.5% vs. 20.0%, respectively, P = 0.5391). When different age groups were monitored, the positivity values of 21.1%, 20.0%, and 30% were found for 20-39, 40-59 and over 60 year-old patients, respectively. In order to determine the genotype of JCPyV isolates, their VP1-large T antigen (VT)-intergenic region was PCR amplified, sequenced and analyzed. Three distinct types, namely 1, 2A and 7B were found in 8%, 24%, and 68% of were found among 25 isolates from HZ patients. Using phylogenetic analysis, the type 1 isolates were assigned to the 1C subtype. These results indicate that HZ does not play an important role in JCPyV reactivation and is not associated with JCPyV. PMID: 16808330 [PubMed - indexed for MEDLINE] 856. Acta Neurochir (Wien). 2006 Aug;148(8):839-43; discussion 843. Epub 2006 Jun 29. Frequency and prognosis of delayed facial palsy after microvascular decompression for hemifacial spasm. Rhee DJ, Kong DS, Park K, Lee JA. Deparment of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. BACKGROUND: Microvascular decompression (MVD) for hemifacial spasm (HFS) provides a long-term cure rate. Delayed facial palsy (DFP) is not an unusual complication, but it has only been sporadically described in the literature. The purpose of this report is to evaluate the incidence of delayed facial palsy after MVD and its clinical course and final results. METHODS: From January, 1998 to April, 2004, 410 patients underwent microvascular decompression for hemifacial spasm at our Institute. During this time, 21 patients (5.4%) developed delayed facial weakness; eighteen of them were given steroid medication and they were followed up in the out-patient clinic. FINDINGS: Twenty-one patients developed DFP after microvascular decompression an incidence of 5.4%. There were seventeen women (81.0%) among the 21 patients with DFP who were included in this study. In twenty of them, the symptoms of HFS improved completely after the operation, but the spasm remained with one of them. The onset of palsy occurred between postoperative day 7 and 23 (average: 12.1 days). The palsy was at least Grade II or worse on the House-Brackmann (HB) scale. The time to recovery averaged 5.7 weeks (range: 25 days-17 weeks); 20 patients improved to complete recovery and 1 patient remained with minimal weakness, as Grade II on the HB scale, at the follow-up examination. CONCLUSION: Our findings demonstrated that the incidence of DFP was not so low as has been reported the literature, and it did not have any striking predisposing factors. Even though the degree of facial palsy was variable, almost all patients exhibited a complete recovery without any further special treatment. The etiology of DFP and its association with herpes infection should be further clarified. PMID: 16804640 [PubMed - indexed for MEDLINE] 857. Anaesth Intensive Care. 2006 Jun;34(3):382-3. Development of bilateral herpes zoster following thoracoscopic splanchnicectomy. Brandon EL, Akers J, Rapeport D. Department of Anaesthesia and Pain Medicine, Royal Perth Hospital, Western Australia. A 39-year-old female presented for elective bilateral thoracoscopic splanchnicectomy for chronic severe visceral pain. Surgery and anaesthesia were uneventful and she gained good symptomatic relief. Postoperative recovery was complicated by the development on day four of bilateral herpes zoster at the T8 dermatome level. This was treated immediately with oral acyclovir. She subsequently developed severe post-herpetic neuralgia requiring the recommencement of gabapentin and amitriptyline. Further benefit was gained from a course of calcitonin. This case report examines the possible causative factors in the development of post-surgical herpes zoster. PMID: 16802497 [PubMed - indexed for MEDLINE] 858. Actas Dermosifiliogr. 2006 Apr;97(3):206-7. [Cutaneous metastases of rectal adenocarcinoma in a herpetiform distribution] [Article in Spanish] Torné J, Bonaut B, Sanz C, Martínez C, Torrero MV, Miranda-Romero A. Servicio de Dermatología, Hospital Clínico Universitario, Valladolid, España. itorne@aedv.es We present the case of a 62-year-old male with cutaneous metastases of a rectal adenocarcinoma located on the groin and left thigh. Due to their clinical similarity, the lesions were initially diagnosed and treated as herpes zoster. Cutaneous metastases have variable clinical presentation patterns. They may mimic benign skin lesions like epidermoid cysts, lipomas, erysipelas or, as in our case, herpes zoster. PMID: 16796970 [PubMed - indexed for MEDLINE] 859. Rev Med Virol. 2006 Jul-Aug;16(4):225-50. Molecular studies of Varicella zoster virus. Quinlivan M, Breuer J. Centre for Infectious Diseases, Institute for Cell and Molecular Science, 4 Newark Street, Whitechapel, London, E1 2AT, UK. m_quinlivan@hotmail.com VZV is a highly cell-associated member of the Herpesviridae family and one of the eight herpesviruses to infect humans. The virus is ubiquitous in most populations worldwide, primary infection with which causes varicella, more commonly known as chickenpox. Characteristic of members of the alphaherpesvirus sub-family, VZV is neurotropic and establishes latency in sensory neurones. Reactivation from latency, usually during periods of impaired cellular immunity, causes herpes zoster (shingles). Despite being one of the most genetically stable human herpesviruses, nucleotide alterations in the virus genome have been used to classify VZV strains from different geographical regions into distinct clades. Such studies have also provided evidence that, despite pre-existing immunity to VZV, subclinical reinfection and reactivation of reinfecting strains to cause zoster is also occurring. During both primary infection and reactivation, VZV infects several PBMC and skin cell lineages. Difficulties in studying the pathogenesis of VZV because of its high cell association and narrow host range have been overcome through the development of the VZV severe combined immunodeficient mouse model carrying human tissue implants. This model has provided a valuable tool for studying the importance of individual viral proteins during both the complex intracellular replication and assembly of new virions and for understanding the underlying mechanism of attenuation of the live varicella vaccine. In addition, a rat model has been developed and successfully used to uncover which viral proteins are important for both the establishment and maintenance of latent VZV infection. PMID: 16791838 [PubMed - indexed for MEDLINE] 860. Euro Surveill. 2005 Jun 9;10(6):E050609.4. Research shows that highly potent vaccine reduces the burden of herpes zoster and the incidence of postherpetic neuralgia in older adults. Ciancio BC. European Programme Intervention Epidemiology Training (EPIET), London, England. bruno.ciancio@hpa.org.uk PMID: 16783098 [PubMed - indexed for MEDLINE] 861. Explore (NY). 2005 Jan;1(1):74. Postherpetic neuralgia in the left buttock after a case of shingles. Nielsen A. Continuum Center for Health and Healing, Beth Israel, USA. PMID: 16781505 [PubMed - indexed for MEDLINE] 862. J Spinal Disord Tech. 2006 Jun;19(4):299-301. Herpes zoster--varicella complicating anterior thoracic surgery: 2 case reports. Godfrey EK, Brown C, Stambough JL. University of Cincinnati College of Nursing, Cincinnati, OH, USA. This article reviews the reactivation of the latent varicella-zoster virus infection within the sensory dorsal root ganglia resulting in shingles. Although the association between surgery and reactivation of the varicella-zoster virus is known, we feel it is important to keep the diagnosis of shingles in mind especially in a patient with sudden onset of increased pain after surgery. Our purpose is to report 2 rare clinical presentations of shingles after spinal surgery in which the patient's initial diagnosis was not clear until the classical rash was observed. Two case reports are presented in which 1 patient developed shingles 5 days after surgery with distribution of the maculopapular rash in a surgical incision, whereas the second patient did not present until 4 weeks after surgery with a disseminated picture. Early recognition of this postoperative problem is imperative for prompt and appropriate management, as misdiagnosis can lead to short-term and long-term pain control issues, postherpetic neuralgia, neuropathic pain, or other related sequelae. PMID: 16778668 [PubMed - indexed for MEDLINE] 863. Am J Dermatopathol. 2006 Jun;28(3):194-6. Nodular herpes zoster with herpetic syringitis and no epidermal involvement in a patient with Burkitt lymphoma. Alonso-Pérez A, Fraga J, Delgado Y, Aragüés M, Nam-Cha S, García-Díez A. Department of Dermatology, Hospital Universitario de la Princesa, Madrid, Spain. palomalav@yahoo.es Herpes zoster (HZ) occurs with an increased incidence in immunosuppressed patients, in whom it frequently displays atypical clinical presentations. Herpetic syringitis, the involvement of the eccrine epithelium by herpes virus infection, is an infrequently described histologic pattern that has been rarely and almost exclusively reported in HIV-infected patients. We report the case of a woman with Burkitt lymphoma who developed 2 nodular, asymptomatic lesions while receiving treatment with chemotherapy and radiotherapy for her hematological disease. Histology showed viropathic changes in the epithelium of eccrine glands not in the epidermis. PCR was positive for varicella-zoster virus (VZV). Nodular herpes zoster seems to be an exceptional clinical presentation. We report another such case which is, as far as we know, the first report of herpetic syringitis with no concomitant epidermal involvement. PMID: 16778483 [PubMed - indexed for MEDLINE] 864. J Ayub Med Coll Abbottabad. 2006 Jan-Mar;18(1):64-5. Simultaneous onset of herpes zoster in a father and son. Raza N, Dar NR, Ejaz A. Department of Dermatology, Combined Military Hospital, Abbottabad. naeemraza561@hotmail.com The Varicella Zoster virus persists in sensory nerve ganglion cells after chicken pox and gets reactivated to cause herpes zoster after variable periods of time as a result of waning of specific cellular immunity. Susceptible contacts of herpes zoster can develop chicken pox and very rarely herpes zoster. We report an interesting case of a father and his son who developed herpes zoster simultaneously without any obvious common predisposition and discuss the possible underlying mechanism. PMID: 16773975 [PubMed - indexed for MEDLINE] 865. Expert Rev Anti Infect Ther. 2006 Jun;4(3):367-76. Valacyclovir for the treatment of genital herpes. Brantley JS, Hicks L, Sra K, Tyring SK. The University of Texas Medical Branch, Department of Dermatology, 301 University Boulevard, Galveston, TX 77555-0783, USA. jsbrantl@utmb.edu Genital herpes is the most prevalent sexually transmitted infection in the USA. While sometimes mild in severity, it can be a distressing and painful chronic condition. Likewise, herpes labialis and herpes zoster can be both physically and psychologically painful. While there is no cure for these conditions, treatment to alleviate symptoms, suppress recurrences and reduce transmission has been drastically improved over the past 20 years with the use of guanine nucleoside antivirals, such as valacyclovir hydrochloride (Valtrex), GlaxoSmithKline) the highly bioavailable prodrug of acyclovir (Zovirax((R)), GlaxoSmithKline), and famciclovir (Famvir, Novartis), a highly bioavailable prodrug of penciclovir (Denavir, Novartis). Clinical trials involving approximately 10,000 patients (including patients from nongenital herpes studies, such as herpes zoster) have assessed the safety and efficacy of valacyclovir in the treatment of initial genital herpes outbreaks, episodic treatment of recurrent episodes and daily suppressive therapy. It was shown that valacyclovir has similar efficacy to acyclovir in the episodic and suppressive treatment of genital herpes. Valacyclovir is the only antiviral drug approved for a once-daily dose of suppressive therapy for genital herpes, as well as the only antiviral drug US FDA approved for a 3-day regimen of episodic treatment of recurrent genital herpes. In addition, valacyclovir is also indicated in the reduction of the sexual transmission of herpes simplex virus infection and for the treatment of herpes labialis. In herpes zoster, valacyclovir is more effective than acyclovir or placebo (and as equally effective as famciclovir) in shortening the length and severity of herpes zoster-associated pain and postherpetic neuralgia. Valacyclovir has an acceptable safety profile in patients with herpes simplex and herpes zoster. The less frequent dosing regimen makes it an attractive option in the treatment of genital herpes and other viral infections, and may contribute to increased patient adherence to therapy. PMID: 16771614 [PubMed - indexed for MEDLINE] 866. Hernia. 2006 Aug;10(4):364-6; discussion 293. Epub 2006 Jun 13. Abdominal-wall postherpetic pseudohernia. Oliveira PD, dos Santos Filho PV, de Menezes Ettinger JE, Oliveira IC. Department of Surgery, Escola Bahiana de Medicina e Saúde Pública, Salvador, Bahia, Brazil. pedroebm@gmail.com Herpes zoster affects 10-20% of the general population. Motor complications sometimes occur in the segments corresponding to the involved sensory dermatomes causing abdominal wall pseudohernias. We present a case of a 57-year-old woman with herpes zoster characteristical rash following T11-T12 right dermatomes. Ten days after dermatologic manifestations onset, she had developed a protrusion at the abdominal wall on the right flank. The electroneuromyography confirmed axonal motor commitment, and morphological defects were ruled out by ultrasonography. The bulge totally disappeared after 4 months of observation. Postherpetic pseudohernia must be suspected when a patient develops signs and symptoms of motor dysfunction that coincide with or follow a herpes zoster eruption resulting in abdominal-wall herniation. A review of the literature concerning these extremely exceptional sequelae of herpes zoster is presented. PMID: 16770518 [PubMed - indexed for MEDLINE] 867. Cardiology. 2007;107(1):63-7. Epub 2006 Jun 7. Herpes zoster and its cardiovascular complications in the elderly--another look at a dormant virus. Ma TS, Collins TC, Habib G, Bredikis A, Carabello BA. Section of Cardiology, Department of Medicine, Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, TX 77030, USA. tma@bcm.tmc.edu Herpes zoster (shingles) is a reactivation of latent Varicella-zoster virus (VZV). We present a case of pleuropericarditis simulating acute myocardial infarction and another with complete heart block in the setting of acute/recent VZV reactivation. These cases are consistent with a modified concept: (1) the VZV dormancy is comprised of multiple foci of infections in the sensory and autonomic ganglia, and (2) the VZV reactivation could involve co-incident activations of two or more loci. Recognition of this possibility of cardiovascular complications of VZV should be helpful in the clinical management of the elderly, in the differential diagnosis of chest pain, ST elevation, and heart block etiology in the setting of acute or recent VZV reactivation. PMID: 16763386 [PubMed - indexed for MEDLINE] 868. Dent Update. 2006 May;33(4):252. Physical signs for the general dental practitioner. Bain S. University of Wales, Swansea. Comment in: Dent Update. 2006 Jul-Aug;33(6):378. PMID: 16756242 [PubMed - indexed for MEDLINE] 869. Epidemiol Infect. 2007 Jan;135(1):131-8. Epub 2006 Jun 2. Epidemiology of hospital admissions for paediatric varicella infections: a one-year prospective survey in the pre-vaccine era. Dubos F, Grandbastien B, Hue V; Hospital Network for Evaluating Management of Common Childhood Diseases, Martinot A. Paediatric Emergency Department, Jeanne de Flandre University Hospital, Lille, France. To evaluate the epidemiology of hospital admissions for varicella in children, a 1-year prospective multicentre study was done in Northern France in the pre-varicella vaccine era. The 405 children aged <16 years seen at local hospitals for varicella or herpes zoster were included. Among them, 143 who had varicella and resided in the district were admitted. Admission incidence rates were 28/100000 children aged <16 years (149/100000 infants aged <1 year, 69/100000 children aged 1-4 years, and 2/100000 children aged 5-15 years). Most admissions (57%) were related to complications, usually skin infection (47%). Independent risk factors for admission were place of residence outside the district [adjusted odds ratio (aOR) 8.7], complication at admission (aOR 5.8), recurrent fever (aOR 4.5), recent varicella in a sibling (aOR 4.0), and previous physician visit for the same condition (aOR 2.0). PMID: 16740185 [PubMed - indexed for MEDLINE] 870. Exp Hematol. 2006 Jun;34(6):770-5. Bortezomib after dose-reduced allogeneic stem cell transplantation for multiple myeloma to enhance or maintain remission status. Kröger N, Zabelina T, Ayuk F, Atanackovic D, Schieder H, Renges H, Zander A. Department of Bone Marrow Transplantation, Transplant Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. nkroeger@uke.uni-hamburg.de OBJECTIVE: We investigated the effect of at least two cycles of bortezomib (1.3 mg/m(2) intravenously, days 1, 4, 8, and 11) after dose-reduced allogeneic stem cell transplantation (SCT) on toxicity, CD3(+) cells, graft-versus-host disease (GvHD), and response in patients with multiple myeloma. METHODS: Eighteen patients with multiple myeloma without progressive disease were included. The proteasome inhibitor was given at median of 8 months after allografting to enhance or maintain remission status. RESULTS: Fourteen patients (78%) completed the proposed two cycles. Four patients had to discontinue therapy due to neurotoxicity (n = 3) or gastrointestinal toxicity (n = 1). Severe grade III/IV toxicity was seen for thrombocytopenia (50%), leukopenia (17%), or neuropathy (17%), which was more often seen in patients treated concomitantly with cyclosporine (p = 0.06). The median circulating CD3(+) cells decreased during treatment from 550 muL to 438 muL (p = 0.03), resulting in herpes zoster infection in three patients (17%). In three patients, a mild aggravation of existing acute or chronic GvHD of the skin, and in one patient de novo skin grade I acute GvHD was noted. In patients with measurable disease, complete remission, partial remission, and minor response was seen in 3 (30%), 5 (50%), and 2 (20%) patients, respective. CONCLUSION: Bortezomib after allogeneic SCT is effective but further studies are needed to balance the efficacy with potential hazards such as infectious complications, aggravation of GvHD, and neurotoxicity. PMID: 16728282 [PubMed - indexed for MEDLINE] 871. J Pediatr (Rio J). 2006 Jul;82(3 Suppl):S115-24. Epub 2006 May 19. Vaccines under development: group B streptococcus, herpes-zoster, HIV, malaria and dengue. da Silva LJ, Richtmann R. Diciplina de Infectologia, Departamento de clínica Médica, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil. ljsilva@unicamp.br OBJECTIVES: To review the current state of development of streptococcus B, herpes-zoster, HIV, malaria and dengue vaccines. These vaccines were selected both because of imminent commercial release and because of specific problems with their development. SOURCES OF DATA: A review of the literature was performed by means of a MEDLINE search, on the period 1996 to 2006, for the epidemiology and immunology of these diseases, analyzing both the greatest obstacles to creating a vaccine and the current state of research, with emphasis on studies in the most advanced stages. SUMMARY OF THE FINDINGS: Each of the five diseases chosen presents specific problems for vaccine development. Nevertheless, in the majority of cases these have been or are in sight of being resolved, allowing for the prediction that a safe and effective vaccine - or vaccines - will be available in the near future. CONCLUSIONS: Despite the problems faced in developing these vaccines, advances in molecular biology and immunology have made it possible to overcome most obstacles, opening up the prospects for new vaccines. PMID: 16721441 [PubMed - indexed for MEDLINE] 872. Bone Marrow Transplant. 2006 Jul;38(1):41-6. Epub 2006 May 22. Clinical relevance of quantitative varicella-zoster virus (VZV) DNA detection in plasma after stem cell transplantation. Kalpoe JS, Kroes AC, Verkerk S, Claas EC, Barge RM, Beersma MF. Department of Medical Microbiology, Leiden University Medical Center, Leiden, The Netherlands. Detection of Varicella-Zoster virus (VZV) DNA in plasma can facilitate the early recognition of complicated VZV-infection in immunocompromised hosts. The correlation of VZV-DNA in plasma with clinical presentations of VZV-infection and subsequent aciclovir treatment in allogeneic stem cell transplant (allo-SCT) recipients was studied. In 81 consecutive VZV-IgG positive allo-SCT recipients, VZV-DNA was measured at regular time points (1, 2 and 4 months) following allo-SCT and patient records were screened for VZV-related symptoms and aciclovir treatment. Subsequently, possible VZV-cases were studied in detail for the course of VZV-DNA and treatment effects. During the initial screening, VZV-DNA was detectable in seven patients. The survey of VZV-related symptoms revealed five additional possible VZV-cases. In cases where suitable plasma samples were available (10 out of 12), VZV-DNA was present almost simultaneously with the first clinical manifestations. No evidence of a preceding phase detectable by VZV-DNA only could be observed. Treatment with aciclovir was associated with a prompt reduction of VZV-DNA load. Detection of VZV-DNA in plasma in allo-SCT recipients accurately reflected the clinical presentation of VZV-infection and treatment with aciclovir. VZV-DNA detection in plasma of allo-SCT recipients appears clinically relevant as this may support early recognition and therapeutic management of VZV-infections following allo-SCT. PMID: 16715108 [PubMed - indexed for MEDLINE] 873. Ann Emerg Med. 2006 Jun;47(6):579, 584. Epub 2006 Feb 2. Images in emergency medicine. Ramsay Hunt syndrome: a rare entity. Bhagra A, Stead LG. Mayo Clinic, Rochester, MN, USA. PMID: 16713790 [PubMed - indexed for MEDLINE] 874. Pain Med. 2006 May-Jun;7(3):243-9; discussion 250. Postherpetic pain: more than sensory neuralgia? Weiner DK, Schmader KE. Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania 15206, USA. dweiner@pitt.edu OBJECTIVE: To describe a series of older adult patients with postherpetic myofascial pain, a heretofore rarely described complication of herpes zoster. DESIGN: Case series. SETTING: Outpatient older adult pain clinic. PATIENTS: Five older adults are presented with myofascial pain that developed as a complication of herpes zoster. RESULTS: Pain duration at the time of presentation ranged from 4 months to 7 years. All patients reported functional impairment from pain despite oral analgesics. Myofascial pathology was diagnosed by the presence of taut bands and trigger points in the affected myotome. Upon successful treatment of the myofascial pain with nonpharmacologic modalities (e.g., physical therapy, trigger point injections, dry needling, and/or percutaneous electrical nerve stimulation), all patients reported symptomatic improvement, and four out of five were able to significantly reduce or discontinue their opioids. CONCLUSION: Postherpetic pain is traditionally conceptualized as a purely sensory phenomenon. Identification of the intrusion of a myofascial component may be worthwhile, both from the standpoint of enhanced pain relief and reduction in the need for oral analgesics. Formal exploration of this phenomenon is needed. PMID: 16712624 [PubMed - indexed for MEDLINE] 875. Cutis. 2006 Apr;77(4):208. Two ounces of prevention. Weinberg JM. PMID: 16706234 [PubMed - indexed for MEDLINE] 876. J Plast Reconstr Aesthet Surg. 2006;59(2):206-7. An unusual cause of trismus: Ramsay Hunt syndrome. Akyol A, Kiylioglu N, Copcu E. PMID: 16703870 [PubMed - indexed for MEDLINE] 877. Eur J Epidemiol. 2006;21(6):469-73. Epub 2006 May 16. Impact of CCR5 Delta32/+ deletion on herpes zoster among HIV-1-infected homosexual men. Krol A, Lensen R, Veenstra J, Prins M, Schuitemaker H, Coutinho RA. Department of Research, Health Service of Amsterdam, Cluster, Infectious Diseases, Amsterdam, The Netherlands. akrol@ggd.amsterdam.nl The association between the presence of CCR5 Delta32 heterozygosity and incidence of clinical herpes zoster was studied among 296 homosexual men from the Amsterdam cohort study (ACS) infected with human immunodeficiency virus type I (HIV-1) with an estimated date of seroconversion. Of them 63 were CCR5 Delta32 heterozygotes and 233 CCR5 wild-type. The incidence rate of a first episode of herpes zoster was 4.2% and 5.3% per person-year, respectively. A higher occurrence of herpes zoster was strongly related to a lower CD4 + cell count. After adjustment for age, presence of CCR2b 64I heterozygosity, HIV RNA load, time since seroconversion, and CD4 + cell count, the rate ratio for herpes zoster of CCR5 Delta32 was 0.9 (95%CI 0.5-1.6). In conclusion, in HIV-1-infected homosexual men, a CCR5 Delta32 heterozygous genotype has no protective effect on the incidence of herpes zoster. PMID: 16703416 [PubMed - indexed for MEDLINE] 878. Drugs Today (Barc). 2006 Apr;42(4):249-54. Varicella-zoster virus vaccine: a review of its use in the prevention of herpes zoster in older adults. Caple J. Medical Information Department, Prous Science, Barcelona, Spain. journals@prous.com Current strategies for managing herpes zoster show variable efficacy and do not prevent its appearance. Varicella-zoster virus vaccine, or "zoster vaccine" is a more potent form of the varicella-zoster virus vaccine currently approved for use in the prevention of varicella in children. Zoster vaccine decreases the incidence of herpes zoster and burden of illness in adults aged 60 years and older and appears more efficacious in patients aged 60-69 than in those over 70 years. Importantly, the incidence of postherpetic neuralgia is significantly reduced in patients who receive zoster vaccine, irrespective of age or sex. The duration of postherpetic neuralgia is also significantly reduced. Zoster vaccine has a favorable safety profile; most treatment-related adverse events are related to the site of injection. This review summarizes the current data on the clinical efficacy and safety of zoster vaccine in adults aged 60 years and older. Copyright (c) 2006 Prous Science. All rights reserved. PMID: 16703121 [PubMed - indexed for MEDLINE] 879. Acta Otolaryngol. 2006 May;126(5):460-6. Inner ear and facial nerve complications of acute otitis media with focus on bacteriology and virology. Hydén D, Akerlind B, Peebo M. Department of Otolaryngology, Linköping University Hospital, Linköping, Sweden. dag.hyden@lio.se CONCLUSION: Among 20 patients with inner ear complications and/or peripheral facial palsy secondary to acute otitis media (AOM) a proven or probable bacteriological cause was found in 13 (65%). In seven patients (35%), a proven or probable viral cause was found. Only two of the patients (10%), with a proven bacterial AOM and a clinical picture of a purulent labyrinthitis in both, together with a facial palsy in one, had a substantial degree of dysfunction. Although the number of patients in this study is relatively low our findings show that inner ear complications and facial palsy due to AOM can be of both bacterial and viral origin. Severe sequelae were found only where a bacterial origin was proven. OBJECTIVES: Inner ear complications and/or peripheral facial palsy secondary to AOM are rare. The general understanding is that they are due to bacterial infections. However, in some of these patients there are no clinical or laboratory signs of bacterial infections and they have negative bacterial cultures. During recent years different viruses have been isolated from the middle ear or serologically proven in AOM patients and are thought to play a pathogenetic role. We suggest that in some cases of AOM complications from the inner ear and the facial nerve can be caused by viruses. The purpose of our study was to analyze infectious agents present in patients with inner ear complications and/or facial palsy arising from AOM. PATIENTS AND METHODS: The medical records of 20 patients who had inner ear complications and/or facial palsy following AOM ( unilateral in 18, bilateral in 2) between January 1989 and March 2003 were evaluated. Bacterial cultures were carried out for all patients. Sera from 12 of the patients were stored and tested for a battery of specific viral antibodies. In three patients, investigated between November 2002 and March 2003, viral cultures were also performed on samples from the middle ear and nasopharynx. RESULTS: Nineteen patients had inner ear symptoms. Eight of them had a unilateral sensorineural hearing loss and vertigo, three had vertigo as an isolated symptom and one, with bilateral AOM, had bilateral sensorineural hearing loss. Seven patients had a combination of facial palsy and inner ear symptoms (unilateral sensorineural hearing loss in three, unilateral sensorineural hearing loss and vertigo in two, bilateral sensorineural hearing loss and vertigo in one, with bilateral AOM, and vertigo alone in one). One patient had an isolated facial palsy. Healing was complete in 11 of the 20 patients. In seven patients a minor defect remained at follow-up (a sensorineural hearing loss at higher frequencies in all). Only two patients had obvious defects (a pronounced hearing loss in combination with a moderate to severe facial palsy (House-Brackman grade 4) in one, distinct vestibular symptoms and a total caloric loss in combination with a high-frequency loss in the other. Eight patients had positive bacteriological cultures from middle ear contents: Streptococcus pneumoniae in two, beta-hemolytic Streptococcus group A in two, beta-hemolytic Streptococcus group A together with Staphylococcus aureus in one, Staph. aureus alone in one and coagulase-negative staphylococci (interpreted as pathogens) in two. In the 12 patients with negative cultures, there was a probable bacteriological cause due to the outcome in SR/CRP and leukocyte count in five. In four patients serological testing showed a concomitant viral infection that was interpreted to be the cause (varicella zoster virus in two, herpes simplex virus in one and adenovirus in one.) In three there was a probable viral cause despite negative viral antibody test due to normal outcome in SR/CRP, normal leukocyte count, serous fluid at myringotomy and a relatively short pre-complication antibiotic treatment period. PMID: 16698694 [PubMed - indexed for MEDLINE] 880. Acta Otorrinolaringol Esp. 2006 Apr;57(4):189-92. [Varicella-zoster infection with isolated cochleovestibular affectation (without facial palsy)] [Article in Spanish] Gundín G, Monedero G, Teba JM, Pérez Esteban L, Sanz R. Servicio de Otorrinolaringología, Hospital Universitario de Getafe, Madrid. Otological complications of Ramsay Hunt syndrome include facial paralysis, tinnitus, hearing loss, vertigo, dysgeusia, and skin eruption. The lower cranial nerves sometimes are affected by this neuritis. A case is reported of a man without immune-system impairment who had a cranial mononeuritis with unilateral involment of the VIII and VII cranial nerves after infection with varicella-zoster without herpetic lesions. PMID: 16686230 [PubMed - indexed for MEDLINE] 881. J Neurol. 2006 Aug;253(8):1103-10. Epub 2006 May 6. Acute urinary retention due to benign inflammatory nervous diseases. Sakakibara R, Yamanishi T, Uchiyama T, Hattori T. Department of Neurology, Chiba University, 1-8-1 Inohana Chuo-ku, 260-8670 Chiba, Japan. sakakibara@faculty.chiba-u.jp Comment in: J Neurol. 2006 Aug;253(8):1102. Both neurologists and urologists might encounter patients with acute urinary retention due to benign inflammatory nervous diseases. Based on the mechanism of urinary retention, these disorders can be divided into two subgroups: disorders of the peripheral nervous system (e.g., sacral herpes) or the central nervous system (e.g., meningitis-retention syndrome [MRS]). Laboratory abnormalities include increased herpes virus titers in sacral herpes, and increased myelin basic protein in the cerebrospinal fluid (CSF) in some cases with MRS. Urodynamic abnormality in both conditions is detrusor areflexia; the putative mechanism of it is direct involvement of the pelvic nerves in sacral herpes; and acute spinal shock in MRS. There are few cases with CSF abnormality alone. Although these cases have a benign course, management of the acute urinary retention is necessary to avoid bladder injury due to overdistension. Clinical features of sacral herpes or MRS differ markedly from those of the original "Elsberg syndrome" cases. PMID: 16680560 [PubMed - indexed for MEDLINE] 882. J Postgrad Med. 2006 Apr-Jun;52(2):153-4. Cicatricial ectropion due to herpes zoster ophthalmicus. Sanghvi CA, Leatherbarrow B, Ataullah S. PMID: 16679689 [PubMed - indexed for MEDLINE] 883. Postgrad Med J. 2006 May;82(967):351-2. Chickenpox, chickenpox vaccination, and shingles. Welsby PD. Infectious Diseases Unit, Western General Hospital, Edinburgh EH4 2XU, UK. P.Welsby@ed.ac.uk Chickenpox in the United Kingdom, where vaccination is not undertaken, has had a stable epidemiology for decades and is a routine childhood illness. Because of vaccination, chickenpox is now a rarity in the USA. In the UK vaccination is not done because introduction of a routine childhood vaccination might drive up the age at which those who are non-immune get the illness (chickenpox tends to be more severe the older you are), and the incidence of shingles may increase. The United Kingdom is waiting to see what happens in countries where vaccination is routine. PMCID: PMC2563790 PMID: 16679476 [PubMed - indexed for MEDLINE] 884. Postgrad Med J. 2006 May;82(967):e6. A 2 year old with a rash. Martin K, Elias-Jones A. Department of Neonatology, Leicester General Hospital, Leicester LE5 4PW, UK. PMCID: PMC2563782 PMID: 16679462 [PubMed - indexed for MEDLINE] 885. Dermatol Clin. 2006 Apr;24(2):271-80, viii. Dermatologic problems of older women. Roberts WE. Loma Linda University Medical School, Loma Linda, and Desert Dermatology Medical Associates, 39-700 Bob Hope Drive, Suite 115, Rancho Mirage, CA 92270, USA. drwerderm@aol.com Women are living longer today, composing the majority of persons aged 65 and over. Their dermatologic needs are unique and cross ethnic and cultural lines. With this increased life expectancy comes an increased occurrence of skin disorders. The identification and treatment of these conditions is important for the practicing clinician. This article reviews some of the more common dermatologic disorders of older women, and discusses the latest treatments and issues facing this geriatric population. PMID: 16677973 [PubMed - indexed for MEDLINE] 886. Mayo Clin Womens Healthsource. 2006 Jun;10(6):6. Shingles. The return of the chickenpox virus. [No authors listed] PMID: 16675921 [PubMed - indexed for MEDLINE] 887. Encephale. 2005 Oct;31 Pt 2:S71-2. [Atypical hypersomnia] [Article in French] Marchand F, Pelatan C, Legout A. Service Hospitalo-Universitaire, Hôpital Sainte-Anne, 1, rue Cabanis, 75014 Paris. PMID: 16673716 [PubMed - indexed for MEDLINE] 888. Indian Pediatr. 2006 Apr;43(4):353-6. Herpes zoster with dissemination. Singal A, Mehta S, Pandhi D. Department of Dermatology and STD, University College of Medical Sciences and GTB Hospital, Delhi 110 095, India. Herpes zoster or shingles is an acute vesico-bullous cutaneous infection characterized by dermatomal distribution, predominantly in adults. Extensive cutaneous dissemination has been reported in immunocompromised patients. However, its existence is documented in immunocompetent individuals as well. We report two children with disseminated herpes zoster, one of whom was immunocompromised secondary to severe mal-nutrition and had associated orbital septal cellulitis. PMID: 16651676 [PubMed - indexed for MEDLINE] 889. J Eur Acad Dermatol Venereol. 2006 Apr;20(4):470-2. Cutaneous multifocal melanoma metastases clinically resembling herpes zoster. Kondras K, Zalewska A, Janowski P, Kordek R. PMID: 16643157 [PubMed - indexed for MEDLINE] 890. J Gastroenterol Hepatol. 2006 Mar;21(3):620. Gastrointestinal: Zosteriform metastases to the skin. Kamisawa T, Takahashi M, Nakajima H, Egawa N. PMID: 16638112 [PubMed - indexed for MEDLINE] 891. Georgian Med News. 2006 Mar;(132):60-4. Hiv prevalence among high risk behavior group persons with herpes zoster infection. Sharvadze L, Tsertsvadze T, Gochitashvili N, Stvilia K, Dolmazashvili E. Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia. The aim of the two year (2003-2005) study was to study the HIV prevalence among high risk behavior groups of persons with Herpes Zoster infection. For this purpose we have investigated the high risk group patients: 1257 prisoners (1st group), 1543 IDUs (2nd group) and 1350 persons including: homosexuals, persons with history of frequent unprotected sex and persons with hepatitis B and C (3rd group). We revealed the persons with current or previous history of Herpes Zoster, and studied HIV prevalence among them. Besides, we have studied the immune status of revealed HIV positive persons, relationship between disease (Herpes Zoster) severity and CD4 count. Herpes Zoster infection was diagnosed based on clinical symptoms, anamnesis and by detection of VZV specific IgM and IgG by ELISA. HIV infection was diagnosed by ELISA method and was confirmed by Western Blot. CD4 count was detected by immunophenotyping technique and was analyzed using a FACSCalibur flow cytometer. The total prevalence of HIV infection among high risk behavior group persons with Herpes Zoster infection was 18,9% (31 HIV cases out of 164). The disease (Herpes Zoster) severity and duration was associated with decreased rate of cellular immunity, CD4 count. Herpes Zoster has a positive predictive value for HIV infection, predominantly recurrent Herpes Zoster. Herpes Zoster should be recognized as a marker condition indicating the necessity of screening for HIV, especially in Georgia, the region where the problem of IDU exists. PMID: 16636383 [PubMed - indexed for MEDLINE] 892. Am J Kidney Dis. 2006 May;47(5):915-22. Fatal relapse of ANCA-associated glomerulonephritis triggered by successive Epstein-Barr and varicella zoster virus infections. Schned AR, Ornvold K, Tsongalis GJ, Chobanian MC. Department of Pathology, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA. alan.schned@dartmouth.edu PMID: 16632033 [PubMed - indexed for MEDLINE] 893. Rinsho Ketsueki. 2006 Mar;47(3):210-3. [Acyclovir combined with plasma exchange for disseminated varicella-zoster virus infection after bone marrow transplantation] [Article in Japanese] Lee C, Koike M, Oshimi K, Terakura S, Kodera Y. Department of Hematology, Juntendo University, Shizuoka Hospital. In 2001, a 45-year-old man with severe aplastic anemia received a bone marrow transplantation from his HLA-identical sister, 2.5 years after which he developed severe liver dysfunction together with abdominal pain, disturbance of consciousness and generalized vesicles. Disseminated varicella-zoster virus infection was diagnosed by the detection of VZV DNA. Acyclovir and plasma exchange rapidly controlled his VZV-related symptoms and signs. Disseminated VZV infection is often fatal, but acyclovir and plasma exchange may be useful for such infection by reducing the circulating viral load. PMID: 16629486 [PubMed - indexed for MEDLINE] 894. Suppl Clin Neurophysiol. 2006;58:153-70. Neuropathic facial pain. Haanpää M, Truini A. Pain Clinic, Department of Neurosurgery, Helsinki University Hospital, 00029 HUS, Helsinki, Finland. maija.haanpaa@hus.fi PMID: 16623329 [PubMed - indexed for MEDLINE] 895. Clin Otolaryngol. 2006 Apr;31(2):144-8. Prognostic value of electroneurography in Bell's palsy and Ramsay-Hunt's syndrome. Lee DH, Chae SY, Park YS, Yeo SW. Department of Otolaryngology - Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, South Korea. leedh0814@catholic.ac.kr OBJECTIVES: This study evaluated the accuracy of electroneurography to predict the prognosis of Bell's palsy and Ramsay-Hunt's syndrome. DESIGN: A retrospective, institutional review board-approved study. SETTING: A secondary referral and a university-based centre. PARTICIPANTS: The patients had been treated for a sudden onset unilateral facial paralysis over the past 10 years (1994-2004). This retrospective study included only those patients who had been followed up for at least 3 months or if they had reached a complete recovery before then. MAIN OUTCOMES MEASURES: House-Backmann grade versus electroneurography value. RESULTS: The recovery rates to House-Brackmann grade II or better were 95% in those with Bell's palsy and 84% in those with herpes zoster oticus. The electroneurography value of the recovery and non-recovery groups from those with either Bell's palsy or herpes zoster oticus was similar. The logistic regression model between the electroneurography values and the probability of recovery showed no correlation in those with Bell's palsy or with herpes zoster oticus. This study did not identify the proper electroneurography value that had enough appropriate sensitivity and specificity to predict the prognosis of paralysis accurately in Bell's palsy or in herpes zoster oticus patients. CONCLUSION: Electroneurography performed between day 7 and 10 for Bell's palsy or day 10 and 14 for herpes zoster oticus does not provide accurate information on the prognosis or recovery rate of the facial paralysis. PMID: 16620335 [PubMed - indexed for MEDLINE] 896. J Dermatol. 2006 Mar;33(3):233-5. Postherpetic paresis of the lower limb. Okamoto O, Kiyomoto Y, Okazaki T, Fujiwara S. PMID: 16620237 [PubMed - indexed for MEDLINE] 897. J Clin Virol. 2006 Jun;36(2):111-8. Epub 2006 Apr 17. European seroepidemiology network 2: Standardisation of assays for seroepidemiology of varicella zoster virus. de Ory F, Echevarría JM, Kafatos G, Anastassopoulou C, Andrews N, Backhouse J, Berbers G, Bruckova B, Cohen DI, de Melker H, Davidkin I, Gabutti G, Hesketh LM, Johansen K, Jokinen S, Jones L, Linde A, Miller E, Mossong J, Nardone A, Rota MC, Sauerbrei A, Schneider F, Smetana Z, Tischer A, Tsakris A, Vranckx R. Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain. fory@isciii.es BACKGROUND: The aim of the European Sero-Epidemiology Network (ESEN2) is to harmonise the serological surveillance of vaccine-preventable diseases in Europe. OBJECTIVE: To allow comparison of antibody prevalence in different countries by standardising results into common units. STUDY DESIGN: For varicella zoster virus (VZV), a reference laboratory established a panel of 148 samples, characterised by indirect enzyme-immunoassay (ELISA), indirect immunofluorescence, and complement fixation test. Fifty-seven samples were also studied by the fluorescence antibody to membrane antigen test. The geometric mean of the antibody activity (GMAA) obtained from four ELISA determinations was used to characterise each sample of the panel as positive (GMAA: >100 mIU/ml), equivocal (GMAA: 50-100 mIU/ml) or negative (GMAA: <50 mIU/ml) for antibody to VZV (anti-VZV). Thirteen laboratories, using five different ELISA tests, tested the panel. RESULTS: Agreement with the reference laboratory was above 85% in all cases, and the R(2) values obtained from regression analysis of the quantitative results were always higher than 0.87. Finally, the regression equations could be used to convert national values into a common unitage. CONCLUSION: This study confirmed that results for anti-VZV obtained by different ELISA methods can be converted into common units, enabling the comparison of the seroprevalence profiles obtained in the participant countries. PMID: 16616612 [PubMed - indexed for MEDLINE] 898. Nippon Rinsho. 2006 Mar;64 Suppl 3:321-5. [Varicella vaccine] [Article in Japanese] Kamiya H. National Hospital Organization Mie National Hospital. PMID: 16615492 [PubMed - indexed for MEDLINE] 899. Nippon Rinsho. 2006 Mar;64 Suppl 3:311-5. [Treatment of alpha herpesvirus infections in ophthalmology] [Article in Japanese] Shiota H, Nakahira T. Department of Ophthalmology & Visual Neuroscience, Institute of Health Biosciences, The University of Tokushima Graduate School. PMID: 16615490 [PubMed - indexed for MEDLINE] 900. Nippon Rinsho. 2006 Mar;64 Suppl 3:306-10. [Treatment of alpha-herpes virus infections] [Article in Japanese] Honda M. Department of Dermatology, Aoto Hospital, Jikei University School of Medicine. PMID: 16615489 [PubMed - indexed for MEDLINE] 901. Nippon Rinsho. 2006 Mar;64 Suppl 3:285-9. [Postherpetic neuralgia] [Article in Japanese] Miyazaki T, Tanabe Y, Iseki M. Department of Anesthesiology & Pain Medicine, Juntendo University, School of Medicine. PMID: 16615485 [PubMed - indexed for MEDLINE] 902. Nippon Rinsho. 2006 Mar;64 Suppl 3:281-4. [Ramsay Hunt syndrome] [Article in Japanese] Furuta Y. Department of Otolaryngology Head & Neck Surgery, Hokkaido University Graduate School of Medicine. PMID: 16615484 [PubMed - indexed for MEDLINE] 903. Nippon Rinsho. 2006 Mar;64 Suppl 3:272-5. [Meningitis] [Article in Japanese] Nakajima H. First Department of Internal Medicine, Osaka Medical College. PMID: 16615482 [PubMed - indexed for MEDLINE] 904. Nippon Rinsho. 2006 Mar;64 Suppl 3:260-3. [Herpes zoster] [Article in Japanese] Yoshida M. First Department of Dermatology, School of Medicine, Toho University. PMID: 16615479 [PubMed - indexed for MEDLINE] 905. Nippon Rinsho. 2006 Mar;64 Suppl 3:243-51. [Acute retinal necrosis due to herpesviridae infections] [Article in Japanese] Usui N. Department of Ophthalmology, Shinkawabashi Hospital. PMID: 16615476 [PubMed - indexed for MEDLINE] 906. Nippon Rinsho. 2006 Mar;64 Suppl 3:239-42. [Keratoconjunctivitis due to alphaherpesvirinae] [Article in Japanese] Shimomura Y. Department of Ophthalmology, Kinki University School of Medicine. PMID: 16615475 [PubMed - indexed for MEDLINE] 907. Nippon Rinsho. 2006 Mar;64 Suppl 3:234-8. [Serodiagnosis for alphaherpesvirinae infections] [Article in Japanese] Saito Y. Department of Infection and Immunology, SRL, Inc. PMID: 16615474 [PubMed - indexed for MEDLINE] 908. Nippon Rinsho. 2006 Mar;64 Suppl 3:230-3. [Diagnosis of VZV infection] [Article in Japanese] Ozaki T. Department of Pediatrics, Showa Hospital. PMID: 16615473 [PubMed - indexed for MEDLINE] 909. Nippon Rinsho. 2006 Mar;64 Suppl 3:221-5. [Epidemiology of VZV infection] [Article in Japanese] Suga S. Department of Pediatrics, Banbuntanehotokukai Hospital, Fujita Health University. PMID: 16615471 [PubMed - indexed for MEDLINE] 910. Nippon Rinsho. 2006 Mar;64 Suppl 3:184-7. [Immune responses to varicella-zoster virus infection] [Article in Japanese] Yasumoto S. Department of Dermatology, Kurume University School of Medicine. PMID: 16615464 [PubMed - indexed for MEDLINE] 911. Nippon Rinsho. 2006 Mar;64 Suppl 3:133-9. [Varicella-zoster virus genome and the genes] [Article in Japanese] Okuno T. Department of Microbiology, Hyogo College of Medicine. PMID: 16615454 [PubMed - indexed for MEDLINE] 912. Nippon Rinsho. 2006 Mar;64 Suppl 3:95-8. [Herpesvirus infections in dermatology] [Article in Japanese] Honda M. Department of Dermatology, Aoto Hospital, Jikei University School of Medicine. PMID: 16615448 [PubMed - indexed for MEDLINE] 913. Nippon Rinsho. 2006 Mar;64 Suppl 3:86-9. [Herpesvirus infection in the field of ophthalmology] [Article in Japanese] Shimomura Y. Department of Ophthalmology, Kinki University School of Medicine. PMID: 16615446 [PubMed - indexed for MEDLINE] 914. Nippon Rinsho. 2006 Mar;64 Suppl 3:81-5. [Herpes virus infection in obstetrics and gynecology] [Article in Japanese] Kawana T. Department of Obstetrics and Gynecology, Teikyo University School of Medicine, Mizonokuchi Hospital. PMID: 16615445 [PubMed - indexed for MEDLINE] 915. Nippon Rinsho. 2006 Mar;64 Suppl 3:73-6. [Herpesvirus infections in hematological diseases] [Article in Japanese] Karasuno T, Hiraoka A. Hematology/Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases. PMID: 16615443 [PubMed - indexed for MEDLINE] 916. Pediatr Blood Cancer. 2007 Jun 15;48(7):716. Disseminated Varicella-Zoster virus infection in a girl with T-lineage acute lymphoblastic leukemia. Akiyama M, Kobayashi N, Fujisawa K, Eto Y. Comment on: Pediatr Blood Cancer. 2005 Aug;45(2):191-4. PMID: 16607647 [PubMed - indexed for MEDLINE] 917. Am J Trop Med Hyg. 2006 Apr;74(4):591-2. Varicella zoster virus meningitis complicating sodium stibogluconate treatment for cutaneous leishmaniasis. Hartzell JD, Aronson NE, Nagaraja S, Whitman T, Hawkes CA, Wortmann G. Department of Internal Medicine, Walter Reed Army Medical Center, Washington, DC 20307-5001, USA. Joshua.hartzell@na.amedd.army.mil Sodium stibogluconate (Pentostam(R); GlaxoSmithKline) is a pentavalent antimonial compound used in the treatment of leishmaniasis, which has an association with reactivation of varicella zoster virus (VZV). We report the first known case of an immunocompetent adult who developed VZV aseptic meningitis and dermatomal herpes zoster during treatment with sodium stibogluconate. PMID: 16606989 [PubMed - indexed for MEDLINE] 918. Actas Dermosifiliogr. 2006 Mar;97(2):103-14. [Update in the treatment of herpes zoster] [Article in Spanish] España A, Redondo P. Departamento de Dermatología, Clínica Universitaria de Navarra, Facultad de Medicina, Spain. The systemic treatment of herpes zoster shortens the healing process, and prevents or alleviates pain and other acute or chronic complications, especially when it is administered in the first 72 hours after symptoms appear. This treatment is especially indicated in patients over the age of 50 and in those who, regardless of age, have head and neck involvement, especially in herpes zoster ophthalmicus. The drugs approved in Europe for the systemic treatment of herpes zoster are aciclovir, valaciclovir, famciclovir and brivudine. Brivudine shows greater effectiveness against the varicella-zoster virus than aciclovir and its derivatives, and can be given just once a day for seven days, compared to multiple doses of the latter. As opposed to the others, brivudine is a non-nephrotoxic drug that should not be administered to immunodepressed patients or to those being treated with 5-fluorouracil. The treatment of herpes zoster to reduce pain should be combined with analgesics and neuroactive agents (amitriptyline, gabapentin, etc). While corticosteroids are of dubious efficacy in the treatment of post-herpes neuralgia, the intensity and duration of the pain can be reduced with some topical treatments (capsaicin, lidocaine patches, etc). Finally, this review discusses treatment guidelines for special locations (cranial nerves) and different subpopulations (children, pregnant women, immunodepressed patients, etc). PMID: 16595111 [PubMed - indexed for MEDLINE] 919. Acta Derm Venereol. 2006;86(1):73-4. Postherpetic paresis mimicking an abdominal herniation. Giuliani A, Galati G, Parisi L, Ricciardulli T, Bartolo M, Tartaglia E, Grimaldi M, Pranteda G. PMID: 16586000 [PubMed - indexed for MEDLINE] 920. Ann Intern Med. 2006 Apr 4;144(7):535-7. Evidence for vascular spread of varicella zoster-associated vasculopathy. Saraya T, Shimura C, Wada H, Aoshima M, Goto H. PMID: 16585673 [PubMed - indexed for MEDLINE] 921. Nursing. 2006 Apr;36(4):18-9. Shutting down shingles. Snow M. CNA Edicational Services, Kaysville, Utah, USA. PMID: 16582721 [PubMed - indexed for MEDLINE] 922. Ann Otol Rhinol Laryngol. 2006 Mar;115(3):233-8. Varicella-zoster virus load and cochleovestibular symptoms in Ramsay Hunt syndrome. Ohtani F, Furuta Y, Aizawa H, Fukuda S. Department of Otolaryngology-Head and Neck Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan. OBJECTIVES: The mechanism by which varicella-zoster virus (VZV) reactivation causes cochleovestibular symptoms (CVSs) in patients with Ramsay Hunt syndrome (RHS) remains to be elucidated. The present study analyzed the relationship between VZV load and the onset of CVSs in RHS. METHODS: The subjects consisted of 56 patients with RHS; 29 exhibited CVSs and facial paralysis (FP; group 1), and 27 exhibited FP without CVSs (group 2). The VZV DNA copy number in the saliva was measured with a quantitative polymerase chain reaction. Anti-VZV antibodies were assayed by an enzyme-linked immunosorbent assay with paired sera. RESULTS: There was no significant difference in maximum viral copy number between the two groups. In group 1, CVSs occurred at various times between the early phase and the regression phase of VZV reactivation. In some patients, CVSs occurred in the early phase of VZV reactivation, before the onset of zoster lesions and FP. CONCLUSIONS: There are various different patterns in the development of eighth cranial nerve dysfunction, which is caused by progression of neuritis or labyrinthitis following VZV reactivation. Our data suggest that CVSs in RHS may also be caused by reactivation of VZV in the spiral and/or vestibular ganglia. PMID: 16572614 [PubMed - indexed for MEDLINE] 923. Am J Ophthalmol. 2006 Apr;141(4):782; author reply 782. Chronic recurrent varicella-zoster virus keratitis confirmed by polymerase chain reaction testing. Mortemousque B. Comment on: Am J Ophthalmol. 2005 Jun;139(6):1135-6. PMID: 16564841 [PubMed - indexed for MEDLINE] 924. Reprod Toxicol. 2006 May;21(4):350-82. Epub 2006 Mar 27. Laboratory assessment and diagnosis of congenital viral infections: Rubella, cytomegalovirus (CMV), varicella-zoster virus (VZV), herpes simplex virus (HSV), parvovirus B19 and human immunodeficiency virus (HIV). Mendelson E, Aboudy Y, Smetana Z, Tepperberg M, Grossman Z. Central Virology Laboratory, Ministry of Health and Faculty of Life Sciences, Bar-Ilan University, Chaim Sheba Medical Center, Tel-Hashomer, Israel. ellamen@sheba.health.gov.il Viral infections during pregnancy may cause fetal or neonatal damage. Clinical intervention, which is required for certain viral infections, relies on laboratory tests performed during pregnancy and at the neonatal stage. This review describes traditional and advanced laboratory approaches and testing methods used for assessment of the six most significant viral infections during pregnancy: rubella virus (RV), cytomegalovirus (CMV), varicella-zoster virus (VZV), herpes simplex virus (HSV), parvovirus B19 and human immunodeficiency virus (HIV). Interpretation of the laboratory tests results according to studies published in recent years is discussed. PMID: 16564672 [PubMed - indexed for MEDLINE] 925. Vaccine. 2006 May 1;24(18):3946-52. Epub 2006 Feb 24. The epidemiology of varicella and herpes zoster in The Netherlands: implications for varicella zoster virus vaccination. de Melker H, Berbers G, Hahné S, Rümke H, van den Hof S, de Wit A, Boot H. Centre for Infectious Disease Epidemiology, National Institute of Public Health and the Environment, P.O. Box 1, 3720 BA Bilthoven, The Netherlands. h.de.melker@rivm.nl We studied the epidemiology of varicella (chickenpox) and herpes zoster (shingles) in The Netherlands to assess the desirability to implement routine varicella zoster virus vaccination in The Netherlands. Data on seroprevalence of varicella zoster virus in the general population (1995-1996), consultations of general practitioners for varicella (2000-2002) and herpes zoster (1998-2001) and hospital admissions due to varicella (1994-2001) and herpes zoster (1994-2001) in The Netherlands were analysed. The seropositivity increased sharply with age from 18.4% for both 0- and 1-year-olds, to 48.9%, 59.0%, 75.7% and 93.0% for 2-, 3-, 4- and 5-year-olds, respectively, and varied between 97.5% and 100% for older age groups. The average annual incidence of GP-consultations amounted to 253.5 and 325.0 per 100,000 for varicella and herpes zoster, respectively. The incidence of hospital admission due to varicella and herpes zoster was 1.3 (2.3 including side diagnosis) and 2.7 (5.8) per 100,000, respectively. Whilst for varicella, the incidence of GP-consultations and hospital admissions were highest in childhood, for herpes zoster, these were highest in elderly. Insight into epidemiology of varicella zoster is needed for the assessment of the desirability of introduction of routine varicella zoster vaccination. PMID: 16564115 [PubMed - indexed for MEDLINE] 926. J Ark Med Soc. 2006 Mar;102(9):237. Call to action: Adult immunization. Hopkins R. PMID: 16562758 [PubMed - indexed for MEDLINE] 927. Nippon Ganka Gakkai Zasshi. 2006 Mar;110(3):193-8. [Case of herpes zoster ophthalmicus with abducent palsy: the cause and magnetic resonance imaging findings] [Article in Japanese] Iwao K, Kobayashi H, Okinami S. Department of Ophthalmology, Faculty of Medicine, Saga University, Japan. PURPOSE: To report the cause and magnetic resonance imaging (MRI) findings in a case of abducent palsy following herpes zoster ophthalmicus. CASE: A 76-year-old man presented with acute onset of pain, a vesicular cutaneous eruption and herpes zoster ophthalmicus on the right side. He developed complete abducent palsy on the right side two weeks after onset. MRI with gadolinium enhancement showed Meckel's sinus, which contains the trigeminal ganglion, and the abducent nerve on the right side. The patient was treated with intravenous acyclovir and methylprednisolone. The abnormal enhancement shown on MRI vanished immediately and the ophthalmoplegia resolved significantly. CONCLUSION: This is the first reported case where an affected cranial nerve was detected next to the inflammatory cavernous sinus in ophthalmoplegia following herpes zoster ophthalmicus. These MRI findings showed that this ophthlamoplegia was induced by direct viral invasion or extension of inflammation to the ipsilateral cranial nerve. Further studies need to be performed to clarify the role of specific antiviral therapy or anti-inflammatory agents in treating this complication of herpes zoster. PMID: 16562507 [PubMed - indexed for MEDLINE] 928. Diagn Cytopathol. 2006 Mar;34(3):232-4. Cytologic findings in Demodex folliculitis: a case report and review of the literature. Dong H, Duncan LD. Department of Pathology, University of Tennessee Medical Center, Knoxville, Tennessee 37920, USA. Infectious folliculitis of the head and neck has various etiologies, including bacteria, viruses, fungi, and parasites. Accurate morphologic recognition of microorganisms in biopsy and cytologic specimens is paramount in facilitating appropriate therapy. We report a case of a 37-yr-old white male with Demodex folliculitis, who presented with an extensive and painful erythematous pustular skin lesion along the right face and scalp in a dermatome pattern clinically suggestive of Varicella zoster. Examination of scraped smears obtained from one of these pustules revealed numerous parasitic organisms having morphologic features typical of Demodex. Herein, we describe the patient's clinical presentation, discuss the cytologic findings of scrape smears, and briefly review the literature. 2006 Wiley-Liss, Inc. PMID: 16548003 [PubMed - indexed for MEDLINE] 929. Br J Dermatol. 2006 Apr;154(4):743-6. Herpes folliculitis: clinical, histopathological, and molecular pathologic observations. Böer A, Herder N, Winter K, Falk T. Dermatologikum Hamburg, Stephansplatz 5, 20354 Hamburg, Germany. boer@dermatologikum.de BACKGROUND: Herpes folliculitis is a rare manifestation of herpes virus infection and it is often misdiagnosed. Diagnostic criteria are not well established, only 24 patients being reported in the literature. Recently it has been suggested that herpetic folliculitis is more common in infections with varicella zoster (VZV) than in those with herpes simplex viruses (HSV-1 and -2). OBJECTIVES: To refine diagnostic criteria for folliculitis caused by VZV, HSV-1 and HSV-2, and to study whether follicular involvement enables morphological differentiation between VZV and HSV infections. PATIENTS AND METHODS: Twenty-one patients with herpetic infection of follicular epithelium were assessed clinically and histopathologically. Polymerase chain reaction (PCR) studies for specific DNA of herpes viruses were performed on paraffin-embedded biopsy specimens. RESULTS: In 17 of our cases PCR was positive for VZV, four were positive for HSV-1, none for HSV-2. The clinical presentation of herpes folliculitis often lacked vesicles or pustules (14/21). Histopathological features were often devoid of ballooning (12/21), multinucleated giant cells (12/21) and keratinocytes with steel grey nuclei (15/21). The most consistent findings were lymphocytic folliculitis and perifolliculitis (20/21) and necrotic keratinocytes in follicular epithelium (12/21). In zoster, but not in varicella eruption or HSV infections, follicular involvement was unaccompanied by marked changes in the epidermal surface. CONCLUSIONS: In biopsy specimens taken from herpes virus infections, involvement of follicular units is more commonly encountered in VZV infections compared with HSV infections. Early in the course, herpes folliculitis presents as lymphocytic folliculitis devoid of epithelial changes considered to be diagnostic of herpes virus infections. Exclusive involvement of follicles is rather typical of zoster. PMID: 16536821 [PubMed - indexed for MEDLINE] 930. Transplantation. 2006 Mar 15;81(5):809-10. Nonspecific immunoglobulin and granulocyte-macrophage colony-stimulating factor use in complicated varicella zoster: the first case report in a renal transplant recipient. Vales-Albertos LJ, Andrade-Sierra J, Gómez-Navarro B, Monteón-Ramos F, Rodríguez-Pérez M, Torres-Lozano C, Cueto-Manzano AM. PMID: 16534489 [PubMed - indexed for MEDLINE] 931. Int J Dermatol. 2006 Mar;45(3):280-4. Patterns of skin manifestations and their relationships with CD4 counts among HIV/AIDS patients in Cameroon. Josephine M, Issac E, George A, Ngole M, Albert SE. Department of Internal Medicine, Faculty of Medicine and Biomedical Sciences, University of Yaounde, Cameroon. BACKGROUND: Skin manifestations are common clinical features among HIV/AIDS-positive patients. Their frequencies, patterns and associated factors have been shown to vary from region to region. The present study is aimed at documenting skin manifestations and their relationships with CD4 cell counts among HIV/AIDS patients in Cameroon. METHODS: This study lasted for 16 months (from September 2001 to December 2002). After informed consent, data on skin disorders, HIV status, CD4 and viral load were obtained by physical examination and laboratory methods. RESULTS: Of the 384 subjects studied, 236 (61.5%) were females and 148 (38.5%) were males. Up to 264 (68.8%) patients presented with at least one type of skin problem. Generalized prurigo, oral candidiasis, herpes zoster, and vaginal candidiasis were the most common skin problems. Mean CD4 cell count (128 +/- 85 cells/mm(3)) and mean viral load (79,433 copies/mL) in patients with herpes zoster were higher (P < 0.001). Patients with oral candidiasis and vaginal candidiasis had significantly lower (109 +/- 127 cells/mm(3), P < 0.02) and higher (131 +/- 85 cells/mm(3), P < 0.05) mean CD4 cell counts, respectively. Prurigo was associated with higher mean viral load (31,623 +/- 20 copies/mL, P < 0.04). Viral lesions were associated with high mean CD4 cell count (123 +/- 83 cells/mm(3), P < 0.001). Kaposi's sarcoma and parasitic lesions (crusted scabies) were both, respectively, associated with lower mean CD4 cell counts [(78 +/- 66 cells/mm(3), P < 0.001) (6 +/- 0 cells/mm(3), P < 0.04)]. CONCLUSION: We conclude, first that skin problems are common in HIV-infected individuals in Cameroon and that patients with advanced stages of these problems have relatively very low mean CD4 cell counts. Second, that mucocutaneous disorders like vaginal candidiasis and herpes zoster occur early in HIV infection while Kaposi's sarcoma is common in advanced HIV infection. PMID: 16533229 [PubMed - indexed for MEDLINE] 932. Pain Med. 2006 Jan-Feb;7(1):89-91. Botulinum toxin A relieved neuropathic pain in a case of post-herpetic neuralgia. Liu HT, Tsai SK, Kao MC, Hu JS. Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan. Botulinum toxin type A (BTX-A) has been widely used in many clinical disorders including migraine, cervical dystonia, etc. The use of BTX-A in neuropathic pain, however, is uncommon, and the application of the anti-nociceptive effect of botulinum toxin is emerging. Here we report a case of an 80-year-old man who suffered from severe pain of post-herpetic neuralgia which was refractory to the usual therapies. However, this neuropathic pain was dramatically relieved by multiple BTX-A injection and the pain relief lasted 52 days. PMID: 16533208 [PubMed - indexed for MEDLINE] 933. Exp Eye Res. 2006 Jul;83(1):69-75. Epub 2006 Mar 10. Characterization of the varicella zoster virus (VZV)-specific intra-ocular T-cell response in patients with VZV-induced uveitis. Milikan JC, Kuijpers RW, Baarsma GS, Osterhaus AD, Verjans GM. Institute of Virology, Erasmus Medical Center, PO Box 1738, 3000 DR, Rotterdam, The Netherlands. Varicella zoster virus (VZV) is a well-known cause of infectious uveitis. The aim of this study was to characterize the VZV-specific T-cell response in eyes of patients with VZV-induced uveitis. T-cell lines (TCL) were generated by mitogenic stimulation of intra-ocular fluid (IOF) samples obtained from eight patients with VZV-induced uveitis. Two patients with herpes simplex virus (HSV)-induced uveitis were included as disease controls. Characterization of individual T-cells in the TCL was performed by stimulating the TCL with mock, HSV-1 and VZV antigen pulsed autologous B cells and subsequent flow cytometric analyses. Virus specificity and phenotype of the T-cells were identified by simultaneous detection of intracellular gamma interferon and cell surface markers CD4, CD8, CD3 or T-cell receptor (TCR) beta chain variable region (TCRBV) usage. The TCL obtained from patients with HSV-1-induced uveitis contained higher numbers of T-cells reactive to HSV-1 compared to VZV. VZV-specific T-cells were detected in all TCL of the patients diagnosed with VZV-induced uveitis. Four out of six TCL obtained from patients with VZV-induced uveitis that were assayed for both viruses, contained higher numbers of T-cells reactive to VZV compared to HSV-1. Detailed analyses of the TCL of two patients demonstrated that the VZV reactivity within the assayed TCL was dominated by T-cells expressing one specific TCRBV gene. The data implicate that VZV-reactive T-cells infiltrate and participate in the local inflammatory response in eyes of patients with VZV-induced uveitis. PMID: 16530754 [PubMed - indexed for MEDLINE] 934. Am Fam Physician. 2006 Mar 1;73(5):882-4. Treatment of herpes zoster. Holten KB. Clinton Memorial Hospital, University of Cincinnati Family Medicine Residency, Wilmington, Ohio, USA. keholtenmd@cmhregional.com PMID: 16529096 [PubMed - indexed for MEDLINE] 935. Rev Stomatol Chir Maxillofac. 2006 Feb;107(1):57-8. [Unusual presentation of a common disease] [Article in French] Loeb I, Shahla M. Service de Stomatologie et Chirurgie Maxillo-faciale, CHU Saint-Pierre, Bruxelles, Belgique. isabelleloeb@yahoo.fr PMID: 16523180 [PubMed - indexed for MEDLINE] 936. Int Urogynecol J Pelvic Floor Dysfunct. 2007 Jan;18(1):103-4. Epub 2006 Mar 7. Herpes zoster-associated acute urinary retention: a case report. Julia JJ, Cholhan HJ. Women's Continence Center of Greater Rochester, Rochester, NY, USA. jjjulia73@hotmail.com An 87-year-old woman presents with a 4-week history of urinary incontinence during which she had been treated for disseminated herpes zoster virus (HZV). On physical exam painful vesicles involving the entire vulvar region with mainly right sacral distribution were found. A catheterized volume exceeded 600 ml of retained urine after the patient failed to void spontaneously. Multichannel voiding-pressure urodynamic studies revealed an acontractile neurogenic bladder with overflow incontinence. The patient was discharged on a conservative regimen with arrangement for visiting nurse services to perform intermittent self-catheterization twice daily. Urodynamic testing was repeated 10 weeks after initial symptoms. During voiding cystometry a biphasic increase in detrusor pressure of 15 cm H2O was observed with no increase in abdominal pressure. The patient emptied 400 ml with a postvoid residual of 300 ml. Recovery from HZV-associated bladder emptying dysfunction can be achieved usually through conservative management, including intermittent self-catheterization. Complete recovery time ranges from 4 to 10 weeks. PMID: 16520890 [PubMed - indexed for MEDLINE] 937. Kansenshogaku Zasshi. 2006 Jan;80(1):46-50. [Varicella-zoster virus symptoms and polyneuropathy in a patient with human immunodeficiency virus infection not improved until highly active anti-retroviral therapy added to acyclovir therapy] [Article in Japanese] Takeoka H, Chong Y, Murata M, Furusyo N, Nabeshima S, Yamaji K, Kishihara Y, Hayashi J. Department of Environmental Medicine and Infectoius Desease, Faculity of Medical Sciences, Kyushu University. In March 2003, a 34-year-old man with left facial palsy, dysphagia, and hoarseness treated with acyclovir suffered worsened dermatological and neurological problems. A routine blood test in early April showed the patient to be HIV-antibody positive, so he was transferred to our hospital. Blood analysis showed serum HIV-RNA at 96,000 copies/mL and a CD 4 count of 170/microL. Brain MRI taken on admission showed a T 2 high lesion in their left medulla. Acyclovir was thought to be ineffective due to reduced cell-mediated immunity because of the HIV infection, and HAART therapy was begun. After two months of HAART, skin lesions and the T 2 high lesion in left medulla improred. HIV-RNA became undetectable and the CD 4 count exceeded 500/microL. Intracellular cytokine analysis by flow cytometry showed a shift from Th 2 to Th 1 dominance. The elimination of VZV may thus have been promoted by the combination of acyclovir and HAART. PMID: 16519124 [PubMed - indexed for MEDLINE] 938. J Neuroophthalmol. 2006 Mar;26(1):47-8. Magnetic resonance imaging of third cranial nerve palsy and trigeminal sensory loss caused by herpes zoster. Quisling SV, Shah VA, Lee HK, Policeni B, Smoker WR, Martin C, Lee AG. Department of Ophthalmology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA. A 44-year-old man with right-sided herpes zoster ophthalmicus (HZO) developed ipsilateral third and sixth cranial nerve palsies and first-division trigeminal (fifth cranial nerve) sensory loss. MRI revealed contrast enhancement of the cisternal and cavernous portions of the third cranial nerve and high signal on a FLAIR sequence within the ipsilateral medulla at the presumed location of the trigeminal nucleus and tract. To our knowledge, this is the first report of the combination of these imaging findings in HZO. PMID: 16518167 [PubMed - indexed for MEDLINE] 939. J Pediatr Surg. 2006 Mar;41(3):e29-31. Acquired intestinal aganglionosis after a lytic infection with varicella-zoster virus. Holland-Cunz S, Göppl M, Rauch U, Bär C, Klotz M, Schäfer KH. Department of Pediatric Surgery, University of Heidelberg, 69120 Heidelberg, Germany. stefan_holland-cunz@med.uni-heidelberg.de BACKGROUND AND PURPOSE: In this report, we present the first case of an immunologically impaired child surviving a lytic varicella-zoster virus infection affecting the enteric nervous system. In histological findings, myenteric and submucous enteric ganglia were nearly completely absent owing to virus infection. METHODS: A 3-year-old girl with acute lymphoblastic leukemia and generalized varicella-zoster infection developed an ileus. She underwent multiple laparotomies in which histological sections of the entire small intestine could be obtained. RESULTS: The histological evaluation of these samples showed a generalized aganglionosis with inflammatory residuals. A more detailed immunohistochemical analysis using neuronal (PGP, enolase), glial (S100), and lymphocytic (LCA) antibodies demonstrated a nearly complete neuronal loss. CONCLUSION: To our knowledge, this is the first case of a secondary intestinal aganglionosis after varicella-zoster virus infection. PMID: 16516611 [PubMed - indexed for MEDLINE] 940. Ann Epidemiol. 2006 Sep;16(9):692-5. Epub 2006 Mar 3. Gender as an independent risk factor for herpes zoster: a population-based prospective study. Opstelten W, Van Essen GA, Schellevis F, Verheij TJ, Moons KG. University Medical Center Utrecht, The Netherlands. w.opstelten@umcutrecht.nl PURPOSE: Several studies reported a difference in herpes zoster (HZ) incidence between males and females, but limitations in design and analysis impeded the assessment of gender as an independent risk factor for HZ. This study examines the independent etiologic association between gender and HZ. METHODS: A total of 335,714 persons were observed prospectively during 2001. We registered gender and HZ occurrence, as well as other risk factors for HZ. We calculated overall crude and adjusted odds ratios (ORs) and stratified to age. RESULTS: The HZ incidence in females was 3.9/1000 patients/year (95% confidence interval [CI], 3.6-4.2), and in males, 2.5/1000 patients/year (95% CI, 2.3-2.8), with a crude OR of 1.53 (95% CI, 1.36-1.74). After adjustment for potential confounders, the adjusted OR was 1.38 (95% CI, 1.22-1.56). The incidence was greater in females in the middle-aged (age, 25 to 64 years; OR range, 1.36 to 1.83) and youngest group (OR, 1.31; 95% CI, 0.90-1.89). Gender effect was inverse in young adults (age, 15 to 24 years; OR, 0.64; 95% CI, 0.41-1.03). CONCLUSION: Female gender is an independent risk factor for HZ in the 25- to 64-year-old age groups. PMID: 16516488 [PubMed - indexed for MEDLINE] 941. Hautarzt. 2006 Mar;57(3):207-12, 214-6. [Infections with herpes simplex and varicella-zoster viruses during pregnancy] [Article in German] Marculescu R, Richter L, Rappersberger K. Abteilung für Dermatologie, Krankenanstalt Rudolfstiftung, Wien. Primary infections with herpes simplex virus (HSV) and varicella-zoster virus (VZV) may lead to severe illness in pregnancy. Both diseases may be associated with transplacental virus transmission and fetal infection. Such infections can lead to intrauterine death, severe malformations and premature birth; the fetal/congenital varicella syndrome is well-defined. Herpes genitalis and varicella at the time of labor may lead to life threatening neonatal-herpes or varicella of the newborn. Currently neither active immunization nor neutralizing immunoglobulin is available for HSV infections. VZV-seronegative women in child-bearing age can be vaccinated and pregnant women exposed to VZV can be given specific immunoglobulins. While an infection is rarely blocked, the severity is generally reduced. For severe disease antiviral treatment is necessary, with valacyclovir and acyclovir represents the drugs of choice. Primary or recurrent overt disease of the genital tract at the time of delivery an indication for caesarean section. Suppression of recurrent genital herpes during the last weeks of pregnancy with valacyclovir and acyclovir reduces the need for surgical intervention. Neonates exposed to VZV should receive specific immunoglobulin. If neonates show signs of either infection, immediate treatment with acyclovir must be initiated. PMID: 16514526 [PubMed - indexed for MEDLINE] 942. J Eur Acad Dermatol Venereol. 2006 Mar;20(3):314-7. Granuloma annulare on herpes zoster scars in a Hodgkin's disease patient following autologous peripheral stem cell transplantation. Sanli HE, Koçyiğit P, Arica E, Kurtyüksel M, Heper AO, Ozcan M. Department of Dermatology, Ankara University School of Medicine, Ankara, Turkey. Various cutaneous lesions including granulomatous reactions may occur at sites of resolved herpes zoster infection. A 46-year-old man with Hodgkin's disease developed localized granuloma annulare lesions on herpes zoster scars 3 months after allogeneic peripheral stem cell transplantation. This is the first case of granuloma annulare localized on herpes zoster scars that developed following peripheral stem cell transplantation. PMID: 16503895 [PubMed - indexed for MEDLINE] 943. Scand J Infect Dis. 2006;38(3):227-8. Varicella-zoster virus infection under administration of ganciclovir after allogeneic bone marrow transplantation. Mori T, Shimizu T, Yamazaki R, Aisa Y, Nakazato T, Ikeda Y, Okamoto S. Division of Hematology, Department of Medicine, Keio University School of Medicine, Shinanomachi, Tokyo, Japan. tmori@sc.itc.keio.ac.jp PMID: 16500790 [PubMed - indexed for MEDLINE] 944. Odontostomatol Trop. 2005 Dec;28(112):19-23. Group II and III lesions in HIV positive Nigerians attending the General Hospital Lagos, Nigeria. Wright AA, Agbelusi GA. Department of Preventive Dentistry, Lagos University Teaching Hospital, Lagos, Nigeria. OBJECTIVE: To document the prevalence of Group II and Ill oral lesions of HIV in adult seropositive Nigerians. STUDY DESIGN: A longitudinal study of 100 HIV infected adult Nigerian patients attending the HIV Clinic of the General Hospital, Lagos, Nigeria. STUDY PERIOD: January 2001 to October 2002. METHOD: Oral lesions were diagnosed based on documented diagnostic criteria by GREENSPAN et al, for oral manifestation of HIV. WHO classification of oral lesions based on the degree of association with HIV infection was also used. Oral lesions were treated using established treatment protocols. RESULTS: Seventy patients had oral lesions of HIV, of these fourteen (20%) patients had Group II and III oral lesions of HIV infection: Five (7%) patients had recurrent aphthous ulcers (RAU), 4 (6%) had herpes zoster of the trigeminal nerve. Majority of patients presented with oral symptoms severe enough to require use of appropriate medication. Recurrence of oral lesions occurred in all cases of RAU seen. CONCLUSION: Group II and III lesions are less prevalent than group I lesions in HIV infected adult Nigerians. They may be the presenting oral lesions of HIV/AIDS. These oral lesions of HIV are associated with a lot of pain, morbidity and may also compromise aesthetics. By compromising adequate nutrition and practice of good oral hygiene, they may lead to further deterioration of the health of the patient and can accelerate the course of the disease. Early recognition and diagnosis of these lesions by the oral clinician and/or trained dental practitioner affords the patient the opportunity of receiving prompt and appropriate medical treatment as well as counseling. PMID: 16491918 [PubMed - indexed for MEDLINE] 945. Korean J Ophthalmol. 2005 Dec;19(4):302-4. A case of complete ophthalmoplegia in herpes zoster ophthalmicus. Shin HM, Lew H, Yun YS. Department of Ophthalmology, Pochun CHA University College of Medicine, Pundang CHA Hospital, Sungnam, Korea. PURPOSE: To report a case with complete ophthalmoplegia after herpes zoster ophthalmicus. METHODS: A 70-year-old male patient visited a clinic because of vesicular eruptions over the left side of his face with severe pain. Drooping and severe swelling of the left eyelid were present, along with keratitis and uveitis. While the lid swelling and uveitis were improving, external ophthalmoplegia and exophthalmos were discovered. Intramuscular injections of dexamethasone 5 mg were given for 10 days, followed by oral administration of prednisolone at a dosage of 15 mg for two weeks and 10 mg for two weeks. RESULTS: The patient was fully recovered from the complete ophthalmoplegia and exophthalmos six months after the onset of the cutaneous lesion. CONCLUSIONS: Complete ophthalmoplegia is a rare ophthalmic complication of herpes zoster infection. Therefore, an evaluation of extraocular muscle and lid function should be performed during the examination of herpes zoster patients in order to screen for ophthalmoplegia. PMID: 16491822 [PubMed - indexed for MEDLINE] 946. Arch Dermatol. 2006 Feb;142(2):250-1. Postherpetic poliosis. Wu JJ, Huang DB, Tyring SK. PMID: 16490864 [PubMed - indexed for MEDLINE] 947. Am J Ophthalmol. 2006 Mar;141(3):584-5. Correlation between clinical suspicion and polymerase chain reaction verification of infectious vitritis. Acharya N, Lietman T, Cevallos V, Whitcher JP, Saidel M, Stone D, Duncan J, Margolis TP. Proctor Foundation, Department of Ophthalmology, University of California-San Francisco, 95 Kirkham Street, San Francisco, CA 94143, USA. nisha@stanfordalumni.org PURPOSE: To compare polymerase chain reaction (PCR) results to presumptive clinical diagnosis in patients with vitritis. DESIGN: Retrospective review of PCR laboratory records from vitreous samples. METHODS: Fifty consecutive laboratory records of vitreous samples sent for PCR testing were reviewed. Three reviewers with uveitis training ranked the clinical suspicion of a specific diagnosis using a classification system (scale of 1 to 4) and were masked to the PCR results. RESULTS: The degree of clinical suspicion of a particular diagnosis was significantly associated with a positive PCR result (P = .048). Higher clinical suspicion was significantly more associated with a positive PCR result compared with cases with lower clinical suspicion (P = .01). CONCLUSIONS: If the clinical suspicion of a specific diagnosis is low, the PCR for any infectious etiology is unlikely to be positive. PMID: 16490520 [PubMed - indexed for MEDLINE] 948. Am J Clin Dermatol. 2006;7(1):13-29. Viral infections affecting the skin in organ transplant recipients: epidemiology and current management strategies. Tan HH, Goh CL. National Skin Centre, Singapore. Viral skin infections are common findings in organ transplant recipients. The most important etiological agents are the group of human herpesviruses (HHV), human papillomaviruses (HPV), and molluscum contagiosum virus. HHV that are important in this group of patients are herpes simplex virus (HSV) types 1 and 2, varicella-zoster virus (VZV), cytomegalovirus (CMV), Epstein-Barr virus (EBV), HHV-6 and -7, and HHV-8, which causes Kaposi sarcoma (KS). HSV infections are characterized by their ability to establish latency and then reactivate at a later date. The most common manifestations of HSV infection in organ transplant recipients are mucocutaneous lesions of the oropharynx or genital regions. Treatment is usually with acyclovir, valaciclovir, or famciclovir. Acyclovir resistance may arise although the majority of acyclovir-resistant strains have been isolated from AIDS patients and not organ transplant recipients. In such cases, alternatives such as foscarnet, cidofovir, or trifluridine may have to be considered. VZV causes chickenpox as well as herpes zoster. In organ transplant recipients, recurrent herpes zoster can occur. Acute chickenpox in organ transplant patients should be treated with intravenous acyclovir. CMV infection occurs in 20-60% of all transplant recipients. Cutaneous manifestations, which include nonspecific macular rashes, ulcers, purpuric eruptions, and vesiculobullous lesions, are seen in 10-20% of patients with systemic infection and signify a poor prognosis. The present gold standard for treatment is ganciclovir, but newer drugs such as valganciclovir appear promising. EBV is responsible for some cases of post-transplant lymphoproliferative disorder, which represents the greatest risk of serious EBV disease in transplant recipients. HHV-6 and HHV-7 are two relatively newly discovered viruses and, at present, the body of information concerning these two agents is still fairly limited. KS is caused by HHV-8, which is the most recently discovered lymphotrophic HHV. Iatrogenic KS is seen in solid-organ transplant recipients, with a prevalence of 0.5-5% depending on the patient's country of origin. HPV is ubiquitous, and organ transplant recipients may never totally clear HPV infections, which are the most frequently recurring infections in renal transplant recipients. HPV infection in transplant recipients is important because of its link to the development of certain skin cancers, in particular, squamous cell carcinoma. Regular surveillance, sun avoidance, and patient education are important aspects of the management strategy. PMID: 16489840 [PubMed - indexed for MEDLINE] 949. J Drugs Dermatol. 2006 Feb;5(2):182-5. The incidence of recurrent herpes simplex and herpes zoster infection during treatment with arsenic trioxide. Nouri K, Ricotti CA Jr, Bouzari N, Chen H, Ahn E, Bach A. Department of Dermatology and Cutaneous Surgery, University of Miami, Miller School of Medicine, Miami, Florida, USA. knouri@med.miami.edu We report the incidence of varicella zoster virus (VZV) and herpes simplex virus (HSV) infection in patients with multiple myeloma and colon cancer who were treated with arsenic trioxide for their disease. In this report, we discuss the effects of arsenic on immune system, and suggest arsenic compounds as a possible predisposing factor for viral reactivation in these patients. PMID: 16485889 [PubMed - indexed for MEDLINE] 950. Scand J Gastroenterol. 2006 Feb;41(2):242-4. Visceral varicella zoster virus infection after stem cell transplantation: a possible cause of severe abdominal pain. Leena M, Ville V, Veli-Jukka A. Department of Medicine, Division of Infectious Diseases, Helsinki University Central Hospital, Finland. leena.mattila@hus.fi Reactivation of varicella zoster virus (VZV) is a common event after stem cell transplantation (SCT). When activated in the abdominal cavity, the infection may be life threatening. Visceral presentation with VZV infection is uncommon, although probably an under-diagnosed event in post-SCT patients. The interval from onset of abdominal pain to the development of skin eruptions may delay the initiation of specific antiviral therapy and symptoms may be incorrectly diagnosed as surgical disease or graft-versus-host disease. We describe the case of a 53-year-old man who had undergone stem cell autograft for multiple myeloma and developed visceral VZV infection with hepatitis, melaena and subileus 7 months later. PMID: 16484131 [PubMed - indexed for MEDLINE] 951. J Med Virol. 2006 Apr;78(4):514-6. Two cases of varicella zoster virus meningitis found in pediatric patients after bone marrow transplantation despite valaciclovir prophylaxis and without skin lesions. Lévêque N, Galambrun C, Najioullah F, Bleyzac N, Pages MP, Bertrand Y. Laboratoire de virologie, Hôpital E. Herriot, Hospices civils de Lyon, Lyon, France. Two cases of varicella zoster virus (VZV) meningitis are described in an 18-year-old girl and an 18-year-old boy. They occurred, respectively, 9 days and 9 months after allogeneic bone marrow transplantation. VZV nucleic acid was detected in the cerebrospinal fluid during the 1st week of illness. This recurrence occurred despite valaciclovir prophylaxis and without skin lesions. The two patients received aciclovir intravenously and immunoglobulins infusion. They responded to treatment and their clinical state improved rapidly. Copyright 2006 Wiley-Liss, Inc. PMID: 16482541 [PubMed - indexed for MEDLINE] 952. Dtsch Med Wochenschr. 2006 Feb 24;131(8):384-6. [Disseminated herpes zoster in diabetes mellitus] [Article in German] Graue N, Grabbe S, Dissemond J. Universitätsklinikum Essen, Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Hufelandstrasse 55, 45147 Essen. Comment in: Dtsch Med Wochenschr. 2006 Jun 2;131(22):1290; author reply 1290. HISTORY AND ADMISSION FINDINGS: A 71-year old man presented with painful hemorrhagic vesicles and papules over the entire body that had persisted for three days. Type 2 diabetes mellitus type 2 had been diagnosed 20 years ago and had not been treated for the last 5 years. Therapy had been discontinued by the patient. INVESTIGATIONS: HbA1c (11,9%) and blood glucose levels (up to 360 mg/dl) were abnormal. Varicella-zoster-DNA was replicated by PCR from the vesicle fluid. DIAGNOSIS AND TREATMENT: After the clinical diagnosis of disseminated herpes zoster had been confirmed systemic therapy with aciclovir 10 mg/kg day was started. There was no evidence of malignancy. Insulin therapy was initiated. CONCLUSION: Dissemination is a rare complication of herpes zoster, aided by immunosuppression. In the presented case there was no evidence of malignancy or other cause of immunosuppression, but the patient also had type 2 diabetes with very high blood glucose levels. The diabetes was thought to be causally related to the ineffective immune response to varicella zoster virus. There has been no previous published report of this relationship. PMID: 16479469 [PubMed - indexed for MEDLINE] 953. Rev Med Suisse. 2006 Jan 4;2(47):30-4. [Infectious disease] [Article in French] Erard P. Département de médecine Hôpital Pourtalès 2000 Neuchâtel. ph.erard@net2000.ch Several articles published in 2005 offer new knowledge in infectious diseases treated by practitioners. This paper discusses viral (influenza) and bacterial (pneumococci and legionella) respiratory infections. Resistant staphylococci, different from healthcare-associated MRSA, are now found in community. The article assesses that epidemics of Norovirus infections are common during winter time. The screening for treatment of asymptomatic bacteriuria is not recommended. The possible development of a successful vaccine to prevent herpes zoster is finally reminded. PMID: 16465942 [PubMed - indexed for MEDLINE] 954. Haematologica. 2005 Dec;90(12 Suppl):EIM04. Ophthalmic zoster sine herpete presenting as oculomotor palsy after marrow transplantation for acute myeloid leukemia. Hon C, Au WY, Cheng VC. Department of Ophthalmology and Visual Sciences, Lee Kar Shing Specialist Block Prince of Wales Hospital, Shatin, Hong Kong. honc@ha.org.hk PMID: 16464763 [PubMed - indexed for MEDLINE] 955. Rev Med Suisse. 2006 Jan 11;2(48):107-8, 111-3. [Dermatology] [Article in French] Kuenzli S, Saurat JH. We are going over therapeutic acquisitions in a club-journal including relevant publications in different fields: mecanism of action, therapeutic perspectives in a near future, and side effects. PMID: 16463794 [PubMed - indexed for MEDLINE] 956. Rev Chilena Infectol. 2006 Mar;23(1):56-9. Epub 2006 Feb 2. [Varicella vaccine] [Article in Spanish] Abarca Villaseca K. Facultad de Medicina, Departamento de Pediatría, Unidad de Infectología, Pontificia Universidad Católica de Chile. kabarca@med.puc.cl Varicella and herpes zoster represent a significant public health problem. Safe and highly effective varicella vaccines against severe and moderate varicella are currently available. Vaccine efficacy is lower and more variable against mild disease and several risk factors have been associated with mild breakthrough disease. Experts are currently discussing the need for a second vaccine dose. Universal varicella vaccination has been highly effective in reducing morbidity and hospitalizations due to varicella, a strategy that has proven to be cost effective in many regions when the societal-perspective is considered in the analysis. Recent data suggests that varicella vaccination may be associated with an increased incidence of herpes zoster in the elderly. Immunity conferred by varicella vaccination seems to be longlasting but a continued evaluation is needed in order to asses the effect of the changing epidemiology associated with universal immunization. PMID: 16462966 [PubMed - indexed for MEDLINE] 957. Am J Ophthalmol. 2006 Feb;141(2):409-12. Rapid progression of diabetic retinopathy in eyes with posterior uveitis. Knol JA, van Kooij B, de Valk HW, Rothova A. Uveitis Center, FC Donders Institute of Ophthalmology, University Medical Center Utrecht, Utrecht, The Netherlands. PURPOSE: To report on two patients who developed rapid progression of asymmetric diabetic retinopathy (DRP) in eyes affected by posterior uveitis in contrast to their fellow eyes not affected by uveitis. DESIGN: Observational case report. METHODS: Two patients with diabetes mellitus (DM) and unilateral uveitis underwent repeated ophthalmologic examinations and fluorescein angiography. RESULTS: Two patients with DM and unilateral posterior uveitis developed proliferative DRP in eyes with previous uveitis within 3 months after the uveitis subsided. In contrast, the retinal findings of nonuveitic eyes remained unchanged on follow-up of several years. CONCLUSIONS: Since the pathogenesis of intraocular inflammation and diabetic retinopathy acts through similar biochemical mediators and pathways, it is feasible that posterior uveitis accelerates the progression of diabetic retinopathy. Our results support this hypothesis and point out a risk for rapid retinopathy development in eyes affected with posterior uveitis. PMID: 16458715 [PubMed - indexed for MEDLINE] 958. Rinsho Ketsueki. 2005 Nov;46(11):1229-32. [Elderly patient with varicella-zoster virus-associated hemophagocytic syndrome refractory to steroid therapy] [Article in Japanese] Yoshida I, Yoshino T, Takeuchi M. Division of Hematology, National Hospital Organization, Minami-Okayama Medical Center. We experienced a case of virus-associated hemophagocytic syndrome (VAHS) after varicella-zoster virus (VZV) infection. The patient, a 101-year-old man, presented with anemia, thrombocytopenia and jaundice two weeks after successful antiviral treatment for the VZV. Histiocytes were detected in the bone marrow examination (2.2%); however, hepatomegaly and triglycemia remained unobserved throughout the course. Reactivation of VZV was detected serologically. The patient died after five weeks because of persistent cytopenia and liver failure refractory to steroid treatment. An autopsy revealed hemophagocytosis in the bone marrow, lung, spleen and liver. PMID: 16440810 [PubMed - indexed for MEDLINE] 959. SADJ. 2005 Nov;60(10):432, 436-7. Herpes zoster post-herpetic neuralgia. Feller L, Jadwat Y, Bouckaert M. Department of Periodontology and Oral Medicine, Medunsa Oral Health Centre, Faculty of Dentistry, University of Limpopo, Medunsa Campus. lfeller@ul.ac.za Post-herpetic neuralgia (PHN) is the most frequent complication of herpes zoster and often results in significant morbidity and a reduction in the patient's quality of life. The peripheral nerve injury that occurs during the acute phase of herpes zoster (HZ) leads to an abnormal tonic impulse discharge from primary nociceptive afferent neurons which induce slow temporal summation. This "wind-up" phenomenon is responsible for continuous partial depolarisation of second-order neurons with increased spontaneous impulse discharge and expanded receptive fields within the dorsal horn nociceptive neurons. The abnormal central processing involves the activation of N-methyl-D-aspartate (NMDA) receptors resulting in neuropathic pain, characterized by spontaneous pain, hyperalgesia and allodynia which is typical of PHN. In addition, tonic input from non-nociceptive AB afferent neurons, maintained by sympathetic efferent activity, contribute to the development and maintenance of neuropathic pain in general, and a burning sensation in particular. PMID: 16438359 [PubMed - indexed for MEDLINE] 960. Br J Dermatol. 2006 Feb;154(2):365-7. Linear Darier disease with herpes zoster superinfection treated successfully by brivudine. Abraham S, Jones A, Toutous-Trellu L, Kerl-Bullani K, Chavaz P, Saurat JH, Piguet V. Department of Dermatology and Venereology, University Hospital Geneva, 24 rue Micheli-du-Crest, CH-1211 Geneva 14, Switzerland. We report the case of a human immunodeficiency virus-positive patient presenting linear Darier disease with varicella-zoster virus superinfection following the lines of Blaschko. The lesions healed after treatment with brivudine. PMID: 16433812 [PubMed - indexed for MEDLINE] 961. Br J Anaesth. 2006 Mar;96(3):381-3. Epub 2006 Jan 23. Repetitive paravertebral nerve block using a catheter technique for pain relief in post-herpetic neuralgia. Naja ZM, Maaliki H, Al-Tannir MA, El-Rajab M, Ziade F, Zeidan A. Department of Anaesthesia and Pain Medicine, Research Unit and Paediatric Intensive Care, Makassed General Hospital, Beirut, Lebanon. zouhnaja@yahoo.com We described in this report a case of post-herpetic neuralgia refractory to medical therapy that was successfully treated with repetitive injections of local aesthetic mixture (bupivacaine 0.5% 19 ml and clonidine 150 microg ml(-1) 1 ml) every 48 h for 3 weeks using a paravertebral catheter inserted at T2-T3 level. PMID: 16431881 [PubMed - indexed for MEDLINE] 962. Age Ageing. 2006 Mar;35(2):132-7. Epub 2006 Jan 23. A cross-sectional survey of health state impairment and treatment patterns in patients with postherpetic neuralgia. van Seventer R, Sadosky A, Lucero M, Dukes E. Amphia Ziekenhuis, Department of Anaesthesiology, Breda, The Netherlands. BACKGROUND: Postherpetic neuralgia (PHN) develops in 8-24% of patients with herpes zoster. Few studies have evaluated the patient burden and treatment of PHN in general practice. OBJECTIVES: To determine the patient burden of PHN with respect to pain intensity and impact on patient functioning and to characterise treatment patterns and health resource utilisation in general practice. METHODS: Eighty-four patients with PHN were identified in general practice settings during an observational survey of neuropathic pain syndromes in six European countries. Patients answered a questionnaire that included: pain severity and interference items from the modified short form brief pain inventory (mBPI-SF); EuroQol (EQ-5D) survey; and questions related to current treatment, health status and resource utilisation. Physicians provided information on medications prescribed for PHN and pain-related co-morbidities (anxiety, depression and sleep disturbance). RESULTS: Mean patient age was 71.0 +/- 12.8 years, 76% were > or = 65 years and 45% of patients had PHN > or = 1 year. The mean pain severity index was 4.2, reflecting moderate pain despite 89% of patients taking prescription medications for PHN. Few medications with demonstrated efficacy against PHN (e.g. carbamazepine and gabapentin) were prescribed, often at suboptimal doses. Pain severity was associated with reduced EQ-5D health state valuation (P<0.001), greater pain interference on all domains (P<0.001) and increased health resource utilisation (P = 0.008). CONCLUSIONS: PHN causes substantial patient burden expressed as interference with daily functioning and reduced health status associated with pain severity. This burden may result in part from suboptimal management strategies and suggests a need for more effective pain management. PMID: 16431855 [PubMed - indexed for MEDLINE] 963. Clin Rheumatol. 2007 May;26(5):779-80. Epub 2006 Jan 21. Remission of rheumatoid arthritis after acute disseminated varicella-zoster infection. Agarwal V, Singh R, Chauhan S. Department of Medicine, Government Medical College & Hospital, Chandigarh, India. vikasagr@sgpgi.ac.in A 65-year-old immunocompetent male presented with symmetric polyarthritis of 12 weeks and paresthesias in the distribution of the left median nerve distribution of 4 weeks duration. He had tender joint count of 20 and swollen joint count of 12. He was positive for rheumatoid factor and his erythrocyte sedimentation rate was 52 mm. Nerve conduction study demonstrated polyneuropathy. Radiographs showed severe juxta articular osteopenia at the wrist and the metacarpophalangeal joints. He received methotrexate of 10 mg/week and prednisolone of 0.15 mg/kg/day along with nonsteroidal antiinflammatory drugs (NSAIDs) with a diagnosis of seropositive rheumatoid arthritis (RA). Thirteen weeks after therapy, he presented to the outpatient clinic with disseminated vesicular eruptions all over his body with erythematous base and pneumonia involving the left upper lobe. Tzanck smear from the lesions and serology (IgG) for varicella-virus infection were positive. A diagnosis of acute disseminated varicella zoster with pneumonia was made. The patient improved on parenteral acyclovir and broad-spectrum antibiotics. With the improvement in rash and pneumonia after 2 weeks, the patient noticed a marked improvement in the joint symptoms. Arthritis remained in remission without the need for any disease-modifying drug or NSAID for next the 24 months and continued to be so until the last follow-up. Our case presents a unique phenomenon of RA remission after disseminated varicella-zoster infection in an immunocompetent individual. PMID: 16429237 [PubMed - indexed for MEDLINE] 964. Eur J Pain. 2006 Nov;10(8):695-700. Epub 2006 Jan 20. Predicting and preventing post-herpetic neuralgia: are current risk factors useful in clinical practice? Coen PG, Scott F, Leedham-Green M, Nia T, Jamil A, Johnson RW, Breuer J. Queen Mary's School of Medicine and Dentistry, University of London, Department of Medical Microbiology, 25-29 Ashfield Street, London E1 1BB, UK. Post-herpetic neuralgia (PHN) following acute herpes zoster remains a significant cause of neuropathic pain especially in the elderly. Early treatment of the zoster rash with antiviral agents, such as aciclovir remains one of the few measures proven to reduce the incidence and duration of PHN albeit only in a subset of patients. It is therefore crucial that the physician who first sees a case of zoster identifies those patients who are most likely to develop long-term pain and treats them accordingly. In particular, prodrugs such as famciclovir and valaciclvoir may be more beneficial in reducing PHN than the shorter acting aciclovir, but can be more expensive. Measures that could be used to predict patients likely to develop PHN would also facilitate the evaluation of early use of antiepileptic, anti-inflammatory and analgesic agents in the prevention of PHN. In a prospective study of 280 herpes zoster (HZ) cases seen by the general practitioner (GP) we evaluated the predictive value of five clinical factors identified in clinical trials as associated with a higher likelihood of PHN. A visual analogue score (VAS) over 5 and/or age over 50 correctly identified all subjects with PHN at 3 and 6 months, respectively. However, the specificity of this prediction was low because as many as 81% and 85% of those aged over 50 recovered within 3 and 6 months, respectively. Better methods are needed to identify patients over 50 at most risk of PHN that enable GPs to better allocate their resources with respect to HZ treatment. PMID: 16427792 [PubMed - indexed for MEDLINE] 965. Clin Nucl Med. 2006 Feb;31(2):104-5. Herpes Zoster mimicking recurrence of lymphoma on PET/CT. Joyce JM, Carlos T. Division of Nuclear Medicine, Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA. joycejm@upmc.edu PMID: 16424700 [PubMed - indexed for MEDLINE] 966. Ann Dermatol Venereol. 2005 Oct;132(10 Suppl):7S28-7S34. [Item no 84: herpes virus infections in immunocompetent children and adults: varicella and zona] [Article in French] [No authors listed] PMID: 16419517 [PubMed - indexed for MEDLINE] 967. Dev Med Child Neurol. 2006 Feb;48(2):139-42. Post-varicella intracranial haemorrhage in a child. Danchaivijitr N, Miravet E, Saunders DE, Cox T, Ganesan V. Department of Radiology, Great Ormond Street Hospital, UK. We report a case of a 7-month-old male with primary intracranial haemorrhage 2 months after infection with varicella zoster virus (VZV). His initial clinical course was complicated by seizures and right hemiparesis; when last seen at 22 months the only positive finding was of left hand preference. Although the literature has recently established the association of arterial ischaemic stroke and VZV infection, primary intracranial haemorrhage has been reported only in one case. The child reported here had anterior interhemispheric haemorrhage due to a focal arteritis of the left anterior cerebral artery. The vascular abnormality was transient and had radiological features compatible with either a focal arteritis or vasospasm as a direct result of blood surrounding the vessels. We postulate that direct invasion of VZV caused extensive inflammation of the vessel wall and aggressive tissue penetration resulting in necrotizing angiitis and intracranial haemorrhage. We suggest that VZV infection should be considered a potential risk factor for intracranial haemorrhage in children. PMID: 16417671 [PubMed - indexed for MEDLINE] 968. J AAPOS. 2005 Dec;9(6):597-8. Herpes zoster ophthalmicus in an otherwise-healthy child. Binder NR, Holland GN, Hosea S, Silverberg ML. Sansum Santa Barbara Medical Foundation Clinic, Santa Barbara, California 93101, USA. Herpes zoster ophthalmicus, although not uncommon in adults, is rarely found in children. Herein we present a case of pediatric herpes zoster ophthalmicus that is unique in 2 ways. First, the child had been vaccinated against varicella and otherwise had no known exposure to varicella-zoster virus. Second, the initial presentation of herpes zoster ophthalmicus was a painful and diffuse subconjunctival hemorrhage that appeared before any of its classic signs were observed. We report this case to document the possible occurrence of herpes zoster ophthalmicus in children who have been vaccinated against varicella and the possibility of a diffuse, painful subconjunctival hemorrhage as a presenting sign. PMID: 16414532 [PubMed - indexed for MEDLINE] 969. Dermatol Online J. 2005 Dec 1;11(3):26. Dermatomal vesicular eruption in an asymptomatic infant. Bhushan P, Sardana K, Mahajan S. Department of Dermatology and STD, Lady Hardinge Medical College, KSCH Hospital, New Delhi, India. We present a case of infantile herpes zoster without clinical evidence of varicella infection in the mother or apparent exposure in the child; our patient's diagnosis was confirmed by serology and by Tzanck smear. We briefly review the etiopathogenesis factors of this condition. We emphasize the benign course and spontaneous uneventful resolution. PMID: 16409922 [PubMed - indexed for MEDLINE] 970. Skin Therapy Lett. 2005 Dec-2006 Jan;10(10):5-7. Famciclovir for the treatment of recurrent genital and labial herpes lesions. Langley RG. Division of Dermatology, Department of Medicine, and Centre for Clinical Research, Dalhousie University, Halifax, NS, Canada. Famciclovir (Famvir, Novartis) is an effective treatment for herpes zoster and herpes simplex. Two separate studies recently examined the effectiveness of single high doses of famciclovir for treating recurrent genital herpes and labial herpes (cold sores). In the randomized, placebo-controlled studies, patients initiated treatment at the first onset of symptoms. For the treatment of genital herpes, a 1,000 mg b.i.d. dose of famciclovir had significant advantages over the placebo, reducing the time required to heal the lesions, preventing the development of lesions beyond the papule stage, and improving the time to resolution of all symptoms. For the treatment of labial herpes, a single 1,500 mg dose of famciclovir shortened the lesion healing time, shortened the time to normal skin, and resulted in faster resolution of pain and tenderness. PMID: 16408140 [PubMed - indexed for MEDLINE] 971. Clin Experiment Ophthalmol. 2005 Dec;33(6):636-8. Herpes zoster ophthalmicus: presenting as giant-cell arteritis. de Castro LE, Petersen AM, Givre SJ, Solomon KD, Vroman DT. Magill Research Center for Vision Correction, Storm Eye Institute, Medical University of South Carolina, Charleston, SC 29425, USA. A 74-year-old woman was referred to the authors' clinic with a 1-week suspicion of giant-cell arteritis. Uncomplicated, bilateral temporal artery biopsies were performed 3 days after admission for therapy. Four hours after the procedure she developed vesicular lesions of the face compatible with herpes zoster ophthalmicus. The temporal artery biopsy revealed perineural lymphocytic aggregation. Both giant-cell arteritis and herpes zoster ophthalmicus form part of the differential diagnosis in elderly patients with headache. In such cases, clues from a temporal artery biopsy may aid in diagnosis of herpes zoster. In addition, the patient in this case developed the rash 10 days after onset of symptoms, which is rare as the average time from onset of symptoms to rash in zoster is 3-5 days. PMID: 16402958 [PubMed - indexed for MEDLINE] 972. MMW Fortschr Med. 2005 Dec 8;147(49-50):76-8. [Neuropathic pain] [Article in German] Ludwig J, Baron R. Sektion Neurologische Schmerzforschung und Therapie, Klinik für Neurologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Schittenhelmstr. 10, D-24105 Kiel. j.ludwig@neurologie.uni-kiel.de Arises after an injury to nociceptive systems. Examples of the most common causes are polyneuropathies, acute zoster neuralgia, and postherpetic neuralgia. The differential diagnosis and management are discussed. PMID: 16401018 [PubMed - indexed for MEDLINE] 973. J Paediatr Child Health. 2005 Nov;41(11):544-52. Varicella vaccination in Australia. Macartney KK, Beutels P, McIntyre P, Burgess MA. National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), The Children's Hospital at Westmead, New South Wales, Australia. kristinm@chw.edu.au Comment in: J Paediatr Child Health. 2005 Nov;41(11):541-2. Varicella zoster virus (VZV) causes both chickenpox and herpes zoster and is responsible for a significant disease burden, including hospitalizations and deaths, in Australian children and adults. Varicella vaccine has been available in Australia for 5 years; however, from November 2005, it will be funded for use in all susceptible children at 18 months and 10-13 years of age under the National Immunisation Program. Experience with universal varicella vaccination of children in the USA over the last 10 years has shown that the vaccine is safe and highly effective in reducing varicella-related disease. This review summarizes the epidemiology of VZV-related disease in Australia, the use of varicella vaccine and the international experience with vaccine efficacy and safety. The potential impact of varicella vaccination on the incidence of herpes zoster is also discussed. PMID: 16398834 [PubMed - indexed for MEDLINE] 974. Acta Ophthalmol Scand. 2005 Dec;83(6):758-60. Peripheral retinal changes in acute retinal necrosis imaged by ultra widefield scanning laser ophthalmoscopy. Neubauer AS, Yu A, Haritoglou C, Ulbig MW. PMID: 16396659 [PubMed - indexed for MEDLINE] 975. Pediatr Infect Dis J. 2006 Jan;25(1):53-8. Immune reconstitution syndrome after highly active antiretroviral therapy in human immunodeficiency virus-infected thai children. Puthanakit T, Oberdorfer P, Akarathum N, Wannarit P, Sirisanthana T, Sirisanthana V. Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand. BACKGROUND: There is little information about the immune reconstitution syndrome (IRS) in children, especially from resource-poor countries. OBJECTIVE: To determine the incidence and spectrum of IRS in advanced stage human immunodeficiency virus (HIV)-infected children after initiation of highly active antiretroviral therapy (HAART). METHODS: Between May 2002 and April 2004, 153 symptomatic HIV-infected children who had CD4 lymphocyte percentage < or =15% initiated HAART in a national antiretroviral drug access program. All patients were followed for 48 weeks. In this study, IRS was defined as a disease event caused by microorganisms or conditions previously reported to be associated with IRS in patients having immunologic and/or virologic response to HAART. RESULTS: The incidence of IRS was 19% (95% confidence interval, 13.1-26.1). The median time of onset was 4 weeks after start of HAART (range, 2-31). There were 32 episodes of IRS, including 14 caused by mycobacterial organisms, 7 by varicella-zoster virus, 7 by herpes simplex virus, 3 by Cryptococcus neoformans and 1 episode of Guillain-Barré syndrome. Patients who had IRS develop had lower baseline CD4 lymphocyte percentages compared with those who did not (P = 0.02). CONCLUSIONS: IRS is common among HIV-infected children who received HAART in their advanced stage of disease. Educational programs for patients and health care workers on recognizing and treating these conditions should be integrated into antiretroviral treatment access programs. PMCID: PMC1924530 PMID: 16395104 [PubMed - indexed for MEDLINE] 976. Indian J Dermatol Venereol Leprol. 2005 May-Jun;71(3):210-1. Multidermatomal herpes zoster in an immunocompetent female. Gupta LK, Kuldeep CM, Mittal A, Singhal H. PMID: 16394421 [PubMed - indexed for MEDLINE] 977. Herpes. 2005 Dec;12(3):59. Varicella immunization and herpes zoster. Volpi A. PMID: 16393520 [PubMed - indexed for MEDLINE] 978. Transpl Infect Dis. 2005 Sep-Dec;7(3-4):116-21. Retrospective analysis of varicella zoster virus (VZV) copy DNA numbers in plasma of immunocompetent patients with herpes zoster, of immunocompromised patients with disseminated VZV disease, and of asymptomatic solid organ transplant recipients. Kronenberg A, Bossart W, Wuthrich RP, Cao C, Lautenschlager S, Wiegand ND, Mullhaupt B, Noll G, Mueller NJ, Speck RF. Division of Infectious Diseases and Hospital Epidemiology, Department of Internal Medicine, University Hospital of Zurich, Zurich, Switzerland. Comment in: Transpl Infect Dis. 2005 Sep-Dec;7(3-4):97-8. BACKGROUND: Varicella zoster virus (VZV) causes significant morbidity and mortality in immunocompromised patients. Subclinical reactivation has been described in solid organ recipients and has been associated with graft versus host disease in bone marrow transplantation. Newer studies assessing the prevalence and impact of subclinical VZV reactivation in solid organ transplant (SOT) recipients are lacking. METHODS AND RESULTS: In a first step we developed a highly sensitive quantitative polymerase chain reaction (qPCR) assay for VZV DNA with a detection limit of < or = 20 copies/mL. Using this assay, we retrospectively analyzed plasma samples of different patient groups for VZV DNA. VZV DNA was found in 10/10 plasma samples of immunocompetent patients with herpes zoster (VZV copy numbers/mL: mean+/-SEM 1710+/-1018), in 1/1 sample of a human immunodeficiency virus-infected patient with primary VZV disease (15,192 copies/mL) and in 4/4 plasma samples of immunocompromised patients with visceral VZV disease (mean of first value 214,214+/-178,572). All 108 plasma samples of asymptomatic SOT recipients off any antiviral therapy, randomly sampled over 1 year, were negative for VZV DNA. CONCLUSION: Our qPCR assay proved to be highly sensitive (100%) in symptomatic VZV disease. We did not detect subclinical reactivation in asymptomatic SOT recipients during the first post-transplant year. Thus, subclinical VZV reactivation is either a rare event or does not exist. These data need to be confirmed in larger prospective trials. PMID: 16390399 [PubMed - indexed for MEDLINE] 979. Stat Med. 2006 Jan 30;25(2):359-60. Phase specific analysis of herpes zoster associated pain data: a new statistical approach by R. B. Arani, S.-J. Soong, H. L. Weiss, M. J. Wood, P. A. Fiddian, J. W. Gnann and R. Whitley, Statistics in Medicine 2001; 20:2429-2439. Kay R. Comment on: Stat Med. 2001 Aug 30;20(16):2429-39. PMID: 16381077 [PubMed - indexed for MEDLINE] 980. Am J Med. 2005 Dec;118(12):1416. Herpes zoster in immunocompromised patients: incidence, timing, and risk factors. Wung PK, Holbrook JT, Hoffman GS, Tibbs AK, Specks U, Min YI, Merkel PA, Spiera R, Davis JC, St Clair EW, McCune J, Ytterberg SR, Allen NB, Stone JH; WGET Research Group. Johns Hopkins University School of Medicine, Johns Hopkins University, Baltimore, Md, USA. PURPOSE: To evaluate the risk factors for herpes zoster as well as the incidence and timing of this complication in patients who were treated with immunosuppression because of active Wegener's granulomatosis. SUBJECTS AND METHODS: We studied the 180 Wegener's granulomatosis patients in the Wegener's Granulomatosis Etanercept Trial (WGET). Herpes zoster events during WGET were documented prospectively. Follow-up questionnaires were employed to describe the location, treatment, and complication(s) of herpes zoster and its therapy. Univariate and multivariate analyses were performed to evaluate risk factors, including history of herpes zoster, for the occurrence of herpes zoster during the trial. All analyses were based on the time to first occurrence of herpes zoster. RESULTS: Eighteen patients (10% of the WGET cohort) suffered a total of 19 herpes zoster episodes over a mean follow-up period of 27 months. The annual incidence of herpes zoster in the WGET cohort was 45 cases/1000 patient-years (95% confidence interval [CI]: 27, 70). The median time from enrollment to the occurrence of herpes zoster in the subgroup of patients with that complication was 16.5 months (+/- 9.4). Fifteen of the 19 herpes zoster events (79%) occurred between months 6 and 36, many months after the period of most intensive immunosuppression. In univariate analyses, history of serum creatinine > or =1.5 mg/dL before enrollment was associated with a relative risk (RR) of 3.0 (95% CI: 1.1, 7.8) for herpes zoster during WGET (P=.03). In multivariate analyses, serum creatinine > or =1.5 mg/dL was associated with an RR of 6.3 (95% CI: 2.0, 19.8; P=.002), and female sex with an RR of 4.6 (95% CI: 1.6, 13.2; P=.004). CONCLUSION: Renal dysfunction and female sex were consistently strong risk factors for herpes zoster events in this population. Contrary to expectation, most herpes zoster events did not occur during periods of most intensive immunosuppression. These data may inform studies of interventions designed to prevent herpes zoster in patients on treatment for immune-mediated diseases. PMID: 16378799 [PubMed - indexed for MEDLINE] 981. MedGenMed. 2005 Jul 13;7(3):63. A 26-year-old woman presented to Kijabe Mission Hospital with a diffuse rash and dyspnea. Fielder JF. Africa Inland Church Kijabe Hospital, Kijabe, Kenya, Africa. jfielder@kijabe.net PMCID: PMC1681677 PMID: 16369289 [PubMed - indexed for MEDLINE] 982. Jpn J Ophthalmol. 2005 Nov-Dec;49(6):536-8. Herpes zoster panuveitis progression despite acyclovir treatment in a patient following bone marrow transplantation. Fujiwara O, Mitamura Y, Ohtsuka K. PMID: 16365806 [PubMed - indexed for MEDLINE] 983. J Dermatol. 2005 Nov;32(11):933-4. Sequential development of herpes zoster duplex unilateralis during oral famciclovir treatment. Goo B, Cho SB, Chung KY. PMID: 16361760 [PubMed - indexed for MEDLINE] 984. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006 Jan;101(1):70-5. Epub 2005 Oct 5. Mandibular osteomyelitis and tooth exfoliation following zoster-CMV co-infection. Meer S, Coleman H, Altini M, Alexander T. Division of Oral Pathology, Department of Anatomical Pathology, University of the Witwatersrand, Johannesburg, South Africa. shabnum.meer@nhls.ac.za Herpes zoster is a common viral infection, the oral soft tissue manifestations of which are widely known and recognized. Reports of spontaneous tooth exfoliation and jaw osteonecrosis following herpes zoster infection in the distribution of the trigeminal nerve are extremely infrequent and sporadic, with only 39 cases being reported in the literature. We report an additional case of mandibular osteomyelitis and spontaneous tooth exfoliation following herpes zoster infection, which occurred in the left mandible of a 70-year-old diabetic man; however, our case also showed CMV co-infection. The role of CMV in the pathogenesis of the osteonecrosis remains uncertain. Awareness of the possibility of CMV co-infection in various oral diseases including oral ulcers, Kaposi's sarcoma, and herpes zoster infections especially in immunocompromised patients is important, since spread of the CMV can easily occur to other sites with potentially fatal consequences. Early diagnosis can lead to effective treatment and prevention of complications. PMID: 16360610 [PubMed - indexed for MEDLINE] 985. Mikrobiyol Bul. 2005 Jul;39(3):339-43. [Short communication: retrospective analysis of 21 HIV/AIDS cases] [Article in Turkish] Akalin H, Heper Y, Yilmaz E, Kazak E, Oral B, Mistik R, Helvaci S, Töre O. Uludağ Universitesi Tip Fakültesi Mikrobiyoloji ve Enfeksiyon Hastaliklari Anabilim Dali, Bursa. In this study, 21 HIV/AIDS cases (18 male, 3 female; age range 17-64 years), followed up in the Department of Infectious Diseases of Uludag University Medical Faculty between 1997-2003 have been analyzed retrospectively, by means of epidemiological, clinical and laboratory aspects. Nineteen (90%) of them were heterosexual, and in 9 cases the diagnosis was coincidental during the blood donations or routine testing. The non-compliance rate of patients to antiretroviral treatment was found as 76%, and the most important factor for non-compliance was the difficulty in providing antiretroviral drugs. The most frequently encountered opportunistic infections were oropharyngeal candidiasis (n:5), herpes zoster (n:4) and community acquired pneumonia (n:4). PMID: 16358494 [PubMed - indexed for MEDLINE] 986. Vaccine. 2006 Feb 27;24(9):1308-14. Epub 2005 Sep 30. The burden of Herpes Zoster: a prospective population based study. Scott FT, Johnson RW, Leedham-Green M, Davies E, Edmunds WJ, Breuer J. Skin Virus Laboratory, Institute for Cell and Molecular Science, 25-29 Ashfield Street, E1 1BB, UK. We analysed prospectively the medical, societal and economic burden among patients from 18 general practices in East London, serving 158,716 patients who presented to their general practitioners with acute Herpes Zoster over an 8-month period. One hundred and eighty-six patients with HZ were seen by GPs during the study period, of whom 96 were referred, 70 enrolled and 65 completed. PHN occurred in 13.4% of patients. The average overall cost of HZ in the first 6 months was calculated at pound524 per patient. Medical costs were highest in those aged over 65 and societal costs highest in those aged under 65 years. PMID: 16352376 [PubMed - indexed for MEDLINE] 987. BMC Fam Pract. 2005 Dec 14;6:50. A rare case of disseminated cutaneous zoster in an immunocompetent patient. Gupta S, Jain A, Gardiner C, Tyring SK. Department of Medicine, University of Texas Health Science Center at Houston, 6431 Fannin, Houston 77030, USA. sachin.gupta@uth.tmc.edu BACKGROUND: Disseminated cutaneous herpes zoster in healthy persons is uncommon, though it has been described in immunocompromised patients. CASE PRESENTATION: We describe a case of disseminated cutaneous herpes zoster in an elderly man with no apparent immunosuppressive condition. The patient was treated successfully with intravenous Acyclovir. CONCLUSION: We suggest that disseminated zoster can occur in an immunocompetent host and should be promptly recognized and treated to prevent serious complications. PMCID: PMC1327670 PMID: 16351732 [PubMed - indexed for MEDLINE] 988. Ultrasound Q. 2005 Dec;21(4):295-308. Ultrasound markers of fetal infection part 1: viral infections. Bailão LA, Osborne NG, Rizzi MC, Bonilla-Musoles F, Duarte G, Bailão TC. Department of Obstetrics and Gynecology, School of Medicine, University of São Paulo, Brazil. Diagnosis of fetal infection has depended on identification of pathogens by means of microbiological cultures, immunologic techniques, and special molecular biology techniques that can identify organisms known or suspected of being associated with adverse outcomes of pregnancy. Rubella, cytomegalovirus (CMV), herpes simplex virus (HSV), and human immunodeficiency virus (HIV), for example, are capable of gaining access to the amniotic cavity and producing fetal infection, even when amniotic membranes are intact. Intrauterine invasion by viruses can be associated with maternal symptoms of infection or can be completely silent. In many instances extensive fetal compromise with irreversible structural damage or fetal death will have occurred by the time infection is confirmed by culture or other histopathological methods. The evidence of fetal infection may be as subtle as nascent intrauterine growth restriction (IUGR), mildly inappropriate calcification of fetal organs, placenta, cord, and membranes, and failure to adequately develop fetal fat reserves. The evidence of infection may be as dramatic as obvious fetal malformation, severe central nervous system structural damage, or fetal death. Sonography is capable of detecting most of the grave alterations and some of the subtle effects that are typical of fetal infection. PMID: 16344748 [PubMed - indexed for MEDLINE] 989. Neurology. 2005 Dec 13;65(11):1812. MRI of trigeminal zoster. Aribandi M, Aribandi L. Department of Radiology, Geisinger Medical Center, Danville, PA 17822, USA. maribandi1@geisinger.edu PMID: 16344530 [PubMed - indexed for MEDLINE] 990. Kinderkrankenschwester. 2005 Nov;24(11):478-9. [News from the "vaccine kitchen": herpes zoster, measles, mumps, rubella and varicella, rotaviruses, papillomaviruses] [Article in German] Deutsches Grúnes Kreuz e.V. PMID: 16334650 [PubMed - indexed for MEDLINE] 991. CMAJ. 2005 Dec 6;173(12):1490; author reply 1490. Giant cell arteritis. Varnholt H. Comment on: CMAJ. 2005 Jul 5;173(1):33. PMCID: PMC1316175 PMID: 16330647 [PubMed - indexed for MEDLINE] 992. Int J Epidemiol. 2006 Apr;35(2):307-14. Epub 2005 Dec 5. Micronutrient intake and the risk of herpes zoster: a case-control study. Thomas SL, Wheeler JG, Hall AJ. Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK. sara.thomas@lshtm.ac.uk BACKGROUND: Herpes zoster can seriously impair quality of life and may also be a marker for age-related immune decline (immunosenescence). Diets low in micronutrients may increase the risk of zoster by temporarily compromising cell-mediated immune function or by hastening immunosenescence. METHODS: Primary objectives were to examine the association between risk of zoster and (i) dietary intake of vitamins A, B(6), C, E, folic acid, zinc, and iron, and (ii) fruit and vegetable consumption. We conducted a community-based case-control study. Cases were adults with incident zoster presenting to 22 general practices in London. Controls were individuals with no zoster history, matched to cases by age, sex, and general practice. Diet was ascertained for 243 cases and 483 controls using an interviewer-administered food-frequency questionnaire. We used conditional logistic regression to estimate odds ratios. RESULTS: There was a strong graded association between lower fruit intake and increasing zoster risk; in adjusted analysis, individuals who ate less than one piece of fruit per week had more than three times the risk of zoster compared with individuals who ate more than three portions per day. None of the dietary intakes of the seven micronutrients examined had a statistically significant association with zoster risk when considered singly. However, amongst individuals aged >60 years, a measure of combined micronutrient intake and vegetable intake showed similar dose-related associations with zoster risk. CONCLUSION: A cocktail of nutrients such as those found in fruit and vegetables may act together, particularly in older individuals, to maintain immune health and prevent zoster. PMID: 16330478 [PubMed - indexed for MEDLINE] 993. Malays J Pathol. 2001 Jun;23(1):47-8. Herpes zoster in children with cancer. Menon BS, Wan Maziah WM. Department of Paediatrics, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia. radi@tm.net.my The aim of this study was to determine the incidence and outcome of herpes zoster hospitalised children with cancer in Kota Baru. It was a retrospective review from January 1994 to December 1998. The diagnosis of herpes zoster was a clinical one. Herpes zoster was diagnosed in 10 of 188 (5%) children with malignancy. The most common malignancy was leukaemia. Nine children were treated with acyclovir. No child developed visceral dissemination and there were no deaths. PMID: 16329548 [PubMed - indexed for MEDLINE] 994. Postgrad Med. 2005 Nov;118(5):45-8, 51-4. Viral infections in the elderly. The challenges of managing herpes zoster, influenza, and RSV. Bader MS, McKinsey DS. Memorial University of Newfoundland Health Sciences Center, St John's, Canada. msbader1@hotmail.com Viral diseases are an important cause of morbidity and mortality in elderly patients, whether they live in the community or in long-term care facilities. Management of viral infections in older adults is complicated by factors that include the infrequency or absence of common signs and symptoms of infection and adverse drug reactions. In this article, Drs Bader and McKinsey discuss the clinical features and treatment of herpes zoster and the respiratory diseases caused by influenza and respiratory syncytial virus (RSV). PMID: 16329530 [PubMed - indexed for MEDLINE] 995. J Pain. 2005 Dec;6(12):782-90. Psychosocial risk factors for postherpetic neuralgia: a prospective study of patients with herpes zoster. Katz J, McDermott MP, Cooper EM, Walther RR, Sweeney EW, Dworkin RH. Department of Anesthesiology, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA. The results of previous studies using retrospective methods or small samples have suggested that there may be psychosocial risk factors for postherpetic neuralgia (PHN). We conducted a prospective study in which 110 patients with herpes zoster were assessed within the first month after rash onset with measures of acute pain and five broad domains of psychosocial functioning-physical, role, social, and emotional functioning, and stress and social support. Twenty of the 102 patients with follow-up data were diagnosed with PHN, defined as pain that had persisted for 4 months after rash onset. Measures of role functioning, personality disorder symptoms, and disease conviction during herpes zoster each made independent contributions to predicting either presence or intensity of PHN in logistic and linear regression analyses that controlled for relevant demographic and clinical variables, including age and acute pain intensity. These findings indicate that psychosocial variables are risk factors for the development of PHN. PERSPECTIVE: The results of this prospective study of patients with herpes zoster suggest that future research on the mechanisms and prevention of PHN should consider psychosocial as well as neurobiologic processes. PMID: 16326366 [PubMed - indexed for MEDLINE] 996. J Ayub Med Coll Abbottabad. 2005 Jul-Sep;17(3):80-1. Recurrence of herpes zoster in an immunocompetent adult male. Raza N, Iqbal P, Anwer J. Combined Military Hospital, Abbottabad. naeemraza561@hotmail.com Repeated and disseminated eruptions herpes zoster are frequently detected in immunocompromised patients, but are rare in immuno-competent individuals. We report a case of recurrent herpes zoster in a young healthy male, who redeveloped herpes zoster in a different dermatome after one year. PMID: 16320806 [PubMed - indexed for MEDLINE] 997. SADJ. 2005 Oct;60(9):386-7. Eye signs that alert the clinician to a diagnosis of AIDS. Meyer D. Department of Ophthalmology, University of Stellenbosch. dm2@sun.ac.za One of the hallmarks of progressive immune deficiency is a steady decline in the absolute number of CD4+ T-lymphocytes. As the immune response thus becomes suppressed, opportunistic systemic infections such as protozoal (Pneumocystis carinii pneumonia, disseminated toxoplasmosis), viral (Cytomegalovirus pneumonitis and colitis and persistent invasive herpes simplex lesions), fungal (cryptococcossis and esophageal candidiasis) and bacterial infections (atypical mycobacterial and extrapulmonary tuberculosis) set in to claim their toll. Ocular complications occur in about 75% of AIDS patients and may be divided into four categories: Retinal microangiopathy, Opportunistic infections, Tumours, Neuro-ophthalmological lesions. Only the most frequently occurring manifestations will be highlighted. PMID: 16320530 [PubMed - indexed for MEDLINE] 998. SADJ. 2005 Oct;60(9):380-2, 384. Herpes zoster: a review of the literature and report of a case. Feller L, Jadwat Y. Department of Periodontology and Oral Medicine, Medunsa Oral Health Centre, Faculty of Dentistry, Medunsa Campus, University of Limpopo. lfeller@ul.ac.za PMID: 16320529 [PubMed - indexed for MEDLINE] 999. Br J Dermatol. 2005 Dec;153(6):1241-3. Erythema annulare centrifugum following herpes zoster infection: Wolf's isotopic response? Lee HW, Lee DK, Rhee DY, Chang SE, Choi JH, Moon KC, Koh JK. PMID: 16307675 [PubMed - indexed for MEDLINE] 1000. Eye (Lond). 2005 Oct;19(10):1035-6. Management of blinding disease: loss of immunity and superinfection. Evans BG. Communicable Disease Surveillance Centre, London, UK. barry.evans@hpa.org.uk Comment in: Eye (Lond). 2006 Dec;20(12):1414-5; author reply 1415. Globally the most important loss of immunity currently occurs with HIV disease. The effects of HIV on the eye, since the advent of highly active antiretroviral therapy, have been less in countries where such treatment is available but even in such situations ophthalmic zoster can occur at higher CD4 cell counts and can still cause problems. Other opportunistic infections such as CMV retinitis tend to occur at lower CD4 cell counts. However, globally treatment is not universally available in resource poor countries where it is most needed. A major impact of HIV in such situations is on premature mortality affecting the health care and education workforce, which indirectly has an impact on blinding disease. In addition, loss of family income due to illness or death of parents can affect nutritional status of remaining family members especially children as well as the direct effect of opportunistic infections in the eyes of those infected with HIV. PMID: 16304581 [PubMed - indexed for MEDLINE] 1001. Am J Emerg Med. 2005 Nov;23(7):899-900. Emergent hemodialysis for acyclovir toxicity. Hsu CC, Lai TI, Lien WC, Chen WJ, Fang CC. Department of Emergency Medicine, National Taiwan University Hospital, and National Taiwan University, College of Medicine, Taipei 100, Taiwan. PMID: 16291450 [PubMed - indexed for MEDLINE] 1002. Arch Neurol. 2005 Nov;62(11):1774-5. Petrositis in Ramsay Hunt syndrome with multiple cranial neuropathies. Espay AJ, Bull RL. Department of Neurology, University of Cincinnati, OH 45267, USA. alberto.espay@uc.edu PMID: 16286554 [PubMed - indexed for MEDLINE] 1003. AIDS. 2005 Dec 2;19(18):2183-4. Alveolar bone necrosis and tooth exfoliation secondary to herpes zoster in the setting of HIV/AIDS. van Heerden WF, McEachen SE, Boy SC. PMID: 16284476 [PubMed - indexed for MEDLINE] 1004. Blood. 2006 Mar 1;107(5):1800-5. Epub 2005 Nov 10. Long-term acyclovir for prevention of varicella zoster virus disease after allogeneic hematopoietic cell transplantation--a randomized double-blind placebo-controlled study. Boeckh M, Kim HW, Flowers ME, Meyers JD, Bowden RA. Fred Hutchinson Cancer Research Center, Program in Infectious Diseases, 1100 Fairview Ave N, Seattle, WA 98109, USA. mboeckh@fhcrc.org Varicella-zoster virus (VZV) disease occurs in 30% of allogeneic hematopoietic cell transplant recipients who had a history of VZV infection. A safe and effective prevention strategy has not been established. In a double-blind controlled trial, 77 hematopoietic cell transplant recipients at risk for VZV reactivation were randomized to acyclovir 800 mg twice daily or placebo given from 1 to 2 months until 1 year after transplantation. VZV disease at 1 year was the primary end point; VZV disease after discontinuation of prophylaxis, VZV-specific T-cell immunity, herpes simplex virus (HSV) infection, cytomegalovirus (CMV) disease, survival, and safety were secondary end points. Acyclovir significantly reduced VZV infections at 1 year after transplantation (HR, 0.16; 95% CI, 0.035-0.74; P = .006). In the post-intervention observation period, this difference was not statistically significant (2 years: HR, 0.52; 95% CI, 0.21-1.3; 5 years: HR, 0.76; 95% CI, 0.36-1.6). There was no statistically significant difference in reconstitution of VZV-specific T-helper cell responses, HSV infections, CMV disease, chronic graft-versus-host disease, and overall survival between the groups. Acyclovir was well tolerated. Post-study VZV disease predominantly occurred in patients with continued need for systemic immunosuppression. In conclusion, acyclovir effectively and safely prevents VZV disease during the first year after hematopoietic cell transplantation. Periods of prophylaxis longer than 12 months may be beneficial for those hematopoietic cell transplant recipients on continued immune suppression. PMCID: PMC1895699 PMID: 16282339 [PubMed - indexed for MEDLINE] 1005. Acta Neurol Scand. 2005 Dec;112(6):417-9. Frequent association of multiple sclerosis with varicella and zoster. Perez-Cesari C, Saniger MM, Sotelo J. Neuroimmunology Unit, National Institute of Neurology and Neurosurgery of Mexico, Mexico City, Mexico. BACKGROUND: A possible association of multiple sclerosis (MS) with viral diseases has been postulated; in previous studies we have found that in Mexican mestizos the antecedent of varicella during childhood represents a risk factor for the development of MS during adulthood. AIM: We conducted a retrospective search for varicella and zoster infections associated with the development of MS. METHODS AND RESULTS: In a cohort of 82 consecutive patients with MS we found six cases, four of varicella and two of zoster, that were concurrent with the development or the progress of MS. CONCLUSIONS: The association of these pathologies is higher than expected and suggests a possible etiological relationship of the varicella zoster virus with MS. PMID: 16281927 [PubMed - indexed for MEDLINE] 1006. J Dtsch Dermatol Ges. 2004 Nov;2(11):931-4. [Zosteriform pigmented purpura of Schamberg: case report and differential diagnosis of zosteriform skin lesions] [Article in German] Babilas P, Roesch A, Szeimies RM, Landthaler M, Vogt T. Klinik und Poliklinik für Dermatologie, Klinikum der Universität Regensburg. philipp.babilas@klinik.uni-regensburg.de A 13-year-old boy presented with progressive pigmented purpura of Schamberg in an unusual zosteriform distribution. He recently has taken methylphenidate which has not been described as a cause of Schamberg disease. Many different skin diseases can present in a zosteriform distribution. They are reviewed systematically and sorted by pathogenetic criteria. PMID: 16281612 [PubMed - indexed for MEDLINE] 1007. J Dtsch Dermatol Ges. 2004 Sep;2(9):770-2. [Granulomatous dermatitis following herpes zoster with detection of varicella zoster virus DNA] [Article in German] Gesierich A, Krahl D, Weiss H, Bröcker EB, Rose C. Universität-Hautklinik Würzburg. The occurrence of a granulomatous inflammation following herpes zoster infection is uncommon and its pathogenesis is unclear. A 74-year-old male patient developed multiple red-brown papules following a secondary generalized infection with varicella zoster virus in the same area. The patient was suffering from a chronic lymphocytic B-cell leukaemia. Histopathologically, granulomatous dermatitis with multinucleate giant cells was found. Varicella zoster virus DNA was identified by polymerase chain reaction in the tissue. After a renewed antiviral therapy, skin lesions disappeared completely. PMID: 16279222 [PubMed - indexed for MEDLINE] 1008. MMW Fortschr Med. 2005 Oct 13;147(41):34, 36. [Immunization in the elderly--necessary, helpful, superfluous?] [Article in German] Popp W. GESUNDE LUNGE - Institut für Atemwegs- und Lungenerkrankungen Wien. wolfgang.popp@wienkav.at For all adults, vaccinations against tetanus, diphtheria, poliomyelitis, pertussis, TBE (in endemic regions) and specific vaccinations for travelers are recommended. In addition to this standard protection, the Robert-Koch Institute also recommends--in particular for over-60-year-olds--an annual vaccination against influenza, as well as against pneumococci that must be repeated every six years. PMID: 16270509 [PubMed - indexed for MEDLINE] 1009. MMW Fortschr Med. 2005 Oct 13;147(41):15-6. [Always consider complications in facial erythema] [Article in German] Paukstadt W. PMID: 16270504 [PubMed - indexed for MEDLINE] 1010. Oral Dis. 2005 Nov;11(6):370-3. Oral lesions as indicators of HIV infection among routine dental patients in Lagos, Nigeria. Agbelusi GA, Wright AA. Department of Preventive Dentistry, College of Medicine, University of Lagos, Lagos, Nigeria. gbemisola4life2004@yahoo.com OBJECTIVES: To document the incidental oral lesions of human immunodeficiency virus (HIV) infection, the pattern and frequency of the lesions based on clinical presentation and oral manifestations in routine dental patients who tested positive in Nigeria. SUBJECTS AND METHODS: The study was conducted at the Oral Diagnosis/Oral Medicine clinic of the Lagos University Teaching Hospital, Lagos, Nigeria between May 2002 and April 2003. During this period, all patients with oral lesions suggestive of HIV/acquired immunodeficiency syndrome (AIDS) as described in the EEC-WHO Classification and diagnostic criteria of oral lesions of HIV were counseled and offered voluntary HIV testing. All the 35 patients who consented and tested positive were included in this study. RESULTS: Of a total of 700 patients 53 patients with oral lesions suggestive of HIV/AIDS were seen, thirty-eight (72%) consented to HIV screening, 15 patients (28%) refused. Thirty-five patients (92%), mean age 36 +/- 13 years were confirmed positive for HIV. Oral candidiasis was the commonest lesion seen (43%) the second common being Herpes zoster (23%). Other lesions seen included erythema multiforme in two (6%), facial palsy in two (6%) and oral hairy leukoplakia in one (3%). CONCLUSION: An oral mucosal lesion may be the presenting lesion of HIV/AIDS in routine patients attending the dental clinic. Oral health care workers should practice optimal infection control based on the Centers for Disease Control 'Standard Precautions' guidelines on infection control for all patients to minimize occupational transmission of HIV. PMID: 16269028 [PubMed - indexed for MEDLINE] 1011. J Eur Acad Dermatol Venereol. 2005 Nov;19(6):774-5. Mondor's disease probably due to herpes zoster. Yang JH, Lee UH, Jang SJ, Choi JC. PMID: 16268897 [PubMed - indexed for MEDLINE] 1012. Bull Soc Pathol Exot. 2005 Sep;98(3):187-92. [Dermatologic manifestations associated with immune reconstitution syndrome in HIV+ patients starting HAART: a retrospective study in French Guiana] [Article in French] Sarazin E, Nacher M, Toure Y, Clyti E, El Guedj M, Aznar C, Vaz T, Sainte-Marie D, Sobesky M, Carme B, Couppié P. Service de dermatologie, Centre hospitalier Andrée-Rosemon, Avenue des Flamboyants, 97306, Cayenne, Guyane française. Immune reconstitution syndrome (IRIS) is an unusual inflammatory reaction to an opportunistic infection in an HIV-positive patient. This syndrome occurs when immunity is restored in the first months of an effective highly active antiretroviral treatment (HAART). First, we described all patients with a cutaneous form of IRIS. Then, between 1992 and 2004 we conducted a retrospective cohort study comparing Herpes Zoster and Herpes Simplex infections among untreated patients, patients treated by HAART for < or = six months, and patients treated for > six months. We observed three cases of atypical leprosy and three original observations: two of these were fistulisation of lymph node histoplasmosis and tuberculosis, the third one reports the recurrence of a treated cutaneous leishmaniasis. Multivariate analysis showed that, after controlling for age, sex and CD4 counts, patients receiving HAART for < or = six months were more likely to develop Herpes Zoster or herpes simplex infections (p < 0.005). Herpes Simplex and Herpes Zoster infections are the two most frequent dermatological manifestations in our tropical setting. Although mycobacterial infections are more rarely observed than in visceral IRIS, the increased incidence of leprosy may be quite significant when the availability of HAART spreads to developing countries. PMID: 16267958 [PubMed - indexed for MEDLINE] 1013. Curr Neurol Neurosci Rep. 2005 Nov;5(6):427-8. A vaccine to prevent herpes zoster and post-herpetic neuralgia in older adults. Jubelt B. PMID: 16263052 [PubMed - indexed for MEDLINE] 1014. Am J Clin Dermatol. 2005;6(5):317-25. Current management of herpes zoster: the European view. Volpi A, Gross G, Hercogova J, Johnson RW. Department of Public Health, University of Rome, Rome, Italy. volpi@med.uniroma2.it The overall incidence of herpes zoster in Europe is approximately 3 per 1000 people per year and more than 10 per 1000 people per year in those aged >80 years. Post herpetic neuralgia (PHN) is a common debilitating complication of herpes zoster, particularly in patients aged >50 years, in persons with severe pain or rash at presentation, and in those with significant prodromal symptoms. Antiviral drugs can effectively control acute symptoms and, if used early enough in the course of the illness, can help prevent the development of PHN and other complications. However, despite this, many patients do not receive such treatment. The economic impact of zoster and PHN is largely underestimated in Europe. Furthermore, there is considerable variation throughout Europe in the management of herpes zoster. Use of antiviral therapy including the newer potent antiviral agents such as brivudin, which requires less frequent administration than acyclovir, is improving patient outcomes in some European countries. However, in many countries, patient awareness of herpes zoster and, as a result, overall antiviral use is low. Guidelines recommending the use of antiviral agents, particularly in patients at risk of developing PHN, are available but are not widely used. More needs to be done to educate the general public and increase awareness among primary healthcare providers of the benefits of timely and appropriate pharmacological therapy in patients with herpes zoster. PMID: 16252931 [PubMed - indexed for MEDLINE] 1015. Med J Aust. 2005 Sep 5;183(5):278-9. Universal varicella vaccination. Comment. Macartney K, Mcintyre P. Comment on: Med J Aust. 2005 Sep 5;183(5):277-9. PMID: 16252446 [PubMed - indexed for MEDLINE] 1016. FDA Consum. 2005 Jul-Aug;39(4):7. Experimental shingles vaccine proves effective in nationwide study. [No authors listed] PMID: 16252393 [PubMed - indexed for MEDLINE] 1017. Bone Marrow Transplant. 2006 Jan;37(1):73-80. Herpes zoster infection in the post-hematopoietic stem cell transplant pediatric population may be preceded by transaminitis: an institutional experience. Berman JN, Wang M, Berry W, Neuberg DS, Guinan EC. Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA 02115, USA. Herpes zoster (HZ), a varicella-zoster virus reactivation, frequently complicates hematopoietic stem cell transplantation (HSCT). Its incidence, complications, and associated risk factors in 310 children undergoing HSCT were reviewed. In all, 61 of 201(32%) patients who had undergone allogeneic and 10 of 109 (9%) patients who had undergone autologous HSCT developed HZ. Of 90 VZV seropositive allogeneic patients, 50 (53%) developed HZ. Seven (17%) of 41 VZV seropositive autologous patients developed HZ. Although a substantial number of patients develop HZ in the early post-HSCT period, risk for HZ persists and HZ can occur up to 5 years post-HSCT. Risk factors for HZ included age >10 years (P<0.0001), allogeneic HSCT (P<0.001), and total body irradiation (TBI) (P<0.059) in allogeneic recipients. Of 37, 22 (59%) patients experienced an elevated alanine aminotransferase (ALT), unassociated with GVHD, in the month preceding HZ. Of the 48/64 patients (75%) hospitalized for treatment (median stay, 6 days; range, 2-39), length of stay was unaffected by donor type but increased by cutaneous dissemination and visceral involvement (P=0.023 and 0.034, respectively) in allogeneic patients. Consideration of HZ infection particularly in patients >10 years of age with elevated ALT after TBI-conditioned allogeneic HSCT may permit earlier diagnosis and therapeutic intervention. PMID: 16247423 [PubMed - indexed for MEDLINE] 1018. Rev Neurol (Paris). 2005 Sep;161(8-9):836-9. [Cerebral vasculitis secondary to Varicella-Zoster virus infection] [Article in French] Outteryck O, Sénéchal O, Berteloot D, Delalande I, Mounier-Vehier F. Service de Neurologie, Hôpital Dr Schaffner, Lens. INTRODUCTION: Central nervous system infection by the varicella-zoster virus (VZV) can be responsible for myelitis, meningitis, ventriculitis and large and small-vessels encephalitis. CASE REPORT: We report the case of a 57-year-old-man hospitalized for deteriorating general health. Physical examination revealed likely encephalitis associated with headache without meningeal syndrome. Successive cerebral MRIs showed bilateral necrosis of the amygdaloid bodies and multiple deep and sub-cortical infarcts suggestive of vasculitis. Cerebral arteriography was normal. Three cerebral fluid examinations disclosed mononuclear pleiocytosis with few red blood cells. PCR analysis for VZV was only positive at the third time. DISCUSSION: The diagnosis of VZV encephalitis is difficult without the rash typical of zoster and because of the low sensitivity of PCR VZV in comparison with PCR HSV. CONCLUSION: In active viral disease, where the prognosis depends on early treatment, we highlight the usefulness of repeated PCR analysis and the search for antibodies in blood and cerebrospinal fluid. PMID: 16244567 [PubMed - indexed for MEDLINE] 1019. J Am Acad Dermatol. 2005 Nov;53(5):890-2. Frequent varicella zoster reactivation associated with therapeutic use of arsenic trioxide: portents of an old scourge. Au WY, Kwong YL. University Department of Medicine, Queen Mary Hospital, Hong Kong. In 44 patients treated with arsenic trioxide (As2(O3)) for acute promyelocytic leukemia, 11 developed varicella zoster virus (VZV) reactivation (median 56 days [range 15-299]) after treatment. There was no preferential dermatome involvement or systemic spread. The actuarial risk of VZV reactivation at 1 year was 26%. No VZV reactivation occurred after the first year of initial treatment with As2(O3). PMID: 16243151 [PubMed - indexed for MEDLINE] 1020. Ophthalmology. 2005 Dec;112(12):2184-8. Epub 2005 Oct 20. Herpetic eye disease in diabetic patients. Kaiserman I, Kaiserman N, Nakar S, Vinker S. Department of Ophthalmology, Hadassah University Hospital, Jerusalem, Israel. igor@dr-kaiserman.com PURPOSE: To study the incidence of herpetic eye disease (HED) of the ocular surface in diabetics. DESIGN: Observational historical cohort study. SETTING: A district of the largest health maintenance organization in Israel (the Central District of Clalit Health Services). PARTICIPANTS: We reviewed the electronic medical records of all patients older than 50 years (159634 patients) in the district, and of these, 22382 (14.0%) patients had diabetes mellitus. METHODS: All filled prescriptions for acyclovir eye ointment between January 1, 2001 and December 31, 2003 (1483 tubes) and all hemoglobin A1c laboratory tests during 2003 (41910 tests) were documented. An ocular surface HED event was defined when a patient consumed at least 1 tube of topical acyclovir per month, whereas no acyclovir use was documented 3 months before and 3 months after that event. MAIN OUTCOME MEASURES: Incidence of ocular surface HED events in diabetics compared with nondiabetics adjusted for age and gender. RESULTS: After age and gender adjustment, significantly more diabetics had ocular surface HED (5.21 per thousand) compared with nondiabetics (4.27 per thousand; P<0.0001). Stratification by age revealed a significantly higher prevalence of HED in diabetics, aged 60 to 79 years. Recurrent herpetic events occurred during the study period in 25.2% of HED-affected diabetics, and in 16.6% of HED-affected nondiabetics (P = 0.05). Diabetics with poor glycemic control (mean annual hemoglobin A1c > 9%) consumed significantly more ocular acyclovir (P = 0.01). Multivariate analysis revealed this effect to be independent of age, gender, place of birth, or place of residency. CONCLUSIONS: Ocular surface HED is significantly more common among patients with diabetes mellitus. Poor glycemic control correlates with increased consumption of ocular acyclovir in diabetic patients. PMID: 16242779 [PubMed - indexed for MEDLINE] 1021. Int Psychogeriatr. 2005;17 Suppl 1:S65-77. Dementia associated with infectious diseases. Almeida OP, Lautenschlager NT. University of Western Australia, School of Psychiatry and Clinical Neurosciences, Mail Delivery Point M573, 35 Stirling Highway, Crawley, Perth, WA 6009, Australia. osvalm@cyllene.uwa.edu.au At the turn of the last century, infectious diseases represented an important cause of health morbidity and behavioral changes. Neurosyphilis, for example, was relatively common at the time and often led to the development of cognitive impairment and dementia. With the advent of effective antibiotic treatment, the association between infectious diseases and dementia became increasingly less frequent, although a resurgence of interest in this area has taken place during the past 15 years with the emergence of acquired immunodeficiency syndrome (AIDS) and variant Creutzfeldt-Jakob disease (vCJD). This paper reviews the most frequent infectious causes of dementia, including prion diseases, as well as infections caused by herpes virus, human immunodeficiency virus (HIV), toxoplasmosis, cryptococcus, cytomegalovirus, syphilis, borrelia and cysticercosis. PMID: 16240484 [PubMed - indexed for MEDLINE] 1022. N Engl J Med. 2005 Oct 20;353(16):e14. Images in clinical medicine. Left sixth cranial nerve palsy with herpes zoster ophthalmicus. Jude E, Chakraborty A. Tameside General Hospital, Ashton-under-Lyne OL6 9RW, United Kingdom. PMID: 16236731 [PubMed - indexed for MEDLINE] 1023. Int J Clin Pract. 2005 Nov;59(11):1326-33. Is Europe ready to embrace a policy of universal varicella vaccination? Ramet J, Weil-Olivier C, Sedlak W; Confederation of the European Specialists of Paediatrics (CESP)/European Academy of Paediatrics (EAP) CESP/EAP. Universiteit Antwerpen, UZA and Paola Kinderziekenhuis ZNA, Antwerp, Belgium. jose.ramet@zna.be Comment in: Int J Clin Pract. 2005 Nov;59(11):1248-50. For the first time, a live attenuated varicella vaccine with an indication for universal vaccination is licensed in all EU countries. It is now time to consider whether in Europe there should be widespread vaccination against varicella to prevent this common and highly infectious disease. Increasing numbers of countries are adopting vaccination programmes against the disease. In those countries where a routine vaccination policy has been adopted, the success of the vaccine has been significant. The USA, which prior to the launch of a universal vaccination programme in 1995 had 4 million cases of varicella per year, has seen a dramatic reduction in varicella morbidity and mortality rates. A universal varicella vaccination policy is an option that needs to be considered for Europe not only in medical terms but also because it would be socially and economically appropriate. PMID: 16236088 [PubMed - indexed for MEDLINE] 1024. Drugs Today (Barc). 2005 Aug;41(8):509-16. Pregabalin: a new agent for the treatment of neuropathic pain. Zareba G. Department of Environmental Medicine, University of Rochester, School of Medicine and Dentistry, Rochester, New York 14642, USA. grazyna_zareba@urmc.rochester.edu Pregabalin (Lyrica, Pfizer) is a GABA analog with similar structure and actions to gabapentin. It has antiepileptic, analgesic and anxiolytic activity. Pregabalin is indicated for the management of neuropathic pain associated with diabetic neuropathy and post-herpetic neuralgia. Peak plasma levels occur approximately 1 hour after oral doses and oral bioavailability is about 90%. Based on AUC data, food does not significantly affect the extent of absorption. Pregabalin is not protein-bound and exhibits a plasma half-life of about 6 hours, which is not dose-dependent. Hepatic metabolism is negligible, and most of the oral dose (95%) appears unchanged in the urine. Pregabalin is a safe and well-tolerated new treatment for neuropathic pain. Furthermore, pregabalin has proven efficacy in adjunctive therapy of refractory partial seizures and in the treatment of acute pain, generalized anxiety disorder and social phobia. PMID: 16234874 [PubMed - indexed for MEDLINE] 1025. J Neurol Neurosurg Psychiatry. 2005 Nov;76(11):1604-5. Conduction block in the forearm associated with acute varicella zoster virus infection. Raasch US, Heath JP. PMCID: PMC1739404 PMID: 16227564 [PubMed - indexed for MEDLINE] 1026. Clin Neurol Neurosurg. 2006 Dec;108(8):772-4. Epub 2005 Oct 13. An extremely unusual presentation of varicella zoster viral infection of cranial nerves mimicking Garcin syndrome. Nishioka K, Fujishima K, Kobayashi H, Mizuno Y, Okuma Y. Department of Neurology, Juntendo University Shizuoka Hospital, 1129 Nagaoka, Inzunokuni, Shizuoka 410-2295, Japan. We report a patient with the varicella zoster viral (VZV) infection of multiple cranial nerves mimicking Garcin syndrome, who initially presented with Ramsay Hunt syndrome (herpes zoster oticus). A 78-year-old man showed left facial palsy with zosteric eruptions in his left auricle and dysphagia, followed by left total ophthalmoplegia. His serum anti-VZV antibody titer was elevated. Cerebrospinal fluid examination revealed pleocytosis with a slightly elevated protein level. He was treated with intravenous acyclovir and corticosteroids. His tongue weakness resolved, and then ocular movement improved. The improvement of facial palsy and swallowing difficulty was delayed. VZV infection should be considered even in patients who show unilateral multiple cranial neuropathy mimicking Garcin syndrome because it is treatable. PMID: 16226370 [PubMed - indexed for MEDLINE] 1027. Br J Dermatol. 2005 Nov;153(5):981-6. The role of CD4 and CD8 cytotoxic T lymphocytes in the formation of viral vesicles. Morizane S, Suzuki D, Tsuji K, Oono T, Iwatsuki K. Department of Dermatology, Okayama University Graduate School of Medicine and Dentistry, 2-5-1 Shikata-cho, Okayama 700-8558, Japan. gmd14058@cc.okayama-u.ac.jp BACKGROUND: Herpetic vesicles caused by herpes simplex virus and varicella zoster virus, and hydroa vacciniforme (HV) are characterized by umbilicated vesicule formation. OBJECTIVES: To understand the histogenesis of umbilicated vesicles in herpetic vesicles and HV, we demonstrated the presence of the virus-associated molecules in the lesions, and the pathogenic role of cytotoxic T-lymphocyte (CTL) immune responses. METHODS: Phenotyping of infiltrating cells was carried out in biopsy specimens from herpes simplex, varicella, herpes zoster and HV, and compared with nonviral contact dermatitis. Viral antigens and Epstein-Barr virus-encoded small nuclear RNA (EBER) were detected by immunostaining and by in situ hybridization, respectively. Infiltrating CTLs expressing granzyme B and granulysin were determined by double immunostaining using confocal laser scanning microscopy. RESULTS: In all herpetic vesicles, the corresponding viral antigens were observed in the cytopathic keratinocytes, and infiltration of lymphoid cells was present in the upper dermis and around the vessels. In all HV lesions studied, EBER+ T cells made up 5-10% of the dermal infiltrates and the dermal infiltrates contained almost no CD56 cells. CTLs expressing granzyme B and granulysin were present in both herpetic and HV lesions, in which they made up 10-30% of the total dermal infiltrates, whereas they comprised less than 5% of the infiltrates of biopsy specimens from nonviral contact dermatitis. Confocal laser microscopic examination demonstrated that both CD4+ and CD8+ T cells expressed granzyme B and granulysin. CONCLUSIONS: CD4+ and/or CD8+ CTLs reactive to the virus-infected cells might be responsible for the histogenesis of herpetic and HV lesions characterized by umbilicated vesicles. PMID: 16225610 [PubMed - indexed for MEDLINE] 1028. Expert Rev Vaccines. 2005 Oct;4(5):629-43. Review of the Varilrix varicella vaccine. Chiu SS, Lau YL. Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China. ssschiu@hkucc.hku.hk Varicella zoster virus causes an acute infection that affects most children globally, but the age of infection can be greater in residents of tropical areas. It has generally been considered a mild disease, although there are accumulating data to show that it can cause significant morbidity and mortality in immunocompetent as well as immunocompromised children and adults. Oka-strain live attenuated varicella vaccines were developed in the 1970s. Varilrix developed by GlaxoSmithKline Biologicals (Rixensart, Belgium), is one of the vaccines produced and marketed in over 80 countries. Similar to the other Oka-strain vaccines, Varilrix is safe, immunogenic and efficacious in both immunocompromised and immunocompetent children and adults. PMID: 16221065 [PubMed - indexed for MEDLINE] 1029. Hong Kong Med J. 2005 Oct;11(5):399-402. Herpetic shoulder paresis in a Chinese elderly patient. Tam TC, Chan KY, Ho SL, Luk JK, Chu LW. Acute Geriatrics Unit, Grantham Hospital, Wong Chuk Hang, Hong Kong. A patient with left shoulder girdle weakness secondary to herpetic myotomal paresis is reported. Needle electromyography revealed denervational discharge from the left supraspinatus, deltoid, and brachioradialis muscles, compatible with a radiculopathy that was relevant to his myotomes affected by zoster infection. The patient was managed with range-of-movement and strengthening exercises as well as pain relief for post-herpetic neuralgia. Further studies are required to determine whether antiviral treatment can limit the extent of motor deficit and hasten recovery. Zoster paresis should be one of the differential diagnoses of girdle muscle weakness. PMID: 16219961 [PubMed - indexed for MEDLINE] 1030. Otolaryngol Head Neck Surg. 2005 Oct;133(4):647. Laryngeal zoster mimicking a laryngeal cancer. Higuchi E, Nakamaru Y, Ohwatari R, Sakashita T, Mesuda Y, Homma A, Furuta Y, Fukuda S. PMID: 16213968 [PubMed - indexed for MEDLINE] 1031. Pain. 2005 Nov;118(1-2):97-111. Epub 2005 Oct 5. Varicella zoster virus induces neuropathic changes in rat dorsal root ganglia and behavioral reflex sensitisation that is attenuated by gabapentin or sodium channel blocking drugs. Garry EM, Delaney A, Anderson HA, Sirinathsinghji EC, Clapp RH, Martin WJ, Kinchington PR, Krah DL, Abbadie C, Fleetwood-Walker SM. Division of Veterinary Biomedical Sciences, Centre for Neuroscience Research, University of Edinburgh, Summerhall, Edinburgh EH9 1QH, UK. Reactivation of latent varicella zoster virus (VZV) within sensory trigeminal and dorsal root ganglia (DRG) neurons produces shingles (zoster), often accompanied by a chronic neuropathic pain state, post-herpetic neuralgia (PHN). PHN persists despite latency of the virus within human sensory ganglia and is often unresponsive to current analgesic or antiviral agents. To study the basis of varicella zoster-induced pain, we have utilised a recently developed model of chronic VZV infection in rodents. Immunohistochemical analysis of DRG following VZV infection showed the presence of a viral immediate early gene protein (IE62) co-expressed with markers of A- (neurofilament-200; NF-200) and C- (peripherin) afferent sensory neurons. There was increased expression of neuropeptide Y (NPY) in neurons co-expressing NF-200. In addition, there was an increased expression of alpha2delta1 calcium channel, Na(v)1.3 and Na(v)1.8 sodium channels, the neuropeptide galanin and the nerve injury marker, Activating Transcription Factor-3 (ATF-3) as determined by Western blotting in DRG of VZV-infected rats. VZV infection induced increased behavioral reflex responsiveness to both noxious thermal and mechanical stimuli ipsilateral to injection (lasting up to 10 weeks post-infection) that is mediated by spinal NMDA receptors. These changes were reversed by systemic administration of gabapentin or the sodium channel blockers, mexiletine and lamotrigine, but not by the non-steroidal anti-inflammatory agent, diclofenac. This is the first time that the profile of VZV infection-induced phenotypic changes in DRG has been shown in rodents and reveals that this profile appears to be broadly similar (but not identical) to changes in other neuropathic pain models. PMID: 16213091 [PubMed - indexed for MEDLINE] 1032. Int J STD AIDS. 2005 Oct;16(10):673-6. Herpes zoster in HIV-1-infected patients in the era of highly active antiretroviral therapy: a prospective observational study. Hung CC, Hsiao CF, Wang JL, Chen MY, Hsieh SM, Sheng WH, Chang SC. Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, 7 Chung-Shan South Road, Taipei, Taiwan. hcc0401@ha.mc.ntu.edu.tw Between June 1994 and May 2003, 93 of 716 (13.0%) HIV-infected patients with a median baseline cell differentiation CD4+ count of 61 x 10(6) cells/L (range, 1-1206 x 10(6) cells/L) developed 103 episodes of herpes zoster [HZ], with an incidence of 5.67 per 100 person-years (PY). The incidence of HZ in the pre-highly active antiretroviral therapy (HAART) era (17.21 per 100 PY) was significantly higher than that in the post-HAART era (5.05 per 100 PY) (P < 0.0001). In the first six months of enrollment, the incidence of HZ was significantly higher than that between six and 12 months both in the pre-HAART (27.65 per 100 PY versus 8.43 per 100 PY, P = 0.02) and post-HAART era (17.79 per 100 PY versus 3.39 per 100 PY, P < 0.0001). In multivariate analyses, only baseline CD4+ count remained a significant risk factor associated with HZ. HZ did not increase mortality rate either in the pre-HAART or post-HAART era, although the risk for HIV progression was significantly higher in patients with HZ (adjusted odds ratio [OR], 1.747, 95% confidence interval, 1.037-2.943). We conclude that the incidence of HZ was highest in the first six months of enrollment in patients at late stage of HIV infection, which did not increase with the introduction of HAART. Baseline CD4+ lymphocyte count was the most significant risk factor associated with development of HZ. HZ was associated with increased risk for HIV progression, but not mortality. PMID: 16212714 [PubMed - indexed for MEDLINE] 1033. Herpes. 2005 Oct;12(2):33-7. Analysis of the cost-effectiveness of varicella vaccine programmes based on an observational survey in the Latium region of Italy. Gialloreti LE, Divizia M, Pica F, Volpi A. Department of Public Health, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy. Comment in: Herpes. 2005 Oct;12(2):32. Varicella is the most widespread childhood disease in Italy. However, as in many parts of the world, the country does not yet have a unified approach to the management of the disease. A cost-effectiveness analysis of varicella vaccination strategies, using the Latium region in Italy as a case study, was undertaken. Mass vaccination is only recommended if the immunization programme can achieve coverage of over 85% in a short time. However, experience in Italy with non-compulsory vaccinations has shown this is difficult to achieve. Consequently, eradication of the disease is not seen as an attainable short-term goal. For mass varicella vaccination to be successful, it must be run at a national as well as regional level in combination with education programmes, and a reliable surveillance system. The interaction between varicella and herpes zoster must also be taken into account when considering vaccination strategies, as zoster vaccination strategies may have an impact on varicella coverage. PMID: 16209858 [PubMed - indexed for MEDLINE] 1034. Herpes. 2005 Oct;12(2):32. Selective versus universal vaccination for varicella zoster virus infection: what holds the key to successful disease control? Schleiss M. Comment on: Herpes. 2005 Oct;12(2):33-7. PMID: 16209857 [PubMed - indexed for MEDLINE] 1035. Health News. 2005 Sep;11(9):5-6. Shingles vaccine found effective; could offer relief to millions. Zoster vaccine could be available as early as next year to prevent this painful skin and nerve condition. [No authors listed] PMID: 16208806 [PubMed - indexed for MEDLINE] 1036. Harv Womens Health Watch. 2005 Aug;12(12):5. Shingles vaccine shows promise in large trial. [No authors listed] PMID: 16208771 [PubMed - indexed for MEDLINE] 1037. Harv Health Lett. 2005 Aug;30(10):4-5. These shots aren't just kid stuff. Adults may soon be rolling up their sleeves to get vaccinated for shingles and whooping cough. [No authors listed] PMID: 16206387 [PubMed - indexed for MEDLINE] 1038. Ann Intern Med. 2005 Oct 4;143(7):539-41. The growing paradigm of preventing disease: vaccines to prevent herpes zoster and pertussis in adults. Poland GA. PMID: 16204167 [PubMed - indexed for MEDLINE] 1039. Br J Hosp Med (Lond). 2005 Sep;66(9):542-3. Unusual presentation of Ramsay-Hunt syndrome without-facial nerve palsy. Leong SC, Karkanevatos A. Department of Otolaryngology, Royal Liverpool University Hospital, Liverpool L7 8XP. PMID: 16200803 [PubMed - indexed for MEDLINE] 1040. Clin Exp Dermatol. 2005 Nov;30(6):643-5. Coexistence of psoriasis and linear IgA disease in a patient with recent herpes zoster infection. Cooke N, Jenkinson H, Wojnarowska F, McKenna K, Alderdice J. Department of Dermatology, Royal Victoria Hospital, UK. nicolacooke36@hotmail.com We report the case of a 29-year-old man with chronic plaque psoriasis who developed linear IgA disease following herpes zoster infection. There has only been one previous report describing the coexistence of psoriasis and linear IgA disease, which was confirmed by immunopathological studies. In our patient, immunoblotting studies identified IgA antibodies binding to BP180 and BP230 antigens, and IgG autoantibodies binding weakly to the BP180 antigen. This is an interesting case that we believe is an example of epitope spreading in the development of autoimmune subepidermal bullous diseases. PMID: 16197377 [PubMed - indexed for MEDLINE] 1041. N Engl J Med. 2005 Sep 29;353(13):1414-5; author reply 1414-5. A vaccine to prevent herpes zoster. Carroll I, Gaeta R, Mackey S. Comment on: N Engl J Med. 2005 Jun 2;352(22):2271-84. PMID: 16196123 [PubMed - indexed for MEDLINE] 1042. N Engl J Med. 2005 Sep 29;353(13):1414-5; author reply 1414-5. A vaccine to prevent herpes zoster. Kessler KM. Comment on: N Engl J Med. 2005 Jun 2;352(22):2271-84. N Engl J Med. 2005 Jun 2;352(22):2344-6. PMID: 16192493 [PubMed - indexed for MEDLINE] 1043. Am Fam Physician. 2005 Sep 15;72(6):1082. Information from your family doctor. Shingles: easing the pain. American Academy of Family Physicians. PMID: 16190506 [PubMed - indexed for MEDLINE] 1044. Am Fam Physician. 2005 Sep 15;72(6):1075-80. Herpes zoster and postherpetic neuralgia: prevention and management. Mounsey AL, Matthew LG, Slawson DC. Department of Family Medicine, University of Virginia, Charlottesville, Virginia 22908, USA. Comment in: Am Fam Physician. 2006 Aug 1;74(3):378; author reply 381. The recognizable appearance and the dermatomal distribution of herpes zoster lesions usually enable a clinical diagnosis to be made easily. Herpes zoster and postherpetic neuralgia occur mainly in older patients. The role of the varicella vaccine in preventing herpes zoster is uncertain, but is being studied. There is evidence to support using antiviral therapy and possibly low-dose tricyclic antidepressants to prevent postherpetic neuralgia. There is good evidence that treating herpes zoster with antiviral medication is beneficial, particularly in patients older than 50 years with severe outbreaks. The use of steroids has an unfavorable risk-benefit ratio. In patients who develop postherpetic neuralgia, there is good evidence to support treatment with gabapentin and tricyclic antidepressants. More evidence for treatment with capsaicin cream, lidocaine patch, and opioids is needed. Intrathecal methylprednisolone is an option for patients with persistent pain. PMID: 16190505 [PubMed - indexed for MEDLINE] 1045. J Virol. 2005 Oct;79(20):13070-81. Dissection of a novel nuclear localization signal in open reading frame 29 of varicella-zoster virus. Stallings CL, Silverstein S. Integrated Program in Cellular, Molecular and Biophysical Studies and the Department of Microbiology, Columbia University, College of Physicians and Surgeons, New York, New York 10032, USA. Open reading frame 29 (ORF29) of varicella-zoster virus (VZV) encodes a 120-kDa single-stranded DNA binding protein (ORF29p) that is not packaged in the virion and is expressed during latency. During lytic infection, ORF29p is localized primarily to infected cell nuclei. In contrast, ORF29p is found exclusively in the cytoplasm in neurons of the dorsal root ganglia obtained at autopsy from seropositive latently infected patients. ORF29p accumulates in the nuclei of neurons in dorsal root ganglia obtained at autopsy from patients with active zoster. The localization of this protein is, therefore, tightly correlated with the proposed VZV lytic/latent switch. In this report, we have investigated the nuclear import mechanism of ORF29p. We identified a novel nuclear targeting domain bounded by amino acids 9 to 154 of ORF29p that functions independent of other VZV-encoded factors. In vitro import assays in digitonin-permeabilized HeLa cells reveal that ORF29p is transported into the nucleus by a Ran-, karyopherin alpha- and beta-dependent mechanism. These data are further supported by the demonstration that a glutathione S-transferase-karyopherin alpha fusion interacts with ORF29p, but not with a protein containing a point mutation in its nuclear localization signal (NLS). Therefore, the region of ORF29p responsible for its nuclear targeting is also involved in the association with karyopherin alpha. As a result of this interaction, this noncanonical NLS appears to hijack the classical cellular nuclear import machinery. Elucidation of the mechanisms governing ORF29p nuclear targeting could shed light on the VZV reactivation process. PMCID: PMC1235848 PMID: 16189009 [PubMed - indexed for MEDLINE] 1046. J Virol. 2005 Oct;79(20):12921-33. T-cell tropism and the role of ORF66 protein in pathogenesis of varicella-zoster virus infection. Schaap A, Fortin JF, Sommer M, Zerboni L, Stamatis S, Ku CC, Nolan GP, Arvin AM. Department of Pediatrics, Stanford University School of Medicine, CA 94305-5208, USA. aschaap@stanford.edu The pathogenesis of varicella-zoster virus (VZV) involves a cell-associated viremia during which infectious virus is carried from sites of respiratory mucosal inoculation to the skin. We now demonstrate that VZV infection of T cells is associated with robust virion production and modulation of the apoptosis and interferon pathways within these cells. The VZV serine/threonine protein kinase encoded by ORF66 is essential for the efficient replication of VZV in T cells. Preventing ORF66 protein expression by stop codon insertion (pOka66S) impaired the growth of the parent Oka (pOka) strain in T cells in SCID-hu T-cell xenografts in vivo and reduced formation of VZV virions. The lack of ORF66 protein also increased the susceptibility of infected T cells to apoptosis and reduced the capacity of the virus to interfere with induction of the interferon (IFN) signaling pathway following exposure to IFN-gamma. However, preventing ORF66 protein expression only slightly reduced growth in melanoma cells in culture and did not diminish virion formation in these cells. The pOka66S virus showed only a slight defect in growth in SCID-hu skin implants compared with intact pOka. These observations suggest that the ORF66 kinase plays a unique role during infection of T cells and supports VZV T-cell tropism by contributing to immune evasion and enhancing survival of infected T cells. PMCID: PMC1235817 PMID: 16188994 [PubMed - indexed for MEDLINE] 1047. J Virol. 2005 Oct;79(20):12658-66. Varicella-zoster virus activates inflammatory cytokines in human monocytes and macrophages via Toll-like receptor 2. Wang JP, Kurt-Jones EA, Shin OS, Manchak MD, Levin MJ, Finberg RW. Department of Medicine, University of Massachusetts Medical Center, Worcester, 01605, USA. jennifer.wang@umassmed.edu The pattern recognition receptor Toll-like receptor 2 (TLR2) has been implicated in the response to several human viruses, including herpes simplex viruses (types 1 and 2) and cytomegalovirus. We demonstrated that varicella-zoster virus (VZV) activates inflammatory cytokine responses via TLR2. VZV specifically induced interleukin-6 (IL-6) in human monocytes via TLR2-dependent activation of NF-kappaB, and small interfering RNA designed to suppress TLR2 mRNA reduced the IL-6 response to VZV in human monocyte-derived macrophages. Unlike other herpesviruses, the cytokine response to VZV was species specific. VZV did not induce cytokines in murine embryonic fibroblasts or in a mouse cell line, although VZV did activate NF-kappaB in a human cell line expressing a murine TLR2 construct. Together, these results suggest that TLR2 may play a role in the inflammatory response to VZV infection. PMCID: PMC1235827 PMID: 16188968 [PubMed - indexed for MEDLINE] 1048. J Acquir Immune Defic Syndr. 2005 Oct 1;40(2):169-74. The incidence of, risk factors for, and sequelae of herpes zoster among HIV patients in the highly active antiretroviral therapy era. Gebo KA, Kalyani R, Moore RD, Polydefkis MJ. Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA. kgebo@jhmi.edu BACKGROUND: Whereas the incidence, risk factors, and clinical sequelae of herpes zoster have been studied in the general population and in HIV patients in the era before highly active antiretroviral therapy (HAART), they have yet to be fully understood in the current era of HAART. METHODS: We conducted a retrospective cohort study of patients enrolled in an urban HIV clinic between January 1, 1997 and December 31, 2001. Patients with an episode of herpes zoster during this period were identified, and their charts were reviewed. A nested case-control analysis was used to assess factors associated with an initial episode of herpes zoster. Multivariate conditional logistic regression analyses were used to assess risk factors for zoster. Logistic regression was performed to assess factors associated with complicated zoster. RESULTS: Two hundred eighty-two episodes of herpes zoster were identified in 239 patients. Of these episodes, 158 were new occurrences of zoster and 124 were recurrent zoster events. The incidence of zoster during the study period was 3.2 per 100 person-years of follow-up. The incident cases reflected the clinic population, with most patients being male (63%) and African American (77%) and having injection drug use as their HIV risk factor (49%). The mean age of the patients was 41 years. Sixty-seven percent of patients had single dermatomal involvement, and the thorax was involved in 41%. In multivariate regression, being on HAART (odds ratio [OR] = 2.39, 95% confidence interval [CI]: 1.65 to 3.49) and a CD4 count of 50 to 200 cells/mm (OR = 2.69, 95% CI: 1.44 to 5.01) compared with a CD4 count less than 50 cells/mm were associated with an increased risk of zoster. Twenty-eight patients (18%) developed post-herpetic neuralgia (PHN), and 29 patients (18%) had other complications. Male-to-male sex as an HIV risk factor (P = 0.02) and being on HAART at a zoster episode (P = 0.03) were protective against complicated zoster. CONCLUSIONS: Our results suggest that zoster infection rates have not changed in the current HAART era but that a significant percentage of patients develop complications, particularly PHN, which is quite remarkable considering the young age of our population. PMID: 16186734 [PubMed - indexed for MEDLINE] 1049. J Gen Virol. 2005 Oct;86(Pt 10):2673-84. Transcriptomal analysis of varicella-zoster virus infection using long oligonucleotide-based microarrays. Kennedy PG, Grinfeld E, Craigon M, Vierlinger K, Roy D, Forster T, Ghazal P. Glasgow University Department of Neurology, Southern General Hospital, Institute of Neurological Sciences, Glasgow G51 4TF, UK. P.G.Kennedy@clinmed.gla.ac.uk Varicella-zoster virus (VZV) is a human herpes virus that causes varicella as a primary infection and herpes zoster following reactivation of the virus from a latent state in trigeminal and spinal ganglia. In order to study the global pattern of VZV gene transcription, VZV microarrays using 75-base oligomers to 71 VZV open reading frames (ORFs) were designed and validated. The long-oligonucleotide approach maximizes the stringency of detection and polarity of gene expression. To optimize sensitivity, microarrays were hybridized to target RNA and the extent of hybridization measured using resonance light scattering. Microarray data were normalized to a subset of invariant ranked host-encoded positive-control genes and the data subjected to robust formal statistical analysis. The programme of viral gene expression was determined for VZV (Dumas strain)-infected MeWo cells and SVG cells (an immortalized human astrocyte cell line) 72 h post-infection. Marked quantitative and qualitative differences in the viral transcriptome were observed between the two different cell types using the Dumas laboratory-adapted strain. Oligonucleotide-based VZV arrays have considerable promise as a valuable tool in the analysis of viral gene transcription during both lytic and latent infections, and the observed heterogeneity in the global pattern of viral gene transcription may also have diagnostic potential. PMID: 16186220 [PubMed - indexed for MEDLINE] 1050. Health News. 2005 Aug;11(8):2. Shingles vaccine proves highly effective. [No authors listed] PMID: 16184636 [PubMed - indexed for MEDLINE] 1051. Neurocrit Care. 2004;1(3):371-4. Pseudo-subarachnoid hemorrhage: report of three cases and review of the literature. Cucchiara B, Sinson G, Kasner SE, Chalela JA. Department of Neurology, University of Pennsylvania Medical Center, Philadelphia, PA 19104, USA. cucchiar@mail.med.upenn.edu Subarachnoid hemorrhage (SAH) appears on CT as hyperdensity in the subarachnoid space. In rare circumstances a similar appearance may occur in the absence of subarachnoid blood, a finding that has been termed "pseudo-subarachnoid hemorrhage." We describe three patients who presented with abrupt alterations in mental status in whom CT falsely suggested SAH, and we review the literature regarding this imaging finding. In contrast to prior reports, all three of our patients had a favorable outcome. PMID: 16174937 [PubMed - indexed for MEDLINE] 1052. Am J Chin Med. 2005;33(4):517-23. Effect of an herbal formula containing Ganoderma lucidum on reduction of herpes zoster pain: a pilot clinical trial. Hijikata Y, Yasuhara A, Sahashi Y. Toyodo Hijikata Clinic, Osaka 567-0031, Japan. hijikata@osb.att.ne.jp Administration of hot water extracts of a herbal formula containing Ganoderma lucidum, WTMCGEPP (Wisteria floribunda 0.38, Trapa natans 0.38, Miristica agrans 0.38, Coix lachryma-jobi 0.75, cultivated Ganoderma lucidum 0.75, Elfuinga applanata 0.38, tissue cultured Panax ginseng 0.3, and Punica granatum 0.38: numerals designate dry weight gram/dose), decreased herpes zoster pain for five Japanese patients suffering from shingles. Pain relief started within a few days of intake and was almost complete within 10 days. Two acute herpes zoster with manifestations including trigeminal nerve ophthalmia (both 74 years old), lower body zoster (70 years old), herpes zoster oticus (17 years old), and leg herpes (28 years old), responded quickly to treatment and no patient developed post-herpetic neuralgia (PHN) after more than one year of follow-up. PMID: 16173526 [PubMed - indexed for MEDLINE] 1053. Rev Med Virol. 2005 Nov-Dec;15(6):393-406. Herpes simplex virus and varicella-zoster virus: why do these human alphaherpesviruses behave so differently from one another? Mori I, Nishiyama Y. Department of Microbiology and Immunology, Aichi Medical University School of Medicine, Nagakute, Aichi 480-1195, Japan. isamor@aichi-med-u.ac.jp Members of the Herpesviridae family of viruses are classified into the alpha, beta and gamma subfamilies. The alpha subfamily is estimated to have diverged from the beta and gamma subfamilies 200-220 million years ago. The ancestors of the herpes simplex virus (HSV) and the varicella-zoster virus (VZV), two ubiquitous and clinically important human pathogens, appeared 70-80 million years ago. As these viruses coevolved with their specific primate hosts, genetic rearrangements led to the development of the contemporary alphaherpesviruses and their distinct complement of genes. Here the distinct features of HSV and VZV are discussed in terms of their transmissibility, clinical picture, tissue tropism, establishment of latency/reactivation and immune evasion, which can, at least in part, be explained by differences in their genomes. PMID: 16173110 [PubMed - indexed for MEDLINE] 1054. J Eur Acad Dermatol Venereol. 2005 Sep;19(5):593-6. Zosteriform cutaneous metastases from breast adenocarcinoma. Bassioukas K, Nakuci M, Dimou S, Kanellopoulou M, Alexis I. Department of Skin and Veneral Diseases, Medical School, University of Ioannina, Greece. konabass@cc.uoi.gr Cutaneous metastases from breast adenocarcinoma are usually nodular, single or multiple. Their zosteriform distribution is very rare. We present a 54-year-old woman with cutaneous zosteriform nodular metastases on the right side of her thorax, and infiltration of the corresponding arm, 3 months after the excision of adenocarcinoma of her right breast. PMID: 16164715 [PubMed - indexed for MEDLINE] 1055. Neurologia. 2005 Sep;20(7):374-6. [Brachial plexitis and myelitis and herpes-zoster lumbar plexus disorder in patient treated with infliximab] [Article in Spanish] Arias M, Arias-Rivas S, Dapena D, Mera A. Servicio de Neurología, Complejo Hospitalario Universitario de Santiago de Compostela, La Coruña. mariasg@meditex.es Infliximab, a chimeric monoclonal antibody, is a TNF-a inhibitor approved for use in refractory rheumatoid arthritis and Crohn s disease. We present the case of a patient affected by severe rheumatoid arthritis who was successfully treated with infliximab. She suffered diverse neurological complications: brachial plexitis, asymptomatic thoracic myelitis with extensive lesions in MRI study, and herpes zoster lumbar plexitis. We review the neurological adverse effects of infliximab (aseptic meningitis, opportunistic germs infections, disseminated herpes zoster) and focus in their potential adverse effect to induce central and peripheral nervous system demyelination. PMID: 16163582 [PubMed - indexed for MEDLINE] 1056. Zhong Xi Yi Jie He Xue Bao. 2005 Sep;3(5):400-1. [Clinical observation on treatment of herpes zoster with collateral-pricking and healthy energy strengthening therapy] [Article in Chinese] Yu F, Xu SW, Zhang W. Department of Acupuncture-Moxibustion, First People's Hospital, Shanghai Jiao Tong University, Shanghai 200080, China. PMID: 16159579 [PubMed - indexed for MEDLINE] 1057. J Med Assoc Thai. 2005 May;88(5):678-81. Herpes zoster, clinical course and associated diseases: A 5-year retrospective study at Tamathibodi Hospital. Tunsuriyawong S, Puavilai S. Department of Medicine, Ramathibodi Hospital, Mahidol University, Rama VI Rd, Bangkok 10400, Thailand. OBJECTIVE: Herpes zoster was more frequently found in immunocompromised hosts and elderly persons than in general population. The aim of this study is to find out the distributions of skin lesions, treatments, complications of herpes zoster and associated diseases that occur in concomitant with or after herpes zoster infections. MATERIAL AND METHOD: The medical records of the patients diagnosed as herpes zoster between January 1995 - December 2000 were reviewed. Only the patients who were followed up regularly at Ramathibodi hospital for at least 3 years after the first diagnosis of herpes zoster were enrolled into the study. Demographic data, distribution of skin lesions, treatments, complications of herpes zoster and associated diseases were recorded. RESULTS: Three hundred and ninety-nine cases were enrolled in the study. Three hundred and ninety-eight patients (99.7%) had one dermatomal involvement. Sixty-seven patients (16.8%) had postherpetic neuralgia. Fifty-six patients had associated HIV infection. In 3 years followed up, 17 patients developed HIV infection, 3 patients developed acute leukemia, 2 patients developed mycosis fungoides. PMID: 16149688 [PubMed - indexed for MEDLINE] 1058. Am J Dermatopathol. 2005 Oct;27(5):411-7. Varicella-zoster-virus folliculitis promoted clonal cutaneous lymphoid hyperplasia. Aram G, Rohwedder A, Nazeer T, Shoss R, Fisher A, Carlson JA. Department of Pathology, Albany Medical College, Albany, New York 12208, USA. Post herpes zoster (HZ) reactions have been associated with panoply of neoplastic, inflammatory, and fibro-inflammatory cutaneous disorders. Varicella zoster virus (VZV) DNA has not been identified in most of these reports. After an episode of HZ, a healthy, active 90-year-old female developed ulcerative nodules in the affected trigeminal V1 dermatome and the contra-lateral trigeminal region over a 1-year period. Excision and/or biopsy of all these lesions showed similar pathologic changes that consisted of herpetic folliculitis, adjacent dense mixed nodular lymphocytic infiltrates with germinal centers (cutaneous lymphoid hyperplasia (CLH)), and in the deeper excision specimens, an obliterative vasculitis of a vessel with smooth muscle in its wall. Immunophenotype analysis revealed a mixed, predominate T- and B-cell population without loss of pan-T cell antigens or aberrant expression by B cells of T-cell antigens. Polymerase chain reaction for herpetic DNA was positive for VZV DNA. Lymphocyte gene rearrangement analysis revealed 2 distinct, anatomically and chronologically, monoclonal B-cell populations and a monoclonal T-cell population in one nodule. Treatment with valacyclovir has lead to almost complete resolution of her cutaneous nodules after 6 months of therapy. In this case, it can be surmised that persistence of VZV infection and lack of effective cell-mediated immunity lead to development of both immunopathology (vasculitis) and excessive lymphoid cell proliferation (CLH). PMID: 16148411 [PubMed - indexed for MEDLINE] 1059. Med J Aust. 2005 Sep 5;183(5):277-9. Universal varicella vaccination. Mackenzie GA. Comment in: Med J Aust. 2005 Sep 5;183(5):278-9. PMID: 16138807 [PubMed - indexed for MEDLINE] 1060. Virol J. 2005 Aug 31;2:77. Varicella zoster virus acute retinal necrosis following eye contusion: case report. Svozílková P, Ríhová E, Diblík P, Kuthan P, Kovarík Z, Kalvodová B. Department of Ophthalmology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic. psvoz@lf1.cuni.cz BACKGROUND: Acute retinal necrosis is a sight-threatening disease caused by the group of herpesviruses. The aim of this paper is to report a case of acute retinal necrosis following ocular trauma in a patient initially treated with vaso-active drugs and corticosteroids for presumed ocular ischemic syndrome. CASE PRESENTATION: A 51-years-old otherwise healthy man, who suffered from sudden visual loss in the left eye following contusion, was commenced on vaso-active drugs and systemic corticosteroids for suspected ocular ischemic syndrome with extensive swelling of the optic disc and macular edema. Subsequently, vision in the initially uninvolved right eye decreased. Polymerase chain reaction of vitreous samples and retinal biopsy confirmed varicella zoster virus. Despite intensive treatment with intravenous antiviral medication, the patient became completely blind in both eyes. CONCLUSION: Initial treatment of acute, unexplained visual decrease with systemic corticosteroids may lead to visual loss in patients with developing acute retinal necrosis. Ocular trauma could have induced and corticosteroid treatment promoted reactivation of a latent viral infection in our patient. PMCID: PMC1208964 PMID: 16135256 [PubMed - indexed for MEDLINE] 1061. Pediatr Nephrol. 2005 Dec;20(12):1750-5. Epub 2005 Aug 24. Infection in children with lupus nephritis receiving pulse and oral cyclophosphamide therapy. Opastirakul S, Chartapisak W. Division of Pediatric Nephrology, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Thailand. sopastir@mail.med.cmu.ac.th Infection is the major complication of cyclophosphamide therapy in patients with lupus nephritis. The objectives of this study were to report and compare the rate of infection between children with lupus nephritis who had received intravenous pulse cyclophosphamide (IVCY) and those who had received oral cyclophosphamide (OCY) and to determine the risk factors for infection during treatment with cyclophosphamide in these groups. Records of nine patients who had received IVCY from the beginning [pure intravenous cyclophosphamide (PIVCY) group], 11 patients who had received prior oral cyclophosphamide and later switched to IVCY [combined intravenous cyclophosphamide (CIVCY) group] and 41 patients who had received OCY were reviewed. Infection occurred in 21 of 61 patients (34%). In the PIVCY group, four episodes of infection occurred in three of nine patients (33%). In the CIVCY group, six episodes of infection occurred in four of 11 patients (36%). In the OCY group, 18 episodes of infection occurred in 14 of 41 patients (34%). The rate of infection between these groups was not different (P=0.99). None of the following parameters were risk factors for infection: cumulative dose of cyclophosphamide, leukopenia and neutropenia. On the contrary, white blood cell (WBC) count and polymorphonuclear cell (PMN) count were significantly less in the no-infection group (P=<0.001, P<0.001, respectively), with odds ratios for leukopenia (WBCs <4,000 mm(3)) and neutropenia (PMNs <1,500 mm(3)) between the infection and the no-infection group equal to 0.18 (95%CI 0.05-0.63) and 0 (95%CI 0-0.19), respectively. Most of the patients who had infection received prednisolone at a dosage of more than 0.5 mg/kg per day (67% of the PIVCY group, 50% of the CIVCY group and 83% of the OCY group). Fatal infections occurred in two patients who had concomitant active systemic lupus erythematosus (SLE). Although lymphopenia (lymphocyte count <1,500/mm(3)) was not the risk factor for infection, it was observed that six of seven patients with herpes zoster had lymphopenia. Herpes zoster seemed to occur more frequently in the OCY group (15%) than in the whole IVCY group (5%), but there was no statistical difference (P=0.41). We conclude that the rate of infection in the IVCY and OCY group was not different. Infection is likely to occur in patients receiving a concomitant high dose of prednisolone. The occurrence of fatal infection in patients with active disease should be noted. No single risk factor was detected in this study. PMID: 16133037 [PubMed - indexed for MEDLINE] 1062. Int J Toxicol. 2005 Jul-Aug;24(4):205-13. Universal varicella vaccination: efficacy trends and effect on herpes zoster. Goldman GS. Medical Veritas International (MVI), Pearblossom, California 93553, USA. pearblossominc@aol.com In 1995, the Varicella Active Surveillance Project (VASP) was established in Antelope Valley (California), a geographically distinct high-desert community of 300,000 residents, as one of three sites in the nation in a cooperative agreement with the Centers for Disease Control and Prevention (CDC) to collect baseline demographic and clinical data and to monitor trends in varicella (chickenpox) following introduction of varicella vaccine. Herpes zoster (shingles) was added to the active surveillance January 1, 2000. The universal varicella program has proven effective in terms of reducing the number of reported verified varicella cases by 85%, from 2,934 in 1995 to 412 in 2002. Prior to this dramatic reduction, immunologic boosting due to exogenous exposures to wild-type varicella-zoster virus (VZV) in the community (1) caused mean serum anti-VZV levels among vaccines to increase with time after vaccination and (2) served as a mechanism that helped suppress the reactivation of herpes zoster (HZ), especially among individuals with a previous history of wild-type varicella. That immunologic boosting might play a significant role in both varicella and the closely related HZ epidemiology is evidenced by (1) a decline in vaccine efficacy by over 20%, from 95.7% (95% C.I., 82.7% to 98.9%) in 1999 to 73.9% (95% C.I., 57.9% to 83.8%) in 2001 and (2) an unexpectedly high cumulative (2000 to 2003) true incidence rate of 223 (95% C.I. 180-273) per 100,000 person-years (p-y) among children <10 years old with a previous history of varicella. Because capture-recapture methods demonstrate a likely lower bound of 50% underreporting, the actual rate is likely double or 446 per 100,000 p-y, approaching the HZ rate reported among older adults. Other recent studies based on VASP data have mitigated against discovery of the above trends that challenge several initial assumptions inherent to the universal varicella program, namely, (1) a single dose confers long-term immunity and (2) there is no immunologically mediated link between varicella and HZ incidence. As vaccinated children replace those with a prior history of wild-type varicella in the <10 age group, increasing HZ incidence among this cohort will be of less concern in the near future. However, previous scientific studies, including the present preliminary results from active surveillance indicate that HZ may be increasing among adults. It may be difficult to design booster interventions that are cost-effective and meet or exceed the level of protection provided by immunologic boosting that existed naturally in the community in the prelicensure era. PMID: 16126614 [PubMed - indexed for MEDLINE] 1063. Ophthalmologica. 2005 Sep-Oct;219(5):272-5. Ocular findings in Japanese patients with varicella-zoster virus infection. Yoshida M, Hayasaka S, Yamada T, Yanagisawa S, Hayasaka Y, Nakamura N, Mihara M. Department of Ophthalmology, Toyama Medical and Pharmaceutical University, Toyama, Japan. ophthal@ms.toyama-mpu.ac.jp PURPOSE: To examine ocular findings in Japanese patients with varicella, herpes zoster ophthalmicus, and acute retinal necrosis. METHODS: A retrospective study was conducted. Information on the ocular, cutaneous, systemic, and virologic findings on pediatric and adult patients was obtained from medical records. RESULTS: A total of 77 (45 male and 32 female) patients were enrolled in the study: 4 children had varicella, 68 adults had herpes zoster ophthalmicus, and 5 adults had acute retinal necrosis. Children with varicella had eruptions on the eyelid. Patients with herpes zoster ophthalmicus had eruptions, conjunctivitis, keratitis, iridocyclitis, and other findings. Patients with acute retinal necrosis had intracameral cells and retinal lesions. Some patients with herpes zoster ophthalmicus had malignancy, type 2 diabetes mellitus, or other disease. One pregnant woman developed acute retinal necrosis shortly after varicella infection. A total of 48% of patients with negative Hutchinson sign had ocular lesions, while all patients with positive sign showed ocular lesions. Patients with varicella and herpes zoster ophthalmicus had good visual acuity at the last visit. Some patients with acute retinal necrosis had poor visual acuity at the last visit. CONCLUSIONS: Patients with varicella, herpes zoster ophthalmicus, and acute retinal necrosis had several ocular complications. Some patients with acute retinal necrosis had poor visual outcomes. Ophthalmologists should be aware that acute retinal necrosis may develop shortly after varicella infection. Copyright 2005 S. Karger AG, Basel. PMID: 16123552 [PubMed - indexed for MEDLINE] 1064. Clin J Oncol Nurs. 2005 Aug;9(4):443-6. Herpes zoster: medical and nursing management. Sandy MC. msandy@kumc.edu Herpes zoster, the latent descendent of the varicella zoster virus, commonly is seen in clinical practice. Healthcare providers must recognize and treat the virus to decrease the incidence of postherpetic neuralgic pain syndrome. Treatment with an antiviral medication regimen should be initiated rapidly for patients who have had lesions for up to 72 hours. Acyclovir has been the treatment of choice for herpes zoster in the past, but newer drugs, such as valacyclovir, a prodrug of acyclovir, and famciclovir, are as effective for treating the virus and have more convenient dosing regimens and decreased incidence of postherpetic neuralgia. PMID: 16117211 [PubMed - indexed for MEDLINE] 1065. J Cutan Pathol. 2005 Sep;32(8):581-4. 'Specific' cutaneous infiltrate of B-cell chronic lymphocytic leukemia at the site of a florid herpes simplex infection. Ziemer M, Bornkessel A, Hahnfeld S, Weyers W. Department of Dermatology, Friedrich-Schiller-University of Jena, Freiburg, Germany. mirjana.ziemer@derma.uni-jena.de Background: Specific cutaneous infiltrates in patients with leukemia generally carry a grim prognosis. However, non-neoplastic skin diseases may be associated with recruitment of normal and neoplastic leukocytes circulating in the peripheral blood. In those instances, neoplastic cells may be detected in skin lesions without an adverse effect on prognosis. Methods: In a patient with B-cell chronic lymphocytic leukemia, a specific infiltrate developed at the site of a florid herpes simplex infection. Clinically, the lesion presented itself as an ulcerated tumor. Results: Histopathologically, the lesion was characterized by a dense, diffuse infiltrate of small hyperchromatic lymphocytes throughout the entire dermis. Lymphocytes showed an aberrant CD20(+)/CD43(+)/CD5(+) phenotype of neoplastic B cells, and monoclonal rearrangement of immunoglobulin gamma genes could be demonstrated by polymerase chain reaction. Although criteria for leukemia cutis were fulfilled, the patient did well. Conclusions: The cutaneous infiltrate of neoplastic cells seemed to be part of a physiologic response to the antigenic stimulus, rather than indicating an exacerbation of leukemia. Ziemer M, Bornkessel A, Hahnfeld S, Weyers W. 'Specific' cutaneous infiltrate of B-cell chronic lymphocytic leukemia at the site of a florid herpes simplex infection. PMID: 16115059 [PubMed - indexed for MEDLINE] 1066. Rev Saude Publica. 2005 Aug;39(4):687-90. Epub 2005 Aug 16. [Varicella outbreak in childcare centers and schools of the of 22nd Regional Health Division, June 2005] [Article in Portuguese] EPISUS-SES/SP. PMID: 16113924 [PubMed - indexed for MEDLINE] 1067. Nippon Rinsho. 2005 Jul;63 Suppl 7:294-6. [Diagnostic tests: Varicella-zoster virus] [Article in Japanese] Yamashita T. Department of Dermatology, Sapporo Medical University, School of Medicine. PMID: 16111254 [PubMed - indexed for MEDLINE] 1068. J Neurol Neurosurg Psychiatry. 2005 Sep;76(9):1308-9. Aciclovir induced posterior leucoencephalopathy. Mahad DJ, Helldén A, Jarvis J, Mitra D, Gholkar A, Chinnery PF. Erratum in: J Neurol Neurosurg Psychiatry. 2005 Dec;76(12):1747. Mahad, D [corrected to Mahad, DJ]. PMCID: PMC1739775 PMID: 16107379 [PubMed - indexed for MEDLINE] 1069. Rev Iberoam Micol. 2005 Jun;22(2):125-6. [Clinical cases in medical mycology. Case No. 16] [Article in Spanish] Negroni R, Tuculet MA. Unidad de Micología, Hospital de Infecciosas Francisco Javier Muñiz, Uspallata 2272 1282, Buenos Aires, Argentina. hmmicologia@intramed.net PMID: 16107174 [PubMed - indexed for MEDLINE] 1070. Adv Exp Med Biol. 2005;568:11-24. Chickenpox party or varicella vaccine? Hambleton S, Arvin AM. Columbia University, Department of Pediatrics, New York, NY 10032, USA. The most compelling rationale for introducing universal vaccination against varicella was the predicted benefits to healthy children. Current evidence from the US experience indicates that these benefits are being realized. As is true for any new vaccine, implementation of such a program necessitates disease surveillance and modifications of the vaccine regimen as needed. In the case of VZV, the epidemiology of herpes zoster must be tracked as well as varicella disease trends. The prevention of herpes zoster may be another use of live attenuated or inactivated varicella vaccines. PMID: 16107063 [PubMed - indexed for MEDLINE] 1071. Rev Neurol (Paris). 2005 May;161(5):590-2. [Complete ophthalmoplegia complicating ophthalmic herpes zoster] [Article in French] Papeix C, Dumurgier J, Miléa D, Pierrot DC. Service de Neurologie 1, Hôpital de la Pitié-Salpêtriere (AP-HP), Paris. caroline.papeix@psl.ap-hop-paris.fr We report a case of a 73-year-old patient with complete ophthalmoplegia following an episode of ophthalmic herpes zoster. MRI showed an associated ipsilateral temporal meningioma with cavernous sinus extension. We discuss the possible responsibility of these two conditions in the ocular motor signs. PMID: 16106813 [PubMed - indexed for MEDLINE] 1072. Eur J Haematol. 2005 Sep;75(3):234-40. Effect of varicella zoster virus infection on bone marrow function. Al-Anazi KA, Al-Jasser AM, Evans DA. Section of Adult Haematology and Bone Marrow Transplant, King Faisal Cancer Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia. khalid_alanazi@yahoo.com BACKGROUND: Most viral infections are known to exert adverse effects on bone marrow function. However, certain viruses have recently been found to be therapeutically beneficial in the treatment of some malignant disorders. METHODS AND MATERIALS: A retrospective study was conducted at the Armed Forces Hospital, Riyadh, Saudi Arabia. The changes in the hematological parameters following varicella-zoster virus (VZV) infection in patients with a variety of hematological disorders were compared with those in a control group having the same spectrum of disorders and treated in the same unit over the same period of time but never had VZV infection. Both groups of patients received the same treatment protocols for their primary hematological disorders. Definitive treatment (DT) such as chemotherapy alone, anti-thymocyte globulin or bone marrow transplant was also employed in the management of patients belonging to both groups. RESULTS: White blood cell counts, platelet counts and hemoglobin concentrations in the study group started to increase 40 d after chickenpox or herpes zoster infection and these increases lasted for periods as long as 1050 d. The changes in platelet counts were more pronounced than those in other hematological parameters. There was a significant difference (P < 0.0001) between the two groups of patients in the values of platelet counts achieved between 280 and 1050 d after DT (mean platelet count: 262 x 10(9)/L in the study group vs. 180 x 10(9)/L in the control group, median: 288.17 x 10(9)/L in the study group vs. 180 x 10(9)/L in the control group, range: 102 to 415 x 10(9)/L in the study group vs. 26 to 365 x 10(9)/L in the control group of patients). Compared to the control group, the study group of patients achieved their maximum blood counts much earlier after DT. The maximum leucocytic count was achieved at a mean duration of 269.21 d in the study group and 349.61 d in the control group. The maximum hemoglobin level was achieved at a mean duration of 319.5 d in the study group and 402.6 d in the control group. The maximum platelet count was achieved at a mean duration of 271.4 d in the study group and 318.9 d in the control group of patients. CONCLUSION: VZV may behave differently from other members of the herpes group of viruses e.g. human cytomegalovirus and Epstein-Barr virus. Our observations suggest that VZV infection causes stimulation of bone marrow activity. Copyright Blackwell Munksgaard 2005. PMID: 16104880 [PubMed - indexed for MEDLINE] 1073. J Virol. 2005 Sep;79(17):11501-6. Replication of varicella-zoster virus in human skin organ culture. Taylor SL, Moffat JF. Department of Microbiology and Immunology, SUNY Upstate Medical University, Syracuse, NY 13210, USA. Varicella-zoster virus (VZV) infection is restricted to humans, which hinders studies of its pathogenesis in rodent models of disease. To facilitate the study of VZV skin tropism, we developed an ex vivo system using human fetal skin organ culture (SOC). VZV replication was analyzed by plaque assay, transmission electron microscopy, and histology. The yield of infectious VZV from SOC increased approximately 100-fold over 6 days, virions were abundant, and lesions developed that contained VZV antigens and resembled varicella and zoster lesions. The SOC system for VZV replication has applications for testing virus mutants and antiviral drugs. PMCID: PMC1193618 PMID: 16103201 [PubMed - indexed for MEDLINE] 1074. Pain. 2005 Sep;117(1-2):154-61. Tactile allodynia in patients with postherpetic neuralgia: lack of change in skin blood flow upon dynamic stimulation. Besson M, Brook P, Chizh BA, Pickering AE. Pain Clinic, Bristol Royal Infirmary, Bristol BS2 8HW, UK. Tactile allodynia is a common, troublesome feature of neuropathic pain. Allodynia has been proposed to involve abnormal Abeta-afferent coupling in the dorsal horn resulting in C-fibre activation and increased skin blood flow (SBF). Thus, changes in SBF could provide an objective measure of allodynia. We searched for this mechanism in patients with postherpetic neuralgia (PHN) with varying degrees of cutaneous sensory loss. We mapped the allodynic area in PHN patients using cotton buds and von Frey hairs. Quantitative thermal testing was performed to assess small fibre function in the affected and mirror-image areas. At a subsequent visit the area of allodynia was remapped. Then the SBF in the affected and control areas was quantified before and after allodynic stimulation using laser Doppler imaging and subsequent single point continuous monitoring to detect rapid changes. We enrolled 10 PHN patients (medians: age 77 yrs, duration 20 months, ongoing pain 5). The allodynic area (range 11-546 cm2) was stable across the sessions. Thermal testing showed similar (n=5) or reduced (n=5) warmth and pain sensation in the affected versus control area. Following allodynic stimulation (median evoked pain-5) we saw no changes in SBF using either imaging (repeated measures ANOVA, P=0.73) or single point monitoring. This was the case for all patients regardless of the degree of sensory impairment in the affected dermatome. In conclusion, in a representative population of PHN patients we found no evidence of changes in SBF in response to allodynic stimulation. Hence, SBF measurements are not suitable for assessing allodynia. PMID: 16098664 [PubMed - indexed for MEDLINE] 1075. Expert Rev Mol Med. 2005 Aug 10;7(15):1-24. Molecular and therapeutic aspects of varicella-zoster virus infection. Quinlivan M, Breuer J. Skin Virus Laboratory, Institute of Cell and Molecular Science, 4 Newark Street, Whitechapel, London, E1 28E, UK. m_quinlivan@hotmail.com Varicella-zoster virus (VZV) is a highly species-specific member of the Herpesviridae family. The virus exhibits multiple cell tropisms, infecting peripheral blood mononuclear cells and skin cells before establishing latency in sensory neurons. Such tropisms are essential both for primary infection, which manifests itself as chickenpox (varicella), and subsequent reactivation to cause herpes zoster (shingles). The highly cell-associated nature of the virus, coupled with its narrow host range, has resulted in the lack of an animal model that mimics its diseases in humans, thereby greatly hindering the study of events in VZV pathogenesis. Despite this, extensive studies both in vitro and in vivo in small-animal models have provided a fascinating insight into molecular events that govern VZV diseases. In addition, VZV has become the first human herpes virus for which a live attenuated vaccine has been developed. PMID: 16098235 [PubMed - indexed for MEDLINE] 1076. J Ky Med Assoc. 2005 Jul;103(7):303-6. Case report on motor neuropathy associated with herpes zoster. Murphy P. University of Louisville, Department of Family and Geriatric Medicine, KY 40202, USA. pjmurph01@gwise.louisville.edu BACKGROUND: Complications associated with herpes zoster are primarily sensory, but motor involvement, especially in late life, can be part of the symptom complex. CASE REPORT: We report a case of herpes zoster with motor neuropathy in a 66-year-old female. Eighteen months after diagnosis and treatment, the patient is regaining muscular strength in the affected limb. DISCUSSION: Treatment of motor neuropathy mainly consists of physical and occupational therapy. Most patients achieve functional recovery. PMID: 16095260 [PubMed - indexed for MEDLINE] 1077. Emerg Med Australas. 2005 Aug;17(4):330-40. Evidence-based emergency medicine at the 'coal face'. Than M, Bidwell S, Davison C, Phibbs R, Walker M. Clinical Decision Support Unit and Centre for Evidence-Based Health Care, Christchurch, New Zealand. martin.than@cdhb.govt.nz While evidence-based medicine may be trumpeted by zealots, managers and politicians, incorporating it into clinical practice is easier said than done. The present article aims to show that it can be achieved and gives some clinical examples to illustrate this. An appendix contains a summary of useful databases and websites for accessing good medical information and evidence, quickly and reliably near the bedside. PMID: 16091095 [PubMed - indexed for MEDLINE] 1078. Neurology. 2005 Aug 9;65(3):444-7. A single dose of gabapentin reduces acute pain and allodynia in patients with herpes zoster. Berry JD, Petersen KL. UCSF Pain Clinical Research Center, Department of Neurology, University of California, San Francisco, CA, USA. Comment in: Neurology. 2005 Aug 9;65(3):349-50. This randomized, double-blind, placebo-controlled crossover study measured the effect of a single dose of oral gabapentin (900 mg) on pain and allodynia associated with herpes zoster. Pain severity decreased by 66% with gabapentin compared to 33% with placebo. Reductions in allodynia area and severity, and overall pain relief, were also greater with gabapentin. PMID: 16087911 [PubMed - indexed for MEDLINE] 1079. Neurology. 2005 Aug 9;65(3):349-50. Herpes zoster and the prevention of postherpetic neuralgia: beyond antiviral therapy. Tenser RB, Dworkin RH. Comment on: Neurology. 2005 Aug 9;65(3):444-7. PMID: 16087894 [PubMed - indexed for MEDLINE] 1080. Biochem Biophys Res Commun. 2005 Sep 23;335(2):505-11. dsRNA-mediated innate immunity of epidermal keratinocytes. Tohyama M, Dai X, Sayama K, Yamasaki K, Shirakata Y, Hanakawa Y, Tokumaru S, Yahata Y, Yang L, Nagai H, Takashima A, Hashimoto K. Department of Dermatology, Ehime University School of Medicine, Shitsukawa, Toon-city, Ehime 791-0295, Japan. MIP-1alpha, a CC chemokine, recruits monocytes, natural killer cells, lymphocytes, and neutrophils, and plays a critical role in viral infection. Since, the lesional epidermis of herpes zoster expressed MIP-1alpha, we hypothesized that keratinocytes produce MIP-1alpha in response to virus-associated dsRNA via TLR3. To investigate this, we examined cultured human keratinocytes for MIP-1alpha production induced by poly(I:C), a TLR3 ligand. Poly(I:C) treatment induced MIP-1alpha production, interestingly, poly(I:C)-induced IFN-alpha and -beta production preceded MIP-1alpha production. A neutralizing antibody for IFN-beta significantly inhibited the poly(I:C)-induced MIP-1alpha production indicating that MIP-1alpha production is via IFN-beta. IFN-alpha priming enhanced TLR3 expression and MIP-1alpha production in poly(I:C)-treated keratinocytes. This suggests that IFN-alpha enhanced the TLR3 expression and reinforced the response of keratinocytes to poly(I:C), which resulted in an increase in MIP-1alpha production. In conclusion, normal human keratinocytes produce MIP-1alpha in response to dsRNA via TLR3, and this production is regulated by IFN-alpha/beta. PMID: 16087162 [PubMed - indexed for MEDLINE] 1081. Clin Perinatol. 2005 Sep;32(3):671-96. Human herpes viruses in pregnancy: cytomegalovirus, Epstein-Barr virus, and varicella zoster virus. Hollier LM, Grissom H. Department of Obstetrics, Gynecology and Reproductive Sciences, University of Texas Houston Medical School, Lyndon B. Johnson General Hospital, 5656 Kelley Street, Houston, TX 77026, USA. lisa.m.hollier@uth.tmc.edu Viruses of the human herpesvirus family can have profound effects on pregnancy. Primary maternal infection with cytomegalovirus (CMV) and varicella during pregnancy has been associated with fetal abnormalities and neonatal disease. Public awareness of the role of cytomegalovirus in the etiology of developmental disorders and chronic disabilities needs to increase. With time, we may see new interventions for treatment of infected pregnant women and prevention of long-term effects. Attention must be focused on development of a safe and effective vaccine. With the introduction of an efficacious varicella vaccine, the rate of varicella in pregnancy is expected to decrease dramatically. Physicians caring for women have the opportunity to prevent the complications of varicella by identifying and vaccinating susceptible women. PMID: 16085026 [PubMed - indexed for MEDLINE] 1082. CMAJ. 2005 Aug 2;173(3):249. Vaccination boosts adult immunity to varicella zoster virus. Weir E. PMCID: PMC1180650 PMID: 16076818 [PubMed - indexed for MEDLINE] 1083. Acta Anaesthesiol Taiwan. 2005 Jun;43(2):73-7. Starting dose of gabapentin for patients with post-herpetic neuralgia--a dose-response study. Jean WH, Wu CC, Mok MS, Sun WZ. Department Anaesthesiology, Far Eastern Memorial Hospital, Taipei, Taiwan, ROC. BACKGROUND: Gabapentin has been shown to provide pain relief for post-herpetic neuralgia at dosage of 1200 to 2400 mg/day. However, the initial dosing strategy has not been thoroughly investigated. The purpose of this study was to establish the initial dosing strategy in the treatment of the gabapentin-naive patients with post-herpetic neuralgia. METHODS: This clinical study was an open-label, randomized, time-sequence and controlled trial. Each gabapentin-naive subject was allocated to receive either 200 mg (100 mg, twice daily), 400 mg (100 mg, four times daily), or 600 mg (200 mg, three times daily) of gabapentin for three days. The analgesic effect and occurrence of dizziness, drowsiness, and fatigue were assessed at day 0 and day 3. RESULTS: A total of 61 subjects (32 male/29 female) were enrolled in this study. The intensity of pain was greatly improved in all three groups after three days of treatment (visual analog scale decreased from 6.5 +/- 1.6 to 4.5 +/- 2.1, P < 0.05). There was no statistically significant difference among subjects taking 200 mg, 400 mg, or 600 mg with respect to dizziness, drowsiness or fatigue. CONCLUSIONS: This study shows that elderly gabapentin-naive subjects no matter whether receiving 200, 400 or 600 mg/day of gabapentin benefited a moderate pain relief with minimal side effects at the first three days of treatment. Since starting with a minimal dose of 200 mg/day did not offer a better reduction of side effects, we suggest that 600 mg/day gabapentin could be a safe and effective starting dose for patients with post-herpetic neuralgia. PMID: 16060401 [PubMed - indexed for MEDLINE] 1084. Br J Oral Maxillofac Surg. 2007 Jan;45(1):71-3. Epub 2005 Jul 28. Herpes zoster associated with tooth resorption and periapical lesions. Ramchandani PL, Mellor TK. Department of Oral and Maxillofacial Surgery, Poole General Hospital, Longfleet Road, Poole, Dorset, UK. parkashr@msn.com A 72-year-old woman presented with multiple periapical lesions and resorption of teeth in a single quadrant 17 years after an attack of herpes zoster (shingles) of the maxillary division of the trigeminal nerve. It is possible that cases of tooth resorption that were previously classified as idiopathic may have a viral aetiology and we suggest that these patients should be asked about a previous attack of shingles. PMID: 16054735 [PubMed - indexed for MEDLINE] 1085. J Gen Intern Med. 2005 Aug;20(8):748-53. The incidence of herpes zoster in a United States administrative database. Insinga RP, Itzler RF, Pellissier JM, Saddier P, Nikas AA. Department of Health Economic Statistics, Merck Research Laboratories, Blue Bell, PA, USA. ralph_insinga@merck.com BACKGROUND: Few recent studies have reported data on the incidence of herpes zoster (HZ) in U.S. general clinical practice. OBJECTIVE: To estimate the age- and sex-specific incidence of HZ among U.S. health plan enrollees. DESIGN: Data for the years 2000 to 2001 were obtained from the Medstat MarketScan database, containing health insurance enrollment and claims data from over 4 million U.S. individuals. Incident HZ cases were identified through HZ diagnosis codes on health care claims. The burden of HZ among high-risk individuals with recent care for cancer, HIV, or transplantation was examined in sub-analyses. Overall incidence rates were age- and sex-adjusted to the 2000 U.S. population. PARTICIPANTS: MarketScan U.S. health plan enrollees of all ages. MEASUREMENTS AND MAIN RESULTS: We identified 9,152 incident cases of HZ (3.2 per 1,000 person-years) (95% confidence interval [CI], 3.1 to 3.2 per 1,000). Annual HZ rates per 1,000 person-years were higher among females (3.8) than males (2.6) (P<.0001). HZ rates rose sharply with age, and were highest among individuals over age 80 (10.9 per 1,000 person-years) (95% CI, 10.2 to 11.6). The incidence of HZ per 1,000 person-years among patients with evidence of recent care for transplantation, HIV infection, or cancer (10.3) was greater than for individuals without recent care for these conditions (3.0) (P<.0001). CONCLUSIONS: The overall incidence of HZ reported in the present study was found to be similar to rates observed in U.S. analyses conducted 10 to 20 years earlier, after age- and sex-standardizing estimates from all studies to the 2000 U.S. population. The higher rate of HZ in females compared with males contrasts with prior U.S. studies. PMCID: PMC1490195 PMID: 16050886 [PubMed - indexed for MEDLINE] 1086. Drug Saf. 2005;28(8):741; author reply 742. Tolerability of treatments for postherpetic neuralgia. Alvarez NA. Comment on: Drug Saf. 2004;27(15):1217-33. PMID: 16048359 [PubMed - indexed for MEDLINE] 1087. Acta Derm Venereol. 2005;85(3):279-80. Zosteriform morphea: a new pattern. Joshi A, Al-Mutairi N. PMID: 16040427 [PubMed - indexed for MEDLINE] 1088. Clin Neurophysiol. 2005 Sep;116(9):2051-7. Diagnostic relevance of transcranial magnetic and electric stimulation of the facial nerve in the management of facial palsy. Nowak DA, Linder S, Topka H. Department of Psychiatry III, University of Ulm, Germany. dr.dennis.nowak@gmx.de OBJECTIVE: Earlier investigations have suggested that isolated conduction block of the facial nerve to transcranial magnetic stimulation early in the disorder represents a very sensitive and potentially specific finding in Bell's palsy differentiating the disease from other etiologies. METHODS: Stimulation of the facial nerve was performed electrically at the stylomastoid foramen and magnetically at the labyrinthine segment of the Fallopian channel within 3 days from symptom onset in 65 patients with Bell's palsy, five patients with Zoster oticus, one patient with neuroborreliosis and one patient with nuclear facial nerve palsy due to multiple sclerosis. RESULTS: Absence or decreased amplitudes of muscle responses to early transcranial magnetic stimulation was not specific for Bell's palsy, but also evident in all cases of Zoster oticus and in the case of neuroborreliosis. Amplitudes of electrically evoked muscle responses were more markedly reduced in Zoster oticus as compared to Bell's palsy, most likely due to a more severe degree of axonal degeneration. The degree of amplitude reduction of the muscle response to electrical stimulation reliably correlated with the severity of facial palsy. CONCLUSIONS: Transcranial magnetic stimulation in the early diagnosis of Bell's palsy is less specific than previously thought. While not specific with respect to the etiology of facial palsy, transcranial magnetic stimulation seems capable of localizing the site of lesion within the Fallopian channel. SIGNIFICANCE: Combined with transcranial magnetic stimulation, early electrical stimulation of the facial nerve at the stylomastoid foramen may help to establish correct diagnosis and prognosis. PMID: 16024292 [PubMed - indexed for MEDLINE] 1089. Med Clin (Barc). 2005 Jul 9;125(6):215-20. [Treatment and prevention in herpes zoster] [Article in Spanish] García A, Guerra-Tapia A, Torregrosa JV. Hospital Universitario La Princesa, Madrid, Spain. PMID: 16022835 [PubMed - indexed for MEDLINE] 1090. BMJ. 2005 Jul 16;331(7509):147-51. Managing ophthalmic herpes zoster in primary care. Opstelten W, Zaal MJ. Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Netherlands. W.Opstelten@umcutrecht.nl PMCID: PMC558704 PMID: 16020856 [PubMed - indexed for MEDLINE] 1091. Acta Chir Iugosl. 2004;51(4):53-7. [DREZ (dorsal root entry zone) surgery for the treatment of the postherpetic intercostal neuralgia] [Article in Serbian] Spaić M, Ivanović S, Slavik E, Antić B. Klinika za neurohirurgiju, Vojnomedicinska akademija, Beograd. Postherpetic intercostal neuralgia proved to be an incapacitating pain often recalcitrant to therapy. Acute pain that accompanied Herpes zoster usually subsides spontaneously but in 10% of patients the pain persists and intensifies. The incidence of postherpetic neuralgia incrises up to 50% among elder patients. We report the case of the two 42 and 48 yers old male patient who were succesfuly relieved from the chronic postherpetic intercostal neuralgia employing the DREZ surgery (Dorzal Root Entry Zone lesion). DREZ surgicall treatment of this pain should be considered when medical therapies failed in controling pain. Subjective sensory nature of the pain should play an important role in setting the indication for DREZ surgical treatment. The most favourable pain pattern for DREZ operation is the pain of intermittent rhythm, confined theritory accompanied with the phenomenon of alodinic pain that could be provoked from the pain theritory. PMID: 16018410 [PubMed - indexed for MEDLINE] 1092. Acta Chir Iugosl. 2004;51(4):39-43. [Neuralgias of the lower cranial nerves: microsurgical posterior fossa exploration] [Article in Serbian] Antić B, Perić P, Ivanović S, Spaić M. Klinika za neurohirurgiju, Vojnomedicinska akademija, Beograd. Neuralgias of the lower cranial nerves are trigeminal neuralgia (TN), glossopharingeal neuralgia (GphN), and geniculate neuralgia (GN). Microsurgical posterior fossa exploration with its variations microvascular decompression (MVD), partial sensory rhisotomy (PSR), and total sensory rhisotomy (TSR) is one of the most efficient ways of treating these neuralgias. It was performed 130 operations in 125 patients with TN, 3 in GphN patients, 1 in GN patient, 1 in GN/TN patients, 1 in GphN/GN patient, and 2 in GN/hemifacial spasm patients. Of total of 125 patients with TN, MVD was performed in 63, PSR in 18, and MVD+PSR in 44 cases. In 5 patients with recidivate TN PSR was performed. Of total 3 patients with GphN MVD was performed in 2 cases, and extirpation of a small meningeoma in 1 case (it was not seen on CT). In the patients with GN TSR of intermediate nerve was performed, in GN/TN patients TSR of intermediate nerve and PSR of trigeminal nerve was performed, in the GN/GphN patients MVD of glossopharingeal and TSR of intermediate nerve were performed, and in the GN/hemifacial spasm patients TSR of intermediate and MVD of facial nerve were performed. The results of TN patients are: excellent in 82.4%, good in 12%, and poor in 5.6% of patients. There is no difference in complete pain relief, rate of recurrence, and complications between MVD, MVD+PSR and PSR operative groups (p0.05). Among patients with other neuralgias the following results are noted: excellent in 4, good in 3, and poor in 1 patient. Microsurgical posterior fossa exploration is the method of choice in the treatment of the neuralgias of the lower cranial nerves. PMID: 16018407 [PubMed - indexed for MEDLINE] 1093. PLoS Med. 2005 Jul;2(7):e164. Epub 2005 Jul 26. Analgesic therapy in postherpetic neuralgia: a quantitative systematic review. Hempenstall K, Nurmikko TJ, Johnson RW, A'Hern RP, Rice AS. Royal Hampshire County Hospital, Winchester, United Kingdom. BACKGROUND: Postherpetic neuralgia (PHN) is a complication of acute herpes zoster, which is emerging as a preferred clinical trial model for chronic neuropathic pain. Although there are published meta-analyses of analgesic therapy in PHN, and neuropathic pain in general, the evidence base has been substantially enhanced by the recent publication of several major trials. Therefore, we have conducted a systematic review and meta-analysis for both efficacy and adverse events of analgesic therapy for PHN. METHODS AND FINDINGS: We systematically searched databases (MEDLINE 1966-2004, EMBASE 1988-2004, CINAHL 1982-2002, and PubMed [29 October 2004]) for trials of PHN. We also searched references of retrieved studies and review articles for further trials. We included trials that examined adult patients with PHN of greater duration than 3 mo, that were blinded, randomised, and had at least one measure of pain outcome. Dichotomous pain outcome data were extracted for 50% decrease in baseline pain using a hierarchy of pain/pain-relief measurement tools. Where available, dichotomous data were also collected for adverse events. Calculated estimates of efficacy included relative benefit and number needed to treat. Of 62 studies identified, 35 were randomised controlled trials. Of these, 31 were placebo controlled and suitable for meta-analysis, from which it was possible to extract dichotomous efficacy outcome data from 25. This meta-analysis revealed that there is evidence to support the use of the following orally administered therapies: tricyclic antidepressants, "strong" opioids, gabapentin, tramadol, and pregabalin. Topical therapies associated with efficacy were lidocaine 5% patch and capsaicin. Finally, a single study of spinal intrathecal administration of lidocaine and methyl prednisolone demonstrated efficacy, although this has yet to be replicated. Data suggest that the following therapies are not associated with efficacy in PHN: certain NMDA receptor antagonists (e.g., oral memantine, oral dextromethorphan, intravenous ketamine), codeine, ibuprofen, lorazepam, certain 5HT1 receptor agonists, and acyclovir. Topical administration of benzydamine, diclofenac/diethyl ether, and vincristine (iontophoresis) are similarly not associated with efficacy, nor are intrathecal administration of lidocaine alone or epidural administration of lidocaine and methylprednisolone, intravenous therapy with lidocaine, subcutaneous injection of Cronassial, or acupuncture. However, many of the trials that demonstrated a lack of efficacy represented comparatively low numbers of patient episodes or were single-dose studies, so it may be appropriate to regard such interventions as "not yet adequately tested" rather than demonstrating "no evidence of efficacy." Topical aspirin/diethyl ether has not been adequately tested. CONCLUSION: The evidence base supports the oral use of tricyclic antidepressants, certain opioids, and gabapentinoids in PHN. Topical therapy with lidocaine patches and capsaicin is similarly supported. Intrathecal administration of methylprednisolone appears to be associated with high efficacy, but its safety requires further evaluation. PMCID: PMC1181872 PMID: 16013891 [PubMed - indexed for MEDLINE] 1094. Neurology. 2005 Jul 12;65(1):170. Delayed oculomotor nerve palsy after bilateral cervical zoster in an immunocompetent patient. Karmon Y, Gadoth N. Department of Neurology, Meir General Hospital, Kfar Saba 44281, Israel. PMID: 16009918 [PubMed - indexed for MEDLINE] 1095. Clin Transplant. 2005 Aug;19(4):566-70. Fatal varicella zoster virus encephalitis in two patients following allogeneic hematopoietic stem cell transplantation. Hackanson B, Zeiser R, Bley TA, Pantazis G, Huzly D, Bertz H, Finke J. Department of Hematology/Oncology, Freiburg University Medical Center, Freiburg, Germany. hackanson@mm11.ukl.uni-freiburg.de BACKGROUND: Reduced cellular immunocompetence following allogeneic hematopoietic stem cell transplantation (aHSCT) increases susceptibility to viral infections. Varicella zoster virus (VZV) reactivation in this setting most commonly manifests as dermatomal herpes zoster but in some cases life-threatening VZV encephalitis occurs. STUDY DESIGN/RESULTS: We describe the cases of two patients who presented with shingles 3 and 18 months, respectively, after HLA-matched peripheral blood stem cell transplantation (PBSCT). Unfortunately, in the further clinical course both patients developed fatal VZV encephalitis, despite initial high-dose intravenous therapy with acyclovir and in one case with additional VZV-immunoglobulin. CONCLUSION: These two cases suggest that rapid intervention with systemic treatment is warranted and raise the question whether initial combination therapy with intravenous acyclovir and foscarnet, VZV vaccination or long-term low-dose acyclovir are needed to improve treatment and clinical outcome in immunocompromised patients, having undergone allogeneic HSCT. PMID: 16008607 [PubMed - indexed for MEDLINE] 1096. Fam Pract. 2005 Oct;22(5):523-8. Epub 2005 Jul 8. Do herpes zoster patients receive antivirals? A Dutch National Survey in General Practice. Opstelten W, van Essen GA, Moons KG, van Wijck AJ, Schellevis FG, Kalkman CJ, Verheij TJ. Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands. w.opstelten@med.uu.nl BACKGROUND: The main complications of herpes zoster (HZ) are postherpetic neuralgia and, in case of HZ ophthalmicus, eye disorders. Antiviral treatment may modify the course of disease and reduce the risk of complications. OBJECTIVE: To assess which doctors' and patients' characteristics were related to prescription of antiviral therapy for HZ. METHODS: Ninety general practices (358 008 patients) in The Netherlands registered all patient contacts in a database for one year as part of the Second Dutch National Survey of General Practice. The present study used ICPC code S70 to search that database for patients with a new diagnosis of HZ. The full-text medical records of the selected patients were then reviewed and the potential determinants for the prescription of antiviral drugs (including characteristics of patients, GPs, and practices) analysed using multilevel logistic regression modelling. RESULTS: Of the 1129 patients diagnosed with HZ (incidence 3.2/1000 patients/year), 22.5% received antiviral drugs. Independent determinants for prescription of antiviral therapy were age [45-54 years: adjusted odds ratio (OR) 2.9 (95% CI 1.6-5.0); 55-64 years: OR 4.2 (95% CI 2.4-7.6); 65-74 years: OR 5.1 (95% CI 2.7-9.6); > or =75 years: OR 8.1 (95% CI 4.4-15.1)], ophthalmic localisation of the shingles (OR 3.2, 95% CI 1.6-6.7), and the presence of asthma/COPD (OR 1.6, 95% CI 1.0-2.6). GPs who reported to strongly adhere to professional guidelines prescribe more frequently antiviral drugs (OR 1.9, 95% CI 1.2-3.1). CONCLUSIONS: A minority of HZ patients were prescribed antiviral treatment. Increasing age, ophthalmic localisation, presence of asthma/COPD, and adherence to professional guidelines were factors favouring prescription. More information on the determinants of GPs' treatment decisions is necessary for successful implementation of HZ guidelines. PMID: 16006497 [PubMed - indexed for MEDLINE] 1097. Int J STD AIDS. 2005 Jul;16(7):475-8. Herpes zoster as an immune restoration disease in AIDS patients during therapy including protease inhibitors. Dunić I, Djurković-Djaković O, Vesić S, Zerjav S, Jevtović D. Institute of Dermatovenereology, School of Medicine, University of Belgrade, Belgrade. iva001@eunet.yu A prospective study to evaluate the incidence of herpes zoster (HZ) as an immune restoration disease in patients with AIDS during highly active antiretroviral therapy (HAART) was conducted in a series of 115 patients diagnosed with AIDS initiated on HAART between 1 January 2000 and 31 July 2001. Of these, a single dermatomal HZ episode occurred in 14 (12%) patients within one and 15 months of HAART (median eight months). The HZ patients were similar to the non-HZ patients in age, sex, and HIV transmission risk factor, but had a more advanced disease. Compared with the baseline values, the viral loads significantly (P<0.01) decreased, while the mean CD4+ T-cell counts increased by almost four-fold (P<0.01) in both groups at the time of the HZ episode (or equivalent in non-HZ), but remained below 400/mL in the HZ patients. HZ during HAART is an immunopathological consequence of the improvement of the host immuneresponse, correlating with the beginning of immune restoration. PMID: 16004625 [PubMed - indexed for MEDLINE] 1098. Arch Phys Med Rehabil. 2005 Jul;86(7):1492-4. Segmental zoster paresis of the upper extremity: a case report. Yoleri O, Olmez N, Oztura I, Sengül I, Günaydin R, Memiş A. Physical Medicine and Rehabilitation department, Atatürk Training and Research Hospital, Izmir, Turkey. yoleri@superonline.com Segmental zoster paresis, a rare complication of herpes zoster, is characterized by focal, asymmetric motor weakness in the myotome that corresponds to the dermatome of the rash. The pathogenesis of segmental zoster paresis is inflammation caused by the spread of the herpes virus. Motor damage may affect the root, plexus, or peripheral nerve. A woman in her early seventies with right shoulder pain and shoulder girdle muscle weakness was diagnosed with involvement of the C5-7 motor roots and upper truncus of the brachial plexus as a complication of herpes zoster. Recognition of herpes zoster as a cause of acute motor weakness is important in avoiding unnecessary interventions as well as in determining the treatment and outcome of the patient. This case is presented to emphasize that herpes zoster infection may be complicated by segmental paresis, which should be considered in the differential diagnosis of acute painful motor weakness of the upper extremity. PMID: 16003688 [PubMed - indexed for MEDLINE] 1099. Lin Chuang Er Bi Yan Hou Ke Za Zhi. 2005 Apr;19(7):297-9. [Auditory brain stem response assessment in Ramsay Hunt syndrome] [Article in Chinese] Wu H, Yin S, Lu W, Yi H. Department of Otorhinolaryngology and Ear Laboratory, Affiliated Sixth People's Hospital of Shanghai Jiaotong University, Shanghai Hearing Measuring Center, Shanghai, 200233, China. OBJECTIVE: To discuss the changes of the auditory brain stem response in patients with Ramsay Hunt syndrome. METHOD: Thirty-six patients of Ramsay Hunt syndrome,who have only unilateral involvement with contralateral good ear, were studied with pure tone test and auditory brain stem response. The latencies of peaks I, III and V and interpeak latencies of I-III, I-V and III-V in bilateral ears were analyzed by SPSS 10.0 for windows. RESULT: Compared to the controlateral, the affected ears were significantly increased in latencies of II, V and interpeak latencies of I-III, I-V ( P < 0.05). CONCLUSION: The audiological data suggested that cochlear or retrocochlear involvement or involvement at more than one site along the auditory pathway existed in Ramsay Hunt syndrome, but pure cochlear hearing loss is not common. PMID: 16001894 [PubMed - indexed for MEDLINE] 1100. An Otorrinolaringol Ibero Am. 2005;32(3):253-9. Postoperative Ramsay-Hunt syndrome after acoustic neuroma resection. Viral reactivation. Magliulo G, D'Amico R, Celebrini A, Cuiuli G. Otorhinolaryngology, Audiology And Phoniatrics Department, G. Ferreri, University La Sapienza, Rome, Italy. The aim of this paper is to present a patient suffering from acoustic neuroma and operated on with immediate postoperative hearing and facial function preservation who developed delayed Ramsay-Hunt syndrome. To our knowledge, this is the first case in whom a postoperative delayed facial palsy and hearing loss occurred. The patient gave an history of previously diagnosed herpes zoster reactivation limited to chest one-year before. This is undoubtdetly a predisposing factor for development of delayed facial palsy. It must not be underestimated and it obliges to consider a prophylaxis. Theoretically, the prophylactic antiviral therapy might prevent the evolution towards the herpes zoster oticus or reduce the severity of the symptoms allowing the preservation of the hearing function. It would be pointed out that the delayed facial plasy has favourable prognosis, while the hearing impairment may recover with a greater difficulty even after an antiviral treatment as in our case. PMID: 16001695 [PubMed - indexed for MEDLINE] 1101. J Clin Microbiol. 2005 Jul;43(7):3290-6. Sensitive and rapid detection of herpes simplex virus and varicella-zoster virus DNA by loop-mediated isothermal amplification. Kaneko H, Iida T, Aoki K, Ohno S, Suzutani T. Department of Microbiology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima 960-1295, Japan. Loop-mediated isothermal amplification (LAMP) is a novel nucleic acid amplification method in which reagents react rapidly and efficiently, with a high specificity, under isothermal conditions. We used a LAMP assay for the detection of herpes simplex virus type 1 (HSV-1), herpes simplex virus type 2 (HSV-2), and varicella-zoster virus (VZV). The virus specificities of primers were confirmed by using 50 HSV-1, 50 HSV-2, and 8 VZV strains. The assay was performed for 45 min at 65 degrees C. The LAMP assay had a 10-fold higher sensitivity than a PCR assay. An analysis of nucleotide sequence variations in the target and primer regions used for the LAMP assay indicated that 3 of 50 HSV-1 strains had single nucleotide polymorphisms. No HSV-2 or VZV strains had nucleotide polymorphisms. Regardless of the sequence variation, there were no differences in sensitivity with the HSV-1-specific LAMP assay. To evaluate the application of the LAMP assay for clinical diagnosis, we tested clinical samples from 40 genital herpes patients and 20 ocular herpes patients. With the LAMP assay, 41 samples with DNA extraction and 26 direct samples without DNA extraction were identified as positive for HSV-1 or HSV-2, although 37 samples with DNA extraction and just one without DNA extraction were positive by a PCR assay. Thus, the LAMP assay was less influenced than the PCR assay by the presence of inhibitory substances in clinical samples. These observations indicate that the LAMP assay is very useful for the diagnosis of HSV-1, HSV-2, and VZV infections. PMCID: PMC1169145 PMID: 16000450 [PubMed - indexed for MEDLINE] 1102. J Neurol. 2005 Jul;252(7):869-71. Vaccination against herpes zoster, small RNA against ALS and IgG antibodies in stiff-person syndrome. Strupp M. Dept. of Neurology, Ludwig-Maximilians University, Klinikum Grosshadern, Marchioninistr. 15, 81366 Munich, Germany. Michael.Strupp@med.uni-muenchen.de PMID: 15999237 [PubMed - indexed for MEDLINE] 1103. Haematologica. 2005 Jul;90(7):996-7. Analysis of the efficacy and toxicity of bortezomib for treatment of relapsed or refractory multiple myeloma in community practice. Wu KL, van Wieringen W, Vellenga E, Zweegman S, Lokhorst HM, Sonneveld P. The clinical data on the efficacy and toxicity of bortezomib as treatment for multiple myeloma patients are restricted to prospective phase II studies in expert myeloma centers. Here we report a multi-institutional analysis of the efficacy and toxicity of bortezomib in patients with relapsed or refractory multiple myeloma who were treated in community centers in a compassionate need program. PMID: 15996946 [PubMed - indexed for MEDLINE] 1104. Neurologist. 2005 Jul;11(4):244-9. Facial pain. Hentschel K, Capobianco DJ, Dodick DW. Mayo Clinic College of Medicine, Mayo Graduate School of Medicine, Jacksonville, FL, USA. Facial pain is a common symptom that may be a feature of a primary headache disorder or a secondary feature of organic disease. A thorough clinical history and physical examination may reveal the characteristic clinical features and assist in diagnosis. However, in some cases, the etiology may remain indeterminate. PMID: 15989697 [PubMed - indexed for MEDLINE] 1105. Prescrire Int. 2005 Jun;14(77):85-91. Chickenpox vaccines: new drugs. A favourable risk-benefit balance in some situations. [No authors listed] (1) Chickenpox is generally mild. Most severe cases of chickenpox occur in immunocompromised patients, adults, and pregnant women (and their foetuses). (2) Two live attenuated chickenpox vaccines derived from the same strain of varicella virus (Oka) are marketed in France, under the trade names Varilrix and Varivax. (3) They have not been adequately evaluated in immunocompromised children. (4) The impact of routine vaccination of women of child-bearing age on complications of chickenpox during pregnancy has not been studied. (5) Immunogenicity studies in several thousand immunocompetent children aged from 1 to 12 years show that the vaccine is almost always immunogenic after a single injection. Other comparative studies in adolescents and adults show that two injections are needed, at least two months apart. (6) A double-blind placebo-controlled trial including 513 immunocompetent children showed that Varilrix prevented 88% of cases of chickenpox after a median follow-up of 29 months, but no data on severe chickenpox were reported. A study that followed up 9202 children aged 1 to 12 years for more than 13 years showed that vaccination with Varivax failed to prevent chickenpox in 12.5% of cases and that 1.7% of these cases were severe. (7) Immunocompetent children vaccinated within three days after exposure to the virus are partially protected, according to one study of Varilrix (104 children) and two small studies of Varivax (10 and 42 children). There are no equivalent studies in adults. (8) Local adverse effects such as fever and rash are common in immunocompetent vaccinees. The rash is sometimes varicella-like and is due to infection by the vaccine strain. Pharmacovigilance studies of Varivax have shown no serious adverse effects. (9) Disseminated and/or persistent infection caused by the vaccine strain has been reported in immunocompromised patients. (10) Vaccination of immunocompetent subjects does not appear to result in a risk of chickenpox transmission to subsequent contacts. There seems to be no increase in the risk of herpes zoster in vaccinated children nor is there any firm evidence that chickenpox vaccination increases the incidence of herpes zoster in the general population. (11) Little information is available on vaccination during pregnancy. As a precaution, however, pregnant women should not be vaccinated. (12) Mass vaccination does not appear to be justified: chickenpox is generally mild during childhood, and several questions concerning the effects of the vaccine remain unanswered. (13) Chickenpox vaccination should be restricted to specific groups of non immune immunocompetent adults who are in a position to transmit chickenpox to immunodeficient contacts (e.g. health care personnel and kindergarten staff); adults who have been in contact with a case of chickenpox within the past three days; and children awaiting transplantation. The potential benefits and risks of vaccinating immunocompromised patients should be assessed on a case by case basis. PMID: 15977369 [PubMed - indexed for MEDLINE] 1106. Time. 2005 Jun 13;165(24):67. A shingles vaccine. Gorman C. PMID: 15974024 [PubMed - indexed for MEDLINE] 1107. J Neurol Sci. 2005 Oct 15;237(1-2):97-101. Unilateral retrobulbar optic neuritis due to varicella zoster virus in a patient with AIDS: a case report and review of the literature. Liu JZ, Brown P, Tselis A. Department of Anesthesiology, Detroit Medical Center, Wayne State University, Detroit, MI 48201, United States. Unilateral retrobulbar optic neuritis developed in a 43-year-old man with acquired immune deficiency syndrome (AIDS). This was secondary to varicella zoster virus (VZV) as confirmed by cerebrospinal fluid (CSF) polymerase chain reaction (PCR) detection of VZV in the cerebrospinal fluid. There was no typical cutaneous infection and no evidence of retinitis. The onset of unexplained visual loss due to optic neuritis in HIV positive individuals may be due to VZV infection. Prompt recognition, and early intervention with antiVZV therapy may preserve vision. Retrobulbar optic neuritis secondary to VZV infection should be considered in immunocompromised patients even in the absence of cutaneous or retinal lesions. Previous cases are reviewed and the varied nature of viral transport in the nervous system is noted. PMID: 15972220 [PubMed - indexed for MEDLINE] 1108. Br J Ophthalmol. 2005 Jul;89(7):923-4. "Ecstasy" induced immunosuppression and herpes zoster ophthalmicus. Zwick OM, Fischer DH, Flanagan JC. PMCID: PMC1772719 PMID: 15965183 [PubMed - indexed for MEDLINE] 1109. J Virol Methods. 2005 Sep;128(1-2):162-7. Development and evaluation of Varicella zoster virus ELISA for oral fluid suitable for epidemiological studies. Talukder Y, Gopal R, Andrews N, Glenn M, Breuer J, Brown D. Centre for Infectious Disease, Department of Virology, Barts and The London School of Medicine and Dentistry, 25-29 Ashfield St., London E1 1BB, UK. ingrej@gmail.com An enzyme-linked immunosorbent assay (ELISA) for detection of Varicella zoster virus (VZV) antibodies in oral fluid is described. The assay was optimised and evaluated using paired serum and oral fluid from healthy adult volunteers (n = 205) and preschool children (n = 98), oral fluid samples collected for routine measles, mumps and rubella testing (n = 537) and samples from a study of atopic dermatitis (n = 252). As chickenpox is predominantly a childhood disease and most adults are immune, it was crucial to have samples from children aged 1-5 years to evaluate the assay. Mixture modelling of the oral fluid results was used to determine the optimum cut-off, sensitivity and specificity of the assay. Compared to paired sera tested by the same ELISA the sensitivity of the oral fluid assay was 93% and specificity 95.7% overall, varying slightly with age group. The assay was shown to have good potential for use in large-scale epidemiological studies. PMID: 15961168 [PubMed - indexed for MEDLINE] 1110. Herpes. 2004 Dec;11(3):63-5. Pain following herpes zoster: implications for management. Johnson RW. Pain Management Clinic, Level 4, Bristol Royal Infirmary, Bristol BS2 8HW, UK. rwjbristol@doctors.org.uk At the 11th Annual Meeting of the International Herpes Management Forum (IHMF), held 27-29 February 2004, I delivered the Martin Wood Memorial Lecture on the management of herpes zoster-associated pain. Prevention of post-herpetic neuralgia is an important goal in the management of herpes zoster. Recognition of individuals at high risk of progression, followed by prompt intervention with antiviral agents, helps to reduce the disability, distress and healthcare resource utilization caused by this disease and its consequences. In established cases of post-herpetic neuralgia, first line therapy with tricyclic antidepressants and second line therapy with some anticonvulsants and opioids have both shown efficacy in many patients, but development of more effective treatments is needed for optimal outcomes. PMID: 15960902 [PubMed - indexed for MEDLINE] 1111. BMC Public Health. 2005 Jun 16;5:68. The incidence of varicella and herpes zoster in Massachusetts as measured by the Behavioral Risk Factor Surveillance System (BRFSS) during a period of increasing varicella vaccine coverage, 1998-2003. Yih WK, Brooks DR, Lett SM, Jumaan AO, Zhang Z, Clements KM, Seward JF. Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, USA. katherine_yih@harvardpilgrim.org BACKGROUND: The authors sought to monitor the impact of widespread varicella vaccination on the epidemiology of varicella and herpes zoster. While varicella incidence would be expected to decrease, mathematical models predict an initial increase in herpes zoster incidence if re-exposure to varicella protects against reactivation of the varicella zoster virus. METHODS: In 1998-2003, as varicella vaccine uptake increased, incidence of varicella and herpes zoster in Massachusetts was monitored using the random-digit-dial Behavioral Risk Factor Surveillance System. RESULTS: Between 1998 and 2003, varicella incidence declined from 16.5/1,000 to 3.5/1,000 (79%) overall with > or = 66% decreases for all age groups except adults (27% decrease). Age-standardized estimates of overall herpes zoster occurrence increased from 2.77/1,000 to 5.25/1,000 (90%) in the period 1999-2003, and the trend in both crude and adjusted rates was highly significant (p < 0.001). Annual age-specific rates were somewhat unstable, but all increased, and the trend was significant for the 25-44 year and 65+ year age groups. CONCLUSION: As varicella vaccine coverage in children increased, the incidence of varicella decreased and the occurrence of herpes zoster increased. If the observed increase in herpes zoster incidence is real, widespread vaccination of children is only one of several possible explanations. Further studies are needed to understand secular trends in herpes zoster before and after use of varicella vaccine in the United States and other countries. PMCID: PMC1177968 PMID: 15960856 [PubMed - indexed for MEDLINE] 1112. Med Monatsschr Pharm. 2005 Jun;28(6):188-92. [Chickenpox (Varicella) and shingles (Herpes zoster)] [Article in German] [No authors listed] PMID: 15960420 [PubMed - indexed for MEDLINE] 1113. Nippon Rinsho. 2005 May;63 Suppl 5:619-24. [Varicella-zoster virus vaccine] [Article in Japanese] Asano Y. Department of Pediatrics, Fujita Health University School of Medicine. PMID: 15954419 [PubMed - indexed for MEDLINE] 1114. Clin Neurophysiol. 2005 Jul;116(7):1542-54. Excitability of facial nucleus and related brain-stem reflexes in hemifacial spasm, post-facial palsy synkinesis and facial myokymia. Oge AE, Yayla V, Demir GA, Eraksoy M. Department of Neurology, Istanbul University, Istanbul Faculty of Medicine, Capa 34390, Istanbul, Turkey. aemreoge@superonline.com OBJECTIVE: To compare the electrophysiological excitability characteristics of the facial nucleus and related structures in hemifacial spasm (HFS), post-facial palsy synkinesis (PFPS) and facial myokymia (FM). METHODS: Facial F-waves, blink reflex recoveries and magnetically elicited silent periods (SP) were prospectively studied in 17 HFS, 17 PFPS, 8 FM cases and in 13 controls. Earlier unpublished observations on abnormal impulse transmission in 36 HFS and 29 PFPS cases were also included. RESULTS: Enhanced F-waves were recorded on the symptomatic side in PFPS and HFS cases with a tendency to be more pronounced in PFPS. HFS and PFPS groups both showed an earlier blink reflex recovery, more prominent in PFPS patients, when stimulated and/or recorded on the symptomatic side. Unelicitable SPs were encountered after 24/39 stimulations in 5 patients with PFPS and rarely in HFS cases. Duration of elicitable SPs did not change remarkably. FM group had similar characteristics as normal controls in the 3 electrophysiological tests. Latencies of the lateral and synkinetic spread responses were significantly prolonged in the earlier PFPS group as compared to HFS. In two-point stimulation, both groups showed a greater latency shift in late responses, again more pronounced in PFPS. CONCLUSIONS: PFPS and HFS cases had similar enhanced excitability patterns at the facial nucleus and related brain-stem structures, more marked on the symptomatic side and more obvious in the PFPS group. Findings elicited in the FM group were thought to be caused by asynchronous hyperactivity of facial motoneurons. SIGNIFICANCE: In this comparative electrophysiological study, similar excitability patterns were found in HFS and PFPS groups, albeit with different intensities. PMID: 15953558 [PubMed - indexed for MEDLINE] 1115. Am J Ophthalmol. 2005 Jun;139(6):1135-6. Chronic recurrent varicella-zoster virus keratitis confirmed by polymerase chain reaction testing. Magone MT, Nasser RE, Cevallos AV, Margolis TP. Francis I. Proctor Foundation, University of California-San Francisco, San Francisco, CA 94143-0944, USA. tm@magones.com Comment in: Am J Ophthalmol. 2006 Apr;141(4):782; author reply 782. PURPOSE: To report a case of chronic recurrent varicella virus epithelial keratitis in a child. DESIGN: Case report. METHODS: Clinical examination and polymerase chain reaction analysis of corneal epithelium. RESULTS: A 10-year-old healthy child developed chronic recurrent varicella virus keratitis with pseudodendrites after recovering from systemic varicella. Analysis of the debrided pseudodendrites was repeatedly positive for VZV DNA and negative for HSV DNA. Treatment with oral acyclovir and topical corticosteroid drops was effective in eliminating the pseudodendrites; however, recurrences occurred once the medications were discontinued. CONCLUSIONS: Varicella virus epithelial keratitis in children can be a recurrent chronic condition requiring prolonged treatment. PMID: 15953460 [PubMed - indexed for MEDLINE] 1116. Saudi Med J. 2005 May;26(5):869-71. Congenital varicella-zoster virus infection. A rare case of severe brain and ocular malformations without limb or cutaneous involvement in a newborn after maternal subclinical infection. Al-Katawee YA, Al-Hasoun YA, Taha MN, Al-Moslem K. Department of Neonatology Al-Yamamah Hospital, PO Box 106208, Riyadh 11666, Kingdom of Saudi Arabia. yrshmh@hotmail.com Although congenital varicella-zoster virus VZV infection is rare, it carries serious morbidity and mortality to the fetus and newborn infant. We report a full term female newborn infant, born to a multipara unbooked mother who had VZV subclinical infection during the first trimester of pregnancy. Routine newborn examination showed cystic malformation of the left eye, and absence of the right eye globe. Radiological work up revealed severe brain and eye malformations, serological studies of both mother and baby were positive for VZV. The baby underwent palliative surgery to the eyes, upon discharge, a plan of multidisciplinary team was made for follow up including neurologist, ophthalmologist, pediatrician and social worker. Congenital VZV infection can be severe enough to cause catastrophic fetal anomalies and damage to the vital organs as many of those infants die in infancy. PMID: 15951887 [PubMed - indexed for MEDLINE] 1117. J Hand Surg Br. 2005 Aug;30(4):355-7. Herpes zoster in the ulnar nerve distribution. Athwal GS, Bartsich SA, Weiland AJ. Hand and Upper Limb Centre, University of Western Ontario, London, Ontario, Canada. Varicella zoster is a ubiquitous virus which usually affects school-aged children as Chicken Pox. While the initial disease is self-limiting and seldom severe, the virus remains in the body. It lies dormant in the dorsal root ganglia and reactivation may occur years later with variable presentations as Herpes Zoster, or Shingles. While Shingles is common, it rarely presents exclusively in the upper extremity. It is important that hand surgeons recognize the possibility of zoster infection, with or without a rash, when evaluating the onset of neuralgia in a dermatomal distribution in the upper limb. Early diagnosis allows rapid and appropriate treatment, with a lower risk of complications. We report on a case of Herpes Zoster isolated to the ulnar nerve distribution in a young woman. PMID: 15950335 [PubMed - indexed for MEDLINE] 1118. J Pain. 2005 Jun;6(6):356-63. Pain, medication use, and health-related quality of life in older persons with postherpetic neuralgia: results from a population-based survey. Oster G, Harding G, Dukes E, Edelsberg J, Cleary PD. Policy Analysis Inc, Brookline, Massachusetts 02445, USA. goster@pai2.com Persons aged >65 years with pain caused by postherpetic neuralgia (PHN) were recruited via advertisements in 24 US newspapers and were mailed a questionnaire that addressed pain intensity (average, worst, least, current), pain interference (with general activity, mood, relations with other people, sleep, enjoyment of life), and health-related quality of life (using the EuroQoL health measure [EQ-5D] and a global rating scale). Respondents also were asked about their use of medication for shingles pain. A total of 385 persons completed the survey; 61% were >75 years of age. Mean (+/-standard deviation) duration of PHN was 3.3 (+/-4.0) years. Only about one half had taken prescription medication for shingles pain during the prior week; dosages were typically low. Mean average, worst, least, and current pain caused by shingles (0- to 10-point scale) was 4.6 (+/-2.1), 6.0 (+/-2.4), 2.9 (+/-2.3), and 4.0 (+/-2.7), respectively. Mean pain interference with general activity, mood, relations with other people, sleep, and enjoyment of life (0- to 10-point scale) was 3.7 (+/-3.1), 4.3 (+/-2.9), 3.0 (+/-2.8), 3.8 (+/-2.9), and 4.5 (+/-3.1), respectively. The mean EQ-5D health index score was 0.61; respondents rated their overall health as 65.7 (+/-21.1) on a 100-point scale. PHN causes substantial pain, dysfunction, and poor health-related quality of life in older persons, many of whom might be suboptimally treated. PERSPECTIVE: Many older persons (age >65 years) with PHN experience longstanding, severe, and debilitating pain and poor health-related quality of life; levels of dissatisfaction with treatment are high. Our study highlights the need for improved management of this disease. PMID: 15943957 [PubMed - indexed for MEDLINE] 1119. Am J Transplant. 2005 Jul;5(7):1777-80. Concurrent verrucous and varicelliform rashes following renal transplantation. Jeyaratnam D, Robson AM, Hextall JM, Wong W, MacMahon E. Department of Infection, St John's Institute of Dermatology, St Thomas' Hospital, London SE1 7EH, UK. Verrucous rashes associated with varicella zoster virus (VZV) infection are well recognized in HIV infection. Seen rarely in transplant patients, no histologically confirmed case has been published in the transplant setting. We now report chronic, localized, verrucous VZV in a renal transplant recipient presenting with cutaneous dissemination. This case highlights the need to consider chronic VZV infection in the differential diagnosis of skin lesions even in the VZV seronegative transplant recipient without substantial exposure to antiviral agents. PMID: 15943639 [PubMed - indexed for MEDLINE] 1120. Int J Dermatol. 2005 Jun;44(6):524-5. Morphea with features of lichen sclerosus et atrophicus at the site of a herpes zoster scar: another case of an isotopic response. Forschner A, Metzler G, Rassner G, Fierlbeck G. PMID: 15941448 [PubMed - indexed for MEDLINE] 1121. MMW Fortschr Med. 2005 May 5;147(18):35-8. [Problems and diseases of the aging skin] [Article in German] Goebeler M, Brócker EB. Klinik für Dermatologie, Venerologie und Allergologie, Klinikum Mannheim gGmbH, Universitätsklinikum, Ruprecht-Karls-Universität Heidelberg. PMID: 15934586 [PubMed - indexed for MEDLINE] 1122. N Engl J Med. 2005 Jun 2;352(22):2344-6. Varicella-zoster virus vaccine--grown-ups need it, too. Gilden DH. Comment in: N Engl J Med. 2005 Sep 29;353(13):1414-5; author reply 1414-5. Comment on: N Engl J Med. 2005 Jun 2;352(22):2271-84. PMID: 15930426 [PubMed - indexed for MEDLINE] 1123. N Engl J Med. 2005 Jun 2;352(22):2271-84. A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults. Oxman MN, Levin MJ, Johnson GR, Schmader KE, Straus SE, Gelb LD, Arbeit RD, Simberkoff MS, Gershon AA, Davis LE, Weinberg A, Boardman KD, Williams HM, Zhang JH, Peduzzi PN, Beisel CE, Morrison VA, Guatelli JC, Brooks PA, Kauffman CA, Pachucki CT, Neuzil KM, Betts RF, Wright PF, Griffin MR, Brunell P, Soto NE, Marques AR, Keay SK, Goodman RP, Cotton DJ, Gnann JW Jr, Loutit J, Holodniy M, Keitel WA, Crawford GE, Yeh SS, Lobo Z, Toney JF, Greenberg RN, Keller PM, Harbecke R, Hayward AR, Irwin MR, Kyriakides TC, Chan CY, Chan IS, Wang WW, Annunziato PW, Silber JL; Shingles Prevention Study Group. Shingles Prevention Study (Mail code 111F-1), VA San Diego Healthcare System, 3350 La Jolla Village Dr., San Diego, CA 92161,USA. mnoxman@ucsd.edu Comment in: N Engl J Med. 2007 Jul 5;357(1):89. N Engl J Med. 2005 Sep 29;353(13):1414-5; author reply 1414-5. Nat Clin Pract Neurol. 2005 Nov;1(1):18-9. ACP J Club. 2005 Nov-Dec;143(3):61. N Engl J Med. 2005 Sep 29;353(13):1414-5; author reply 1414-5. N Engl J Med. 2005 Jun 2;352(22):2344-6. N Engl J Med. 2005 Jun 2;352(22):2266-7. BACKGROUND: The incidence and severity of herpes zoster and postherpetic neuralgia increase with age in association with a progressive decline in cell-mediated immunity to varicella-zoster virus (VZV). We tested the hypothesis that vaccination against VZV would decrease the incidence, severity, or both of herpes zoster and postherpetic neuralgia among older adults. METHODS: We enrolled 38,546 adults 60 years of age or older in a randomized, double-blind, placebo-controlled trial of an investigational live attenuated Oka/Merck VZV vaccine ("zoster vaccine"). Herpes zoster was diagnosed according to clinical and laboratory criteria. The pain and discomfort associated with herpes zoster were measured repeatedly for six months. The primary end point was the burden of illness due to herpes zoster, a measure affected by the incidence, severity, and duration of the associated pain and discomfort. The secondary end point was the incidence of postherpetic neuralgia. RESULTS: More than 95 percent of the subjects continued in the study to its completion, with a median of 3.12 years of surveillance for herpes zoster. A total of 957 confirmed cases of herpes zoster (315 among vaccine recipients and 642 among placebo recipients) and 107 cases of postherpetic neuralgia (27 among vaccine recipients and 80 among placebo recipients) were included in the efficacy analysis. The use of the zoster vaccine reduced the burden of illness due to herpes zoster by 61.1 percent (P<0.001), reduced the incidence of postherpetic neuralgia by 66.5 percent (P<0.001), and reduced the incidence of herpes zoster by 51.3 percent (P<0.001). Reactions at the injection site were more frequent among vaccine recipients but were generally mild. CONCLUSIONS: The zoster vaccine markedly reduced morbidity from herpes zoster and postherpetic neuralgia among older adults. Copyright 2005 Massachusetts Medical Society. PMID: 15930418 [PubMed - indexed for MEDLINE] 1124. N Engl J Med. 2005 Jun 2;352(22):2266-7. Aging, immunity, and the varicella-zoster virus. Arvin A. Stanford University School of Medicine, Stanford, Calif, USA. Comment on: N Engl J Med. 2005 Jun 2;352(22):2271-84. PMID: 15930416 [PubMed - indexed for MEDLINE] 1125. JAMA. 2005 May 25;293(20):2459-60. When shingles wanes but pain does not: researchers target chronic postherpetic neuralgia. Hampton T. PMID: 15914732 [PubMed - indexed for MEDLINE] 1126. Am J Dermatopathol. 2005 Jun;27(3):189-94. Exclusive involvement of folliculosebaceous units by herpes: a reflection of early herpes zoster. Walsh N, Boutilier R, Glasgow D, Shaffelburg M. Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada. noreen.walsh@cdha.nshealth.ca The histopathological changes of herpes simplex, herpes zoster, and varicella are considered to be indistinguishable from one another. Evaluation of the clinical setting, with adjunctive studies if necessary, generally clarifies the specific diagnosis. Vesicular lesions in all three conditions can involve epidermal and adnexal epithelium with characteristic cytopathic features. We describe three patients with non-vesicular eruptions on the head and neck whose biopsies revealed exclusive folliculosebaceous involvement by herpes. All three patients developed typical herpes zoster within days of the biopsy. There is compelling scientific evidence in the literature indicating that, in herpes zoster, the virus is transported from dorsal root or trigeminal ganglia via myelinated nerves to the skin. These terminate at the isthmus of hair follicles and primary infection of follicular and sebaceous epithelium occurs. Spread of infection to the epidermis follows. In contrast, data pertaining to recurrent herpes simplex indicates that axonal transport of the virus from sensory ganglia to the skin is directed primarily to the epidermis, via terminal non-myelinated nerve twigs. The clinical evolution of our three cases and scientific data in the literature indicate that exclusive folliculosebaceous involvement by herpes, in the setting of a non-vesicular eruption, represents early herpes zoster. PMID: 15900120 [PubMed - indexed for MEDLINE] 1127. J Infect Dis. 2005 Jun 15;191(12):2002-7. Epub 2005 May 12. Incidence of herpes zoster, before and after varicella-vaccination-associated decreases in the incidence of varicella, 1992-2002. Jumaan AO, Yu O, Jackson LA, Bohlke K, Galil K, Seward JF. Centers for Disease Control and Prevention, Atlanta, Georgia 30345, USA. ajumaan@cdc.gov Comment in: J Infect Dis. 2005 Jun 15;191(12):1999-2001. BACKGROUND: Varicella zoster virus (VZV) causes varicella and, later in the life of the host, may reactivate to cause herpes zoster (HZ). Because it is hypothesized that exposure to varicella may boost immunity to latent VZV, the vaccination-associated decrease in varicella disease has led some to suggest that the incidence of HZ might increase. We assessed the impact that varicella vaccination has on the incidence of varicella and of HZ. METHODS: Codes for cases of varicella and of HZ in an HMO were determined in automated databases of inpatients and outpatients, on the basis of the Ninth Revision of the International Classification of Diseases. We calculated the incidence, during 1992-2002, of varicella and of HZ. RESULTS: The incidence of HZ remained stable as the incidence of varicella decreased. Age-adjusted and -specific annual incidence rates of varicella decreased steadily, starting with 1999. The age-adjusted rates decreased from 2.63 cases/1000 person-years during 1995 to 0.92 cases/1000 person-years during 2002; among children 1-4 years old, there was a 75% decrease between 1992-1996 and 2002. Age-adjusted and -specific annual incidence rates of HZ fluctuated slightly over time; the age-adjusted rate was highest, at 4.05 cases/1000 person-years, in 1992, and was 3.71 cases/1000 person-years in 2002. CONCLUSIONS: Our findings revealed that the vaccination-associated decrease in varicella disease did not result in an increase in the incidence of HZ. These early findings will have to be confirmed as the incidence of varicella disease continues to decrease. PMID: 15897984 [PubMed - indexed for MEDLINE] 1128. J Infect Dis. 2005 Jun 15;191(12):1999-2001. Epub 2005 May 12. Changing dynamics of varicella-zoster virus infections in the 21st century: the impact of vaccination. Whitley RJ. Comment on: J Infect Dis. 2005 Jun 15;191(12):2002-7. PMID: 15897983 [PubMed - indexed for MEDLINE] 1129. Pediatr Infect Dis J. 2005 May;24(5):476-7. Varicella zoster virus encephalitis in a previously healthy five-year-old child with herpes zoster ophthalmicus. Ofek-Shlomai N, Averbuch D, Wolf DG, Engelhard D. PMID: 15876958 [PubMed - indexed for MEDLINE] 1130. Am J Epidemiol. 2005 May 15;161(10):929-38. History of chickenpox and shingles and prevalence of antibodies to varicella-zoster virus and three other herpesviruses among adults with glioma and controls. Wrensch M, Weinberg A, Wiencke J, Miike R, Sison J, Wiemels J, Barger G, DeLorenze G, Aldape K, Kelsey K. Department of Neurological Surgery, School of Medicine, University of California, San Francisco, CA 94102, USA. wrensch@itsa.ucsf.edu Whether viruses or immunologic factors might cause or prevent human brain cancer is of interest. Statistically significant inverse associations of adult glioma with history of chickenpox and immunoglobulin G antibodies to varicella-zoster virus have been reported. The authors evaluate associations of immunoglobulin G antibodies to varicella-zoster virus and three other herpesviruses among 229 adults with glioma and 289 controls in the San Francisco Bay Area Adult Glioma Study (1997-2000). Cases were less likely than controls to report a history of chickenpox (for self-reported cases vs. controls: the age-, gender-, and ethnicity-adjusted odds ratio = 0.59, 95% confidence interval: 0.40, 0.86), and they also had lower levels of immunoglobulin G to varicella-zoster virus (for being in the highest quartile vs. the lowest quartile: the age-, gender-, and ethnicity-adjusted odds ratio = 0.41, 95% confidence interval: 0.24, 0.70). The inverse association with anti-varicella-zoster virus immunoglobulin G was most marked for glioblastoma multiforme cases versus controls and was only somewhat attenuated by excluding subjects taking high-dose steroids and other medications. Cases and controls did not differ notably for positivity to three other herpesviruses, Epstein-Barr virus, cytomegalovirus, and herpes simplex virus. Cohort studies may help to clarify the nature of the association between immunity to and/or clinical manifestations of varicella-zoster virus and glioblastoma. PMID: 15870157 [PubMed - indexed for MEDLINE] 1131. Ir Med J. 2005 Mar;98(3):68. Is it time to introduce varicella vaccination? Murphy JF. PMID: 15869059 [PubMed - indexed for MEDLINE] 1132. Clin Evid. 2004 Dec;(12):1182-93. Postherpetic neuralgia. Wareham D. Queen Mary University of London & Barts & The London NHS Trust, London, UK. Update in: Clin Evid. 2005 Dec;(14):1017-25. Update of: Clin Evid. 2003 Dec;(10):942-52. PMID: 15865712 [PubMed - indexed for MEDLINE] 1133. J Dermatol. 2005 Apr;32(4):311-2. Giant annular lichen planus: wolf's isotopic response. Choi HJ, Kim KJ, Lee MW, Choi JH, Moon KC, Koh JK. PMID: 15863859 [PubMed - indexed for MEDLINE] 1134. Clin Infect Dis. 2005 May 15;40(10):1545-7. Epub 2005 Apr 13. A case of Ramsay Hunt-like syndrome caused by herpes simplex virus type 2. Diaz GA, Rakita RM, Koelle DM. Department of Medicine, University of Washington, Seattle, WA, USA. geodiaz@u.washington.edu We report an immunocompetent patient with recurrent auricular and facial vesicles associated with painful paresthesias and facial paralysis, consistent with Ramsay Hunt syndrome, due to herpes simplex virus (HSV) type 2. Clinical and laboratory-proven acyclovir resistance developed during therapy. Immunologic assays revealed normal reactivity to HSV-2. PMCID: PMC1255911 PMID: 15844081 [PubMed - indexed for MEDLINE] 1135. Emerg Med J. 2005 May;22(5):384-6. The reawakening of a sleeping little giant. Goddard R. General Surgery, Queen Elizabeth and Queen Mary Hospitals, East Kent Hospitals NHS Trust. goddard1998@aol.com This case report and literature review highlights the classical signs and symptoms of herpes zoster infection involving the trigeminal nerve. Incorrect diagnosis leads to delay in providing effective treatment and could result in failure to identify potentially hazardous ocular complications and to prevent chronic post-herpetic pain. PMCID: PMC1726788 PMID: 15843717 [PubMed - indexed for MEDLINE] 1136. Vaccine. 2005 May 9;23(25):3349-55. Cost-benefit analysis of universal varicella vaccination in the U.S. taking into account the closely related herpes-zoster epidemiology. Goldman GS. Medical Veritas International (MVI), Pearblossom, CA 93553, USA. pearblossominc@aol.com Many models concur that universal varicella vaccination of children is beneficial from the perspective of reducing societal costs. Yet, the majority of such cost analyses have been modeled under the assumption that varicella vaccination has no adverse effect on the closely related herpes-zoster (HZ) epidemiology. Historical models have assumed that asymptomatic endogenous reactivation is the chief mechanism of boosting that suppresses the reactivation of HZ and that immunity wanes due to the aging process. Recent studies suggest instead that periodic exogenous exposures to wild-type varicella are the predominant factor influencing the curve of increasing HZ incidence rate with advancing age among individuals <50, after which an age-related decline dominates in the elderly. Based on a realistic age-structured model, we compare differences in outcomes of the number of HZ cases and direct medical costs associated with the population existing in 2000 and as it ages (according to the mortality given in the 2000 U.S. census) during the following 50 years with and without implementation of universal varicella vaccination. Under universal varicella vaccination, we assume that 15 years post-licensure, the boosting mechanism known as asymptomatic endogenous reactivation principally serves to limit HZ incidence to 550 per 100,000 person-years in unvaccinated individuals <50 with a previous history of natural varicella--since there has been a vaccine-induced decline in exogenous boosting. We estimate universal varicella vaccination has the impact of an additional 14.6 million (42%) HZ cases among adults aged <50 years during a 50 year time span at a substantial cost burden of 4.1 billion US dollars or 80 million US dollars annually utilizing an estimated mean healthcare provider cost of 280 US dollars per HZ case. PMID: 15837242 [PubMed - indexed for MEDLINE] 1137. Ann Rheum Dis. 2005 May;64(5):780-2. Human parvovirus B19, varicella zoster virus, and human herpes virus 6 in temporal artery biopsy specimens of patients with giant cell arteritis: analysis with quantitative real time polymerase chain reaction. Alvarez-Lafuente R, Fernández-Gutiérrez B, Jover JA, Júdez E, Loza E, Clemente D, García-Asenjo JA, Lamas JR. Rheumatology Service, Hospital Clínico San Carlos, Madrid, Spain. OBJECTIVE: To evaluate the role of parvovirus B19 (B19), varicella zoster virus (VZV), and human herpes virus 6 (HHV-6) in the aetiopathology of giant cell arteritis (GCA). METHODS: Temporal artery biopsy specimens from 57 patients with GCA and 56 controls were investigated. DNA was obtained by biopsy, and quantitative real time polymerase chain reaction assay performed to establish the prevalence and viral load of B19, VZV, and HHV-6. Amplification of the human beta-globin gene was used as internal positive control. RESULTS: (a) B19 was detected in 31/57 (54%) patients (median viral load 45.2 (25th-75th centiles 0-180.2) copies/microg DNA) v 21/56 (38%) controls (median viral load 0 (0-66.7) copies/microg of DNA; p = 0.07 for DNA prevalence, p = 0.007 for viral load. Among 31 B19 positive samples, 21 (68%) patients with biopsy proven GCA had >10(2) B19 copies/microg of DNA v 5/21 (24%) controls; p = 0.001. (b) No significant difference was found for VZV (p = 0.94 for DNA prevalence; p = 0.76 for viral load) and HHV-6 (p = 0.89 for DNA prevalence; p = 0.64 for viral load) in the GCA group compared with controls. CONCLUSION: B19 may have a role in the aetiopathology of GCA, particularly in those patients with high viral load; no evidence was found for VZV and HHV-6. PMCID: PMC1755502 PMID: 15834059 [PubMed - indexed for MEDLINE] 1138. J Trop Pediatr. 2005 Jun;51(3):141-4. Epub 2005 Apr 14. Varicella zoster seroprevalence in children less than 5 years old. Ozkan S, Maral I, Ilhan F, Aycan S, Cirak MY, Beyazova U, Aygun R. Gazi University Faculty of Medicine, Department of Public Health, Ankara, Turkey. ozkans@gazi.edu.tr This study was designed to evaluate the age-specific varicella-zoster virus (VZV) seroprevalence in children less than 5 years old who presented at a healthy child outpatient clinic and to compare the results with the data from other countries. The study was a cross-sectional study determining the prevalence of serum IgG against VZV in children who presented to the Healthy Child Outpatient Clinic of the Gazi University Medical Faculty and who were aged between 9 months and 5 years, in the 3rd--97th percentile as regards height and weight, not suffering from any disease, and without a history of vaccination against varicella. The information on the children was obtained from a questionnaire, by physical examination, and from patient files. Serum samples were obtained from babies and children at 9, 15, 24, 36, 48, and 60 months. The 295 serum samples were kept at --20 degrees C following centrifugation until used for serologic analysis (ELISA). The 292 children of the study group consisted of 168 males (57.5 per cent) and 124 females (42.5 per cent). VZV antibodies were found to be positive in 65 children aged between 9 months and 5 years (22.3 per cent); 22.0 per cent in males and 22.6 per cent in females with no statistically significant difference between the sexes (p>0.05). The VZV seroprevalence was highest at the 48th and 60th months and this difference was statistically significant (p=0.000). PMID: 15831668 [PubMed - indexed for MEDLINE] 1139. J Periodontol. 2005 Jan;76(1):148-53. Alveolar bone necrosis and tooth exfoliation following herpes zoster infection: a review of the literature and case report. Mendieta C, Miranda J, Brunet LI, Gargallo J, Berini L. Dental Faculty, University of Barcelona, Barcelona, Spain. cmendieta@ub.edu BACKGROUND: Herpes zoster (HZ) presents as a cutaneous vesicular eruption in the area innervated by the affected sensory nerve, usually associated with severe pain. Oral manifestations of HZ appear when the mandibular or maxillary divisions of the trigeminal nerve are affected. METHODS: This is a case report of a 63-year-old woman with HZ infection with trigeminal nerve involvement that led to a rapid loss of alveolar bone and exfoliation of two teeth. RESULTS: The initial intraoral examination showed redness of the alveolar mucosa and gingiva of the lower right quadrant with multiple well-delimited and painful erosive lesions affecting the attached gingiva around the teeth. Two weeks later, teeth number 27 (lower right canine) and 28 (lower right first premolar) had class III mobility, flow of purulent exudate from the gingival sulcus, and deep pockets (>11 mm). The radiological examination showed advanced alveolar bone loss around both teeth. The prognosis for teeth number 27 and 28 was considered hopeless, and they were extracted. Due to extensive necrosis there was no interdental alveolar bone. The case is presented with a review of clinical data from patients with trigeminal HZ infection associated with osteonecrosis or exfoliation of teeth previously reported in the literature. The mechanisms by which the HZ infection leads to the alveolar bone necrosis are discussed. CONCLUSIONS: Extensive osteonecrosis and exfoliation of teeth in the area innervated by the nerve affected by HZ has been reported after HZ infection. Clinicians should be aware of this possible outcome after a trigeminal HZ infection. PMID: 15830651 [PubMed - indexed for MEDLINE] 1140. Neurology. 2005 Apr 12;64(7):1138. MRI of segmental zoster paresis. Samuraki M, Yoshita M, Yamada M. PMID: 15824336 [PubMed - indexed for MEDLINE] 1141. Epidemiol Infect. 2005 Apr;133(2):245-53. Incidence of herpes zoster, 1997-2002. Mullooly JP, Riedlinger K, Chun C, Weinmann S, Houston H. Kaiser Permanente Center for Health Research, Northwest Region, 3800 N. Interstate Drive, Portland, OR 97227-1098, USA. john.mullooly@kpchr.org We estimated age-specific herpes zoster (HZ) incidence rates in the Kaiser Permanente Northwest Health Plan (KPNW) during 1997-2002 and tested for secular trends and differences between residents of two states with different varicella vaccine coverage rates. The cumulative proportions of 2-year-olds vaccinated increased from 35% in 1997 to 85% in 2002 in Oregon, and from 25% in 1997 to 82% in 2002 in Washington. Age-specific HZ incidence rates in KPNW during 1997-2002 were compared with published rates in the Harvard Community Health Plan (HCHP) during 1990-1992. The overall HZ incidence rate in KPNW during 1997-2002 (369/100,000 person-years) was slightly higher than HCHP's 1990-1992 rate when adjusted for age differences. For children 6-14 years old, KPNW's rates (182 for females, 123 for males) were more than three times HCHP's rates (54 for females, 39 for males). This increase appears to be associated with increased exposure of children to oral corticosteroids. The percentage of KPNW children exposed to oral corticosteroids increased from 2.2% in 1991 to 3.6% in 2002. Oregon residents had slightly higher steroid exposure rates during 1997-2002 than Washington residents. There were significant increases in HZ incidence rates in Oregon and Washington during 1997-2002 among children aged 10-17 years, associated with increased exposure to oral steroids. PMID: 15816149 [PubMed - indexed for MEDLINE] 1142. Nat Med. 2005 Apr;11(4 Suppl):S16-9. The process development challenge for a new vaccine. Buckland BC. Merck Research Laboratories, West Point, Pennsylvania 19486, USA. barry_buckland@merck.com The challenges of vaccine development are not limited to identification of suitable antigens, adjuvants and delivery methods, but include regulatory, technical and manufacturing hurdles in translating a vaccine candidate to the clinic. Process development is the technological foundation that underlies the manufacture of new vaccines and is central to successful commercialization. PMID: 15812483 [PubMed - indexed for MEDLINE] 1143. Bone Marrow Transplant. 2005 Jun;35(11):1065-9. The effect of low-dose aciclovir on reactivation of varicella zoster virus after allogeneic haemopoietic stem cell transplantation. Thomson KJ, Hart DP, Banerjee L, Ward KN, Peggs KS, Mackinnon S. Department of Haematology, University College London Hospitals, 98 Chenies Mews, London WC1E 6HX, UK. kirsty.thomson@uclh.org Patients undergoing haemopoietic stem cell transplants (HSCT) are at high risk of varicella zoster virus (VZV) reactivation, with a significant incidence of dissemination. This study reports a retrospective analysis of 247 allogeneic HSCT recipients receiving anti-viral prophylaxis with low-dose oral aciclovir 400 mg/day, administered until immunosuppression was discontinued and the CD4(+) cell count exceeded 200/mm(3). Viral reactivation was successfully suppressed by aciclovir prophylaxis, with only one case of breakthrough infection. The cumulative incidence of zoster infection at 1 year post transplant was 2% and at 5 years 34%. In all, 64 patients discontinued prophylaxis. Zoster developed in 26 of these, giving a cumulative incidence of infection at 1 year after stopping aciclovir of 39% and at 3 years 44%. Infection occurred in a localised dermatomal distribution in 93% of cases. This supports previous findings that aciclovir prophylaxis prevents early VZV reactivation, although the long-term incidence is not affected as infection occurs once prophylaxis is discontinued. Such infection, however, is mild and localised. This study does not support the idea that use of such low-dose aciclovir regimens reduces the zoster incidence by permitting subclinical reactivation during prophylaxis, and therefore the re-establishment of protective anti-viral immunity. PMID: 15806119 [PubMed - indexed for MEDLINE] 1144. Int Ophthalmol Clin. 2005 Spring;45(2):89-97. Herpetic posterior uveitis. Zamir E. Ocular Immunology Service, The Royal Victorian Eye and Ear Hospital, 32 Gisborne Street, East Melbourne, Victoria 3002, Australia. PMID: 15791160 [PubMed - indexed for MEDLINE] 1145. Int Ophthalmol Clin. 2005 Spring;45(2):41-55. Polymerase chain reaction in the diagnosis of uveitis. Chan CC, Shen D, Tuo J. Section of Immunopathology, Laboratory of Immunology, National Eye Institute/NIH, Bldg. 10, Rm. 10N103, 10 Center Drive, Bethesda, MD 20892-1857, USA. PMCID: PMC2654605 PMID: 15791157 [PubMed - indexed for MEDLINE] 1146. Br J Dermatol. 2005 Mar;152(3):569-70. Reactivation of ophthalmic herpes zoster following pulsed-dye laser treatment for inflammatory acne vulgaris. Clayton TH, Stables GI. PMID: 15787833 [PubMed - indexed for MEDLINE] 1147. G Ital Nefrol. 2005 Jan-Feb;22(1):66-9. [On the mailing list: use of acyclovir in patients on hemodialysis] [Article in Italian] D'Amico M, Fraticelli M, Limido A. Unita' Operativa di Nefrologia, Azienda Ospedaliera S. Anna, Como - Italy. In the SIN Mailing List a message published in May 2004 gave rise to an interesting debate as to the use and dosage of acyclovir in dialysis patients for the treatment of varicella-zoster infection, considering the side effects (mainly neurological) reported in patients affected by renal insufficiency. In this issue, we summarised the main pharmacological characteristics of acyclovir and the clinical indications for using this drug. Finally, we analysed the literature data concerning acyclovir side effects in the setting of renal insufficiency. As they indicate that acyclovir-induced neurotoxicity in renal insufficiency patients may be unpredictable even at reduced dosages, this should discourage the use of acyclovir when severe renal insufficiency is present, unless severe herpes infection is present and after evaluating carefully the risk-benefit. In this case, the patient has to be kept under strict medical control to detect the acyclovir-induced side effects early. The use of new antiviral drugs, such as famciclovir or brivudine, to treat herpes virus infections in patients with renal insufficiency is currently not supported by sufficient data for a critical review. PMID: 15786379 [PubMed - indexed for MEDLINE] 1148. Klin Monbl Augenheilkd. 2005 Mar;222(3):264-6. Varicella-zoster virus retinitis: successful evolution with a combination of antiviral therapies. Oueghlani E, Baglivo E, Durakovic O, Safran AB. Clinique d'Ophtalmologie, Hôpitaux Universitaires de Genève, Geneva, Switzerland. BACKGROUND: We present the description of a successful outcome in a case of varicella-zoster virus (VZV) acute retinal necrosis (ARN). HISTORY AND SIGNS: A healthy 40-year-old patient was admitted for a VZV retinitis. THERAPY AND OUTCOME: 10 days after the onset of intravenous (i. v.) acyclovir treatment, new small peripheral retinal necrotic lesions appeared in the right eye. A viral resistance was suspected and the acyclovir therapy was optimised with i. v. foscarnet combined with 2 intravitreal injections of ganciclovir. The outcome was favourable with a final vision of 1.0 after a follow-up of 30 months. No systemic or local complications were observed. CONCLUSIONS: VZV ARN is a severe infection with a poor prognosis. This case demonstrates that combination of antiviral therapies given intravenously (acyclovir + foscarnet) and in the vitreous (ganciclovir) may be safe and efficacious in the management of necrotising herpetic retinopathies affecting immunocompetent patients. PMID: 15785997 [PubMed - indexed for MEDLINE] 1149. Oftalmologia. 2004;48(4):70-6. [The Bioptron light therapy] [Article in Romanian] Dediulescu L. Spitalul Municipal Râmnicul Sărat, Daniela Florentina Dediulescu Absolventa U.M.F. Iuliu Hatieganu, Cluj-Napoca. The Bioptron light therapy system acts naturally, upholding the capacity of regeneration of the body. Since the discovery of the therapeutical effects of the Bioptron light, over 20 years ago, its use as treatment has been developed for a large variety of diseases, among which also the eye-diseases (simplex and zoster herpes, conjunctivitis). PMID: 15782767 [PubMed - indexed for MEDLINE] 1150. Neurology. 2005 Mar 22;64(6):1007. CNS myelomatosis. Lupu VD, Saini N, Balish M. EMG section, National Institute of Neurologic Disorders and Stroke, NIH, Bldg. 10, Room 5C101, 10 Center Drive MSC-1404, Bethesda, MD 20892-1404, USA. lupuv@ninds.nih.gov PMID: 15781817 [PubMed - indexed for MEDLINE] 1151. J Neurol. 2005 Jun;252(6):677-86. Epub 2005 Mar 23. Postherpetic neuralgia: topical lidocaine is effective in nociceptor-deprived skin. Wasner G, Kleinert A, Binder A, Schattschneider J, Baron R. Dept. of Neurological Pain Research and Therapy, Neurological Clinic, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Schittenhelmstrasse 10, 24105 Kiel, Germany. g.wasner@neurologie.uni-kiel.de OBJECTIVES: Topical lidocaine is effective in postherpetic neuralgia (PHN). The aim of the present investigation was to classify patients according to their predominant peripheral nociceptor function and to compare these data with the results of a controlled study using dermal lidocaine patch. METHODS: Within the skin area of maximal pain QST (thermotest) and QCART (histamine iontophoresis and laser Doppler flowmetry) were performed prospectively in 18 PHN patients. A controlled study using cutaneous lidocaine (lidocaine 5% patch, IBSA) followed. RESULTS: Six patients (group I, sensitised nociceptors) had no sensory loss. Heat pain thresholds were equal or lower than on the contralateral side. Histamine-induced flare and axon reflex vasodilatation were not different on both sides. Histamine evoked pain increased. In 12 patients (group II, nociceptor impairment) heat pain thresholds were higher than contralateral. Histamine-induced flare was impaired or abolished. Histamine did not induce any sensation. Lidocaine was efficacious in the entire group of patients. Subgroup analysis revealed that patients with impairment of nociceptor function had significantly greater pain reduction under lidocaine vs placebo. Patients with preserved and sensitised nociceptors demonstrated no significant pain relief. CONCLUSIONS: PHN patients differ concerning their cutaneous nociceptor function: In the group I pain is caused by pathologically sensitised nociceptors. In subset II there is a loss of function of cutaneous C-nociceptors within the allodynic skin. Patients responded well to topical lidocaine even if the skin was completely deprived of nociceptors. Different underlying mechanisms of lidocaine action in nociceptor-deprived skin are discussed. PMID: 15778907 [PubMed - indexed for MEDLINE] 1152. Eye (Lond). 2006 Feb;20(2):247. High dosage of oral valaciclovir as an alternative treatment of varicella zoster acute retinal necrosis syndrome. Guex-Crosier Y, Meylan PR. Comment on: Eye (Lond). 2004 May;18(5):544-5. PMID: 15776013 [PubMed - indexed for MEDLINE] 1153. J Neurol Neurosurg Psychiatry. 2005 Apr;76(4):572. Post herpetic neuralgia. Pearce JM. jmsp@freenet.co.uk PMCID: PMC1739604 PMID: 15774448 [PubMed - indexed for MEDLINE] 1154. Treat Guidel Med Lett. 2005 Apr;3(32):23-32. Drugs for non-HIV viral infections. [No authors listed] Erratum in: Treat Guidel Med Lett. 2005 May;3(33):38. PMID: 15767977 [PubMed - indexed for MEDLINE] 1155. S Afr Med J. 2005 Jan;95(1):30-1. Herpes zoster ophthalmicus. Dawodu OA, Osahon AI, Alikah AA, Bakare CE. Opthalmology Department, University of Benin Teaching Hospital, PMB 1111, Benin City, Nigeria. PMID: 15762243 [PubMed - indexed for MEDLINE] 1156. Eur J Pediatr. 2005 Jun;164(6):366-70. Epub 2005 Mar 4. Prospective surveillance of hospitalisations associated with varicella-zoster virus infections in children and adolescents. Bonhoeffer J, Baer G, Muehleisen B, Aebi C, Nadal D, Schaad UB, Heininger U. Division of Paediatric Infectious Diseases, University Children's Hospital, P.O. Box, 4005, Basel, Switzerland. Our goal was to determine the epidemiology of severe varicella-zoster virus (VZV) infections in hospitalised paediatric patients. Admissions associated with VZV infection of patients aged 0-16 years were reported by all 38 paediatric units in Switzerland to the Swiss Paediatric Surveillance Unit (SPSU) during 3 consecutive years (4/2000-3/2003). We verified completeness of reporting by capture-recapture analysis with patient records identified by ICD-10 codes. Outcome of illness was assessed 6 months after hospitalisation. A total of 335 cases (235 identified by SPSU reports, 100 by ICD-10 code) were included in this study. Mean age of patients was 4.1 years (median 3.5 years, range 0-16 years); 54% were male. Some 293 (87%) patients presented with chickenpox, 42 (13%) with herpes zoster and 291 (87%) patients were not immunocompromised. A total of 319 complications occurred in 237 (71%) patients: secondary bacterial infections (n =109); central nervous system involvement (n =76); VZV pneumonitis (n =7); others (n =127). Eleven (3%) patients required intensive care and three died. On follow-up, 303 (96%) of 315 patients had completely recovered; sequelae were present in 12 (4%) patients. The calculated hospitalisation rate was 13 per 10(4) cases. CONCLUSION: This study describes a sizeable hospitalisation and complication rate of varicella-zoster virus infections and provides a solid basis for future immunisation recommendations in Switzerland. PMID: 15747132 [PubMed - indexed for MEDLINE] 1157. Acta Neurol Scand. 2005 Apr;111(4):229-32. Oxcarbazepine monotherapy in postherpetic neuralgia unresponsive to carbamazepine and gabapentin. Criscuolo S, Auletta C, Lippi S, Brogi F, Brogi A. U.O.C. Terapia Antalgica e Terapia Postoperatoria, Azienda Ospedaliera Senese Policlinico Le Scotte Siena, Italy. OBJECTIVES: We present the results of a preliminary, open-label trial to evaluate the efficacy and tolerability of oxcarbazepine in postherpetic neuralgia (PHN) unresponsive to treatment with antiepileptic drugs (carbamazepine and gabapentin) and local anesthetic blocks. MATERIALS AND METHODS: Twenty-four patients were treated with oxcarbazepine monotherapy for 8 weeks. Starting dose was 150 mg/day, subsequently increased by 150 mg/day every 2 days until a maintenance dose of 900 mg/day. Pain was assessed using a visual analog scale (VAS). RESULTS: There was a significant decrease in the mean VAS score following 8 weeks of treatment (Delta=5.33; paired t-test: P <0.0001) compared with baseline. Oxcarbazepine was effective from the first week of treatment. There was a significant reduction in allodynia, leading to improvements in patients' functioning and quality of life. Oxcarbazepine was generally well tolerated. CONCLUSION: Oxcarbazepine appears to be a promising alternative monotherapeutic approach for patients affected by PHN. PMID: 15740573 [PubMed - indexed for MEDLINE] 1158. Eur J Pain. 2005 Apr;9(2):167-71. Use of the Rydel-Seiffer graduated tuning fork in the assessment of vibration threshold in postherpetic neuralgia patients and healthy controls. Whitton TL, Johnson RW, Lovell AT. United Bristol Healthcare Trust, Bristol, UK. BACKGROUND AND AIMS: Afferent large fibre impairment has been reported as a useful predictor of postherpetic neuralgia (PHN) in patients with acute herpes zoster infection, using an electromechanical device to provide quantitative vibrametry. We aimed to demonstrate a clinically significant increase in vibration threshold in individuals with PHN compared to age-matched controls, using the portable and affordable Rydel-Seiffer graduated tuning fork. METHODS: We studied 45 PHN subjects aged over 55 years, and 45 age-matched controls with no history of herpes zoster infection. We excluded subjects with a history of disorders associated with neuropathy or immunocompromise. Measurements were performed at the ulnar styloid process and the head of the first metatarsal on the right side, in a warm room with the subject seated. Readings were taken in triplicate and the data analysed by a repeated measures design. RESULTS: We observed a significant difference in vibration threshold at both wrist and toe between the PHN and control groups (p < 0.001). Age-stratification of subjects produced an increased and clinically useful difference between the two groups at both sites in subjects between 55 and 70 years (p < 0.0001). CONCLUSIONS: We have shown a statistically significant decrease in vibration sensitivity in individuals with PHN aged 55-70 years compared to age-matched healthy controls, using the Rydel-Seiffer graduated tuning fork. A prospective study of patients with acute zoster infection is needed to determine the sensitivity and specificity of the graduated tuning fork in predicting PHN in patients with acute zoster infection. PMID: 15737809 [PubMed - indexed for MEDLINE] 1159. Pediatr Neurol. 2005 Mar;32(3):211-2. Zoster-associated intracranial hypertension. Millichap JJ, Freeman JL. Departments of Pediatrics and Internal Medicine, Brody School of Medicine at East Carolina University, Greenville, NC, USA. A 14-year-old female presented with headache, vomiting, and a rash. She was found to have papilledema and herpes zoster. Examination of the cerebrospinal fluid revealed pleocytosis and an elevated protein concentration. Varicella-zoster virus deoxyribonucleic acid was detected in the cerebrospinal fluid by polymerase chain reaction. Intracranial hypertension was treated by repeated lumbar puncture and with acetazolamide. This case represents an unusual complication of the reactivation of varicella-zoster virus. PMID: 15730906 [PubMed - indexed for MEDLINE] 1160. West Afr J Med. 2004 Oct-Dec;23(4):300-4. Clinical spectrum of herpes zoster in HIV-infected versus non-HIV infected patients in Benin City, Nigeria. Onunu AN, Uhunmwangho A. Department of Medicine, University of Benin Teaching Hospital, Benin City, Nigeria. BACKGROUND: Herpes zoster is due to reactivation of the varicella-zoster virus (VZV) at the sensory nerve ganglia. Some reports indicate that there might be differences in the pattern of presentation of herpes zoster in HIV infected patients. The objective of this study therefore, is to compare the clinical spectrum of herpes zoster in HIV-infected versus non-HIV infected patients. STUDY DESIGN: In this prospective study all patients presenting with clinical features of Herpes zoster had serological test (ELISA) for Human immunodeficiency viral (HIV) antibodies done and confirmed by the Double/Triple test algorithm. They were examined clinically to determine the dermatome(s) involved, the severity of the disease and the presence of any complication. The patients were categorized according to their HIV-status for the purpose of statistical analysis. RESULTS: Fifty-two out of the seventy-three patients seen during the study period were evaluated: 22 male (42.3 %) and 30 female (57.7 %) patients. Thirty-six (69.2 %) patients were HIV-positive while 16 (30.8%) were HIV-negative. The age distribution of the patients was bimodal; the mean age of patients in the HIV-positive group was 36.1+/-16.14 years while that of the HIV-negative group was 56.3+/-17.51 years. Multidermatomal involvement, affectation of the Trigeminal nerve dermatome and the presence of systemic symptoms such as fever and weakness correlated significantly with the presence of HIV infection. Mean times to cessation of new vesicle formation, crusting, and resolution of zoster-associated pain were also significantly longer in the HIV-positive patients. There were no statistically significant differences in the incidence of post-herpetic neuralgia, keloids, and bacterial super-infection in both groups. CONCLUSION: Herpes zoster was generally more severe in the presence of HIV infection. PMID: 15730088 [PubMed - indexed for MEDLINE] 1161. J Pediatr Ophthalmol Strabismus. 2005 Jan-Feb;42(1):57-8. Ophthalmic herpes zoster in an 18-month-old child. Gandhewar J, Birchall W, Kwartz J. Eye Unit, Royal Bolton Hospital, Bolton, England. We present a case of herpes zoster ophthalmicus in an 18-month-old child. Early exposure to varicella zoster virus while being breast-fed appears to account for this clinical presentation. The incidence of herpes zoster in children younger than age 2 years is discussed. PMID: 15724901 [PubMed - indexed for MEDLINE] 1162. Br J Gen Pract. 2005 Feb;55(511):102-7. Is herpes zoster a marker for occult or subsequent malignancy? Buntinx F, Wachana R, Bartholomeeusen S, Sweldens K, Geys H. Department of General Practice, University of Leuven, Leuven, Belgium. Frank.buntinx@med.kuleuven.ac.be BACKGROUND: It has been suggested that herpes zoster may be a marker for occult malignancy. AIM: To examine the emergence of a subsequent cancer diagnosis in patients with and without herpes zoster. DESIGN OF STUDY: Retrospective cohort study. SETTING: Results were based on the database of Intego, an ongoing Belgian general practice-based morbidity registry, covering 37 general practitioners and including about 311 000 patient years between the years 1994 and 2000. METHOD: Survival analysis comparing the emergence of malignancy in patients with and without herpes zoster. RESULTS: The number of patients below the age of 65 years with herpes zoster, cancer or both was too low to draw any sensible conclusions. Above the age of 65 years we identified a significant increase of cancer emergence in the whole group and in females (hazard ratio = 2.65, 95% confidence interval = 1.43 to 4.90), but not in males. No difference could be identified in the first year after the herpes zoster infection. CONCLUSION: Our results do not justify extensive testing for cancer in herpes zoster patients. The association we identified, however, leaves open a number of questions with respect to the physiopathology behind it. PMCID: PMC1463183 PMID: 15720930 [PubMed - indexed for MEDLINE] 1163. Liver Transpl. 2005 Mar;11(3):320-5. Herpes zoster infection after liver transplantation: a case-control study. Levitsky J, Kalil A, Meza JL, Hurst GE, Freifeld A. Department of Internal Medicine/Gastroenterology, University of Nebraska Medical Center, University of Nebraska, Omaha, Nebraska, 68198-5400, USA. Prior case series have suggested that herpes zoster (HZ) after orthotopic liver transplantation (OLT) may lead to serious complications due to visceral involvement. We sought to determine the incidence, risk factors, and long term outcomes of HZ after OLT. Clinical data from September 1993 to April 2004 were collected on all cases of HZ after OLT, and at the same post-OLT time points in age, gender, and transplant-year-matched HZ-negative controls. Risk factors for HZ infection and long-term outcomes were compared between cases and controls. A total of 29 patients developed HZ at a median of 4.9 years (range .5-12.9) after OLT. All HZ infections except 1 were localized to a single dermatome. Only 8 (28%) were hospitalized and 16 (55%) were treated with oral antivirals alone. No patients developed visceral involvement or died of HZ infection. No risk factors for HZ infection were identified on multivariate analysis. Of the long-term outcomes, the estimated 10-year survival was lower (P = .05) for cases than controls. The lower survival in HZ cases was not directly attributable to HZ infection. In conclusion, this study is the largest series on HZ after OLT. HZ is neither a common nor a serious infection after OLT and can be managed with antiviral therapy with a low likelihood of visceral dissemination. PMID: 15719387 [PubMed - indexed for MEDLINE] 1164. Nippon Jibiinkoka Gakkai Kaiho. 2005 Jan;108(1):1-7. [Accuracy of the prognostic diagnosis in acute peripheral facial palsy] [Article in Japanese] Aoyagi M. Department of Otolaryngology, Head and Neck Surgery, Course of Biological Structure and Cognitive Integration Science, Yamagata University School of Medicine, Yamagata. The important factors in the prognostic diagnosis of acute peripheral facial palsy are (1) the causal disease, (2) the site of injury and (3) the degree of injury, although the age of the patient, complication, treatment method and initial day of treatment are also important. Among these 3 factors, the degree of injury is most strongly related to the prognosis. However, the diagnosis of etiology is the most important for the selection of the treatment method. Above all, the differential diagnosis between Bell's palsy and zoster sine herpete (Ramsay Hunt syndrome), is the most significant. However, it is impossible to diagnose all patients with complete accuracy within 3 days after the onset of palsy, even using molecular biological examination including polymerase chain reaction analysis. The diagnosis of the site of injury does not contribute to the prediction of prognosis or the selection of treatment method, except for the determination of the approaching route of the facial nerve decompression for traumatic facial palsy. The scoring system of facial movement (40-point method), nerve excitability test (NET), electroneurography (ENoG), transcranial magnetic stimulation (TMS) and stapedial reflex (SR) are commonly used to estimate the degree of injury. To estimate the accuracy of these examinations, sensitivity and specificity of the tests were calculated according to the findings within 3 days after the onset of palsy and the outcome of 116 patients with Bell's palsy and 31 with Ramsay Hunt syndrome. According to the results, none of these tests seem to be a perfect diagnostic examination for the completely precise prediction of prognosis. However, a patient is predicted to have a good prognosis, if the following 3 findings are observed: (1) more than 10 points in the 40-point scoring system of facial movement, (2) a positive response to TMS and (3) a positive response to SR. An antidromic facial nerve response probably contributes to a precise prediction of prognosis within 3 days after the onset of facial palsy. PMID: 15712490 [PubMed - indexed for MEDLINE] 1165. J Biopharm Stat. 2005;15(1):165-78. Responder cell frequency estimation and binomial three-level nonlinear mixed effects model in limiting dilution assays. Ellison MC, Zerbe GO, Levin MJ. Division of Biostatistics, National Jewish Medical and Research Center, Denver, Colorado 80206, USA. ellisonm@njc.org Responder cell frequencies (RCF), which describe vaccine-boosted immune responses in herpes zoster (HZ) prevention studies, have been estimated by using limiting dilution assays (LDA). The theoretical linearity assumption between the logarithm of the proportion of nonresponding wells (s) and the cell concentration (N) (or dilution level) in LDA, based on the single-hit Poisson model, is often violated with observed data resulting in biased estimates of RCF. In this article, the Poisson assumption is modified by applying a mixture of Poisson and gamma distributions, resulting in a negative binomial assumption, which presents a better fit between s and N. In LDA for HZ prevention studies, binary responses (responder or non-responder wells) are measured repeatedly at different cell concentrations and over time. To account for the correlation between responses to varying dilution levels from individuals, and the correlation between repeated assays of individuals over time simultaneously, a binomial three-level nonlinear mixed-effects model is proposed. For parameter estimation, a maximum likelihood method is applied via adaptive Gaussian quadrature. There is a lack of non-Gaussian multilevel nonlinear mixed-effects software, which can execute such a complicated fit. In this article, an algorithm for the three-level nonlinear mixed-effects model, which can be inserted into the code in the SAS procedure NLMIXED, is suggested. PMID: 15702611 [PubMed - indexed for MEDLINE] 1166. Pediatr Infect Dis J. 2005 Feb;24(2):102-7. Varicella zoster in Guinea-Bissau: intensity of exposure and severity of infection. Poulsen A, Cabral F, Nielsen J, Roth A, Lisse IM, Vestergaard BF, Aaby P. Projecto de Saude de Bandim, Guinea-Bissau, Statens Serum Institut, Copenhagen, Denmark. anja@dadlnet.dk OBJECTIVE: To describe the epidemiology of and risk factors for severe chickenpox in Guinea- Bissau. METHODS: A prospective household study in a semiurban area of the capital. Severity was assessed by number of pox, fever response and presence of pneumonia. Severity was compared for the first case in a house, that is, the index case, and the secondary cases infected at home. RESULT: We identified 1539 cases of chickenpox. The median age was lower for boys and secondary cases (both P < 0.03); 44.6% of children were 1-4 years of age. The likely minimum interval between index and secondary cases was 10 days; most secondary cases occurred 14-17 days after the index case. The length of the incubation period was related to the intensity of exposure (P < 0.01). The number of pox was higher for secondary cases (P < 0.01) and was related to intensity of exposure (P < 0.01). Secondary cases had higher fever and more frequently pneumonia (relative risk, 2.17; 95% confidence interval, 1.54-3.08). Children with pneumonia were younger and had more pox. Nutritional status was not related to severity. CONCLUSIONS: Age and intensity of exposure are important determinants for severity of chickenpox infection. The length of the incubation period depends on intensity of exposure, suggesting that the dose of infection might be important. PMID: 15702036 [PubMed - indexed for MEDLINE] 1167. Pediatr Infect Dis J. 2005 Feb;24(2):97-101. Varicella-zoster virus reactivation is an important cause of acute peripheral facial paralysis in children. Furuta Y, Ohtani F, Aizawa H, Fukuda S, Kawabata H, Bergström T. Department of Otolaryngology-Head and Neck Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan. yfuruta@med.hokudai.ac.jp BACKGROUND: Reactivation of herpes simplex virus type 1 is thought to be a major cause of adult idiopathic peripheral facial paralysis or Bell's palsy. However, few studies have examined the pathogenesis of this condition in children. Serologic assays and polymerase chain reaction (PCR) analysis of paired sera and saliva samples were used here to investigate the causes of acute peripheral facial paralysis in pediatric patients. METHODS: A total of 30 children with acute peripheral facial paralysis were recruited. Paired sera were assayed for evidence of herpesvirus, mumps virus or Borrelia infection. PCR was used to detect herpes simplex virus type 1 and varicella-zoster virus (VZV) DNA in saliva samples. RESULTS: Ramsay Hunt syndrome with accompanying zoster lesions was diagnosed clinically in 2 patients, and VZV reactivation was confirmed serologically. VZV reactivation in the absence of zoster (zoster sine herpete) was diagnosed in 9 patients with either serologic assays or PCR. Thus VZV reactivation was demonstrated in 11 of 30 (37%) patients. The prevalence of VZV reactivation among patients between 6 and 15 years of age was significantly higher than in those younger than 5 years of age (53% versus 9%, P = 0.023). CONCLUSIONS: Our data indicate that VZV reactivation is an important cause of acute peripheral facial paralysis in children, especially those between 6 and 15 years of age. PMID: 15702035 [PubMed - indexed for MEDLINE] 1168. J Pediatr Hematol Oncol. 2005 Feb;27(2):106-8. Varicella-zoster reactivation in a patient receiving routine revaccinations after an allogeneic hemopoietic progenitors transplant. Patel SR, Ortín M. Royal Marsden Hospital, Sutton, UK. soonier@hotmail.com Primary varicella-zoster virus (VZV) infection and herpes zoster are important infectious complications after an allogeneic hemopoietic progenitors transplant (HPT). The authors describe a girl with second relapse of acute lymphoblastic leukemia who received an HPT at age 13 years. Two years after the HPT she started a revaccination program of routine childhood vaccines. With each course of vaccines she developed herpes zoster of the C6 dermatome, initially with the rash and later zoster sine herpete. The vaccinations appear to have triggered VZV reactivation by vaccine-induced immunomodulation in this HPT recipient. PMID: 15701988 [PubMed - indexed for MEDLINE] 1169. Euro Surveill. 2005 Jan;10(1):43-5. Varicella zoster virus vaccination policies and surveillance strategies in Europe. Pinot de Moira A, Nardone A; ESEN2 group. Immunisation Department, Health Protection Agency, CDSC, London, United Kingdom. The incorporation of varicella zoster virus (ZVV) vaccination in childhood immunisation schedules is becoming an increasingly common option in Europe. The current study forms part of the European Sero-Epidemiology Network 2 (ESEN2) organisational analysis for VZV and describes current passive immunisation policies, as well as current and proposed active immunisation strategies, and existing surveillance systems for diseases caused by the varicella zoster virus in ESEN countries. A questionnaire was compiled and distributed to 23 participating countries. A VZV vaccine is currently licensed in 14 of the 20 participating ESEN countries. Germany is the only country to have incorporated VZV vaccination into its routine childhood immunisation programme. Three further countries currently recommend vaccination of children against VZV and five countries are also considering introducing routine immunisation against VZV for children. However, of the eight countries with or considering introducing childhood VZV immunisation, only six have case-based mandatory notification of varicella, and only two countries have primary care surveillance data available for herpes zoster. PMID: 15701939 [PubMed - indexed for MEDLINE] 1170. Indian J Ophthalmol. 2004 Dec;52(4):323-4. Maxillary zoster with corneal involvement. Jain S, Rathore MK. Department of Ophthalmology, S S Medical College, Rewa, India. A case, of maxillary zoster with corneal involvement in a young patient is described. Corneal involvement in maxillary zoster (Medline search) is rare. PMID: 15693326 [PubMed - indexed for MEDLINE] 1171. Jpn J Ophthalmol. 2005 Jan-Feb;49(1):63-4. Polymerase chain reaction during the treatment of acute retinal necrosis. Kaneko H, Matsuzaki S, Okazaki Y, Kudo D. PMID: 15692780 [PubMed - indexed for MEDLINE] 1172. J Am Acad Dermatol. 2005 Feb;52(2):375. Linear lichen planus of the face and neck versus amalgam-induced "isotopic" cutaneous lichen planus. Happle R. Comment on: J Am Acad Dermatol. 2004 Apr;50(4):653-4. PMID: 15692500 [PubMed - indexed for MEDLINE] 1173. Plast Reconstr Surg. 2005 Feb;115(2):669-71. A novel internal nasal prosthesis to maintain three-dimensional stability after reconstruction of the nose. Anderson AR, Whitaker IS, Fynes D, Telfer MR. PMID: 15692397 [PubMed - indexed for MEDLINE] 1174. N Engl J Med. 2005 Feb 3;352(5):439-40. Varicella vaccine and infection with varicella-zoster virus. Vázquez M, Shapiro ED. Department of Pediatrics, Yale University School of Medicine, New Haven, Conn, USA. Comment on: N Engl J Med. 2005 Feb 3;352(5):450-8. PMID: 15689581 [PubMed - indexed for MEDLINE] 1175. Semin Pediatr Infect Dis. 2005 Jan;16(1):38-43. The impact of varicella vaccination in the United States. Hambleton S, Gershon AA. Department of Pediatrics, Columbia University, New York, NY 10032, USA. The addition of varicella vaccine to the universal childhood immunization schedule in the United States in 1995 can be seen as a bold step. Shown to be safe and efficacious against varicella in extensive prelicensure studies, it is nonetheless the first vaccine against a herpesvirus and, furthermore, it is a live, attenuated vaccine. Both wild-type and vaccine strain varicella zoster virus (VZV) are noteworthy for their ability to establish latent infection within the host, with the subsequent possibility of reactivation. Therefore, at the population level, a successful vaccination program could result in the eventual displacement of wild-type VZV by the attenuated vaccine virus. The immediate objective of universal vaccination, however, was to reduce the significant morbidity and mortality associated with primary VZV infection. Data now accumulating suggest that the varicella vaccine as used in the United States has so far been highly effective. The challenge for the future is to predict how the resulting substantial reduction in circulation of VZV will affect immunity among both vaccinees and the unvaccinated. Vaccination strategies likely will need to be adjusted as the epidemiology of VZV in the United States continues to evolve. PMID: 15685148 [PubMed - indexed for MEDLINE] 1176. Can J Anaesth. 2005 Feb;52(2):186-90. Relief of pain in acute herpes zoster by nerve blocks and possible prevention of post-herpetic neuralgia. Hardy D. Department of Anesthesiology, The Ottawa Hospital-Civic Campus, 1053 Carling Avenue, Ottawa, Ontario K1Y 4E9, Canada. dhardy@ottawahospital.on.ca PURPOSE: This report describes two cases of acute herpes zoster (AHZ) treated by nerve block resulting in immediate pain relief and possible prevention of post-herpetic neuralgia (PHN). CLINICAL FEATURES: Two elderly females with AHZ of cervical dermatomes and severe pain received deep cervical and greater occipital nerve blocks with a local anesthetic, epinephrine and steroid. In both patients, pain resolved immediately and permanently (one year follow-up) after a single treatment. Case #1: A 79-yr-old female with a mechanical mitral valve and anticoagulated with warfarin presented with AHZ of 17 days duration of the right C2, 3, 4 dermatomes and severe pain. A stellate ganglion block was not performed because of anticoagulation. Rather, a deep cervical root block at C3 and a greater occipital nerve block were performed with bupivacaine, epinephrine and methylprednisolone. No adverse events were evident. Case #2: A 73-yr-old female with a history of osteoarthritis and Meniere's disease presented with AHZ of seven days duration of the left C2, 3, 4 dermatomes and severe pain. Deep cervical root blocks at C3 and C4 and a greater occipital nerve block were performed with bupivacaine, epinephrine and methylprednisolone. Side effects of dizziness, hoarseness, hypertension and Horner's syndrome resolved in a few hours. A mild sensation of itching persisted for two weeks. CONCLUSION: This report illustrates the potential of nerve blocks in severe AHZ to treat acute pain and possibly prevent PHN. PMID: 15684261 [PubMed - indexed for MEDLINE] 1177. Eur J Epidemiol. 2004;19(12):1113-8. The consistency of shingles and its significance for health monitoring. Fleming DM, Bartelds A, Chapman RS, Cross KW. Royal College of General Practitioners, Harborne, Birmingham, UK. dfleming@rcgpbhamresunit.nhs.uk Accurate estimation of monitored populations is essential for epidemiological study. Many countries do not have systems of patient registration and routine disease surveillance is thereby hindered. We studied the incidence of shingles over time and investigated the hypothesis that the incidence is consistent and could be used as a proxy for estimating the monitored population. Annual incidence rates of shingles reported in the Weekly Returns Service (WRS) since 1970 and in the Dutch Sentinel Network (DSN) over the period 1998--2001 were studied. Gender specific annual rates (1998--2001) were compared after standardising for age. The population in the DSN was estimated by applying the WRS incidence rates to the numbers of DSN incident cases. The incidence of shingles was annually and seasonally consistent. Incidence in males was similar in both networks and in females approximately 18% greater in the WRS: in age groups 15-64 years, incidence was similar in both networks, but in children 0-14 years and in persons 65 years and over, it was higher in the WRS. The total populations in the DSN estimated from average age/gender specific rates in the WRS were within 12% of the observed in each of the 4 years surveyed. The incidence of shingles in the two countries was sufficiently close to estimate the surveyed population aged 15-64 years from knowledge of incident cases in the community. Routine monitoring of shingles in sentinel practice networks is commended as a method of assuring recording quality and as a means of estimating the survey population where the registered population is not known. PMID: 15678791 [PubMed - indexed for MEDLINE] 1178. Australas J Dermatol. 2005 Feb;46(1):42-3. Herpes zoster following cryosurgery. Lee MR, Ryman W. Department of Dermatology, Royal North Shore Hospital, St Leonards, New South Wales, Australia. mick155@bigpond.net.au A 56-year-old man developed reactivation of herpes zoster infection on his right forehead after treatment of several solar keratoses with cryosurgery. The rash was blistering and painful. Treatment with oral aciclovir was instituted and the lesions healed within 2 weeks. Known risk factors for reactivation include age and decreased immunity. Previous case reports have indicated trauma may be a risk factor in herpes zoster. We report a case of herpes zoster as a complication of cryosurgery. PMID: 15670178 [PubMed - indexed for MEDLINE] 1179. Intern Med J. 2005 Jan;35(1):69-70. Acalculous cholecystitis, multifocal gastrointestinal infarction and pancreatitis resulting from Varicella-zoster virus. Kurtovic J, Webster GJ, Singh-Grewal I, Bullpitt P, Haindl W, Wakefield D, Riordan SM. PMID: 15667476 [PubMed - indexed for MEDLINE] 1180. BJOG. 2005 Jan;112(1):50-6. Seroprevalence, incidence of prenatal infections and reliability of maternal history of varicella zoster virus, cytomegalovirus, herpes simplex virus and parvovirus B19 infection in South-Western Finland. Alanen A, Kahala K, Vahlberg T, Koskela P, Vainionpää R. Department of Obstetrics and Gynaecology, University of Turku, Finland. OBJECTIVE: To study seroprevalence and incidence and fetal transmission of varicella zoster virus (VZV), cytomegalovirus (CMV), herpes simplex virus (HSV) types 1 and 2 and parvovirus B19 infections during pregnancy and to evaluate the reliability of maternal past history of VZV, HSV and parvovirus infections. DESIGN: Prospective study of parturient women. SETTING: South-Western Finland. PARTICIPANTS: Five hundred and fifty-eight parturient women. METHODS: IgG and IgM antibodies against VZV, CMV, HSV-1 and -2, and parvovirus B19 were measured from maternal serum in the first trimester and at delivery and from cord serum, mother's own information of her past infections was compared with her serological status. MAIN OUTCOME MEASURES: Seroprevalence, seroconversions and fetal transmission of VZV, CMV, HSV and parvovirus B19, reliability of maternal history of VZV, HSV and parvovirus B19. RESULTS: Seroprevalences were 96.2% for VZV, 56.3% for CMV, 54.3% for HSV, 46.8% for HSV-1, 9.3% for HSV-2 and 58.6% for parvovirus B19. Parity was associated with CMV seropositivity, maternal age differed only between HSV-2 seropositive and seronegative women, while area of residence (urban or rural) had no effect. Six seroconversions were observed: two VZV, one CMV and three parvovirus infections. No cases of primary HSV infections occurred. Fetal transmission was observed in two cases of parvovirus infection. No infants with anti-CMV IgM antibodies were born to CMV immunised women. False positive history of chickenpox was given only by 1.5% of the women, history of herpes infections was less reliable, and history of parvovirus infection was unreliable. CONCLUSIONS: Seroprevalence and the risk of viral infections during pregnancy cannot be extrapolated from one pregnant population to another. PMID: 15663397 [PubMed - indexed for MEDLINE] 1181. J Neurosurg. 2005 Jan;102 Suppl:276-82. Gamma knife surgery for refractory postherpetic trigeminal neuralgia: targeting in one session both the retrogasserian trigeminal nerve and the centromedian nucleus of the thalamus. Keep MF, DeMare PA, Ashby LS. The Gamma Knife Center of the Pacific, Honolulu, Hawaii, USA. mkeep@salud.unm.edu OBJECT: The authors tested the hypothesis that two targets are needed to treat postherpetic trigeminal neuralgia (TN): one in the trigeminal nerve for the direct sharp pain and one in the thalamus for the diffuse burning pain. METHODS: Three patients with refractory postherpetic TN were treated with gamma knife surgery (GKS) through a novel two-target approach. In a single treatment session, both the trigeminal nerve and centromedian nucleus were targeted. First, the trigeminal nerve, ipsilateral to the facial pain, was treated with 60 to 80 Gy. Second, the centromedian nucleus was localized using standard coordinates and by comparing magnetic resonance images with a stereotactic atlas. A single dose of 120 to 140 Gy was delivered to the target point with a single 4-mm isocenter. Patients were followed clinically and with neuroimaging studies. Pain relief was scored as excellent (75-100%), good (50-75%), poor (25-50%); or none (0-25%). Follow up ranged from 6 to 53 months. There were no GKS-related complications. Two patients died of unrelated medical illnesses but had good or excellent pain relief until death. One patient continues to survive with 44 months follow up and no decrease in pain intensity, but with a decreased area of pain. CONCLUSIONS: Combined GKS of the centromedian nucleus and trigeminal nerve in a single treatment session is feasible and safe, and the effect was promising. A larger study is required to confirm and expand these results. PMID: 15662825 [PubMed - indexed for MEDLINE] 1182. Virology. 2005 Feb 5;332(1):337-46. Analysis of varicella zoster virus attenuation by evaluation of chimeric parent Oka/vaccine Oka recombinant viruses in skin xenografts in the SCIDhu mouse model. Zerboni L, Hinchliffe S, Sommer MH, Ito H, Besser J, Stamatis S, Cheng J, Distefano D, Kraiouchkine N, Shaw A, Arvin AM. Department of Pediatrics, S-356, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305-5208, USA. zerboni@stanford.edu Varicella-zoster virus (VZV) is the only human herpes virus for which a vaccine has been licensed. A clinical VZV isolate, designated the parent Oka (pOka) strain was passed in human and non-human fibroblasts to produce vaccine Oka (vOka). The pOka and vOka viruses exhibit similar infectivity in cultured cells but healthy susceptible individuals given vaccines derived from vOka rarely develop the cutaneous vesicular lesions characteristic of varicella. Inoculation of skin xenografts in the SCIDhu mouse model of VZV pathogenesis demonstrated that vOka had a reduced capacity to replicate in differentiated human epidermal cells in vivo (Moffat, J.F., Zerboni, L., Kinchington, P.R., Grose, C., Kaneshima, H., Arvin A.M., 1998a. Attenuation of the vaccine Oka strain of varicella-zoster virus and role of glycoprotein C in alphaherpesvirus virulence demonstrated in the SCID-hu mouse. J Virol. 72:965-74). In order to investigate the attenuation of vOka in skin, we made chimeric pOka and vOka recombinant viruses from VZV cosmids. Six chimeric pOka/vOka viruses were generated using cosmid sets that incorporate linear overlapping fragments of VZV DNA from cells infected with pOka or vOka. The cosmid sets consist of pOka and vOka DNA segments that have identical restriction sites. As expected, the growth kinetics and plaque morphologies of the six chimeric pOka/vOka viruses were indistinguishable in vitro. However, the chimeric viruses exhibited varying capacities to replicate when evaluated in skin xenografts in vivo. The presence of ORFs 30-55 from the pOka genome was sufficient to maintain wild-type infectivity in skin. Chimeric viruses containing different vOka components retained the attenuation phenotype, suggesting that vOka attenuation is multi-factorial and can be produced by genes from different regions of the vOka genome. PMID: 15661165 [PubMed - indexed for MEDLINE] 1183. Graefes Arch Clin Exp Ophthalmol. 2005 Jun;243(6):607-9. Epub 2005 Jan 19. Progression of varicella-zoster virus necrotizing retinopathy in an HIV-negative patient with transient immune deviation. Lim WK, Chee SP, Nussenblatt RB. Singapore National Eye Center, 11, Third Hospital Avenue, Singapore, Singapore, 168751. PURPOSE: To report a case of unilateral varicella-zoster virus (VZV) necrotizing retinopathy that progressed from outer retinitis with features of progressive outer retinal necrosis (PORN) to typical acute retinal necrosis (ARN) in an HIV-negative patient with a transient decrease in CD4 lymphocyte counts and CD4/CD8 ratio. METHOD: Case report. RESULTS: A 41-year-old Chinese man presenting with blurred vision in the right eye was diagnosed with herpetic necrotizing retinitis without vitritis. Fundus examination revealed retinal arteritis and extensive deep whitish retinal lesions in the mid-periphery with minimal vitritis. Aqueous humor and vitreous PCR were positive for VZV. His CD4 count on presentation was depressed (239 cells/ul) and the CD4/CD8 ratio was low (0.8). The referring ophthalmologist had treated him with prednisolone 60 mg/day. At our institution, when intravenous acyclovir was started and the steroid therapy discontinued, he developed severe vitritis and the deep retinal lesions progressed to full-thickness retinitis typical of ARN. Repeat CD4 count was 512 cells/ul at day 14. In total, he was treated with 14 days of i.v. acyclovir (12 mg/kg 8-hourly) followed by oral valaciclovir 500 mg three times a day for 3 months. Prednisolone 30 mg once daily was restarted and tapered over 3 months. Despite prophylactic argon retinal photocoagulation to the edge of the retinitis, the patient developed a total retinal detachment at 3 months. CONCLUSIONS: VZV retinal infection in an HIV-negative patient with transient immune deviation can manifest initially as outer retinitis with features similar to PORN and progress to typical ARN when CD4 counts return to normal. PMID: 15657772 [PubMed - indexed for MEDLINE] 1184. Clin Microbiol Rev. 2005 Jan;18(1):70-80. Preventing varicella-zoster disease. Hambleton S, Gershon AA. Columbia University College of Physicians and Surgeons, 650 W. 168th Street, New York, NY 10032, USA. Varicella-zoster virus (VZV), the cause of chickenpox and shingles, is a pathogen in retreat following the introduction of mass vaccination in the United States in 1995. The live attenuated Oka vaccine, which is safe and immunogenic, gives good protection against both varicella and zoster in the short to medium term. It has undoubtedly been highly effective to date in reducing all forms of varicella, especially severe disease. However, the huge pool of latent wild-type virus in the population represents a continuing threat. Both the biology and the epidemiology of VZV disease suggest that new vaccination strategies will be required over time. PMCID: PMC544176 PMID: 15653819 [PubMed - indexed for MEDLINE] 1185. Vestn Ross Akad Med Nauk. 2004;(11):18-21. [Results of Befnorin clinical trails in healthy volunteers] [Article in Russian] Masycheva VI, Shirinskiĭ VS, Starostina NM, Kozhevnikov VS, Meledina IV, Novikova LM, Meniaeva EV, Kristosova NV, Shevchuk NI, Evsiukova EV, Danilenko ED, Pustoshilova NM, Kozlov VA. Clinical trails of Befnorin based on the human recombinant TNF-beta elaborated at the Research Design and Technology Institute of Biologically Active Substances, "Vector" State Research Center of Virology and Biotechnology, were carried out on healthy volunteers in compliance with a decision passed by the Committee of Medical and Immunobiological Preparations, Russia's Health Ministry. Single Befnorin doses of 5-10(4) U, 10(5) U, 5-10(5) U, and 10(6) U were administered as intramuscular injections. Clinical, biochemical and immunological parameters were registered for 7 days after a single dose. The drug had an impact on the below immunity indices: Fc-phagocytosis of monocytes, migration index and migration inhibition index. The dose of 10(5) U was proven to be most effective and safe. Supposedly, the drug can be effective in the treatment of herpetic diseases. PMID: 15651658 [PubMed - indexed for MEDLINE] 1186. J Eur Acad Dermatol Venereol. 2005 Jan;19(1):47-55. Brivudin compared with famciclovir in the treatment of herpes zoster: effects in acute disease and chronic pain in immunocompetent patients. A randomized, double-blind, multinational study. Wassilew S; Collaborative Brivudin PHN Study Group. Dermatological Department, Klinikum Krefeld, Krefeld, Germany. swassilew.dermatologie@klinikum-krefeld.de OBJECTIVE: This was a double-blind, randomized multicentre trial comparing efficacy and safety of brivudin (125 mg, once a day) and famciclovir (250 mg, three times a day), both given orally for 7 days, in the treatment of herpes zoster. METHODS: A total of 2027 immunocompetent zoster patients>or=50 years with zoster-related pain at presentation were included. Outcome measures embraced prevalence of postherpetic neuralgia (PHN), defined as at least moderate pain 3 months after treatment initiation, duration of PHN, prevalence and duration of zoster-associated pain (ZAP), duration of vesicle formation and rash healing. RESULTS: The prevalence of PHN at month 3 was 11.3% with brivudin and 9.6% with famciclovir [per-protocol (PP) population]. Equivalence of the two drugs could be demonstrated (P=0.01, PP and intention-to-treat analysis). The median duration of PHN was 46.5 days with brivudin and 58 days with famciclovir (P=0.54, PP analysis). Prevalence and duration of ZAP did not differ significantly between treatment groups. The prevalence of PHN was higher in patients>or=65 years (brivudin: 16.4%, famciclovir: 16.4%), and in patients with severe rash (brivudin: 13.4%, famciclovir: 15.7%), without significant differences between treatment groups. In patients>or=65 years, median duration of PHN was shorter with brivudin than with famciclovir (39.5 vs. 57.5 days), although the difference was not statistically significant. The two drugs had equivalent efficacy in being able to accelerate the stop of vesicle formation, and lesion healing. Adverse events were similar in nature and prevalence among groups. CONCLUSIONS: The study demonstrated equivalent efficacy of brivudin and famciclovir in the treatment of herpes zoster regarding the prevention of chronic pain and the resolution of signs and symptoms of acute herpes zoster. Compared with famciclovir, brivudin provides equivalent efficacy and safety at a more convenient once-daily dose schedule. PMID: 15649191 [PubMed - indexed for MEDLINE] 1187. Neurology. 2005 Jan 11;64(1):21-5. VZV vasculopathy and postherpetic neuralgia: progress and perspective on antiviral therapy. Gilden DH, Cohrs RJ, Mahalingam R. Department of Neurology, Mail Stop B182, University of Colorado Health Sciences Center, 4200 East 9th Avenue, Denver, CO 8026, USA. don.gilden@uchsc.edu Two serious complications of varicella-zoster virus (VZV) reactivation are vasculopathy and postherpetic neuralgia (PHN). Clinical-virologic analyses have proven that VZV vasculopathy is caused by chronic active virus infection in cerebral arteries. Conclusive evidence that PHN is caused by persistent or productive VZV infection is less compelling because human ganglia are not accessible during life for pathologic and virologic examination. However, the notion that PHN may reflect a smoldering VZV ganglionitis is supported by 1) the detection of VZV DNA and proteins in peripheral blood mononuclear cells of many patients with PHN; 2) studies of multiple patients with zoster sine herpete, which indicate a productive VZV ganglionitis; and 3) a favorable response of some patients with zoster sine herpete and PHN to antiviral treatment. Few studies have used antiviral therapy to manage PHN with conflicting results. Larger, double-blind studies, which give IV antiviral drug, are needed. PMID: 15642898 [PubMed - indexed for MEDLINE] 1188. J Orofac Pain. 2004 Fall;18(4):366-73. Management issues of neuropathic trigeminal pain from a medical perspective. Watson CP. Department of Medicine, University of Toronto, Toronto, Ontario, Canada. The purpose of this article is to review the pharmacological treatment of neuropathic trigeminal pain by means of a systematic review. A number of randomized controlled trials and important historical and uncontrolled studies in trigeminal neuralgia and postherpetic neuralgia were identified. Trigeminal neuralgia is a unique neuropathic pain disorder with a specific therapy. It does not respond to the usual drugs used for other neuropathic pains. The drug therapy of trigeminal postherpetic neuralgia is similar to that of other neuropathic trigeminal pain conditions. PMID: 15636022 [PubMed - indexed for MEDLINE] 1189. J Orofac Pain. 2004 Fall;18(4):281-6. Neuropathic pain in the orofacial region: clinical and research challenges. Bennett GJ. Canada Research Chair, Department of Anesthesia, Faculty of Dentistry, and Centre for Research on Pain, McGill University, Montreal, Quebec, Canada. gary.bennett@mcgill.ca Neuropathic pain in the orofacial region poses a difficult challenge to the treating physician. In some cases diagnosis is far from easy. Common causes of orofacial neuropathic pain are reviewed here, with a focus on the 2 most common: postherpetic neuralgia and posttraumatic painful peripheral neuropathy. In addition, the discussion includes idiopathic trigeminal neuralgia (tic douloureux), a neuropathic pain syndrome that is nearly unique to the trigeminal distribution (very rarely, it has also been reported in the glossopharyngeal region). Brief summaries of major research problems and successes are also provided. PMID: 15636009 [PubMed - indexed for MEDLINE] 1190. Pol Merkur Lekarski. 2004 Sep;17(99):275-7. [Diagnostic problems in the course of varicella-zoster virus reactivation leading to meningitis and hepatitis--case report] [Article in Polish] Skwara P, Biesiada G, Postawa-Kłosińska B, Mach T. Katedra i Klinika Chorób Zakaznych Collegium Medicum UJ. pawels@mp.pl Reactivation of varicella-zoster virus (VZV) usually leads to developing of characteristic skin lesions with dermatomal distribution. In very rare cases typical clinical picture can be absent, which impairs diagnostic procedure. Atypical case of young non HIV infected man was described. Clinical picture of meningitis and hepatitis due to VZV reactivation without typical skin eruptions resulted in diagnostic problems and required differentiation with proliterative process. Essential role of serologic testing in such cases was emphasized. PMID: 15628058 [PubMed - indexed for MEDLINE] 1191. Rev Neurol. 2004 Dec 16-31;39(12):1199. [Horner's syndrome secondary to thoracic herpes zoster] [Article in Spanish] Agudo R, López-Ramos E, Alonso H, Gómez-Escalonilla CI, García-Albea E, Jiménez-Jiménez FJ. Departamento de Medicina-Neurología, Hospital Príncipe de Asturias, Universidad de Alcalá, Alcalá, Spain. PMID: 15625644 [PubMed - indexed for MEDLINE] 1192. QJM. 2005 Jan;98(1):29-34. Divalproex sodium in the management of post-herpetic neuralgia: a randomized double-blind placebo-controlled study. Kochar DK, Garg P, Bumb RA, Kochar SK, Mehta RD, Beniwal R, Rawat N. C-54, Sadul Ganj, Bikaner (Raj) 334003, India. drdkkochar@indiatimes.com BACKGROUND: Post-herpetic neuralgia is difficult to treat. Divalproex sodium (valproic acid and sodium valproate in molar ratio 1:1) has been used successfully in the management of various painful neuropathies. AIM: To study the effectiveness and safety of divalproex sodium in the management of post-herpetic neuralgia. DESIGN: Randomized double-blind placebo-controlled trial. METHODS: We enrolled 48 consecutively attending out-patients with post-herpetic neuralgia, out of whom three were excluded (two had insufficient pain, one withdrew consent). Quantification of pain was by Short Form-McGill pain questionnaire (SF-MPQ), visual analogue scale (VAS), present pain intensity score (PPI) and 11 point Likert scale (11 PLS) at the beginning of the study, after 2 weeks, 4 weeks and at the end of the study (8 weeks). We also assessed patients' global impression of change by questionnaire at the end of the study. RESULTS: After 8 weeks treatment with 1000 mg/day divalproex sodium, there was significant reduction in pain: SF-MPQ, 20.47 +/- 2.29 to 11.90 +/- 6.52 (p < 0.0001); PPI 4.0 +/- 0.52 to 1.95 +/- 1.29 (p < 0.0001); VAS 70.17 +/- 9.21 to 31.27 +/- 29.74 (p < 0.0001) and 11 PLS 6.97 +/- 0.73 to 3.63 +/- 2.34 (p < 0.0001) in comparison to placebo (means +/- SEM). The 'global impression of change' questionnaire showed much or moderate improvement in pain in 58.2% of patients receiving divalproex vs. 14.8% of those receiving placebo. The drug was well tolerated by all patients, except one who developed severe vertigo after 10 days of treatment. DISCUSSION: Divalproex sodium provides significant pain relief in patients of post-herpetic neuralgia, with very little incidence of adverse reactions. These data provide a basis for longer trials in a larger group of patients. PMID: 15625351 [PubMed - indexed for MEDLINE] 1193. Dermatol Nurs. 2004 Oct;16(5):431-2. What's your assessment? Herpes zoster. Bielan B. Dermatology, Kaiser Permanente, San Francisco, CA, USA. PMID: 15624707 [PubMed - indexed for MEDLINE] 1194. Neurology. 2004 Dec 28;63(12):2423-5. Progressive outer retinal necrosis presenting with isolated optic neuropathy. Nakamoto BK, Dorotheo EU, Biousse V, Tang RA, Schiffman JS, Newman NJ. Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, USA. Comment in: Neurology. 2005 Nov 22;65(10):1682-3. Progressive outer retinal necrosis is a necrotizing herpetic retinopathy usually seen in immunocompromised patients. The authors describe two patients with this disease who initially had findings suggestive of an optic neuropathy. Vision declined after treatment with methylprednisolone, after which fundus examination became consistent with progressive outer retinal necrosis. These cases underscore the importance of careful examination of the retinal periphery before management of any presumed optic neuropathy with steroids. PMID: 15623719 [PubMed - indexed for MEDLINE] 1195. Cell. 2004 Dec 29;119(7):915-26. Mannose 6-phosphate receptor dependence of varicella zoster virus infection in vitro and in the epidermis during varicella and zoster. Chen JJ, Zhu Z, Gershon AA, Gershon MD. Department of Anatomy & Cell Biology, Columbia University, P&S, New York, NY 10032, USA. Varicella zoster virus (VZV) is a highly infectious human pathogen; nevertheless, infectious virions are not released in vitro where infection is cell associated. Four VZV envelope glycoproteins contain mannose 6-phosphate (Man 6-P), and Man 6-P blocks infection of cells by cell-free VZV. Expression of antisense cDNA or siRNA-like transcripts were used to generate five stable human cell lines deficient in cation-independent mannose 6-phosphate receptors (MPRci). All 5 MPRci-deficient lines resisted infection by cell-free, but not cell-associated, VZV, secreted lysosomal enzymes, and released infectious virions when infected by cell-associated VZV. Intracellular MPRci thus appear to divert newly enveloped VZV to late endosomes, and plasmalemmal MPRci are necessary for entry by cell-free VZV. Biopsies from VZV-infected human skin supported the idea that because MPRci expression is naturally lost in maturing superficial epidermal cells, these cells do not divert VZV to endosomes and constitutively secrete infectious VZV. PMID: 15620351 [PubMed - indexed for MEDLINE] 1196. Swiss Med Wkly. 2004 Nov 27;134(47-48):700-4. Diagnostic significance of intrathecally produced herpes simplex and varizella-zoster virus-specific antibodies in central nervous system infections. Schultze D, Weder B, Cassinotti P, Vitek L, Krausse K, Fierz W. Institute for Clinical Microbiology and Immunology, St. Gallen, Switzerland. detlev.schultze@ikmi.ch BACKGROUND AND OBJECTIVES: The optimal strategy for the diagnosis of herpes simplex virus (HSV) and varizella-zoster virus (VZV) disease of the central nervous system is the detection of viral DNA by polymerase chain reaction assay (PCR) in cerebrospinal fluid (CSF) and the examination of intrathecal production of specific antibodies. However, in acute neurological disease caused by either HSV or VZV, dual intrathecal synthesis of HSV-1, 2- as well as VZV-specific antibodies may be detectable and thus can hamper accurate aetiological diagnosis. This paper illustrates such equivocal findings in two case reports, investigates their frequency and discusses the possible reasons. METHODS: Consecutive CSF/serum pairs of two patients with central nervous system (CNS) disease were tested by HSV-1-, HSV-2-, and VZV-specific PCR and by different serological assays for detection of neurotropic viruses and bacteria. Additionally, the results of microbiological investigations of 1'155 CSF/serum samples were retrospectively analyzed for coincident intrathecal antibody synthesis against HSV-1, 2 and VZV. RESULTS: Although only HSV-1 and VZV-specific DNA was detectable in the CSF of two patients with encephalitis and chronic meningitis, respectively, increasing intrathecal antibody production against both virus species could be demonstrated. Retrospective analysis of 1155 CSF/serum pairs revealed 55 (4.8%) pairs with evidence for intrathecally produced antibodies against either HSV-1, 2 (30/55) or VZV (14/55). Eleven of these 55 (20%) pairs showed intrathecal antibody-production against both virus species. CONCLUSIONS: Patients with CNS infection with HSV and VZV can be diagnosed by detecting intrathecally produced virus-specific antibodies, in addition to virus-specific PCR. However, in an appreciable proportion of patients a correct diagnosis is hampered by coincidentally detected antibodies in CSF against both virus species. Possible reasons for these equivocal findings are given. PMID: 15616903 [PubMed - indexed for MEDLINE] 1197. Drugs. 2005;65(1):111-8; discussion 119-20. Pregabalin: in the treatment of postherpetic neuralgia. Frampton JE, Foster RH. Adis International Limited, Auckland, New Zealand. demail@adis.co.nz Pregabalin, the pharmacologically active S-enantiomer of 3-aminomethyl-5-methyl-hexanoic acid, has a similar pharmacological profile to that of its developmental predecessor gabapentin, but showed greater analgesic activity in rodent models of neuropathic pain. The exact mechanism of action of pregabalin is unclear, although it may reduce excitatory neurotransmitter release by binding to the alpha2-delta protein subunit of voltage-gated calcium channels. Oral pregabalin 150-600 mg/day, administered twice or three times daily, was superior to placebo in relieving pain and improving pain-related sleep interference in three randomised, double-blind, placebo-controlled, multicentre studies of 8-13 weeks' duration in a total of 776 evaluable patients with postherpetic neuralgia (PHN). Weekly mean pain scores (primary endpoint; assessed in all three studies) and weekly mean sleep interference scores (assessed in two studies) were significantly improved at 1 week. In two studies, significant improvements in daily mean pain scores were apparent on the first or second day of treatment with pregabalin administered three times daily. Pregabalin was generally well tolerated when force-titrated over 1 week to fixed dosages (maximum 600 mg/day) in clinical trials that enrolled most elderly PHN patients. Dizziness, somnolence and peripheral oedema of mild-to-moderate intensity were the most common adverse events. PMID: 15610058 [PubMed - indexed for MEDLINE] 1198. J Acquir Immune Defic Syndr. 2005 Jan 1;38(1):111-3. The incidence of herpes zoster is less likely than other opportunistic infections to be reduced by highly active antiretroviral therapy. Vanhems P, Voisin L, Gayet-Ageron A, Trepo C, Cotte L, Peyramond D, Chidiac C, Touraine JL, Livrozet JM, Fabry J, Voirin N. PMID: 15608535 [PubMed - indexed for MEDLINE] 1199. Arch Neurol. 2004 Dec;61(12):1974-7. The neurology of varicella-zoster virus: a historical perspective. Nogueira RG, Traynor BJ. Department of Neurology, Massachusetts General Hospital, Blake 1291, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA. rnogueira@partners.org Erratum in: Arch Neurol. 2005 Apr;62(4):687. Traynor, Bryan [corrected to Traynor, Bryan J]. PMID: 15596626 [PubMed - indexed for MEDLINE] 1200. Clin Dermatol. 2004 Nov-Dec;22(6):487-98. Cutaneous markers of HIV infection. Rigopoulos D, Paparizos V, Katsambas A. Department of Dermatology, University of Athens, A. Sygros Hospital, Athens, Greece. Despite the development of laboratory methods, dermatological symptoms are a basic index of the presence and physical course of HIV infection. HIV infection usually undergoes a long latent period, proceeds to a period of immunodeficiency-related symptoms, and ends in an advanced immunodeficiency state characterized by opportunistic infections and neoplasms. Occasionally, dermatological manifestations can be the first signs of asymptomatic disease, indices of advanced immunodeficiency, or symptoms of opportunistic infections or neoplasms. The variety of symptoms and signs for the skin during the course of HIV infection is a consequence of the progressing immunodeficiency and therefore indicates the underlying disorder. The use of these manifestations is a challenge for clinical praxis. PMID: 15596320 [PubMed - indexed for MEDLINE] 1201. Joint Bone Spine. 2004 Nov;71(6):588-91. Herpes zoster sciatica with paresis preceding the skin lesions. Three case-reports. Wendling D, Langlois S, Lohse A, Toussirot E, Michel F. Rheumatology Department, Jean Minjoz Teaching Hospital, Boulevard Fleming, 25030 Besançon, France. daniel.wendling@ufc-chu.univ-fcomte.fr We report three cases of herpes zoster sciatica with motor loss preceding the typical skin lesions. Serological tests and cerebrospinal fluid examination established the diagnosis. Two patients had residual motor loss after 1 and 3 months, respectively. Immunodepression and other risk factors should be looked for routinely. Early diagnosis and treatment may improve the prognosis. Tests for antibodies or viral DNA in cerebrospinal fluid can be helpful, although negative results do not rule out the diagnosis. PMID: 15589447 [PubMed - indexed for MEDLINE] 1202. J Pain Symptom Manage. 2004 Dec;28(6):535-6. Oxcarbazepine (Trileptal) monotherapy dramatically improves quality of life in two patients with postherpetic neuralgia refractory to carbamazepine and gabapentin. Criscuolo S, Auletta C, Lippi S, Brogi F, Brogi A. PMID: 15589078 [PubMed - indexed for MEDLINE] 1203. Drug Saf. 2004;27(15):1217-33. Tolerability of treatments for postherpetic neuralgia. Douglas MW, Johnson RW, Cunningham AL. Centre for Virus Research, Westmead Millennium Institute, Westmead Hospital and University of Sydney, Westmead, Australia. Comment in: Drug Saf. 2005;28(8):741; author reply 742. Herpes zoster occurs in up to 20% of people infected with varicella-zoster virus, due to reactivation of the virus from latently infected sensory ganglia. Although pain is a typical feature of acute zoster, pain persisting for more than a month after resolution of the rash is less common and is termed postherpetic neuralgia (PHN). The pain associated with PHN is neuropathic in origin and is notoriously difficult to treat. The incidence of herpes zoster and its associated complications both increase with age, so PHN should be seen more commonly in an aging population. Vaccination with live, attenuated varicella vaccine is safe and efficacious, particularly in children. It decreases the incidence of acute varicella and subsequent herpes zoster. Aciclovir is well tolerated, with renal toxicity only at high intravenous doses. Treatment of acute varicella with aciclovir attenuates acute illness but does not prevent herpes zoster. Treatment of herpes zoster with aciclovir or its derivatives minimises symptoms and may reduce the rate of PHN. Foscarnet is an alternative for an aciclovir-resistant virus but its use is limited by renal and CNS toxicity. Corticosteroids reduce acute pain in herpes zoster but do not affect the incidence of PHN. Their use in some patients may be limited by adverse effects such as gastritis and impaired glucose tolerance. Treatment of established PHN is difficult and may require a holistic approach. Tricyclic antidepressants and gabapentin are the systemic agents with the most proven benefit, although opioids such as oxycodone and NMDA receptor antagonists such as ketamine may be useful in some people. Adverse effects from tricyclic antidepressants are common but usually mild, while gabapentin is generally well tolerated. Although effective, the relatively common adverse effects of opioids and ketamine limit their usefulness in treating PHN. Topical treatment with 5% lidocaine patch or capsaicin is of benefit in some patients and is generally well tolerated. Intrathecal methyl prednisolone may be considered for intractable pain but efficacy and safety have not been confirmed. PMID: 15588117 [PubMed - indexed for MEDLINE] 1204. J Clin Microbiol. 2004 Dec;42(12):5698-704. Varicella seroprevalence and molecular epidemiology of varicella-zoster virus in Argentina, 2002. Dayan GH, Panero MS, Debbag R, Urquiza A, Molina M, Prieto S, Del Carmen Perego M, Scagliotti G, Galimberti D, Carroli G, Wolff C, Schmid DS, Loparev V, Guris D, Seward J. Epidemiology and Surveillance Division, National Immunization Program, Centers for Disease Control and Prevention, MS E-61, 1600 Clifton Rd., Atlanta, GA 30333, USA. gdayan@cdc.gov There is limited data on immunity against varicella-zoster virus (VZV) in adults in different parts of Argentina, and it is not known which VZV strains are circulating in Argentina. The objectives of this study were as follows: (i) to evaluate seroprevalence of varicella among adults, assessing the accuracy of clinical history and determining the sociodemographic factors associated with seropositivity; and (ii) to determine the VZV strains circulating in Argentina. A cross-sectional serological survey enrolling 2,807 women aged 15 to 49 years attending public health-care settings in four cities in Argentina (i.e., Buenos Aires, Salta, Mendoza, and Rosario) and one rural area was conducted from August to November 2002. Specimens for identification of VZV strains were obtained from vesicular lesions from 13 pediatric patients with varicella from different areas of the country. PCR amplification was used for genotyping. The overall seroprevalence of varicella antibodies was 98.5% (95% confidence interval, 98.0 to 98.9), ranging from 97.2% in central Buenos Aires to 99.3% in southern Buenos Aires and Salta. Varicella seroprevalence increased with age. Crowding and length of residence in the same place were associated with seropositivity. The positive predictive value of varicella history for immunity to varicella was 99.4%; however, the negative predictive value was 2.5%. The European genotype was identified in all viral specimens. In Argentina, seroprevalence in women more than 15 years old was high regardless of the area of residence. Negative or uncertain varicella history was not a good predictor of immunity. VZV genotype was stable in all areas of the country. PMCID: PMC535276 PMID: 15583301 [PubMed - indexed for MEDLINE] 1205. J Clin Microbiol. 2004 Dec;42(12):5604-8. Genetic profile of an Oka varicella vaccine virus variant isolated from an infant with zoster. Sauerbrei A, Rubtcova E, Wutzler P, Schmid DS, Loparev VN. Institute of Virology and Antiviral Therapy, Friedrich-Schiller University, Jena, Germany. Comment in: J Clin Microbiol. 2005 Oct;43(10):5415-6; author reply 5416-7. Varicella virus vaccine strain Oka (V-Oka) has in rare cases caused zoster in vaccinated people. Despite broad usage of V-Oka, little is known about varicella-zoster virus genomic sequence variation of strains in vaccine and isolates from patients with vaccine adverse events. Direct sequencing of 20 regions of V-Oka-GSK was compared to the sequences of the original V-Oka-Biken, GlaxoSmithKline Oka vaccine (V-Oka-GSK), and Oka-parental (P-Oka) strains. We analyzed single nucleotide polymorphisms (SNP) differentiating the Oka parental and Oka vaccine strains identified in open reading frames (ORFs) 6, 9A, 10, 21, 31, 39, 50, 51, 52, 54, 55, and 59 and eight base substitutions within ORF 62. Sixteen of these SNP impose an amino acid change in the corresponding gene product. The genotypic analysis revealed that (i) both V-Oka-GSK and V-Oka-Biken comprise mixtures of strains represented in variable proportion from lot to lot; (ii) V-Oka-GSK/zoster isolated from the zoster patient had six wild-type SNP in ORF 9A, 10, 21, 52, 55, and 62 (mutation 108838); (iii) none of the six revertant SNP would reliably discriminate Oka vaccine from the wild type; and (iv) the genomic variation found in V-Oka/zoster might be associated with changes in the biological behavior of the virus. Further studies will be needed to identify potential virulence factors in variant vaccine strains. PMCID: PMC535228 PMID: 15583288 [PubMed - indexed for MEDLINE] 1206. MMWR Recomm Rep. 2004 Dec 3;53(RR-14):1-92. Treating opportunistic infections among HIV-exposed and infected children: recommendations from CDC, the National Institutes of Health, and the Infectious Diseases Society of America. Mofenson LM, Oleske J, Serchuck L, Van Dyke R, Wilfert C; CDC; National Institutes of Health; Infectious Diseases Society of America. Pediatric, Adolescent and Maternal AIDS Branch, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland 20852, USA. Erratum in: MMWR Morb Mortal Wkly Rep. 2006 Aug 4;55(30):824. Dosage error in article text. In 2001, CDC, the National Institutes of Health, and the Infectious Diseases Society of America convened a working group to develop guidelines for therapy of human immunodeficiency virus (HIV)-associated opportunistic infections to serve as a companion to the Guidelines for Prevention of Opportunistic Infections Among HIV-Infected Persons. In recognition of unique considerations related to HIV infection among infants, children, and adolescents, a separate pediatric working group was established. Because HIV-infected women coinfected with opportunistic pathogens might be more likely to transmit these infections to their infants than women without HIV infection, guidelines for treating opportunistic pathogens among children should consider treatment of congentially acquired infections among both HIV-exposed but uninfected children and those with HIV infection. In addition, the natural history of opportunistic infections among HIV-infected children might differ from that among adults. Compared with opportunistic infections among HIV-infected adults, which are often caused by reactivation of pathogens acquired before HIV infection when host immunity was intact, opportunistic infections among children often reflect primary acquisition of the pathogen and, among children with perinatal HIV infection, infection acquired after HIV infection has been established and begun to compromise an already immature immune system. Laboratory diagnosis of opportunistic infections can be more difficult with children. Finally, treatment recommendations should consider differences between adults and children in terms of drug pharmacokinetics, dosing, formulations, administration, and toxicities. This report focuses on treatment of opportunistic infections that are common in HIV-exposed and infected infants, children, and adolescents in the United States. PMID: 15577752 [PubMed - indexed for MEDLINE] 1207. J Acquir Immune Defic Syndr. 2004 Dec 15;37(5):1604-9. Herpes zoster in women with and at risk for HIV: data from the Women's Interagency HIV Study. Glesby MJ, Hoover DR, Tan T, Shi Q, Gao W, French AL, Maurer T, Young M, Dehovitz J, Ru J, Anastos K. Division of International Medicine and Infectious Diseases, Department of Medicine, Weill Medical College of Cornell University, New York, NY 10021, USA. mag2005@med.cornell.edu BACKGROUND: Herpes zoster occurs at all CD4 cell counts in HIV-infected adults. It was hypothesized that even in the era of highly active antiretroviral therapy (HAART), zoster risk is higher in HIV-infected than uninfected women. METHODS: Generalized estimating equations modeled self-reported occurrence of zoster between semiannual visits among 1832 HIV-infected and 489 HIV-uninfected women in the Women's Interagency HIV Study followed for up to 7.5 years. RESULTS: A total of 337 (18.4%) HIV-infected and 7 (1.4%) HIV-uninfected women reported zoster at some time during follow-up. Using HIV-infected women with CD4 >750 cells/microL as the reference category, the odds ratios for reporting zoster since the prior visit were: 1.43 (95% CI 0.86-2.37) for CD4 500-749 cells/microL, 2.07 (95% CI 1.27-3.38) for CD4 350-499 cells/microL, 2.72 (95% CI 1.66-4.46) for CD4 200-349 cells/microL, and 3.16 (95% CI 1.92-5.18) for CD4 <200 cells/microL, compared with 0.11 (95% CI 0.046-0.26) for HIV-uninfected women. In multivariate analyses using visits from all HIV-infected women and only those who initiated HAART, lower CD4 cell count was more strongly associated with zoster incidence than were other clinical indicators. CONCLUSIONS: Herpes zoster is associated with degree of immunosuppression in HIV-infected women, but even women with high CD4 counts are at greater risk of zoster than HIV-uninfected women. PMID: 15577417 [PubMed - indexed for MEDLINE] 1208. Expert Opin Emerg Drugs. 2004 Nov;9(2):237-56. Emerging therapies for herpes viral infections (types 1 - 8). Chakrabarty A, Pang KR, Wu JJ, Narvaez J, Rauser M, Huang DB, Beutner KR, Tyring SK. Solano Clinical Research, Davis, California, USA. There are eight members of the herpesviridae family: herpes simplex virus-1 (HSV-1), HSV-2, varicella-zoster virus, Epstein-Barr virus, cytomegalovirus, human herpes virus-6, human herpes virus-7 and human herpes virus-8. The diseases caused by viruses of the herpesviridae family are treated with and managed by systemic and topical antiviral therapies and immunomodulating drugs. Because these viruses establish a latent state in hosts, antiherpetic agents, such as nucleoside analogues, only control symptoms of disease or prevent outbreaks, and cannot cure the infections. There is a need for treatments that require less frequent dosing, can be taken even when lesions are more advanced than the first signs or symptoms, and can treat resistant strains of the viruses without the toxicities of existing therapies. Immunomodulating agents, such as resiquimod, can act on the viruses indirectly by inducing host production of cytokines, and can thereby reduce recurrences of herpes. The new helicase primase inhibitors, which are the first non-nucleoside antiviral compounds, are being investigated for treatment of HSV disease, including infections resistant to existing therapy. PMID: 15571482 [PubMed - indexed for MEDLINE] 1209. AJNR Am J Neuroradiol. 2004 Nov-Dec;25(10):1722-9. CNS MR and CT findings associated with a clinical presentation of herpetic acute retinal necrosis and herpetic retrobulbar optic neuritis: five HIV-infected and one non-infected patients. Bert RJ, Samawareerwa R, Melhem ER. Boston Medical Center, Jamaica Plain, MA, USA. INTRODUCTION: This report demonstrates the spectrum of central nervous system (CNS) abnormalities observed on MR imaging and CT studies in 6 patients with clinical or pathologic diagnoses of acute retinal necrosis (ARN) and retrobulbar optic neuritis (RBON-H) resulting from Herpes Zoster Virus and Cytomegalovirus. We discuss the etiologic and pathophysiologic implications regarding these findings. METHODS: Standard MR imaging sequences of the whole brain and selected high-resolution images of the orbits and globes, from 6 patients, were reviewed by three neuroradiologists for consensus interpretation of the findings. Special sequences augmenting disease were obtained in individual cases. Axial CT images were obtained from two patients using 5mm sequential slices. RESULTS: MR imaging findings showed both T2 signal brightening and contrast enhancement in one or both optic nerves, optic tracts and lateral geniculate bodies, as well as the postsynaptic optic radiations and optic cortex. Similar findings were observed in the superior colliculus, lateral midbrain and cerebellum, with multiple potential etiologic possibilities regarding pathways of dissemination. Low T2* signal (indicating magnetic field susceptibility effects) and CT hyperdensity, consistent with prior hemorrhage, were also observed in the optic tracts, optic radiations and lateral geniculate bodies. Post-contrast enhancement was observed in the meninges and Meckle's cave in one HIV negative patient. CONCLUSION: These cases demonstrate CNS imaging findings associated with RBON that are temporally-related to ARN. They support the hypothesis that RBON can either precede or follow ARN and implicate transneuronal, transsynaptic and/or transcerebrospinal fluid viral spread by the herpetic family. PMID: 15569737 [PubMed - indexed for MEDLINE] 1210. Anesthesiology. 2004 Dec;101(6):1472-4. Sacral postherpetic neuralgia and successful treatment using a paramedial approach to the ganglion impar. McAllister RK, Carpentier BW, Malkuch G. Department of Anesthesiology, Scott and White Memorial Hospital and Clinic, Temple, Texas, USA. mcallister@swmail.sw.org Comment in: Anesthesiology. 2005 Jul;103(1):211-2. Anesthesiology. 2005 Jul;103(1):212; author reply 212-3. PMID: 15564959 [PubMed - indexed for MEDLINE] 1211. Curr Med Res Opin. 2004;20 Suppl 2:S21-8. Effectiveness of the lidocaine patch 5% on pain qualities in three chronic pain states: assessment with the Neuropathic Pain Scale. Argoff CE, Galer BS, Jensen MP, Oleka N, Gammaitoni AR. Cohn Pain Management Center, North Shore University Hospital/NYU School of Medicine, Bethpage, NY 11714, USA. pargoff@optonline.net OBJECTIVE: To determine the impact of the lidocaine patch 5% on pain qualities associated with chronic pain from postherpetic neuralgia (PHN), painful diabetic neuropathy (DN), and low-back pain (LBP), using the Neuropathic Pain Scale (NPS). PATIENTS AND METHODS: Patients with PHN, painful DN, and LBP were enrolled if they had partial response to gabapentin-containing analgesic regimens and if they reported moderate-to-severe pain on the NPS at study enrollment. Eligible patients were included in an open-label, non-randomized, prospective, 2-week study across 7 clinical trial sites in the United States. The lidocaine patch 5% was applied to the area of maximal pain, using no more than a total of 4 patches changed every 24 h. Patients were maintained on their other analgesic regimens with no dose adjustment or additions allowed. Treatment effect was measured by change from baseline to Week 2 in 4 composite measures of the NPS: NPS-10, NPS-4, NPS-8, and NPS-non-allodynia. Safety was assessed by adverse events (AEs), dermal assessment of application site(s), and skin sensory testing. RESULTS: In the combined patient population (n = 77), 2 weeks of treatment with the lidocaine patch 5% significantly improved all 4 composite measures (p < 0.01). In the subgroup analyses, the lidocaine patch 5% demonstrated numerical advantage for all 4 NPS composite measures for the PHN patients (n = 8), and significantly improved all 4 composite measures for the painful DN patients (n = 41; p < 0.001) and LBP patients (n = 28; p < or = 0.005). Overall, 8 patients (10%) experienced mild-to-moderate treatment-related AEs. CONCLUSIONS: The lidocaine patch 5% effectively reduces the intensity of all common pain qualities in patients with moderate-to-severe chronic pain resulting from PHN, painful DN, or LBP. Treatment is well tolerated in combination with other analgesic regimens, with no reports of serious AEs or adverse drug interactions. Assessment scales such as the NPS may offer the possibility to differentiate between various pain states and to assess treatment outcomes for various pain qualities associated with a given pain state. PMID: 15563743 [PubMed - indexed for MEDLINE] 1212. Am J Geriatr Pharmacother. 2004 Sep;2(3):157-62. Gabapentin: a pooled analysis of adverse events from three clinical trials in patients with postherpetic neuralgia. Parsons B, Tive L, Huang S. Pfizer Inc., New York, NY 10017-5755, USA. BACKGROUND: Gabapentin has been shown to be well tolerated and effective in the management of the pain associated with postherpetic neuralgia (PHN). It is assumed that adverse events occurring with gabapentin are dose related, their frequency and severity increasing with increasing doses. OBJECTIVE: The aim of this study was to assess the dose dependence of adverse events with gabapentin by determining the relationship between increasing doses of gabapentin and the onset and/or worsening of adverse events in patients with PHN. METHODS: Data were pooled from 3 randomized, double-blind, placebo-controlled, parallel-group studies of gabapentin that focused on or included patients with PHN. Gabapentin was initiated at 300 mg/d and titrated to maintenance doses of 1800 to 3600 mg/d by day 12 to 24. The analysis of adverse events was based on 3 distinct groups: patients who received gabapentin <1800 mg/d, those who received gabapentin >or=1800 mg/d, and those who received placebo. Patients who were given higher doses of gabapentin had already received lower doses. An adverse event was recorded at the dose of its first onset and recorded again if its severity worsened at a higher dose. RESULTS: This study included data from 603 patients with PHN: 358 patients (196 [54.7%] women, 162 [45.3%] men; mean [SD] age, 72.3 [10.3] years) received gabapentin, and 245 (133 [54.3%] women, 112 [45.7%] men; mean [SD] age, 73.3 [10.7] years) received placebo. The 3 most common adverse events were dizziness, somnolence, and peripheral edema. Patients receiving gabapentin >or=1800 mg/d had a higher incidence of peripheral edema (7.5%) than those receiving gabapentin <1800 mg/d (1.4%) or placebo (1.6%) (P<0.002, gabapentin >or=1800 mg/d vs placebo). In contrast, the incidence of dizziness and somnolence was not higher in patients receiving gabapentin >or=1800 mg/d compared with those in the other groups. Compared with placebo recipients, patients receiving gabapentin <1800 mg/d reported a significantly greater frequency of dizziness (20.2% gabapentin <1800 mg/d vs 7.4% placebo; P<0.002) and somnolence (14.9% vs 5.8%, respectively; P=0.005). However, at >or=1800 mg/d, rates of dizziness (9.7%) and somnolence (6.9%) were comparable to those with placebo. Discontinuation rates were comparable between patients receiving gabapentin and those receiving placebo. CONCLUSIONS: In this pooled analysis of adverse-event data from 3 clinical trials in patients with PHN, the incidence of peripheral edema was increased when gabapentin was titrated to >or=1800 mg/d. Dizziness and somnolence, the other most commonly occurring adverse events, were transient and did not occur more frequently or worsen with titration to >or=1800 mg/d. Based on these findings, it does not appear that safety concerns should limit titration of gabapentin to achieve optimal efficacy. PMID: 15561647 [PubMed - indexed for MEDLINE] 1213. Ann Thorac Surg. 2004 Dec;78(6):2159-61. Acute postoperative shingles after thoracic sympathectomy for hyperhidrosis. Massad MG, Navarro RA, Rubeiz H, Kpodonu J, Karol J, Blacha M, Evans A. Division of Cardiothoracic Surgery, Department of Surgery, The University of Illinois at Chicago, Chicago, Illinois 60612, USA. mmassad@uic.edu Shingles secondary to reactivation of a previous varicella-zoster virus infection has been reported to develop within surgical wounds and after trauma. We report the case of a 17-year-old girl with history of chicken pox in childhood who had acute postoperative shingles develop along the T3-T4 dermatomes after thoracic sympathectomy for hyperhidrosis. The possible causes and precipitating factors are discussed. PMID: 15561060 [PubMed - indexed for MEDLINE] 1214. J Immunol. 2004 Dec 1;173(11):6592-602. Plasmacytoid dendritic cell recruitment by immobilized CXCR3 ligands. Kohrgruber N, Gröger M, Meraner P, Kriehuber E, Petzelbauer P, Brandt S, Stingl G, Rot A, Maurer D. Division of Immunology, Allergy and Infectious Diseases, Department of Dermatology, Medical University of Vienna, Vienna, Austria. Plasmacytoid dendritic cells (pDCs) recognize microbes, viruses in particular, and provide unique means of innate defense against them. The mechanism of pDC tissue recruitment remained enigmatic because the ligands of CXCR3, the cardinal chemokine receptor on pDCs, have failed to induce in vitro chemotaxis of pDCs in the absence of additional chemokines. In this study, we demonstrate that CXCR3 is sufficient to induce pDC migration, however, by a migratory mechanism that amalgamates the features of haptotaxis and chemorepulsion. To mediate "haptorepulsion" of pDCs, CXCR3 requires the encounter of its cognate ligands immobilized, optimally by heparan sulfate, in a form of a negative gradient. This is the first report of the absolute requirement of chemokine immobilization and presentation for its in vitro promigratory activity. The paradigmatic example of pDC haptorepulsion described here may represent a new pathophysiologically relevant migratory mechanism potentially used by other cells in response to other chemokines. PMID: 15557149 [PubMed - indexed for MEDLINE] 1215. Clin Evid. 2003 Dec;(10):942-52. Postherpetic neuralgia. Wareham D. Queen Mary University of London & Barts & The London NHS Trust, London, UK. Update in: Clin Evid. 2004 Dec;(12):1182-93. Update of: Clin Evid. 2003 Jun;(9):890-900. PMID: 15555130 [PubMed - indexed for MEDLINE] 1216. Clin Evid. 2003 Dec;(10):809-30. HIV: prevention of opportunistic infections. Ioannidis J, Wilkinson D. Department of Hygiene and Epidemiology University of Ioannina School of Medicine, Ioannina, Greece. Update in: Clin Evid. 2005 Jun;(13):834-53. Update of: Clin Evid. 2003 Jun;(9):795-816. PMID: 15555123 [PubMed - indexed for MEDLINE] 1217. Rinsho Ketsueki. 2004 Oct;45(10):1090-4. [Analysis of varicella zoster virus infection following allogeneic stem cell transplants] [Article in Japanese] Doki N, Hoshino T, Irisawa H, Sakura T, Miyawaki S. Division of Hematology, Saiseikai Maebashi Hospital. The purpose of this study was to evaluate patients who contracted the varicella zoster virus infection (VZV) following their allogeneic stem cell transplants. We retrospectively reviewed the incidence and the timing of varicella zoster virus (VZV) infections, including the clinical course, complications, and associated clinical risk factors. Between January 1998 and April 2003, a total of 71 patients received allogeneic stem cell transplants in our hospital. For prophylaxis of the herpes virus infection, all patients were given a daily oral 1000 mg dose of acyclovir from day -7 to day +35. Among the 71 patients, 28 of them (39.4%) developed VZV infection between day 77 and day 980 (median 182 days) following their allogeneic stem cell transplants. In 21 of these infected patients (75%) the occurrence was within the first 300 days after the transplant. Twenty-two patients (78.5%) were under treatment with immunosuppressive agents. Twenty-six patients developed only one episode of the VZV infection after their transplants, but two other patients developed two episodes. Twenty one patients (75%) stricken with the VZV infections had cutaneous reactivation infections of a single dermatome, and in one patient two dermatomes were affected. Five patients (17.8%) developed disseminated cutaneous zoster, and one patient (3.6%) developed a visceral infection. Treatment with acyclovir (oral or drip infusion) was successful in 25 patients. Two patients improved with vidarabine treatment, however the patient with the visceral infection died despite the use of acyclovir. The incidence of visceral infection was low, but the one case was fatal. PMID: 15553042 [PubMed - indexed for MEDLINE] 1218. Skin Therapy Lett. 2004 Oct;9(8):1-4. Treatment of postherpetic neuralgia. Sra KK, Tyring SK. University of Texas, Health Sciences Center, Houston, Texas, USA. Postherpetic neuralgia (PHN) is a serious complication of herpes zoster that has a predilection for older individuals. PHN is often associated with significant morbidity, and it can cause insomnia, fatigue, depression and interference with daily activities in affected individuals. Treatment for PHN is initiated with antivirals during the acute herpes zoster outbreak. Acyclovir (Zoviraxr, GlaxoSmithKline), valacyclovir (Valtrex, GlaxoSmithKline) or famciclovir (Famvir, Novartis) can be used to treat herpes zoster, and all three have been shown to reduce the duration of the herpetic rash and zoster-associated pain. These antivirals are most effective when used within the first 72 hours of the onset of the rash. Side-effects of these antivirals are low and include nausea, vomiting, abdominal pain and headache. Other treatment options for PHN include topical analgesics, opioid analgesics, tricyclic antidepressants and gabapentin. Because of the complexity of PHN, most patients require a combination of treatment modalities for adequate pain relief. PMID: 15550990 [PubMed - indexed for MEDLINE] 1219. Biochem Pharmacol. 2004 Dec 15;68(12):2301-15. Discovery and development of BVDU (brivudin) as a therapeutic for the treatment of herpes zoster. De Clercq E. Department of Microbiology and Immunology, Rega Institute for Medical Research, Katholieke Universiteit Leuven, Minderbroedersstraat B-3000 Leuven, Belgium. erik.declercq@rega.kuleuven.ac.be This Commentary is dedicated to the memory of Dr. Jacques Gielen, the late Editor of Biochemical Pharmacology, whom I have known as both an author and reviewer for the Journal for about 25 years. This is, quite incidentally, about the time it took for bringing brivudin (BVDU) [(E)-5-(2-bromovinyl)-2'-deoxyuridine] from its original description as an antiviral agent to the market place (in a number of European countries, including Germany and Italy) for the treatment of herpes zoster in immunocompetent persons. BVDU is exquisitely active and selective against varicella-zoster virus (VZV) and herpes simplex virus type 1 (HSV-1). BVDU owes this high selectivity and activity profile to a specific phosphorylation by the virus-encoded thymidine kinase, followed by a potent interaction with the viral DNA polymerase. The (E)-5-(2-bromovinyl)-substituent can be considered as the hallmark for the activity of BVDU against VZV and HSV-1. Extensive clinical studies have indicated that BVDU as a single (oral) daily dose of 125 mg (for no more than 7 days) is effective in the treatment of herpes zoster, as regards both short-term (suppression of new lesion formation) and long-term effects (prevention of post-herpetic neuralgia). In this sense, BVDU is as efficient and/or convenient, if not more so, than the other drugs (acyclovir, valaciclovir, famciclovir) that have been licensed for the treatment of herpes zoster. There is one caveat; however, BVDU should not be given to patients under 5-fluorouracil therapy, as the degradation product of BVDU, namely (E)-5-(2-bromovinyl)uracil (BVU), may potentiate the toxicity of 5-fluorouracil, due to inhibition of dihydropyrimidine dehydrogenase, the enzyme involved in the catabolism of 5-fluorouracil. PMID: 15548377 [PubMed - indexed for MEDLINE] 1220. Vaccine. 2004 Dec 21;23(6):755-61. The burden and cost of hospitalised varicella and zoster in Australian children. Carapetis JR, Russell DM, Curtis N. Department of Paediatrics, Murdoch Children's Research Institute, Royal Children's Hospital, University of Melbourne, Melbourne, Australia. jonathan.carapetis@rch.org.au BACKGROUND: Economic analyses of varicella-zoster virus (VZV) immunisation are sensitive to the costs of hospitalised cases, so there is a need to validate VZV hospitalisation data. AIMS: To assess the accuracy of hospital VZV coding data and to apply these parameters to a population-based sample to estimate incidence and costs. METHODS: A 3-year retrospective chart review from one hospital to document clinical features and validate coding data. A separate 9-year analysis of discharge data from two hospitals draining a defined region of suburban Melbourne, with adjustment for miscoding and estimates of direct hospital costs. RESULTS: After correction for miscoding, 224 patients were admitted to one hospital over 3 years, 79% with varicella and 21% with zoster. Miscoding resulted in a 15% underestimate of zoster cases and a 4% overestimate of varicella cases. Thirty-six percent of varicella admissions compared to 80% of zoster admissions were immunocompromised and/or had chronic disease. Compared to otherwise-healthy patients, immunocompromised patients were admitted earlier in their illness and had lower complication rates. Forty-two percent of immunocompromised/chronic disease patients with varicella had a known exposure, usually from a family member. The incidence of hospitalised varicella and zoster in under 15-year olds was 15.7 and 1.8 per 100,000 per year, respectively. This suggests that there are 615 varicella hospitalisations and 72 zoster hospitalisations in this age group each year in Australia, at a total direct cost of over 2.2 million AU dollars. CONCLUSION: These results highlight the considerable burden of hospitalised zoster and the importance of immunising non-immune contacts of immunocompromised individuals. They also support previous estimates of the incidence of hospitalised varicella in Australian children and adolescents, although direct medical costs may be higher than those previously estimated. PMID: 15542199 [PubMed - indexed for MEDLINE] 1221. MMW Fortschr Med. 2004 Jul 22;146(29-30):60. [Appearance diagnosis. Facial shingles] [Article in German] Mehling P. Allgemeinmedizin, Höchberg. PMID: 15540566 [PubMed - indexed for MEDLINE] 1222. Postgrad Med J. 2004 Nov;80(949):679, 681. Shortness of breath. Dawson JS, Hetherington CJ. Division of Anaesthesia and Intensive Care, Queen's Medical Centre, University Hospital NHS Trust, Nottingham NG7 2UH, UK. james@dawson.me.uk PMCID: PMC1743130 PMID: 15537859 [PubMed - indexed for MEDLINE] 1223. Agri. 2004 Oct;16(4):64. Comment on: Isin Unal Cevik: Postherpetic neuralgia. Agri 2004; 16(3): 17-24. [Article in English, Turkish] Cimen A. Comment on: Agri. 2004 Jul;16(3):17-24. PMID: 15536576 [PubMed - indexed for MEDLINE] 1224. Antivir Chem Chemother. 2004 Sep;15(5):251-3. Recent clinical experience with famciclovir--a "third generation" nucleoside prodrug. Chakrabarty A, Tyring SK, Beutner K, Rauser M. Solano Research, Davis, Calif, USA. chakak3@yahoo.com The herpesviruses continue to produce considerable morbidity in man. Once infected with herpes simplex (HSV), the virus remains dormant within the nervous system and may reactivate if provoked by stress, trauma and/or other factors. To date, there is no cure, but antiviral medication can reduce duration and severity of symptoms and prophylaxis can suppress recurrent episodes of disease. The second-generation guanosine nucleosides, acyclovir and penciclovir, are effective inhibitors with low toxicity; both, however, have relatively low oral bioavailability. Subsequently, the orally bioavailable prodrugs valaciclovir and famciclovir have been introduced. These compounds offer high oral bioavailabilty and deliver acyclovir and penciclovir, respectively, to the target cells by means of more convenient dosing schedules. This short review points to recent experience with famciclovir in the management of HSV and varicella-zoster virus. PMID: 15535046 [PubMed - indexed for MEDLINE] 1225. Cranio. 2004 Oct;22(4):304-13. Craniofacial neural disorders: a guide for diagnosis and management. Kilpatrick SR. 2909 S. 74th Street Fort Smith, AR 72903, USA. srkaacp@swbell.net The purpose of this article is to provide a succinct diagnosis and management regimen for neural disorders of the craniofacial region. This guide is an attempt to organize available data in a format for use by the craniofacial pain practitioner. The management regimens are brief because the management of many of these disorders may be outside the scope of dentistry. Also, the purpose of this guide is to be user-friendly and complete. Terminology is based on a literature review so individual disorders may be researched more completely. PMID: 15532315 [PubMed - indexed for MEDLINE] 1226. Dermatol Online J. 2004 Oct 15;10(2):20. Facial cellulitis associated with Pseudomonas aeruginosa complicating ophthalmic herpes zoster. Atzori L, Ferreli C, Zucca M, Fanni D, Aste N. Clinica Dermatologica, Universita di Cagliari, Italy. lauratzori@tin.it Cellulitis is a rare and severe soft-tissue infection characterized by acute, diffuse, spreading inflammation, often associated with systemic symptoms such as malaise and fever. Surgery of the head and neck, dental infections, sinusitis, upper respiratory tract infections, and trauma are the most common portal of entry for pathogens in facial cellulitis. A very unusual case complicating an ophthalmic herpes zoster in a 74-year-old woman was observed at the department of dermatology, Cagliari University (Italy). Culture of skin swabs showed growth of numerous Gram-negative bacilli, further identified as Pseudomonas aeruginosa. Therapy with intravenous ciprofloxacin was promptly instituted on the basis of the culture and sensitivity report. She was initially treated with daily drainage and twice-daily topical fusidic acid. The lesion completely resolved in 4 weeks, and no general complications or recurrence have been observed for 6 months. Early recognition and management of facial cellulitis is mandatory to avoid serious and generalized complications. Pseudomonas aeruginosa is rarely reported in facial cellulitis; there are apparently no reports of this infection occurring as a complication of ophthalmic herpes zoster. Herpetic damage of the anatomic barrier as well as impairment of defense mechanisms because of decompensated diabetes mellitus may have facilitated the colonization and proliferation of this opportunistic pathogen in our patient. PMID: 15530310 [PubMed - indexed for MEDLINE] 1227. MMW Fortschr Med. 2004 Jul 8;146(27-28):4-5. [Not only diabetics have experienced the pain... distressing neuralgia] [Article in German] Wepner U. PMID: 15526649 [PubMed - indexed for MEDLINE] 1228. Curr Opin Ophthalmol. 2004 Dec;15(6):531-6. Herpes zoster virus infection. Liesegang TJ. Mayo Clinic Medical School, Jacksonville, Florida, USA. tliesegang@mayo.edu PURPOSE OF REVIEW: The virology, pathophysiology, and treatment of the varicella zoster virus (VZV) have been investigated for many years now. Infection with VZV has different ramifications for people of different ages and immune status. The various aspects of VZV disease make it difficult to treat. Selected aspects of VZV disease that pertain to ocular disease are presented. RECENT FINDINGS: The risk factors for VZV disease in the different age spectrums and with concomitant immunodeficiencies have been further clarified. Studies suggest that the VZV may persist for prolonged periods on the cornea after herpes zoster ophthalmicus (HZO). Herpes Simplex Virus (HSV) or VZV may cause many cases of idiopathic uveitis with sectoral iris atrophy. The different patterns of retinal disease caused by VZV may relate to the immune status. Systemic antiviral medications for herpes zoster should be instituted within 72 hours of the rash but could be used later. Systemic antivirals combined with systemic corticosteroids improve the early quality of life in HZ patients. Postherpetic neuralgia is not prevented by early systemic antivirals or corticosteroids. Present systemic antivirals are all effective, but Famvir offers the best dosing schedule. The VZV vaccine is effective but there are some issues that suggest the need for a different vaccination regimen. SUMMARY: Further research must be performed on the clinical and therapeutic aspects of the VZV disease. Although both the vaccine and systemic antivirals have brought tremendous improvements, the disease persists. Therapy lessens but does not eliminate many of the complications. The disease may manifest in unpredictable patterns in this era of vaccination. PMID: 15523199 [PubMed - indexed for MEDLINE] 1229. Clin Microbiol Infect. 2004 Nov;10(11):954-60. Effects of varicella vaccination on herpes zoster incidence. Wagenpfeil S, Neiss A, Wutzler P. Institute for Medical Statistics and Epidemiology, Technical University of Munich, Munich, Germany. Stefan.Wagenpfeil@imse.med.tu-muenchen.de The effects of a general varicella vaccination programme on the incidence of herpes zoster are of major public health importance. This review focuses on two key aspects, namely the relationship between wild-type virus spread and the incidence of herpes zoster, as obtained from recent surveys, surveillance and observational studies, and the results from mathematical population models. Although knowledge is limited, close contact with varicella cases seems to have a protective effect. Thus, an increase in zoster incidence after varicella immunisation is possible, but the extent is unknown because of the influence of other factors independent of immunisation. Currently, vaccination effects estimated from mathematical modelling depend strongly on pre-specified assumptions. In order to obtain more precise predictions, the results of ongoing monitoring and clinical studies are awaited and further studies are suggested. Vaccination recommendations can be adapted at any time to take account of further findings in this area. PMID: 15521996 [PubMed - indexed for MEDLINE] 1230. Acta Otorhinolaryngol Belg. 2004;58(1):61-6. Varicella zoster virus: beyond facial paralysis. Van de Steene V, Kuhweide R, Vlaminck S, Casselman J. Department of ENT, Head and Neck Surgery, AZ St-Jan Hospital, Bruges, Belgium. J. Ramsay Hunt's hypothesis that herpes zoster oticus results from a reactivation of the herpes zoster virus in the geniculate ganglion, has been supported by the demonstration of varicella zoster viral DNA in the geniculate ganglion of the side with facial paralysis in patients with Ramsay Hunt syndrome, with the use of the polymerase chain reaction. Similarly, DNA of the varicella zoster virus has been identified in the spiral and vestibular ganglion as well. We report on three patients with cochleovestibular symptoms as the first manifestations of Ramsay Hunt syndrome. A 64-year old woman and a 72-year old man presented with vertigo and an auricular herpetiform eruption. Only the woman developed later on a mild facial paralysis. A 58-year old man presented with an acute cochleovestibular syndrome, serologically proven to be a varicella zoster viral reactivation, which was followed three weeks later by the typical cutaneous recrudescence. We believe that these cases result from reactivation of latent varicella zoster virus in the spiral and/or vestibular ganglion. As the varicella zoster virus is dormant in the non-neuronal satellite cells, the facial symptoms in our patients as well as the high incidence of cochleovestibular symptoms in classical Ramsay Hunt syndrome can be explained by viral transmission across the nerves inside the internal auditory canal. Therefore, we think there are grounds to recommend a prompt treatment with an antiviral and a corticosteroid agent, not only in case of an acute facial paralysis but also when confronted with an acute cochleovestibular syndrome. PMID: 15517838 [PubMed - indexed for MEDLINE] 1231. J Rheumatol. 2004 Nov;31(11):2151-5. Association of reduced CD4 T cell responses specific to varicella zoster virus with high incidence of herpes zoster in patients with systemic lupus erythematosus. Park HB, Kim KC, Park JH, Kang TY, Lee HS, Kim TH, Jun JB, Bae SC, Yoo DH, Craft J, Jung S. Department of Internal Medicine, The Hospital for Rheumatic Diseases, Hanyang University College of Medicine, Seoul, Korea. OBJECTIVE: To examine whether the high incidence of herpes zoster in patients with systemic lupus erythematosus (SLE) is associated with the frequency of memory T cells specific to varicella zoster virus (VZV). METHODS: Whole blood samples from 47 subjects [24 patients with SLE, 11 with rheumatoid arthritis (RA) as a disease control, and 12 healthy negative controls] were stimulated with VZV antigen, stained for surface CD4 and CD8 and intracellularly stained for the cytokines interferon-gamma (IFN-gamma), tumor necrosis factor-alpha (TNF-alpha), interleukin 4 (IL-4), and IL-10, followed by flow cytometry analyses. Correlations of VZV-specific T cell frequencies with the clinical status of patients were analyzed. RESULTS: Percentage of IFN-gamma-positive CD4 T cells was significantly lower in patients with SLE (0.043 +/- 0.009%) than in RA (0.102 +/- 0.019%) and healthy controls (0.126 +/- 0.025%) upon VZV stimulation. A similar pattern was seen in TNF-alpha-positive CD4 T cell responses. These low frequencies of VZV-specific CD4 T cells in patients with SLE were significantly related with disease activity (r = -0.435, p = 0.043). CONCLUSION: These data suggest that the high incidence of herpes zoster in patients with SLE was related to the intrinsic defects in controlling VZV reactivation, and thus VZV-specific CD4 T cell frequency could be another practical risk factor of herpes zoster in patients with SLE. PMID: 15517626 [PubMed - indexed for MEDLINE] 1232. Rinsho Ketsueki. 2004 Sep;45(9):1053-7. [Fatal acute visceral disseminated varicella-zoster virus infection in a patient with chronic graft-versus-host disease] [Article in Japanese] Yamazaki E, Kamijoh A, Taguchi J, Hyoh R, Motomura S, Kodama F, Kobayashi S, Maruta A, Nagao T, Ishigatsubo Y. Division of Hematology, Kanagawa Cancer Center. A 34-year-old woman was admitted for chronic graft-versus-host disease ten months after an unrelated bone marrow transplantation. Cytomegalovirus (CMV) antigenemia on day 5 of hospitalization was negative. Thrombocytopenia occurred on day 9. Laboratory findings revealed severe liver dysfunction on day 13. On day 14, the patient developed interstitial pneumonia and disseminated intravascular coagulation, and died from progressive respiratory failure. Multinucleated giant cells were found in the lung, liver, spleen, esophagus, pancreas and intestine obtained at autopsy. Varicella-zoster virus (VZV) was detected in the blood using the polymerase chain reaction (PCR) technique. CMV, herpes virus type 6 and Epstein-Barr virus were detected in the liver and lung with the PCR technique. We concluded visceral VZV infection was the main cause of her death because of her aggressive clinical course and the histology at autopsy. In this case, chronic GVHD and its immunosuppressive treatment resulted in her fatal VZV reactivation. PMID: 15510835 [PubMed - indexed for MEDLINE] 1233. East Afr Med J. 2004 May;81(5):226-9. Assessment of clinical case-definition for HIV/AIDS in Tanzania. Amirali W, Moshiro C, Ramaiya K. Medical Department, Shree Hindu Mandal Hospital, Dar es Salaam, Tanzania. OBJECTIVE: To evaluate the usefulness of World Health Organisation (WHO's) clinical case-definition (CCD) for AIDS in a private hospital. DESIGN: A prospective study. SETTING: Shree Hindu Mandal Hospital, Dar es Salaam, Tanzania. SUBJECTS: A total of 601 patients (> 14 years) were studied from January 1995 to December 1997. METHODS: Using HIV test results as a reference standard, sensitivity, specificity, positive predictive values (PPV) and negative predictive values of signs and symptoms were calculated. Multiple logistic regression was used to determine a set of predictive symptoms and signs. Stepwise logistic regression modelling was used to choose the final model. RESULTS: The frequently occurring signs and symptoms among the 473 sero-positive patients were fever (226), oral candidiasis (167), weight loss (161), chronic cough (157), diarrhoea (100) and pulmonary tuberculosis in 69 cases. The presence of anorectal lesions and the rarity of pneumocystis carinii pneumonia in this study are important findings. Seven clinical characteristics predicted HIV infection. These included pulmonary tuberculosis (p=0.009), lymphadenopathy (p=0.007), diarrhoea (p=0.000), chronic cough (p=0.001), dermatitis (p=0.003), herpes zoster (p=0.01) and oral candidiasis (p=0.000). CONCLUSIONS: A greater number of HIV positive patients presented with signs and symptoms different from those proposed by WHO's CCD were observed in this study. With environmental pathogens varying from one geographical region to another and new ones appearing, opportunistic disease cannot be constant in AIDS patients. Therefore, AIDS diagnosis based on clinical case definition alone without at least one positive HIV antibody test is inaccurate and no longer justified. PMID: 15508335 [PubMed - indexed for MEDLINE] 1234. Neurology. 2004 Oct 26;63(8):1538-9. MRI abnormalities in chronic active varicella zoster infection. Blumenthal DT, Salzman KL, Baringer JR, Forghani B, Gilden DH. Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA. deborah.blumenthal@hsc.utah.edu PMID: 15505191 [PubMed - indexed for MEDLINE] 1235. Emerg Med J. 2004 Nov;21(6):752-3. Acute urinary retention attributable to sacral herpes zoster. Acheson J, Mudd D. Department of Surgery, Antrim Area Hospital, 45 Bush Road, Antrim BT28 3QE, Northern Ireland. achesonjonny@hotmail.com Acute urinary retention in women is uncommon. A 63 year old woman presented with suprapubic pain, a palpable bladder, and multiple grouped vesicles on the right buttock. Catheterisation showed a residual of 2000 ml. A case is reported of acute urinary retention secondary to herpes zoster infection of the sacral nerves (S2-4). PMCID: PMC1726492 PMID: 15496718 [PubMed - indexed for MEDLINE] 1236. Johns Hopkins Med Lett Health After 50. 2004 Sep;17(7):8. I was diagnosed with shingles several months ago, and although the rash has healed, I continue to experience pain. How long can this pain persist, is it treatable, and is it possible I could have another outbreak of shingles? [No authors listed] PMID: 15495356 [PubMed - indexed for MEDLINE] 1237. Arch Dermatol. 2004 Oct;140(10):1268-72. Herpes zoster in the first year of life following postnatal exposure to varicella-zoster virus: four case reports and a review of infantile herpes zoster. Kurlan JG, Connelly BL, Lucky AW. Department of Dermatology, Wright State University, Dayton, Ohio, USA. BACKGROUND: Herpes zoster, a painful vesicular dermatomal eruption, is the result of reactivation of the varicella-zoster virus (VZV) from infected sensory ganglia. Traditionally, it is considered to be a disease of adults, in contrast to primary infection with VZV, which tends to occur mainly in children. OBSERVATIONS: We report 4 cases of infantile herpes zoster in healthy immunocompetent children, all of whom were exposed to primary varicella infection within the first few months of life. A review of 62 cases from the literature reveals that postnatally acquired herpes zoster is less common than intrauterine infection (31% [n = 19] vs 69% [n = 43]) and that there is a 1.5:1 male predominance. All dermatomes are equally affected. CONCLUSIONS: Although uncommon, herpes zoster can develop in immunocompetent children as young as a few weeks of age and should be considered in the differential diagnosis of vesicular eruptions in infants. Most frequently, it is the result of intrauterine VZV infection, but it can be secondary to postnatal exposure to VZV at an early age. PMID: 15492192 [PubMed - indexed for MEDLINE] 1238. MMW Fortschr Med. 2003 Oct 9;145 Suppl 3:71-6. [Controlled-release oxycodone--a therapeutic option for severe neuropathic pain. Two multicenter observational studies] [Article in German] Wörz R, Frank M, Achenbach U. Medizinische Abteilung Mundi- pharma GmbH, Limburg (Lahn). woerz.roland@t-online.de Two postmarketing studies (PMS) involving 603 patients with neuropathic pain treated with controlled-release oxycodone were performed. Pain intensity and impairment of performance were evaluated using a numeric rating scale (NRS) ranging from 0 to 10 (0 = no pain/impairment, 10 = most severe pain/impairment) measured at the start of the study, and at one week and some three weeks into the study. Mean pain intensity decreased from more than 6 at the start of the PMS to about 4 after one week, and under 3 after three weeks, of treatment. The mean dose of oxycodone after three weeks was slightly more than 40 mg per day. Impairment, quality of life and performance (daily activities, mood, sleep quality and joie de vivre) improved substantially. PMID: 15490770 [PubMed - indexed for MEDLINE] 1239. Int J Dermatol. 2004 Oct;43(10):779-80. Herpes zoster and pruritus. Ozdemir M, Tüzün Y. PMID: 15485542 [PubMed - indexed for MEDLINE] 1240. Med Clin (Barc). 2004 Sep 25;123(10):399. [Epilepticus status and valaciclovir in chronic renal failure] [Article in Spanish] Rodríguez Uranga JJ, Franco Macías E, Delgado López F, Villalobos Chávez F. PMID: 15482711 [PubMed - indexed for MEDLINE] 1241. Expert Rev Anti Infect Ther. 2003 Aug;1(2):283-95. Review of antiviral therapy for herpes labialis, genital herpes and herpes zoster. Moomaw MD, Cornea P, Rathbun RC, Wendel KA. Oklahoma University Health Science Center Department of Internal Medicine, Section Infectious Diseases, Oklahoma City, OK, USA. Acyclovir (Zovirax) was approved for the treatment of herpesvirus infections almost two decades ago. It was the first agent in a novel group of antiviral medications that now include valacyclovir (Valtrex), penciclovir (Denavir and famciclovir (Famvir). These agents have made a dramatic impact on the morbidity associated with herpes simplex virus infections and herpes zoster. Topical and oral antiviral use have shown modest but statistically significant efficacy in treating herpes labialis with most studies demonstrating a significant reduction in episode length and/or healing time. Oral acyclovir, valacyclovir and famciclovir are efficacious and safe for the treatment of the first episode and recurrent genital herpes and are useful as suppressive therapy for individuals with frequent genital herpes recurrences. In addition, high doses of oral acyclovir, valacyclovir and famciclovir have been shown to speed the healing of herpes zoster, and data suggests that these agents also decrease associated acute and chronic pain in people of 50 years of age or older. Further research is required to clarify the safety of these agents in pregnant women with genital herpes, the role of antiviral therapy in decreasing the sexual transmission of genital herpes, and the efficacy and cost-effectiveness of these agents in treating herpes zoster in people below the age of 50 years. PMID: 15482124 [PubMed - indexed for MEDLINE] 1242. Eur J Clin Microbiol Infect Dis. 2004 Nov;23(11):857-8. Epub 2004 Oct 8. Prevalence of herpes simplex virus, varicella zoster virus and cytomegalovirus in HIV-positive and HIV-negative patients with viral retinitis in India. Priya K, Mahalakshmi B, Malathi J, Biswas J, Sukumar B, Madhavan HN. Larsen and Toubro Microbiology Research Centre, Vision Research Foundation, Sankara Nethralaya, 600006 Chennai, India. PMID: 15480882 [PubMed - indexed for MEDLINE] 1243. CMAJ. 2004 Oct 12;171(8):859. Fever after aortic valve replacement in a 71-year-old man. Schattner A, Cohen J, Zimhony O. Addenbrookes Hospital, University of Cambridge, Cambridge, UK. PMCID: PMC522650 PMID: 15477623 [PubMed - indexed for MEDLINE] 1244. J Pain Symptom Manage. 2004 Oct;28(4):396-411. Treatment of postherpetic neuralgia: a review of therapeutic options. Argoff CE, Katz N, Backonja M. Cohn Pain Management Center, North Shore University Hospital, Cohn Pain Management Center, Bethpage, New York 11714, USA. Postherpetic neuralgia (PHN) is a disabling consequence of the reactivation of the varicella zoster infection. The observation that patients with PHN experience various types of pain suggests that multiple pathophysiologic mechanisms are involved, which may include the peripheral and central nervous systems. A reasonable initial strategy would involve selecting from among multiple agents that have complementary mechanisms of action and that have been proven effective in controlled clinical trials, such as the lidocaine patch 5%, gabapentin, tricyclic antidepressants, and opioids. Based on initial assessment and ongoing reassessment, sequential trials should be undertaken until adequate pain relief is achieved. This may ultimately lead to therapy with more than one medication. Safety and tolerability are important considerations in choosing initial therapy, particularly in older patients. Physicians can either add another agent to the current regimen or switch to a new type of monotherapy if there is inadequate response to initial therapy. Alternative therapies, (i.e., ketamine, intrathecal corticosteroid injections) have not been adequately studied. Well-designed, multicenter, controlled clinical trials are needed to develop a treatment algorithm that provides an evidence-based, rational approach to treating PHN. PMID: 15471658 [PubMed - indexed for MEDLINE] 1245. Dermatol Nurs. 2004 Aug;16(4):362. Herpes zoster. Barthel D, Crutchfield CE. Crutchfield Dermatology, Eagan, MN, USA. PMID: 15471051 [PubMed - indexed for MEDLINE] 1246. Brain Res Brain Res Rev. 2004 Oct;46(2):234-42. Allodynia in rats infected with varicella zoster virus--a small animal model for post-herpetic neuralgia. Dalziel RG, Bingham S, Sutton D, Grant D, Champion JM, Dennis SA, Quinn JP, Bountra C, Mark MA. Center for Infectious Disease, School of Veterinary Medicine, Division of Veterinary Biomedical Sciences, University of Edinburgh, Edinburgh EH9 1QH, UK. bd1@staffmail.ed.ac.uk The most common complication of herpes zoster is post-herpetic neuralgia (PHN), which has been defined as severe pain occurring 1 month after rash onset or persisting for greater than 3 months. PHN is classed as a neuropathic pain that is associated with mechanical allodynia where normally innocuous tactile stimuli are perceived as painful. The development of therapies to treat PHN has been hampered by the lack of animal models, which mimic the clinical situation. We have previously reported that varicella zoster virus (VZV) infection in the rat results in mechanical allodynia and thermal hyperalgesia. Here, we report that following VZV infection of the left footpad rats develop a chronic mechanical allodynia, which is present for longer than 60 days post-infection and which resolves by 100 days PI. The model is robust and reproducible with animals consistently developing allodynia by 3 days PI and continuing to present with symptoms for at least 30 days. The reproducible nature of the induction and course of the allodynia allows the use of this model to determine the effect of various compounds on, and to investigate the pathogenic mechanisms underlying the development of VZV-induced allodynia. Comparative studies using HSV-1 show that the induction of the chronic allodynia is VZV-specific and is not a result is of virus replication-induced tissue damage or accompanying inflammation. Therefore, we propose that the rat VZV infection model could prove useful in studying the mechanisms underlying post-herpetic neuralgia. PMID: 15464211 [PubMed - indexed for MEDLINE] 1247. Postgrad Med. 2004 Sep;116(3):16-8, 21-4, 31-2 passim. Three common neuralgias. How to manage trigeminal, occipital, and postherpetic pain. Ashkenazi A, Levin M. Jefferson Headache Center, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA. avi.ashkenazi@mail.tju.edu The pain experienced by patients with trigeminal, occipital, or postherpetic neuralgia is often severe, chronic, and difficult to treat. In this article, Drs Ashkenazi and Levin outline the pathologic mechanisms of pain in these common neuralgias and discuss individually tailored pharmacologic and surgical approaches to their treatment. PMID: 15460087 [PubMed - indexed for MEDLINE] 1248. Ann Otol Rhinol Laryngol. 2004 Sep;113(9):700-5. Varicella-zoster virus DNA level and facial paralysis in Ramsay Hunt syndrome. Furuta Y, Aizawa H, Ohtani F, Sawa H, Fukuda S. Department of Otolaryngology-Head and Neck Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan. We have investigated whether the copy number of varicella-zoster virus (VZV) in saliva correlates with the clinical symptoms in patients with Ramsay Hunt syndrome. A real-time quantitative polymerase chain reaction assay was used to examine the VZV DNA copy number in saliva samples from 37 patients. We detected VZV DNA in 6 of the 7 patients with oropharyngeal zoster lesions (86%) and in 17 of the 30 patients who had zoster lesions only on the skin (57%). Patients with oropharyngeal zoster lesions had a high VZV load in their saliva, and the difference between the copy number in patients with oropharyngeal zoster lesions and those without was around 10,000 copies per 50 microL. In addition, patients with oropharyngeal zoster lesions showed worse recovery of facial function than those without. It seems that the VZV DNA level in saliva reflects the kinetics of viral reactivation in the facial nerve, as well as in the oropharyngeal epithelium, in patients with Ramsay Hunt syndrome. PMID: 15453526 [PubMed - indexed for MEDLINE] 1249. Praxis (Bern 1994). 2004 Jul 28;93(31-32):1253-5. [A 59-year old patient with herpes zoster V1-V2] [Article in German] Hartsleben CH. Medizinische Universitätspoliklinik, Departement Innere Medizin, Kantonsspital, Basel. PMID: 15453148 [PubMed - indexed for MEDLINE] 1250. Eur J Health Econ. 2004 Feb;5(1):54-7. Do costs of varicella justify routine infant vaccination? Pharmacoeconomic and clinical considerations. Postma MJ, Bos JM, Welte R, de Groot R, Luytjes W, Rümke HC, Beutels P. Groningen University Institute for Drug Exploration/University of Groningen Research Institute of Pharmacy, 9713 AV Groningen, The Netherlands. m.postma@farm.rug.nl PMID: 15452765 [PubMed - indexed for MEDLINE] 1251. Ann Hematol. 2005 Jan;84(1):59-60. Epub 2004 Sep 25. Concomitant zoster myelitis and cerebral leukemia relapse after stem cell transplantation. Au WY, Hon C, Cheng VC, Ma ES. PMID: 15452668 [PubMed - indexed for MEDLINE] 1252. Neurology. 2004 Sep 28;63(6):959-65. Practice parameter: treatment of postherpetic neuralgia: an evidence-based report of the Quality Standards Subcommittee of the American Academy of Neurology. Dubinsky RM, Kabbani H, El-Chami Z, Boutwell C, Ali H; Quality Standards Subcommittee of the American Academy of Neurology. A systematic review of the literature on postherpetic neuralgia was performed. The authors identified studies using the National Library of Medicine's Medline database and Cochrane Library database. The authors determined absolute reduction rate, number needed to treat (NNT), 95% CI for NNT, and number needed to harm (NNH) for successful therapies of postherpetic neuralgia. Tricyclic antidepressants, gabapentin, pregabalin, opioids, and lidocaine patch were found to be effective in reducing the pain of postherpetic neuralgia. PMID: 15452284 [PubMed - indexed for MEDLINE] 1253. J Exp Med. 2004 Oct 4;200(7):917-25. Epub 2004 Sep 27. Varicella-zoster virus transfer to skin by T Cells and modulation of viral replication by epidermal cell interferon-alpha. Ku CC, Zerboni L, Ito H, Graham BS, Wallace M, Arvin AM. Department of Pediatrics, Stanford University, School of Medicine, Stanford, CA 94305, USA. cck@stanford.edu Primary infection with varicella-zoster virus (VZV) causes the characteristic syndrome of varicella, or chickenpox. Experiments in severe combined immunodeficiency mice with human skin grafts (SCIDhu mice) indicate that VZV infection of T cells can mediate transfer of infectious virus to skin. VZV-infected T cells reached epithelial sites of replication within 24 h after entering the circulation. Memory CD4+ T cells were the predominant population recovered from skin in SCIDhu mice given uninfected or infected mononuclear cells, suggesting that immune surveillance by memory T cells may facilitate VZV transfer. The increased susceptibility of memory T cells to VZV infection may further enhance their role in VZV pathogenesis. During VZV skin infection, viral gene products down-regulated interferon-alpha to permit focal replication, whereas adjacent epidermal cells mounted a potent interferon-alpha response against cell-cell spread. Interleukin-1alpha, although activated in VZV-infected cells, did not trigger expression of endothelial adhesion molecules, thereby avoiding early recruitment of inflammatory cells. The prolonged varicella incubation period appears to represent the time required for VZV to overcome antiviral responses of epidermal cells and generate vesicles at the skin surface. Modulation of VZV replication by cutaneous innate immunity may avoid an incapacitating infection of the host that would limit opportunities for VZV transmission. PMCID: PMC2213285 PMID: 15452178 [PubMed - indexed for MEDLINE] 1254. Rev Med Virol. 2004 Nov-Dec;14(6):363-81. Simian varicella: a model for human varicella-zoster virus infections. Gray WL. Department of Microbiology and Immunology, 4301 West Markham Street, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205, USA. graywayne1@uams.edu Simian varicella virus (SVV) causes a natural varicella-like disease in nonhuman primates. Epizootics of simian varicella occur sporadically in facilities housing Old World monkeys. SVV is antigenically and genetically related to varicella-zoster virus (VZV), the etiologic agent of varicella (chickenpox) and herpes zoster (shingles) in humans. The SVV and VZV genomes are similar in size and structure, share 70%-75% DNA homology and are co-linear with respect to gene organisation. Simian varicella is a highly contagious disease characterised by fever and vesicular skin rash and may progress to pneumonia and hepatitis. Infected monkeys may resolve the disease within 2 weeks although epizootics are sometimes associated with high morbidity and mortality. SVV, like VZV, establishes life-long latent infection, as indicated by detection of viral DNA within neural ganglia. Subsequently, SVV may reactivate to cause secondary disease and spread of the virus to susceptible monkeys. The relatedness of VZV and SVV and the similarities in the clinical symptoms and pathogenesis of human and simian varicella make SVV infection of nonhuman primates an excellent animal model to investigate VZV pathogenesis and latency, and to evaluate potential antiviral strategies. 2004 John Wiley & Sons, Ltd. PMID: 15386593 [PubMed - indexed for MEDLINE] 1255. Arch Dis Child. 2004 Oct;89(10):966-9. Declining incidence of chickenpox in the absence of universal childhood immunisation. Lowe GL, Salmon RL, Thomas DR, Evans MR. National Public Health Service Communicable Disease Surveillance Centre, Abton House, Cardiff CF14 3QX, UK. Gwen.lowe@nphs.wales.nhs.uk OBJECTIVE: To examine the epidemiology of chickenpox in Wales from 1986 to 2001. DESIGN: Descriptive analysis of chickenpox consultations reported by the Welsh general practice sentinel surveillance scheme for infectious diseases, compared with annual shingles consultation rates from the same scheme to exclude reporting fatigue and data from a general practice morbidity database to validate results. SETTING: A total of 226,884 patients registered with one of 30 volunteer general practices participating in the sentinel surveillance scheme. MAIN OUTCOME MEASURES: Age standardised and age specific incidence of chickenpox. RESULTS: Crude and age standardised consultation rates for chickenpox declined from 1986 to 2001, with loss of epidemic cycling. Rates remained stable in 0-4 year olds but declined in all older age groups, particularly those aged 5-14 years. Shingles consultation rates remained constant over the same period. Data from the morbidity database displayed similar trends. CONCLUSION: General practitioner consultation rates for chickenpox are declining in Wales except in pre-school children. These findings are unlikely to be a reporting artefact but may be explained either by an overall decline in transmission or increased social mixing in those under 5 years old, through formal child care and earlier school entry, and associated increasing rates of mild or subclinical infection in this age group. Further investigation, particularly by serological surveillance, is necessary before universal varicella immunisation can be considered in the UK. PMCID: PMC1719669 PMID: 15383443 [PubMed - indexed for MEDLINE] 1256. Agri. 2004 Jul;16(3):17-24. [Postherpetic neuralgia] [Article in Turkish] Cevik IU. Harvard Medical School, Massachusetts General Hospital, Pain Center, Boston, MA 02114, USA. icevik@partners.org Comment in: Agri. 2004 Oct;16(4):64. Following chicken pox infection, varicella-zoster virus stays as a latent infection in sensory root ganglia. After many years, the reactivation of this latent virus in sensory ganglia causes "herpes zoster". Herpes zoster (shingles) is an unilateral, dermatomal, localised, painful, vesicular, and contagious skin infection. In elderly and immunocompromised patients, shingles can cause complications such as postherpetic neuralgia (PHN) and direct central nervous system invasion. Early intervention with antiviral treatment, analgesic therapy and antidepressant therapy may reduce the risk of these complications. The treatment of PHN is same as for other neuropathic pain syndromes. The clinical importance of PHN is due to the severity and chronicity of pain which is usually not responsive to many treatments, and quality of life may be adversely affected by PHN. PMID: 15382001 [PubMed - indexed for MEDLINE] 1257. Can J Urol. 2004 Aug;11(4):2314; discussion 2314. Herpes zoster infection: a rare cause of urinary retention. Darabi K, Segal AM, Torres G. Comment on: Can J Urol. 2003 Jun;10(3):1912-3. PMID: 15380052 [PubMed - indexed for MEDLINE] 1258. Reg Anesth Pain Med. 2004 Sep-Oct;29(5):454-61. Neuraxial and sympathetic blocks in herpes zoster and postherpetic neuralgia: an appraisal of current evidence. Kumar V, Krone K, Mathieu A. Olentangy Pain Clinic, Columbus, OH 43235, USA. vkumarmd@att.net BACKGROUND AND OBJECTIVES: Epidural, intrathecal, and sympathetic blocks are used for the treatment of pain caused by herpes zoster (HZ) and postherpetic neuralgia (PHN). This study was undertaken to evaluate and synthesize existing evidence for using these nerve blocks with various injectates (local anesthetic [LA] alone, LA + steroids) in treating pain of HZ, PHN (>6 months), and its prevention. METHODS: A computerized search of published trials in the English language from 1966 to 2001 was carried out on Medline, EMBASE, and Cochrane Clinical Trial databases. Levels of evidence and grades of recommendations were made based on criteria published by the Oxford Centre for Evidence-Based Medicine. RESULTS: Among the studies meeting inclusion criteria, treatment was initiated during acute pain in 71% (15/21) and PHN in 29% (6/21). Randomized controlled trials (RCTs, level 1b evidence) constituted 19% (4/21), individual cohort (levels 2b, 3b) 29% (6/21), and case series (level 4) 43% (9/21). Overall, 80% (15/21) of trials showed a positive outcome with these blocks. The use of sympathetic (LA) and epidural blocks (LA + steroid) for pain of HZ was supported by 1 RCT each, and intrathecal block (LA + steroid) for PHN was supported by 2 RCTs. CONCLUSIONS: Evidence for the beneficial effect of epidural LA + steroid in HZ, and intrathecal LA + steroid in PHN appears to be consistent (grade A). If given within 2 months of HZ, epidural LA + steroid may reduce the incidence of PHN after 1 year (grade A). Evidence for use of sympathetic blocks in HZ and PHN, although generally useful (Grade B), requires RCTs for validation. PMID: 15372391 [PubMed - indexed for MEDLINE] 1259. Acta Dermatovenerol Croat. 2004;12(3):166-8. Unusual presentation of herpes zoster in an immunocompromised patient: case report. Kovacević Vojtusek I, Sabljar Matovinović M, Planinić G, Vucković Rebrina S, Kardum Skelin I, Knotek M, Skegro D. Vuk Vrhovac Institute for Diabetes, Endocrinology and Metabolism, Dugi dol 4a, 10000 Zagreb, Croatia. ivana.kovacevic-vojtusek@zg.hinet.hr We present a case of an immunocompromised patient with unusual presentation of herpes zoster infection. After having been treated with corticosteroids for several weeks, the patient developed the zoster infection with atypical clinical course and skin localization. Parenteral treatment with acyclovir for 10 days resulted in a complete clinical resolution of the skin lesions. Similar cases of unusual presentation of herpes zoster have been described in immunocompromised patients. PMID: 15369641 [PubMed - indexed for MEDLINE] 1260. Clin Evid. 2003 Jun;(9):890-900. Postherpetic neuralgia. Lancaster T, Wareham D, Yaphe J. Department of Primary Health Care, University of Oxford, Oxford, UK. Update in: Clin Evid. 2003 Dec;(10):942-52. Update of: Clin Evid. 2002 Jun;(7):738-46. PMID: 15366174 [PubMed - indexed for MEDLINE] 1261. Vaccine. 2004 Sep 28;22(29-30):3947-51. Epidemiology of severe varicella-zoster virus infection in Spain. Gil A, San-Martín M, Carrasco P, González A. Department of Health Sciences, Rey Juan Carlos University, Avda de Atenas s/n, 28922 Alcorcón, Madrid, Spain. a.gildemiguel@cs.urjc.es Data of hospitalizations for varicella and herpes zoster in Spain during the 1999-2000 period were obtained from the national surveillance system for hospital data. A total of 3083 hospitalizations for varicella and 6324 for herpes zoster were identified, representing an annual incidence of 4.1 and 8.4 per 100,000 persons per year, respectively. Almost half of patients hospitalized for varicella were children under 5 years of age. In contrast, 78% of hospitalizations for zoster occurred in adults >50 years of age. Hospitalizations for varicella and herpes zoster resulted annually in 11,141 and 40,090 days of hospitalization and a cost of 3.2 and 7.0 million, respectively. PMID: 15364443 [PubMed - indexed for MEDLINE] 1262. BMC Infect Dis. 2004 Sep 8;4:33. A new method for determination of varicella-zoster virus immunoglobulin G avidity in serum and cerebrospinal fluid. Kneitz RH, Schubert J, Tollmann F, Zens W, Hedman K, Weissbrich B. Institute of Virology and Immunobiology, University of Würzburg, Versbacher Str. 7, 97078 Würzburg, Germany. ralf.kneitz@gmx.de BACKGROUND: Avidity determination of antigen-specific immunoglobulin G (IgG) antibodies is an established serological method to differentiate acute from past infections. In order to compare the avidity of varicella-zoster virus (VZV) IgG in pairs of serum and cerebrospinal fluid (CSF) samples, we developed a new technique of avidity testing, the results of which are not influenced by the concentration of specific IgG. METHODS: The modifications introduced for the new VZV IgG avidity method included the use of urea hydrogen peroxide as denaturing reagent, the adaptation of the assay parameters in order to increase the sensitivity for the detection of low-level VZV IgG in CSF, and the use of a new calculation method for avidity results. The calculation method is based on the observation that the relationship between the absorbance values of the enzyme immunoassays with and without denaturing washing step is linear. From this relationship, a virtual absorbance ratio can be calculated. To evaluate the new method, a panel of serum samples from patients with acute and past VZV infection was tested as well as pairs of serum and CSF. RESULTS: For the serum panel, avidity determination with the modified assay gave results comparable to standard avidity methods. Based on the coefficient of variation, the new calculation method was superior to established methods of avidity calculation. CONCLUSIONS: The new avidity method permits a meaningful comparison of VZV IgG avidity in serum and CSF and should be of general applicability for easy determination of avidity results, which are not affected by the concentration of specific IgG. PMCID: PMC522815 PMID: 15355548 [PubMed - indexed for MEDLINE] 1263. Curr Opin Pharmacol. 2004 Oct;4(5):453-64. Antivirals against DNA viruses (hepatitis B and the herpes viruses). Hewlett G, Hallenberger S, Rübsamen-Waigmann H. hbsc, Krutscheider Weg 96, 42327 Wuppertal, Germany. Antiviral drugs against DNA viruses are widely used for the management of diseases caused by infections with the Herpes viruses and have recently been introduced for Hepatitis B. There are also several emerging treatments (i.e. those that are in clinical development) and novel treatments that are still in the preclinical phase. Although the majority of emerging drugs are nucleoside analogues, there is a trend towards the development of non-nucleosidic drugs with unique mechanisms of action, in the hope that efficacy will be maximised and drug resistance and viral rebound minimised. PMID: 15351349 [PubMed - indexed for MEDLINE] 1264. Liver Transpl. 2004 Sep;10(9):1140-3. Herpes zoster after liver transplantation: incidence, risk factors, and complications. Herrero JI, Quiroga J, Sangro B, Pardo F, Rotellar F, Alvarez-Cienfuegos J, Prieto J. Liver Unit, Clinica Universitaria de Navarra, Pamplona, Spain. iherrero@unav.es Herpes zoster is the consequence of the reactivation of latent varicella-zoster infection. Immunosuppression may be a predisposing factor for herpes zoster. We have retrospectively assessed the risk of herpes zoster, the risk factors for its occurrence, and its evolution in a population of 209 consecutive liver transplant recipients. Herpes zoster developed in 25 (12%) of patients. One-, 3-, 5-, and 10-year actuarial rates of herpes zoster were 3%, 10%, 14%, and 18%, respectively. In a case-control study, patients developing herpes zoster were younger, received a higher number of immunosuppressive drugs, and were more frequently receiving mycophenolate mofetil or azathioprine. In multivariate analysis, the only factor related to herpes zoster occurrence was treatment with mycophenolate mofetil or azathioprine. Eight patients (31%) developed postherpetic neuralgia. In conclusion, herpes zoster is a relatively common complication after liver transplantation. It is related to immunosuppressive therapy. Postherpetic neuralgia develops in one third of patients with posttransplant herpes zoster. PMID: 15350004 [PubMed - indexed for MEDLINE] 1265. J Pediatr Hematol Oncol. 2004 Sep;26(9):587-90. Bullous herpes zoster in a child with leukemia: case report and review of the literature. Haimi M, Ben-Arush MW, Kassis I, Postovsky S, Kra-Oz Z, Elhasid R. Department of Pediatric Hemato-Oncology, Meyer Children's Hospital, Rambam Medical Center, Haifa, Israel. morx@netvision.net.il Blistering disorders in childhood are usually difficult to diagnose and pose complicated management dilemmas. The incidence of herpes zoster in children with malignancy and immunodeficiency is greatly increased compared to normal children of comparable age. Although herpes zoster is known to occur in children with malignancy, the bullous form of herpes zoster is rare; to the authors' knowledge, there was no previous report of this phenomenon in children in general and in children with cancer in particular. The authors describe a 3.5-year-old girl who was diagnosed with acute lymphoblastic leukemia; 7 months after presentation, during chemotherapy treatment, she developed the bullous form of herpes zoster on her right hand. The authors describe the method of diagnosis and provide a review of the literature concerning this rare phenomenon. Recognizing this entity and differentiating it from other bullomatous conditions enable the application of appropriate treatment, without unnecessary delay. PMID: 15342986 [PubMed - indexed for MEDLINE] 1266. Drugs. 2004;64(18):2091-7; discussion 2098-9. Brivudin (bromovinyl deoxyuridine). Keam SJ, Chapman TM, Figgitt DP. Adis International Limited, Auckland, New Zealand. demail@adis.co.nz Brivudin is an oral thymidine analogue indicated for the early treatment of acute herpes zoster in immunocompetent adults. It has high, selective activity against varicella zoster virus (VZV), inhibiting VZV replication, possibly through competitive inhibition of viral DNA polymerase, or by acting as an alternative substrate to deoxythymidine triphosphate, causing viral DNA strand breakage. In a large, 7-day, phase III trial in immunocompetent patients with herpes zoster, once-daily brivudin 125mg was significantly more effective than oral acyclovir 800mg five times daily in reducing the mean time from start of treatment to last vesicular eruption, and was as effective as acyclovir at healing lesions and alleviating acute zoster-related pain. The likelihood of developing post-herpetic neuralgia (PHN) in immunocompetent patients aged > or =50 years was significantly lower with brivudin than with acyclovir. Brivudin was as effective as oral famciclovir 250mg three times daily in terms of the prevalence of PHN, the time to last vesicular eruption and lesion healing in another large, 7-day, phase III study in immunocompetent patients with herpes zoster. Oral brivudin is generally well tolerated, with a similar tolerability profile to those of oral acyclovir or famciclovir. Nausea was the most commonly reported adverse event. PMID: 15341504 [PubMed - indexed for MEDLINE] 1267. J Pain. 2004 Aug;5(6):344-56. Development of a measure of the burden of pain due to herpes zoster and postherpetic neuralgia for prevention trials: adaptation of the brief pain inventory. Coplan PM, Schmader K, Nikas A, Chan IS, Choo P, Levin MJ, Johnson G, Bauer M, Williams HM, Kaplan KM, Guess HA, Oxman MN. Merck Research Laboratories, West Point, Pennsylvania 19486, USA. alexander_nikas@merck.com In preparation for clinical trials of a vaccine against herpes zoster (HZ), we conducted a prospective, observational study to evaluate (1) the Zoster Brief Pain Inventory (ZBPI), an HZ-specific questionnaire to quantify HZ pain and discomfort, (2) an operational definition of postherpetic neuralgia (PHN), and (3) a severity-duration measure of the burden of illness caused by HZ. HZ patients aged 60 years or older (n = 121) were enrolled within 14 days of rash onset and completed ZBPI, McGill Pain Questionnaire Present Pain Intensity (PPI), quality of life (QoL), and activities of daily living (ADL) questionnaires on a predetermined schedule. Reliability, measured by intraclass correlation coefficients within 14 days of rash onset, ranged between 0.63 and 0.78. ZBPI pain scores were strongly correlated with other pain measures, interference with ADL, and worsening QoL. The operational definition of PHN, a ZBPI pain score of 3 or greater occurring 90 or more days after rash onset, had high agreement with pain worse than mild on the PPI (kappa = 0.72). The ZBPI pain severity-duration measure had high correlations with severity-duration measures of ADL interference, worsening QoL, and other pain scales. These findings support the validity and utility of the ZBPI, the definition of PHN, and the severity-duration measure of the burden of HZ illness. PERSPECTIVE: Herpes zoster pain, as measured by the ZBPI severity-duration measure, is associated with impairment in daily living activities and quality of life. The ZBPI measure appears useful for quantifying herpes zoster pain, postherpetic neuralgia, and impairment in daily living activities for clinical trials of herpes zoster prevention. PMID: 15336639 [PubMed - indexed for MEDLINE] 1268. Am J Otolaryngol. 2004 Sep-Oct;25(5):357-60. Lateral sinus thrombosis associated with zoster sine herpete. Chan J, Bergstrom RT, Lanza DC, Oas JG. Department of Otolaryngology and Communicative Disorders, The Cleveland Clinic Foundation, Cleveland, OH 44195, USA. Herpes zoster results from reactivation of the varicella zoster virus (VZV). Zoster sine herpete (ZSH) is an uncommon manifestation of VZV infection and presents with similar symptoms but without the vesicular rash. We describe an unusual case of lateral sinus thrombosis (LST) that developed during the clinical course of ZSH in the C2 distribution. A 55-year-old woman presented with a 3-day history of left temporal and postauricular pain, nausea, vomiting, and mild photophobia. She denied otalgia, otorrhea, and hearing loss. Examination revealed hyperesthesia in the left C2 nerve root distribution without evidence of herpetic rash. A computed tomography scan showed minimal fluid in the left mastoid cavity (not mastoiditis) and thrombus within the left lateral and sigmoid dural sinus. Magnetic resonance imaging and magnetic resonance angiogram confirmed these findings. Laboratory studies revealed elevated neurotrophic immunoglobulin G levels to VZV. Hypercoagulable studies were normal. She was subsequently treated with Neurontin, acyclovir, and anticoagulation. Her symptoms improved, and she was discharged 3 days later. LST is generally a complication of middle ear infection. Nonseptic LST, however, may result from dehydration, oral contraceptive use, coagulopathy, or thyroid disease. This unusual case raises the suspicion that thrombosis resulted from VZV associated thrombophlebitis in the ipsilateral cerebral venous sinuses along the second cervical nerve root distribution. A high index of suspicion is necessary in such cases so that a different treatment course can be identified and antiviral medication initiated promptly. PMID: 15334402 [PubMed - indexed for MEDLINE] 1269. Br J Cancer. 2004 Oct 4;91(7):1275-9. The risk and prognosis of cancer after hospitalisation for herpes zoster: a population-based follow-up study. Sørensen HT, Olsen JH, Jepsen P, Johnsen SP, Schønheyder HC, Mellemkjaer L. Department of Clinical Epidemiology, Aarhus University Hospital, Vennelyst Boulevard 6, Building 260, 8000 Aarhus C, Denmark. hts@soci.au.dk We examined the risk of cancer and survival in a cohort of patients hospitalised with herpes zoster between 1977 and 1996, drawn from the Danish National Registry of Patients. Through linkage with the Danish Cancer Registry, we compared the observed number of cancers with the expected number on the basis of national age-, gender-, and site-specific incidence rates. The survival of herpes zoster patients with cancer was compared with that of non-herpes zoster patients with cancer. Among the 10 588 patients hospitalised with herpes zoster whom we identified, 1427 cancers were observed compared with 1239 expected (relative risk=1.2, 95% confidence interval 1.1-1.2). The risk was substantially elevated during the first year of follow-up, mainly for haematological cancer. Patients with cancer within 1 year of follow-up had a higher prevalence of distant metastases than controls, although the mortality was similar. For those with haematological cancer, however, the mortality was higher for herpes zoster patients than for controls. Haematological cancer following hospitalisation for herpes zoster has a poorer prognosis than in non-herpes zoster patients. PMCID: PMC2409892 PMID: 15328522 [PubMed - indexed for MEDLINE] 1270. Med Pregl. 2004 Jan-Feb;57(1-2):18-21. [Corticosteroid therapy of zoster-associated pain] [Article in Serbian] Cvjetović D, Jovanović J, Hrnjaković-Cvjetković I, Dordević-Aleksić M, Radojcić A, Bogdanović M. INTRODUCTION: Lack of exact clinical studies on effects of corticosteroids in therapy and prevention of herpes zoster-related pain, elicited many controversies in the past. The aim of our study was to estimate effects of prednisone on frequency, intensity and duration of postherpetic neuralgia. MATERIAL AND METHODS: 68 immunocompetent herpes zoster patients, 8-90 years of age (37 females and 31 males, mean age 55.7 years) were enrolled for study; 30 patients were treated with acyclovir (5 x 800 mg daily for a 7-day period) and prednisone (initial daily dose 60 mg, tapering over 14 days), and the control group of 38 patients with acyclovir only. Patients were clinically followed up for 3 months after complete resolution of skin lesions. Chi-square test was used in statistical data analysis. RESULTS: The difference regarding incidence of postherpetic neuralgia in acyclovir/prednisone group and acyclovir group (although slightly less in the former one) was not significant. Duration of postherpetic neuralgia over 3 months was similar in both groups. Mild postherpetic pain was more common in the acyclovir/prednisone group (44.4%) than in the acyclovir group (28.6%); however, statistical validation requires more patients to be studied. DISCUSSION: Results of our study didn't confirm efficiency of prednisone regarding occurrence and characteristics of postherpetic neuralgia. Failure of prednisone therapy may be partly contributed to advanced age of patients and delayed onset of therapy. CONCLUSION: Use of corticosteroids in zoster patients gives neither reliable protection from appearance of postherpetic neuralgia, nor shortens its duration. Further investigations are necessary to estimate their effects on postherpetic pain. PMID: 15327184 [PubMed - indexed for MEDLINE] 1271. Int J Infect Dis. 2004 Sep;8(5):259-70. A review of the varicella vaccine in immunocompromised individuals. Sartori AM. Clinic of Infectious and Parasitic Diseases, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, SP, Brazil. amsartori@sti.com.br BACKGROUND: Individuals with underlying cell-mediated immunodeficiency disorders are at high risk of developing severe, life-threatening illness associated with varicella-zoster virus infection. A live-attenuated varicella vaccine is recommended for routine childhood immunisation in some countries. In healthy children, the vaccine is efficacious and safe but because immunocompromised individuals may be unable to limit replication of live-attenuated vaccine viruses, the varicella vaccine is not recommended for them and there are few exceptions. OBJECTIVES: The purpose of this paper is to review the published studies addressing the use of the varicella vaccine in people with cell-mediated immunodeficiency disorders. METHODS: A computerised search on the PubMed database was used to collect the relevant papers published up to March 2003. RESULTS: The varicella vaccine has been extensively studied in susceptible children with acute lymphoblastic leukaemia in remission, but studies involving individuals with other immunodeficiency disorders are scarce. Some of the current recommendations are based on very few and small studies with short follow-up. Immunocompromised individuals should be given the varicella vaccine only with complete knowledge of their clinical and immunological conditions and after considering the risks of natural infection and vaccination. PMID: 15325594 [PubMed - indexed for MEDLINE] 1272. Gastroenterol Hepatol. 2000 Jun-Jul;23(6):313-4. [Abdominal pain as initial clinical presentation of herpes zoster in an immunocompetent adult] [Article in Spanish] Muelas MS, Menasalvas AI, Ramos J. PMID: 15324632 [PubMed - indexed for MEDLINE] 1273. Clin J Pain. 2004 Sep-Oct;20(5):302-8. Optimum pain relief with continuous epidural infusion of local anesthetics shortens the duration of zoster-associated pain. Manabe H, Dan K, Hirata K, Hori K, Shono S, Tateshi S, Ishino H, Higa K. Department of Anesthesiology, Kitakyushu Municipal Medical Center, Bashaku, Kokurakita-ku, Japan. hymanabe@mx7.tiki.ne.jp OBJECTIVE: To investigate effects of continuous epidural infusion (CEI) of 0.5% bupivacaine added to intermittent epidural boluses (IEB) on the duration of zoster-associated pain (ZAP), as compared with continuous infusion of normal saline placebo added to IEB. DESIGN: A prospective, double-blind, randomized, placebo-controlled study. SETTING: A university hospital and an affiliated clinic in Japan from 1996 through 1999. PATIENTS: 56 immunocompetent herpes zoster (HZ) patients, 50 years or older, within 10 days of rash onset and with severe pain and eruption. INTERVENTIONS: Patients were hospitalized and randomly allocated into 2 groups. CEI group given CEI of 0.5% bupivacaine (0.5-1.0 mL/h) plus IEB of 0.5% bupivacaine 4 times daily (n = 29). IEB group given normal saline infusion plus IEB of 0.5% bupivacaine 4 times daily (n = 27). All patients received oral acyclovir 800 mg, 5 times daily, for 7 days. OUTCOME MEASURES: The number of days required for complete cessation of ZAP and the proportion of subjects with allodynia beyond 30 days. RESULTS: The median time to cessation of ZAP was significantly shorter in the CEI group than in the IEB group (29 days vs. 40 days, P = 0.002). The number of patients whose allodynia persisted beyond 30 days of treatment was significantly lower in the CEI group than in the IEB group (10% vs. 37%, P = 0.027). CONCLUSIONS: CEI of 0.5% bupivacaine plus IEB was associated with a shorter duration of ZAP and fewer patients with allodynia beyond 30 days, compared with IEB plus normal saline infusion. Patients at high risk for developing postherpetic neuralgia (PHN) can be managed with intensive therapies at the early stage of disease, such as CEI, which maintains effective analgesia and may reduce the burden of PHN. PMID: 15322436 [PubMed - indexed for MEDLINE] 1274. Eur Neurol. 2004;52(2):121-2. Epub 2004 Aug 18. Recurrent varicella-zoster virus myelitis in an immunocompetent patient. Jacobus Gilhuis H, Visser CE, Portegies P. Department of Neurology, Reinier de Graaf Group, Delft, The Netherlands. gilhuis@rdgg.nl PMID: 15319558 [PubMed - indexed for MEDLINE] 1275. Herpes. 2004 Jun;11 Suppl 2:89A-94A. Varicella zoster virus and central nervous system syndromes. Gilden D. Department of Neurology, University of Colorado Health Sciences Center, Denver, Colorado 80262, USA. don.gilden@ushsc.edu Varicella zoster virus (VZV) causes chicken pox (varicella) after which it establishes latency and can subsequently reactivate to cause herpes zoster. Central nervous system (CNS) complications can follow both primary infection and reactivation of VZV. The more serious manifestations arise when VZV invades the spinal cord or cerebral arteries after reactivation of the virus, causing diseases such as myelitis and focal vasculopathies. The International Herpes Management Forum (IHMF) has developed guidelines to aid in the diagnosis and management of CNS syndromes associated with VZV and these have focused on VZV vasculopathy. The new guidelines recommend that where VZV vasculopathy is suspected, cerebrospinal fluid (CSF) should be analysed by polymerase chain reaction (PCR) for VZV DNA. As VZV antibodies may be present in the CSF in the presence or absence of detectable VZV DNA, CSF should also be analysed for VZV-specific antibody if there is a high likelihood of CNS disease. Early diagnosis of these serious complications is important, as aggressive antiviral treatment can be effective. Patients with VZV focal vasculopathy should be treated with intravenous aciclovir (10 mg/kg every 8 h for adults, 500 mg/m2 body surface area for children) for 7 days. The immunocompromised patient may require longer treatment. However, treatment should be discontinued if negative results are obtained for both VZV DNA and anti-VZV antibody in CSF. Steroid therapy (prednisone 60-80 mg/day for 3-5 days) should be considered in VZV vasculopathy to reduce inflammation. PMID: 15319095 [PubMed - indexed for MEDLINE] 1276. Hautarzt. 2004 Sep;55(9):831-40. [Varicella-zoster virus infections] [Article in German] Lilie HM, Wassilew SW. Dermatologische Klinik, Klinikum Krefeld, Lutherplatz 40, 47805 Krefeld, Germany. lilie@klinikum-krefeld.de The primary infection with varicella-zoster virus (VZV) is manifest clinically as varicella. It is a common very contagious disease, normally appearing in childhood. VZV is a ubiquitous virus with a high prevalence. Clinically it is characterized by pleomorphic skin lesions. Normally antiviral therapy is necessary only in severe cases, in adults or in immunosuppressed patients. Herpes zoster, also caused by (VZV), is a neurodermal disease representing the endogenous relapse of the primary varicella infection. Herpes zoster is characterized by lesions concentrated in the innervation region of a cranial or spinal nerve. One of the most feared manifestations of herpes zoster is pain. Several antiviral drugs are approved and many studies have shown that antiviral therapy, started early in the course of disease, can significantly reduce risk and duration of postherpetic neuralgia in elderly patients. Therefore, antiviral therapy in combination with an adequate pain management should be given to all elderly patients as soon as herpes zoster is diagnosed. PMID: 15316637 [PubMed - indexed for MEDLINE] 1277. J Korean Med Sci. 2004 Aug;19(4):598-600. Concurrent reactivation of varicella zoster virus and herpes simplex virus in an immunocompetent child. Park HH, Lee MH. Department of Dermatology, College of Medicine, Kyunghee University, Seoul, Korea. Latency within the nervous system is a characteristic feature of herpesviridae infection. It is reactivated by triggering factors such as UV exposure, stress, and trauma. Simultaneous reactivation of herpes simplex and herpes zoster is uncommon, however, an observation provably explained by differences in the triggering mechanism. Concurrent reactivation of herpes simplex virus (HSV) and varicella zoster virus (VZV) is occasionally encountered in immunosuppressed patients; on the other hand, it is rarely reported in immunocompetent individuals. We present the case of an immunocompetent 8-yr-old female patient with concurrent reactivation of HSV on the face and VZV on the right L2 dermatome. Copyright The Korean Academy of Medical Sciences PMCID: PMC2816897 PMID: 15308854 [PubMed - indexed for MEDLINE] 1278. Vaccine. 2004 Sep 3;22(25-26):3228-31; author reply 3232-6. Scientific commentary. Jumaan A, Schmid DS, Gargiullo P, Seward J. Comment on: Vaccine. 2003 Oct 1;21(27-30):4250-5. Vaccine. 2003 Oct 1;21(27-30):4238-42. Vaccine. 2003 Oct 1;21(27-30):4243-9. PMID: 15308342 [PubMed - indexed for MEDLINE] 1279. Clin Infect Dis. 2004 Aug 1;39(3):342-8. Epub 2004 Jul 19. Acute pain in herpes zoster and its impact on health-related quality of life. Katz J, Cooper EM, Walther RR, Sweeney EW, Dworkin RH. Department of Anesthesiology, University of Rochester School of Medicine and Dentistry, Rochester, NY, 14642, USA. Although the effects of postherpetic neuralgia on physical and emotional functioning have been examined in a number of studies, the impact of acute pain in herpes zoster ("shingles") on health-related quality of life has been neglected. We describe the characteristics of herpes zoster pain and examine its relationship to physical, role, social, and emotional functioning in 110 patients with herpes zoster. When we controlled for relevant covariates, we found that greater pain burden, as assessed by the product of pain intensity and duration, was associated with poorer physical functioning, increased emotional distress, and decreased role and social functioning. The results demonstrate that herpes zoster pain has broad effects on the daily lives of patients and on their emotional health. The increasing incidence of herpes zoster that can be anticipated as the population ages requires that clinical trials that examine interventions to prevent or treat herpes zoster pain be given a high priority. PMID: 15307000 [PubMed - indexed for MEDLINE] 1280. Lancet. 2004 Aug 7-13;364(9433):502. Povidone-iodine for herpes zoster. Shann F. PMID: 15302192 [PubMed - indexed for MEDLINE] 1281. Mayo Clin Proc. 2004 Aug;79(8):1055-8. 80-year-old man with fever and ear pain. Lim LS, Takahashi PY. Mayo Graduate School of Medicine, Mayo Clinic College of Medicine, Rochester, Minn 55905, USA. PMID: 15301334 [PubMed - indexed for MEDLINE] 1282. Nervenarzt. 2004 Jul;75(7):688-90. [Coenaesthesia after infection with Varicella zoster virus. The psychodynamic meaning of suffering a children's disease at adult age] [Article in German] Brüggemann BR, Machleidt W. Abteilung Sozialpsychiatrie und Psychotherapie, Medizinische Hochschule Hannover. Brueggemann.Bernd@MH-Hannover.de The case report is presented of a 33-year-old male who developed coenaesthesia after suffering from chickenpox. While central nervous involvement of the herpes zoster virus infection was not found, suffering a children's disease at an adult age proved an important psychodynamic factor for release of the coenaesthetic symptomatology. PMID: 15300325 [PubMed - indexed for MEDLINE] 1283. J Anesth. 2004;18(3):177-80. Systemic ATP infusion improves spontaneous pain and tactile allodynia, but not tactile hypesthesia, in patients with postherpetic neuralgia. Moriyama M, Kitamura A, Ikezaki H, Nakanishi K, Kim C, Sakamoto A, Ogawa R. Department of Anesthesia, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, 113-8603 Tokyo, Japan. PURPOSE: Activation of purinoceptors may improve neuropathic pain. Accordingly, the effects of systemic ATP infusion were assessed in patients with postherpetic neuralgia (PHN). METHODS: Eight patients with PHN lasting over 3 months were enrolled. Initially, patients received the vehicle (20% dextrose) or ATP (at a dose of 1 mg x kg(-1) in 20% dextrose) infused intravenously for 60 min on two separate occasions in a single-blinded manner. The levels of spontaneous continuous pain, paroxysmal pain, and tactile allodynia were assessed by a visual analogue scale (VAS), and tactile hypesthesia was assessed by Semmes-Weinstein monofilament before and after infusion. Subsequently, the eight patients received an ATP infusion (1 mg.kg(-1) in 20% dextrose) once a week for 5-12 weeks in an open-label manner, and changes in the above parameters were assessed. RESULTS: In the initial study, VAS for spontaneous continuous pain and tactile allodynia decreased significantly with ATP infusion but not with placebo infusion. After repeated ATP infusions for 5-12 weeks, the median VAS for spontaneous continuous pain, paroxysmal pain, and tactile allodynia decreased significantly from 32.1 to 13.0, from 46.9 to 17.5, and from 49.5 to 15.6 respectively. However tactile hypesthesia did not improve significantly. CONCLUSION: This study demonstrated that repetitive intravenous ATP infusion could improve spontaneous continuous pain and paroxysmal pain, as well as improving tactile allodynia, but did not influence tactile hypesthesia. PMID: 15290415 [PubMed - indexed for MEDLINE] 1284. AIDS. 2004 Aug 20;18(12):1615-27. Immune restoration disease after antiretroviral therapy. French MA, Price P, Stone SF. Department of Clinical Immunology and Biochemical Genetics, Royal Perth Hospital and School of Surgery and Pathology, University of Western Australia, Perth, Australia. martyn.french@health.wa.gov.au Suppression of HIV replication by highly active antiretroviral therapy (HAART) often restores protective pathogen-specific immune responses, but in some patients the restored immune response is immunopathological and causes disease [immune restoration disease (IRD)]. Infections by mycobacteria, cryptococci, herpesviruses, hepatitis B and C virus, and JC virus are the most common pathogens associated with infectious IRD. Sarcoid IRD and autoimmune IRD occur less commonly. Infectious IRD presenting during the first 3 months of therapy appears to reflect an immune response against an active (often quiescent) infection by opportunistic pathogens whereas late IRD may result from an immune response against the antigens of non-viable pathogens. Data on the immunopathogenesis of IRD is limited but it suggests that immunopathogenic mechanisms are determined by the pathogen. For example, mycobacterial IRD is associated with delayed-type hypersensitivity responses to mycobacterial antigens whereas there is evidence of a CD8 T-cell response in herpesvirus IRD. Furthermore, the association of different cytokine gene polymorphisms with mycobacterial or herpesvirus IRD provides evidence of different pathogenic mechanisms as well as indicating a genetic susceptibility to IRD. Differentiation of IRD from an opportunistic infection is important because IRD indicates a successful, albeit undesirable, effect of HAART. It is also important to differentiate IRD from drug toxicity to avoid unnecessary cessation of HAART. The management of IRD often requires the use of anti-microbial and/or anti-inflammatory therapy. Investigation of strategies to prevent IRD is a priority, particularly in developing countries, and requires the development of risk assessment methods and diagnostic criteria. PMID: 15280772 [PubMed - indexed for MEDLINE] 1285. Pain. 2004 Jul;110(1-2):329-36. The human histocompatibility leukocyte antigen (HLA) haplotype is associated with the onset of postherpetic neuralgia after herpes zoster. Sato-Takeda M, Ihn H, Ohashi J, Tsuchiya N, Satake M, Arita H, Tamaki K, Hanaoka K, Tokunaga K, Yabe T. Department of Anesthesiology and Pain Relief Center, University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan. In some herpes zoster patients, pain persists for more than 3 months or more after healing of vesicular eruptions; this condition is termed postherpetic neuralgia (PHN). We have recently reported the association of the human histocompatibility leukocyte antigens (HLA) haplotype, HLA-A*3303-B*4403-DRB1*1302 with PHN patients; however, it has not been determined whether the haplotype is also associated with herpes zoster that did not develop subsequent PHN. To distinguish whether the haplotype is associated with herpes zoster or the development of PHN, we examined if herpes zoster patients without subsequently PHN are also associated with the HLA haplotype or not. Herpes zoster patients were followed up for more than 6 months, and HLA alleles and haplotypes were compared among the PHN patients (n = 52) the herpes zoster patients who did not develop PHN (n = 42) and healthy controls (n = 125). The frequencies of the risk haplotype in the PHN patients, in the healthy controls and in the herpes zoster patients without subsequent PHN were 16.3, 5.2 and 4.8%, respectively. While the frequency of the risk haplotype was significantly higher in the PHN patients than in the healthy controls (P = 0.0006) no difference was observed between the herpes zoster patients without subsequent PHN and the healthy controls. No significant association was found between the duration of symptoms or the site of herpes zoster and the HLA alleles and the haplotype. These results suggest that the HLA-A*3303-B*4403-DRB1*1302 haplotype plays an important role in the development of PHN after herpes zoster, but not in the onset of herpes zoster. PMID: 15275783 [PubMed - indexed for MEDLINE] 1286. Pain. 2004 Jul;110(1-2):e1-12. Complex regional pain syndrome-like symptoms during herpes zoster. Berry JD, Rowbotham MC, Petersen KL. UCSF Pain Clinical Research Center, University of California, San Francisco 94115, USA. Complex Regional Pain Syndrome (CRPS) associated with herpes zoster (HZ) was first reported by Sudeck in 1901 (Sudeck, 1901) and is recognized clinically. However, only 13 cases have been published in the literature, and nothing is known about the incidence, prevalence, or natural history (Chester, 1992; Foster et al., 1989; Grosslight et al., 1986; Ketz and Schliack,1968; Kishimoto et al., 1995; Querol and Cisneros, 2001; Sudeck, 1901; Visitsunthorn and Prete, 1981). The aim of the present study was to determine the prevalence of CRPS-like symptoms in a prospectively gathered cohort of subjects with HZ and to follow the natural history of their pain and sensory disturbance during the first 6 months after onset of HZ. Subjects were evaluated at four time points after HZ: 2-6 weeks, 6-8 weeks, 3 months, and 6 months. Only subjects aged 50 or older with pain VAS ratings of >/=20/100 at 2-6 weeks were eligible. The first (screening) visit included a neurological and physical examination that was updated at each subsequent visit. Assessments included ratings of pain intensity, allodynia severity, and rash severity. The neurological exam included determination of presence or absence of the following CRPS-like symptoms: (1) increased sweating, (2) color changes, (3) skin temperature changes, (4) weakness of the affected area based on physical exam, (5) edema, and (6) extension of CRPS-like symptoms outside the affected dermatome. For subjects with HZ in dermatomes that can include the limbs (C4-T2 and L1-S2), extremity involvement was considered present if allodynia or rash extended beyond the neck of the humerus (upper extremity), the inguinal ligament (anterior lower extremity), or gluteal sulcus (posterior lower extremity). Involvement of the extremity was considered proximal if neither HZ rash nor allodynia extended past the elbow (upper extremity) or knee (lower extremity). Of the first 75 subjects recruited, 25 had HZ outbreaks in dermatomes that extended into the extremities (C4-T2 and L1-S2). In this group, 8 subjects had no extremity involvement, 8 had proximal extremity involvement, and 9 had distal extremity involvement. Subjects with distal extremity HZ reported more pain across the four visits (p < 0.05). At 3 months, more subjects with distal extremity involvement met criteria for PHN (8 out of 9, 89%), while only 4 out of 8 (50%) with proximal involvement and 2 out of 8 (25%) of subjects without extremity involvement met criteria for PHN (Chi-square test: p < 0.05). Only 25 out of the remaining 50 (50%) subjects with outbreaks in dermatomes that do not include the extremities met criteria for PHN at 3 months (Chi-square test: p < 0.05). Six months after onset of HZ, 6 out of 9 subjects with distal extremity involvement met PHN criteria compared with 2 out of 8 (25%) with proximal involvement and 2 out of 8 (25%) without extremity involvement (Chi-square test: p = 0.12). Fifteen out of 50 (30%) subjects with outbreaks in dermatomes that do not include the extremities met criteria for PHN (Chi-square test: p < 0.05). No subject had all six CRPS-like symptoms. Of the 17 subjects with extremity involvement, 9 subjects had '0-2 CRPS-like symptoms' and 8 had '3-5 CRPS-like symptoms'. None of the eight subjects without extremity involvement had any CRPS-like symptoms. Of the 50 subjects with HZ outside the extremity, only one had abdominal weakness. Pain ratings were higher in subjects with '3-5 CRPS-like symptoms'. More subjects with '3-5 CRPS-like symptoms' met criteria for PHN at 3 months (7 out of 8, 88%), compared to 5 out of 9 (55%) of subjects with '0-2 CRPS-like symptoms' (p = 0.07). At 6 months, 2 out of 9 (22%) of subjects with '0-2 CRPS-like symptoms' met criteria for PHN, compared with 6 out of 8 (75%) of subjects with '3-5 CRPS-like symptoms' (Chi-square test: p < 0.03). Two case-reports are presented. In summary, the occurrence of CRPS-like symptoms is common in subjects with HZ outbreaks affecting the extremity, particularly if the distal extremity is involved. It is uncertain if the pathophysiology underlying the CRPS-like symptoms observed in this study is similar to that of CRPS from other causes, or if it is relatively specific to HZ. Development of PHN is common in subjects who have experienced CRPS-like symptoms. More aggressive preventive treatments may be justified in this high-risk subset of HZ subjects to prevent development of PHN. Prospective randomized controlled studies are needed to determine which subjects are most likely to benefit and when treatment should begin. PMID: 15275746 [PubMed - indexed for MEDLINE] 1287. J Infect Dis. 2004 Aug 15;190(4):793-6. Epub 2004 Jul 15. Rashes occurring after immunization with a mixture of viruses in the Oka vaccine are derived from single clones of virus. Quinlivan ML, Gershon AA, Steinberg SP, Breuer J. Skin Virus Laboratory, Institute of Cell and Molecular Medicine, London, United Kingdom. Vaccination against chickenpox causes a varicella-like rash in up to 5% of healthy children and 50% of children with leukemia. The vaccine may establish latency and reactivate to cause herpes zoster, albeit more rarely than wild-type virus. All vaccine preparations are composed of a mixture of varicella-zoster virus strains that show genotypic variation at several loci. We have shown, by DNA sequencing of 40 polymorphic loci, that viruses sampled from vesicles in varicella-like and herpes zoster rashes are single clones. This finding suggests that, between the time of inoculation of the vaccine and development of rash, selection of single strains occurs. The results have general implications for the pathogenesis of varicella-zoster virus. PMID: 15272408 [PubMed - indexed for MEDLINE] 1288. Expert Rev Vaccines. 2004 Aug;3(4):391-6. Vaccines and vaccination strategies. Odio C. Hospital Nacional de Ninos, Apartado 1654-1000, San Jose, Costa Rica. codio@hnn.sa.cr PMID: 15270643 [PubMed - indexed for MEDLINE] 1289. Indian J Lepr. 2003 Jul-Sep;75(3):263-4. Leprosy and herpes zoster; an association or dissociation? Jain R, Dogra S, Kaur I, Kumar B. Department of Dermatology, Venereology and Leprology, Post-graduate Institute of Medical Education and Research, Chandigarh 160 012, India. Nerve involvement is common to the pathogenesis of both leprosy and herpes zoster. We report two cases of borderline leprosy in which the skin lesions characteristically spared the healed zoster scar. Possible mechanisms and relationship are discussed. PMID: 15267196 [PubMed - indexed for MEDLINE] 1290. Rev Neurol. 2004 Jul 1-15;39(1):95-6. [Central nervous system disorders caused by the herpes virus. Magnetic resonance imaging findings] [Article in Spanish] Montull-Ferrer C, Peri-Nogués J, Mercader-Sobrequés JM, Aracil-Martínez MA, Baquero M. Centre Radiològic Computaritzat (CRC)-CRMV, Barcelona, Spain. cmontull@crccorp.es PMID: 15257534 [PubMed - indexed for MEDLINE] 1291. Korean J Ophthalmol. 2004 Jun;18(1):65-9. A case of atypical progressive outer retinal necrosis after highly active antiretroviral therapy. Woo SJ, Yu HG, Chung H. Department of Ophthalmology, College of Medicine, Seoul National University, Seoul, Korea. This is a report of an atypical case of progressive outer retinal necrosis (PORN) and the effect of highly active antiretroviral therapy (HAART) on the clinical course of viral retinitis in an acquired immunodeficiency syndrome (AIDS) patient. A 22-year-old male patient infected with human immunodeficiency virus (HIV) presented with unilaterally reduced visual acuity and a dense cataract. After cataract extraction, retinal lesions involving the peripheral and macular areas were found with perivascular sparing and the mud-cracked, characteristic appearance of PORN. He was diagnosed as having PORN based on clinical features and was given combined antiviral treatment. With concurrent HAART, the retinal lesions regressed, with the regression being accelerated by further treatment with intravenous acyclovir and ganciclovir. This case suggests that HAART may change the clinical course of PORN in AIDS patients by improving host immunity. PORN should be included in the differential diagnosis of acute unilateral cataract in AIDS patients. PMID: 15255240 [PubMed - indexed for MEDLINE] 1292. Rev Neurol (Paris). 2004 Jul;160(6-7):721-5. [Thoughts on the definition of postherpetic pain: the time criterion adds nothing] [Article in French] Groupe d'Experts Douleurs Neuropathiques. In postherpetic neuralgia, as in all types of neuropathic pain, it is generally accepted that outcome can be affected early management with specific analgesics. However, when one looks at the diagnostic criteria appearing in the literature, there is no consensus. Authors use the notion of latency to situate the onset of postherpetic neuralgia within the continuum of herpetic pain. Depending on the Author, this latency period ranges from one to six Months after the skin eruption. This latency is poorly compatible with early intervention and not well-adapted to everyday practice. With the aim of finding ways to improve the management of pain, the Neuropathic Pain Expert Group agreed upon a new definition. Postherpetic neuralgia is pain in the involved site after the skin eruption has healed and which displays the features of neuropathic pain. This definition, which does away with the latency criterion, is based on the identification of one or more clinical features of neuropathic pain in a situation of treatment failure, namely: presence of chronic unsolicited pain (burning, tightness, pressure) and/or paroxysmal pain (tingling, stabbing pain) and/or mechanical hyperalgia/allodynia (to friction or pressure) and/or temperature sensitivity (to heat and/or cold). Such pain occurs in circumscribed neurologic zones in which a sensory deficit can be demonstrated and is usually associated with dysesthesia and/or paresthesia. PMID: 15247865 [PubMed - indexed for MEDLINE] 1293. Proc Natl Acad Sci U S A. 2004 Jul 20;101(29):10792-7. Epub 2004 Jul 9. Varicella-zoster virus infection of human neural cells in vivo. Baiker A, Fabel K, Cozzio A, Zerboni L, Fabel K, Sommer M, Uchida N, He D, Weissman I, Arvin AM. Department of Pediatrics, Stanford University School of Medicine, Stanford, CA 94305, USA. Varicella-zoster virus (VZV) establishes latency in sensory ganglia and causes herpes zoster upon reactivation. These investigations in a nonobese diabetic severe combined immunodeficient mouse-human neural cell model showed that VZV infected both neurons and glial cells and spread efficiently from cell to cell in vivo. Neural cell morphology and protein synthesis were preserved, in contrast to destruction of epithelial cells by VZV. Expression of VZV genes in neural cells was characterized by nuclear retention of the major viral transactivating protein and a block in synthesis of the predominant envelope glycoprotein. The attenuated VZV vaccine strain retained infectivity for neurons and glial cells in vivo. VZV gene expression in differentiated human neural cells in vivo differs from neural infection by herpes simplex virus, which is characterized by latency-associated transcripts, and from lytic VZV replication in skin. The chimeric nonobese diabetic severe combined immunodeficient mouse model may be useful for investigating other neurotropic human viruses. PMCID: PMC490013 PMID: 15247414 [PubMed - indexed for MEDLINE] 1294. J Am Acad Dermatol. 2004 Jul;51(1):123-6. Cutaneous T-cell lymphoma sparing resolving dermatomal herpes zoster lesions: an unusual phenomenon and implications for pathophysiology. Twersky JM, Nordlund JJ. Department of Dermatology, University of Cincinnati Medical Center, USA. Exclusion of cutaneous T-cell lymphoma (CTCL) by another dermatosis has not been reported. The mechanism for the epidermotropism of helper T lymphocytes in this indolent malignancy is not known. Although there is evidence that Langerhans cells (LC) play a role in the epidermotropism of lymphocytes in CTCL, clinical or in vivo support is lacking. We describe a patient with CTCL who developed herpes zoster involving the left T8 dermatome. When his CTCL became widespread after the herpes zoster healed, the previously affected areas of herpes zoster and their periphery were clinically free of lymphoma. Immunohistochemical analysis of a clinically uninvolved patch revealed absence of CD1a(+) cells in the epidermis, consistent with loss of LC in the areas spared by CTCL. There was no loss of LC in areas affected by CTCL. This is an unusual inhibition of CTCL by a prior viral infection. The loss of LC in the clinically spared skin suggests a role for LC in the epidermotropism of lymphocytes in CTCL. PMID: 15243537 [PubMed - indexed for MEDLINE] 1295. Health News. 2004 Jul;10(7):9. Older women face higher risk of post-shingles pain. [No authors listed] PMID: 15239158 [PubMed - indexed for MEDLINE] 1296. No To Shinkei. 2004 Apr;56(4):339-43. [Dramatic improvement of urinary retention and the left lower limb paresis with methylprednisolone in a case of regional encephalitis following varicella zoster infection] [Article in Japanese] Kubota M, Kawamura M. Department of Pediatrics, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan. We report a previously well 14-year-old male who developed left-sided hemiconvulsion, urinary retention and hemiplegia 1 months after varicella-zoster virus (VZV) infection. Brain T2-weighted MRI showed hyperintensity in medial fronto-parietal area including cyngulate gyrus, foot division of the motor cortex, para-central lobule and corpus callosum with right predominance, which corresponded to hyperperfusion area in SPECT study. MR angiography revealed no occlusion or narrowing of vessels. Cerebrospinal fluid (CSF) showed mononuclear pleocytosis. After methylprednisolone pulse tharapy under diagnosis of regional encephalitis, the patient recovered completely. Although polymerase chain reaction(PCR) could not detect VZV-DNA in CSF, antecedent VZV infection might be closely related to pathomechanism of the regional encephalitis. Dramatic response to steroid, rapid recovery on MRI and good prognosis supported that the underlying pathology was mainly vasogenic edema rather than cytotoxic edema. PMID: 15237726 [PubMed - indexed for MEDLINE] 1297. Eye (Lond). 2005 Feb;19(2):224-6. Horner's syndrome and sixth nerve palsy due to herpes zoster ophthalmicus arteritis. Pandey PK, Garg D, Bhatia A, Jain V. PMID: 15232597 [PubMed - indexed for MEDLINE] 1298. J Pediatr Health Care. 2004 Jul-Aug;18(4):192-7; quiz 198-9. Childhood immunizations (part two). Whitehill J, Raucci J, Sandritter T. Children's Mercy Hospital, 2401 Gillham Rd., Kansas City, MO 64108, USA. PMID: 15224044 [PubMed - indexed for MEDLINE] 1299. J Med Virol. 2004 Aug;73(4):631-5. Are false negative direct immnufluorescence assays caused by varicella zoster virus gE mutant strains? Taha YA, Quinlivan M, Scott FT, Leedham-Green M, Hawrami K, Thomas JM, Breuer J. Skin Virus Laboratory, Centre for Cutaneous Research, St Bartholomew's and The Royal London School of Medicine and Dentistry, Queen Mary College, London, United Kingdom. Strains of Varicella zoster virus (VZV) have been described recently in which a single base mutation in the gE epitope abrogates binding of the 3B3 monoclonal antibody, which is widely used for virus detection in diagnostic laboratories. These strains, named VZV-MSP, are associated with a distinct phenotype in both in vitro culture and in SCID-hu mice. We investigated the possibility that negative direct immunofluorescence results, using the 3B3 antibody, where the presence of virus was confirmed by polymerase chain reaction (PCR) or tissue culture are due in some cases to the MSP strain of VZV. A total of 249 vesicle fluid specimens from people with suspected shingles were examined using direct immunofluorescence, tissue culture and a nested multiplex PCR for VZV, herpes simplex virus type 1 (HSV-1) and 2 (HSV-2). VZV was detected in 218 of 249 (87.6%) cases. Forty-five confirmed VZV specimens, but with negative (30) or indeterminate (15) immunofluorescence results, were analysed further. PCR was used to amplify a fragment in ORF 68 that encodes the VZV gE ectodmain recognised by 3B3 antibody. The fragments were sequenced and analysed for the single base change G448A (D150N), which is present in VZV-MSP as compared with the reference Dumas strain. No VZV gE mutant (MSP/MSP-like) was detected. Overall, PCR was found to be the most sensitive method of confirming VZV infection. False negative VZV immunofluorescence results are unlikely to be due to virus variants. Copyright 2004 Wiley-Liss, Inc. PMID: 15221911 [PubMed - indexed for MEDLINE] 1300. Anesthesiology. 2004 Jul;101(1):244-7. Spinal alcohol neurolysis for intractable thoracic postherpetic neuralgia after test bupivacaine spinal analgesia. Lauretti GR, Trevelin WR, Frade LC, Lima IC. Faculty of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil. grlauret@fmrp.usp.br PMID: 15220798 [PubMed - indexed for MEDLINE] 1301. Nefrologia. 2004;24 Suppl 3:26-9. [Multiple complications after renal transplantation] [Article in Spanish] Manrique J, Rossich E, Hernández Sierra A. Servicio de Nefrología, Clínica Universitaria de Navarra, Pamplona. jmanrique@unav.es This is the case of a 32-year-old male patient, diagnosed with end stage renal disease secondary to a focal and segmental glomerulonephritis. After four years of haemodialysis, he received a renal graft from a cadaveric donor. During the following sixteen years, he developped many different complications. In the early post-transplant period, he developed a severe acute tubular necrosis and two episodes of acute rejection took place, both of them with later recovery. Among the outstanding infectious complications were a virus herpes zoster dorsal infection and a Pseudomonas aeruginosa nosocomial pneumonia. Twelve months later, a series of severe digestive complications took place: cholecystitis that required cholecystectomy, pancreatic pseudocyst which required laparotomy because of an abdominal complication, two separate episodes of upper digestive bleeding that finally required gastric surgery, and an hemorrhagic subphrenic abscess that required a second laparotomy. Currently he has developed a calcified chronic pancreatitis. Moreover, metabolic complications must be mentioned carbohydrate intolerance, cataracts and an avascular bone necrosis, all of them closely related to the immunosuppressive therapy. In spite of these multiple complications, he mantains a good renal function and his quality of life is acceptable. PMID: 15219064 [PubMed - indexed for MEDLINE] 1302. J Oral Maxillofac Surg. 2004 Jul;62(7):840-4. The use of botulinum toxin type A in the treatment of Frey and crocodile tears syndromes. Kyrmizakis DE, Pangalos A, Papadakis CE, Logothetis J, Maroudias NJ, Helidonis ES. Department of Otolaryngology, University of Crete School of Medicine, Heraklion, Crete, Greece. dkyrmiz@yahoo.com PURPOSE: We sought to investigate the efficacy of botulinum toxin type A in the treatment of Frey and crocodile tears syndromes. Frey syndrome is a common complication after surgical intervention or injury in the region of the parotid gland. Crocodile tears syndrome is unusual and manifests after facial nerve paralysis and other causes such as head trauma. PATIENTS AND METHODS: This was a prospective nonrandomized, nonblinded study. We used botulinum toxin type A for the treatment of 11 patients with gustatory sweating and 2 patients with crocodile tears syndrome. RESULTS: The follow-up (6 to 23 months) of patients with gustatory sweating syndrome showed complete absence of sweating in the affected regions. One patient had recurrence after 16 months and was retreated successfully. At 1 and 24 weeks after treatment of the patients with the crocodile tears syndrome, the Schirmer test showed a reduction of stimulated lacrimation on the impaired side approaching the normal values of the unaffected side. CONCLUSIONS: Our study supports the widely accepted aspect that botulinum toxin type A could be the treatment of choice for gustatory sweating syndrome. We also propose the toxin as a valuable treatment for crocodile tears syndrome. PMID: 15218563 [PubMed - indexed for MEDLINE] 1303. Prog Urol. 2004 Apr;14(2):224-6; discussion 226. [Urinary retention secondary to herpes zoster infection] [Article in French] Gamé X, Bigay-Gamé L, Bialek D, Sailler L, Astudillo L, Rischmann P. Service d'Urologie, d'Andrologie et de Transplantation Rénale, CHU Rangueil, Toulouse, France. xaviergame@hotmail.com The authors report the cases of 67-year-old male patient who suddenly developed urinary retention concomitant with herpes zoster of the left buttock. Urodynamic assessment showed a hyposensitive and atonic bladder. Voiding gradually returned after 10 weeks and, after 14 weeks, the patient no longer presented any voiding disorders. This case illustrates a rare complication of herpes zoster. It can occur in any site of infection, but is more frequent in the case of lumbosacral lesions. Urinary retention is spontaneously reversible over a mean interval of 6 to 10 weeks and treatment is based on self-catheterization. PMID: 15217143 [PubMed - indexed for MEDLINE] 1304. J Infect Dis. 2004 Jul 15;190(2):267-70. Epub 2004 Jun 9. Varicella-Zoster virus-specific cell-mediated immunity in HIV-infected children receiving highly active antiretroviral therapy. Weinberg A, Wiznia AA, LaFleur BJ, Shah S, Levin MJ. Section of Pediatric Infectious Diseases, and Department of Medicine, University of Colorado School of Medicine, Denver, Colorado, USA. adriana.weinberg@uchsc.edu Herpes zoster (HZ) is a frequent complication of advanced human immunodeficiency virus (HIV) infection. We determined the effect of highly active antiretroviral therapy (HAART) on reconstitution of varicella-zoster virus (VZV)-specific cell-mediated immunity (VZV-CMI) in 56 VZV- and HIV-infected children. VZV-CMI did not change over the course of >/=3 years of observation, despite a reduction in HIV load. VZV-CMI correlated with lower HIV load but not with CD4 cell percentage. The incidence of HZ was unaffected by HAART. None of 5 patients who developed HZ during the study had VZV-CMI before developing HZ. After developing HZ, only the 2 HAART-compliant patients developed VZV-CMI. Thus, VZV-specific immune reconstitution in HIV infection may require antigenic reexposure, in addition to control of HIV replication. PMID: 15216460 [PubMed - indexed for MEDLINE] 1305. Neurosurgery. 2004 Jul;55(1):135-41; discussion 141-2. Peripheral stimulation for treatment of trigeminal postherpetic neuralgia and trigeminal posttraumatic neuropathic pain: a pilot study. Johnson MD, Burchiel KJ. Department of Neurological Surgery, Harvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts, USA. OBJECTIVE: Trigeminal neuropathic pain (TNP) after facial trauma or herpes zoster infection is often refractory to treatment. Peripheral nerve stimulation has been used to treat occipital neuralgia; however, efficacy in controlling facial TNP or postherpetic neuralgia is unknown. A retrospective case series of patients who underwent subcutaneous placement of stimulating electrodes for treatment of V(1) or V(2) TNP secondary to herpetic infection or facial trauma is presented. METHODS: Ten patients received implanted subcutaneous pulse generators and quadripolar electrodes for peripheral stimulation of the trigeminal nerve supraorbital or infraorbital branches. Long-term treatment results were determined by retrospective review of medical records (1998-2003) and by independent observers interviewing patients using a standard questionnaire. Surgical complication rate, preoperative symptom duration, degree of pain relief, preoperative and postoperative work status, postoperative changes in medication usage, and overall degree of therapy satisfaction were assessed. Mean follow-up was 26.6 +/- 4.7 months. RESULTS: Peripheral nerve stimulation provided at least 50% pain relief in 70% of patients with TNP or postherpetic neuralgia. Medication use declined in 70% of patients, and 80% indicated that they were mostly or completely satisfied with treatment overall. There were no treatment failures (<50% pain relief and a lack of decrease in medication use) in the posttraumatic group, and two failures (50%) occurred in the postherpetic group. The complication rate requiring reoperation was 30%. CONCLUSION: Peripheral nerve stimulation of the supraorbital or infraorbital branches of the trigeminal nerve is an effective method for relief of TNP after facial trauma or herpetic infection. A prospective trial using this novel approach to treat these disorders is thus warranted. PMID: 15214982 [PubMed - indexed for MEDLINE] 1306. Neuromuscul Disord. 2004 Jul;14(7):438-41. External ophthalmoplegia due to ocular myositis in a patient with ophthalmic herpes zoster. Krasnianski M, Sievert M, Bau V, Zierz S. Department of Neurology, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany. sekretariat.neurologie@medizin.uni-halle.de External ocular muscle palsies in patients with ophthalmic zoster are traditionally interpreted as diseases of III, IV or VI cranial nerves. Orbital myositis associated with zoster ophthalmicus has been diagnosed only rarely. We describe a patient with ophthalmic zoster and external ophthalmoplegia due to ocular myositis demonstrated by MR imaging. Treatment with acyclovir and cortisone resulted in a rapid improvement of the ophthalmoplegia. In ophthalmic herpes zoster associated with external ocular muscle palsies, ocular myositis is an important differential diagnosis to inflammatory involvement of the cranial nerves III, IV, and VI. PMID: 15210167 [PubMed - indexed for MEDLINE] 1307. J Am Geriatr Soc. 2004 Jul;52(7):1221-2. Squamous cell carcinoma occurring at site of prior herpes zoster of the scalp: case report of Marjolin ulcer. Mishra D, Raji MA. PMID: 15209673 [PubMed - indexed for MEDLINE] 1308. Ocul Immunol Inflamm. 2004 Mar;12(1):17-24. Immune deviation and ocular infections with varicella zoster virus. Kezuka T. Department of Ophthalmology, Tokyo Medical University, Tokyo, Japan. tkezuka@tokyo-med.ac.jp Since experimental, herpes simplex virus-induced acute retinal necrosis (ARN) develops in mice only if the mice fail to acquire virus-specific delayed hypersensitivity (DH) and despite their production of anti-viral antibodies (i.e. ACAID), I investigated whether a similar situation exists for patients with either varicella zoster virus (VZV)-induced ARN or anterior uveitis caused by VZV. Patients with either acute VZV-induced ARN, anterior uveitis with dermatitis (herpes zoster ophthalmicus, ZO-AU), or anterior uveitis without dermatitis (zoster sine herpete, ZSH-AU) were skin-tested with VZV to evaluate DH. The formal diagnoses of ARN associated with VZV, ZO-AU, and ZSH-AU were established by PCR analysis of the ocular samples and/or by the Goldmann-Witmer coefficient to determine levels of local antibody production. ARN, ZO-AU, and ZSH-AU activity were assessed clinically, and DH skin tests were repeated three months after onset when ocular recovery had taken place. All patients with VZV-induced skin disease alone (control group) displayed intense DH when tested with VZV antigen. In contrast, subsets of patients with ARN or ZO-AU displayed loss of VZV-specific DH. Patients with the most severe ARN or ZO-AU had the lowest DH responses to VZV antigens. Serum anti-VZV antibody titers were higher in ARN patients than in normal controls, and the anti-viral titer correlated inversely with the intensity of anti-VZV DH responses. VZV-specific DH responses were restored in patients who recovered from ARN. Patients with ZSH-AU also failed to display VZV-specific DH. The absence of DH reactivity to VZV antigens (i.e. immune deviation) appears to be a concomitant feature of VZV uveitis of high intensity, implying that virus-specific DH may interfere with the emergence of VZV-induced ARN or anterior uveitis. PMID: 15209460 [PubMed - indexed for MEDLINE] 1309. Laryngorhinootologie. 2004 Jun;83(6):355-62. [Herpes zoster oticus: symptom constellation and serological diagnosis] [Article in German] Walther LE, Prosowsky K, Walther A, Gudziol H. Universitäts-HNO-Klinik, Friedrich-Schiller-Universität Jena. LWalther@ukaachen.de BACKGROUND: Herpes zoster oticus is a rare illness with cutaneous symptoms (eruptions) and a colored picture of brain nerve failures. The clinical symptoms, the symptom constellation, diagnostics and therapy, however, have been examined till now only in few studies. PATIENTS AND METHODS: In this study 91 cases of a zoster oticus were looked at in retrospect from the complete archives of the university ENT clinic Jena/Germany in the period from 1932 to 2001. Inclusion criterion was the occurrence eruptions in the ear region. The demographic data, subjective and objective symptoms, the symptom constellations, diagnostic methods and the therapy were arranged. RESULTS: Women (68.1 %) were concerned more frequently than men (31.9 %). The average illness age was 51.2 days. The prodromal stage lasted for 2.2 days in the average. Earache (50.2 %) and headache (11.0 %) were the most frequent first symptoms. No prodroma appeared in 27.5 % of the cases. The facial nerve (86.8 %) was most frequently affected, the vestibular nerve in 76.9 % and the cochlear nerve in 36.3 %. Other brain nerve damages were extremly rare. The therapy success was identical with regard to the brain nerve regeneration at all times. A positive antibody titer for VZV-IgM and/or IgA or an IgG is a sign for an acute infektion. VZV-IgA antibody titers appeared more constantly, frequent and early than an IgM. CONCLUSIONS: Women have a greater risk of falling ill at a zoster oticus than men. Although more than 72 hours is behind the beginning of the symptoms in this study, treatment with virostatic drugs should always be carried out in zoster oticus. Different therapy methods do not have any influence to the success therapy of the therapy. The facial nerve showed the best cure trend. A postzosteric pain develops approximately the half of the cases at the zoster oticus. The serological diagnostic is not necessary in clinically clear cases. PMID: 15197674 [PubMed - indexed for MEDLINE] 1310. Med J Malaysia. 2003 Dec;58(5):771-3. Bilateral optic neuritis in pregnancy. Suraiya MS, Norazlina B, Carmen C, Muhaya M. Department of Ophthalmology, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur. A 25-year old primigravida at 11-weeks period of amenorrhoea presented with bilateral optic neuritis following Varicella Zoster viral (VZV) infection. She was serologically positive for systemic lupus erythematosus but negative for virus. The exact pathogenesis of the patient's severe optic neuritis, adduction and neurological deficit was unknown. The initiation of high dose steroids for optic neuritis was a big clinical dilemma in a pregnant patient with viral infection. The patient was treated with high dose steroids after three days of commencement of antiviral treatment. At 6 months after presentation, her visual acuity in the right eye was 6/36 with perception to light in the left. PMID: 15190668 [PubMed - indexed for MEDLINE] 1311. AIDS Patient Care STDS. 2004 May;18(5):255-7. Failure of valacyclovir for herpes zoster in a moderately immunocompromised HIV-infected patient. Breton G, Bouldouyre MA, Gervais A, Duval X, Longuet P, Leport C, Vildé JL. Department of Infectious and Tropical Diseases Bichat Claude Bernard Hospital, Paris, France. guillaume.breton@bch.ap-hop-paris.fr Whereas valacyclovir is widely used and is recommended by some authors in moderately immunocompromised HIV-infected patients, its use has not been validated by clinical studies. We report a case of herpes zoster in an HIV-infected patient for whom neurologic complication was not avoided despite valacyclovir therapy. Clinical outcome was favorable after intravenous acyclovir. This case suggests careful monitoring of valacyclovir in HIV-infected patients is necessary. PMID: 15186709 [PubMed - indexed for MEDLINE] 1312. Eye (Lond). 2005 Jun;19(6):692-3. A hypopyon is a sign of post-trabeculectomy endophthalmitis or not? Kaburaki T, Sato S, Kawashima H, Sakurai M, Numaga J, Fujino Y, Araie M. Comment on: Eye (Lond). 2003 Jul;17(5):656-8. PMID: 15184940 [PubMed - indexed for MEDLINE] 1313. J Microbiol Immunol Infect. 2004 Apr;37(2):75-81. Double-blind, randomized, acyclovir-controlled, parallel-group trial comparing the safety and efficacy of famciclovir and acyclovir in patients with uncomplicated herpes zoster. Shen MC, Lin HH, Lee SS, Chen YS, Chiang PC, Liu YC. Section of Infectious Diseases, Department of Medicine, Kaohsiung Veterans General Hospital, 386 Ta-chung 1st Road, Kaohsiung, Taiwan 813, ROC. This randomized, double-blind, parallel-group study compared the efficacy and safety of famciclovir administered at 250 mg thrice daily with acyclovir 800 mg 5 times daily for the treatment of acute uncomplicated herpes zoster in immunocompetent adults. A total of 55 patients participated in this trial. Twenty seven patients (49.1%) were randomized into the famciclovir plus placebo treatment group and 28 (50.9%) into the acyclovir plus placebo group. Six of the 55 patients did not complete the study. Two of these patients were in the famciclovir plus placebo group and dropped out due to deviation from the study protocol. Four patients in the acyclovir plus placebo group did not complete the study protocol due to adverse events (n = 2), deviation from the protocol (n = 1), or loss to follow-up (n = 1). Treatment was initiated within 72 h of onset of the zoster rash and was continued for 7 days. When treatment was initiated within 72 h, famciclovir was as effective as acyclovir for healing the cutaneous lesion, as indicated by the time to full crusting, loss of acute phase pain, loss of vesicles, and loss of crusts. Famciclovir was well tolerated and had a more favorable adverse event profile compared to acyclovir. Constipation, hematuria, and glycosuria were the most commonly reported adverse events, but only constipation was considered to have a possible relationship to the treatment. In conclusion, famciclovir, administered less frequently and at lower unit doses than acyclovir, is an effective treatment for uncomplicated herpes zoster. PMID: 15181487 [PubMed - indexed for MEDLINE] 1314. AIDS. 2004 May 21;18(8):1218-21. Compartmentalization of the immune response in varicella zoster virus immune restoration disease causing transverse myelitis. Clark BM, Krueger RG, Price P, French MA. PMID: 15166543 [PubMed - indexed for MEDLINE] 1315. Virology. 2004 May 20;323(1):85-90. Varicella-Zoster virus proteins encoded by open reading frames 14 and 67 are both dispensable for the establishment of latency in a rat model. Grinfeld E, Sadzot-Delvaux C, Kennedy PG. Department of Neurology, Division of Clinical Neurosciences, Institute of Neurological Sciences, Southern General Hospital, Glasgow, Scotland, UK. A rat model of Varicella-Zoster virus (VZV) provides a system in which to investigate the molecular determinants of viral latency in dorsal root ganglia (DRG). In this study, we determined whether the VZV glycoproteins gC and gI, corresponding to VZV open reading frames (ORFs) 14 and 67, respectively, were required for the establishment of latency in this model. A VZV gI deletion mutant (DeltagI) derived from a recombinant Oka (rOka) cosmid and a gC null mutant obtained from a clinical isolate were inoculated into the footpads of 6-week-old rats, and the presence of viral DNA and eight different VZV RNA transcripts corresponding to the three classes of genes was investigated by in situ RT-PCR amplification and in situ hybridization (ISH) in the DRG at 1 week, 1 month, and 18-24 months after infection. VZV DNA and restricted RNA expression was established with both deletion mutants as well as the parental rOka virus. Both VZV DNA and RNA were detected in neurons and non-neuronal cells. The pattern of viral RNA expression detected with both gC and gI mutants was restricted with transcripts for VZV genes 62 and 63 most frequently expressed 18-24 months after infection. Transcripts for VZV genes 18, 28, and 29 were also detected at these time points but at a slightly lower frequency. Transcripts for the late gene 40 were never detected. We conclude that VZV ORFs 14 and 67 are dispensable for the establishment of a latent infection in this model. PMID: 15165821 [PubMed - indexed for MEDLINE] 1316. Pediatr Dermatol. 2004 May-Jun;21(3):279-80. Childhood herpes zoster complicated by neurogenic bladder dysfunction. Pandhi D, Reddy BS. PMID: 15165218 [PubMed - indexed for MEDLINE] 1317. Nihon Shinkei Seishin Yakurigaku Zasshi. 2004 Apr;24(2):79-81. [Postherpetic neuralgia alleviated by an SSRI fluvoxamine: two cases of PHN accompanied with depression were treated with fluvoxamine] [Article in Japanese] Ohyama S, Kuniyoshi M, Nishi S, Inanaga K. Chikusuikai Hospital, 1191, Yoshida, Yame, 834-0006 Japan. Case 1: female, age 76. Fluvoxamine (50 mg/day) initiated a reduction of pain on the 14th day of administration and completely ameliorated pain as well as depression. Case 2: female, age 76. Fluvoxamine (25 mg/day) was administered with tandospirone (15 mg/day) which augments the effect of an SSRI. This combination regimen induced a reduction of PHN-pain on the 10th day and as the analgesic effect attained nearly 50%, there occurred a reflaming of pain on the 35th day. Increasing fluvoxamine to 50 mg/day reameliorated pain on the 49th day, and a further increase to 75 mg/day finally eliminated pain and depression at the end of the 3rd month. The long latency of fluvoxamine action, its shortening by tandospirone and the parallel changes of PHN and depression are all indicative of that the same mechanism, namely renormalization of the dysfunctioned central serotonergic transmission would be underlying both the anti-PHN and antidepressant actions. It would be concluded that fluvoxamine alleviates PHN by restoration of the descending serotonergic inhibition of primary afferent activity that carries pain impulses. PMID: 15164615 [PubMed - indexed for MEDLINE] 1318. Emerg Nurse. 2004 May;12(2):14-21. Cranial nerve damage. Cox CL, Boswell GM, McGrath A, Reynolds T, Cole E. City University, St Bartholomew's School of Nursing and Midwifery, London. PMID: 15160588 [PubMed - indexed for MEDLINE] 1319. Harv Womens Health Watch. 2004 May;11(9):6-7. Managing shingles and postherpetic neuralgia. Reactivation of the chickenpox virus causes severe pain and rash in older adults. [No authors listed] PMID: 15153382 [PubMed - indexed for MEDLINE] 1320. Neurology. 2004 May 11;62(9):1545-51. Risk factors for postherpetic neuralgia in patients with herpes zoster. Jung BF, Johnson RW, Griffin DR, Dworkin RH. University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA. OBJECTIVES: To identify risk factors for postherpetic neuralgia (PHN) using a validated definition of this chronic neuropathic pain syndrome, to determine combinations of risk factors that identify patients with a high risk of developing PHN, and to examine the characteristics of patients with subacute herpetic neuralgia, that is, pain that persists beyond the acute phase of herpes zoster but that resolves before PHN can be diagnosed. METHODS: The authors examined baseline and follow-up data from 965 herpes zoster patients enrolled within 72 hours of rash onset in two clinical trials of famciclovir. RESULTS: Univariate and multivariate analyses indicated that older age, female sex, presence of a prodrome, greater rash severity, and greater acute pain severity made independent contributions to identifying which patients developed PHN. Patients with subacute herpetic neuralgia who did not develop PHN were significantly younger and had less severe acute pain than PHN patients but were significantly more likely to have severe and widespread rash than patients without persisting pain. CONCLUSIONS: The independent contributions to the prediction of PHN made by older age, female sex, presence of a prodrome, greater rash severity, and greater acute pain severity suggest that these risk factors reflect different mechanisms that each contribute to the development of PHN. Subacute herpetic neuralgia that does not progress to PHN may reflect peripheral tissue damage and inflammation caused by a particularly severe or widespread rash. PMID: 15136679 [PubMed - indexed for MEDLINE] 1321. Eur J Ophthalmol. 2004 Mar-Apr;14(2):85-93. Corneal surface changes in Thygeson's superficial punctate keratitis: a clinical and non-contact photomicrographic in vivo study in the human cornea. Tabery HM. Department of Ophthalmology, Malmö University Hospital, Malmö, Sweden. helena.tabery@skane.se PURPOSE: To elucidate mechanisms behind the morphology of Thygeson's superficial punctate keratitis (TSPK). METHODS: Sixteen patients were examined with the slit lamp and photographed by non-contact photomicrography. The results were compared with morphology of epithelial keratitis in herpes simplex type 1 (HSV1), varicella zoster (VZV), and adenovirus type 8 (Ad8) infections, all previously studied by the same method, and with published histologic findings in TSPK. RESULTS: In the photographs, the corneal epithelium showed various numbers of abnormal subsurface cells measuring about 10-15 microm in diameter, present individually, in small groups, or aggregated in larger lesions (coarse lesions with the slit lamp). The surface epithelium was well preserved, except in larger lesions, which showed surface debris. The morphology was unlike HSV1 and VZV epithelial keratitis, but strongly resembled epithelial changes occurring in Ad8 infections on day 5, and later, after the onset of symptoms. CONCLUSIONS: TSPK shows a more widespread epithelial involvement than suspected with the slit lamp. Its morphology seems to reflect an action of a noxious agent targeted at the deeper epithelial layers, with the appearance of abnormal cells as a result. These might represent invading inflammatory cells, damaged intraepithelial ones, or both. The coarse lesions visualize areas of major involvement showing discernible signs of cell destruction. The similarity to Ad8 keratitis suggests that the source of the noxious agent might be located outside the cornea. The morphology, in conjunction with clinical features, is compatible with an immunologically mediated injury. The etiology remains unknown. PMID: 15134103 [PubMed - indexed for MEDLINE] 1322. Skinmed. 2004 May-Jun;3(3):130-1. Ramsay Hunt syndrome revisited. Mishriki YY. The Pennsylvania State University School of Medicine and Division of General Internal Medicine, Lehigh Valley Hospital, Allentown, PA 18103, USA. yehia.miskriki@lvh.com PMID: 15133391 [PubMed - indexed for MEDLINE] 1323. Eye (Lond). 2004 May;18(5):544-5. Oral valganciclovir treatment of varicella zoster virus acute retinal necrosis. Savant V, Saeed T, Denniston A, Murray PI. Comment in: Eye (Lond). 2006 Feb;20(2):247. PMID: 15131692 [PubMed - indexed for MEDLINE] 1324. Pediatr Infect Dis J. 2004 May;23(5):451-7; quiz 458-60. Herpes zoster in otherwise healthy children. Feder HM Jr, Hoss DM. Department of Pediatrics, University of Connecticut Health Center, Farmington, CT, USA. In normal infants and children, zoster can occur at any time after varicella or varicella vaccination. It is usually diagnosed clinically: a unilateral vesicular eruption following a dermatome or dermatomes. The incidence of zoster increases with age, although children who have had varicella during the first year of life (or in utero) are at increased risk of developing zoster. The incidence of zoster is less after varicella vaccination than after natural infection. Zoster in children is frequently mild, postzoster neuralgia rarely if ever occurs, and antiviral therapy is usually not needed. In a previously normal child with zoster, if the history and physical examination are normal, a laboratory search for occult immunodeficiency or malignancy is not needed. We present five cases of zoster in healthy children and review zoster in the pediatric age group. PMID: 15131470 [PubMed - indexed for MEDLINE] 1325. Pediatr Infect Dis J. 2004 May;23(5):379-89. Consensus: varicella vaccination of healthy children--a challenge for Europe. Rentier B, Gershon AA; European Working Group on Varicella. Fundamental Virology Unit, University of Liége, Belgium. brentier@ulg.ac.be The seriousness of varicella-zoster virus (VZV) infection as a public health issue is becoming clearer as country-specific epidemiologic and pharmacoeconomic data become available. In Germany, for example, studies have shown that >5.5% of immunologically healthy individuals develop varicella-related complications such as bacterial superinfections, acute neurologic disorders, pneumonia, bronchitis and otitis media; whereas in Italy, 3.5 to 5% of childhood cases of varicella cause complications such as upper respiratory tract and cutaneous infections. Varicella vaccines are now available. These live attenuated Oka strain vaccines have been shown in extensive studies to be highly immunogenic and well-tolerated in immunocompetent and immunocompromised children, with seroconversion rates ranging from 94 to 100% and 53 to 100%, respectively. These vaccines are also highly effective against clinical disease. These considerations led to a reevaluation of varicella vaccination policies. A routine varicella vaccination program targeting healthy children has already been implemented in the US, and data produced are encouraging and valuable. Similar strategies have not yet been adopted across Europe. The European Working Group on Varicella (EuroVar) was formed in 1998 to address the issues surrounding varicella epidemiology in Europe. After a series of meetings, the EuroVar members prepared a consensus statement recommending routine varicella vaccination for all healthy children between 12 and 18 months and to all susceptible children before their 13th birthday, in addition to catch-up vaccination in older children and adults who have no reliable history of varicella and who are at high risk of transmission and exposure. However, such a policy is recommended only if a very high coverage rate can be achieved. This could be reached with a measles-mumps-rubella-varicella combined vaccine. PMID: 15131459 [PubMed - indexed for MEDLINE] 1326. Int J Dermatol. 2004 Feb;43(2):136-7. Mandibular alveolar bone necrosis after trigeminal herpes zoster. Arikawa J, Mizushima J, Higaki Y, Hoshino J, Kawashima M. Department of Dermatology, Tokyo Women's Medical University, and Hoshino Dental Clinic, Tokyo, Japan. jun-ari@derm.twmu.ac.jp PMID: 15125505 [PubMed - indexed for MEDLINE] 1327. Int J Dermatol. 2004 Feb;43(2):126-8. Zosteriform skin metastases. LeSueur BW, Abraham RJ, DiCaudo DJ, O'Connor WJ. Mayo Clinic Scottsdale, Department of Dermatology, Scottsdale, AZ 85259, USA. benjamin.lesueur@mayo.edu PMID: 15125503 [PubMed - indexed for MEDLINE] 1328. Ceylon Med J. 2003 Dec;48(4):119-21. Varicella-zoster virus infection in the Infectious Diseases Hospital, Sri Lanka. Welgama U, Wickramasinghe C, Perera J. Infectious Diseases Hospital, Sri Lanka. OBJECTIVES: To determine the morbidity and mortality patterns of varicella and risk factors affecting its outcome, and the facilities available at the Infectious Diseases Hospital (IDH), Sri Lanka. METHODS: A retrospective study on all patients admitted with varicella-zoster virus (VZV) infection to the IDH from August 2000 to July 2001. Data were collected from the hospital records. RESULTS: Among the 1690 patients admitted during the study period, 1090 (64.9%) were due to VZV infection. Nine hundred and eighty nine (90.7%) had varicella and 101 (9.3%) herpes zoster. Common complications were secondary bacterial infection (62.1%), neurological complications (3.4%), pneumonia (9.1%) and carditis (1.01%). They were significantly commoner in patients with coexisting diseases. Hospital stay was significantly shorter in patients who received early aciclovir, which was not available on a regular basis. Forty one patients died and mortality was highest in the elderly. The commonest cause of death was pneumonia. CONCLUSIONS: Varicella related complications are high in patients with coexisting diseases. Mortality rates are higher than reported elsewhere. Health care facilities available at IDH are quite inadequate, and should be improved. PMID: 15125402 [PubMed - indexed for MEDLINE] 1329. J Rheumatol. 2004 May;31(5):925-30. Unique angiopathy after herpes virus infection. Shimizu J, Inatsu A, Oshima S, Kubota T. Department of Medicine, the Japan Self Defense Forces Central Hospital, Tokyo, Japan. hemijun@nyc.odn.ne.jp OBJECTIVE: We describe 3 Japanese patients with peculiar renal and/or coronary arterial stenosis and/or multiple aneurysms after herpes virus infection, following ischemic symptoms. We investigated for viral antigens and viral DNA in situ, and for shared abnormalities of cellular immunity. METHODS: Panarteriography was performed diagnostically, and patients were grouped as follows: 3 patients with peculiar renal and/or coronary artery narrowing and/or multiple aneurysms; another 3 patients with renal fibromuscular dysplasia; and other young adults with effort angina, with no history of herpes virus infection, as controls. Detection of viral antigens and viral DNA in situ was done by polymerase chain reaction method and immunohistochemical staining. Cellular immunity was examined at the time of ischemic symptoms. RESULTS: Viral antigens and DNA were scarcely detected, except in herpes zoster skin lesion with leukocytoclastic vasculitis. However, shared abnormalities of cellular immunity, such as a decreased CD4+ T cell number and reduced natural killer cell activity, were more prominent in the 3 patients with unique vasculopathy after herpes virus infection. CONCLUSION: Unique vasculopathy following herpes virus infection might be a more severe and extensive disease. We speculate that sustained viral infection, repetitive activation of virus related antigens, and suppressed immune state might contribute to formation of peculiar vascular alterations. PMID: 15124252 [PubMed - indexed for MEDLINE] 1330. J Tradit Chin Med. 2004 Mar;24(1):51-2. Acupuncture treatment of 3 difficult cases according to Dr. Xu Benren's experience. Zhang Z. Qingdao Sanatorium of the Air Force, Qingdao, Shandong Province 266071. PMID: 15119177 [PubMed - indexed for MEDLINE] 1331. J Tradit Chin Med. 2004 Mar;24(1):24-5. Clinical application of moxibustion. Wang S, Wei H. Central Hospital of Handan City, Hebei Province, 056001. PMID: 15119165 [PubMed - indexed for MEDLINE] 1332. Dermatology. 2004;208(3):206-16. Systematic overview of the pharmacological management of postherpetic neuralgia. An evaluation of the clinical value of critically selected drug treatments based on efficacy and safety outcomes from randomized controlled studies. Plaghki L, Adriaensen H, Morlion B, Lossignol D, Devulder J. Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium. plaghki@read.ucl.ac.be OBJECTIVE: This study systematically reviews current evidence on drug treatments commonly used in postherpetic neuralgia. METHODS: Randomized controlled trials were critically selected using predefined search criteria. Efficacy was evaluated as percentage of improvement in pain intensity between baseline and endpoint, tolerability by number of study discontinuations because of adverse events and incidence of adverse events. RESULTS: Currently published trials enrolled different patient populations and small patient numbers. The great variability in doses, titration schemes, designs and washout periods together with other design flaws made comparison between different studies scientifically impossible. CONCLUSIONS: There is a real need for well-performed clinical trials with standardization in design and reporting. Development of adequate and validated questionnaires for evaluation and comparison of efficacy and safety of treatments is also needed. Based on the evaluation of individual studies, it is concluded that only gabapentin is studied in large (over 200 patients), placebo-controlled studies showing good efficacy and safety. Copyright 2004 S. Karger AG, Basel PMID: 15118369 [PubMed - indexed for MEDLINE] 1333. Clin Exp Dermatol. 2004 May;29(3):323; author reply 324. Which term should be used to describe drug eruptions confined to sites of previous herpes zoster lesions, 'isotopic response' or 'recall phenomenon'? Mizukawa Y, Shiohara T. Comment on: Clin Exp Dermatol. 2002 Mar;27(2):132-4. PMID: 15115529 [PubMed - indexed for MEDLINE] 1334. Plast Reconstr Surg. 2004 May;113(6):1838-40. Herpes zoster as a rare complication of liposuction. Andrews TR, Perdikis G, Shack RB. Departments of Plastic and Reconstructive Surgery, Mayo Clinic Jacksonville, 4500 San Pablo Road, Jacksonville, FL 32224, USA. Liposuction typically has a low incidence of complications and is associated with significant cosmetic benefit. In this case, the patient developed a dermatomal rash with vesicles on an erythematous base consistent with herpes zoster 8 days after liposuction to the back and flanks. To the authors' knowledge, herpes zoster has not been previously reported as a complication of liposuction. Although the precise relationship of herpes zoster infection to the liposuction procedure is difficult to determine, mechanical irritation most likely reactivated the varicella zoster virus in the involved dermatomal distribution. The patient was treated with antiviral and analgesic medications and healed without any further complications. PMID: 15114155 [PubMed - indexed for MEDLINE] 1335. J Virol Methods. 2004 Jul;119(1):25-30. Immunofluorescence test for sensitive detection of varicella-zoster virus-specific IgG: an alternative to fluorescent antibody to membrane antigen test. Sauerbrei A, Färber I, Brandstädt A, Schacke M, Wutzler P. Institute of Virology and Antiviral Therapy, Friedrich-Schiller University of Jena, Postfach, D-07740 Jena, Germany. Andreas.Sauerbrei@med.uni-jena.de A highly sensitive indirect fluorescence antibody test (IFAT) has been developed on the basis of varicella-zoster virus (VZV)-infected human lung carcinoma (A549) cells and evaluated for the determination of immunity to VZV. Different serum panels with negative, low, moderate or high anti-VZV IgG levels detected by the fluorescent antibody to membrane antigen (FAMA) assay were investigated. As a result, the sensitivity and the specificity of IFAT were 100% compared to FAMA test. In anti-VZV IgG-positive sera, a significant correlation between the results of FAMA procedure and IFAT could be shown. However, there were considerably higher antibody titers by the IFAT than by FAMA. Whereas the FAMA test had a detection limit of 250 mIU/ml anti-VZV IgG, the limit of detection of IFAT was 50 mIU/ml. In conclusion, the IFAT using VZV-infected A549 cells as antigen allows a highly sensitive, specific, and rapid detection of anti-VZV IgG class antibodies. This simple technique can replace the labor-intensive FAMA procedure for laboratory determination of immunity to VZV. PMID: 15109817 [PubMed - indexed for MEDLINE] 1336. Geriatr Nurs. 2004 Mar-Apr;25(2):120-1. Pharmacology update-managing postherpetic neuralgia. Luggen AS. Northern Kentuckey University, Highland Heights, USA. PMID: 15107799 [PubMed - indexed for MEDLINE] 1337. Antibiot Khimioter. 2003;48(11):7-9. [Effect of L-lysine-alpha-oxidase gel on development of ophthalmic herpes and herpetic skin lesions in rabbit] [Article in Russian] Smirnova IP, Alekseev SB, Podboronov VM. Russian Peoples' Friendship University, Moscow. N.F. Gamaleya Research Institute of Epidemiology and Microbiology, Russian Academy of Medical Sciences, Moscow. The effect of various doses of L-lysine-alpha-oxidase gel (1.4-3.5 and 70 mcg/ml) on development of eye and skin herpetic lesions due to type 1 herpes simplex virus was studied on rabbits. The doses of 1.4 to 3.5 mcg/ml were not sufficient for the therapeutic effect. The dose of 70 mcg/ml provided complete healing of the lesions in 3 to 4 days. The results were confirmed by the immunological tests. PMID: 15106305 [PubMed - indexed for MEDLINE] 1338. Rinsho Ketsueki. 2004 Mar;45(3):250-1. [Progressive outer retinal necrosis in a patient with malignant lymphoma] [Article in Japanese] Takei Y, Usui N, Dobashi N, Hagino T, Okawa Y, Takahara S, Asai O, Kobayashi M. Division of Hematology and Oncology, Department of Internal Medicine, Jikei University School of Medicine. A 29-year-old man with diffuse large B-cell lymphoma treated by radiotherapy for his relapsed lesion followed by 4 doses of weekly rituximab was admitted to our hospital with interstitial pneumonia. After steroid pulse therapy, he had contraction of the left visual field. He was diagnosed as having progressive outer retinal necrosis due to a varicella-zoster virus that was detected from the left vitreous sample. Systemic antiviral treatment failed to prevent rapid development of whole layer necrosis of the left retina. Vitrectomy with silicone oil tamponade saved his final visual acuity. This unusual event might be related to rituximab causing deterioration of humoral immunity. PMID: 15103942 [PubMed - indexed for MEDLINE] 1339. Kansenshogaku Zasshi. 2004 Jan;78(1):64-9. A case of fatal varicella zoster infection with refractory abdominal pain as an early symptom. Yakushijin Y, Minamoto Y, Takada K, Otsuka M, Yasukawa M, Fujita S. First Department of Internal Medicine, Ehime University School of Medicine, Onsen-gun, Shigenobu-cho, Ehime 791-0295, Japan. PMID: 15103896 [PubMed - indexed for MEDLINE] 1340. Drugs. 2004;64(9):937-47. Review of lidocaine patch 5% studies in the treatment of postherpetic neuralgia. Davies PS, Galer BS. Department of Neurology, Seattle Veterans' Medical Center, Seattle, Washington, USA. Postherpetic neuralgia (PHN) is a chronic pain syndrome that disproportionately affects the elderly; its incidence is anticipated to increase as the population ages. PHN presents as pain (continuous burning or intense paroxysmal), most often with tactile allodynia, which may be severe and disabling, resulting in poor quality of life and depression. Traditional treatments have included tricyclic antidepressants, anticonvulsants and opioids; however, adverse systemic effects associated with these agents have led to the development of a newer and potentially safer agent, the topical lidocaine patch 5% (Lidoderm), a targeted peripheral analgesic. This article reviews the clinical pharmacology of the lidocaine patch 5% for the treatment of PHN and summarises data from clinical trials of its safety, tolerability and efficacy. The Medline search terms "lidocaine" and "patch" were used to search for English-language articles on the pharmacokinetics of the lidocaine patch 5% and its clinical use for the treatment of PHN. Additional published studies not identified by the database search but performed by the authors or their colleagues were also included in the review. The systemic absorption of lidocaine from the patch was minimal in healthy adults when four patches were applied for up to 24 hours/day, and lidocaine absorption was even lower among PHN patients than healthy adults at the currently recommended dose. Vehicle-controlled and open-label trials found the lidocaine patch 5%, either alone or in combination with other agents, to be effective in the treatment of PHN. Most adverse events were at patch application sites; no clinically significant systemic adverse effects were noted, including when used long term or in an elderly population.In patients with PHN, the lidocaine patch 5% has demonstrated relief of pain and tactile allodynia with a minimal risk of systemic adverse effects or drug-drug interactions. Because of its proven efficacy and safety profile, the lidocaine patch 5% has been recommended as a first-line therapy for the treatment of the neuropathic pain of PHN. PMID: 15101784 [PubMed - indexed for MEDLINE] 1341. J Allergy Clin Immunol. 2004 Apr;113(4):742-6. Varicella zoster as a manifestation of immune restoration disease in HIV-infected children. Tangsinmankong N, Kamchaisatian W, Lujan-Zilbermann J, Brown CL, Sleasman JW, Emmanuel PJ. Division of Allergy and Immunology, Department of Pediatrics, University of South Florida/All Children's Hospital, 801 Sixth Street South, Box 9350, St Petersburg, FL 33701, USA. tangsinn@allkids.org BACKGROUND: Exacerbation of opportunistic infections in HIV-infected patients shortly after initiation of highly active antiretroviral therapy (HAART) has been named immune restoration disease (IRD). Thus far, IRD has not been reported in children. OBJECTIVE: We describe the clinical and immune characteristics of IRD in HIV-infected children treated with HAART. METHODS: A historical cohort study was conducted in a tertiary HIV center in perinatally HIV-infected children who were started on a first stable HAART between January 1996 and July 2002. The incidence of opportunistic infections, newly AIDS-defining events or death after initiation of HAART, and virologic and immunologic information was evaluated at baseline and every 3 months post-HAART. RESULTS: Sixty-one perinatally HIV-infected children were started and maintained on HAART for >6 months. Seven episodes of IRD occurred. All were cutaneous herpes zoster (HZ). Children who developed HZ had significantly lower baseline CD4+ and CD8+ T-cell numbers compared with children who did not. HZ occurred only in children (7 of 34 subjects) with virological and immunological success to HAART. In children with a previous history of varicella infection, the risk of developing HZ after HAART was higher in those without a protective level of varicella-specific IgG (50%, or 5 of 10 subjects) compared with those with seroprotection (10%, or 2 of 20). CONCLUSION: Herpes zoster is a common manifestation of IRD in HIV-infected children after the initiation of HAART. Risks for developing HZ include no protective varicella-specific antibody despite previous varicella infection, severe immunodeficiency at baseline, and vigorous immunologic and virologic responses to HAART. PMID: 15100682 [PubMed - indexed for MEDLINE] 1342. J Drugs Dermatol. 2004 Mar-Apr;3(2):127-9. Veni, VD, vici: twelve points about herpes that need to be conquered. Burkhart CG, Burkhart CN. PMID: 15098964 [PubMed - indexed for MEDLINE] 1343. Ann Acad Med Singapore. 2004 Mar;33(2):243-7. Varicella screening and vaccination for healthcare workers at KK Women's and Children's Hospital. Chong CY, Lim SH, Ng WY, Tee N, Lin RV. Infectious Disease Service, Department of Paediatrics, KK Women's and Children's Hospital, Singapore. cychong@kkh.com.sg INTRODUCTION: Varicella is a highly contagious disease with significant morbidity and mortality, especially in adults. It can lead to nosocomial transmission with dire consequences, especially in a healthcare facility where children and pregnant women form the majority of patients. At KK Women's and Children's Hospital, we embarked on a programme in 2 phases, between 1997 and 1999, to screen healthcare workers (HCWs) for varicella immunity and to offer varicella vaccination to those who tested negative for antibody. MATERIALS AND METHODS: HCWs were initially screened via a questionnaire; those with no previous history of chickenpox underwent a blood test for varicella zoster antibody. Varicella vaccine was offered to those who tested negative for antibody and they were monitored for adverse reactions. RESULTS: Of the HCWs surveyed, 14.7% and 26.9% in phases 1 and 2, respectively, had no previous history of chickenpox. Of these, 55.3% in phase 1 and 26.1% in phase 2 tested negative for antibodies. Thus, the overall seronegativity of all HCWs surveyed was between 6.5% and 7.6%. Among those who tested negative for antibodies, 42.9% in phase 1 and 74% in phase 2 were vaccinated. Hence, the overall vaccination rate in HCWs was 3.2% and 4.8% in phases 1 and 2, respectively. Adverse reactions were observed in 2 (22.2%) HCWs in phase 1 and in 9 (9.3%) in phase 2, consisting mostly of maculopapular rashes or vesicles around the injection site. CONCLUSIONS: Our study shows that 26% to 55% of HCWs with no history of chickenpox and who tested negative for antibody against varicella required vaccination. Hence, in healthcare facilities, varicella screening and vaccination should be offered to all HCWs. PMID: 15098642 [PubMed - indexed for MEDLINE] 1344. Postgrad Med. 2004 Apr;115(4):63-5. Childhood shingles. Herpes zoster can occur in healthy children too. Brodell RT, Zurakowski JE. Northeastern Ohio Universities College of Medicine, Rootstown, OH, USA. rtb@neoucom PMID: 15095537 [PubMed - indexed for MEDLINE] 1345. Int J Dermatol. 2004 Apr;43(4):298-9. Subcutaneous granuloma annulare following herpes zoster. Chang SE, Bae GY, Moon KC, Do SH, Lim YJ. Department of Dermatology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, South Korea. cse@snu.md PMID: 15090019 [PubMed - indexed for MEDLINE] 1346. Int J Dermatol. 2004 Apr;43(4):265-8. Prevalence of dermatological disorders in Thai HIV-infected patients correlated with different CD4 lymphocyte count statuses: a note on 120 cases. Wiwanitkit V. Department of Laboratory Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. wviroj@pioner.netserve.chula.ac.th BACKGROUND: Skin disease is one health problem among human immunodeficiency virus (HIV)-seropositive patients. Several dermatological findings in HIV-infected patients have been investigated. In this study, the skin lesions of 120 HIV-infected patients with different CD4 count statuses in Bangkok, Thailand, are studied. METHODS: This study was performed as a cross-sectional descriptive study. All subjects had a complete physical examination to detect their dermatological disorders and carried out the necessary diagnostic procedures by consultation with the dermatologist. RESULTS: Eighty percent of all patients were observed to have one or more skin disorders. Xerosis (73.33%) and oral candidiasis (54.17%) were the most common skin disorders, followed by seborrheic dermatitis (46.67%), pruritic papular eruption (36.67%), oral hairy leucoplakia (12.50%), folliculitis (11.67%), herpes zoster (9.17%), and alopecia (6.67%). CONCLUSION: Although the pattern of cutaneous lesions was comparable with previous reports, the strikingly lower prevalence of skin tumor and drug eruption was reviewed. Patients with advanced HIV infection were found to have significantly more skin disorders than those with early stage HIV. PMID: 15090008 [PubMed - indexed for MEDLINE] 1347. Pain. 2004 May;109(1-2):26-35. Pregabalin reduces pain and improves sleep and mood disturbances in patients with post-herpetic neuralgia: results of a randomised, placebo-controlled clinical trial. Sabatowski R, Gálvez R, Cherry DA, Jacquot F, Vincent E, Maisonobe P, Versavel M; 1008-045 Study Group. Department of Anaesthesiology, University of Cologne, Cologne, Germany. rainer.sabatowski@uni-koeln.de This study was designed to assess the efficacy and safety of pregabalin-a novel alpha(2)-delta ligand with analgesic, anxiolytic, and anticonvulsant activity-for treating neuropathic pain in patients with post-herpetic neuralgia (PHN). Two hundred and thirty-eight patients were randomised into this multicentre, doubleblind, placebo-controlled trial to receive 150 (n=81), 300 mg/day (n=76) pregabalin, or placebo (n=81) for 8 weeks. Among the exclusion criteria was failure to respond to previous treatment for PHN with gabapentin at doses > or =1200 mg/day. Endpoint mean pain scores were significantly reduced in patients receiving 150 or 300 mg/day pregabalin compared with placebo. Efficacy was observed as early as week 1 and was maintained throughout the study. Significantly more patients in both pregabalin groups (150 mg, 26%; 300 mg, 28%) were responders (> or =50% decrease in mean pain score from baseline to endpoint) than in the placebo group (10%). Additionally, by week 1 and for the study's duration, 150 and 300 mg/day pregabalin significantly reduced weekly mean sleep interference scores. More pregabalin-treated patients than placebo-treated patients reported that they were 'much improved' or 'very much improved'. Health-related quality-of-life (HRQoL) measurements using the SF-36 Health Survey demonstrated improvement in the mental health domain for both pregabalin dosages, and bodily pain and vitality domains were improved in the 300 mg/day group. The most frequent adverse events were dizziness, somnolence, peripheral oedema, headache, and dry mouth. Pregabalin efficaciously treated the neuropathic pain of PHN. Additionally, pregabalin was associated with decreased sleep interference and significant improvements in HRQoL measures. PMID: 15082123 [PubMed - indexed for MEDLINE] 1348. J Clin Virol. 2004 May;30(1):39-44. Routine use of a highly automated and internally controlled real-time PCR assay for the diagnosis of herpes simplex and varicella-zoster virus infections. Stránská R, Schuurman R, de Vos M, van Loon AM. Department of Virology, Eijkman-Winkler Center, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands. r.stranska@azu.nl BACKGROUND: Detection of herpes viruses can be significantly improved by PCR. The development of real-time PCR, which has overcome several limitations of conventional PCR, improved the prospects for implementation of PCR-based assays in diagnostic laboratory. OBJECTIVES: To compare the diagnostic performance of an automated sample extraction procedure in combination with an internally controlled real-time PCR assay for detection of herpes simplex virus (HSV) and varicella-zoster virus (VZV) to conventional shell vial culture. STUDY DESIGN: One hundred eighty-two consecutive specimens from patients suspected of HSV or VZV infection were examined by internally controlled PCR and shell vial culture. An internal control consisting of phocine herpes virus was processed along with the specimens during the entire procedure and permitted to monitor extraction and amplification efficiency, including inhibition. RESULTS: A total of 48 (26.4%) specimens were positive for HSV or VZV by culture, and 77 (42.3%) by real-time PCR. Thus, overall sensitivity increased by 60.4%. All culture-positive specimens were detected and typed correctly by PCR, except for a single specimen that contained PCR inhibitors. Specifically, the real-time PCR assay increased the detection rate for HSV-1 and HSV-2 by 43.9% and 62.5%, respectively. In PCR-positive specimens, lower levels of viral DNA were found in culture-negative than in culture-positive specimens. The increase of HSV detection rates by PCR varied with the origin of specimen and was particularly significant for skin specimens (7/14 versus 3/14 detected by culture) and bronchoalveolar lavages (8/8 versus 1/8). In addition, real-time PCR significantly increased the detection rate for VZV. CONCLUSIONS: Compared to shell vial culture, our real-time PCR assay demonstrated a superior sensitivity and an added value of using internal control for checking the quality of examination of each specimen. These results provide a solid basis for implementation of real-time PCR in the routine diagnosis of HSV and VZV infections in various clinical specimens. PMID: 15072752 [PubMed - indexed for MEDLINE] 1349. J Clin Microbiol. 2004 Apr;42(4):1409-13. Detection and genotyping of varicella-zoster virus by TaqMan allelic discrimination real-time PCR. Campsall PA, Au NH, Prendiville JS, Speert DP, Tan R, Thomas EE. Department of Pathology and Laboratory Medicine, University of British Columbia and Children's & Women's Health Centre of British Columbia, Canada. A proportion of individuals vaccinated with live attenuated Oka varicella-zoster virus (VZV) vaccine subsequently develop attenuated chicken pox and/or herpes zoster. To determine whether postvaccination varicella infections are caused by vaccine or wild-type virus, a simple method for distinguishing the vaccine strain from wild-type virus is required. We have developed a TaqMan real-time PCR assay to detect and differentiate wild-type virus from Oka vaccine strains of VZV. The assay utilized two fluorogenic, minor groove binding probes targeted to a single nucleotide polymorphism in open reading frame 62 that distinguishes the Oka vaccine from wild-type strains. VZV DNA could be genotyped and quantified within minutes of thermocycling completion due to real-time monitoring of PCR product formation and allelic discrimination analysis. The allelic discrimination assay was performed in parallel with two standard PCR-restriction fragment length polymorphism (RFLP) methods on 136 clinical and laboratory VZV strains from Canada, Australia, and Japan. The TaqMan assay exhibited a genotyping accuracy of 100% and, when compared to both PCR-RFLP methods, was 100 times more sensitive. In addition, the method was technically simpler and more rapid. The TaqMan assay also allows for high-throughput genotyping, making it ideal for epidemiologic study of the live attenuated varicella vaccine. PMCID: PMC387589 PMID: 15070981 [PubMed - indexed for MEDLINE] 1350. J Pediatr. 2004 Apr;144(4):505-11. Immunodeficiency and infections in ataxia-telangiectasia. Nowak-Wegrzyn A, Crawford TO, Winkelstein JA, Carson KA, Lederman HM. Eudowood Division of Pediatric Allergy and Immunology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD 21287-3923, USA. OBJECTIVE: To characterize the immunodeficiency in ataxia-telangiectasia (A-T) and to determine whether the immunodeficiency is progressive and associated with increased susceptibility to infections. STUDY DESIGN: Records of 100 consecutive patients with A-T from the Johns Hopkins Ataxia-Telangiectasia Clinical Center (ATCC) were reviewed. RESULTS: Immunoglobulin (Ig) deficiencies are common, affecting IgG4 in 65% of patients, IgA in 63%, IgG2 in 48%, IgE in 23%, and IgG in 18%. Lymphopenia affected 71% of patients, with reduced B-lymphocyte number in 75%, CD4 T lymphocytes in 69%, and CD8 T lymphocytes in 51%. There was no trend for increased frequency or severity of immune abnormalities with age. Recurrent upper and lower respiratory tract infections were frequent: otitis media in 46% of patients, sinusitis in 27%, bronchitis in 19%, and pneumonia in 15%. Sepsis occurred in 5 patients, in 2 patients concurrent with cancer chemotherapy. Warts affected 17% of patients, herpes simplex 8%, molluscum contagiosum 5%, candidal esophagitis 3%, and herpes zoster 2%. Uncomplicated varicella infection occurred in 44% of patients; 2 patients had more than one clinical episode. No patient had Pneumocystis jerovici pneumonia or a complication of live viral vaccine. CONCLUSIONS: In spite of the high prevalence of laboratory immunologic abnormalities, systemic bacterial, severe viral, and opportunistic infections are uncommon in A-T. Cross-sectional analysis suggests that the immune defect is rarely progressive. PMID: 15069401 [PubMed - indexed for MEDLINE] 1351. Ann Hematol. 2004 Mar;83(3):198-200. Epub 2003 Oct 8. Herpes zoster during treatment with arsenic trioxide. Tanvetyanon T, Nand S. Cardinal Bernardin Cancer Center, 2160 S First Avenue, Maywood, IL 60153-3304, USA. ttanve@lumc.edu Comment in: Ann Hematol. 2004 Jun;83(6):408. In vitro data suggest that arsenic compounds can suppress cell-mediated immunity by inducing apoptosis of T helper lymphocytes. We describe an occurrence of herpes zoster during treatment with arsenic trioxide (ATO) in two patients who were already in remission from acute promyelocytic leukemia and received ATO as consolidation treatment. During this complication, their leukocyte counts and differentials were within normal limits. Our report suggested the immunosuppressive effect of ATO in vivo. Both patients responded well to an oral antiviral. Clinicians should be aware of this complication during treatment with ATO since early antiviral treatment may help avoid complications including post-herpetic neuralgia. PMID: 15064871 [PubMed - indexed for MEDLINE] 1352. Eur J Neurol. 2004 Apr;11 Suppl 1:3-11. Post-herpetic neuralgia case study: optimizing pain control. Baron R. Neurological Clinic, Christian-Albrechts-Universität zu Kiel, Kiel, Germany. r.baron@neurologie.uni-kiel.de Post-herpetic neuralgia (PHN) is a chronic pain syndrome associated with the reactivation of a primary infection with varicella zoster virus (chicken pox), which leads to a chronic infection of the dorsal root ganglia. Under various clinical circumstances, including immunosuppressive diseases or treatments and certain cancers, reactivation of the infection can occur in adults as shingles. Other factors such as psychological distress and stressful life events also appear to play a role in the onset of shingles and the development of PHN. The most common risk factor for shingles and its potential sequela, PHN, is advanced age. For a significant number of patients, the pain following healing of shingles can persist for months to years; this pain is classified as PHN if it persists longer than 3 months. PHN often leads to depression, disrupted sleep, decreased functioning and increased healthcare utilization. Prompt use of antiviral therapy appears to reduce the period of pain following an episode of shingles by about half and may possibly reduce the overall incidence of PHN. Damage to a variety of neurologic pathways as a result of herpes zoster reactivation suggests that intervention with multiple agents having divergent mechanisms of action is an appropriate treatment approach. Current treatment options aimed at relieving the symptoms of PHN include antidepressants, opioids, anticonvulsants and topical analgesics. It is important for the clinician to establish a baseline pain intensity and character as well as quality of life measures against which to judge the effectiveness of any treatment. This review article features a case study of a patient with PHN to illustrate current diagnostic and treatment approaches. PMID: 15061819 [PubMed - indexed for MEDLINE] 1353. Enferm Infecc Microbiol Clin. 2004 Apr;22(4):253-4. [Infection due to acyclovir-resistant varicella-zoster herpes virus in a patient with AIDS] [Article in Spanish] Ramos C, Lajusticia J. PMID: 15056447 [PubMed - indexed for MEDLINE] 1354. Gen Dent. 2003 May-Jun;51(3):281-6; quiz 287. Herpes simplex and varicella-zoster infections: clinical and laboratory diagnosis. Stoopler ET, Pinto A, DeRossi SS, Sollecito TP. University of Pennsylvania, School of Dental Medicine, Philadelphia, USA. One of a dentist's most common diagnostic challenges is determining the cause of vesiculo-ulcerative disorders of the oral cavity. The most common etiology of oral vesicles is herpes simplex virus (HSV) infection. Varicella-zoster virus (VZV) is a less common etiology of vesicles in the oral cavity. Dentists often are able to differentiate these two viruses based on the clinical presentation of infectious symptoms; however, further laboratory testing is required to identify herpetically induced vesiculo-ulcerative lesions definitively. This article reviews the basic clinical signs and symptoms of HSV and VZV infection and describes the various laboratory tests that can determine the definitive etiology of the vesiculo-ulcerative disorder. PMID: 15055715 [PubMed - indexed for MEDLINE] 1355. J Am Acad Nurse Pract. 2003 Dec;15(12 Suppl):16-21; quiz 22-4. Managing the comorbidities of postherpetic neuralgia. McCarberg B. Chronic Pain Management Program, Kaiser Permanente, California, USA. PURPOSE: To discuss the impact of pain and its associated comorbidities in elderly patients with postherpetic neuralgia (PHN). To review the pharmacologic treatments available for patients with chronic pain and concurrent sleep disturbance, depression, and/or anxiety. DATA SOURCES: Relevant clinical literature pertaining to the management of common comorbid conditions in patients with PHN and chronic pain syndromes. CONCLUSIONS: Chronic pain strongly influences physical and psychological function in elderly patients. Comorbid illnesses, such as insomnia, depression, or anxiety, often develop in patients with chronic pain and complicate overall pain management and worsen prognosis. Pharmacologic treatment strategies that reduce pain frequently result in concurrent improvements in common pain-associated comorbidities. Pharmacologic treatment should be selected based on the efficacy of the selected agent(s), potential for adverse effects, and impact on pain-associated comorbidity. A multidisciplinary pain care management approach is essential to alleviate pain, manage pain-associated comorbidities, and improve function and quality of life. IMPLICATIONS FOR PRACTICE: Elderly patients who often deny their chronic pain are at increased risk for such conditions as sleep disturbance, depression, and/or anxiety. Nurses and nurse practitioners are in a unique position to improve pain care management by recognizing pain and its associated comorbidities early, educating patients regarding their perception of pain, and facilitating rational pharmacotherapy with the goal to improve function and quality of life. PMID: 15055385 [PubMed - indexed for MEDLINE] 1356. J Am Acad Nurse Pract. 2003 Dec;15(12 Suppl):10-5. Diagnosis and treatment of herpes zoster: role of the nurse practitioner. Wright WL. Merrimack Village Family Practice Center, New Hampshire, USA. DATA SOURCES: Case example and review of clinical trials, meta-analyses, and reviews provide relevant data regarding the management of herpes zoster. CONCLUSIONS: Herpes zoster is a relatively common disease in elderly patients. It results from reactivation of varicella zoster virus (chickenpox). Characteristic vesicular lesions are often accompanied by significant acute pain. The risk of complications, such as postherpetic neuralgia (PHN), increases when patients age or are inadequately treated. IMPLICATIONS FOR PRACTICE: Appropriate diagnosis and management of herpes zoster may shorten the overall disease course, accelerate cutaneous healing, and reduce the risk of PHN, a chronically painful complication. Greater understanding of the epidemiology, clinical manifestations, diagnosis, and available treatment options is essential for nurse practitioners and other primary care providers to initiate early treatment in patients with suspected herpes zoster infection. PMID: 15055384 [PubMed - indexed for MEDLINE] 1357. J Am Acad Nurse Pract. 2003 Dec;15(12 Suppl):3-9. Diagnosis and management of neuropathic pain: a balanced approach to treatment. Nicholson BD. Division of Pain Medicine and Hospice, Lehigh Valley Hospital and Health Network, Allentown, Pennsylvania, USA. PURPOSE: To provide nurse practitioners with a conceptual framework from which to diagnose and manage chronic neuropathic pain, specifically postherpetic neuralgia (PHN). A current review of the available treatment options for the management of neuropathic pain and PHN is provided. DATA SOURCES: A comprehensive literature review was conducted. Clinical articles, meta-analyses, and reviews were selected for their relevance to the diagnosis and management of chronic neuropathic pain and PHN. CONCLUSIONS: Managing patients with chronic neuropathic pain is a common clinical challenge due to variability in individual symptoms, mechanisms, and treatment responses. In patients with PHN, a balanced treatment approach focusing on efficacy, safety, and tolerability is recommended. With appropriate treatment, most patients are able to achieve clinically significant relief from neuropathic pain. IMPLICATIONS FOR PRACTICE: Diagnosis and management of neuropathic pain syndromes is challenging. Because of the complexity of chronic pain, successful long-term treatment can be especially difficult (Nicholson, 2003b). While most acute pain is nociceptive (i.e., a response to noxious stimuli), chronic pain can be nociceptive, neuropathic, or of mixed origin. PHN is a chronic pain syndrome that can last for years, causing physical and social disability and psychological distress (Kanazi, 2000). Despite major recent advances in the treatment of PHN, many patients remain refractory to current therapy (Dworkin, 2003). For practicing clinicians, including nurse practitioners, viewing pain as a disease rather than a symptom is the first step towards its successful management. Understanding the pathophysiology of chronic pain and emerging treatment paradigms for the management of neuropathic pain and PHN is critical to optimal care. PMID: 15055383 [PubMed - indexed for MEDLINE] 1358. J Neurol Sci. 2004 Apr 15;219(1-2):147-50. Painful legs and moving toes syndrome associated with herpes zoster myelitis. Ikeda K, Deguchi K, Touge T, Sasaki I, Tsukaguchi M, Shimamura M, Komatsu E, Takeuchi H, Kuriyama S. Third Department of Internal Medicine, Kagawa University School of Medicine, 1750-1 Ikenobe, Miki-cho, Kita-gun, 761-0793 Kagawa, Japan. A 75-year-old woman developed painful legs and moving toes syndrome (PLMT) 16 months after the onset of herpes zoster (HZ) myelitis. Although the scattered extensive lesions due to HZ myelitis were observed to be eccentric near the posterior horn on MRI, these changes had disappeared upon the development of PLMT. Combined median and tibial nerve somatosensory evoked potentials demonstrated abnormal findings only in the tibial nerve stimuli, suggesting that a severe alteration occurred in the somatosensory fibers coming selectively from the lower legs. These findings suggest plasticity in the ascending somatosensory pathway including the posterior horn cells, probably involving the interneuron networks, for the lower legs may underlie the development of PLMT associated with HZ myelitis. PMID: 15050450 [PubMed - indexed for MEDLINE] 1359. J Med Virol. 2004 May;73(1):131-6. Genetic variation in clinical varicella-zoster virus isolates collected in Ireland between 2002 and 2003. Carr MJ, McCormack GP, Crowley B. Department of Clinical Microbiology, St. James's Hospital, Dublin, Ireland. Analysis of genetic variation in 16 varicella-zoster virus (VZV) isolates selected at random and circulating in the Irish population between March 2002 and February 2003 was carried out. A 919 bp fragment of the glycoprotein E gene (open reading frame 68) encompassing codon 150, at which a non-synonymous mutation defines the escape mutant VZV-MSP, and including two other epitope regions e1 and c1, was sequenced. No new single nucleotide polymorphisms (SNPs) were detected, indicating stability of these epitopes in clinical isolates of VZV. However, when four informative polymorphic markers consisting of defined regions from genes 1, 21, 50, and 54 were sequenced 14 variable nucleotide positions were identified. Phylogenetic analysis showed the presence of three highly supported clades A, B, and C circulating in the Irish population. Approximately one third (6/16; 37.5%) of the Irish VZV isolates in this study belonged to genotype C, 4/16 (25%) to genotype A, and 4/16 (25%) to genotype B. A smaller number 2/16 (12.5%) belonged to genotype J1. This indicates remarkable heterogeneity in the Irish population given the small sample size. No evidence was found to suggest any of the 16 isolates was a recombinant. These findings have implications for the model of geographic isolation of VZV clades to certain regions as the circulating Irish VZV population appears to comprise approximately equal numbers of each of the main genotypes. This data is inconsistent with a model of strict geographical separation of VZV genotypes and suggests that VZV diversity is more pronounced in certain areas than had been thought previously. Copyright 2004 Wiley-Liss, Inc. PMID: 15042660 [PubMed - indexed for MEDLINE] 1360. Minerva Stomatol. 2004 Jan-Feb;53(1-2):49-59. [Herpes zoster of the trigeminal nerve: a case report and review of the literature] [Article in Italian] Carbone V, Leonardi A, Pavese M, Raviola E, Giordano M. UOADU di Odontostomatologia, ASO S. Luigi Gonzaga, Orbassano, Turin. Herpes zoster (shingles) is caused when the varicella zoster virus that has remained latent since an earlier varicella infection (chicken-pox) is reactivated. Herpes Zoster is a less common and endemic disease than varicella: factors causing reactivation are still not well known, but it occurs in older and/or immunocompromised individuals. Following reactivation, centrifugal migration of herpes zoster virus (HZV) occurs along sensory nerves to produce a characteristic painful cutaneous or mucocutaneous vesicular eruption that is generally limited to the single affected dermatome. Herpes zoster may affect any sensory ganglia and its cutaneous nerve: the most common sites affected are thoracic dermatomes (56%), followed by cranial nerves (13%) and lumbar (13%), cervical (11%) and sacral nerves (4%). Among cranial nerves, the trigeminal and facial nerves are the most affected due to reactivation of HZV latent in gasserian and geniculated ganglia. The 1st division of the trigeminal nerve is commonly affected, whereas the 2nd and the 3rd are rarely involved. During the prodromal stage, the only presenting symptom may be odontalgia, which may prove to be a diagnostic challenge for the dentist, since many diseases can cause orofacial pain, and the diagnosis must be established before final treatment. A literature review of herpes zoster of the trigeminal nerve is presented and the clinical presentation, differential diagnosis and treatment modalities are underlined. A case report is presented. PMID: 15041920 [PubMed - indexed for MEDLINE] 1361. Can J Ophthalmol. 2004 Feb;39(1):74-6. Management of ophthalmic zoster mucous plaque keratopathy: report of three cases. Al-Muammar A, Jackson WB. University of Ottawa Eye Institute, Ottawa, Ont. PMID: 15040618 [PubMed - indexed for MEDLINE] 1362. Clin Infect Dis. 2004 Apr 1;38(7):e57-62. Epub 2004 Mar 12. Lower-limb hypoplasia due to intrauterine infection with herpes simplex virus type 2: possible confusion with intrauterine varicella-zoster syndrome. Johansson AB, Rassart A, Blum D, Van Beers D, Liesnard C. Neonatal Intensive Care Unit, Hopital Universitaire des Enfants Reine Fabiola, Brussels, Belgium. anne-britt.johansson@huderf.be A neonate with lower-limb hypoplasia, cutaneous scars, bilateral chorioretinitis, and multiple brain abnormalities is presented. Intrauterine herpes simplex virus type 2 (HSV-2) infection was established on the basis of serological testing of the mother and viral cultures of the child's cutaneous lesions, obtained soon after birth. This is, to the best of our knowledge, the first case of a patient with in utero-acquired HSV-2 infection presenting with a limb hypoplasia. It illustrates that, in addition to congenital varicella-zoster syndrome, HSV-2 infection should also be considered in patients presenting with limb hypoplasia. PMID: 15034848 [PubMed - indexed for MEDLINE] 1363. Ann Hematol. 2004 Jun;83(6):408. Epub 2004 Mar 18. Herpes zoster during treatment with arsenic trioxide. Lanska DJ. Comment on: Ann Hematol. 2004 Mar;83(3):198-200. PMID: 15034759 [PubMed - indexed for MEDLINE] 1364. Recenti Prog Med. 2004 Jan;95(1):47-50. [Saint Anthony's fire and herpes zoster in various pages of Antonio Tabucchi] [Article in Italian] Giusti G. II Università, Napoli. PMID: 15032342 [PubMed - indexed for MEDLINE] 1365. J Clin Virol. 2004 Apr;29(4):248-53. Once, twice, or three times daily famciclovir compared with aciclovir for the oral treatment of herpes zoster in immunocompetent adults: a randomized, multicenter, double-blind clinical trial. Shafran SD, Tyring SK, Ashton R, Decroix J, Forszpaniak C, Wade A, Paulet C, Candaele D. Division of Infectious Diseases, Department of Medicine, 2E4.16 Walter C. Mackenzie Health Sciences Centre, University of Alberta Hospital, 8440-112 Street, Edmonton, Alta., Canada T6G 2B7. sshafran@ualberta.ca BACKGROUND: Famciclovir, the well absorbed oral pro-drug of penciclovir, is effective in the treatment of herpes zoster when given three times daily. Because the intracellular half-life of penciclovir triphosphate in varicella-zoster virus (VZV)-infected cells (7h) is considerably longer than that of aciclovir triphosphate (1h), it may be possible to administer famciclovir less frequently than three times daily for herpes zoster: aciclovir is administered five times daily. METHODS: 559 immunocompetent adults presenting with herpes zoster whose skin lesions were present for less than 72 h were randomized to receive famciclovir 750 mg once daily (od), 500 mg twice daily (bid), or 250 mg three times daily (tid), or aciclovir 800 mg five times daily. All treatments were given for 7 days. Participants were evaluated until complete healing or for 4 weeks, whichever occurred first. RESULTS: There were no significant differences between the four treatment groups with respect to times to full crusting; loss of vesicles, ulcers and crusts; cessation of new lesion formation; a 50% reduction in the area of affected skin; and the loss of acute pain. CONCLUSIONS: Famciclovir 750 mg once daily, 500 mg twice daily and 250 mg daily, and aciclovir 800 mg five times daily are three times comparable in efficacy with respect to the cutaneous healing of herpes zoster. The current study was not designed to assess the effects of the treatments on postherpetic neuralgia (PHN). PMID: 15018852 [PubMed - indexed for MEDLINE] 1366. Pharm World Sci. 2004 Feb;26(1):10-1. Medication error due to ambiguous labelling of a commercial product. Guchelaar HJ, Kalmeijer MD, Jansen ME. Department of Clinical Pharmacy & Toxicology, Leiden University Medical Centre, Albinusdreef 2, 2300 RC Leiden, The Netherlands. h.j.guchelaar@lumc.nl Medication errors may involve prescribing, dispensing, preparation and administration of drugs. We report a case in which an administration error occurred due to ambiguous labelling of a commercial drug. Tablets were packed in sets of two tablets per blister with the print on the blister 'Zelitrex 500', making the amount of drug per tablet unclear. A short survey among nurses and pharmacy technicians showed that the majority interpreted the strength of the tablets incorrectly. This case shows that, despite regulations for controlling and accepting labelling before marketing, ambiguous labelling may occur and can lead to medication errors. PMID: 15018253 [PubMed - indexed for MEDLINE] 1367. Pharm World Sci. 2004 Feb;26(1):8-9. Clostridium difficile colitis associated with valaciclovir. De Andrés S, Ferreiro D, Ibánez M, Ballesteros A, García B, Agud JL. Pharmacy Service, Severo Ochoa Hospital, 28911 Leganés (Madrid), Spain. OBJECTIVE: To report a case of Clostridium difficile colitis associated with valaciclovir treatment. CASE SUMMARY: A 73-year-old man with lumbar herpes-zoster started valaciclovir 1 g tid. After three days he began vomiting and developed diarrhea, three to four stools per day. Symptoms worsened over the following days and he was admitted. Valaciclovir was stopped and fluid and electrolyte replacement was started. He continued 6 days later with diarrhea of 7 to 13 stools per day and a stool test for diagnosis of C. difficile infection was performed with a positive result. The patient received oral metronidazole (500 mg/t.i.d. for 10 days) and rapid improvement and eventual resolution of his diarrhea was observed after 3 days of therapy. DISCUSSION: Although no conclusive reports of this reaction exist, we think this is a case of C difficile colitis that appeared three days after valaciclovir was initiated. Colitis improved with metronidazole. Other causes of diarrhea were excluded, such as diabetes mellitus, renal failure, intestinal surgery and intestinal obstruction. Infection was confirmed by a positive test for C. difficile. The application of Naranjo's algorithm asserts the reaction as 'probable'. CONCLUSIONS: Valaciclovir-associated C. difficile colitis, although rare, can have severe consequences for the patient's health. It should be included as a possible adverse effect of valaciclovir treatment by health professionals. PMID: 15018252 [PubMed - indexed for MEDLINE] 1368. Dermatol Clin. 2004 Jan;22(1):51-61. Skin infections in the elderly. Weinberg JM, Vafaie J, Scheinfeld NS. Department of Dermatology, St. Luke's-Roosevelt Hospital Center, 1090 Amsterdam Avenue, Suite 11D, New York, NY 10025, USA. jmw27@columbia.edu The diagnosis and management of viral diseases of the skin are significant issues in the elderly population. With advances in these areas, there are new tools to combat these diseases and limit morbidity. It is important for clinicians to monitor and treat these diseases aggressively in the elderly because of the potential for immunosuppression in this population. Further advances in antiviral therapy and the potential for the development of antiviral vaccines will aid in the therapy of these diseases. Onychomycosis is found more frequently in the elderly. In this population, the most common clinical presentations are distal and lateral subungual onychomycosis (which usually affects the great or first toe) and white superficial onychomycosis (which generally involves the third or fourth toes). Over the past several years, new treatments for this disorder have emerged that offer shorter courses of therapy and greater efficacy than previous therapies. The treatment of bacterial skin and skin structure infections in the elderly is an important issue. There has been an alarming increase in the incidence of gram-positive infections, including resistant bacteria, such as MRSA and drug-resistant pneumococci. Although vancomycin has been considered the drug of last defense against gram-positive multidrug-resistant bacteria, the late 1980s saw a rise in vancomycin-resistant bacteria, including VRE. With treatment options limited, it has become critical to identify antibiotics with novel mechanisms of activity. Several new drugs have emerged as possible therapeutic alternatives, including linezolid and quinupristin-dalfopristin. PMID: 15018009 [PubMed - indexed for MEDLINE] 1369. Expert Opin Pharmacother. 2004 Mar;5(3):551-9. Management of herpes zoster (shingles) and postherpetic neuralgia. Johnson RW, Whitton TL. Pain Management Clinic, Bristol Royal Infirmary, Bristol, UK. rwjbristol@doctors.org.uk Herpes zoster (HZ) results from recrudescence of varicella zoster virus latent since primary infection (varicella). The overall incidence of HZ is approximately 3/1000 of the population per year rising to 10/1000 per year by 80 years of age. Approximately 50% of individuals reaching 90 years of age will have had HZ. In approximately 6%, a second attack may occur (usually several decades after the first). Patients with HZ can transmit the virus to a non-immune individual causing varicella. HZ is not contracted from individuals with varicella or HZ. Reduced cell-mediated immunity to HZ occurs with ageing, explaining the increased incidence in the elderly and from other causes such as tumours, HIV and immunosuppressant drugs. Diagnosis is usually clinical from typical unilateral dermatomal pain and rash. Prodromal symptoms, pain, itching and malaise, are common. The most common complication of HZ is postherpetic neuralgia (PHN), defined as significant pain or dysaesthesia present >or= 3 months after HZ. PHN results from damage and secondary changes within components of the nervous system subserving pain. Some motor deficit is common; severe and long-lasting paresis may rarely accompany HZ. More than 5% of elderly patients have PHN at 1 year after acute HZ. Predictors of PHN are, greater age, acute pain and rash severity, prodromal pain, the presence of virus in peripheral blood as well as adverse psychosocial factors. Therapy for acute HZ is intended to reduce acute pain, hasten rash healing and reduce the risk of PHN and other complications. Antiviral drugs are close to achieving these aims but do not entirely remove risk of PHN. Oral steroids show no protective effect against PHN. Adequate analgesia during the acute phase may require strong opioid drugs. Nerve blocks and tricyclic antidepressants (TCAs) may reduce the risk of PHN although firm evidence is lacking. PHN requires thorough evaluation and development of a management strategy for each individual patient. Initial therapy is with TCAs (e.g., nortriptyline) or the anticonvulsant gabapentin. Topical lidocaine patches frequently reduce allodynia. Strong opioids are sometimes required. Topical capsaicin cream is beneficial for a small proportion of patients but is poorly tolerated. NMDA antagonists have not proved beneficial with the exception of ketamine. Transcutaneous Electrical Nerve Stimulation (TENS) may be effective in some cases. HZ is a common condition. Severe complications such as stroke, encephalitis and myelitis are relatively rare whereas sight threatening complications of ophthalmic HZ are more common. PHN is common, distressing and often intractable. Good management improves outcome. PMID: 15013924 [PubMed - indexed for MEDLINE] 1370. Headache. 2004 Mar;44(3):286-8. Herpes zoster ophthalmicus, ophthalmoplegia, and trauma. Evans RW, Lee AG. Department of Ophthalmology, The University of Iowa Hospital and Clinics, Iowa City 52242, USA. PMID: 15012669 [PubMed - indexed for MEDLINE] 1371. Eye (Lond). 2004 Mar;18(3):304-5. PCR for varicella zoster virus genome negative in corneal epithelial cells of patients with Thygeson's superficial punctate keratitis. Reinhard T, Roggendorf M, Fengler I, Sundmacher R. Eye Hospital, Heinrich-Heine University, Düsseldorf, Germany. thomas.reinhard@uni-duesseldorf.de PURPOSE: To find out if varicella zoster virus is the causative agent of Thygeson's superficial punctuate keratitis. METHODS: Epithelial cells were harvested from the punctuate epithelial lesions 9 patients with Thygeson's superficial punctate keratitis. After DNA extraction polymerase chain reaction was carried out with varicella zoster virus primers. RESULTS: All samples were negative with regard to varicella zoster virus genome. CONCLUSIONS: This result suggests that varicella zoster virus is most probably not the causative agent of Thygeson's superficial punctate keratitis. PMID: 15004582 [PubMed - indexed for MEDLINE] 1372. J Infect Dis. 2004 Mar 15;189(6):1009-12. Epub 2004 Feb 27. Detection of aerosolized varicella-zoster virus DNA in patients with localized herpes zoster. Suzuki K, Yoshikawa T, Tomitaka A, Matsunaga K, Asano Y. Department of Dermatology, Fujita Health University School of Medicine, Toyoake, Japan. kayokos@fujita-hu.ac.jp We examined the excretion of varicella zoster virus (VZV) in hospitalized patients with herpes zoster localized to the thoracic region whose skin lesions were covered with either hydrocolloid dressing agents (hydrocolloid group) or conventional gauze bandages (gauze group). The presence of VZV DNA in swab samples from lesion coverings, the throat, and filters of air purifiers was examined by use of a sensitive polymerase chain reaction assay. For the hydrocolloid group, VZV was detected in none of the samples from lesion coverings or air purifier filters; for the gauze group, VZV DNA was detected in samples from gauze coverings and air purifier filters for all 6 patients. VZV DNA was detected less frequently in throat samples from patients in the hydrocolloid group than in those from patients in the gauze group. The results of the present study suggest that hydrocolloid dressing agents prevent excretion of aerosolized VZV DNA from skin lesions of patients with localized herpes zoster. PMID: 14999603 [PubMed - indexed for MEDLINE] 1373. Ophthalmologe. 2004 Sep;101(9):941-4. [HIV seroprevalence in ophthalmologic patients of Cameroon] [Article in German] Wilhelm F, Herz E, McArthur C, Werschnik C. Universitätsklinik und Poliklinik für Augenheilkunde, Martin-Luther-Universität, Halle/Saale. BACKGROUND: It is difficult to estimate the exact HIV infection rates in countries such as Cameroon because of diagnostic and statistical problems. The majority of people seek help from traditional healers outside the health system. PATIENTS AND METHODS: A screening for human immunodeficiency virus type 1 (HIV-1) and type 2 (HIV-2) was performed on 2452 patients of the western province of Cameroon. All data were evaluated regarding HIV seroprevalence and ophthalmological findings in HIV-seropositive patients. The test covered all patients who came for cataract surgery (group 1), all outpatients with suspicious ophthalmological findings (group 2), and all remarkable patients of the collaborating department of general medicine (group 3) between 20 September 2000 and 20 September 2001. RESULTS: Of the 2452 screened patients, 467 (19.0%) were HIV seropositive. A positive test result was obtained in 29 (5.5%) of the 525 patients in group 1, 154 (35.6%) of the 433 patients in group 2, and 284 (19.0%) of the 1494 patients in group 3. The main ocular manifestations of the 154 HIV-seropositive patients in group 2 were uveitis (17.6%), squamous cell carcinoma of the conjunctiva (14.9%), zoster ophthalmicus (14.9%), and corneal ulcers (11.0%). CONCLUSIONS: This study shows that the seroprevalence of the screened population of Cameroon lies between 5.5% (results of group 1) and 19.0% (results of group 3). PMID: 14999411 [PubMed - indexed for MEDLINE] 1374. Med Microbiol Immunol. 2005 Jan;194(1-2):7-12. Epub 2004 Mar 2. Quantitative real time PCR detection of Varicella-zoster virus DNA in cerebrospinal fluid in patients with neurological disease. Aberle SW, Aberle JH, Steininger C, Puchhammer-Stöckl E. Institute of Virology, Medical University of Vienna, Kinderspitalgasse 15, 1095, Vienna, Austria. stephan.aberle@meduniwien.ac.at Varicella-zoster virus (VZV) reactivation can lead to the development of neurological disease. Diagnosis has been based on the detection of VZV DNA in cerebrospinal fluid (CSF) by PCR-based methods. The aim of this study was to determine whether the VZV DNA copy number in the CSF correlates with the course of the disease and to determine its prognostic relevance. VZV DNA was quantified in CSF samples obtained from 30 patients with neurological disease due to VZV reactivation using real time PCR, and the VZV DNA copy number was correlated to the clinical and laboratory findings for each case. Viral loads ranged from 50 copies/ml to 2.6 x 10(8) copies/ml. Significantly higher viral loads [geometric mean (GM): 7.2 x 10(4) copies/ml] were found in patients with encephalitis compared to patients with meningitis (GM: 4.1 x 10(3) copies/ml) (P=0.01, Mann-Whitney U test). In eight patients without zoster dermal lesions no significant difference in viral load (GM: 4.6 x 10(3)) was detected compared to patients exhibiting dermal lesions (GM: 2.2 x 10(4)) (P=0.14). High copy numbers of VZV DNA in CSF were clearly associated with the severity of neurological disease and none of the patients with a VZV viral load below 10(4) copies had a disease course which required intensive care. PMID: 14997388 [PubMed - indexed for MEDLINE] 1375. Br J Dermatol. 2004 Feb;150(2):365-6. Herpes zoster occurring as a solitary nodule on the index finger. Izu K, Yamamoto O, Yasumoto S, Hashimoto T, Sata T, Tokura Y. Department of Dermatology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu 807-8555, Japan. k-izu@med.uoeh-u.ac.jp PMID: 14996113 [PubMed - indexed for MEDLINE] 1376. Ann Otol Rhinol Laryngol. 2004 Feb;113(2):113-4. Herpes zoster laryngis with prelaryngeal skin erythema. Wu CL, Linne OC, Chiang CW. Dept of Otorhinolaryngology-Head and Neck Surgery, Lo-Tung Poh-Ai Hospital, 83 Nan Chang St, Lo-Tung 265, I-Lan, Taiwan. A 74-year-old man came to our hospital with complete left vocal cord paralysis and erythema of the prelaryngeal skin. The patient also had mucosal swelling and erosions in the left arytenoid cartilage, aryepiglottic fold, and pyriform sinus. Herpetic vesicles developed over the prelaryngeal erythema 4 days after admission. An increase in the varicella-zoster immunoglobulin G level to 3,294 IU/mL confirmed varicella-zoster virus infection of the larynx and prelaryngeal skin. The patient was treated with acyclovir without marked effect. Nevertheless, in cases of unilateral vocal cord paralysis and erythema of the ipsilateral prelaryngeal skin, we advise that herpes zoster laryngis must be considered and treatment with early intravenous acyclovir started. PMID: 14994764 [PubMed - indexed for MEDLINE] 1377. J Anesth. 2004;18(1):36-8. Intravenous infusion of adenosine 5"-triphosphate alleviated a disabling postherpetic neuralgia. Hayashida M, Sato K, Fukunaga A, Fukuda K, Sekiyama H, Sawamura S, Arita H, Hanaoka K. Department of Anesthesiology and Pain Relief Center, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, 113-8655, Tokyo, Japan. PMID: 14991473 [PubMed - indexed for MEDLINE] 1378. An Pediatr (Barc). 2004 Mar;60(3):282-3. [Herpes zoster in a 2-month-old infant, intragestational varicella and reexposure to exogenous varicella zoster] [Article in Spanish] Guerrero-Fernández J, Guerrero Vázquez J, Russo de la Torre F, Luengo Casasola JL, de Paz Aparicio P. PMID: 14987525 [PubMed - indexed for MEDLINE] 1379. Rheumatol Int. 2004 Nov;24(6):359-61. Epub 2004 Feb 18. Meningitis in mixed connective tissue disease complicated by herpes virus infection: case report. Bodolay E, Diószeghy P, Demeter J, Bányai A, Csipö I, Szegedi G, Szekanecz Z. Division of Clinical Immunology, Third Department of Internal Medicine, University of Debrecen Medical and Health Science Center, 4004 Debrecen, Móricz Zs. 22., Hungary. bodolai@iiibel.dote.hu The authors report a rare case of a female patient diagnosed with mixed connective tissue disease (MCTD). After a few years in remission, the patient acquired herpes zoster infection followed by a disease flare. Disease activity was accompanied by the development of meningitis. To determine whether the meningitis was caused by the previous herpes virus infection or was aseptic meningitis associated with the activity of MCTD raised important differential diagnostic issues. Repeated laboratory assessments of the patient's sera and cerebrospinal fluid revealed leukocytopenia, high anti-U1 ribonucleoprotein autoantibody level, increased immune complex, and decreased complement concentrations. The administration of corticosteroids resulted in rapid improvements in clinical symptoms and laboratory indicators. PMID: 14986060 [PubMed - indexed for MEDLINE] 1380. Am J Med. 2004 Mar 1;116(5):318-24. Cerebrospinal fluid interleukin 8 concentrations and the subsequent development of postherpetic neuralgia. Kotani N, Kudo R, Sakurai Y, Sawamura D, Sessler DI, Okada H, Nakayama H, Yamagata T, Yasujima M, Matsuki A. Department of Anesthesiology, Yamagata University, Japan. kotani@med.id.yamagata-u.ac.jp PURPOSE: Other than age, the risk factors for postherpetic neuralgia are not well established. We studied whether the concentration of interleukin 8 in the cerebrospinal fluid is associated with the risk of postherpetic neuralgia. METHODS: We enrolled 170 patients more than 50 years old who had a typical painful and nontrigeminal herpetic rash. Patients were treated with acyclovir; no corticosteroids were given. Cerebrospinal fluid was taken for analysis of interleukin 8 during and at full crusting of the herpetic rash. Age, sex, comorbid conditions, prodromal pain, localization and severity of herpetic rash, number of skin lesions, and degree of pain were recorded. We used multivariate logistic regression modeling to identify significant predictive factors. Receiver operating characteristic (ROC) curves were evaluated to determine the contribution of each factor. RESULTS: Six months after healing, 31 patients (18%) had postherpetic neuralgia; 27 patients still had it after 1 year. Only three variables-age (odds ratio [OR] = 2.7 per 10-year increase; 95% confidence interval [CI]: 1.2 to 6.2), acute pain (OR = 1.8 per unit increase in visual analog scale; 95% CI: 1.2 to 2.8), and interleukin 8 concentration in the cerebrospinal fluid at full crusting of the herpetic rash (OR = 1.6 per 20-microg/L increase; 95% CI: 1.3 to 2.0)-were significant predictors of postherpetic neuralgia at 1 year. Interleukin 8 concentration also had the highest area under the ROC curve at these evaluation points (P <0.001). CONCLUSION: Our results suggest that interleukin 8 concentration in the cerebrospinal fluid at full crusting of herpetic rash may be useful for identifying patients who are likely to develop intractable postherpetic neuralgia. PMID: 14984817 [PubMed - indexed for MEDLINE] 1381. Anaesthesia. 2004 Mar;59(3):213-5. Design issues for studies into prevention of chronic pain: lessons from post-herpetic neuralgia. Opstelten W, van Wijck AJ, Moons KG. PMID: 14984516 [PubMed - indexed for MEDLINE] 1382. Epidemiol Infect. 2004 Jan;132(1):1-5. Gender difference in the incidence of shingles. Fleming DM, Cross KW, Cobb WA, Chapman RS. Birmingham Research Unit of the Royal College of General Practitioners, 54 Lordswood Road, Harborne, Birmingham B17 9DB, UK. We investigated age- and gender-specific incidence of shingles reported in a large sentinel practice network monitoring a defined population over the years 1994-2001. In total, 5915 male and 8617 female incident cases were studied. For each age group, we calculated the relative risk of females to males presenting with shingles. Incidence rates of chickenpox and herpes simplex were examined similarly. Shingles incidence was greater in females in each age group (except for 15-24 years). Relative risks (female to male) were greatest in age groups 45-64 years (1.48) and 0-14 years (1.43). There were no gender differences in the incidence of chickenpox except in the 15-24 years age group (female excess): for herpes simplex there were female excesses in all age groups. Gender-specific age-standardized incidence rates of shingles were calculated for each year and showed a consistent female excess in each of the 8 years (average annual excess 28%). PMID: 14979582 [PubMed - indexed for MEDLINE] 1383. J Reprod Med. 2004 Jan;49(1):38-40. Outcome of IgM- and IgG-seropositive cases of varicella zoster in pregnancy. Barak M, Weinberger R. Central Laboratory, Faculty of Medicine, Technion, Haifa, Israel. OBJECTIVE: To study the outcome of IgG- and IgM-seropositive cases of varicella zoster virus (VZV) in pregnancy. STUDY DESIGN: The VZV immune status of 120 pregnant women who had been exposed to VZV and did not recall a history of VZV infection was determined, and 109 were VZV immune. Eleven women were both IgG and IgM seropositive, and the outcomes of their pregnancies were studied. RESULTS: Nine of the 11 VZV IgM-, IgG-seropositive pregnant women were asymptomatic, without fetal damage. CONCLUSION: The majority of the women were asymptomatic, but no statement about the relative risk of being affected by the virus can be made. PMID: 14976794 [PubMed - indexed for MEDLINE] 1384. An Med Interna. 2004 Feb;21(2):100-1. [Deep venous thrombosis associated with varicella pneumonia and anticardiolipin antibody] [Article in Spanish] Maldonado JA, Belinda Manzano M, Rodríguez Vidigal FF. PMID: 14974901 [PubMed - indexed for MEDLINE] 1385. Wiad Lek. 2003;56(7-8):375-7. [Ramsay Hunt syndrome--a case study] [Article in Polish] Fota-Markowska HZ, Rolla-Szczepańska R, Modrzewska R, Kiciak SG. Katedry i Kliniki Chorób Zakaźnych Akademii Medycznej w Lublinie. In this work we present a patient, aged 40 with Ramsay Hunt syndrome, who was treated at the Department of Infectious Disease, Medical Academy in Lublin (Poland). The diagnosis of the disease was based on the anamnesis concerning epidemiology of the disease, the course and three major symptoms: facial paralysis, neuralgia, herpetic eruption in the mouth and on the ear. The combined treatment with antiviral drugs and corticosteroids was partially successful and did not resolve the seventh nerve palsy. PMID: 14969168 [PubMed - indexed for MEDLINE] 1386. Nippon Ganka Gakkai Zasshi. 2004 Jan;108(1):55-64. [Program for Continuing Professional Education in Ophthalmology. A review 17 viral eye diseases] [Article in Japanese] Shimomura Y. PMID: 14969094 [PubMed - indexed for MEDLINE] 1387. J Fr Ophtalmol. 2004 Jan;27(1):7-13. [Acute retinal necrosis: clinical presentation, treatment, and prognosis in a series of 22 patients] [Article in French] Morel C, Metge F, Roman S, Scheer S, Larricart P, Monin C, Laroche L. Centre Hospitalier des Quinze-Vingts, Paris. morel@quinze-vingts.fr PURPOSE: To evaluate the clinical outcome and medical management in a series of patients diagnosed with acute retinal necrosis. MATERIAL AND METHODS: Between 1993 and 2000, 22 patients suffering from acute retinal necrosis were referred to our department. We retrospectively reviewed the clinical course, delay between diagnosis and first clinical manifestation, biological profiles, treatment and complications. RESULTS: All patients had vitreous inflammation; retinitis was seen upon examination in 82% of the cases. Nevertheless, for six patients (27% of the cases), failure to recognize the diagnosis led to delay (mean, 5.5 days) between the first ophthalmological examination and antiviral therapy. Nineteen patients underwent laboratory evaluation, and virological diagnosis was made in 16 of them: varicella zoster virus was found in 11 cases, herpes simplex type 1 in three cases, and herpes simplex type 2 and cytomegalovirus in one case each. Nine patients were treated with a combination of aciclovir and foscarnet and 13 with aciclovir alone. Among the 16 patients who received aciclovir, one did not respond to therapy after 2 days and was cured only after foscarnet was added. Recurrence occurred at the end of treatment in only one patient. Retinal detachment complicated the course for 11 patients and was always associated with proliferative vitreoretinopathy. Among those, seven of the ten patients who accepted surgery were successfully treated. Eleven out of 22 patients had a final visual acuity up to 20/200 and two up to 20/40. CONCLUSION: In our series, acyclovir alone was sufficient to cure the majority of cases. Even with antiviral therapy, the prognosis of acute retinal necrosis remains poor. Retinal detachment is the main complication. PMID: 14968071 [PubMed - indexed for MEDLINE] 1388. Can Commun Dis Rep. 2004 Feb 1;30:1-26. National Advisory Committee on Immunization (NACI) update on varicella. [Article in English, French] [No authors listed] PMID: 14964716 [PubMed - indexed for MEDLINE] 1389. N Engl J Med. 2004 Feb 12;350(7):e6. Images in clinical medicine. Use of multinucleated giant cells to diagnose a viral eruption. Koranda FC. University of Kansas Medical Center, Kansas City, KS 66160, USA. PMID: 14960757 [PubMed - indexed for MEDLINE] 1390. Pediatr Infect Dis J. 2004 Feb;23(2):132-7. Ten year follow-up of healthy children who received one or two injections of varicella vaccine. Kuter B, Matthews H, Shinefield H, Black S, Dennehy P, Watson B, Reisinger K, Kim LL, Lupinacci L, Hartzel J, Chan I; Study Group for Varivax. Merck Research Laboratories, PO Box 4, West Point, PA 19486, USA. barbara_kuter@merck.com Comment in: Pediatr Infect Dis J. 2008 Feb;27(2):190; author reply 190-1. BACKGROUND: The rate of varicella and persistence of varicella antibody after a one dose vs. a two dose regimen of varicella virus vaccine live Oka/Merck (VARIVAX; Merck & Co., Inc., West Point, PA) in approximately 2000 children were compared during a 9- to 10-year follow-up period. METHODS: Children 12 months to 12 years of age with a negative history of varicella were randomized in late 1991 to early 1993 to receive either one or two injections of varicella vaccine given 3 months apart. Subjects were actively followed for varicella, any varicella-like illness or zoster and any exposures to varicella or zoster on a yearly basis for 10 years after vaccination. Persistence of varicella antibody was measured yearly for 9 years. RESULTS: Most cases of varicella reported in recipients of one or two injections of vaccine were mild. The risk of developing varicella >42 days postvaccination during the 10-year observation period was 3.3-fold lower (P < 0.001) in children who received two injections than in those who received one injection (2.2% vs. 7.3%, respectively). The estimated vaccine efficacy for the 10-year observation period was 94.4% for one injection and 98.3% for two injections (P < 0.001). Measurable serum antibody persisted for 9 years in all subjects. CONCLUSIONS: Administration of either one or two injections of varicella vaccine to healthy children results in long term protection against most varicella disease. The two dose regimen was significantly more effective than a single injection. PMID: 14872179 [PubMed - indexed for MEDLINE] 1391. Pediatr Dermatol. 2004 Jan-Feb;21(1):18-23. Revisiting childhood herpes zoster. Nikkels AF, Nikkels-Tassoudji N, Piérard GE. Department of Dermatopathology, University Medical Center of Liège, Liège, Belgium. af.nikkels@chu.ulg.ac.be Herpes zoster is rare in otherwise healthy children, but it is more common in association with immunosuppression. Maternal varicella infection during pregnancy and varicella occurring in the newborn represent risk factors for childhood herpes zoster. However, some controversies persist about risk factors, diagnosis, and the natural history of childhood disease. In a 2-year prospective study, 18 children with herpes zoster were clinically diagnosed in outpatient consultations in a hospital dermatology unit. Data about age, dermatome involvement, underlying disease, and history of previous varicella were recorded. Tzanck smears, biopsy specimens, and sera were obtained from 18, 4, and 10 children, respectively. The varicella zoster virus major envelope glycoprotein gE was detected in 16 of 18 smears and all four biopsies. Herpes simplex virus I was demonstrated in one of the smears. The established risk factors for childhood herpes zoster were only found in one child. Evidence for previous full-blown varicella and varicella with few lesions was recorded in 7 and 4 of the 17 immunocompetent children, respectively. No history of varicella was recalled in 6 of 17 cases, although a serologic clue of past varicella infection (IgM negative, IgG positive) was disclosed. Recurrent herpes zoster was diagnosed in one immunocompromised child. Zoster-associated pain was localized and the disease severity remained mild in all children. Established risk factors for childhood herpes zoster were only rarely found in our series of patients. In contrast, unrecognized varicella and varicella with few lesions were frequently recorded and may represent additional risk factors for shingles in childhood. Zosteriform herpes simplex virus infections should be differentiated from childhood herpes zoster, emphasizing the importance of precise viral identification. PMID: 14871320 [PubMed - indexed for MEDLINE] 1392. J Eur Acad Dermatol Venereol. 2003 Nov;17(6):686-8. Granuloma annulare in a site of healed herpes zoster: Wolf's isotopic response. Ruocco E, Baroni A, Cutrì FT, Filioli FG. Department of Dermatology, Second University of Naples, Naples, Italy. A case of granuloma annulare that developed in a site of healed herpes zoster is reported. Polymerase chain reaction failed to detect VZV DNA in a biopsy specimen. The occurrence of different types of cutaneous reactions in a body area previously affected by herpes virus infection is known as Wolf's isotopic response. Pathogenesis may be due to a local neuroimmune dysregulation set off by herpesvirus-induced lesions of dermal sensory nerve fibres. PMID: 14761138 [PubMed - indexed for MEDLINE] 1393. Saudi Med J. 2004 Jan;25(1):112-4. Ramsay Hunt syndrome in focal segmental glomerulosclerosis. Cheema KM, Kanu MK, Kutaiba M, Sohail M. ENT Department, Huraymala General Hospital, Huraymala, Kingdom of Saudi Arabia. khalid_cheema@hotmail.com PMID: 14758395 [PubMed - indexed for MEDLINE] 1394. Clin Transplant. 2003 Dec;17(6):522-7. Skin infections in renal transplant recipients and the relation with solar ultraviolet radiation. Termorshuizen F, Hogewoning AA, Bouwes Bavinck JN, Goettsch WG, de Fijter JW, van Loveren H. Laboratory for Toxicology, Pathology and Genetics, National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands. BACKGROUND: Ultraviolet radiation (UVR) is an important risk factor for skin cancer in transplant recipients. In view of the potential suppressive effect of UVR on host resistance it was examined whether exposure to UVR was also associated with the occurrence of various skin infections. METHODS: In a cohort of renal transplant recipients (n = 137), lifetime exposure was assessed by means of a retrospective questionnaire on cumulative sunlight exposure. Diagnosed skin infections since renal transplantation were extracted from the patient's medical charts. Season of diagnosis was regarded as indicative of short-term exposure. RESULTS: In comparison with winter a high rate of herpes simplex infections was found in spring [rate ratio (RR) = 4.09, 95% confidence interval (CI) 1.2-14.5], and high rates of herpes zoster infections (RR = 1.6, 95% CI: 0.8-3.5) and fungal/yeast infections in summer (RR = 2.1, 95% CI: 1.3-3.4). A higher lifetime exposure (RR = 2.31, 95% CI: 1.04-5.1) and a greater cumulative number of reported sunburns (RR = 2.3, 95% CI: 1.1-5.1) were independently associated with a higher risk of bacterial infections. CONCLUSIONS: The seasonal association with the occurrence of clinical herpes infections indicates an effect of short-term UVR. Our data suggest that the number of sunburn episodes in the past is also relevant for the susceptibility to certain skin infections. PMID: 14756268 [PubMed - indexed for MEDLINE] 1395. J Rheumatol. 2004 Feb;31(2):274-9. Close association of herpes zoster reactivation and systemic lupus erythematosus (SLE) diagnosis: case-control study of patients with SLE or noninflammatory nusculoskeletal disorders. Pope JE, Krizova A, Ouimet JM, Goodwin JL, Lankin M. Division of Rheumatology, Department of Medicine, The University of Western Ontario, London, Ontario, Canada. janet.pope@sjhc.london.on.ca OBJECTIVE: To investigate the prevalence of infections, particularly the frequency of shingles and the timing of varicella zoster virus (VZV) reactivation, and antibiotic use, vaccinations, and joint trauma prior to and at diagnosis of systemic lupus erythematosus (SLE). METHODS: We sent questionnaires to patients with SLE (n = 93) and controls with noninflammatory musculoskeletal disorders (MSK; n = 353) including osteoarthritis, fibromyalgia, and tendonitis. We matched SLE patients to controls for sex (up to 1:3). RESULTS: The response rate in SLE was 66% and in controls 69% (p < 0.53). Four of 61 SLE patients and 12 of 173 controls were men. The mean disease duration in the SLE group was 8 +/- 1 years compared to 10 +/- 1 years in controls (p < 0.23). SLE patients were significantly younger than controls (mean age of SLE patients 49 +/- 2 vs 57 +/- 1 years for controls; p < 0.0004), and results were adjusted for age. A significantly higher proportion of SLE participants had a history of VZV (shingles) (19% vs 7%, respectively; OR 2.98, p < 0.003), whereas rubella was reported less in SLE (23% vs 42%; OR 0.43, p < 0.03). VZV infections were clustered just prior to or after diagnosis in SLE but were more widely spaced temporally in the controls (1 +/- 4.5 years after the diagnosis of SLE vs -14.7 +/- 4 years before the diagnosis of noninflammatory MSK disorder; p < 0.003). Diagnosis of shingles was observed in 6 of 11 SLE patients within +/- 2 years of SLE diagnosis, whereas only 2 of 15 controls had shingles within +/- 2 years of diagnosis (OR 7.2, p < 0.03). Only 2 patients with SLE were taking immunosuppressive drugs or steroids at time of shingles, so immunosuppressive therapy was not usually concomitant at time of VZV reactivation. Common infections (respiratory, urinary tract, ear, and eye) in the SLE group exceeded controls, but not significantly (23% vs 9%; OR 2.98, p < 0.06) and SLE patients were more likely to have been vaccinated since 18 years of age with any type of vaccine (69% vs 51%; OR 2.21, p < 0.04). SLE patients were less likely than controls to report joint trauma within one year prior to their diagnosis (25% vs 40%; OR 0.49, p < 0.04). There were no differences with respect to streptococcal throat infection (p < 0.96), diarrhea/vomiting (p < 0.84), rash with fever (p < 0.07), parvovirus infection (p < 0.16), infection after surgery (p < 0.58), respiratory tract infection (p < 0.71), or ear (p < 0.09) and eye infection (p < 0.68) one year prior to diagnosis. A higher proportion of SLE patients had a history of urinary tract infections (46% vs 25%), but this was not significant (p < 0.17), nor was it significant one year prior to diagnosis (p < 0.63). Overall, the likelihood of having any infection one year prior to diagnosis was not significantly higher in the SLE group (p < 0.56). There were no differences one year prior to diagnosis in travel history (p < 0.69), hospitalizations (p < 0.47), use of antibiotics (p < 0.54), history of rheumatic fever, positive TB skin test, or hepatitis A, B or C infection. CONCLUSION: Varicella reactivation as shingles is increased in patients with SLE and clusters around diagnosis. Vaccinations are increased in those with SLE compared to controls. Common infections are not significantly increased in SLE patients prior to onset of symptoms. We cannot determine if VZV infections are causally associated with SLE in some people, are from an abnormal immune system response due to the lupus itself or from the use of steroids or other immunosuppressive drugs to control the disease, or are spurious. PMID: 14760796 [PubMed - indexed for MEDLINE] 1396. Postgrad Med J. 2004 Jan;80(939):26. Severe herpes zoster after infliximab infusion. Kinder A, Stephens S, Mortimer N, Sheldon P. Leicester Royal Infirmary, UK. alisonkinder@dsl.pipex.com PMCID: PMC1757965 PMID: 14760175 [PubMed - indexed for MEDLINE] 1397. J Clin Virol. 2004 Feb;29(2):113-9. New method of differentiating wild-type varicella-zoster virus (VZV) strains from Oka varicella vaccine strain by VZV ORF 6-based PCR and restriction fragment length polymorphism analysis. Takayama M, Takayama N. Department of Virology I, National Institute of Infectious Diseases, 1-23-1, Toyama, Shinjuku-ku, Tokyo 162-8640, Japan. A new method was developed to distinguish accurately wild-type varicella-zoster virus (VZV) strains from the Oka vaccine strain. Several DNA fragments covering open reading frame (ORF) 1-37 were amplified from wild-type VZV strains including the Oka parent strain and from the Oka vaccine strain. Restriction fragment length polymorphisms of these regions were compared, and nucleotide differences between the vaccine virus and other wild-type VZV strains were noted in ORFs 6, 10, and 35. In addition, variations of the R2 and R4 reiterated structures of the vaccine and its parent strains were examined. The Oka vaccine strain used in Japan was shown to be a mixture of viruses with different nucleotide sequences that had variations in at least three nucleotide positions in ORF 1-37 and had variable polymorphisms at R2 and R4 repeat regions (two and three patterns, respectively). The Oka parent strain on the other hand showed a single sequence and had only one reiterated structure at these regions. When VZV ORF 6 was amplified and its product was digested with AluI, the Oka vaccine strain could be precisely differentiated from its parent and from 56 other Japanese clinical isolates. PMID: 14747030 [PubMed - indexed for MEDLINE] 1398. Br J Dermatol. 2004 Jan;150(1):158-9; author reply 159. Lisinopril and Kaposi's sarcoma. Di Carlo A. Comment on: Br J Dermatol. 2002 Nov;147(5):1042-4. PMID: 14746638 [PubMed - indexed for MEDLINE] 1399. Neurol Neurochir Pol. 2003;37(4):943-53. [The DREZ lesion as an effective treatment for chronic hypothetically post-herpetic neuropathic pain. Case report and review of literature] [Article in Polish] Koszewski W, Jarosz J, Pernak-De Gast J. Kliniki Neurochirurgii A.M. w Warszawie. The authors present a case of a 54-year-old woman with a 3-year history of chronic pain syndrome, probably of postherapeutic origin, with diffuse segmentary dermatome characteristics, both somatic and autonomic. The former were exemplified by a constant "burning" skin pain in the representation of Th8-LI dermatomes unilaterally, while the latter by a unilateral visceral pain within the abdominal cavity. Electrophysiological examination indicated a neuropathic origin of the pain, despite the lack of clinically evident sensory deficits and/or hypersensitivity. The pain was so intense that normal walking was difficult for the patient and ineffectiveness of her treatment made her suicidal. Since both pharmacological treatment (non-steroid analgesics, opioids, antidepressants, and anticonvulsants including gabapentin) and minimally invasive methods of treatment (blockades, thermolesions) failed to control pain, she was subjected to surgery. A right-sided DREZ lesion within the Th8-LI dermatomes resulted in a complete pain relief, both within the somatic and autonomic innervation projections, and in the patient's functional recovery. PMID: 14746252 [PubMed - indexed for MEDLINE] 1400. BMJ. 2004 Feb 21;328(7437):439. Epub 2004 Jan 23. Case-control study of the effect of mechanical trauma on the risk of herpes zoster. Thomas SL, Wheeler JG, Hall AJ. Infectious Disease Epidemiology Unit, London School of Hygiene and Tropical Medicine, London WC1E 7HT. sara.thomas@lshtm.ac.uk PMCID: PMC344263 PMID: 14742350 [PubMed - indexed for MEDLINE] 1401. J Dermatol. 2003 Dec;30(12):929-30. Zosteriform herpetic folliculitis involving eccrine gland. Kim KJ, Choi HJ, Suh HS, Lee MW, Choi JH, Moon KC, Koh JK. PMID: 14739524 [PubMed - indexed for MEDLINE] 1402. Pain. 2004 Feb;107(3):202-6. Interventions to prevent postherpetic neuralgia: cutaneous and percutaneous techniques. Opstelten W, van Wijck AJ, Stolker RJ. Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, P.O. Box 85060, 3500 AB, Utrecht, The Netherlands. w.opstelten@med.uu.nl PMID: 14736581 [PubMed - indexed for MEDLINE] 1403. Reg Anesth Pain Med. 2004 Jan-Feb;29(1):75; author reply 75. Clarifying the use of lidoderm patch to treat pain associated with postherpetic neuralgia. Alvarez NA. Comment on: Reg Anesth Pain Med. 2003 Jul-Aug;28(4):289-93. PMID: 14727292 [PubMed - indexed for MEDLINE] 1404. Am J Dermatopathol. 2004 Feb;26(1):27-32. Absence of intercellular adhesion molecule 1 expression in varicella zoster virus-infected keratinocytes during herpes zoster: another immune evasion strategy? Nikkels AF, Sadzot-Delvaux C, Piérard GE. Department of Dermatopathology, University of Liège, Liège, Belgium. af.nikkels@chu.ulg.ac.be Downregulation of major histocompatibility complex (MHC) class I, MHC-II, and intercellular adhesion molecule 1 (ICAM-1) expression in infected cell lines allows some viruses to escape host immunity. In skin lesions of varicella zoster virus (VZV), MHC-II transcripts were demonstrated in keratinocytes around vesicles, but not in VZV-infected cells. Whether other immunoevasive mechanisms are present during herpes zoster (HZ) is not yet elucidated. The aim of the study was to disclose the temporal immunohistochemical expression of immune escape mechanisms during HZ. Sequential skin biopsies were performed in 5 HZ patients. VZV IE63, CD1a, CD3, CD4, CD8, CD56, CD68, L1, HLA-DR, HLA-ABC, interleukin (IL)-6, IL-10, interferon gamma (IFNgamma), tumor necrosis factor alpha (TNFalpha), and ICAM-1 expressions were assessed on frozen sections using immunohistochemistry. Controls consisted of normal skin, herpes simplex virus (HSV) skin infections, and other distinct bullous skin diseases. HLA-DR and ICAM-1 expressions were not observed in VZV- and HSV-infected keratinocytes, contrasting with their upregulation in the surrounding epidermis and inside nonviral blisters. However, HLA-ABC expressions were not inhibited in VZV-infected keratinocytes. Furthermore, the CD4/CD8 ratio remained unmodified during the infection evolution, and this ratio was variable among patients. Increased IFNgamma, TNFalpha, and IL-6 expressions were present, but IL-10 expression only increased in later stages. In contrast to in vitro MHC-I and MHC-II downregulation, VZV infection is related to MHC-II but not MHC-I expression on infected keratinocytes. The absence of ICAM-1 expression on infected keratinocytes may reduce their antigen presentation capacities to LFA-1 ligand-bearing T cells. This may represent another VZV-associated immune escape mechanism. Increased IFNgamma, TNFalpha, and IL-6 expressions suggest a TH1 profile. PMID: 14726820 [PubMed - indexed for MEDLINE] 1405. J Virol. 2004 Feb;78(3):1181-94. The immediate-early 63 protein of Varicella-Zoster virus: analysis of functional domains required for replication in vitro and for T-cell and skin tropism in the SCIDhu model in vivo. Baiker A, Bagowski C, Ito H, Sommer M, Zerboni L, Fabel K, Hay J, Ruyechan W, Arvin AM. Departments of Pediatrics and Microbiology & Immunology, Stanford University School of Medicine, Stanford, California, USA. The immediate-early 63-kDa (IE63) protein of varicella-zoster virus (VZV) is a phosphoprotein encoded by open reading frame (ORF) ORF63/ORF70. To identify functional domains, 22 ORF63 mutations were evaluated for effects on IE63 binding to the major VZV transactivator, IE62, and on IE63 phosphorylation and nuclear localization in transient transfections, and after insertion into the viral genome with VZV cosmids. The IE62 binding site was mapped to IE63 amino acids 55 to 67, with R59/L60 being critical residues. Alanine substitutions within the IE63 center region showed that S165, S173, and S185 were phosphorylated by cellular kinases. Four mutations that changed two putative nuclear localization signal (NLS) sequences altered IE63 distribution to a cytoplasmic/nuclear pattern. Only three of 22 mutations in ORF63 were compatible with recovery of infectious VZV from our cosmids, but infectivity was restored by inserting intact ORF63 into each mutated cosmid. The viable IE63 mutants had a single alanine substitution, altering T171, S181, or S185. These mutants, rOKA/ORF63rev[T171], rOKA/ORF63rev[S181], and rOKA/ORF63rev[S185], produced less infectious virus and had a decreased plaque phenotype in vitro. ORF47 kinase protein and glycoprotein E (gE) synthesis was reduced, indicating that IE63 contributed to optimal expression of early and late gene products. The three IE63 mutants replicated in skin xenografts in the SCIDhu mouse model, but virulence was markedly attenuated. In contrast, infectivity in T-cell xenografts was not altered. Comparative analysis suggested that IE63 resembled the herpes simplex virus type 1 U(S)1.5 protein, which is expressed colinearly with ICP22 (U(S)1). In summary, most mutations of ORF63 made with our VZV cosmid system were lethal for infectivity. The few IE63 changes that were tolerated resulted in VZV mutants with an impaired capacity to replicate in vitro. However, the IE63 mutants were attenuated in skin but not T cells in vivo, indicating that the contribution of the IE63 tegument/regulatory protein to VZV pathogenesis depends upon the differentiated human cell type which is targeted for infection within the intact tissue microenvironment. PMCID: PMC321405 PMID: 14722273 [PubMed - indexed for MEDLINE] 1406. Lancet Infect Dis. 2004 Jan;4(1):26-33. What does epidemiology tell us about risk factors for herpes zoster? Thomas SL, Hall AJ. Infectious Disease Epidemiology Unit, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK. sara.thomas@lshtm.ac.uk Reactivation of latent varicella zoster virus as herpes zoster is thought to result from waning of specific cell-mediated immunity, but little is known about its determinants in individuals with no underlying immunosuppression. We systematically reviewed studies of zoster epidemiology in adults and analysed data from a large morbidity study to identify factors that might be modulated to reduce the risk of zoster. Annual zoster incidence in population-based studies varied from 3.6-14.2/10(3) in the oldest individuals. Risk factors identified in analytical studies that could explain this variation included age, sex, ethnicity, genetic susceptibility, exogenous boosting of immunity from varicella contacts, underlying cell-mediated immune disorders, mechanical trauma, psychological stress, and immunotoxin exposure. Our review highlights the lack of information about risk factors for zoster. We suggest areas of research that could lead to interventions to limit the incidence of zoster. Such research might also help to identify risk factors for age-related immune decline. PMID: 14720565 [PubMed - indexed for MEDLINE] 1407. Adv Virus Res. 2003;62:1-17. Varicella virus-mononuclear cell interaction. White TM, Gilden DH. Departments of Neurology and Microbiology, University of Colorado Health Sciences Center, Denver, Colorado 80262, USA. Varicella zoster virus (VZV) causes varicella (chickenpox), becomes latent in cranial nerve, dorsal root, and autonomic ganglia; and reactivates decades later to produce zoster (shingles). The main complication of zoster is postherpetic neuralgia (PHN), pain that persists for months and often years after zoster. VZV also causes chronic radicular pain without rash (zoster sine herpete). Viremia is associated with each stage of VZV infection. Viral DNA has been found in peripheral blood mononuclear cells (MNCs) of patients with varicella, zoster, PHN, and zoster sine herpete. In varicella, viremia contributes to the widespread distribution of skin lesions and infection of multiple organs. Although the role of viremia in other VZV-associated diseases is not as clear, the detection of VZV DNA (and sometimes VZV RNA and proteins) helps diagnose neurological diseases produced by VZV, has indicated that PHN may reflect a chronic VZV ganglionitis, and has established that VZV reactivates subclinically, especially in immunocompromised humans. In vitro studies have established that VZV can productively infect MNCs for a short time and have identified the subpopulations of MNCs that are infected. Finally, simian varicella virus (SVV) infection of nonhuman primates shares clinical, pathological, and virologic features with VZV in humans. Like VZV, SV viremia in nonhuman primates during acute infection plays an important role in the pathogenesis of SVV. Infectious virus can be isolated from MNCs, and SVV DNA can be detected in MNCs during varicella. Further, SVV DNA can be detected for months in MNCs of monkeys after experimental infection with SVV. Herein, we review the current literature related to VZV infection of MNCs during naturally occurring varicella, PHN, and zoster sine herpete in humans, including studies of experimental infection of human MNCs with VZV. We also review SVV MNC interaction during naturally occurring simian varicella and after experimental infection of primates with SVV. PMID: 14719363 [PubMed - indexed for MEDLINE] 1408. Vestn Oftalmol. 2003 Nov-Dec;119(6):35-8. [Clinical forms and treatment of keratitis caused by varicella-zoster virus] [Article in Russian] Maĭchuk IuF. PMID: 14708173 [PubMed - indexed for MEDLINE] 1409. Clin Ther. 2003 Nov;25(11):2809-21. Change in opioid use after the initiation of gabapentin therapy in patients with postherpetic neuralgia. Berger A, Dukes E, McCarberg B, Liss M, Oster G. Policy Analysis Inc., Brookline, Massachusetts 02445, USA. BACKGROUND: Postherpetic neuralgia (PHN) is a chronic painful disorder that sometimes develops after an acute episode of herpes zoster infection (shingles) and can be difficult to treat. Although opioids are sometimes effective for chronic neuropathic pain, adverse effects are common, particularly among the elderly, and may cause many patients to discontinue therapy. OBJECTIVE: This study examined changes in opioid use after the initiation of gabapentin therapy in patients with PHN. METHODS: A health insurance claims database was used to identify all persons aged >or= 18 years who began therapy with gabapentin in 2000 or 2001 and had either (1) >or=2 medical claims with a diagnosis of PHN during the 6-month period before the first receipt of gabapentin (index date) or (2) 1 such claim or=2 prescriptions for gabapentin. RESULTS: Forty-five patients with PHN began therapy with gabapentin during the period of interest; 35 (77.8%) received >or=2 prescriptions for gabapentin. The proportion of patients receiving opioids decreased significantly between pretreatment and follow-up (from 88.9% to 71.1%; P = 0.03); the mean number of opioid prescriptions per patient also decreased significantly (from 3.9 to 3.0; P = 0.03). These reductions were observed only in patients who received >or=2 prescriptions for gabapentin; there was no significant change in opioid use among those who received only 1 prescription for gabapentin. CONCLUSION: In this study, initiation of gabapentin therapy in patients with PHN was associated with a reduction in the use of opioid analgesics. PMID: 14693306 [PubMed - indexed for MEDLINE] 1410. Eur J Neurol. 2004 Jan;11(1):68-9. Neurotoxicity of acyclovir and valacyclovir in a hemodialyzed patient. Strumia S, De Mitri P, Bionda E. PMID: 14692893 [PubMed - indexed for MEDLINE] 1411. Leuk Lymphoma. 2003 Oct;44(10):1793-5. Varicella-zoster viral meningitis mimicking lymphoma. Park S, Leymarie V, Agbalika F, Galicier L, Oksenhendler E, Sigaux F, Noguera ME. Laboratoire d'hématologie, Hôpital Saint-Louis, 1 av Claude Vellefaux, 75010 Paris, France. parksophie@yahoo.com We report the case of a 30-year-old HIV-infected man admitted for a meningeal syndrome and a zoster rash. The CSF had cytological features suggesting a primary CNS lymphoma (PCNSL). The large lymphoid cells had a fine chromatin with nucleoli, a basophilic cytoplasm with azurophilic granules and high mitotic activity. Several arguments demonstrated the viral origin of the meningitis: the large lymphoid cells were of T origin with no evidence of clonal TCR gamma gene rearrangement. The PCR was positive for Varicella-Zoster Virus (VZV) and EBV DNA. Clinical evolution was favorable under acyclovir. We should be cautious in the differential diagnosis between viral meningitis and PCNSL. PMID: 14692535 [PubMed - indexed for MEDLINE] 1412. Prof Nurse. 2003 Dec;19(4):195-6. Varicella-zoster virus, shingles and postherpetic neuralgia. Shuttleworth A. PMID: 14692251 [PubMed - indexed for MEDLINE] 1413. Am J Transplant. 2004 Jan;4(1):108-15. Herpes zoster infection following solid organ transplantation: incidence, risk factors and outcomes in the current immunosuppressive era. Gourishankar S, McDermid JC, Jhangri GS, Preiksaitis JK. Department of Medicine, Division of Nephrology & Transplantation Immunology, University of Alberta, Edmonton, Alberta, Canada. sitag@ualberta.ca Herpes zoster (HZ) infection is a frequent and serious complication of organ transplantation that has not been examined in the current era of immunosuppression. All solid organ transplants performed between 1994 and 1999 (n = 869) at our center were analyzed to determine the incidence, complications and risk factors for developing HZ. The overall incidence of HZ was 8.6% (liver 5.7%, renal 7.4%, lung 15.1% and heart 16.8%). The median time of onset was 9.0 months. We observed high rates of cutaneous scarring (18.7%) and post-herpetic neuralgia (42.7%). Independent organ-specific risk factors included: female gender and mycophenolate mofetil therapy (liver), and antiviral treatment other than prolonged cytomegalovirus (CMV) prophylaxis (renal and heart). For all organs combined, induction therapy and antiviral treatment other than prolonged CMV prophylaxis were independent predictors for the development of HZ. Herpes zoster is common and results in significant morbidity for solid organ transplant recipients. Risk factors include induction therapy and antiviral drug therapy other than CMV prophylaxis. The latter variable identifies a subpopulation that is likely at increased risk of latent herpesvirus reactivation. The high first-year post-transplant incidence rate suggests immunization pretransplant, even in varicella zoster virus immunoglobulin seropositive individuals, may be preventative. PMID: 14678041 [PubMed - indexed for MEDLINE] 1414. J Neurol. 2003 Dec;250(12):1492-3. Zoster paresis with Horner's syndrome. Gabriel CM, Gale AN, Rossor MN. PMID: 14673585 [PubMed - indexed for MEDLINE] 1415. Skinmed. 2003 Jul-Aug;2(4):253-5. Herpes zoster: reassessment of isolation-precautions in hospitals. Burkhart CN, Barnett R. The Department of Immunology and Microbiology, Medical College of Ohio at Toledo, Toledo, OH 43623, USA. cburkhart@mco.edu PMID: 14673281 [PubMed - indexed for MEDLINE] 1416. Clin Ther. 2003 Oct;25(10):2597-608. Use of gabapentin for postherpetic neuralgia: results of two randomized, placebo-controlled studies. Stacey BR, Glanzman RL. Pain Management Center, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA. staceyb@ohsu.edu BACKGROUND: Postherpetic neuralgia (PHN), which affects up to 70% of elderly persons with herpes zoster, can have debilitating effects, including physical and social disability and significant psychological distress. A variety of agents have been used, either singly or in combination, to control PHN, including topical and oral analgesics, antidepressants, and antiepileptic drugs (AEDs). However, PHN often proves refractory to these therapies. OBJECTIVE: This article reviews available data on the use of the newer AED gabapentin for the control of PHN. METHODS: A MEDLINE search was undertaken to identify all randomized, placebo-controlled trials on the use of gabapentin in PHN. The search terms were gabapentin and postherpetic neuralgia. RESULTS: The literature search identified 2 published studies of the efficacy of gabapentin in a total of 563 patients with PHN that had persisted for at least 3 months after the healing of herpes zoster rash. The studies employed multiple outcome measures, including visual analog and Likert scales for pain intensity, and quality-of-life and functional measures that included the Medical Outcomes Study 36-item Short Form Health Survey (SF-36) and the Profile of Mood States. At maximum target dosages of 1800 to 3600 mg/d, gabapentin produced significant reductions in mean daily pain scores compared with placebo on both visual analog(P < 0.001) and Likert scales (P < 0.01). Improvements were also seen on the SF-36 subscales for physical functioning, bodily pain, vitality, and mental health(P < 0.01). CONCLUSION: Gabapentin may provide benefits in terms of alleviation of pain and overall quality of life in patients with chronic PHN. PMID: 14667960 [PubMed - indexed for MEDLINE] 1417. J Oral Maxillofac Surg. 2003 Dec;61(12):1505; author reply 1505. Etiology of maxillary necrosis. Peñarrocha-Diago M, Uribe-Origone R. Comment on: J Oral Maxillofac Surg. 2003 Apr;61(4):489-93. PMID: 14666937 [PubMed - indexed for MEDLINE] 1418. Klin Med (Mosk). 2003;81(10):63-4. [Documented case of recurrent herpes zoster] [Article in Russian] Shishov AS, Virych IE, Rudometov IuP, Kupriianova LV. The paper presents a comparative description of the clinical picture of herpes zoster observed in a patient twice in 1989 and 1997. For its differential diagnosis with herpes simplex, emphasis is laid on a difference between the concepts "relapse" and "recurrence". PMID: 14664179 [PubMed - indexed for MEDLINE] 1419. MMW Fortschr Med. 2003 Oct 30;145(44):37. [Efficacy and tolerability of gabapentin in the treatment of patients with neuropathic pain. Results of an observational study involving 5620 patients] [Article in German] Junker U, Brunnmüller U. Abt. Spezielle Schmerztherapie und Palliativmedizin Sana Klinikum Remscheid GmbH Hans-Potyka-Str. 28, D-42827 Remscheid. PMID: 14655505 [PubMed - indexed for MEDLINE] 1420. Melanoma Res. 2003 Dec;13(6):635-9. Cutaneous zosteriform melanoma metastases arising after herpes zoster infection: a case report and review of the literature. Zalaudek I, Leinweber B, Richtig E, Smolle J, Hofmann-Wellenhof R. PMID: 14646630 [PubMed - indexed for MEDLINE] 1421. MMW Fortschr Med. 2003 Sep 25;145(39):45. [Controlled-release oxycodone -- a therapeutic option for severe neuropathic pain] [Article in German] Wörz R, Frank M, Achenbach U. woerz.roland@t-online.de PMID: 14649073 [PubMed - indexed for MEDLINE] 1422. J Am Acad Dermatol. 2003 Dec;49(6):1121-4. Hiccups, eructation, and other uncommon prodromal manifestations of herpes zoster. Berlin AL, Muhn CY, Billick RC. Department of Dermatology, the University of Illinois College of Medicine, Chicago, Illinois, USA. Although the most frequent presentation of herpes zoster involves sensory neurons, motor and autonomic symptomatology is also known to occur in this disease. An unusual symptom of hiccups is described here. Other infrequent manifestations of this common illness, including the Ramsay Hunt syndrome, herpes zoster ophthalmicus, urinary and fecal retention, sexual dysfunction, and zoster sine herpete, are reviewed. Greater awareness of unusual presentations of herpes zoster is necessary for proper diagnosis and timely management of complications that may otherwise lead to disability and serious long-term sequelae. PMID: 14639397 [PubMed - indexed for MEDLINE] 1423. Int J Dermatol. 2003 Nov;42(11):919-20. Topical tretinoin in Indian male with zosteriform porokeratosis. Agrawal SK, Gandhi V, Madan V, Bhattacharya SN. PMID: 14636214 [PubMed - indexed for MEDLINE] 1424. J Med Virol. 2004 Jan;72(1):174-9. Stress-induced subclinical reactivation of varicella zoster virus in astronauts. Mehta SK, Cohrs RJ, Forghani B, Zerbe G, Gilden DH, Pierson DL. Enterprise Advisory Services Inc., Lyndon B. Johnson Space Center, Houston, Texas. Varicella zoster virus (VZV) becomes latent in human ganglia after primary infection. VZV reactivation occurs primarily in elderly individuals, organ transplant recipients, and patients with cancer and AIDS, correlating with a specific decline in cell-mediated immunity to the virus. VZV can also reactivate after surgical stress. The unexpected occurrence of thoracic zoster 2 days before space flight in a 47-year-old healthy astronaut from a pool of 81 physically fit astronauts prompted our search for VZV reactivation during times of stress to determine whether VZV can also reactivate after non-surgical stress. We examined total DNA extracted from 312 saliva samples of eight astronauts before, during, and after space flight for VZV DNA by polymerase chain reaction: 112 samples were obtained 234-265 days before flight, 84 samples on days 2 through 13 of space flight, and 116 samples on days 1 through 15 after flight. Before space flight, only one of the 112 saliva samples from a single astronaut was positive for VZV DNA. In contrast, during and after space flight, 61 of 200 (30%) saliva samples were positive in all eight astronauts. No VZV DNA was detected in any of 88 saliva samples from 10 healthy control subjects. These results indicate that VZV can reactivate subclinically in healthy individuals after non-surgical stress. Copyright 2004 Wiley-Liss, Inc. PMID: 14635028 [PubMed - indexed for MEDLINE] 1425. Rev Mal Respir. 2003 Nov;20(5 Pt 1):773-6. [Severe varicella zoster pneumonia during the course of treatment with azathioprine for Crohn's disease] [Article in French] Lemyze M, Tavernier JY, Chevalon B, Lamblin C. Service de Pneumologie, Centre Hospitalier, Lens, France. INTRODUCTION: Disseminated varicella zoster infection has only rarely been reported in patients with inflammatory bowel disease, despite the frequent use of azathioprine for this disorder. CASE REPORT: We report the case of an 18-year-old woman who developed severe varicella zoster pneumonia 9 months after starting azathioprine for Crohn's disease. The patient recovered after prompt treatment with acyclovir and discontinuation of the azathioprine. CONCLUSIONS: Strategies concerning the treatment and the prevention of varicella infection in the immunocompromised patient are discussed. PMID: 14631259 [PubMed - indexed for MEDLINE] 1426. J Hist Neurosci. 2003 Sep;12(3):266-75. A biography of James Ramsay Hunt (1874-1937). Louis ED, Williams M. Gertrude H. Sergievsky Center, Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA. EDL2@columbia.edu James Ramsay Hunt (1874-1937) was a pre-eminent twentieth-century American neurologist. The name of Ramsay Hunt is known today because several neurological disorders bear his name, including the herpetic geniculate ganglion syndrome and a form of ataxia and myoclonus. Despite his importance in the field of neurology, few biographical details have been recorded about Hunt's life. One of the authors of this report recently located Hunt's daughter. This biographical sketch was based on interviews conducted with her and review of documents in her possession, including letters written by Hunt. Details are depicted about Hunt's family background and childhood, medical education and early professional development, courtship and marriage, wartime experiences, family and social life, daily routine and professional development, as well as illness and death. PMID: 14628542 [PubMed - indexed for MEDLINE] 1427. J Lab Clin Med. 2003 Oct;142(4):246-51. Laboratory diagnosis to differentiate smallpox, vaccinia, and other vesicular/pustular illnesses. Besser JM, Crouch NA, Sullivan M. Public Health Laboratory, Minnesota Department of Public Health, Minneapolis, MN 55414, USA. PMID: 14625530 [PubMed - indexed for MEDLINE] 1428. Arch Neurol. 2003 Nov;60(11):1607-9. Multifocal varicella-zoster virus vasculopathy without rash. Russman AN, Lederman RJ, Calabrese LH, Embi PJ, Forghani B, Gilden DH. Department of Neurology, The Cleveland Clinic Foundation, Cleveland, OH 44195, USA. russmaa@ccf.org A 51-year-old woman with CREST syndrome (calcinosis, Raynaud phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia) developed stepwise progressive focal neurological deficits without zoster rash. Multifocal ischemic infarcts were seen on magnetic resonance imaging, and cerebral angiography revealed focal stenosis of arteries affecting the intracranial circulation. A brain biopsy was nondiagnostic. Virological etiology of the disease was verified by the detection of varicella-zoster virus antibody in cerebrospinal fluid and by reduced serum-cerebrospinal fluid varicella-zoster virus IgG ratios (compared with normally high ratios of total IgG and albumin). Treatment with intravenous acyclovir stabilized but did not significantly improve her neurological deficits. PMID: 14623735 [PubMed - indexed for MEDLINE] 1429. J Pain. 2003 Aug;4(6):338-43. Herpes zoster itch: preliminary epidemiologic data. Oaklander AL, Bowsher D, Galer B, Haanpää M, Jensen MP. Nerve Injury Unit, Department of Anesthesiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA. aoaklander@partners.org The best-known complication of shingles (herpes zoster) is postherpetic neuralgia (PHN). PHN is commonly studied to investigate causes of and treatments for neuropathic pain. However, many patients with shingles experience neuropathic itch accompanying, or instead of, pain. Some report severe disabling postherpetic itch (PHI), and though it is rare, some patients injure themselves by scratching itchy skin that has lost protective sensation. To date, there is virtually no mention of PHI in the medical literature; neither epidemiologic, anatomic, physiologic, nor treatment studies. We analyzed 3 independent existing sets of data from 586 adults with shingles or PHN to glean epidemiologic information about pruritus during and after shingles. All data refer to itch localized to shingles-affected areas and initiated by shingles. They indicate that pruritus, usually mild or moderate, commonly accompanies both acute zoster and PHN. There was no significant difference in age between subjects with and without PHI. In one group, but not in another, there was an increased number of women with PHI. Subjects whose shingles affected the head, face, and neck were more likely to experience PHI than those whose shingles affected the torso. These findings indicate a need for research on zoster-associated itch, including prospective studies on frequency, impact, and treatment. PMID: 14622691 [PubMed - indexed for MEDLINE] 1430. Br J Dermatol. 2003 Oct;149(4):862-5. Disseminated zoster, hyponatraemia, severe abdominal pain and leukaemia relapse: recognition of a new clinical quartet after bone marrow transplantation. Au WY, Ma SY, Cheng VC, Ooi CG, Lie AK. Department of Medicine, Queen Mary Hospital, University of Hong Kong, Pokfulam Road, Hong Kong SAR, China. auwing@hotmail.com Reactivation of varicella-zoster virus (VZV) is one of the commonest complications after stem cell transplantation, and often presents with atypical manifestations. We describe two unusual cases of occult disseminated zoster in allogeneic stem cell transplant recipients, presenting as severe abdominal pain and syndrome of inappropriate antidiuretic hormone secretion/hyponatraemia, and accompanied by leukaemia relapse. There was complete clinical recovery with high-dose aciclovir and intravenous immunoglobulin. Prompt treatment of leukaemia relapse also resulted in complete remission. A possible immunological link between concurrent breakdown of immune control of VZV and leukaemia is discussed. PMID: 14616382 [PubMed - indexed for MEDLINE] 1431. Ther Umsch. 2003 Oct;60(10):605-14. [Herpes simplex and varicella zoster virus infections] [Article in German] Lautenschlager S. Dermatologisches Ambulatorium des Stadtspitals Triemli Zürich. stephan.lautenschlager@triemli.stzh.ch Herpes simplex virus (HSV) and varicella-zoster virus (VZV) are both human alpha-herpes viruses. They are capable of establishing latent infections in neural tissues and to reactive from these sites, determining the clinical features of the disease (primary infection versus recurrences). Infections with these viruses are common; an increased number of elderly and immunocompromised individuals will likely lead to an even higher prevalence. HSV infection--in its typical form characterized by grouped vesicles--is frequently inapparent or atypical in both primary and recurrent disease. The clinical spectrum is wide, ranging from trivial labial blisters to the most severe fatal sporadic encephalitis and neonatal infection. Seroprevalence studies in the Western world demonstrate a much higher percentage of people infected with HSV-2 than are currently identified by clinical studies. Since undiagnosed genital herpes infections are the major factor in fueling the genital herpes epidemic, awareness and more accurate diagnosis followed by therapy and counseling are mandatory. Primary VZV infection and herpes zoster are usually diagnosed clinically, but can be confirmed by virus detection methods from swabs of lesions or antibody tests. Antiviral therapy should be considered in varicella if the disease is complicated. In herpes zoster antiviral therapy should be given within 72 hours in immunocompromised patients and those at risk of postherpetic neuralgia. The availability of effective antiviral therapy makes early diagnosis most important. PMID: 14610899 [PubMed - indexed for MEDLINE] 1432. MMW Fortschr Med. 2002 Dec 12;144(50):12. [Does vaccination for chickenpox prevent herpes zoster? (interview by Waldtraut Paukstadt)] [Article in German] Doerr HW. PMID: 14610859 [PubMed - indexed for MEDLINE] 1433. MMW Fortschr Med. 2002 Dec 12;144(50):8-10. [Current guidelines for therapy of herpes zoster. Preventing chronification of pain] [Article in German] Paukstadt W. PMID: 14610858 [PubMed - indexed for MEDLINE] 1434. Minerva Urol Nefrol. 2003 Sep;55(3):157-72. Antiviral drug-induced kidney and electrolytes disorders. Izzedine H, Launay-Vacher V, Isnard-Bagnis C, Deray G. Department of Nephrology, Pitie-Salpetriere Hospital, Paris, France. hassan.izzedine@psl.ap-hop-paris.fr HIV patients are at a high risk for nephrotoxicity (HIV-induced nephrotoxicity, HIVAN). As a result, renal insufficiency, tubular dysfunction and renal-related biological disorders are frequently observed in those patients. However, in some cases those defects or anomalies in renal function may be related to antiviral therapies rather than the disease itself. This article reviews the incidence, presentation, prevention and management of antiviral drug-induced renal dysfunction. PMID: 14610435 [PubMed - indexed for MEDLINE] 1435. Neurology. 2003 Nov 11;61(9):1306-7. Ramsay Hunt syndrome associated with spinal trigeminal nucleus and tract involvement on MRI. Nogueira RG, Seeley WW. Massachusetts General Hospital, Boston, MA 02114, USA. rnogueira@partners org PMID: 14610151 [PubMed - indexed for MEDLINE] 1436. Scand J Infect Dis. 2003;35(10):770-2. A case of chronic renal dysfunction following treatment with oral acyclovir. Sodhi PK, Ratan SK. Department of Ophthalmology, Safdarjung Hospital, New Delhi, India. hardeep333@hotmail.com Nephrotoxicity is a well-known side effect of intravenous acyclovir treatment but occurs rarely by oral treatment. A 76-y-old healthy male, with normal baseline renal functions (blood creatinine 0.6 mg%), received oral acyclovir at a dose of 800 mg five times daily for 10 days for treatment of herpes zoster ophthalmicus. He developed renal failure with blood creatinine levels of 3 mg% and his renal function failed to improve within eight months of end of treatment. Affection of renal function has to be considered also in relation to oral acyclovir treatment, especially in elderly subjects. PMID: 14606623 [PubMed - indexed for MEDLINE] 1437. Scand J Infect Dis. 2003;35(10):750-3. Development of antibodies against cytomegalovirus, varicella-zoster virus and herpes simplex virus in Finland during the first eight years of life: a prospective study. Aarnisalo J, Ilonen J, Vainionpää R, Volanen I, Kaitosaari T, Simell O. Department of Virology, University of Turku, Turku, Finland. johanna.aarnisalo@utu.fi To clarify when antibodies against cytomegalovirus (CMV), varicella-zoster virus (VZV) and herpes simplex virus (HSV) develop among young children, 1206 serum samples collected prospectively from 199 children born in 1989 and 1990 were studied. The samples were drawn at the ages of 7 and 13 months, then yearly until the age of 5 y and then at 7 and 8 y. In each age group at least 106 samples were collected. Immunoglobulin G class antibodies to the 3 viruses were measured using an enzyme immunoassay. At the age of 7 months 27% of the children had CMV antibodies, whereas only 3% had antibodies against VZV and 2% against HSV. The prevalence of seropositivity for CMV increased slowly to 41% by the age of 8 y. Seroconversions to VZV antibody positivity occurred frequently after 2 y of age, so that by 8 y 83% of children had VZV antibodies. The proportion of children with HSV antibodies remained low throughout the study, as only 17% of children had HSV antibodies at the age of 8 y. The data show that HSV infection is becoming acquired later in life and the proportion of uninfected children is increasing. The proportion of CMV infections during the perinatal period and early infancy remains high, in one-third of the children, and most children also have VZV infection during the early years of life. PMID: 14606615 [PubMed - indexed for MEDLINE] 1438. Tech Coloproctol. 2003 Jul;7(2):105-7. Massive zosteriform cutaneous metastasis from rectal carcinoma. Damin DC, Lazzaron AR, Tarta C, Cartel A, Rosito MA. Department of Coloproctologic Surgery, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil. damin@terra.com.br A 44-year-old man presented with a large and rapidly growing skin lesion approximately six months after resection of a rectal carcinoma. The lesion measured 40 cm in size, extended from the suprapubic area to the proximal half of the left groin, and showed a particular zosteriform aspect. Biopsy confirmed a metastatic skin adenocarcinoma. Cutaneous metastases from rectal cancer are very uncommon. Their gross appearance is not distinctive, although the skin tumors are usually solid, small (less than 5 cm) and painless nodules or papules. Early biopsies for suspicious skin lesions are needed in patients with a history of colorectal cancer. PMID: 14605930 [PubMed - indexed for MEDLINE] 1439. Am J Med. 2003 Nov;115(7):586-7. Temporary relief of postherpetic neuralgia pain with topical geranium oil. Greenway FL, Frome BM, Engels TM 3rd, McLellan A. PMID: 14599644 [PubMed - indexed for MEDLINE] 1440. Spine J. 2002 Jan-Feb;2(1):85. From the dermatology clinic...postherpetic neuralgia, in which the source of radiculopathy is revealed by examination of the skin. Fardon D. PMID: 14598807 [PubMed - indexed for MEDLINE] 1441. Ryumachi. 2003 Oct;43(4):703-9. [Successfully treated case with microscopic polyangiitis complicated severe varicella zoster virus infection including encephalitis and disseminated varicella zoster] [Article in Japanese] Matsumoto J, Nakajima A, Suwa A, Yasuki Y, Yasui T, Inada S. Division of Rheumatic Diseases, Tokyo Metropolitan Otsuka Hospital, Tokyo. We report a case with microscopic polyangiitis (MPA) complicated by varicella zoster encephalitis. A 60-year-old woman caught a common cold and had acute otitis media in April 1998. Proteinuria and hematuria with hyaline cast were noted at the routine medical check in May, and she was referred to our hospital because of high fever and chest pain. MPA was diagnosed with acute progressive renal failure, pleuritis and elevated anti-neutrophil cytoplasmic myeloperoxidase antibody (MPO-ANCA). Corticosteroid therapy was administered under hemodialysis but MPA was flared several times with various symptoms including interstitial pneumonitis, alveolar hemorrhage and erythema multiforme exudativum. During the course of the disease she developed disseminated varicella zoster and encephalitis. Positive polymerase chain reaction to varicella zoster in cerebrospinal fluid helped to differentiate her encephalitis from central nervous system symptoms due to microscopic angiitis and herpes simplex encephalitis. Combination of corticosteroid and acyclovir therapies for MPA and varicella zoster encephalitis under hemodialysis were successful. The diagnostic process and therapies to these complicated contexts were thought to be very important. PMID: 14598666 [PubMed - indexed for MEDLINE] 1442. Ann Neurol. 2003 Nov;54(5):678-82. Dually infected (HSV-1/VZV) single neurons in human trigeminal ganglia. Theil D, Paripovic I, Derfuss T, Herberger S, Strupp M, Arbusow V, Brandt T. Department of Neurology, Klinikum Grosshadern, Ludwig-Maximilians University, Marchioninistrasse 23, 81377 Munich, Germany. dtheil@brain.nefo.med.uni-muenchen.de Human trigeminal ganglia were tested by double fluorescence in situ hybridization for the presence and distribution of herpes simplex virus type 1 (HSV-1) and varicella-zoster virus (VZV) latency. Latency transcripts of both viruses were detected in common areas within the ganglia. Also, a few single neurons were shown to harbor HSV-1 and VZV together. PMID: 14595659 [PubMed - indexed for MEDLINE] 1443. Pediatr Rev. 2003 Nov;24(11):372-9. Varicella. English R. Louisiana State University Health Sciences Center, New Orleans, LA, USA. PMID: 14595034 [PubMed - indexed for MEDLINE] 1444. J Infect Dis. 2003 Nov 1;188(9):1336-44. Epub 2003 Oct 17. Decline in varicella-zoster virus (VZV)-specific cell-mediated immunity with increasing age and boosting with a high-dose VZV vaccine. Levin MJ, Smith JG, Kaufhold RM, Barber D, Hayward AR, Chan CY, Chan IS, Li DJ, Wang W, Keller PM, Shaw A, Silber JL, Schlienger K, Chalikonda I, Vessey SJ, Caulfield MJ. Department of Pediatrics, Section of Infectious Diseases, University of Colorado School of Medicine, Denver, Colorado, USA. myron.levin@uchsc.edu. The safety and immunogenecity of a booster dose of live attenuated varicella-zoster virus (VZV) vaccine was evaluated in 196 healthy subjects, >or=60 years old, who had already received a VZV vaccine >5 years before. This repeat booster dose was well tolerated. Cell-mediated immunity (CMI) to VZV was measured by an interferon-gamma (IFN-gamma) enzyme-linked immunosorbent spot-forming cell (ELISPOT) assay and a limiting dilution responder cell frequency (RCF) assay. Prevaccination responses decreased as a function of increasing age but were detectable in all subjects by use of the IFN-gamma ELISPOT assay. In most subjects, VZV-specific CMI was increased at 6 weeks postvaccination. The magnitude of the vaccine-induced IFN-gamma ELISPOT response was inversely related to prevaccination values. Although there was a significant correlation between the IFN-gamma ELISPOT and RCF assays, the ELISPOT assay had greater sensitivity and a wider dynamic range. A live attenuated VZV vaccine is safe and immunogenic in an elderly population, and the vaccine-induced immunity may be monitored by the IFN-gamma ELISPOT assay. PMID: 14593591 [PubMed - indexed for MEDLINE] 1445. Rheumatol Int. 2005 Mar;25(2):97-102. Epub 2003 Oct 31. Clinical and genetic risk factors of herpes zoster in patients with systemic lupus erythematosus. Kang TY, Lee HS, Kim TH, Jun JB, Yoo DH. Hospital for Rheumatic Diseases, Hanyang University Hospital, 17 Haengdang-dong, Seong Dong-ku, Seoul 133-792, Republic of Korea. OBJECTIVE: The aim of this study was to determine the clinical and genetic risk factors that influence herpes zoster occurrence in patients with systemic lupus erythematosus (SLE). METHODS: Three hundred three SLE patients meeting the American College of Rheumatology criteria were enrolled in this study. Herpes zoster was diagnosed when classic grouped vesicles were noted. Medical records were reviewed retrospectively to collect clinical information. For Fc gamma receptor IIa (Fc gamma RIIa) and Fc gamma RIIIa genotyping, polymerase chain reaction (PCR) using allele-specific primers was performed. The PCR sequence-specific oligonucleotide probe method was utilized in human HLA-DRB1 genotyping. RESULTS: Forty-two cases (13.9%) of zoster occurred among 303 SLE patients. The incidence of zoster in patients with SLE was 32.5/1,000 patients per year. Patients who developed zoster had higher rates of lupus nephritis (P = 0.018) and positive anti-Sm antibody (P = 0.019). However, Fc gamma RIIa and Fc gamma RIIIa polymorphism and the HLA-DRB1 genotype did not influence herpes zoster occurrence. CONCLUSION: Systemic lupus erythematosus patients with lupus nephritis or anti-Sm antibody are at higher risk of herpes zoster. Fc gamma RIIa (H/R131), Fc gamma RIIIa (F/V176), and HLA-DRB1 genetic polymorphisms did not influence the occurrence of herpes zoster in these patients. PMID: 14593495 [PubMed - indexed for MEDLINE] 1446. Med Hypotheses. 2003 Nov-Dec;61(5-6):533-4. Varicella inoculation to prevent shingles, and cytomegalovirus inoculation to prevent cytomegalovirus associated graft failures. Altschuler EL. Mount Sinai School of Medicine, New York, New York 10029, USA. eric.altschuler@mssm.edu I suggest varicella virus inoculation be considered to reduce the risk of herpes zoster (the shingles), and cytomegalovirus (CMV) inoculation be considered to reduce the risk of CMV associated transplant graft failure. Such inoculations are inexpensive and easy to implement, and are simple potential solutions to common and often severe medical problems with suboptimal current treatments. PMID: 14592783 [PubMed - indexed for MEDLINE] 1447. Rinsho Shinkeigaku. 2003 Jul;43(7):431. [Consideration on spreading mechanisms of cranial neuropathy in Ramsay Hunt syndrome: possibility of the vascular mechanism] [Article in Japanese] Segawa F, Kuroiwa Y. PMID: 14582371 [PubMed - indexed for MEDLINE] 1448. Adv Skin Wound Care. 2003 Sep-Oct;16(5):236-43. Herpesvirus infections and herpetic wounds. Trent JT, Kirsner RS. Department of Dermatology and Cutaneous Surgery, University of Miami School of Medicine, Miami, FL, USA. PMID: 14581815 [PubMed - indexed for MEDLINE] 1449. Neurology. 2003 Oct 28;61(8):1153-4. Conduction block of varicella zoster virus neuropathy. Murakami T, Shibazaki K, Kurokawa K, Ichikawa Y, Ohsawa Y, Sunada Y. Division of Neurology, Department of Internal Medicine, Kawasaki Medical School, Kurashiki City, Okayama, Japan. tatsum@med.kawasaki-m.ac.jp PMID: 14581691 [PubMed - indexed for MEDLINE] 1450. Herpes. 2003 Aug;10(2):38-45. Herpes zoster in the immunocompetent patient: management of post-herpetic neuralgia. Johnson RW. Pain Management Clinic, University of Bristol and Bristol Royal Infirmary, Bristol, UK. RWJBRISTROL@aol.com Post-herpetic neuralgia (PHN) is the most common complication of herpes zoster (HZ, shingles), particularly in the elderly and those with severe acute phase symptoms. Unless or until varicella vaccination reduces the incidence of HZ and attenuates the risk and/or severity of complications, PHN will continue to result in patient suffering and remain a significant cause of healthcare and social support resource consumption. There have been useful advances in PHN management (e.g. use of the anticonvulsant gabapentin and topical local anaesthetic patches), but some cases remain intractable. Prevention is an important strategy, and antiviral drugs, while not totally effective, provide the most accepted method. Other acute interventions require further evaluation (nerve blocks, acute phase use of tricyclic antidepressants or anticonvulsants). As prevention of PHN requires early recognition and prompt management of at-risk patients presenting with acute HZ, public education and provision of information to relevant healthcare personnel are important. This article discusses issues relevant to PHN management and prevention, and provides a review of the pertinent literature. PMID: 14577953 [PubMed - indexed for MEDLINE] 1451. Klin Monbl Augenheilkd. 2003 Oct;220(10):710-5. [Brivudine as an alternative systemic therapy to aciclovir and ganciclovir in acute retinal necrosis syndrome due to varicella-zoster virus] [Article in German] Vij O, Bornfeld N, Roggendorf M, Fiedler M, Schilling H. Abteilung für Erkrankungen des hinteren Augenabschnitts, Zentrum für Augenheilkunde der Universität Essen. BACKGROUND: Two cases of acute retinal necrosis (ARN-) syndrome caused by an infection with varicella zoster virus (VZV) are demonstrated. VZV-DNA was detected in vitreous biopsies by polymerase-chain-reaction (PCR). The course of retinal necrosis was decisively improved by changing antiviral therapy from aciclovir and/or ganciclovir to brivudine. MATERIAL AND METHODS: Patient 1: 51 years, male, initial visual acuity 20/40; patient 2: 17 years, female, initial visual acuity 20/30. Both patients were immunocompetent and presented with an unilateral acute retinal necrosis syndrome with peripheral chorioretinitis, retinal vasculitis, vitreous inflammation and optic disc swelling, which resulted in progressive visual loss in a few days. RESULTS: In both patients VZV-DNA was detected in vitreous biopsies with PCR. A regression of intraocular inflammation and necrotic retinal foci was only observed after changing the initial systemic therapy from aciclovir (Zovirax) intravenously 1500 mg/day) and/or ganciclovir (Cymeven) intravenously 250 mg/day) to brivudine (Zostex) per os 500 mg/day). Vitreoretinal surgery was necessary in both patients because of rhegmatogenous retinal detachment. Visual acuity stabilised in patient 1 to 20/200 and in patient 2 to 20/25 during a follow-up of 16 or 32 months, respectively. CONCLUSION: Brivudine represents an alternative therapy, if standard treatment with aciclovir and/or ganciclovir failed in cases of ARN-syndrome due to presumed drug-resistant varicella zoster virus-subtypes. Complete remission and preservation of a satisfactory function can be achieved. PMID: 14577039 [PubMed - indexed for MEDLINE] 1452. Otolaryngol Head Neck Surg. 2003 Oct;129(4):379-81. Acyclovir in the treatment of Ramsay Hunt syndrome. Uri N, Greenberg E, Kitzes-Cohen R, Doweck I. Otolaryngology-Head and Neck Surgery, Carmel Medical Center, 7 Michal St, Haifa 34362, Israel. druri@netvision.net.il Ramsay Hunt syndrome is an herpetic disease with ominous prognosis regarding the facial nerve. Treatment with acyclovir, a well-known virostatic agent, has been given in a small number of patients in recent years with excellent results. We report on the administration of acyclovir intravenously for 7 days in 31 patients with Ramsay Hunt syndrome, with overall recovery rate of 82.6%. There were no side effects regarding this treatment. PMID: 14574292 [PubMed - indexed for MEDLINE] 1453. Retina. 2003 Oct;23(5):716-7. Posterior scleritis presenting with annular choroidal detachment as a complication of herpes zoster ophthalmicus. Tranos PG, Ong T, Nolan W, Manzouri B, Forbes J. Department of Opthalmology, Royal Free Hampstead NHS Trust, London, UK. ptranos@hotmail.com PMID: 14574263 [PubMed - indexed for MEDLINE] 1454. J Med Virol. 2003 Dec;71(4):557-60. Real-time nested multiplex PCR for the detection of herpes simplex virus types 1 and 2 and varicella zoster virus. O'Neill HJ, Wyatt DE, Coyle PV, McCaughey C, Mitchell F. Regional Virus Laboratory, Royal Victoria Hospital, Belfast, Northern Ireland, United Kingdom. hugh.oneill@bll.n-i.nhs.uk One hundred forty-nine specimens were tested in a LightCycler nested multiplex polymerase chain reaction (LCnmPCR) for Herpes simplex virus (HSV)1, HSV2, and VZV. Eighty-one were from genitourinary medicine (GUM) patients and the other 68 specimens were from other patients with skin lesions. The results were compared to a conventional multiplex nested PCR (nmPCR) using agarose gel electrophoresis. Twenty-five specimens were positive in both assays for HSV1 and 29 were positive for VZV. For HSV2 there were 27 positive in the LCnmPCR and 26 positive in the nmPCR assay. The melting temperatures (Tms) of each target were different with a mean of 84.75 degrees C for HSV1, 88.57 degrees C for HSV2, and 83.62 degrees C for VZV. The melting curves of positive specimens directly overlaid the melting curves of the positive controls in the assay. The LCnmPCR assay is a convenient alternative to conventional PCR using agarose gel electrophoresis. It improves specimen turnaround time by eliminating the need for gel electrophoresis, transillumination, and gel photography. It also shows increased sensitivity for HSV2 over our standard assay. This LCnmPCR reduces further the possibility of amplicon contamination with nested PCR protocols. Copyright 2003 Wiley-Liss, Inc. PMID: 14556269 [PubMed - indexed for MEDLINE] 1455. CNS Drugs. 2003;17(13):983. Gabapentin: a viewpoint by Brett R. Stacey. Stacey BR. Oregon Health Sciences University, Portland, Oregon, USA. Comment on: CNS Drugs. 2003;17(13):975-82. PMID: 14533948 [PubMed - indexed for MEDLINE] 1456. CNS Drugs. 2003;17(13):975-82. Gabapentin: in postherpetic neuralgia. Curran MP, Wagstaff AJ. Adis International Limited, Auckland, New Zealand. demail@adis.co.nz Comment in: CNS Drugs. 2003;17(13):983-4. CNS Drugs. 2003;17(13):983. Gabapentin is a structural analogue of the neurotransmitter gamma-aminobutyric acid (GABA) approved for use in adults with postherpetic neuralgia. Gabapentin does not bind to GABA(A) or GABA(B) receptors. Its mechanism of action in humans is unclear, but may involve binding to alpha2delta calcium channel subunits in animal models. Reductions in the mean daily pain score from baseline to week 7 or 8 of treatment (primary endpoint) were significantly greater with gabapentin 1800-3600 mg/day than placebo therapy in two well designed trials in patients with postherpetic neuralgia. The proportion of responders (patients showing a > or =50% reduction in mean daily pain score at endpoint versus baseline) was significantly greater with gabapentin than placebo. Daily sleep rating scores, the Short Form McGill Pain Questionnaire (total pain scores), Patient and Clinician Global Impression of Change and measures on the Short Form-36 Health Survey (including physical functioning, role-physical, bodily pain, vitality or mental health) improved to a significantly greater extent with gabapentin than placebo. Adverse events associated with gabapentin in patients with postherpetic neuralgia were usually mild to moderate in intensity, with dizziness, somnolence and peripheral oedema being commonly reported. PMID: 14533947 [PubMed - indexed for MEDLINE] 1457. Ocul Immunol Inflamm. 2003 Jun;11(2):141-4. Successful treatment with combination of systemic antiviral drugs and intravitreal ganciclovir injections in the management of severe necrotizing herpetic retinitis. Chau Tran TH, Cassoux N, Bodaghi B, Lehoang P. Department of Ophthalmology, Hopital Pitié-Salpêtrière, Paris, France. PURPOSE: To report the use of intravenous (IV) antiviral agents and intravitreal ganciclovir injections in three immunocompetent patients with severe acute retinal necrosis (ARN). METHOD: Case series. RESULTS: Three immunocompetent patients, who had lost vision in the first eye due to ARN, received intensive treatment with IV foscarnet or acyclovir or ganciclovir and intravitreal ganciclovir injections for the treatment of severe ARN involving the fellow eye. The retinitis resolved and final visual acuity of the fellow eye improved to 20/20 in all three cases after a mean follow-up of 17 months. CONCLUSIONS: Intensive treatment with a combination of two intravenous antiviral drugs and intravitreal ganciclovir injections was successful in the management of patients with acyclovir-resistant ARN and monocular status. PMID: 14533033 [PubMed - indexed for MEDLINE] 1458. J Travel Med. 2003 Sep-Oct;10(5):290-2. Irrational prescribing in South Asia: a case of fluoroquinolone-associated phototoxicity. Cave W, Pandey P, Chatterjee S. The CIWEC Clinic Travel Medicine Center, Kathmandu, Nepal. Prescribing habits in South Asian countries have been subjected to some scrutiny.1-6 Most studies conclude that the quality of prescribing is poor, with overuse of antimicrobials and irrational use of fixed-dose combination therapy, particularly in the private sector.1 Prescriptions for multiple drugs are the rule rather than the exception, with up to seven items being prescribed for a single disease entity. Analgesics, anti-inflammatories and drugs of uncertain pharmacologic efficacy, such as vitamins, minerals and glucose water, are also frequently prescribed. PMID: 14531983 [PubMed - indexed for MEDLINE] 1459. West Afr J Med. 2003 Jun;22(2):136-8. Herpes zoster infection and HIV seropositivity among eye patients--University of Ilorin Teaching Hospital experience. Owoeye JF, Ademola-Popoola DS. Department of Ophthalmology, University of Ilorin Teaching Hospital, Ilorin, Nigeria. This paper reports cases of Herpes Zoster Ophthalmicus (HZO) seen in 10 Nigerian adults at the Eye clinic of the University of Ilorin Teaching Hospital (UITH), Ilorin, Kwara State, Nigeria, some of whom tested positive to HIV infection using ELISA method with confirmation using the Western blot test. There were 6 female and 4 male patients. Five (50%) of the patients tested positive for HIV. A high index of suspicion should be maintained among Ophthalmologists when confronted with patients with HZO who are healthy looking. PMID: 14529222 [PubMed - indexed for MEDLINE] 1460. Ann Neurol. 2003 Oct;54(4):459-63. Oligoclonal immunoglobulins in cerebrospinal fluid during varicella zoster virus (VZV) vasculopathy are directed against VZV. Burgoon MP, Hammack BN, Owens GP, Maybach AL, Eikelenboom MJ, Gilden DH. Department of Neurology, University of Colorado Health Sciences Center, Denver, CO 80262, USA. mark.burgoon@uchsc.edu Limited analyses of cerebrospinal fluid from patients with central nervous system infections have shown that the oligoclonal IgG is antibody directed against the agent that causes disease. Using a new method involving binding of IgG to beads coated with lysates prepared from candidate infectious antigens, we showed that the oligoclonal IgG in cerebrospinal fluid of a patient with chronic varicella zoster virus vasculopathy is directed against the causative virus. This approach holds promise in identifying and purifying the relevant oligoclonal IgGs in inflammatory central nervous system diseases of unknown cause. PMID: 14520657 [PubMed - indexed for MEDLINE] 1461. Rev Med Chil. 2003 Jul;131(7):759-64. [Infections caused by Varicella Zoster virus in children with cancer aged less than 15 years old] [Article in Spanish] Folatre I, Zolezzi P, Schmidt D, Marín F, Täger M. Instituto de Hematología R. Virchow, Instituto de Pediatría, Facultad de Medicina, Universidad Austral de Chile, Casilla 567-Valdivia. ifolatre@telsur.cl BACKGROUND: Infections caused by Varicella Zoster virus in children with cancer have a high rate of complications and mortality. AIM: To report the outcome of this infection in children with cancer. PATIENTS AND METHODS: Retrospective analysis of medical records of 216 children aged less than 15 years old with the diagnosis of an hematological or solid tumor, admitted to the National Program of Antineoplastic Drugs (PINDA). RESULTS: Eighty seven children had a Varicella Zoster virus infections, 73 (84%) had varicella, 8 (9%) had herpes zoster and 6 (7%) had varicella and herpes zoster. Ninety four percent acquired the infection during antineoplastic treatment and 78% received Acyclovir as antiviral therapy. During a nosocomial outbreak of varicella, three patients with an Acute Lymphoblastic leukemia died in the initial phase of chemotherapy, in spite of an early administration of Acyclovir. No patient with herpes zoster died. CONCLUSIONS: The incidence of varicella was higher in children with leukemia or lymphoma than in children with other types of cancer. Virus reactivation was uncommon and had a benign course. Varicella mortality in these children could be favorably modified through an active immunization of immunocompetent children. PMID: 14513696 [PubMed - indexed for MEDLINE] 1462. J Infect Dis. 2003 Oct 1;188(7):954-9. Epub 2003 Sep 26. Development of resistance to acyclovir during chronic infection with the Oka vaccine strain of varicella-zoster virus, in an immunosuppressed child. Levin MJ, Dahl KM, Weinberg A, Giller R, Patel A, Krause PR. Section of Pediatric Infectious Diseases, University of Colorado Health Sciences Center, Denver, Colorado 80262, USA. myron.levin@uchsc.edu Comment in: J Infect Dis. 2003 Oct 1;188(7):945-7. A 1-year-old boy was vaccinated with the Oka strain of varicella just prior to the discovery of a tumor that required intensive antitumor therapy. Three months later he developed herpes zoster, which developed into chronic verrucous lesions that were refractory to treatment with acyclovir and which subsequently disseminated. DNA from a biopsy specimen of a chronic herpes-zoster lesion indicated that the Oka vaccine strain of the the virus caused this severe complication. Analysis of this viral DNA demonstrated a mutation in the viral thymidine kinase gene. Plasmids containing this altered gene were unable to produce functional thymidine kinase in an in vitro translation system. The presence of this mutation would explain the clinical resistance to acyclovir. This is the first report of Oka-strain varicella virus causing severe disease after reactivation and of resistance to acyclovir during an infection caused by this virus. PMID: 14513413 [PubMed - indexed for MEDLINE] 1463. J Infect Dis. 2003 Oct 1;188(7):948-53. Epub 2003 Sep 26. Disseminated varicella infection due to the vaccine strain of varicella-zoster virus, in a patient with a novel deficiency in natural killer T cells. Levy O, Orange JS, Hibberd P, Steinberg S, LaRussa P, Weinberg A, Wilson SB, Shaulov A, Fleisher G, Geha RS, Bonilla FA, Exley M. Division Infectious Diseases, Children's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA. Comment in: J Infect Dis. 2003 Oct 1;188(7):945-7. An 11-year-old girl presented with a papulovesicular rash and severe respiratory distress 5 weeks after receiving varicella vaccine. Restriction fragment length-polymorphism analysis of virus isolated from an endotracheal-tube aspirate and from bronchoalveolar lavage revealed that this patient's illness was due to the Oka vaccine strain of varicella. An extensive immunologic analysis failed to identify a known diagnostic entity to explain her susceptibility to this attenuated vaccine strain. Analysis of her lymphocytes on separate occasions, months after recovery from her illness, revealed a profound deficiency of natural killer T (NKT) cells and of NKT-cell activity, suggesting that NKT cells contribute to host defense against varicella virus. PMID: 14513412 [PubMed - indexed for MEDLINE] 1464. Int J STD AIDS. 2003 Sep;14(9):638-9. Multiple opportunistic AIDS-associated disorders strictly related to immunodeficiency levels, in a girl with congenital HIV infection. Manfredi R, Calza L, Chiodo F. Department of Clinical and Experimental Medicine, Division of Infectious Diseases, University of Bologna, Alma Mater Studiorum, S Orsola Hospital, Via Massarenti 11, I-40138 Bologna, Italy. manfredi@med.unibo.it A 16-year-old girl with vertical HIV disease treated since birth suffered from six different AIDS-defining disorders until now. Even during the highly active antiretroviral therapy, multiple AIDS-related opportunistic infections may complicate the course of long-term congenital HIV disease, showing a strict relationship with immunological deterioration, which occurs shortly after virologic failure, due to an extensive genotypic resistance to all available antiretroviral compounds. PMID: 14511504 [PubMed - indexed for MEDLINE] 1465. Dermatol Ther. 2003;16(3):195-205. Cutaneous infections in the elderly: diagnosis and management. Weinberg JM, Scheinfeld NS. Department of Dermatology, St. Luke's-Roosevelt Hospital Center, New York, New York, USA. jmw27@columbia.edu Over the past several years there have been many advances in the diagnosis and treatment of cutaneous infectious diseases. This review focuses on the three major topics of interest in the geriatric population: herpes zoster and postherpetic neuralgia (PHN), onychomycosis, and recent advances in antibacterial therapy. Herpes zoster in adults is caused by reactivation of the varicella-zoster virus (VZV) that causes chickenpox in children. For many years acyclovir was the gold standard of antiviral therapy for the treatment of patients with herpes zoster. Famciclovir and valacyclovir, newer antivirals for herpes zoster, offer less frequent dosing. PHN refers to pain lasting > or = 2 months after an acute attack of herpes zoster. The pain may be constant or intermittent and may occur spontaneously or be caused by seemingly innocuous stimuli such as a light touch. Treatment of established PHN through pharmacologic and nonpharmacologic therapy will be discussed. In addition, therapeutic strategies to prevent PHN will be reviewed. These include the use of oral corticosteroids, nerve blocks, and treatment with standard antiviral therapy. Onychomycosis, or tinea unguium, is caused by dermatophytes in the majority of cases, but can also be caused by Candida and nondermatophyte molds. Onychomycosis is found more frequently in the elderly and in more males than females. There are four types of onychomycosis: distal subungual onychomycosis, proximal subungual onychomycosis, white superficial onychomycosis, and candidal onychomycosis. Over the past several years, new treatments for this disorder have emerged which offer shorter courses of therapy and greater efficacy than previous therapies. The treatment of bacterial skin and skin structure infections in the elderly is an important issue. There has been an alarming increase in the incidence of gram-positive infections, including resistant bacteria such as methicillin-resistant Staphylococcus aureus (MRSA) and drug-resistant pneumococci. While vancomycin has been considered the drug of last defense against gram-positive multidrug-resistant bacteria, the late 1980s saw an increase in vancomycin-resistant bacteria, including vancomycin-resistant enterococci (VRE). More recently, strains of vancomycin-intermediate resistant S. aureus (VISA) have been isolated. Gram-positive bacteria, such as S. aureus and Streptococcus pyogenes are often the cause of skin and skin structure infections, ranging from mild pyodermas to complicated infections including postsurgical wound infections, severe carbunculosis, and erysipelas. With limited treatment options, it has become critical to identify antibiotics with novel mechanisms of activity. Several new drugs have emerged as possible therapeutic alternatives, including linezolid and quinupristin/dalfopristin. PMID: 14510876 [PubMed - indexed for MEDLINE] 1466. Psychosom Med. 2003 Sep-Oct;65(5):824-30. Effects of a behavioral intervention, Tai Chi Chih, on varicella-zoster virus specific immunity and health functioning in older adults. Irwin MR, Pike JL, Cole JC, Oxman MN. Cousins Center for Psychoneuroimmunonology, UCLA Neuropsychiatric Institute, University of California, Los Angeles 90095-7057, USA. mirwin1@ucla.edu OBJECTIVE: Both the incidence and severity of herpes zoster (shingles) increase markedly with increasing age in association with a decline in varicella-zoster virus (VZV) specific cell-mediated immunity (CMI). This study examined whether a behavioral intervention, Tai Chi Chih (TCC), affects VZV specific immunity and health functioning in older adults who, on average, show impairments of health status and are at risk for shingles. METHODS: Thirty-six men and women (age > or =60 years) were assigned randomly to a 15-week program of TCC instruction (three 45 minute classes per week; N = 18) or a wait list control condition (N = 18). VZV-specific CMI was measured at baseline and at 1-week postintervention. Health functioning (Medical Outcome scale: SF-36) was assessed at baseline, and at 5, 10, and 15 weeks during the intervention, and at 1-week postintervention. RESULTS: In the intent-to-treat sample, VZV-specific CMI increased 50% from baseline to 1-week postintervention in the TCC group (p < 0.05) but was unchanged in the wait list control group. In those who completed the study, 1-week postintervention SF-36 scale scores for role-physical (p < 0.05) and physical functioning (p < 0.05) were higher in the TCC group (N = 14) as compared with controls (N = 17). Older adults who had impairments of physical status at baseline showed the greatest increases of SF-36 role-physical (p < 0.01) and physical functioning (p < 0.001) during the TCC intervention. CONCLUSIONS: Administration of TCC for 15 weeks led to an increase in VZV-specific CMI. Gains in health functioning were found in participants who received TCC and were most marked in those older adults who had the greatest impairments of health status. PMID: 14508027 [PubMed - indexed for MEDLINE] 1467. Harv Health Lett. 2003 Sep;28(11):4-5. Shingles: When a slumbering virus stirs. [No authors listed] PMID: 14505966 [PubMed - indexed for MEDLINE] 1468. Vaccine. 2003 Oct 1;21(27-30):4243-9. Incidence of herpes zoster among children and adolescents in a community with moderate varicella vaccination coverage. Goldman GS. P.O. Box 847, Pearblossom, CA 93553, USA. pearblossominc@aol.com Comment in: Vaccine. 2004 Sep 3;22(25-26):3228-31; author reply 3232-6. Active surveillance for herpes zoster (HZ) was conducted for 2 years (2000-2001) in the Antelope Valley community of 312,000 residents among 290 public and private schools, daycares, and healthcare providers. The true ascertainment-adjusted HZ incidence rate is 307 per 100,000 person-years and 138 per 100,000 person-years among children <10 and individuals aged 10-19, respectively. The unadjusted rate among vaccinated children is 9.5 per 100,000 person-years and an estimated 22 per 100,000 vaccine doses. Unvaccinated children with a previous history of varicella may have greater sensitivity to exogenous exposures (boosting) and a poorer cell-mediated response following primary infection relative to older age groups. PMID: 14505905 [PubMed - indexed for MEDLINE] 1469. Vaccine. 2003 Oct 1;21(27-30):4238-42. Varicella susceptibility and incidence of herpes zoster among children and adolescents in a community under active surveillance. Goldman GS. P.O. Box 847, Pearblossom, CA 93553, USA. pearblossominc@aol.com Comment in: Vaccine. 2004 Sep 3;22(25-26):3228-31; author reply 3232-6. Licensure of varicella vaccine by the US Food and Drug Administration in March 1995 has given rise to concerns that include a potential shift in varicella incidence to susceptible adults and increase in herpes zoster (HZ) incidence. Baseline values prior to widespread vaccination were obtained through distribution of an adolescent survey to all 13 public middle (seventh and eighth grade) schools in the Antelope Valley, CA health district. Based on 4216 respondents aged 10-14 years, varicella susceptibility is 7.7% (95% CI, 6.9-8.5%) and true cumulative (1987-2000) HZ incidence rate is 133 per 100,000 person-years (95% CI, 95-182 per 100,000 person-years). PMID: 14505904 [PubMed - indexed for MEDLINE] 1470. Vaccine. 2003 Oct 1;21(27-30):4119. Human immunodeficiency virus transmitted through sheep brain anti-rabies vaccination. Singh S. PMID: 14505888 [PubMed - indexed for MEDLINE] 1471. J Cutan Med Surg. 2003 Sep-Oct;7(5):372-81. Epub 2003 Sep 24. Valacyclovir in the treatment of herpes simplex, herpes zoster, and other viral infections. Wu JJ, Brentjens MH, Torres G, Yeung-Yue K, Lee P, Tyring SK. Department of Internal Medicine, Baylor College of Medicine, Houston, Texas, USA. BACKGROUND: Genital herpes and herpes labialis are prevalent, physically and psychologically painful, and often disabling. Herpes zoster is often very painful and may result in months or years of postherpetic neuralgia (PHN). Over the past two decades, the treatment of these conditions has been transformed by guanosine nucleoside antivirals such as valacyclovir (Valtrex, a highly bioavailable prodrug of acyclovir (Zovirax, and famciclovir (Famvir), a highly bioavailable prodrug of penciclovir (Denavir). OBJECTIVE: We describe the pharmacology, pharmacokinetics, and clinical efficacy of valacyclovir for the treatment of herpes simplex, herpes zoster, and other viral infections. Valacyclovir is also compared with acyclovir and famciclovir. METHODS: All published literature containing the word "valacyclovir" was reviewed and summarized. RESULTS: Valacyclovir is the only oral antiviral agent approved for therapy of herpes labialis, the only antiviral drug approved for a 3-day course in the episodic treatment of recurrent genital herpes, as well as the only antiviral drug approved for once daily dosing for suppressive therapy. In herpes zoster, valacyclovir is more effective than acyclovir and equally effective as famciclovir at hastening the healing of zoster-associated pain and PHN. CONCLUSION: Valacyclovir is safe and effective in the therapy of patients with herpes simplex and herpes zoster and may be useful in other viral infections. PMID: 14505192 [PubMed - indexed for MEDLINE] 1472. Neurology. 2003 Sep 23;61(6):866-7. Pilot tolerability and effectiveness study of levetiracetam for postherpetic neuralgia. Rowbotham MC, Manville NS, Ren J. UCSF Pain Clinical Research Center, Department of Neurology, School of Medicine, University of California San Francisco, CA 94115, USA. mcrwind@itsa.ucsf.edu PMID: 14504347 [PubMed - indexed for MEDLINE] 1473. Am J Nurs. 2003 Sep;103(9):75, 77-8. Lidocaine patch 5%. Pasero C. cpasero@aol.com PMID: 14501479 [PubMed - indexed for MEDLINE] 1474. Arch Dis Child. 2003 Oct;88(10):862-9. Varicella vaccination in England and Wales: cost-utility analysis. Brisson M, Edmunds WJ. Immunisation Division, PHLS Communicable Disease Surveillance Centre, London NW9 5EQ, UK. AIMS: To assess the cost-effectiveness of varicella vaccination, taking into account its impact on zoster. METHODS: An age structured transmission dynamic model was used to predict the future incidence of varicella and zoster. Data from national and sentinel surveillance systems were used to estimate age specific physician consultation, hospitalisation, and mortality rates. Unit costs, taken from standard sources, were applied to the predicted health outcomes. RESULTS: In England and Wales, the annual burden of VZV related disease is substantial, with an estimated 651 000 cases of varicella and 189 000 cases of zoster, resulting in approximately 18 000 QALYs lost. The model predicts that although the overall burden of varicella will significantly be reduced following mass infant vaccination, these benefits will be offset by a significant rise in zoster morbidity. Under base case assumptions, infant vaccination is estimated to produce an overall loss of 54 000 discounted QALYs over 80 years and to result in a net cost from the health provider (NHS) and the societal perspectives. These results rest heavily on the impact of vaccination on zoster. Adolescent vaccination is estimated to cost approximately 18 000 pounds sterling per QALY gained from the NHS perspective. CONCLUSION: Routine infant varicella vaccination is unlikely to be cost-effective and may produce an increase in overall morbidity. Adolescent vaccination is the safest and most cost-effective strategy, but has the least overall impact on varicella. PMCID: PMC1719324 PMID: 14500303 [PubMed - indexed for MEDLINE] 1475. Anesth Analg. 2003 Oct;97(4):1117-8, table of contents. Severe acute visceral pain from varicella zoster virus. Hyland JM, Butterworth J. Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157-1009, USA. Varicella zoster virus infection often will not present in the characteristic dermatomal distribution of vesicles in patients who have undergone bone marrow transplantation. We cared for a 51-yr-old man with severe abdominal pain after bone marrow transplantation for non-Hodgkin's lymphoma. The diagnosis of varicella zoster was not entertained until he developed a diffuse vesicular rash several days after the onset of pain. We report this case to alert others who may be consulted regarding pain management options for similar oncology patients. IMPLICATIONS: We report a patient with lymphoma, prior bone marrow transplant, and acute visceral pain for whom IV opioids in large doses proved inadequate. An interventional pain management technique was considered until characteristic varicella vesicles appeared over the patient's trunk. We report this case to alert others who treat oncology patients that the diagnosis of visceral zoster should be considered when patients who have undergone bone marrow transplantation present with severe visceral pain. PMID: 14500167 [PubMed - indexed for MEDLINE] 1476. Support Care Cancer. 2003 Nov;11(11):739-41. Epub 2003 Sep 17. Vaccination of autologous stem cell transplant recipients with live varicella vaccine: a pilot study. Ljungman P, Wang FZ, Nilsson C, Solheim V, Linde A. Department of Hematology, Huddinge University Hospital, 14186, Stockholm, Sweden. Per.Ljungman@medhs.ki.se A pilot study of vaccination with live, attenuated varicella vaccine for prevention of zoster was performed in autologous stem cell transplant (SCT) recipients. Nine patients were vaccinated between 3-4 months after transplantation. The antigen-specific immune response was studied by lymphocyte proliferation. No systemic side effects were seen. One of nine patients developed herpes zoster HZ during follow-up. There was a tendency for a strengthened specific immune response after SCT ( p=0.12). This pilot study shows that vaccination with live, attenuated varicella vaccine can be performed safely 3-4 months after autologous stem cell transplantation. Additional studies are needed to assess efficacy of this approach in the prevention of HZ. PMID: 13680325 [PubMed - indexed for MEDLINE] 1477. Retina. 2003 Aug;23(4):567-9. Herpes zoster vasculitis presenting as giant cell arteritis with choroidal infarction. Al-Abdulla NA, Kelley JS, Green WR, Miller NR. Wilmer Eye Institute of the Johns Hopkins Hospital, 600 North Wolfe Street, Baltimore, MD 21287, USA. PMID: 12972779 [PubMed - indexed for MEDLINE] 1478. J Coll Physicians Surg Pak. 2003 Sep;13(9):524-5. Bilateral symmetrical herpes zoster in an immunocompetent patient (Herpes zoster duplex symmetricus). Arfan-ul-Bari, Iftikhar N, ber Rahman S. Department of Dermatology, PAF Hospital, Sargodha, Pakistan. albariul@yahoo.com Herpes zoster is a common disease of adulthood. Its incidence is low in childhood and adolescence. Certain risk factors like hematological malignancies or immunosuppression due to any cause may lead to onset at an early age. There is a unilateral appearance of grouped vesicular eruption on an erythematous background which may involve contiguous dermatomes. Rarely the lesions may occur bilaterally in an otherwise healthy individual. We present a case of herpes zoster, with lesions having atypical distribution involving bilaterally symmetrical dermatomes over the lower chest. PMID: 12971875 [PubMed - indexed for MEDLINE] 1479. Am J Ophthalmol. 2003 Sep;136(3):574-5. An unusual presentation of herpes zoster ophthalmicus: orbital myositis preceding vesicular eruption. Kawasaki A, Borruat FX. Department of Neuro-ophthalmology, Hôpital Ophthalmique Jules Gonin, Lausanne, Switzerland. aki-kawasaki@ophthal.vd.ch PURPOSE: To present a case of orbital myositis associated with herpes zoster ophthalmicus. DESIGN: Observational case report. METHODS: A 47-year-old woman with acute retrobulbar eye pain and diplopia preceding the vesicular rash of herpes zoster ophthalmicus was evaluated and treated. RESULTS: Magnetic resonance imaging showed enlargement and enhancement of extraocular muscles consistent with an inflammatory myopathy. Following acyclovir and prednisone treatment, all symptoms resolved, and neuralgia did not develop. CONCLUSIONS: Herpes zoster may cause symptoms and signs of orbital myositis before eruption of cutaneous skin lesions and thus should be considered in the differential diagnosis of an acute orbital myositis. PMID: 12967827 [PubMed - indexed for MEDLINE] 1480. J Pain Symptom Manage. 2003 Sep;26(3):788-90. Post-surgical herpes zoster of the plantar aspect of the foot. Muché JA, Raghavendra M. PMID: 12967727 [PubMed - indexed for MEDLINE] 1481. Transplant Proc. 2003 Aug;35(5):2004-5. Characteristics and repercussion of varicella-zoster virus infection in cardiac transplant. Cabezón Ruiz S, Cisneros JM, Lage Galle E, Ordóñez A, Hinojosa RF, Morán Risco JE, Hernández A. Generally, the need for information about varicella-zoster virus (VVZ) infection in cardiac transplantation (CT) is greater than that for other organ transplants. All cases of VVZ infection among the 175 CT patients included herpes zoster as the clinical syndrome in all 11 cases (men, 90.9%; mean age, 50.3+/-5 years; incidence, 6.3%). The infection was limited to one dermatome in seven patients (63.6%: thoracic, 6%; ophthalmic, 1), or two contiguous dermatomes in four patients (36.4%). The infection onset was after the first semester in seven patients (63.6%). All patients received three drug immunosuppressive therapy. Cardiac rejection during the three previous months occurred in one patient (3A grade). Previous CMV disease was observed in three patients (27.3%: range, 7-14 months). Intravenous acyclovir was administered to five patients (ophthalmic and several dermatome forms), and oral therapy for the rest. All the patients recovered; there were no complications or postherpetic neuralgia (mean follow-up: 16.5 months). VVZ infection, a frequent late infection among CT recipients, presents as a clinical syndrome of herpes zoster, frequently in patients with previous CMV infection. In CT, herpes zoster frequently affects two dermatomes, but the clinical courses and responses to treatment are favorable. There was no postherpetic neuralgia. PMID: 12962877 [PubMed - indexed for MEDLINE] 1482. Transplant Proc. 2003 Aug;35(5):1758-9. Disseminated varicella infection in adult renal allograft recipients: role of mycophenolate mofetil. Lauzurica R, Bayés B, Frías C, Fontseré N, Hernandez A, Matas L, Jimenez A, Bonet J, Romero R. Nephrology Department, Kidney Transplant Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain. rlauzu@ns.hugtip.scs.es Disseminated varicella zoster virus (VZV) infection is a rare complication after renal transplantation in adults. We report 4 cases diagnosed in our transplant patients. One of which was a primary infection (chicken pox) with multivisceral involvement (hepatitis, pneumonitis, myocarditis, and disseminated intravascular coagulation). The other 3 patients VZV-seropositive before transplantation suffered from disseminated zoster. No immunosuppressive drug was significantly associated with a higher risk of disseminated VZV infection. However, from our experience, we believe that mycophenolate mofetil (MMF), plays a part in the clinical presentation of the disease. Early treatment with high doses of acyclovir is fundamental in infection control. It is essential to perform a pretransplantation serological VZV study on all patients. PMID: 12962784 [PubMed - indexed for MEDLINE] 1483. Clin Exp Dermatol. 2003 Sep;28(5):555-6. Multiple epidermoid cysts occurring at site of healed herpes zoster in a renal transplant recipient: an isotopic response? Sandhu K, Saraswat A, Handa S. Comment on: Int J Dermatol. 1995 May;34(5):341-8. PMID: 12950353 [PubMed - indexed for MEDLINE] 1484. Epidemiol Infect. 2003 Aug;131(1):675-82. Use of hospitalization and pharmaceutical prescribing data to compare the prevaccination burden of varicella and herpes zoster in Australia. MacIntyre CR, Chu CP, Burgess MA. National Center for Immunisation Research and Surveillance of Vaccine Preventable Diseases, Children's Hospital at Westmead, Westmead, NSW, Australia 2145. The aims of the study were to compare the burden of varicella and herpes zoster in Australia. No national surveillance exists for varicella or herpes zoster. We used hospital morbidity data from 1993-9 and pharmaceutical prescribing data from 1995-9. In the financial year 1998/99, there were 4718 hospitalizations for zoster compared to 1991 for varicella. For varicella the mean age of patients was 15 years compared to 69 years for zoster. The mean length of stay in hospital was 4.2 days for varicella and 12.7 days for zoster. Varicella accounted for 8396 (3726 with principal diagnosis varicella) bed days compared to 26 266 (5382 with principal diagnosis of zoster) for zoster. The in-hospital case-fatality rate was 0.4% for varicella and 1% for zoster. In 1999, 59 200 community-based cases of zoster were treated with antivirals. We estimate that 157 266 cases of zoster occurred in the community in 1999, a rate of 830 per 100 000 population. Herpes zoster has a higher burden of disease than varicella, and must be a component of disease surveillance in order to determine the full impact of vaccination on the epidemiology of varicella zoster virus (VZV). PMID: 12948367 [PubMed - indexed for MEDLINE] 1485. Reg Anesth Pain Med. 2003 Jul-Aug;28(4):344-6. Epidural clonidine relieves intractable neuropathic itch associated with herpes zoster-related pain. Elkersh MA, Simopoulos TT, Malik AB, Cho EH, Bajwa ZH. Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02445, USA. elkershmd@hotmail.com OBJECTIVE: We present a case of intense herpes zoster-related pain and itching in the ophthalmic division of the trigeminal nerve (V1). Successful pain and itch management was achieved after insertion of a high thoracic epidural catheter with a continuous infusion of bupivacaine and clonidine. CASE REPORT: A 73-year-old woman with metastatic malignant melanoma developed acute herpes zoster-related pain and itching unresponsive to conventional oral medications. The patient described severe and frequent attacks of lancinating pain occurring in the dermatomal distribution of the left ophthalmic division of the trigeminal nerve. She also had a disturbing itch in the same distribution as her pain. The patient had significant reduction in the frequency and intensity of the lancinating attacks after placement of a thoracic epidural catheter with continuous infusion of 1 microg/mL clonidine and 0.05% bupivacaine. The itching resolved completely as well. CONCLUSION: High thoracic epidural infusion of bupivacaine and clonidine was beneficial in relieving neuropathic itch in a patient with acute herpes zoster-related pain in the distribution of the trigeminal nerve. PMID: 12945030 [PubMed - indexed for MEDLINE] 1486. Reg Anesth Pain Med. 2003 Jul-Aug;28(4):315-20. Postherpetic neuralgia: a descriptive analysis of patients seen in pain clinics. Lázaro C, Caseras X, Baños JE; Catalonian Group for the Study of Postherpetic Neuralgia. Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain. BACKGROUND AND OBJECTIVE: Postherpetic neuralgia (PHN) is a common ailment that pain specialists must often cope with. The goal of the present survey is to investigate the pain characteristics of 119 PHN patients with persistent pain seen at different pain clinics. Methods information on demographic features, pain characteristics (MPQ-SV, VAS, VRS), and treatment was recorded by means of a standard case report form. RESULTS: Gender, age, location, and treatment were consistent with previous reports. Antidepressant, antiepileptic, and analgesic drugs were the most commonly used by patients. The patients seen in pain clinics are probably a subset of severe cases of PHN, where delayed referral to these units plays an important role. The most frequent qualitative features of the disease were the McGill Pain Questionnaire-Spanish Version (MPQ-SV). These features may change in relation to illness evolution; electric shocklike pain and emotional distress were significantly higher after 6 months of evolution and age (those younger than 70 were more able to locate painful areas and to feel pain as pricking or sharp), and gender (men selected spatial pressure and traction pressure more frequently). None of the explored variables was relevant to predicting pain intensity. CONCLUSIONS: This study reveals a subset of patients, mostly suffering from long-term PHN, where pain persists. The most frequent qualitative traits of PHN patients are described. Some variables were involved in modulation of pain characteristics in these patients. The effect of study design in interpretation of results is discussed. PMID: 12945025 [PubMed - indexed for MEDLINE] 1487. Lancet Neurol. 2003 Sep;2(9):567-71. An unusual cause of trigeminal-distribution pain and tumour. Hevner R, Vilela M, Rostomily R, Cohrs R, Mahalingam R, Wellish M, Gilden DH. Department of Pathology, University of Washington, Seattle, WA, USA. PMID: 12941580 [PubMed - indexed for MEDLINE] 1488. J Med Virol. 2003 Oct;71(2):313-9. Molecular characterisation of varicella-zoster virus strains in Germany and differentiation from the Oka vaccine strain. Sauerbrei A, Eichhorn U, Gawellek S, Egerer R, Schacke M, Wutzler P. Institute of Virology and Therapy, Friedrich-Schiller University of Jena, Jena, Germany. Andreas.Sauerbrei@med.uni-jena.edu With the introduction of varicella vaccination, surveillance of varicella-zoster virus (VZV) strains occurring in cases of chickenpox or zoster should be considered. Differentiating Oka vaccine strain from wild-type VZV can be achieved only using molecular genotyping. In the present study, the VZV genotype was examined in 53 VZV strains isolated from patients with varicella or zoster and in 73 samples from skin eruptions, cerebrospinal fluid, and throat swabs obtained from patients with VZV infections in Germany. The polymerase chain reaction and restriction fragment length polymorphisms analysis using DNA fragments of the open reading frames 38, 54, 62, and the R5 repeat region were used. Whereas all VZV isolates could be typed, direct genotyping of viral DNA in patients' samples was achieved in 63 of 73 cases (86.3%). The dominant genotype of VZV found in 88.8% of 116 patients had the wild-type pattern PstI(+) BglI(-) R5A followed by the wild-genotype PstI(+) BglI(+) R5A in 6.0%, the wild-genotype PstI(+) BglI(-) R5B in 3.4%, the wild-genotype PstI(+) BglI(-) R5C and the Oka vaccine genotype PstI(-) BglI(+) R5B in 0.9% of patients each. BglI(-) wild-types were found in 90.7% of patients with zoster and in 9.3% of patients with varicella. By contrast, the BglI(+) wild-type was diagnosed in five patients with varicella and in two patients with zoster. In conclusion, VZV strains found in Germany are similar to strains circulating in the United States and the United Kingdom. VZV wild-type strains containing a BglI restriction site in ORF 54 as well as Oka vaccine strains can rarely be detected. Copyright 2003 Wiley-Liss, Inc. PMID: 12938208 [PubMed - indexed for MEDLINE] 1489. Rinsho Ketsueki. 2003 Jul;44(7):451-5. [Successful treatment with foscarnet for disseminated varicella-zoster infection after reduced intensity stem cell transplantation in a case of relapsed refractory central nervous system lymphoma] [Article in Japanese] Aoyama Y, Yamamura R, Shima E, Nakamae H, Makita K, Hasegawa T, Sakamoto C, Terada Y, Kho G, Ohta K, Yamane T, Takubo T, Hino M. Graduate School of Medicine, Osaka City University. Visceral disseminated varicella-zoster virus (VZV) infection occurred with acute graft-versus-host disease in a 33-year-old Japanese male with non-Hodgkin lymphoma who had undergone allogeneic stem cell transplantation from an HLA-identical sibling after reduced intensity conditioning chemotherapy. Although ganciclovir and acyclovir treatment was effective temporarily, the number of VZV-DNA copies in the blood remained at a high level, and the hepatitis was prolonged. The patient was treated with foscarnet, which led to improvement of the VZV viremia and the hepatic dysfunction. Foscarnet therapy should be considered for acyclovir-resistant VZV infection in the setting of allogeneic hematopoietic stem cell transplantation. PMID: 12931563 [PubMed - indexed for MEDLINE] 1490. Br J Haematol. 2003 Sep;122(5):802-5. Varicella-zoster virus infection in adult patients after unrelated cord blood transplantation: a single institute experience in Japan. Tomonari A, Iseki T, Takahashi S, Ooi J, Takasugi K, Shimohakamada Y, Ohno N, Nagamura F, Uchimaru K, Tani K, Tojo A, Asano S. Department of Hematology/Oncology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan. atomonar@ims.u-tokyo.ac.jp Varicella-zoster virus (VZV) infection was studied in 40 adult patients who underwent cord blood transplantation (CBT) from unrelated donors. Twenty-five patients developed VZV reactivation at a median of 5 months after CBT (range 1.7-26 months). The cumulative incidence of VZV reactivation after CBT was 80% at 30 months. Twenty-two patients developed localized herpes zoster. The remaining three patients developed atypical non-localized herpes zoster, which was associated with visceral dissemination in one patient. All the patients responded well to antiviral therapy. Unexpectedly, the absence of grade II-IV acute graft-versus-host disease (GVHD) was associated with a higher rate of VZV reactivation after CBT (100% versus 55%, P=0.01). These results suggest that recovery of VZV-specific immune responses after CBT is delayed even in patients without severe acute GVHD. PMID: 12930392 [PubMed - indexed for MEDLINE] 1491. Graefes Arch Clin Exp Ophthalmol. 2003 Dec;241(12):982-7. Epub 2003 Aug 20. Interferon gamma expression and clinical features in patients with acute retinal necrosis syndrome. Abe T, Sato M, Saigo Y, Tamai M. Department of Ophthalmology, School of Medicine, Tohoku University, Sendai, 980-8574 Miyagi, Japan. toshi@oph.med.tohoku.ac.jp BACKGROUND: Interferon gamma (IFN-gamma) has been reported to play an important role during virus infections. The purpose of this study was to examine the relationship between IFN-gamma expression and the clinical course of patients with acute retinal necrosis syndrome (ARN) associated with the varicella-zoster virus (VZV). METHODS: Six patients with ARN were studied. The aqueous and/or vitreous were examined by reverse transcriptase-polymerase chain reaction (RT-PCR) and enzyme-linked immunosorbent assay during the follow-up period. The presence of VZV genome was also determined by PCR. The results were correlated with the clinical data and features and compared with patients with other ocular diseases. RESULTS: A statistically significant higher level of IFN-gamma was detected in the aqueous and/or vitreous in eyes with ARN than in eyes with other ocular diseases. A statistically significant positive correlation was observed between the level of IFN-gamma in the vitreous and the final visual acuity. IFN-gamma was reduced to undetectable levels within 30 days after the initial eye symptoms. Three of five patients had severe inflammation initially, and the visual acuity gradually recovered with the disappearance of VZV and higher levels of IFN-gamma. Conversely, the other 2 patients showed mild inflammation, had a slow decrease of visual acuity with persistent VZV, and lower levels of IFN-gamma expression. CONCLUSION: Our results suggest that IFN-gamma may be one of the factors that plays an important role in the clinical course of VZV-associated ARN. PMID: 12928903 [PubMed - indexed for MEDLINE] 1492. J Clin Virol. 2003 Sep;28(1):104-10. Genomic analysis of varicella-zoster virus: primers for individual open reading frames. Wagenaar TR, Grose C, Loparev VN, Schmid DS, Breuer J. Departments of Microbiology and Pediatrics, University of Iowa Hospital/2501 JCP, 200 Hawkins Drive, Iowa City, IA 52242, USA. The genome of varicella-zoster virus (VZV) contains nearly 125,000 bp. Preliminary genomic analysis has revealed that VZV may be less immutable than once thought. Through the investigation of the VZV genome using specifically designed oligonucleotides, it has been learned that sequence variation within VZV open reading frame 62 can distinguish between vaccine and wild-type virus. Additionally, the presence of single nucleotide polymorphisms within the VZV genome has identified distinct VZV populations originating from circumscribed geographic locations. In order for future studies of VZV genetic diversity to be carried out, amplifying and sequencing primers for individual VZV genes have been catalogued. Additionally, this report will facilitate the selection of VZV primers by which to distinguish clinical VZV isolates from vaccinia virus isolates. PMID: 12927757 [PubMed - indexed for MEDLINE] 1493. Acta Derm Venereol. 2003;83(4):298-9. Pneumothorax secondary to ipsilateral herpes zoster pectoralis. Park SW, Kang SH, Lee D, Wang HY, Sung HS. PMID: 12926807 [PubMed - indexed for MEDLINE] 1494. CNS Drugs. 2003;17(11):771-80. Pharmacological management of postherpetic neuralgia. Pappagallo M, Haldey EJ. Department of Pain Medicine and Palliative Care, Beth Israel Medical Center, New York, NY, USA. Postherpetic neuralgia, which occurs most typically in older persons, is one of the most common and serious complications of herpes zoster (or shingles). It is a chronic neuropathic pain syndrome and remains one of the most difficult pain disorders to treat. Known beneficial agents include antidepressants, antiepileptic drugs, opioid analgesics, local anaesthetics, capsaicin and other, less applied, modalities. Although monotherapy is commonly applied, no single best treatment for postherpetic neuralgia has been identified; nevertheless, gabapentin (antiepileptic) and transdermal lidocaine (anaesthetic) are often used as the first-choice treatments. Recent research has shed light on possible pain mechanisms as well as new avenues of treatment, which are discussed in the article. For patients with pain that is not adequately controlled, individualised treatment plans must be pursued. It is critical to recognise that postherpetic neuralgia, while difficult to manage, can be a treatable neuropathic pain syndrome. PMID: 12921490 [PubMed - indexed for MEDLINE] 1495. Neurol Neurochir Pol. 2003 Jan-Feb;37(1):243-9. [Guillain-Barre syndrome following Herpes zoster infection] [Article in Polish] Kochanowski J, Stepniak I, Dolińska E. II Kliniki Neurologii Akademii Medycznej w Warszawie. A male patient with a bi-phasic Guillain-Barré syndrome is presented in the paper. Initially a paralysis of his left lower extremity was observed, with hypotonia and removal of deep reflexes, followed by a flaccid paralysis of the remaining extremities. This syndrome had been preceded by a Herpes zoster infection producing symptoms in the left shank and foot. The paresis of his left lower extremity had been increasing during the week before his admission, while the paralysis of the other extremities occurred not earlier than by the end of the second week of his hospitalization. The diagnosis of the Guillain-Barré syndrome was based on the clinical course of the disease, and results of EMG examination and of general laboratory tests of his cerebrospinal fluid. PMID: 12910845 [PubMed - indexed for MEDLINE] 1496. Man Ther. 2003 Aug;8(3):180-4. Post-herpetic neuralgia: possible mechanisms for pain relief with manual therapy. Rabey MI. Fulham Physiotherapy, Swan Mews, Parsons Green Lane, SW6 4QT, London, UK. m.rabey@btinternet.com PMID: 12909440 [PubMed - indexed for MEDLINE] 1497. J Anesth. 2003;17(1):57-8. Postherpetic neuralgia as a risk factor for classic heatstroke. Sekiyama H, Sumida T, Hayashida M, Chinzei M, Ide Y, Arita H, Hanaoka K. Department of Anesthesiology and Pain Relief Center, Faculty of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan. PMID: 12908690 [PubMed - indexed for MEDLINE] 1498. Can J Urol. 2003 Jun;10(3):1912-3. Herpes zoster infection: a rare cause of acute urinary retention. Chan JE, Kapoor A. Department of Surgery (Urology), St. Joseph's Hospital, McMaster University, Hamilton, Ontario, Canada. Comment in: Can J Urol. 2004 Aug;11(4):2314; discussion 2314. Herpes zoster (HZ) infection has been reported as a rare cause of acute urinary retention. HZ infection involving sacral, thoracolumbar, and rarely high thoracic dermatomes is believed to occasionally cause motor and sensory neuropathy of the bladder. This is specifically achieved by the interruption of the detrusor reflex causing subsequent bladder atonia. As the course and management of this entity is quite benign, HZ should remain a diagnostic consideration in the management of urinary retention. We report a case of acute urinary retention of approximately 2.5 liters associated with HZ infection and review the proposed pathogenesis and therapeutic considerations in the management of this entity. PMID: 12892580 [PubMed - indexed for MEDLINE] 1499. Int J Neurosci. 2003 Aug;113(8):1081-6. Cell-mediated immune hypersensitivity is stronger on noninvolved side than involved side in patients with herpes zoster. Erdem T, Dane S, Kadi M. Department of Dermatology, Medical Faculty, Atatürk University, Erzurum, Turkey. The difference between involved and noninvolved sides of the body in cell-mediated immunity was investigated in this work; tuberculin reactions in two forearms were assessed in men and women with herpes zoster. The tuberculin reaction was smaller on the involved side than in the noninvolved side of the body in total sample, men and women. The results suggested that the lower activity of cell-mediated immune system in one side of the body may be related to the unilateral involvement of the zona-zoster infection. PMID: 12888422 [PubMed - indexed for MEDLINE] 1500. Am J Surg. 2003 Aug;186(2):148. Postherpetic self-limited abdominal wall herniation. Safadi BY. Department of Surgery, Stanford University, VA Palo Alto HCS, 3801 Miranda Ave., 112G, Palo Alto, CA 94304, USA. Bassem.safadi@med.va.gov PMID: 12885607 [PubMed - indexed for MEDLINE] 1501. J Clin Virol. 2003 Aug;27(3):308-9. Herpes zoster guidelines of the German Dermatological Society. Gross G, Doerr HW. Comment on: J Clin Virol. 2003 Apr;26(3):277-89; discussion 291-3. PMID: 12878095 [PubMed - indexed for MEDLINE] 1502. J Infect. 2003 Aug;47(2):133-8. Quantification of circulating varicella zoster virus-DNA for the early diagnosis of visceral varicella. Ishizaki Y, Tezuka J, Ohga S, Nomura A, Suga N, Kuromaru R, Kusuhara K, Mizuno Y, Kasuga N, Hara T. Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan Varicella zoster virus (VZV)-DNA was quantified in peripheral blood of 2 patients with visceral varicella due to endogenous reactivation. An 18-year-old male contracted varicella following the courses of chemotherapy for T cell lymphoma. Another 18-year-old male suffered from varicella 16 months after the complete engraftment of hematopoietic stem cell transplantation. Both patients had past VZV infection, but no recent contact with the disease. Paralytic ileus and ascites preceded the skin lesions. Quantitative real-time polymerase chain reaction revealed >200 copies of VZV per 1 ml of whole blood before or at the time when cropping vesicles emerged. The viral load reflected their prolonged clinical courses. Similar levels of VZV-DNA were detected in primary varicella patients, but not in herpes zoster patients or immunocompromised children without varicella or zoster. Quantitative monitoring of circulating VZV-DNA may be useful for the diagnosis and assessing the treatment response of visceral varicella in immunocompromized hosts. PMID: 12860147 [PubMed - indexed for MEDLINE] 1503. Panminerva Med. 2003 Jun;45(2):155-6. Maternally acquired varicella-zoster virus antibodies disappear at 6 months of age in prematurely born children. Akisu M, Yalaz M, Aksu G, Arslanoglu S, Genel F, Kutukculer N, Kultursay N. PMID: 12855941 [PubMed - indexed for MEDLINE] 1504. Pain. 2003 Jul;104(1-2):423-4. Treatment of post-herpetic pain in myasthenia gravis: exacerbation of weakness due to gabapentin. Scheschonka A, Beuche W. Department of Neuroradiology, J.W. Goethe-Universität Frankfurt, Schleusenweg 2-16, 60528 Frankfurt am Main, Germany. scheschonka@mpih-frankfurt.mpg.de Here, we present a case of a 64-year-old female suffering from a severe form of antibody-positive myasthenia gravis. Under an immunosuppressive regimen with cyclosporine A, she experienced an episode of thoracic herpes zoster followed by intense post-herpetic neuralgia. In order to avoid drug interactions as well as adverse effects of carbamazepine in myasthenia gravis, gabapentin was chosen for the treatment of neuropathic pain. Within a few days she noticed increasing weakness, but continued medication for 8 weeks as gabapentin was not identified as the hazardous agent by her physician. Acetylcholine receptor antibody levels remained unchanged, but increased decrement was observed clinically and in repetitive nerve stimulation. After withdrawal of gabapentin, she recovered quickly to her previous condition. PMID: 12855353 [PubMed - indexed for MEDLINE] 1505. Pain. 2003 Jul;104(1-2):323-31. Tramadol in post-herpetic neuralgia: a randomized, double-blind, placebo-controlled trial. Boureau F, Legallicier P, Kabir-Ahmadi M. Centre d'Evaluation et de Traitement de la Douleur, CHU Saint-Antoine, 184 rue du Fg Saint Antoine, 75571 Paris, France. francois.boureau@sat.ap-hop-paris.fr The efficacy and safety of sustained-release tramadol compared to placebo in the treatment of post-herpetic neuralgia were evaluated in a multicenter, randomized, double-blind, parallel-group study in 127 outpatients. Treatment was administrated for 6 weeks. The dose of tramadol could be increased from 100 mg/day to 400 mg/day (300 mg/day in patients more than 75 years old). Groups were compared on changes in pain intensity on a Visual Analogue Scale (VAS) between inclusion and the 6th week of treatment (covariance analysis as main analysis and repeated measures analysis as complementary analysis) in the per protocol (PP) population. The randomized population comprised 127 patients aged 35-85 years, mostly females (72.4%). Groups were comparable at inclusion both in the intent to treat (ITT) population (63 patients in the tramadol group and 62 patients in the placebo group) and in the PP population (53 patients in the tramadol group and 55 patients in the placebo group). Mean pain intensity on day 43 adjusted on day 1 (covariance analysis) was significantly lower in the tramadol group than in the placebo group in both the PP (P=0.0499), and the ITT (P=0.031) populations. The two groups significantly differed on change in pain intensity over time (repeated measures analysis) in the ITT population (P=0.012). The percentage of pain relief over the 6th week was significantly higher in the tramadol group than in the placebo group (P=0.017). During the 6th week, patients in the tramadol group required less rescue medication than patients in the placebo group (P=0.022). No significant difference was found between groups either in pain intensity on a 5-point Verbal Scale (VRS) or in quality of life measurements. Tramadol was administered at an average dosage of 275.5 (89.7) mg/day after a 1-week dose-adaptation period. Tramadol was well tolerated. No notable difference appeared between groups either in the percentage of patients with treatment-associated adverse events (TAAE) (29.7% in the tramadol group and 31.8% in the placebo group) or in the total number of TAAE (31 in the tramadol group and 28 in the placebo group). PMID: 12855342 [PubMed - indexed for MEDLINE] 1506. J Clin Neurosci. 2003 Jul;10(4):512-4. Post-herpetic trigeminal neuralgia treated with deep brain stimulation. Green AL, Nandi D, Armstrong G, Carter H, Aziz T. Department of Neurosurgery, Radcliffe Infirmary, Oxford, UK. Post-herpetic neuralgic affects up to 20% of patients after an attack of trigeminal Herpes Zoster infection. Past medical and surgical treatments have been unrewarding. We report the successful treatment of such a case with deep brain stimulation into the region of the contralateral periventricular grey area (PVG) and ventral posterior lateral thalamic nucleus (VPL). PMID: 12852900 [PubMed - indexed for MEDLINE] 1507. Clin Ther. 2003 Mar;25(3):852-89. The use of gabapentin for the treatment of postherpetic neuralgia. Singh D, Kennedy DH. Pharmacy Practice, Nova Southeastern University College of Pharmacy-Davie Campus, Fort Lauderdale, Florida 33328-2018, USA. singh@nova.edu BACKGROUND: Varicella-zoster virus causes chickenpox and can reemerge later in life to cause herpes zoster or shingles. One of the most common and disabling complications of herpes zoster is postherpetic neuralgia (PHN). OBJECTIVES: This article reviews the current primary literature about the efficacy and tolerability of gabapentin for the treatment of PHN. Gabapentin pharmacokinetics and drug interactions are also reviewed. METHODS: A literature search in the English language was conducted using OVID Web, which contained the following databases: MEDLINE (1966-present), EMBASE (1980-2002), Current Contents/Clinical Medicine (1999-2002), Cochrane Controlled Trials Register (1898-present), Cochrane Database of Systemic Reviews (fourth quarter, 2002), and International Pharmaceutical Abstracts (1970-2002). Search terms used were postherpetic neuralgia; zoster; gabapentin; neuropathic pain; pain; pharmacoeconomic; cost; controlled clinical trial; randomized, controlled trial; postherpetic neuralgia and gabapentin; gabapentin and pain; treatment and postherpetic neuralgia; gabapentin and age; gabapentin and gender; gabapentin and ethnicity; and gabapentin and pharmacokinetics. RESULTS: Gabapentin displays nonlinear absorption kinetics, is minimally protein bound (< 3%), has a high mean (SD) volume of distribution (50.4 [8.0] L), and is excreted via the kidneys as unchanged drug. Two randomized, placebo-controlled, parallel-group, multicenter clinical trials demonstrated the effectiveness of gabapentin at doses of up to 3600 mg/d to significantly reduce pain (P < 0.01 and P < 0.001), improve sleep (P < 0.01), and improve some parameters on the Short Form-McGill Pain Questionnaire (P < 0.05). Dizziness and somnolence were the most common side effects leading to withdrawal from the trials. The recommended dosage in adults is 300 mg at bedtime on day 1,300 mg BID on day 2, and 300 mg TID on day 3, titrating up as needed to 2400 to 3600 mg/d. To reduce adverse events in patients with renal impairment, the dose should be adjusted based on the patient's creatinine clearance. CONCLUSIONS: Gabapentin appears to be effective and well tolerated for the short-term treatment of PHN. However, future controlled studies are needed to determine whether the effectiveness of gabapentin for PHN is maintained for > 2 months, to establish the optimal dose of gabapentin for PHN, and to compare the efficacy of gabapentin with that of other pharmacologic agents used for the treatment of PHN. PMID: 12852705 [PubMed - indexed for MEDLINE] 1508. Neurology. 2003 Jul 8;61(1):139-40. Recurrent myelopathy after HAART in a patient with spinal mycobacterial infection. Sumner CJ, Newman M, Jay CA. Department of Neurology, University of California, San Francisco, USA. PMID: 12847179 [PubMed - indexed for MEDLINE] 1509. Hepatogastroenterology. 2003 Jul-Aug;50(52):1043-6. Gastrointestinal cancer and herpes zoster in adults. Yamamoto M, Mine H, Akazawa K, Maehara Y, Sugimachi K. Department of Gastroenterologic Surgery, Shin-Nakama Hospital, Nakama, Japan. myamamo@nk-cc.go.jp BACKGROUND/AIMS: Herpes zoster is associated with immunosuppression, and also has an increased risk of malignancy. The aim of this study is to determine whether patients with Herpes zoster are at a higher risk of occult malignancy and gastrointestinal diseases. METHODOLOGY: We examined 131 of 201 Japanese patients who showed evidence of Herpes zoster in the gastrointestinal tract including the large intestine using gastrointestinal endoscopy, total colonoscopy and CT scanning. RESULTS: Six of 131 patients (4.6%) with Herpes zoster, who had undergone all three examinations, had malignancies. This rate is significantly higher than the predicted rate (P < 0.05). Five of six patients had gastrointestinal or colon cancer. Previously, 17 of the 201 patients has been surgically treated for cancers (17/201 = 8.5%, predictable rate = 8.9%), eleven of these 17 patients had surgery for gastric cancer, or for colon cancer etc. We also diagnosed three patients to have cancers after an episode of Herpes zoster, out of the 140 patients who we examined as study prospects (3/140 = 2.1%, relative risks = 1.75). No significant increases in the malignant rates were observed before or after the onset of Herpes zoster. CONCLUSIONS: These findings are considered to support the policy to investigate patients with Herpes zoster for the presence of occult malignancies, though the rate of malignancy in such patients before or after episodes of Herpes zoster was not significantly different from that of the predictable rate. PMID: 12845977 [PubMed - indexed for MEDLINE] 1510. Int J Dermatol. 2003 Jul;42(7):562-4. Dermatomal lichenoid graft-versus-host disease within herpes zoster scars. Sanli H, Anadolu R, Arat M, Ekmekci P, Birol A, Erdem C, Koç H. Department of Dermatology, Medical Faculty, Ankara University, Ankara, Turkey. PMID: 12839612 [PubMed - indexed for MEDLINE] 1511. Postgrad Med. 2003 Jun;113(6):87-8. Patient notes: shingles. [No authors listed] PMID: 12838806 [PubMed - indexed for MEDLINE] 1512. Electromyogr Clin Neurophysiol. 2003 Jun;43(4):231-4. Zoster paresis. Tilki HE, Mutluer N, Selçuki D, Stålberg E. Department of Neurology, Ondokuz Mayis University, Medical Faculty, Samsun, Turkey. hacererdem@superonline.com Herpes zoster (HZ) is essentially a viral disease of the posterior root ganglia and sensory nerve fibers, which presents clinically with vesicular eruption of the skin, radicular pain and sensory changes in the distribution of the affected ganglion. However, motor involvement can be seen as well. If classic cutaneous lesions are present, HZ-related motor paresis is easily diagnosed. Otherwise, the diagnosis may be suspicious, especially if the weakness occurs before the cutaneous lesions have appeared, or weeks after they have subsided. We present a patient with HZ-related motor paresis due to radiculopathy in the cervical segments whose motor symptoms and signs appear as major clinical features. PMID: 12836588 [PubMed - indexed for MEDLINE] 1513. Acta Otorhinolaryngol Belg. 2003;57(2):139-46. Bilateral simultaneous facial paralysis--differential diagnosis and treatment options. A case report and review of literature. Gevers G, Lemkens P. Department of Otorhinolaryngology, Head and Neck Surgery, Katholieke Universiteit Leuven, Belgium. Bilateral facial paralysis or paresis of peripheral origin is a rare condition and therefore represents a diagnostic challenge. We here present a case of a previously healthy woman who was hospitalized for symptoms of meningitis. On the second day of her hospital stay, she developed bilateral facial paresis. Later, the patient developed also tachycardia and dysrhythmias. A thorough diagnostic procedure including lumbar puncture, routine blood investigation with serological tests, MRI of the brain, Holter monitoring and transoesophageal echocardiographia, revealed meningitis with radiculitis, facial paresis and myocarditis. The clinical triad of meningitis, radiculitis and facial palsy is known as the Bannwarth Syndrome (Lyme disease). The patient was treated with ceftriaxone and recovered well. Despite repeatedly taken serological tests, Borrelia burgdorferi immunoglobulins were not detected. Acquired bilateral facial paralysis can occur in several diseases of infectious, neurological, idiopathic, iatrogenic, toxic, neoplastic or traumatic origin. In this article, we review the differential diagnoses and treatment options of bilateral facial paresis and present a scheme that is helpful in the diagnostic evaluation of this condition. PMID: 12836471 [PubMed - indexed for MEDLINE] 1514. Antiviral Res. 2003 Jun;59(1):57-60. Oral brivudin in comparison with acyclovir for herpes zoster: a survey study on postherpetic neuralgia. Wassilew SW, Wutzler P; Brivddin Herpes Zoster Study Group. Dermatological Department, Klinikum Krefeld, Lutherplatz 40, D-47805, Krefeld, Germany. swassilew.dermatologie@klinikum-krefeld.de This concerns a double-blind survey study on 608 herpes zoster patients treated with 1x 125 mg oral brivudin (n=309) or 5x 800 mg acyclovir (n=299), both for 7 days, during two prospective, randomised clinical herpes zoster trials. The survey aimed at evaluating the outcome of the two treatment regimens on postherpetic neuralgia (PHN). During a follow-up ranging from 8 to 17 months after start of treatment, former study participants aged >/=50 years were interviewed for the occurrence of PHN. Neither the investigators nor the patients were aware of which treatment the patients received during acute herpes zoster. The incidence of PHN, defined as zoster-associated pain occurring or persisting after rash healing was significantly lower in brivudin recipients (32.7%) than in acyclovir recipients (43.5%, P=0.006). Mean duration of PHN was similar with brivudin (173 days) and acyclovir (164 days, P=0.270). Despite some methodological disadvantages common to this type of study, the present survey provides for the first evidence that brivudin treatment during acute herpes zoster favourably affects the incidence of PHN in immunocompetent elderly herpes zoster patients. PMID: 12834861 [PubMed - indexed for MEDLINE] 1515. Antiviral Res. 2003 Jun;59(1):49-56. Oral brivudin in comparison with acyclovir for improved therapy of herpes zoster in immunocompetent patients: results of a randomized, double-blind, multicentered study. Wassilew SW, Wutzler P; Brivddin Herpes Zoster Study Group. Dermatological Department, Klinikum Krefeld, Lutherplatz 40, D-47805, Krefeld, Germany. swassilew.dermatologie@klinikum-krefeld.de Brivudin [(E)-5-(2-bromovinyl)-2'-deoxyuridine] is a nucleoside analogue with a high and selective antiviral activity against varicella-zoster virus (VZV) and herpes simplex virus type 1 (HSV-1). The double-blind, randomized study presented here compared efficacy and safety of oral brivudin 1 x 125 mg and acyclovir 5 x 800 mg, both for 7 days, in 1227 immunocompetent patients with herpes zoster. Main results were as follows: brivudin was superior to acyclovir in accelerating the "time to last formation of new vesicles" (primary parameter; risk ratio(ITT): 1.13, P=0.014). Equivalent effects of brivudin and acyclovir were observed for the secondary parameters "time to first crust" (RR(ITT): 0.93, P=0.004), "time to full crusting" (risk ratio(ITT): 1.03, P<0.001), and "time to loss of crusts" (RR(ITT): 0.95, P=0.002). The incidence of potentially treatment-related adverse events was similar under brivudin (7.7%) and acyclovir (10.0%). In conclusion, brivudin proved to be more effective than acyclovir in terminating vesicle formation, the parameter which reflects the end of viral replication, thus confirming, in the clinical setting, the greater in vitro antiviral activity of brivudin. Compared with acyclovir, brivudin provides a similar safety profile and a significant improvement in efficacy. PMID: 12834860 [PubMed - indexed for MEDLINE] 1516. Am J Ophthalmol. 2003 Jul;136(1):192-4. Acute retinal necrosis following epidural steroid injections. Browning DJ. Charlotte Eye, Ear, Nose, and Throat Associates, Charlotte, North Carolina, USA. djbrowning@carolina.rr.com PURPOSE: To report a side effect of epidural corticosteroid injections for back pain. DESIGN: Case series. METHODS: Review of clinical charts and photographs. SETTING:Private retina practice.RESULTS: Two patients developed acute retinal necrosis syndrome following epidural corticosteroid injections for back pain. Referral was delayed in one patient. One patient developed bilateral secondary rhegmatogenous retinal detachment, and both developed secondary macular pucker. CONCLUSIONS: Acute retinal necrosis can follow epidural corticosteroid injections. Patients should be warned about this possibility and advised to report should photopsias, photosensitivity, blurred vision, or new floaters develop after treatment. Orthopedists should be aware of the complication and promptly refer patients with symptoms for dilated fundus examination by an ophthalmologist. PMID: 12834695 [PubMed - indexed for MEDLINE] 1517. Clin Infect Dis. 2003 Jul 1;37(1):e16-8. Epub 2003 Jun 24. Multiple cerebral infarcts due to varicella-zoster virus large-vessel vasculopathy in an immunocompetent adult without skin involvement. Ahmad NM, Boruchoff SE. Division of Infectious Diseases, Allergy, and Immunology, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick 08903-0019, USA. We report the case of a 52-year-old immunocompetent man with varicella-zoster virus large-vessel vasculopathy and multiple bilateral cerebral infarcts who had no history of skin involvement. Etiologic diagnosis was made by isolation of varicella-zoster virus from a cerebrospinal fluid specimen. The patient had marked improvement in mental status after acyclovir therapy was initiated. PMID: 12830433 [PubMed - indexed for MEDLINE] 1518. J Clin Virol. 2003 Jul;27(2):190-9. Molecular diagnosis of zoster post varicella vaccination. Sauerbrei A, Uebe B, Wutzler P. Institute of Virology and Antiviral Therapy, Friedrich-Schiller University of Jena, Winzerlaer Strasse 10, D-07745, Jena, Germany. andreas.sauerbrei@med.uni-jena.de BACKGROUND: Herpes zoster can be caused by endogenous reactivation of both wild-type virus or vaccine varicella-zoster virus (VZV) becoming latent within sensory ganglia after natural primary infection or varicella vaccination. OBJECTIVES: To demonstrate molecular biological methods for reliable discrimination between wild-type VZV and vaccine strain Oka by an example of zoster in a vaccinated girl. STUDY DESIGN: VZV was isolated from zoster occurring 16 months after varicella vaccination in a 2-year-old infant. Including VZV wild-type and different Oka strains as controls, viral DNA fragments located in the open reading frames (ORF) 38, 54, 62 and the R5 variable repeat region were characterized by amplification and restriction fragment length polymorphisms (RFLP) analysis. RESULTS: VZV vaccine strain Oka was definitely proven to be the causative virus in this case of zoster post vaccination. CONCLUSIONS: Molecular procedures for characterization of ORF 38 allow reliable discrimination between Oka-like and wild-type VZV outside Japan and Japanese communities. To distinguish Oka vaccine virus from Oka-like wild strains, analysis of DNA fragments located in the ORF 62 should be included. PMID: 12829041 [PubMed - indexed for MEDLINE] 1519. Clin Nucl Med. 2003 Jul;28(7):594-5. Varicella zoster infection associated rhabdomyolysis demonstrated by Tc-99m MDP imaging. Bhargava P, Bhutani C, Feng Q, Alavi A, Zhuang H. Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, 19104, USA. PMID: 12819419 [PubMed - indexed for MEDLINE] 1520. J Neurol Sci. 2003 Aug 15;212(1-2):7-9. Chronic active VZV infection manifesting as zoster sine herpete, zoster paresis and myelopathy. Morita Y, Osaki Y, Doi Y, Forghani B, Gilden DH. Department of Medicine and Geriatrics, Kochi Medical School, Kochi, Japan. After lumbar-distribution zoster, an HTLV-1-seropositive woman developed chronic radicular sacral-distribution pain (zoster sine herpete), cervical-distribution zoster paresis and thoracic-distribution myelopathy. Detection of anti-varicella zoster virus (VZV) IgM and VZV IgG antibody in cerebrospinal fluid (CSF), with reduced serum/CSF ratios of anti-VZV IgG compared to normal serum/CSF ratios for albumin and total IgG, proved that VZV caused the protracted neurological complications. Diagnosis by antibody testing led to aggressive antiviral treatment and a favorable outcome. PMID: 12809993 [PubMed - indexed for MEDLINE] 1521. Neurourol Urodyn. 2003;22(4):335-7. Loss of urinary voiding sensation due to herpes zoster. Hiraga A, Nagumo K, Sakakibara R, Kojima S, Fujinawa N, Hashimoto T. Department of Neurology, Matsudo Municipal Hospital, Matsudo, Chiba, Japan. hiragaa@mail3.alpha-net.ne.jp A case of sacral herpes zoster infection in a 56-year-old man with the complication of loss of urinary voiding sensation is presented. He had typical herpes zoster eruption on the left S2 dermatome, hypalgesia of the S1-S4 dermatomes, and absence of urinary voiding sensation. There was no other urinary symptom at the first medical examination. Urinary complications associated with herpes zoster are uncommon, but two types, acute cystitis and acute retention, have been recognized. No cases of loss of urinary voiding sensation due to herpes zoster have been reported. In this case, hypalgesia of the sacral dermatomes was mild compared to the marked loss of urethral sensation. This inconsistency is explained by the hypothesis that the number of urethral fibers is very small as compared to that of cutaneous fibers, therefore, urethral sensation would be more severely disturbed than cutaneous sensation. Copyright 2003 Wiley-Liss, Inc. PMID: 12808709 [PubMed - indexed for MEDLINE] 1522. Drugs Aging. 2003;20(8):561-70. The role of antivirals in the management of neuropathic pain in the older patient with herpes zoster. Lilie HM, Wassilew S. Dermatology Department, Klinikum Krefeld, Krefeld, Germany. lilie@klinikum-krefeld.de Herpes zoster has been known since ancient times. It is a ubiquitous disease, occurring sporadically without any seasonal preference and is caused by the varicella-zoster virus. It may be defined as an endogenous relapse of the primary infection varicella. Herpes zoster is characterised by typical efflorescences in the innervation region of a cranial or spinal nerve and starts and ends with pain of varying intensity. Currently, several antiviral drugs are approved and many studies have shown that antiviral therapy, started early in the course of disease, can significantly reduce the risk and the duration of postherpetic neuralgia in elderly patients. The effects of all antivirals discussed in this article, given either orally or intravenously, are comparable with regards to the resolution of virus replication, prevention of dissemination of skin lesions and reduction of acute herpes zoster pain. Valaciclovir (valacyclovir), famciclovir and brivudine (brivudin) are comparably effective in the reduction of the incidence and/or prevention of zoster-associated pain and postherpetic neuralgia. Brivudine 125mg once daily is as effective as famciclovir 250mg three times daily in reducing the prevalence and the duration of zoster-associated pain and postherpetic neuralgia, especially if therapy is combined with a structured-pain therapy. The intensity of the therapy for pain should depend on the intensity of the pain that it is treating. Famciclovir and brivudine offer an advantage over other antivirals because they are administered less frequently; this is particularly relevant for elderly patients who may already be taking a number of medications for other diseases. Therefore, antiviral therapy in combination with adequate pain management should be given to all elderly patients as soon as herpes zoster is diagnosed. PMID: 12795624 [PubMed - indexed for MEDLINE] 1523. Cornea. 2003 May;22(4):371-3. Sequestered viscoelastic after deep lamellar keratoplasty using viscodissection. Bhojwani RD, Noble B, Chakrabarty AK, Stewart OG. General Infirmary at Leeds, Leeds, West Yorkshire, United Kingdom. bbhojwani@hotmail.com PURPOSE: Deep lamellar keratoplasty (DLKP) is an intricate procedure that preserves the host's endothelium, thus eliminating the possibility of endothelial graft rejection and potentially offering great benefits over penetrating keratoplasty. DLKP may be performed by a variety of techniques including viscodelamination, in which the stroma is separated from Descemet's membrane using viscoelastic. METHODS: Here we present an operative complication of this technique, which was not initially recognized, that caused significant morbidity to our patient and eventually led to the eye requiring a full thickness regraft. We also attempt to reproduce the lesion using nonviable cadaver corneas and illustrate histologically the nature of the corneal stroma and its relationship to Descemet's membrane following viscoelastic delamination. PMID: 12792483 [PubMed - indexed for MEDLINE] 1524. J Fam Pract. 2003 Jun;52(6):496-7. Clinical inquiries. What is the prognosis of postherpetic neuralgia? Gazewood JD, Meadows S, Halverson L. University of Virginia, Charlottesville, Virginia, USA. PMID: 12791234 [PubMed - indexed for MEDLINE] 1525. Acta Cytol. 2003 May-Jun;47(3):480-4. Cytology of pleural effusion associated with disseminated infection caused by varicella-zoster virus in an immunocompromised patient. A case report. Mori M, Imamura Y, Maegawa H, Yoshida H, Naiki H, Fukuda M. Department of Surgical Pathology, Fukui Medical University Hospital, Departments of Pathology and Clinical Laboratory Medicine, Fukui Medical University, Matsuoka, Fukui, Japan. BACKGROUND: Pleural effusion caused by varicella-zoster virus (VZV) is rare. We report a case of a woman with acute lymphocytic leukemia (ALL) who developed a pleural effusion caused by VZV infection. CASE: A 55-year-old woman with ALL treated with consolidation therapy developed skin vesicles and a pleural effusion. Pleural fluid smears contained numerous mesothelial cells, which had ground-glass nuclei or eosinophilic nuclear inclusions. Some multinucleated giant cells were also seen. Electron microscopic examination revealed intranuclear virus particles, about 150 nm in diameter, in some mesothelial cells. Tissue samples from the skin, lungs, pleura, liver, pancreas, kidneys and gastrointestinal tract, obtained at autopsy, contained many virus-infected cells. They were positive for VZV glyco-protein 1 by immunohistochemistry. CONCLUSION: VZV infection should be considered in the differential diagnosis of an unexplained exudative pleural effusion, especially in immunocompromised hosts. PMID: 12789936 [PubMed - indexed for MEDLINE] 1526. Int J Dermatol. 2003 Jun;42(6):491-5. The role of gabapentin in treating diseases with cutaneous manifestations and pain. Scheinfeld N. Department of Dermatology, St. Luke's Roosevelt Hospital Center, New York, NY 10025, USA. Scheinfeld@rcn.com BACKGROUND: Gabapentin was first approved by the FDA in 1993 as an add-on treatment for partial epileptic seizures. In May of 2002, it was approved as treatment for post-herpetic neuralgia by the Food and Drug Administration. It appears to be a promising agent in the treatment of pain, alterations of sensation and pruritus associated with dermatological disease, but no review of these uses exists. METHODS: Medline and Google searches were performed for the words "Gabapentin" and "Neurontin." The articles found were reviewed. Article identified that contained references to the treatment of skin disease and neuropathic pain were examined and their contents surveyed. RESULTS: Approximately 1200 articles were located in Medline that referred to Garbapentin or Neurontin. Over 150 articles reviewed its use for neuropathic pain, neuritis or neuralgia of various sorts. Approximately 20 articles reviewed its use for a variety of dermatological conditions or diseases with dermatological manifestations that included: pain control associated with wound dressing changes, erythromelagia, piloleiomyoma related pain, brachioradial pruritus, Glossodynia, vulvodynia, and reflex sympathetic dystrophy. Over 100 articles that related to Gabapentin side effects were reviewed. CONCLUSIONS: Gabapentin is a very promising medication in the treatment of post-herpetic neuralgia and pain. Because dermatological patients suffer pain from painful tumors, after surgery, in conjunction with neuropathic ulcers, during dressing changes involving serious medical conditions, its applications seem manifold. Future studies must assess its role in the treatment of pruritus and other dermatological conditions involving pain or alteration of sensation. PMID: 12786883 [PubMed - indexed for MEDLINE] 1527. Indian J Pathol Microbiol. 2002 Jul;45(3):269-71. Role of viral serology in the diagnosis of acute retinal necrosis syndrome. Grover R, Ratho RK, Gupta V, Mahajan RC, Gupta A. Department of Virology, PGIMER, Chandigarh. Due to the devastating nature of acute retinal necrosis syndrome (ARNS), early diagnosis is essential. 5 cases of clinically diagnosed ARNA were investigated for CMC, herpes simplex and varicella zoster virus (VZV) infections. Of the three VZV IgM positive cases, two were positive in acute blood samples and one in vitreous fluid. Thus VZU can be incriminated as the causative agent of ARNS cases in North India. PMID: 12785164 [PubMed - indexed for MEDLINE] 1528. Rev Clin Esp. 2003 Jun;203(6):307-8. [Fever and cutaneous lesions in leg in a 20 month-old girl] [Article in Spanish] Gamo Villegas R, Guerra Tapia A, Iglesias Díez L. Servicio de Dermatología. Hospital 12 de Octubre. Madrid. Spain. PMID: 12783721 [PubMed - indexed for MEDLINE] 1529. Jpn J Ophthalmol. 2003 May-Jun;47(3):260-4. Multiplex polymerase chain reaction for detection of herpes simplex virus type 1, type 2, cytomegalovirus, and varicella-zoster virus in ocular viral infections. Zhang Y, Kimura T, Fujiki K, Sakuma H, Murakami A, Kanai A. Department of Ophthalmology, Juntendo University School of Medicine, Tokyo, Japan. PURPOSE: To detect simultaneously herpes simplex virus type 1 (HSV-1), type 2 (HSV-2), cytomegalovirus (CMV), and varicella-zoster virus (VZV) in ocular specimens suspected of indicating viral infection, and to compare the results of multiplex polymerase chain reaction (PCR) with those of uniplex PCR. METHODS: Forty specimens, collected from 33 patients with clinically suspected herpes virus ocular infection, were tested. DNA was extracted from the specimens and amplified by multiplex and uniplex PCR. RESULTS: Both multiplex PCR and uniplex PCR gave the same results. Nineteen (19/33, 57.6%) patients were PCR-positive, among whom HSV-1 was detected in 13 (13/19, 68.4%) patients, and VZV in 6 (6/19, 31.6%) patients. CONCLUSION: These results demonstrated that multiplex PCR is as reliable as uniplex PCR, and is an accurate and a cost-saving method to identify several agents from a single specimen. PMID: 12782161 [PubMed - indexed for MEDLINE] 1530. Clin Exp Dermatol. 2003 May;28(3):257-9. Giant lichenification of the scalp. Arseculeratne G, Altmann P, Millard PR, Todd P, Wojnarowska F. Department of Dermatology, Churchill Hospital, Oxford, UK. Lichenification is characterized clinically by thickening of areas of skin as a result of the itch-scratch cycle and therefore is seen in conditions associated with chronic pruritus. The characteristic feature of giant lichenification is the occurrence of tumour-like growths with a warty cribriform surface. We describe a renal transplant patient presenting with giant lichenification of the scalp following an attack of herpes zoster at the same site. Chronic pruritus following scalp dysaethesia secondary to herpes zoster was considered the most likely explanation for the occurrence of these lesions. PMID: 12780706 [PubMed - indexed for MEDLINE] 1531. Acta Ophthalmol Scand. 2003 Jun;81(3):216-20. Visual prognosis in immunocompetent patients with herpes zoster ophthalmicus. Zaal MJ, Völker-Dieben HJ, D'Amaro J. Department of Ophthalmology, VU University Medical Centre, Amsterdam, The Netherlands. mjw.zaal@vumc.nl PURPOSE: To determine the normal spectrum of ocular complications and associated visual outcome in patients with herpes zoster ophthalmicus. METHODS: This prospective observational cohort study included 73 immunocompetent adults with herpes zoster ophthalmicus, referred by their general practitioners within 7 days of skin rash onset. The follow-up period was 6 months. All patients received a 7-14-day course of systemic aciclovir treatment combined with longterm application of a lubricating ophthalmic ointment as long as the corneal epithelium was affected. Topical corticosteroids were strictly avoided in the acute phase of ocular disease. Acquired visual loss scores at 1, 2 and 6 months were based on best corrected visual acuity (BCVA) level and evaluation of the ophthalmological history and findings. RESULTS: Ophthalmic herpes zoster led to a variety of transient inflammatory reactions within the anterior eye segment of the involved side in 46 patients (63%), but did not seriously compromise their ultimate visual outcome. Mild to moderate visual loss, with corrected VA between 0.3 and 0.8, was found in 17 patients at 1 month (23%), in 10 patients at 2 months (14%) and in seven patients at 6 months follow-up (10%). None of the patients developed visual loss with a corrected VA of less than 0.3. CONCLUSION: Functional vision was retained in all ophthalmic zoster patients referred to the ophthalmologist in the acute phase of the disease by vigorous antiviral treatment and adequate prevention of corneal exposure. PMID: 12780396 [PubMed - indexed for MEDLINE] 1532. J Neurovirol. 2003 Jun;9(3):404-7. Chronic varicella-zoster virus ganglionitis--a possible cause of postherpetic neuralgia. Gilden DH, Cohrs RJ, Hayward AR, Wellish M, Mahalingam R. Department of Neurology, University of Colorado Health Sciences Center, Denver, Colorado, USA. don.gilden@uchsc.edu Postherpetic neuralgia (PHN) is dermatomal distribution pain that persists for months to years after the resolution of herpes zoster rash. The cause of PHN is unknown. Herein, we report clinical, molecular virological, and immunological findings over an 11-year period in an immunocompetent elderly woman with PHN. Initially, blood mononuclear cells (MNCs) contained varicella-zoster virus (VZV) DNA on two consecutive occasions. Random testing after treatment with famciclovir to relieve pain did not detect VZV DNA. However, the patient was reluctant to continue famciclovir indefinitely and voluntarily stopped drug treatment five times. Pain always recurred within 1 week, and blood MNCs contained many, but not all, regions of the VZV genome on all five occasions. Immunological analysis revealed increased cell-mediated immunity to VZV. Chronic VZV ganglionitis-induced PHN best explains the recurrence of VZV DNA in MNCs whenever famciclovir was discontinued; the detection of only some regions of the viral genome in MNCs, compared to the detection of all regions of the VZV genome in latently infected ganglia; the increased cell-mediated immunity to VZV; and a gratifying clinical response to famciclovir. The presence of fragments of VZV DNA in MNCs likely represents partial degradation of viral DNA in MNCs that trafficked through ganglia during productive infection. PMID: 12775423 [PubMed - indexed for MEDLINE] 1533. J Virol. 2003 Jun;77(12):6979-87. Varicella-zoster virus DNA in cells isolated from human trigeminal ganglia. Levin MJ, Cai GY, Manchak MD, Pizer LI. Section of Pediatric Infectious Diseases, School of Medicine, University of Colorado, Denver, Colorado 80262, USA. myron.levin@uchsc.edu To determine the type of cell(s) that contain latent varicella-zoster virus (VZV) DNA, we prepared pure populations of neurons and satellite cells from trigeminal ganglia of 18 humans who had previously had a VZV infection. VZV DNA was present in 34 of 2,226 neurons (1.5%) and in none of 20,700 satellite cells. There was an average of 4.7 (range of 2 to 9) copies of VZV DNA per latently infected neuron. Latent VZV DNA was primarily present in large neurons, whereas the size distribution of herpes simplex virus DNA was markedly different. PMCID: PMC156183 PMID: 12768016 [PubMed - indexed for MEDLINE] 1534. J Virol. 2003 Jun;77(12):6660-5. Varicella-zoster virus gene 66 transcription and translation in latently infected human Ganglia. Cohrs RJ, Gilden DH, Kinchington PR, Grinfeld E, Kennedy PG. Department of Neurology, University of Colorado Health Sciences Center, Denver, Colorado 80262, USA. randall.cohrs@uchsc.edu Latent infection with varicella-zoster virus (VZV) is characterized by restricted virus gene expression and the absence of virus production. Of the approximately 70 predicted VZV genes, only five (genes 4, 21, 29, 62, and 63) have been shown by multiple techniques to be transcribed during latency. IE62, the protein product of VZV gene 62, is the major immediate-early (IE) virus-encoded transactivator of viral gene transcription and plays a pivotal role in transactivating viral genes during lytic infection. The protein kinase (66-pk) encoded by VZV gene 66 phosphorylates IE62, resulting in cytoplasmic accumulation of IE62 that mitigates nuclear IE62-induced gene activation. Analysis of latently infected human trigeminal ganglia for 66-pk expression by reverse transcriptase-dependent nested PCR, including DNA sequence analysis, in situ hybridization, and immunohistochemistry, revealed VZV open reading frame 66 to be a previously unrecognized latently expressed virus gene and suggests that prevention of IE62 import to the nucleus by VZV 66-pk phosphorylation is one possible mechanism by which VZV latency is maintained. PMCID: PMC156202 PMID: 12767985 [PubMed - indexed for MEDLINE] 1535. Diagn Mol Pathol. 2003 Jun;12(2):103-7. Rapid diagnosis of smallpox infection and differentiation from its mimics. Nuovo GJ, Plaza JA, Magro C. Department of Pathology, The Ohio State University Medical Center S305E Rhodes Hall, 450 W 10th Avenue Columbus, OH 43210, USA. gnuovomd@pol.net The potential for a bioterrorism-induced smallpox outbreak has been much discussed of late. The literature of the late 1960s stressed that the distinction between smallpox and the other viral-induced vesicle-forming diseases, namely varicella zoster and disseminated herpes simplex, was difficult to make. Given that the cutaneous manifestations of smallpox would be among the initial symptoms, we reviewed 2 cases of smallpox diagnosed in South America in the 1970s in conjunction with 9 cases of multiple skin vesicles diagnosed as either disseminated herpes simplex or varicella-zoster. These were examined by routine hematoxylin and eosin stain (H&E) as well as by in situ hybridization. A blind review of the cases demonstrated that each showed striking intraepithelial vesicles containing multinucleated squamous cells exhibiting a ground glass appearance of the nuclear chromatin. Thus, as expected, routine H&E examination could not differentiate the 2 smallpox cases from the other 9 samples. In situ hybridization easily distinguished the 2 cases of smallpox from the other 9 samples, 5 of which contained varicella-zoster (two had been misdiagnosed as herpes) and the other 4 were disseminated herpes simplex. The in situ test, readily accomplished in any histology-based molecular laboratory in 4 hours, allows for the rapid and specific identification of smallpox infection and, importantly, its distinction from its mimics. Formalin fixation, which is optimal for in situ hybridization, guarantees the inactivation of the smallpox virus. PMID: 12766615 [PubMed - indexed for MEDLINE] 1536. N Engl J Med. 2003 May 15;348(20):2044-5; author reply 2044-5. Herpes zoster. Crider EF. Comment on: N Engl J Med. 2002 Aug 1;347(5):340-6. PMID: 12751476 [PubMed - indexed for MEDLINE] 1537. Dermatol Nurs. 2003 Apr;15(2):175. Herpes zoster. Roberts EJ, Heitman B. PMID: 12751354 [PubMed - indexed for MEDLINE] 1538. Nephrol Dial Transplant. 2003 Jun;18(6):1135-41. High serum concentrations of the acyclovir main metabolite 9-carboxymethoxymethylguanine in renal failure patients with acyclovir-related neuropsychiatric side effects: an observational study. Helldén A, Odar-Cederlöf I, Diener P, Barkholt L, Medin C, Svensson JO, Säwe J, Ståhle L. Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Huddinge University Hospital, Stockholm, Sweden. anders.hellden@hs.se Comment in: Nephrol Dial Transplant. 2003 Dec;18(12):2680; author reply 2680-1. BACKGROUND: Acyclovir (ACV) has been used for over two decades to treat herpes virus infections. Serious neurological adverse side effects have occurred during ACV treatment in patients with renal failure, but the cause of the symptoms remains unknown. We hypothesized that increased concentrations of the ACV main metabolite 9-carboxymethoxymethylguanine (CMMG) correlated to these symptoms. METHODS: We conducted an observational study from 1991 to mid 1999 based on samples sent for analysis of ACV concentration from various hospital departments in Sweden. Patients with neuropsychiatric symptoms (NS+, n=49) were compared with patients without symptoms (NS-, n=44). ACV and CMMG concentrations were analysed by HPLC. Medical records were analysed for symptoms and compared with pertinent cases identified from Medline. RESULTS: The serum CMMG levels were significantly higher in the NS+ group (mean=34.1 micro mol/l, 95% confidence interval 23.4-46.1) compared with the NS- group (mean=4.7 micro mol/l, 95% confidence interval 3.3-6.6; P<0.001). CMMG was the strongest predictor in a receiver-operating characteristics curve analysis (ROC), based on 77 patients, of ACV-related neuropsychiatric symptoms. The ROC curve for CMMG demonstrated that neuropsychiatric symptoms could be predicted with a sensitivity of 91% and a specificity of 93% with the use of a cut-off value of 10.8 micro mol/l of CMMG. Thirty-five of 49 patients in the NS+ group showed levels exceeding this concentration compared with only three of 44 of patients in the NS- group (P<0.001). ACV exposure, ACV concentration, creatinine clearance and creatinine concentration were weaker but statistically significant predictors. Haemodialysis reduced CMMG and ACV levels and relieved the symptoms. CONCLUSIONS: The determination of CMMG levels in serum may be a useful tool in supporting the diagnosis of ACV-associated neuropsychiatric symptoms. Furthermore, the monitoring of CMMG levels may prevent the emergence of symptoms. PMID: 12748346 [PubMed - indexed for MEDLINE] 1539. N Engl J Med. 2003 May 15;348(20):2044-5; author reply 2044-5. Herpes zoster. Feder HM Jr. Comment on: N Engl J Med. 2002 Aug 1;347(5):340-6. PMID: 12748328 [PubMed - indexed for MEDLINE] 1540. AJNR Am J Neuroradiol. 2003 May;24(5):971-4. Varicella-zoster vasculitis presenting with intracranial hemorrhage. Jain R, Deveikis J, Hickenbottom S, Mukherji SK. Division of Neuroradiology and Department of Radiology, University of Michigan Health System, Ann Arbor 48109, USA. Cerebral vasculitis presenting with intracranial hemorrhage is a rare but known entity. We discuss here the case of a 61-year-old woman presenting with subarachnoid hemorrhage. Cerebral angiography showed vasculitic changes involving the small and medium-sized vessels. She also had a concomitant herpes zoster rash on her back. A 3-month follow-up angiogram revealed partial resolution of the vasculitic changes. PMID: 12748105 [PubMed - indexed for MEDLINE] 1541. Vaccine. 2003 Jun 2;21(19-20):2541-7. The incidence of shingles and its implications for vaccination policy. Chapman RS, Cross KW, Fleming DM. Birmingham Research Unit of the Royal College of General Practitioners, Lordswood House, 54 Lordswood Road, Harborne, Birmingham B17 9DB, UK. A vaccine is now available to prevent varicella-zoster infection, but its place in routine preventive care is not yet determined. The age specific incidence of shingles was examined separately by gender and age groups (15-24, 25-44, 45-64, 65-74 and 75 years and more) over the years 1994-2001. These incidence data were applied to national available data for the UK on current life expectancy to calculate the risk of shingles infections at varying ages. The potential benefit of an effective vaccine was estimated using three models of vaccine efficacy applied separately to males and females at ages 50, 60 and 65 years and assuming vaccination at a single age. Similar calculations were made using a two dose strategy at age 45 and 65 years and at age 50 and 70 years. The cost per case saved was estimated from a vaccination cost of pound 40 per dose. The probability of having had an attack of shingles before age 45 years is 8.6% for males and 10.5% for females, The risk of acquiring shingles over an expected lifetime (assuming no preventive vaccination) for males aged 45 years is 22% and for females 32%. Whichever vaccine efficacy model was chosen, a single vaccination policy at age 65 years was the most favourable option in both males and females. A two age vaccination policy was estimated to increase the cost per case saved by 30% over a single age policy but administration at age 50 and 70 years substantially increased the number of cases saved as compared with a single age policy and was potentially better than vaccination at 45 and 65 years. PMID: 12744889 [PubMed - indexed for MEDLINE] 1542. BMJ. 2003 May 10;326(7397):1025-6. Zosteriform metastasis from melanoma. Evans AV, Child FJ, Russell-Jones R. Skin Tumour Unit, St John's Institute of Dermatology, St Thomas's Hospital, London SE1 7EH. alun@hotmail.com PMCID: PMC1125931 PMID: 12742928 [PubMed - indexed for MEDLINE] 1543. Clin Cornerstone. 2001;4(1):39-44. Common skin disorders in the elderly. Webster GF. Department of Dermatology and Cutaneous Biology, Center for Cutaneous Pharmacology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA. Skin diseases commonly seen in the elderly are more often than not the effects of sun damage or vascular disease. The effects of a lifetime of even casual sun exposure can be dramatic. Chronically sun-exposed skin becomes thin, loses collagen, and has disrupted elastin and decreased glycosaminoglycans. The result is skin that breaks easily, bruises, sags, irritates easily, and itches. The spots and bumps that patients associate with age are all sun-induced. Consider how lesionless a 60-year-old's buttock is compared to the extensor forearm. The reason that bruising attributed to anticoagulation seems to occur exclusively on the extensor forearm and not the volar aspect of the arm is that sun-induced elastin degradation is greatest on the extensor forearm. Even trivial trauma will cause unsupported capillaries to shear and bleed whether the patient is anticoagulated or not. This article reviews the primary skin disorders associated with the elderly and some of the management approaches that the primary care physician can use. PMID: 12739321 [PubMed - indexed for MEDLINE] 1544. IRB. 2002 Sep-Oct;24(5):6-8. The right of subjects to see the protocol. Veatch RM. Kennedy Institute of Ethics, Georgetown University, Washington, DC, USA. PMID: 12737168 [PubMed - indexed for MEDLINE] 1545. Hua Xi Yi Ke Da Xue Xue Bao. 2001 Mar;32(1):129-30, 139. [Study on bolus cyclosphamide treatment for 64 cases of lupus nephritis] [Article in Chinese] Liu G, Chen Y, Zuo C, Xie Q, Wang Z, Wang L, Lin M. Department of Clinical Immunology, First Affiliated Hospital, WCUMS, Chengdu 610041, China. OBJECTIVE: To report on the dosing, efficacy and side-effects of bolus cyclosphamide treatment for lupus nephritis (LN). METHODS: 64 consecutive cases of LN with 10 or more erythrocytes per high-power field, proteinuria (> 1 g of protein per day) and serum creatinine increased (> 133 mumol/L) were treated by bolus therapy with cyclophosphamide (CTX) given monthly for 6 months and then quarterly for 18 months. RESULTS: 49 patients had renal remission (defined as < 10 erythrocytes per high-power field, absence of cellular casts, excretion of < 1 g of protein per day and normal serum creatinine). The mean of doses was 1.1 g for each time (0.6-1.6 g), the mean of times of bolus CTX needed was 3.6 (1-8 times). The adverse events were amenorrhea (in 41% female patients), herpes zoster (in 13% patients) and hemorrhagic cystitis (in 1 patient). CONCLUSION: The results indicate that monthly bolus CTX therapy is effective and safe for patients with LN. Its adverse effect is relatively not a serious problem. PMID: 12733378 [PubMed - indexed for MEDLINE] 1546. Med Trop (Mars). 2002;62(6):599. [Ramsay Hunt syndrome] [Article in French] Adehossi E, Parola P, Delmont J. Service des Maladies Infectieuses et Tropicales, Universités-Assistant des Hôpitaux Associé. PMID: 12731304 [PubMed - indexed for MEDLINE] 1547. Eye (Lond). 2003 Apr;17(3):449-51. Scleromalacia as a complication of herpes zoster ophthalmicus. Berry-Brincat A, Von Lany H, Evans N. PMID: 12724725 [PubMed - indexed for MEDLINE] 1548. Nippon Rinsho. 2003 Feb;61 Suppl 2:200-4. [Varicella-zoster virus infection] [Article in Japanese] Yoshida M. First Department of Dermatology, Toho University School of Medicine. PMID: 12722214 [PubMed - indexed for MEDLINE] 1549. J Virol. 2003 May;77(10):6062-5. Construction of varicella-zoster virus recombinants from parent Oka cosmids and demonstration that ORF65 protein is dispensable for infection of human skin and T cells in the SCID-hu mouse model. Niizuma T, Zerboni L, Sommer MH, Ito H, Hinchliffe S, Arvin AM. Department of Pediatrics, Stanford University School of Medicine, Stanford, California 94305, USA. We generated an ORF65 deletion mutant by using a cosmid system constructed from the genome of a low-passage clinical isolate (P-Oka). Using the SCID-hu mouse model, we demonstrated that the ORF65 protein is dispensable for viral replication in skin and T cells, which are critical host cell targets during primary varicella-zoster virus infection. PMCID: PMC154042 PMID: 12719598 [PubMed - indexed for MEDLINE] 1550. J Virol. 2003 May;77(10):5964-74. Differentiation of varicella-zoster virus ORF47 protein kinase and IE62 protein binding domains and their contributions to replication in human skin xenografts in the SCID-hu mouse. Besser J, Sommer MH, Zerboni L, Bagowski CP, Ito H, Moffat J, Ku CC, Arvin AM. Department of Pediatrics and Microbiology, School of Medicine, Stanford University, Stanford, California 94305, USA. jbesser@stanford.edu To investigate the role of the ORF47 protein kinase of varicella-zoster virus (VZV), we constructed VZV recombinants with targeted mutations in conserved motifs of ORF47 and a truncated ORF47 and characterized these mutants for replication, phosphorylation, and protein-protein interactions in vitro and for infectivity in human skin xenografts in the SCID-hu mouse model in vivo. Previous experiments showed that ROka47S, a null mutant that makes no ORF47 protein, did not replicate in skin in vivo (J. F. Moffat, L. Zerboni, M. H. Sommer, T. C. Heineman, J. I. Cohen, H. Kaneshima, and A. M. Arvin, Proc. Natl. Acad. Sci. USA 95:11969-11974, 1998). The construction of VZV recombinants with targeted ORF47 mutations made it possible to assess the effects on VZV infection of human skin xenografts of selectively abolishing ORF47 protein kinase activity. ORF47 mutations that resulted in a C-terminal truncation or disrupted the DYS kinase motif eliminated ORF47 kinase activity and were associated with extensive nuclear retention of ORF47 and IE62 proteins in vitro. Disrupting ORF47 kinase function also resulted in a marked decrease in VZV replication and cutaneous lesion formation in skin xenografts in vivo. However, infectivity in vivo was not blocked completely as long as the capacity of ORF47 protein to bind IE62 protein was preserved, a function that we identified and mapped to the N-terminal domain of ORF47 protein. These experiments indicate that ORF47 kinase activity is of critical importance for VZV infection and cell-cell spread in human skin in vivo but suggest that it is the formation of complexes between ORF47 and IE62 proteins, both VZV tegument components, that constitutes the essential contribution of ORF47 protein to VZV replication in vivo. PMCID: PMC154036 PMID: 12719588 [PubMed - indexed for MEDLINE] 1551. Ann Dermatol Venereol. 2002 Oct;129(10 Suppl):S37-43. [Herpes virus infections in immunocompetent children and adults. Varicella and zona] [Article in French] Beylot C, Bagot M, Cambazard F, Berbis P. PMID: 12718123 [PubMed - indexed for MEDLINE] 1552. Nippon Rinsho. 2003 Mar;61 Suppl 3:575-81. [Varicella-zoster virus] [Article in Japanese] Yoshikawa T, Nishiyama Y. Laboratory of Virology, Research Institute for Disease Mechanism and Control, Graduate School of Medicine, Nagoya University. PMID: 12718031 [PubMed - indexed for MEDLINE] 1553. Neurol Neurochir Pol. 2002 Nov-Dec;36(6):1221-6. [Neural listeriosis presenting as leptomeningitis: a case report] [Article in Polish] Łysiak Z, Litwin T, Barańska-Gieruszczak M, Poniatowska R. Zakładu Radiologii, II Kliniki Neurologii Instytutu Psychiatrii i Neurologii w Warszawie. The Listeria monocytogenes infection is rare and difficult to diagnosis. However, it is associated with a high mortality in adults. A case is presented of a 78-year-old woman with an immunological deficit following viral infection (herpes zoster). PMID: 12715698 [PubMed - indexed for MEDLINE] 1554. Cytopathology. 2003 Apr;14(2):91-2. Varicella-zoster virus basophilic meningitis: a case report. Courtade M, Viguier A, Sailler L, Busato F, Corberand J, Caratero C. Laboratoire d'Histologie-Cytologie, CHU Rangueil-Larrey, Toulouse Cedex, France. courtade@cict.fr PMID: 12713483 [PubMed - indexed for MEDLINE] 1555. Pediatr Infect Dis J. 2003 Apr;22(4):384-6. Progressive outer retinal necrosis caused by varicella-zoster virus in children with acquired immunodeficiency syndrome. Purdy KW, Heckenlively JR, Church JA, Keller MA. Division of Infectious Diseases, Department of Pediatrics, Jules Stein Eye Institute, UCLA School of Medicine, Harbor-UCLA Medical Center, Torrance, CA, USA. PMID: 12712978 [PubMed - indexed for MEDLINE] 1556. Rinsho Shinkeigaku. 2002 Sep;42(9):855-8. [A case of Ramsay Hunt syndrome initiated with hoarseness and dysphagia: consideration on spreading mechanisms of cranial neuropathy] [Article in Japanese] Miyazaki Y, Tajima Y, Sudo K, Matsumoto A, Kikuchi S, Tashiro K. Department of Neurology, Sapporo City General Hospital. A 85-year-old woman was admitted to our hospital because of progressive hoarseness and dysphagia of two days' duration. Neurological examination on admission revealed right pharyngeal and vocal cord palsies. After admission, gradual swelling of her right ear was noted, and on day 6, vesicular eruptions in her right geniculate zone, the right VII and the VIIIth cranial nerve palsies were added. On the basis of these findings, she was diagnosed as Ramsay Hunt syndrome. Varicella zoster virus (VZV) infection was confirmed by the elevation of serum anti-VZV-antibody titer, and detection of VZV DNA from cerebrospinal fluid. Ramsay Hunt syndrome associated with multiple cranial neuropathy is not frequently reported. Reviewing Japanese literatures, we found that the IX and the Xth cranial nerves were most frequently affected, and the half of these cases were initiated with cranial neuropathy other than the VIIth. Additionally, spreading mechanisms of cranial neuropathy, and the early diagnostic problems of these conditions were discussed. PMID: 12710084 [PubMed - indexed for MEDLINE] 1557. Arch Phys Med Rehabil. 2003 Mar;84(3 Suppl 1):S57-62; quiz S63-8. Interventions in chronic pain management. 5. Disease-specific issues in chronic pain. Rashbaum IG, Lacerte M, Braverman DL, Ericksen JJ. Department of Rehabilitation Medicine, New York University Medical Center, New York, NY 10016, USA. rashbi01@endeavor.med.nyu.edu This self-directed learning module highlights the importance of applying principles described earlier in the Study Guide to specific diseases encountered by practitioners managing chronic pain in order to administer appropriate treatment. This chapter focuses on several challenging and increasingly common maladies and attempts to delineate rationales for holistic, comprehensive care. OVERALL ARTICLE OBJECTIVE: To explore diagnostic concepts and therapeutic strategies in fibromyalgia syndrome, central pain, multiple sclerosis, complex regional pain syndrome, and postherpetic neuralgia. PMID: 12708560 [PubMed - indexed for MEDLINE] 1558. J Neurovirol. 2003 Apr;9(2):194-204. Herpes simplex virus-1 and varicella-zoster virus latency in ganglia. Mitchell BM, Bloom DC, Cohrs RJ, Gilden DH, Kennedy PG. Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA. Two human alpha-herpesviruses, herpes simplex virus (HSV)-1 and varicella zoster virus (VZV), account for the most frequent and serious neurologic disease caused by any of the eight human herpesviruses. Both HSV-1 and VZV become latent in ganglia. In this review, the authors describe features of latency for these viruses, such as distribution, prevalence, abundance, and configuration of viral DNA in latently infected human ganglia, as well as transcription, translation, and cell type infected. Studies of viral latency in animal models are also discussed. For each virus, remaining questions and future studies to understand the mechanism of latency are discussed with respect to prevention of serious cutaneous, ocular, and neurologic disease produced by virus reactivation. PMID: 12707850 [PubMed - indexed for MEDLINE] 1559. J Dermatol. 2003 Apr;30(4):348-9. A rather rare encounter with herpes zoster in a male infant. Kashima M. PMID: 12707476 [PubMed - indexed for MEDLINE] 1560. J Dermatol. 2003 Apr;30(4):346-7. Herpes zoster neonatorum. Brar BK, Pall A, Gupta RR. PMID: 12707475 [PubMed - indexed for MEDLINE] 1561. Neurology. 2003 Apr 22;60(8):E6-7. Patient pages. Treatment of postherpetic neuralgia. Lovitt S. Comment on: Neurology. 2003 Apr 22;60(8):1274-83. Neurology. 2003 Apr 22;60(8):1391-2. PMID: 12707463 [PubMed - indexed for MEDLINE] 1562. Neurology. 2003 Apr 22;60(8):1391-2. Topical ketamine treatment of postherpetic neuralgia. Quan D, Wellish M, Gilden DH. Department of Neurology, University of Colorado Health Sciences Center, Denver 80262, USA. Comment in: Neurology. 2003 Apr 22;60(8):E6-7. PMID: 12707455 [PubMed - indexed for MEDLINE] 1563. Neurology. 2003 Apr 22;60(8):1274-83. Pregabalin for the treatment of postherpetic neuralgia: a randomized, placebo-controlled trial. Dworkin RH, Corbin AE, Young JP Jr, Sharma U, LaMoreaux L, Bockbrader H, Garofalo EA, Poole RM. University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA. robert_dworkin@urmc.rochester.edu Comment in: Neurology. 2003 Apr 22;60(8):E6-7. OBJECTIVE: To evaluate the efficacy and safety of pregabalin in the treatment of postherpetic neuralgia (PHN). METHODS: The authors conducted a multicenter, parallel-group, double-blind, placebo-controlled, 8-week, randomized clinical trial in PHN, defined as pain for 3 or more months following herpes zoster rash healing. Patients (n = 173) were randomized to treatment with pregabalin or placebo. Patients randomized to pregabalin received either 600 mg/day (creatinine clearance > 60 mL/min) or 300 mg/day (creatinine clearance 30 to 60 mL/min). The primary efficacy measure was the mean of the last seven daily pain ratings. Secondary endpoints included additional pain ratings, sleep interference, quality of life, mood, and patient and clinician ratings of global improvement. RESULTS: Pregabalin-treated patients had greater decreases in pain than patients treated with placebo (endpoint mean scores 3.60 vs 5.29, p = 0.0001). Pain was significantly reduced in the pregabalin-treated patients after the first full day of treatment and throughout the study, and significant improvement on the McGill Pain Questionnaire total, sensory, and affective pain scores was also found. The proportions of patients with >or=30% and >or=50% decreases in mean pain scores were greater in the pregabalin than in the placebo group (63% vs 25% and 50% vs 20%, p = 0.001). Sleep also improved in patients treated with pregabalin compared to placebo (p = 0.0001). Both patients and clinicians were more likely to report global improvement with pregabalin than placebo (p = 0.001). Given the maximal dosage studied, pregabalin had acceptable tolerability compared to placebo despite a greater incidence of side effects, which were generally mild to moderate in intensity. CONCLUSIONS: Treatment of PHN with pregabalin is safe, efficacious in relieving pain and sleep interference, and associated with greater global improvement than treatment with placebo. PMID: 12707429 [PubMed - indexed for MEDLINE] 1564. Arch Neurol. 2003 Apr;60(4):616-7. Surgical induction of zoster in a contralateral homologous dermatomal distribution. Gilden DH, Katz RI. Department of Neurology, University of Colorado Health Sciences Center, Denver, 80262, USA. don.gilden@uchsc.edu Herpes zoster occurs most often in elderly and immunocompromised individuals, and rarely after surgery. We report 2 cases in which zoster developed in the contralateral dermatome distribution homologous to the surgical site. The mechanism by which unilateral surgery might affect homologous ganglia is likely to involve spinal cord pathways above the dermatomal level of surgical trauma. PMID: 12707078 [PubMed - indexed for MEDLINE] 1565. Indian J Ophthalmol. 2003 Mar;51(1):71-5. The diagnostic significance of enzyme linked immuno-sorbent assay for herpes simplex, varicella zoster and cytomegalovirus retinitis. Madhavan HN, Priya K. L & T Microbiology Centre, Vision Research Foundation, Sankara Nethralaya, Chennai, India. drhnm@sankaranethralaya.org PURPOSE: To evaluate the diagnostic usefulness of enzyme linked immuno-sorbent assay (ELISA) in single serum samples to associate herpes simplex virus (HSV), varicella zoster virus (VZV) or cytomegalovirus (CMV) with viral retinitis as against polymerase chain reaction (PCR) on intraocular specimens. It was also designed to study the seroprevalence in normal healthy individuals, and the genomic prevalence of HSV, VZV and CMV in patients without an active viral inflammatory process. METHODS: PCR for the detection of HSV, VZV and CMV genomes was done on 33 and 90 intraocular fluids from viral retinal patients and non-viral controls respectively. ELISA was done on 30 and 100 serum samples from viral retinitis patients and normal healthy controls respectively. RESULTS: PCR did not detect HSV, VZV and CMV genomes except one, in which VZV-DNA was detected. ELISA showed prevalence rates of 28%, 83% and 90% for antibodies against HSV, VZV and CMV respectively in the normal population. In the 30 viral retinitis patients, PCR detected HSV-DNA in 2 (6.7%), VZV-DNA in 7 (23.3%) and CMV-DNA in 6 (20.0%) patients, while ELISA detected antibodies against HSV, VZV and CMV in 13 (43.3%), 24 (80.0%) and 23 (76.7%) patients respectively. ELISA was of value in indirect diagnosis only in 6 (20.0%) as compared to 15 (50.0%) of 30 patients by PCR, this difference was statistically significant (McNemar test, P value = 0.005). CONCLUSION: Serology by ELISA is no longer a useful diagnostic tool to associate HSV, VZV and CMV viruses with viral retinitis. PMID: 12701866 [PubMed - indexed for MEDLINE] 1566. AIDS. 2003 May 2;17(7):1110-1. Progressive outer retinal necrosis in a 73-year-old man: treatment with valganciclovir. Peck R, Gimple SK, Gregory DW, Youree B. PMID: 12700472 [PubMed - indexed for MEDLINE] 1567. Vestn Ross Akad Med Nauk. 2003;(2):44-9. [Modern aspects in the treatment of ophthalmic herpes] [Article in Russian] Kasparov AA, Vorob'eva OK, Kasparova EA. The author report about study results conducted in Russia during the recent 30 years and dedicated to the treatment of ocular pathologies caused by the virus of herpes simplex. Three high-efficiency directions took shape during the mentioned period: 1. Non-specific antiviral therapy based on the local and systemic administration of interferon inductors (poludan--complexes of poly A, poly U etc.) possessing an extensive spectrum of the antiviral and immune-modeling actions; 2. Antirecurrent therapy, including the application of herpetic vaccine against the virus of herpes simplex, types I and II, combined with immune-modeling agents. A focal allergic test with herpetic vaccine was offered, it made it possible, for the first time, a non-invasive diagnostics of intraocular herpes. 3. A system of sparing microsurgical methods adapted to the treatment of an active herpetic keratitis and its outcomes. A synergistic effect of interferon inductors and acyclovir was proven both experimentally and clinically; a method of local autocytokinotherapy (based on poludan), which turned out to be most effective in the treatment of severe lesions at the cornea and of intraocular herpes, was worked out. The authors believe that the methods and means offered for the treatment of ophthalmoherpes contribute, to a great extent, to handling with the ocular herpes viral infection. PMID: 12698890 [PubMed - indexed for MEDLINE] 1568. Z Gastroenterol. 2003 Apr;41(4):325-8. [Functional asplenia after severe varicella zoster-infection diagnosis by colour Doppler ultrasound] [Article in German] Diedrich J, Görg C, Eissele R, Arnold R. Zentrum für Innere Medizin, Abteilung für Innere Medizin mit Schwerpunkt Gastroenterologie, Stoffwechsel, Endokrinologie, Klinikum der Philipps-Universität Marburg. Infiltrative, inflammatory or thromboembolic processes in the parenchyma of the spleen can cause a functional loss of the organ. This phenomenon is called functional asplenia and occurs as a complication especially in sickle cell disease, lupus erythematosus and after bone marrow transplantation. We present the case of a patient with Crohn's disease under immunosuppressive therapy who developed a spontaneous covered spleen rupture in the course of a septic shock with DIG due to a Varizella zoster infection. Later on, sonography showed a diminution of the spleen size. No flow signals could be derived by colour doppler measurements from the spleen. Because of the colour doppler findings we suspected a functional asplenia which was then verified by spleen scintigraphy and Howell-Jolly-Bodies in the blood count. Remarkably, the Crohn's disease remains in complete remission since the development of the functional asplenia (for 4 years now). The underlying pathomechanism remains unclear. PMID: 12695938 [PubMed - indexed for MEDLINE] 1569. Praxis (Bern 1994). 2003 Mar 19;92(12):558-61. [A different headache] [Article in German] Fehr J. Medizinische Universitätspoliklinik, Departement Innere Medizin, Kantonsspital Basel. PMID: 12693148 [PubMed - indexed for MEDLINE] 1570. J Dermatol. 2003 Feb;30(2):109-15. Role of neutralizing antibody in the pathogenesis of zoster and the correlation of severity with anti-gE: gI antibody response. Matsuo K, Honda M, Shiraki K. Department of Dermatology, The Jikei University School of Medicine, Tokyo, Japan. Antibody response to varicella-zoster virus glycoproteins and neutralizing antibodies were examined to correlate them with the severity of the zoster. Antibody rise to whole viral antigen was observed in 17 of 19 patients, that to gE: gI was not increased in 7 patients, and antibody to gE: gI in severe cases was significantly lower compared with mild cases in the convalescent phase than in the acute phase (p<0.05 Fisher's exact test). Antibody rise to gE: gI was well correlated with limited development of zoster lesions and, in contrast, antibody titer without rise was associated with increased severity and wider development of zoster lesions. As gE is the most abundant glycoprotein in the infected cells, the antibodies may be consumed in severe and widespread lesions, resulting in an antibody response to gE: gI without a rise. When the ratio of neutralizing antibody to anti-gE: gI antibody titers in the acute phase was compared with that in the recovery phase, the former was significantly lower in the severe cases than the latter (p=0.0082 Student t-test). This suggested that neutralizing antibody was specifically consumed in the acute phase of zoster among the anti-VZV antibodies. The role of humoral immunity in the pathogenesis of zoster might have been reflected in the antibody response to the neutralizing antibody in the acute phase and antibody to gE: gI in the severe cases. PMID: 12692377 [PubMed - indexed for MEDLINE] 1571. J Clin Microbiol. 2003 Apr;41(4):1565-8. Rapid detection of herpes simplex virus and varicella-zoster virus infections by real-time PCR. Weidmann M, Meyer-König U, Hufert FT. Department of Virology, Institute for Medical Microbiology and Hygiene, University of Freiburg, 79104 Freiburg, Germany. The herpes simplex viruses types 1 and 2 (HSV-1 and HSV-2) and varicella-zoster virus (VZV) can cause life-threatening infections of the central nervous system and lead to severe infections in immunocompromised subjects and newborns. In these cases, rapid diagnosis is crucial. We developed three different real-time PCR assays based on TaqMan chemistry for the LightCycler instrument to detect HSV-1, HSV-2, and VZV. When the TaqMan assays were compared to our in-house nested PCR assays, the test systems had equal sensitivities of 1, the virus persists over time and so chickenpox and shingles remain endemic. PMID: 12591619 [PubMed - indexed for MEDLINE] 1619. Jpn J Ophthalmol. 2003 Jan-Feb;47(1):107-9. A case of acute dacryoadenitis associated with herpes zoster ophthalmicus. Obata H, Yamagami S, Saito S, Sakai O, Tsuru T. Department of Ophthalmology, Jichi Medical School, Tochigi, Japan. BACKGROUND: Acute dacryoadenitis is an uncommon disease. CASE: We present what we believe to be the first reported case of herpes zoster ophthalmicus with the onset of acute dacryoadenitis. OBSERVATIONS: A 30-year-old man complained of severe ocular pain and hyperemia in his right eye. Magnetic resonance imaging (MRI) demonstrated enlargement of the right lacrimal gland and acute dacryoadenitis was diagnosed. Two days after treatment with systemic antibiotics he developed iridocyclitis and skin lesions confined to the first division of the trigeminal nerve; therefore, herpes zoster ophthalmicus was diagnosed. Treatment with acyclovir immediately resolved the ocular pain and swelling of the upper eyelid. MRI conducted in the 4 months after the initial examination showed there was no longer enlargement of the right lacrimal gland. CONCLUSION: Clinicians should be aware that varicella-zoster virus may cause acute dacryoadenitis. PMID: 12586188 [PubMed - indexed for MEDLINE] 1620. Med Pregl. 2002 Sep-Oct;55(9-10):412-4. [Clinical characteristics and prognostic significance of preherpetic neuralgia] [Article in Croatian] Cvjetković D, Jovanović J, Hrnjaković Cvjetković I, Aleksić Dordević M. Klinika za infektivne bolesti Institut za zastitu zdravlja, Novi Sad. ivacvj@neobee.net INTRODUCTION: Herpes zoster is a world-wide disease of older age commonly presenting with preherpetic pain. The aim of the study was to determine clinical characteristics of preherpetic neuralgia and its influence on occurrence of postherpetic neuralgia. MATERIAL AND METHODS: A prospective, controlled trial included 88 patients with preherpetic neuralgia. 44 herpes zoster patients without preherpetic neuralgia were included in the control group. All of them were clinically followed-up for three months after complete healing of skin lesions. RESULTS: Older age (> 60 years) was significantly predominant (59.1%) compared with other age groups (p < 0.01) as well as female sex (59.9%) compared with the male sex (p < 0.01). There was no significant predominance of any type of preherpetic neuralgia (stabbing, burning, itching, dull pain). More intense preherpetic pain (reported as "severe" and "moderate") was established more often than mild pain. The mean duration of preherpetic pain was 4.4 days (ranged between 1-20 days). Postherpetic neuralgia developed in 36/88 patients with preherpetic neuralgia (affecting predominantly older than 50 years of age--31/36), but there was no significant difference in proportion of postherpetic neuralgia (PHN) according to those without preherpetic neuralgia. DISCUSSION AND CONCLUSION: People older than 60 years are the most common age group among herpes zoster patients suffering from preherpetic neuralgia. Sex distribution of patients with preherpetic pain reveals highly significant predominance of female sex. Opposite to some other authors' reports, preherpetic neuralgia and its severity have not been proven as risk factors for postherpetic neuralgia in patients involved in our trial. PMID: 12584895 [PubMed - indexed for MEDLINE] 1621. Eur Arch Otorhinolaryngol. 2003 Feb;260(2):86-90. Epub 2002 Sep 4. Herpes zoster-associated trigeminal trophic syndrome: a case report and review. Litschel R, Winkler H, Dazert S, Sudhoff H. Department of Otorhinolaryngology, Head and Neck Surgery, University of Bochum, St. Elisabeth Hospital, Germany. The case of a 75-year-old Caucasian woman with a trigeminal trophic syndrome (TTS) is presented and discussed. TTS of the ala nasi subsequent to a herpes zoster infection has not been described previously. We provide a review of the literature with insights into the pathogenesis and current therapeutic strategies. PMID: 12582785 [PubMed - indexed for MEDLINE] 1622. Clin J Pain. 2002 Nov-Dec;18(6 Suppl):S177-81. A focused review on the use of botulinum toxins for neuropathic pain. Argoff CE. Cohn Pain Management Center, North Shore University Hospital, New York University School of Medicine, Bethpage, New York 11714, USA. pargoff@optonline.net Understanding the pathophysiology of a pain syndrome is helpful in selecting appropriate treatment strategies. Nociceptive pain is related to damage to tissues due to thermal, chemical, mechanical, or other types of irritants. Neuropathic pain results from injury to the peripheral or central nervous system. Common examples of neuropathic pain include postherpetic neuralgia, diabetic neuropathy, complex regional pain syndrome, and pain associated with spinal cord injuries. Nociceptive pain may have similar clinical characteristics to neuropathic pain. It is also possible for acute nociceptive pain to become neuropathic in nature, as with myofascial pain syndrome. A clear benefit of botulinum toxin therapy for treatment of neuropathic pain disorders is that it often relieves pain symptoms. Although the precise mechanism of pain relief is not completely understood, the injection of botulinum toxin may reduce various substances that sensitize nociceptors. As a result, botulinum toxin types A and B are now being actively studied in nociceptive and neuropathic pain disorders to better define their roles as analgesics. PMID: 12569966 [PubMed - indexed for MEDLINE] 1623. Laryngoscope. 2003 Feb;113(2):307-11. Vertigo from herpes zoster oticus: superior or inferior vestibular nerve origin? Lu YC, Young YH. Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan. OBJECTIVE/HYPOTHESIS: This study aims to analyze which division of vestibular nerve in the internal auditory canal is responsible for inducing vertigo in patients with herpes zoster oticus (HZO). METHODS: Eight patients (three men and five women) suffered from auricular vesicles, otalgia, and facial palsy, and five of them also had vertigo. Each patient received a battery of tests, including neurological examination, blood examination, audiometry, caloric test, electronystagmography, and vestibular evoked myogenic potential (VEMP) test. RESULTS: All five HZO patients with vertigo had facial palsy on the lesioned side and spontaneous nystagmus beating toward the healthy side. Absent VEMPs were noted in five patients, absent caloric response was noted in four, and sensorineural HL was noted in three. Compared to another three HZO patients without vertigo, all revealed normal responses in both the caloric test and the VEMP test. On MRI scan, two out of four had abnormal gadolinium enhancement along the nerve segments within the internal auditory canal. Six months after treatment, a follow-up caloric test and VEMP test in these eight patients did not alter the results compared with before treatment. CONCLUSION: The nerve trunks within the internal auditory canal are widely affected in HZO patients with vertigo. Both superior division and inferior division of the vestibular nerve attribute to the vertiginous attack. Further, large numbers of HZO patients undergoing caloric testing and VEMP testing are required to support this tentative conclusion. PMID: 12567087 [PubMed - indexed for MEDLINE] 1624. Commun Dis Public Health. 2002 Dec;5(4):343. Varicella vaccination--an ethical issue. Smithson R. Comment on: Commun Dis Public Health. 2002 Sep;5(3):185-6. PMID: 12564257 [PubMed - indexed for MEDLINE] 1625. Clin Exp Immunol. 2003 Feb;131(2):318-23. Local immune responses and systemic cytokine responses in zoster: relationship to the development of postherpetic neuralgia. Zak-Prelich M, McKenzie RC, Sysa-Jedrzejowska A, Norval M. Dermatology, Medical University of Lodz, Lodz, Poland. Varicella zoster virus (VZV) causes varicella (chickenpox) as the primary infection and zoster (shingles) on reactivation from latency, often many years later. One of the most common and most severe sequela of zoster is postherpetic neuralgia (PHN). Apart from age, factors which predispose towards PHN are unknown. In the present study, the concentration of a variety of Th1 and Th2 cytokines in the serum of 30 zoster patients at the time of the acute disease were correlated with the subsequent development of PHN in nine of these patients, but no association was found. In addition, although some cytokines such as IFN-gamma, IL-6 and IL-8 were slightly raised in the zoster group compared with a group of normal healthy subjects of a similar age distribution, these differences only verged on significance. Antibody titres to VZV were raised in the zoster group compared with the controls but these did not differ between the patients who developed PHN and those who did not. Biopsies of zoster lesions were collected from nine patients. There were significantly fewer infiltrating lymphocytes in the lesions of the three patients who subsequently developed PHN compared with the six who did not, although the expression of the neuropeptide, substance P, did not differ between the two groups. It is possible that the poor inflammatory response at the time of the acute zoster may result in less effective containment of the VZV and more damage in the dermatome, thus contributing to the persistence of the neuralgia. PMCID: PMC1808626 PMID: 12562395 [PubMed - indexed for MEDLINE] 1626. Epidemiol Infect. 2002 Dec;129(3):593-7. The role of solar ultraviolet irradiation in zoster. Zak-Prelich M, Borkowski JL, Alexander F, Norval M. Department of Dermatology, Medical University of Lodz, Lodz, Poland. Ultraviolet radiation (UVR) suppresses many aspects of cell-mediated immunity but it is uncertain whether solar UV exposure alters resistance to human infectious diseases. Varicella-zoster virus (VZV) causes varicella (chickenpox) and can reactivate from latency to cause zoster (shingles). The monthly incidence of chickenpox and zoster in a defined Polish population over 2 years was recorded and ground level solar UV was measured daily. There was a significant seasonality of UVR. Evidence of seasonal variation was found for all zoster cases and for zoster in males, with the lowest number of cases in the winter. The number of zoster cases with lesions occurring on exposed body sites (the face) demonstrated highly significant seasonality with a peak in July/August. Seasonal models for UVR and zoster cases showed similar temporal patterns. By contrast, for varicella, the maximum number of cases was found in March and the minimum in August/September, probably explained by the respiratory spread of VZV. It is tempting to speculate that the increase in solar UVR in the summer could induce suppression of cellular immunity, thus contributing to the corresponding rise in the incidence of zoster. PMID: 12558343 [PubMed - indexed for MEDLINE] 1627. Cutis. 2003 Jan;71(1):86; author reply 86. Childhood herpes zoster. Plumb RL. Comment on: Cutis. 2001 Jul;68(1):21-3. PMID: 12553636 [PubMed - indexed for MEDLINE] 1628. Anticancer Res. 2002 Nov-Dec;22(6B):3701-8. Evaluation of infectious complications and immune recovery following high-dose chemotherapy (HDC) and autologous peripheral blood progenitor cell transplantation (PBPC-T) in 148 breast cancer patients. Zambelli A, Montagna D, Da Prada GA, Maccario R, Zibera C, Moretta A, Ponchio L, Lozza L, Baiardi P, Maserati R, Marone P, Della Cuna GR. Area Omogenea Oncologica, Divisione di Oncologia Medica, Fondazione Salvatore Maugeri, Clinica del Lavoro e della Riabilitazione (IRCCS), Istituto Scientifico di Pavia, Italy. azambelli@fsm.it BACKGROUND AND OBJECTIVES: High-dose chemotherapy (HDC) with autologous PBPC-T has been reported to be effective in hematological and in selected solid malignancies. In this setting, infectious complications represent a relevant cause of morbidity. PATIENTS AND METHODS: To ascertain the incidence, types and factors influencing the development of early and late infections, we retrospectively analyzed 148 consecutive breast cancer (BC) patients receiving HDC and PBPC-T, both for primary high-risk BC (pBC) and metastatic disease (mBC). RESULTS: Early infection strongly associated with the occurrence of grade 4 mucositis (p < 0.001), was documented in 28 patients (19%). Late re-activation of varicella zoster virus (VZV) occurred in 14 patients (9%); an inverse correlation between the VZV re-activation and the total amount of T-cells transferred with the graft was observed. Evaluation of immune reconstitution, carried out in 10 out of 148 patients, showed a long-lasting CD+ T-cells depression (> 2 year), mainly involving the naive CD4+ T-cell subset. Conversely, the analysis of the frequency of proliferating T-lymphocyte precursors, specific for antigens expressed by 3 different widespread pathogens, demonstrated that, notwithstanding the delayed recovery of CD4+ cells, many T-lymphocyte functions were within normal range 1 year after PBPC-T. CONCLUSION: Altogether these results show that severe mucositis is associated with early bacterial infections and the infusion of large numbers of T-cells plays a role in controlling late VZV reactivation. PMID: 12552979 [PubMed - indexed for MEDLINE] 1629. Commun Dis Intell. 2002;26(4):576-80. Surveillance of viral pathogens in Australia--varicella-zoster virus. Roche P, Blumer C, Spencer J. Surveillance and Epidemiology Section, Department of Health and Ageing, Canberra. Comment in: Commun Dis Intell. 2003;27(1):100-1. PMID: 12549527 [PubMed - indexed for MEDLINE] 1630. J Urol. 2003 Feb;169(2):619-20. Herpes zoster following sacral nerve stimulation for overactive bladder. Rosenblum N, Eilber KS, Raz S. Department of Urology, University of California, Los Angeles School of Medicine, Los Angeles, California, USA. PMID: 12544325 [PubMed - indexed for MEDLINE] 1631. Auris Nasus Larynx. 2003 Feb;30 Suppl:S89-92. Vestibular-evoked myogenic potentials in two patients with Ramsay Hunt syndrome. Saito S, Ochi K, Kobayashi T, Sugiura N, Komatsuzaki Y, Ohashi T. Department of Otolaryngology, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-ku, 216-8511, Kawasaki, Japan. We report on the function of the inferior vestibular nerve, as monitored by the vestibular-evoked myogenic potentials (VEMP), in two patients suffering from Ramsay Hunt syndrome. Both the patients presented canal paresis (CP) and hearing loss, but in one patient normal VEMP was recorded while the other presented vagus nerve paralysis plus no VEMP response at the highest stimulus intensity used in our institute (i.e., 105 dB nHL). PMID: 12543168 [PubMed - indexed for MEDLINE] 1632. Neuropediatrics. 2002 Oct;33(5):262-5. Hypercytokinemia in hemiconvulsions-hemiplegia syndrome associated with dual infection with varicella zoster and Epstein-Barr viruses. Wakamoto H, Ohta M, Nakano N. Department of Pediatrics, Ehime Prefecture Niihama Hospital, Ehime, Japan. wakamot@mail2.netwave.or.jp Hemiconvulsions-hemiplegia (HH) syndrome is an acquired condition in which hemiplegia develops after a preceding febrile unilateral status epilepticus in a previously healthy child. Although viral encephalitis or vascular diseases may be the underlying etiology, the pathogenesis remains unknown in the majority of cases. We measured both plasma and cerebrospinal fluid cytokine levels in a girl with HH syndrome, and found elevated plasma concentrations of soluble interleukin-2 receptor and tumor necrosis factor-alpha, and a slightly increased plasma level of interleukin-6. Furthermore, she had a high serum concentration of soluble E-selectin, which is a marker of inflammatory endothelial activation. These findings suggest that proinflammatory cytokine-induced cerebrovascular endothelial injury could play a role in the pathogenesis of HH syndrome. PMID: 12536369 [PubMed - indexed for MEDLINE] 1633. Eur J Pain. 2003;7(1):1-7. Factors influencing the features of postherpetic neuralgia and outcome when treated with tricyclics. Bowsher D. Pain Research Institute, Clinical Sciences Building, University Hospital Aintree, Liverpool L9 7AL, UK. bowsher@liv.ac.uk Erratum in: Eur J Pain. 2003;7(2):201. This paper retrospectively reviews features of postherpetic neuralgia (PHN) in up to 279 personal patients in relation to treatment outcome when treated with tricyclic antidepressants (TCAs). Factors affecting characteristics of PHN: (i) Patients with allodynia (89%) and/or burning pain (56%) have a much higher visual analogue pain intensity score than those without; (ii) Acyclovir (ACV) given for acute shingles (HZ) does not reduce the incidence of subsequent PHN, but reduces the pain intensity in PHN patients with allodynia; (iii) ACV given for acute HZ reduces the incidence of burning pain in subsequent PHN, but not of allodynia; (iv) ACV given for acute HZ reduces the incidence of clinically detectable sensory deficit in subsequent PHN. Factors affecting outcome of TCA-treated PHN: (i) The point in time at which TCA treatment is commenced is by far the most critical factor: started between 3 and 12 months after acute HZ onset, more than two-thirds obtain pain relief (NNT=1.8); between 13 and 24 months, two-fifths (41%) (NNT=3.6); and more than two years, one-third (NNT=8.3). Background and paroxysmal pain disappear earlier and are more susceptible of relief than allodynia. (ii) Twice as many (86%) of PHN patients without allodynia obtain pain relief with TCA treatment than those with (42%); (iii) the use of ACV for acute HZ more than halves the time-to-relief of PHN patients by TCAs; (iv) PHN patients with burning pain are significantly less likely to obtain pain relief with TCAs than those without (p<0.0001). PMID: 12527312 [PubMed - indexed for MEDLINE] 1634. Gastroenterol Hepatol. 2003 Jan;26(1):19-22. [Opportunistic infections in patients with inflammatory bowel disease undergoing immunosuppressive therapy] [Article in Spanish] Bernal I, Domènech E, García-Planella E, Cabré E, Gassull MA. Servicio de Aparato Digestivo. Hospital Universitari Germans Trias i Pujol. Badalona. Barcelona. España. Immunosuppressive agents (azathioprine, methotrexate) are increasingly being used in the treatment of inflammatory bowel disease. The use of immunosuppressive agents is associated with a greater risk of opportunistic infections, the most frequent of which are those caused by cytomegalovirus and varicella zoster virus. We present four cases of opportunistic infections due to Herpesviruses in patients undergoing immunosuppressive treatment with azathioprine for Crohn's disease. We also review the literature published on this topic. Two patients presented cutaneous varicella complicated by pneumonia and esophagitis respectively, one patient had cutaneous herpes zoster and the other had fatal pneumonia possibly caused by the Herpesvirus. In the first three the clinical course of the infection was favorable after withdrawing immunosuppressant treatment and initiating treatment with aziclovir. In patients Crohn's disease azathioprine treatment increases the risk of opportunistic infection by Herpesvirus. However, in the absence of other factors that increase immunosuppression, these infections usually have a benign course with specific antiviral therapy. PMID: 12525323 [PubMed - indexed for MEDLINE] 1635. Curr Pain Headache Rep. 2003 Feb;7(1):24-33. Antidepressants for chronic neuropathic pain. Reisner L. University of California, San Francisco, Department of Clinical Pharmacy, Box 0622, San Francisco, CA 94143, USA. reisnerL@pamf.org Tricyclic antidepressants have been used to manage pain for several decades, and are superior treatments for some patients suffering from neuropathic pain. Unfortunately, older antidepressants have dose-limiting side effects that can lead to drug intolerance. The most common are anticholinergic side effects, although some patients experience sexual dysfunction. Cognitive impairment, sedation, and orthostatic hypotension also are relatively common. Taking an overdose of tricyclic antidepressants can be lethal in overdose. Several weeks of therapy may be required before antinociception occurs, but tricyclic antidepressants in optimal doses appear to be the most effective treatment for neuropathic pain; this is supported by systematic reviews comparing them with other agents. Newer medications such as atypical antidepressants and anticonvulsants may be overtaking older antidepressants, but they should not be overlooked as important options for the management of pain. PMID: 12525267 [PubMed - indexed for MEDLINE] 1636. J Voice. 2002 Dec;16(4):560-3. Laryngeal herpes: a case report. Pinto JA, Pinto HC, Ramalho Jda R. Nucleus of Otolaryngology, Head and Neck Surgery of São Paulo, Indianopolis, São Paulo, Brazil. japorl@vol.com.br Herpetic laryngitis is a rare inflammatory disease caused by herpes simplex or herpes zoster virus. The propensity for spreading along peripheral nerves and within the central nervous system, with frank herpetic meningoencephalitis, is a rare complication. We present one case of herpetic laryngitis by reactivation of varicella zoster, with central nervous system spreading, and discuss the relevant literature on the pathophysiology, diagnosis, evaluation, and management of this disease. PMID: 12512643 [PubMed - indexed for MEDLINE] 1637. J Virol Methods. 2003 Feb;107(2):257-60. Development of a multiplex RT-PCR to detect transcription of varicella-zoster virus encoded genes. Rahaus M, Desloges N, Wolff MH. Institute of Microbiology and Virology, University of Witten/Herdecke, Stockumer Str. 10, D-58448, Witten, Germany. The reverse transcription polymerase chain reaction (RT-PCR) is used commonly to analyse transcription of genes. In the field of virology it is an extremely helpful method to analyse the transcriptional activity of both, DNA and RNA viruses. The standard RT-PCR allows an investigation of the activity of only one gene. Here, we describe the development of a sensitive multiplex RT-PCR assay for single tube amplification to analyse a set of different genes encoded by the varicella-zoster virus (VZV), a member of the human-pathogenous herpesviruses. This multiplex RT-PCR amplifies the genes ORF 4, ORF 21 and ORF 68; each of these three genes belongs to a distinct class of genes, which is expressed one after the other within the infectious cycle. This method provides the possibility for rapid but extensive examination of VZV transcriptional activity and could be used in both fields, fundamental research as well as clinical diagnostic work. PMID: 12505641 [PubMed - indexed for MEDLINE] 1638. Lancet Infect Dis. 2003 Jan;3(1):12. Concomitant bilateral herpes zoster ophthalmicus. MacMahon EM. Virology Section, Department of Infection, Guy's and St Thomas' Hospital, London, UK. eithne.macmahon@gstt.sthames.nhs.uk Comment on: Lancet Infect Dis. 2002 Nov;2(11):699. PMID: 12505026 [PubMed - indexed for MEDLINE] 1639. Emerg Infect Dis. 2002 Dec;8(12):1504-5. New variant of varicella-zoster virus. Tipples GA, Stephens GM, Sherlock C, Bowler M, Hoy B, Cook D, Grose C. National Microbiology Laboratory, Winnipeg, Manitoba, Canada. graham_tipples@hc-sc.gc.ca In 1998, a varicella-zoster virus glycoprotein E (gE) mutant virus (VZV-MSP) was isolated from a child with chickenpox. VZV-MSP, representing a second VZV serotype, was considered a rarity. We isolated another VZV-MSP-like virus from an elderly man with herpes zoster. These gE mutant viruses may have arisen through independent mutation or may represent a distinct VZV subpopulation that emerged more than 50 years ago. PMCID: PMC2738511 PMID: 12498673 [PubMed - indexed for MEDLINE] 1640. J Neurovirol. 2002 Dec;8 Suppl 2:80-4. Key issues in varicella-zoster virus latency. Kennedy PG. Department of Neurology, Glasgow University, and Institute of Neurological Sciences, Southern General Hospital, Glasgow, Scotland, United Kingdom. P.G.Kennedy@clinmed.gla.ac.uk The molecular mechanisms by which varicella-zoster virus (VZV) causes a latent infection in human trigeminal and spinal ganglia are not well understood. It is known that VZV establishes latency in ganglia following the primary infection causing varicella (chickenpox), and that the virus may reactivate after years of dormancy to produce herpes zoster (shingles). Two key issues have been the cell-type localization of latent VZV in human ganglia, and the nature and extent of VZV gene expression during latency. Although the cell specificity of latent VZV has been controversial for almost a decade, it is now widely accepted that the virus is mainly latent in neuronal cells, with only a small proportion of non-neuronal cells infected. All of the studies carried out so far have indicated that VZV gene expression is highly restricted during ganglionic latency. Although at least four VZV genes have been identified as being expressed, the possibility that latent gene expression is significantly greater than this cannot yet be excluded. There is also evidence for VZV gene-encoded proteins being expressed during latency, although the precise extent of this is unclear. Advances in this difficult field may be expected to arise from both newly developed molecular technology and more refined animal models of VZV latency. PMID: 12491156 [PubMed - indexed for MEDLINE] 1641. J Neurovirol. 2002 Dec;8 Suppl 2:75-9. The protean manifestations of varicella-zoster virus vasculopathy. Gilden DH, Mahalingam R, Cohrs RJ, Kleinschmidt-DeMasters BK, Forghani B. Department of Neurology, University of Colorado Health Sciences Center, Denver, Colorado 80262, USA. don.gilden@uchsc.edu Varicella-zoster virus (VZV) vasculopathy in the central nervous system (CNS) affects large and small cerebral vessels. Large-vessel disease is most common in immunocompetent individuals, whereas small-vessel disease usually develops in immunocompromised patients. In some patients, both large and small vessels are involved. Neurological features are protean. Neurological disease often occurs months after zoster and sometimes without any history of zoster rash. Magnetic resonance imaging (MRI) scanning, cerebral angiography, and examination of cerebrospinal fluid (CSF) with virological analysis are needed to confirm the diagnosis. VZV vasculopathy patients do not always have VZV DNA in CSF, but diagnosis can be confirmed by finding anti-VZV antibody in CSF, along with reduced serum/CSF ratios of VZV immunoglobulin G (IgG) compared to albumin or total IgG. When VZV vasculopathy develops months after zoster, antiviral treatment is often effective. PMID: 12491155 [PubMed - indexed for MEDLINE] 1642. J Med Microbiol. 2003 Jan;52(Pt 1):1-3. Live attenuated vaccine for the prevention of varicella-zoster virus infection: does it work, is it safe and do we really need it in the UK? Breuer J. PMID: 12488559 [PubMed - indexed for MEDLINE] 1643. Genes Immun. 2002 Dec;3(8):477-81. Association of HLA-A*3303-B*4403-DRB1*1302 haplotype, but not of TNFA promoter and NKp30 polymorphism, with postherpetic neuralgia (PHN) in the Japanese population. Sato M, Ohashi J, Tsuchiya N, Kashiwase K, Ishikawa Y, Arita H, Hanaoka K, Tokunaga K, Yabe T. Department of Research, Tokyo Metropolitan Red Cross Blood Center, Tokyo, 150-0012 Japan. Herpes zoster is a common disease caused by reactivation of the varicella zoster virus (VZV). In a small number of herpes zoster patients, pain persists beyond 4 weeks or more after healing of vesicular eruptions; this condition is termed postherpetic neuralgia (PHN). Positive associations of human histocompatibility leukocyte antigens (HLA) class I antigens, A33 and B44, with PHN in the Japanese population have been reported. Our hypothesis is that susceptibility genes to PHN might exist in the HLA region and the study objective is to further examine possible associations of genes in HLA class I, II and III regions, HLA-A, -B, -DRB1, tumor necrosis factor alpha (TNFA) promoter, and a natural killer cell activating receptor, NKp30 polymorphisms with PHN. Although TNFA or NKp30 in the class III region had been considered as a candidate locus, we found no associations of TNFA promoter or NKp30 polymorphisms with PHN in this study. We demonstrated that HLA-A*3303, -B*4403 and -DRB1*1302 alleles were significantly associated with PHN (P = 0.0007 for A*3303, P = 0.001 for B*4403 and P = 0.001 for DRB1*1302). The frequency of the HLA-A*3303-B*4403-DRB1*1302 haplotype was also significantly higher in the PHN patients than in the healthy controls (P = 0.0039). Our results suggest that this haplotype might be related to the pathogenesis of PHN. PMID: 12486606 [PubMed - indexed for MEDLINE] 1644. J Dermatol. 2002 Nov;29(11):748-53. Primary cutaneous T-cell-rich B-cell lymphoma in a zosteriform distribution associated with Epstein-Barr virus infection. Watabe H, Kawakami T, Soma Y, Baba T, Mizoguchi M. Department of Dermatology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan. T-cell-rich B-cell lymphoma (TRBL) is a lately recognized B-cell lymphoma variant characterized by a minor population of neoplastic B cells existing in a background of predominant polyclonal T cells. We report an 86-year-old man with primary cutaneous TRBL associated with Epstein-Barr (EB) virus infection. Clinically, palpable scaly erythemas were distributed in a zosteriform pattern on the right abdomen. Histologically, massive cellular infiltrates were located in the upper- and mid-dermis. Higher magnification showed that the cellular infiltration was composed mainly of abnormal mononuclear, large lymphoid cells with clear cytoplasm and scattered mitoses and small lymphocytes, which represented in excess of 75% of all the infiltrating cells. Immunohistochemical staining revealed that the large cells were positive for the B cell marker, CD20, but negative for the T cell marker, CD3. On the other hand, the small cells were positive for CD3, but negative for CD20. Polymerase chain reaction (PCR) revealed EB virus DNA in the skin lesion. Primary cutaneous TRBL has only been reported in 15 cases worldwide. To our knowledge, this is the first case of primary cutaneous TRBL in a zosteriform distribution reported in the literature and the second case of primary cutaneous TRBL associated with the EB virus infection. We postulate that the EB virus may be a contributory pathogenetic event leading to monoclonal B-cell proliferation. PMID: 12484440 [PubMed - indexed for MEDLINE] 1645. Acta Otolaryngol Suppl. 2002;(549):4-30. Bell's palsy: the spontaneous course of 2,500 peripheral facial nerve palsies of different etiologies. Peitersen E. Department of Otorhinolaryngology-Head & Neck Surgery, Rigshospitalet, Copenhagen, Denmark. RH01836@rh.dk OBJECTIVE: The Copenhagen Facial Nerve Study aims to explain the spontaneous course of idiopathic peripheral facial nerve palsy which occurs without any kind of treatment. In this study Bell's palsy and idiopathic palsy are considered to be synonymous and specify an acute, monosymptomatic, unilateral peripheral facial paresis of unknown etiology. MATERIAL AND METHODS: The material includes 2,570 cases of peripheral facial nerve palsy studied during a period of 25 years. It includes 1,701 cases of Bell's palsy and 869 of non-Bell's palsy. In the total patient sample, 116 had herpes zoster, 76 were diabetic, 46 were pregnant and 169 were neonates. A total of 38 different etiologies were observed. At the first consultation a standard ENT examination was performed, including a thorough description of the grade and localization of the paresis, taste, stapedius reflex and nasolacrimal reflex tests and acoustic-vestibular examination. Follow-up was done once a week during the first month and subsequently once a month until normal function was restored or for up to 1 year. RESULTS: The initial examination revealed 30% incomplete and 70% complete palsies. Follow-up showed that in 85% of patients function was returned within 3 weeks and in the remaining 15% after 3-5 months. In 71% of patients normal mimical function was obtained. Sequelae were slight in 12% of patients, mild in 13% and severe in 4%. Contracture and associated movements were found in 17% and 16% of patients, respectively. CONCLUSION: A survey of the literature showed that no kind of treatment, including prednisone, was able to give a better prognosis. The use of prednisone raises a big ethical problem because no evidence of its efficacy exists and the euphoric side-effect induces a false feeling of benefit in the patients. PMID: 12482166 [PubMed - indexed for MEDLINE] 1646. J Eur Acad Dermatol Venereol. 2002 Nov;16(6):628-30. Granulomatous folliculitis at sites of herpes zoster scars: Wolf's isotopic response. Fernández-Redondo V, Amrouni B, Varela E, Toribio J. Department of Dermatology, Complejo Hospitalario Universitario, Faculty of Medicine, Santiago de Compostela, Spain. mejaime@usc.es Cutaneous eruptions described on herpes zoster scars are variable. We present a case of granulomatous folliculitis occurring 4 weeks after an episode of herpes zoster infection in a woman with cutaneous T-cell lymphoma. The pathogenesis of the lesions remains unclear. The viral genome was detected only in early lesions. PMID: 12482051 [PubMed - indexed for MEDLINE] 1647. Viral Immunol. 2002;15(3):507-16. Memory cytotoxic T cell responses to viral tegument and regulatory proteins encoded by open reading frames 4, 10, 29, and 62 of varicella-zoster virus. Arvin AM, Sharp M, Moir M, Kinchington PR, Sadeghi-Zadeh M, Ruyechan WT, Hay J. Department of Pediatrics Stanford University School of Medicine, Stanford, California 94305, USA. aarvin@stanford.edu Cytotoxic T cell recognition of tegument and regulatory proteins encoded by open reading frames (ORFs) 4, 10, 29, and 62 of varicella-zoster virus (VZV) was evaluated using limiting dilution conditions to estimate the precursor frequencies of memory T cells specific for these proteins in immune subjects. Responder cell frequencies for ORFs 4, 10, and 62 gene products, which are virion tegument components and function as immediate early viral transactivating proteins, were equivalent. CTLp recognition of VZV proteins made in latently infected cells, which include ORF4 and ORF62 proteins, was not maintained preferentially when compared to ORF10 protein, which has not been shown to be expressed during latency. T cell recognition of ORF29 protein, the major DNA binding protein, which is expressed during replication but not incorporated into the virion tegument, was less common than responses to ORFs 4, 10, and 62 gene products. Older individuals had diminished numbers of memory CTLp that lysed autologous targets expressing IE62 protein; these responses were increased after immunization with live attenuated varicella vaccine to the range observed in younger adults. Adaptive immunity to VZV is characterized by a broad repertoire of memory CTL responses to proteins that comprise the virion tegument and regulate viral gene expression in infected cells. PMID: 12479399 [PubMed - indexed for MEDLINE] 1648. N Engl J Med. 2002 Dec 12;347(24):1962-3. Varicella vaccine--are two doses better than one? Gershon AA. Comment in: N Engl J Med. 2003 Apr 3;348(14):1405-7; author reply 1405-7. N Engl J Med. 2003 Apr 3;348(14):1405-7; author reply 1405-7. N Engl J Med. 2003 Apr 3;348(14):1405-7; author reply 1405-7. Comment on: N Engl J Med. 2002 Dec 12;347(24):1909-15. PMID: 12477947 [PubMed - indexed for MEDLINE] 1649. Addiction. 2002 Dec;97(12):1505-7. Death of the 'stepping-stone' hypothesis and the 'gateway' model? Comments on Morral et al. Anthony JC. Mental Hygiene and Epidemiology, Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, MD 21205, USA. janthony@jhsph.edu Comment in: Addiction. 2002 Dec;97(12):1509-10. Comment on: Addiction. 2002 Dec;97(12):1493-504. PMID: 12472631 [PubMed - indexed for MEDLINE] 1650. Prescrire Int. 2002 Dec;11(62):184-6. Treatment of postherpetic neuralgia: tricyclic antidepressants still the reference. [No authors listed] (1) Pain generally disappears when herpes zoster lesions have healed, but the risk of postherpetic neuralgia, though it is low, increases with age. (2) Antivirals prescribed during the acute phase do not reduce the risk of postherpetic neuralgia, but they do reduce its duration. (3) Common non specific analgesics such as paracetamol seem inadequate against postherpetic neuralgia. Amitriptyline and desipramine, despite their limited efficacy, are the reference. Gabapentin, although somewhat less effective, is a possible second line option. It is unclear how long treatment should last. PMID: 12472100 [PubMed - indexed for MEDLINE] 1651. Am J Ophthalmol. 2002 Dec;134(6):912-4. Herpes zoster vasculitis presenting as giant cell arteritis with bilateral internuclear ophthalmoplegia. Al-Abdulla NA, Rismondo V, Minkowski JS, Miller NR. Wilmer Eye Institute, The Johns Hopkins Hospital, Baltimore, Maryland 21287, USA. PURPOSE: To present a case of herpes zoster vasculitis presenting as giant cell arteritis. DESIGN: Interventional case report. METHODS: A 77-year-old woman presented with sudden onset of diplopia associated with temple headaches and a previous history of herpes zoster ophthalmicus. A temporal artery biopsy was obtained and in-situ hybridization performed for herpes zoster DNA. RESULTS: The patient presented with a bilateral internuclear ophthalmoplegia. Initial diagnostic evaluation, including erythrocyte sedimentation rate, C-reactive protein, and temporal artery biopsy, was consistent with giant cell arteritis. However, in-situ hybridization of the temporal artery specimen was positive for herpes zoster DNA. CONCLUSIONS: Herpes zoster vasculitis may mimic giant cell arteritis and should be considered in the differential of any patient with presumed giant cell arteritis with suspicious findings, central nervous system involvement, or previous herpes zoster infection. PMID: 12470766 [PubMed - indexed for MEDLINE] 1652. Ocul Immunol Inflamm. 2002 Mar;10(1):41-6. Successful treatment of varicella zoster virus retinitis with aggressive intravitreal and systemic antiviral therapy. Zambarakji HJ, Obi AA, Mitchell SM. Department of Ophthalmology, Chelsea and Westminster Hospital, London, UK. AIMS: To describe the successful treatment of varicella zoster virus retinitis (VZVR) using intravenous cidofovir as part of an aggressive management strategy. CASE REPORTS: Two patients with bilateral VZVR were treated with a combination of intravenous cidofovir and ganciclovir with adjuvant intravitreal foscarnet or ganciclovir. Both patients maintained good vision in the less severely affected eye. Retinal detachment did not occur in either patient. CONCLUSIONS: VZVR should be treated aggressively with a combination of intravenous and intravitreal therapy to improve visual prognosis. Intravenous cidofovir, in the absence of contra-indications, should be considered as part of this aggressive therapeutic approach, especially in patients with AIDS in whom the prognosis is particularly poor. PMID: 12461702 [PubMed - indexed for MEDLINE] 1653. Pediatr Ann. 2002 Nov;31(11):710-5. The success of varicella vaccine. LaRussa P. College of Physicians and Surgeons, Columbia University, PH 4 West-462, 622 West 168th St., New York, NY 10032, USA. PMID: 12455479 [PubMed - indexed for MEDLINE] 1654. Am J Clin Nutr. 2002 Dec;76(6):1358-66. Low plasma concentrations of retinol and alpha-tocopherol in hematopoietic stem cell transplant recipients: the effect of mucositis and the risk of infection. High KP, Legault C, Sinclair JA, Cruz J, Hill K, Hurd DD. Sections of Infectious Diseases and of Hematology and Oncology and the Comprehensive Cancer Center, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC 27157-1042, USA. khigh@wfubmc.edu BACKGROUND: Although vitamin deficiencies are rare in the United States, acute reductions in concentrations of plasma retinol (vitamin A) or alpha-tocopherol (vitamin E) have been associated with impaired immune responses in some clinical settings. OBJECTIVE: The objectives were to determine the plasma concentrations of retinol and alpha-tocopherol in patients undergoing dose-intensive therapy and hematopoietic stem cell transplant and to examine the association of plasma concentrations with clinical outcomes reflecting immunity. DESIGN: This was an observational trial of 120 consecutive recipients of hematopoietic stem cell transplant and a multivariate analysis of plasma vitamin concentrations, mucositis, infections in the first 30 d, and herpes zoster infections in the first year after hematopoietic stem cell transplant. RESULTS: Plasma retinol and alpha-tocopherol concentrations declined from baseline to day 7, typically recovering without specific replacement toward baseline by day 14. The severity of mucositis was a strong predictor of low plasma retinol on day 7 (P = 0.001). Eighty-two patients (68%) had at least one plasma retinol concentration < or = 1.05 micro mol/L, a concentration previously determined to be of immunologic significance, during the peritransplant period (day -8 to day 14). Men more frequently acquired herpes zoster than women, and men who developed hyporetinolemia (< or = 1.05 micro mol/L) had a significantly higher risk of herpes zoster (OR: 6.6; 95% CI: 1.5, 29.6). Plasma alpha-tocopherol was not associated with any clinical event measured in this study. CONCLUSION: Hyporetinolemia is common, particularly in subjects with severe mucositis, and is associated with an increased risk of herpes zoster infection in recipients of hematopoietic stem cell transplant. Additional investigations are required to determine whether these findings indicate a causal relation. PMID: 12450904 [PubMed - indexed for MEDLINE] 1655. Am Fam Physician. 2002 Nov 1;66(9):1732. Information from your family doctor. What you should know about HZO. [No authors listed] Comment on: Am Fam Physician. 2002 Nov 1;66(9):1723-30. PMID: 12449271 [PubMed - indexed for MEDLINE] 1656. Am Fam Physician. 2002 Nov 1;66(9):1723-30. Evaluation and management of herpes zoster ophthalmicus. Shaikh S, Ta CN. Stanford University Medical Center, California, USA. Comment in: Am Fam Physician. 2002 Nov 1;66(9):1732. Herpes zoster ophthalmicus occurs when the varicella-zoster virus is reactivated in the ophthalmic division of the trigeminal nerve. Herpes zoster ophthalmicus represents up to one fourth of all cases of herpes zoster. Most patients with herpes zoster ophthalmicus present with a periorbital vesicular rash distributed according to the affected dermatome. A minority of patients may also develop conjunctivitis, keratitis, uveitis, and ocular cranial-nerve palsies. Permanent sequelae of ophthalmic zoster infection may include chronic ocular inflammation, loss of vision, and debilitating pain. Antiviral medications such as acyclovir, valacyclovir, and famcidovir remain the mainstay of therapy and are most effective in preventing ocular involvement when begun within 72 hours after the onset of the rash. Timely diagnosis and management of herpes zoster ophthalmicus. with referral to an ophthalmologist when ophthalmic involvement is present, are critical in limiting visual morbidity. PMID: 12449270 [PubMed - indexed for MEDLINE] 1657. Am J Clin Dermatol. 2002;3(9):591-8. Oral antivirals revisited in the treatment of herpes zoster: what do they accomplish? Nikkels AF, Piérard GE. Department of Dermatopathology, University Medical Center, Sart Tilman, Liège, Belgium. af.nikkels@chu.ulg.ac.be Oral antiviral agents currently represent the most important therapeutic keystone in the treatment of herpes zoster. Three oral antiviral agents are available for the treatment of herpes zoster: acyclovir, its derivative valacyclovir, and famciclovir. Meta-analysis of published data has shown that oral acyclovir significantly reduces various herpes zoster-related symptoms as well as the duration, intensity and prevalence of zoster-associated pain (ZAP). However, this drug does not influence postherpetic neuralgia. The newer agents famciclovir and valacyclovir exhibit a better oral bioavailability than acyclovir. These agents have demonstrated similar efficacy to acyclovir with ZAP and they require less frequent administration. When initiated within 72 hours, oral antiviral therapy of herpes zoster is beneficial in selected, elderly immunocompetent patients, reducing the duration and intensity of ZAP and providing more rapid skin lesion healing. Oral antivirals are also of benefit in immunocompromised patients with uncomplicated herpes zoster. However, signs of cutaneous and visceral dissemination should be monitored; if signs occur, intravenous antiviral therapy is indicated. PMID: 12444801 [PubMed - indexed for MEDLINE] 1658. BMC Complement Altern Med. 2002 Nov 20;2:11. Epub 2002 Nov 20. GFS, a preparation of Tasmanian Undaria pinnatifida is associated with healing and inhibition of reactivation of Herpes. Cooper R, Dragar C, Elliot K, Fitton JH, Godwin J, Thompson K. Anubha Mountain Health Retreat. 680 Summerleas Road, Kingston, Tasmania, Australia. anubha@southcom.com.au BACKGROUND: We sought to assess whether GFS, a proprietary preparation of Tasmanian Undaria pinnatifida, has effects on healing or re-emergence of Herpetic infections, and additionally, to assess effects of GFS in vitro. Undaria is the most commonly eaten seaweed in Japan, and contains sulphated polyanions and other components with potential anti-viral activity. Herpes simplex virus type 1 (HSV-1) infections have lower reactivation rates and Herpes type 2 (HSV-2) infections have lower incidence in Japan than in the west. METHODS: Patients with active (15 subjects) or latent (6 subjects) Herpetic infections (HSV-1, 2, EBV, Zoster) were monitored for response to ingestion of GFS. GFS extract was tested in vitro for human T cell mitogenicity and anti-Herpes activity. RESULTS: Ingestion of GFS was associated with increased healing rates in patients with active infections. In addition, patients with latent infection remained asymptomatic whilst ingesting GFS. GFS extract inhibited Herpes viruses in vitro and was mitogenic to human T cells in vitro. CONCLUSIONS: Ingestion of GFS has inhibitory effects on reactivation and is associated with increased rate of healing after Herpetic outbreaks. GFS extract potently inhibited Herpes virus in vitro, and had mitogenic effects on human T cells. PMCID: PMC139995 PMID: 12443533 [PubMed - indexed for MEDLINE] 1659. Home Healthc Nurse. 2002 Nov;20(11):718-23; quiz 724. Assessing and treating neuropathic pain. Cabaleiro J. Triangle Compounding Pharmacy, Cary, NC 27511, USA. joe@trianglecompounding.com PMID: 12442041 [PubMed - indexed for MEDLINE] 1660. Clin J Pain. 2002 Nov-Dec;18(6):350-4. Epidemiology and impact on quality of life of postherpetic neuralgia and painful diabetic neuropathy. Schmader KE. Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA. schma001@mc.duke.edu OBJECTIVE: This article reviews the prevalence, risk factors, natural history, and impact on quality of life of painful diabetic neuropathy (PDN) and postherpetic neuralgia (PHN). DISCUSSION: Diabetes mellitus afflicts more than 14 million persons in the U.S. An estimated 20% to 24% of these persons experience PDN. Data on risk factors for PDN are limited, but duration of diabetes mellitus and poor glycemic control are probably important factors. Painful diabetic neuropathy may interfere with general activity, mood, mobility, work, social relations, sleep, leisure activities, and enjoyment of life. Herpes zoster strikes an estimated 800,000 persons each year in the U.S., most of whom are elderly or immunosuppressed. Using pain at 3 months after rash onset as a definition of PHN, between 25% and 50% of adults older than 50 years develop PHN, depending on early antiviral therapy for herpes zoster. Increasing age, greater pain and rash severity, greater degree of sensory impairment, and psychological distress are risk factors for PHN. Postherpetic neuralgia may cause fatigue, insomnia, depression, anxiety, interference with social roles and leisure activity, and impaired basic and instrumental activities of daily living. CONCLUSIONS: Both conditions are common complications of their underlying disorders and can profoundly diminish the quality of life of affected persons. PMID: 12441828 [PubMed - indexed for MEDLINE] 1661. Eye (Lond). 2002 Nov;16(6):778-80. Unilateral varicella zoster virus ophthalmicus and contralateral acute retinal necrosis. Matthews BN, Erb N, Gordon C, Callear AB, Murray PI, Salmon M. Academic Unit of Ophthalmology Division of Immunity and Infection The University of Birmingham, Birmingham, UK. We report two patients who developed varicella zoster virus (VZV) ophthalmicus complicated by ipsilateral keratouveitis, and within 4 weeks developed acute retinal necrosis (ARN) in the contralateral eye. The ipsilateral retina was spared in each case. One patient had systemic lupus erythematosus (SLE) and the other Hodgkin's disease. Both patients were in remission at the time of presentation. PMID: 12439676 [PubMed - indexed for MEDLINE] 1662. J Laryngol Otol. 2002 Oct;116(10):844-8. Ramsay Hunt syndrome: pathophysiology of cochleovestibular symptoms. Kuhweide R, Van de Steene V, Vlaminck S, Casselman JW. Department of Otorhinolaryngology-Head and Neck Surgery, AZ Sint-Jan Hospital, Brugge, Belgium. Ramsay Hunt's hypothesis that herpes zoster oticus results from reactivation of the varicella zoster virus (VZV) in the geniculate ganglion is supported by the detection of viral genome in archival temporal bones of normals and Ramsay Hunt patients by the polymerase chain reaction. Ramsay Hunt syndrome is characterized by the presence of cochleovestibular symptoms in association with facial paralysis. VZV has also been demonstrated in the spiral and/or vestibular ganglion. Two cases are reported in which cochleovestibular symptoms outweighed the facial nerve symptoms, presumably representing VZV reactivation in the spiral and/or vestibular ganglion. From these observations and the known dormancy of VZV in non-neuronal satellite cells, it is argued that the cochleovestibular symptoms in Ramsay Hunt syndrome may result from VZV transmission across the nerves inside the internal auditory canal and that prompt treatment with an antiviral-corticosteroid combination might be justified in the management of any acute non-hydropic cochleovestibular syndrome. PMID: 12437843 [PubMed - indexed for MEDLINE] 1663. N Engl J Med. 2002 Nov 14;347(20):1624-5; author reply 1624-5. Varicella vaccine in recipients of hematopoietic-cell transplants. Mehta J. Comment on: N Engl J Med. 2002 Jul 4;347(1):26-34. PMID: 12434769 [PubMed - indexed for MEDLINE] 1664. Commun Dis Public Health. 2002 Sep;5(3):240-2. Susceptibility to varicella-zoster virus in applicants for nurse training in Scotland. Waclawski ER, Stewart M. Argyll and Clyde Occupational Health Service, Hollybush Dykebar Hospital, Grahamston Road, Paisley PA2 7DE. eugene.waclawski@renver-pct.scot.nhs.uk We investigated the immunity to varicella-zoster virus (VZV) of a cohort of applicants for nurse training and determined the relationship between immune status and history of chickenpox or shingles based on a self-completed questionnaire. Three hundred and fifty-six applicants for nurse training were enrolled at an occupational health department in NHS Scotland and 96% were immune to VZV. The positive predictive value of a history of VZV infection for seropositivity was 98% (286/292). The negative predictive value was 14% (9/64). History of chicken pox/shingles had a sensitivity of 84% (286/341) and specificity of 60% (9/15). Screening using past clinical history compatible with VZV infection would have missed 40% of those possibly susceptible to VZV on the basis of the ELISA IgG test. We conclude absence of past history of chickenpox or shingles is an unreliable identifier of susceptibility to VZV in healthcare workers. The Control of Substances Hazardous to Health (COSHH) Regulations 1999 require employers to make effective vaccines available for those employees who are not already immune to a biological agent to which they are exposed or liable to be exposed. Serological testing of healthcare workers would better identify those who are susceptible to VZV infection. PMID: 12434695 [PubMed - indexed for MEDLINE] 1665. Commun Dis Public Health. 2002 Sep;5(3):185-6. Varicella vaccination: a double-edged sword? Edmunds WJ, Brisson M, Gay NJ, Miller E. Comment in: Commun Dis Public Health. 2002 Dec;5(4):343. PMID: 12434688 [PubMed - indexed for MEDLINE] 1666. Proc West Pharmacol Soc. 2002;45:73. Lidocaine and methylprednisolone in management of herpes zoster and post-herpetic neuralgia. Gintautas J, Abraham Y, Doss NW, Ghobriel A, Kashem A, Fogler RJ. Brookdale University Hospital and Medical Center, New York, USA. gintautasj@aol.com PMID: 12434534 [PubMed - indexed for MEDLINE] 1667. Med Klin (Munich). 2002 Nov 15;97(11):650-8. [Late infectious complications after high-dose therapy and autologous blood stem cell transplantation] [Article in German] Metzner B, Grüneisl R, Gebauer W, Reschke D, Ost E, Müller TH, Reichert D, Rosien B, Del Valle F, Zirpel I, Kohse KP, Schunter F, Illiger HJ. Klinik für Innere Medizin II, Klinikum Oldenburg, Germany. metzner.bernd@klinikum-oldenburg.de AIM: Only a few data on frequency and character of late infectious complications after high-dose therapy (HDT) and autologous blood stem cell transplantation (ASCT) have been published. This prospective study was carried out to identify potential predictive factors for late infections (occurring after discharge following HDT) and to clarify the usefulness of prophylactic measures. PATIENTS AND METHODS: Clinical data of 192 consecutive patients treated with HDT and ASCT in a single hospital were analyzed on late infectious complications. After discharge following HDT, the 166 evaluable patients (84 with hematologic malignancies, 82 with solid tumors) had been examined and interviewed on infections every 4-12 weeks after ASCT. For Pneumocystis carinii prophylaxis, inhalation with pentamidine or oral cotrimoxazole was used for 3-4 months following ASCT. RESULTS: In the first 6 months following ASCT (after discharge) we saw on average one infectious episode per patient (median, range 0-6), usually light infections (mostly banal upper airway infections). 17 patients had to be treated in hospital for infectious (15 of whom with hematologic malignancies), three of whom (only with hematologic malignancies) died in spite of intensive care as a result of pneumonias due to opportunistic causative agents (mainly Pneumocystis carinii [PcP]). In the second half of the year after ASCT, five patients (with hematologic malignancies) had to be hospitalized due to infections. No further infection-related death occurred. Early documented infections (pneumonia, bacteremia or Clostridium difficile colitis) were associated with an increased risk for late serious infections. Zoster occurred in 18% of patients within 12 months, more frequently after increased pretreatment (25% vs. 11% after less pretreatment), most frequently in patients with relapsed lymphomas (32%). CONCLUSIONS: Significant late infectious complications after ASCT are uncommon. Patients with hematologic malignancies have a significantly increased risk of more serious infections and should be observed carefully. For risk patients with hematologic malignancies and possibly solid tumors, a strict PcP prophylaxis is required. Patients with relapsed lymphomas could possibly be treated preventively against zoster with low-dose aciclovir to reduce the extent of zoster disease. Each patient should be informed carefully that early signs of zoster require an effective zoster treatment as soon as possible. PMID: 12434273 [PubMed - indexed for MEDLINE] 1668. N Engl J Med. 2002 Nov 14;347(20):1624-5; author reply 1624-5. Varicella vaccine in recipients of hematopoietic-cell transplants. Kami M, Kim SW, Takaue Y. Comment on: N Engl J Med. 2002 Jul 4;347(1):26-34. PMID: 12432055 [PubMed - indexed for MEDLINE] 1669. Swiss Med Wkly. 2002 Jul 13;132(27-28):374-8. Management of viral infections in immunocompromised cancer patients. Reusser P. Division of Medicine, Hôpital régional, Porrentruy, Switzerland. pierre.reusser@cgh.ch Immunocompromised cancer patients are at elevated risk for serious viral disease. The introduction into clinical use of potent antiviral agents and of rapid diagnostic tests resulted in the development of efficient management strategies for infections due to herpes simplex virus, varicellazoster virus, and cytomegalovirus. The emergence of herpesvirus resistance to acyclovir, ganciclovir, cidofovir, or foscarnet represents an important challenge. The new neuraminidase inhibitors zanamivir and oseltamivir are efficacious in the treatment of influenza in otherwise healthy adults, and need to be investigated among immunodeficient patients with malignancy. Preliminary data on pleconaril, a first broad-spectrum anti-picornaviral compound, are promising. PMID: 12428191 [PubMed - indexed for MEDLINE] 1670. Eur J Pediatr. 2002 Nov;161(11):588-93. Epub 2002 Sep 24. The seroepidemiology of primary varicella-zoster virus infection in Flanders (Belgium). Thiry N, Beutels P, Shkedy Z, Vranckx R, Vandermeulen C, Wielen MV, Damme PV. Centre for the Evaluation of Vaccination, Department of Epidemiology and Community Medicine, University of Antwerp, Universiteitsplein 1, 2610 Antwerp, Belgium. nancy.thiry@ua.ac.be The age-specific seroprevalence of varicella-zoster virus (VZV) antibodies was assessed in a sample of the Flemish (Belgian) population. ELISA tests were used to analyse 1673 sera from subjects aged 1 to 44 years (October 1999-April 2000). Chickenpox infections in Flanders appear to affect children at a younger age than in other European countries since 47.37% (95% CI: 37.33-57.41) is already immune at 2 years of age. For older age-groups, the prevalence is similar to that of most European countries: 80.19% (95% CI: 72.60-87.78) at 5 years, 92.52% (95% CI: 87.54-97.51) at 9 years and 100%> or =40 years. The accuracy of non-positive recollections of varicella histories among Flemish 10 to 17-year olds was examined on the basis of a second (residual) serum bank. In this group, VZV seroprevalence was almost always 100% (or nearly 100%), irrespective of age, degree of reliability (negative or uncertain answers) or level of ascertainment (child personally or parents). The limited size of this second data set did not allow for an accurate assessment of the negative predictive value of such recollections. CONCLUSION: since varicella-zoster virus predominantly affects very small children and is generally perceived as benign, the required high coverage rate of a universal childhood varicella vaccination programme may be hard to attain. Adolescent strategies can minimise the population risks involved but the accuracy of non positive antecedents of chickenpox needs to be documented to assess the efficiency of such strategies. PMID: 12424583 [PubMed - indexed for MEDLINE] 1671. J Clin Virol. 2002 Dec;25(3):293-301. Acute central nervous system complications in varicella zoster virus infections. Koskiniemi M, Piiparinen H, Rantalaiho T, Eränkö P, Färkkilä M, Räihä K, Salonen EM, Ukkonen P, Vaheri A. Department of Virology, Haartman Institute, Helenski University, Finland. marjaleena.koskiniemi@helsinki.fi BACKGROUND: In a previous multicenter study on central nervous system (CNS) viral infections varicella zoster virus (VZV) appeared the most frequent etiologic agent and appeared often without rash. OBJECTIVE: To evaluate the appearance and diagnostics of VZV in CNS more thoroughly, we studied the cases systematically by using sensitive and specific methods to learn the best diagnostic approach in order to start specific therapy. STUDY DESIGN: We analyzed all serum and cerebrospinal fluid samples of 174 patients, 88 females and 86 males, with acute CNS symptoms associated with VZV infection diagnosed in the multicenter study on viral CNS infections. RESULTS: About 38 patients (22%) had chickenpox, 59 (34%) had shingles, and 77 (44%) had no cutaneous symptoms at all. The mean age of chickenpox patients was 8.6 years, of the others 46.6 and 41.4 years. VZV-specific nucleic acid was detected in the CSF in one fourth of the patients in all groups, primarily during the first week of illness. In serum specimens, specific IgM was present in two thirds of the patients with chickenpox, whereas in the others in one third of the cases. In CSF, specific IgM was present in 15-17% of patients with skin manifestations, compared with 6% of those without rash. CONCLUSIONS: The role of VZV infections in CNS complications seems remarkable, often presenting without rash. Even these cases should be promptly recognized in order to conduct proper antiviral therapy. In children, a combination of PCR and IgM tests is the best approach. In adults, PCR, together with the measurement of intrathecal antibody production yields best results. PMID: 12423693 [PubMed - indexed for MEDLINE] 1672. J Clin Virol. 2002 Dec;25(3):241-66. Antiviral prophylaxis and treatment (excluding HIV therapy). Waugh SM, Pillay D, Carrington D, Carman WF. West of Scotland Specialist Virology Centre, Gartnavel General Hospital, Great Western Road, Glasgow G12 OYN, UK. Erratum in: J Clin Virol. 2003 Jan;26(1):117-120.. PMID: 12423690 [PubMed - indexed for MEDLINE] 1673. Arch Phys Med Rehabil. 2002 Nov;83(11):1624-8. Herpes zoster-associated voiding dysfunction: a retrospective study and literature review. Chen PH, Hsueh HF, Hong CZ. Department of Physical Medicine and Rehabilitation, Kuo General Hospital, Tainan, Taiwan. vspmnr70@yahoo.com.tw OBJECTIVES: (1) To describe the demographic features of patients with voiding dysfunction associated with herpes zoster; (2) to discuss the pathophysiology of voiding dysfunction associated with herpes zoster; and (3) to suggest the best management policy. DESIGN: A retrospective study. SETTING: A university-affiliated medical center in Taiwan. PARTICIPANTS: Four hundred twenty-three patients (mean age, 55.5y) admitted with the diagnosis of herpes zoster from 1988 to 2000. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Dermatomal distribution of skin eruptions, urologic symptoms, treatment (catheterization, urecholine), clinical course of voiding dysfunction, and outcome. RESULTS: Seventeen (mean age, 61.2+/-14.1y) of 423 patients (4.02%) with voiding dysfunction related to this virus infection were identified. Ten (58.8%) were men, and 7 (41.2%) were women. The incidence of dysfunction was as high as 28.6% if only lumbosacral dermatome-involved patients were considered. We classified urologic manifestations caused by herpes zoster into 3 groups: cystitis-associated (n=12), neuritis-associated (n=4), and myelitis-associated (n=1). Urinalysis revealed pyuria in all patients with cystitis-associated voiding dysfunction and microscopic hematuria in all patients with neuritis-associated voiding dysfunction. All patients, although receiving different treatment regimens for voiding dysfunction, regained a normal or balanced bladder within 8 weeks. No major urologic sequelae were noted. CONCLUSION: Voiding dysfunction, although a transient course, is not uncommon in patients with herpes zoster involving lumbosacral dermatomes. Treatment with intermittent catheterization (our preferred choice) or indwelling catheter placement is recommended if the patients have prolonged difficulty in urination. This disease entity usually has a benign clinical course, and almost every patient will either regain normal voiding or, at least, balanced bladder function. Copyright 2002 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation PMID: 12422336 [PubMed - indexed for MEDLINE] 1674. N Engl J Med. 2002 Nov 7;347(19):1500-3. Two patients with unusual forms of varicella-zoster virus vasculopathy. Gilden DH, Lipton HL, Wolf JS, Akenbrandt W, Smith JE, Mahalingam R, Forghani B. Department of Neurology, University of Colorado Health Sciences Center, Denver 80262, USA. don.gilden@uchsc.edu PMID: 12421892 [PubMed - indexed for MEDLINE] 1675. Indian J Dent Res. 2002 Jan-Mar;13(1):11-4. Tooth exfoliation, osteonecrosis and neuralgia following herpes zoster of trigeminal nerve. Volvoikar P, Patil S, Dinkar A. Department of Oral Medicine & Radiology, Goa Dental College, Bambolim, Goa-403202, India. A case of herpes zoster of the trigeminal nerve with complications of osteonecrosis and neuralgia in the absence of local or systemic predisposing factors is presented. The literature is reviewed and the role of varicella zoster virus in the pathology of tooth exfoliation and osteonecrosis is discussed. PMID: 12420562 [PubMed - indexed for MEDLINE] 1676. Indian J Gastroenterol. 2002 Sep-Oct;21(5):203-4. Colonic pseudo-obstruction due to herpes zoster. Rodrigues G, Kannaiyan L, Gopasetty M, Rao S, Shenoy R. Department of General Surgery, Kasturba Medical College and Hospital, Manipal, Karnataka. gabyrodricks@eudoramail.com Visceral motor complications are uncommon manifestations of herpes zoster (varicella zoster). We report a 59-year-old man who developed acute colonic pseudo-obstruction, which followed the appearance of dermatomal herpes zoster. PMID: 12416757 [PubMed - indexed for MEDLINE] 1677. Haematologica. 2002 Nov;87(11):ECR33. Guillain-Barre' syndrome following Varicella zoster reactivation in Chronic Lymphocytic Leukemia treated with fludarabine. Laurenti L, Garzia M, Sabatelli M, Piccioni P, Sora' F, Leone G. Istituto di Ematologia, Università Cattolica Sacro Cuore, Rome, Italy. emacat@rm.unicatt.it PMID: 12414359 [PubMed - indexed for MEDLINE] 1678. Eur J Pain. 2002;6(6):435-45. Prevention of postherpetic neuralgia with varicella-zoster hyperimmune globulin. Hügler P, Siebrecht P, Hoffmann K, Stücker M, Windeler J, Altmeyer P, Laubenthal H. Department of Anesthesiology, Miners' Association Hospital Bottrop, Osterfelderstrasse 156, D-46242 Bottrop, Germany. peter.e.huegler@ruhr-uni-bochum.de Recovery after an acute attack of herpes zoster is followed by postherpetic neuralgia (PHN) in 9-14% of all patients. Depending on the patient's age, the severity of the acute attack of herpes zoster and the dermatome involved, the incidence of PHN may be as high as 65%. The purpose of our study was to ascertain the incidence of PHN after a prophylactic intravenous injection of varicella-zoster hyperimmune globulin (VZV-IG) (Varitect Biotest Pharma). For this double-blind placebo-controlled randomised investigation we defined PHN as pain confined to the dermatome previously affected by herpes zoster, and we required a pain intensity of at least 15% points on a visual analogue scale (VAS) for this dermatome. The inclusion criteria were the dermatological diagnosis of herpes zoster together with age over 50 years. On Day 1, 20 patients received a single intravenous infusion of VZV-IG in a dose of 2mL/kg body weight, 20 patients (control group) received a single infusion of human albumin 5% in a dose of 2mL/kg body weight. All patients received acyclovir intravenously in a dose of 15mg/kg body weight per 24h for 5 days. The patients were followed up for a total of 42 days. The incidence of PHN at Day 42 was selected as the main outcome criterion for assessing the efficacy of prophylaxis. On reaching a significant difference between the groups (t test; alpha<0.05) in favour of the active treatment group, prophylaxis of PHN by VZV-IG was assessed as effective. Pain was assessed on a VAS and a NAS. As auxiliary outcome criteria, we used the McGill Pain-Rating Questionnaire in its German version, the revised multidimensional pain scale (RMSS) and the Freiburg symptom list (FBL). All results were assessed by the t test (alpha<0.05). The frequency of PHN in the placebo group was 70% (14/20), in the active treatment group it was 35% (7/20) at Day 42. The results of the McGill test showed the variability of the perception of pain in the placebo group significantly greater. No significant group differences were found in the FBL. Being tested with the RMSS, the patients of the placebo group assessed their pains as significantly "more obstinate" (p=0.047). The results can be summed up by saying that VZV-IG not only reduces the incidence of PHN, but also that in certain respects the patients' assessments of their pain experience were different. In our study we found a 50% reduction in PHN incidence However, the outcome time point of our trial was so close to the acute phase of the zoster illness that spontaneous remissions of PHN still have to be taken into account. Despite the widely varied approaches to the problem, reliably effective therapy, let alone 100% prevention of PHN, is still not feasible. PMID: 12413432 [PubMed - indexed for MEDLINE] 1679. Lancet Infect Dis. 2002 Nov;2(11):699. Concomitant bilateral herpes zoster opthalmicus. Pervez H, Potti A, Mehdi SA. Department of Internal Medicine, University of North Dakota School of Medicine and Health Sciences, Fargo, ND 58102, USA. Comment in: Lancet Infect Dis. 2003 Jan;3(1):12. PMID: 12409051 [PubMed - indexed for MEDLINE] 1680. Aust Fam Physician. 2002 Oct;31(10):887. Antiherpes zoster treatment. Bowell G. PMID: 12404823 [PubMed - indexed for MEDLINE] 1681. Aust Fam Physician. 2002 Oct;31(10):887. Antiherpes zoster treatment. Watson A. PMID: 12404822 [PubMed - indexed for MEDLINE] 1682. Presse Med. 2002 Oct 5;31(32):1521-9. [Ocular infections of the elderly] [Article in French] Labetoulle M, Lautier-Frau M, Frau E. Service d'ophtalmologie Centre hospitalier universitaire de Bicêtre AP-HP, Le Kremlin-Bicêtre (94). A CLINICAL ASPECT DEPENDING ON THE PHYSIOPATHOGENESIS: Ocular infections are a frequent motive for ophthalmological consultations in geriatric settings because of the mechanical factors related to age (modifications in palpebral dynamics and lacrymal function) and in local and general immune factors leading to the rapid and/or more severe development of infections. The mechanism of microbial contamination of the eye also determines the clinical damage: predominantly local (dirty hands, traumas) with involvement of the surface tissues (conjunctive and cornea) or general, hematogenic or neurogenic, frequently at the origin of more internal infections (iris, choroid, retina, optical nerve). CONJUNCTIVITIS AND KERATITIS: These provoke reddening of the eyes, tears and above all pain when the corneal epithelium is involved. Microbiological samples are useful in cases of severe, presumably infectious keratitis or conjunctivitis. Two emergency situations must be distinguished: any suspicion of herpes for which local corticosteroids are contraindicated and keratitis or conjunctivitis with the use of lenses, often due to Gram negative bacilli, amoeba or fungus, the treatment of which is intensive and the prognosis often severe. OPHTHALMOLOGICAL HERPES ZOSTER: The rapid diagnosis and introduction of efficient doses of antivirals reduces the initial pain, the ocular complications of herpes zoster and post-zoster pain. The latter, when it exists, requires specialized management. ACUTE UVEITIS: A context of intra-ocular inflammation in an elderly patient must always evoke a pseudo-uveitis syndrome, the principle cause of which is lymphoma. Conversely, an uveitis occurring in the days or weeks following ocular surgery, including cataract, must be considered as suggestive of a post-surgical infection and rapidly referred to a specialist. ACUTE DACRYOCYSTITIS: Is manifested by a hard and painful tumefaction below the internal angle of the eye. Following collection, it requires draining through an in incision in the skin, washing and packing of the sac, and systemic antibiotherapy. The preventive treatment of recurrences requires open dacryocystorhinostomy or via endonasal endoscopy. PMID: 12402761 [PubMed - indexed for MEDLINE] 1683. Presse Med. 2002 Oct 5;31(32):1517-20. [Characteristics of infectious diseases in the elderly] [Article in French] Merrien D. Service de médecine interne, centre hospitalier de Compiègne 60200 Compiègne. IN GENERAL: Infectious diseases represent the third cause of mortality in patients aged over 65. Age-related immune deficiency and underlying diseases frequently favour infections. The symptoms are often fickle and misleading, delay diagnosis and worsen the prognosis. THE PRINCIPLE INFECTIONS: Broncho-pulmonary and urinary infections predominate in this context. More rare but severe complications specifically related to age are also possible, notably meningitis, tuberculosis, herpes zoster and septicemia in the elderly. PREVENTIVE MEASURES: Influenza and anti-pneumococcal vaccines have demonstrated their efficacy in limiting the broncho-pulmonary infections in these patients. PMID: 12402760 [PubMed - indexed for MEDLINE] 1684. Nephrol Dial Transplant. 2002 Nov;17(11):2030-2. Giant cells and pneumonia in a transplant patient. What is the link? Kleshinski JF, Rao PS, Duggan J, Zaher A. Department of Medicine. Department of Pathology, Medical College of Ohio, Toledo, OH, USA. PMID: 12401869 [PubMed - indexed for MEDLINE] 1685. Br J Anaesth. 2002 Nov;89(5):711-4. Efficacy of intravenous magnesium in neuropathic pain. Brill S, Sedgwick PM, Hamann W, Di Vadi PP. Department of Anaesthetics and Pain Management, University Hospital Lewisham, Lewisham High Street, London SE13 6LH, UK. Comment in: Br J Anaesth. 2003 Aug;91(2):302; author reply 302. BACKGROUND: Postherpetic neuralgia is a complication of acute herpes zoster characterized by severe pain and paraesthesia in the skin area affected by the initial infection. There is evidence that the N-methyl-D-aspartate receptor is involved in the development of hypersensitivity states and it is known that magnesium blocks the N-methyl-D-aspartate receptor. METHOD: A double-blind, placebo-controlled, cross-over study was conducted in which magnesium sulphate was administered as an i.v. infusion. Spontaneous pain was recorded and qualitative sensory testing with cotton wool was performed in seven patients with postherpetic neuralgia before and after the i.v. administration of either magnesium sulphate 30 mg kg(-1) or saline. RESULTS: During the administration, pain scores were significantly lower for magnesium compared with placebo at 20 and 30 min (P=0.016) but not at 10 min. I.V. magnesium sulphate was safe, well-tolerated and effective in patients with postherpetic neuralgia. CONCLUSION: The present study supports the concept that the N-methyl-D-aspartate receptor is involved in the control of postherpetic neuralgia. PMID: 12393768 [PubMed - indexed for MEDLINE] 1686. Headache. 2002 Sep;42(8):826-8. Geniculate neuralgia as a manifestation of neuroborreliosis. Frese A, Lüttmann RJ, Husstedt IW, Ringelstein EB, Evers S. Department of Neurology, University of Münster, Germany. PMID: 12390649 [PubMed - indexed for MEDLINE] 1687. J Virol. 2002 Nov;76(22):11425-33. Tropism of varicella-zoster virus for human tonsillar CD4(+) T lymphocytes that express activation, memory, and skin homing markers. Ku CC, Padilla JA, Grose C, Butcher EC, Arvin AM. Department of Pediatrics, Stanford University, Stanford, California 94305, USA. cck@stanford.edu Varicella-zoster virus (VZV) is an alphaherpesvirus with the characteristic neurotropism of this group, but VZV also infects T cells productively and downregulates major histocompatibility complex (MHC) class I expression on infected T cells, as shown in the SCID-hu mouse model. T-cell tropism is likely to be critical for the cell-associated viremia associated with primary VZV infection. In these experiments, we found that VZV infects human tonsillar CD4(+) T cells in culture, with 15 to 25% being positive for VZV proteins as detected by polyclonal anti-VZV immunoglobulin G (IgG) staining and monitored by flow cytometry analysis. RNA transcripts for VZV gE, a late gene product, were detected in T-cell populations that expressed VZV surface proteins, but not in the VZV-negative cell fraction. Exposure to phorbol myristate acetate resulted in an increase in VZV-positive T cells, indicating that viral DNA was present within these cells and that VZV gene expression could be induced by T-cell activation. By immune scanning electron microscopy, VZV virions were detected in abundance on the surfaces of infected tonsillar T cells. The predominant CD4(+) T-lymphocyte subpopulations that became infected were activated CD69(+) T cells with the CD45RA(-) memory phenotype. Subsets of CD4(+) T cells that expressed skin homing markers, cutaneous leukocyte antigen, and chemokine receptor 4 were also infected with VZV. By chemotaxis assay, VZV-infected T cells migrated to SDF-1, demonstrating that skin migratory function was intact despite VZV infection. The susceptibility of tonsil T cells to VZV suggests that these cells may be important targets during the initial VZV infection of upper respiratory tract sites. Viral transfer to migrating T cells in the tonsils may facilitate cell-associated viremia, and preferential infection of CD4 T cells that express skin homing markers may enhance VZV transport to cutaneous sites of replication. PMCID: PMC136789 PMID: 12388703 [PubMed - indexed for MEDLINE] 1688. Infection. 2002 Oct;30(5):320-2. Rapid molecular discrimination between infection with wild-type varicella-zoster virus and varicella vaccine virus. Lässker U, Harder TC, Hufnagel M, Suttorp M. Dept. of Pediatrics, Christian-Albrechts-University, Schwanenweg 20, D-24105 Kiel, Germany. laessker@pediatrics.uni-kiel.de Varicella-zoster virus (VZV) infection is immunocompromised patients may cause life-threatening complications. Prevention measures include administration of VZV immuloglobulin, acyclovir and live attenuated varicella vaccine. After vaccination, a mild varicella-like exanthem appears in up to 5% of vaccinees. Morphologically this exanthem cannot be differentiated from wild-type (wt) varicella. The risk of virus transmission after varicella vaccination, in contrast to wt varicella, is low, even in immunocompromised patients. We report on a 2-year-old girl with relapse of cereral anaplastic ependymoma, who received one dose of varicella vaccine. Two weeks later, a maculopapular rash developed while she was an inpatient on the oncology ward. Using VZV-specific PCR and restriction fragment length polymorphism (RFLP) analysis, we were able to diagnose wt varicella infection. Thus, appropriate prevention measures (VZV immunoglobulin and acyclovir) were justified for close contacts to prevent virus transmission. No secondary cases occurred. PMID: 12382096 [PubMed - indexed for MEDLINE] 1689. Rev Med Interne. 2002 Sep;23(9):802-3. [Superficial thrombophlebitis of the scalp preceding zona zoster eruption] [Article in French] Gaultier M, Launay J, Koechlin M, Guedj A, Mourad JJ. PMID: 12378839 [PubMed - indexed for MEDLINE] 1690. J Korean Med Sci. 2002 Oct;17(5):655-9. Prognostic factors of postherpetic neuralgia. Herr H. Department of Dermatology, Kangnung Asan Hospital, University of Ulsan College of Medicine, Kangnung, Korea. herr@knh.co.kr The investigation was aimed to determine prognostic factors related to postherpetic neuralgia (PHN), and treatment options for preventing PHN. The data showed 34 (17.0%) out of 188 patients with herpes zoster had severe pain after 4 weeks, and 22 (11.7%) after 8 weeks, compared with 109 (58.0%) at presentation. The age (>/=50 yr), surface area involved (>/=9%), and duration of severe pain (>/=4 weeks) might be the main factors that lead to PHN. On the other hand, gender, dermatomal distribution, accompanied systemic conditions, and interval between initial pain and initiation of treatment might not be implicated in PHN. The subjects were orally received antiviral (valacyclovir), tricyclic antidepressant (amitriptyline), and analgesic (ibuprofen) as the standard treatment in the group 1. In addition to the standard medication, lidocaine solution was sub- and/or perilesionally injected in the group 2, while lidocaine plus prilocaine cream was topically applied to the skin lesions in the group 3. The rates of PHN in the 3 treatment groups were not significantly different, suggesting adjuvant anesthetics may not be helpful to reduce the severity of pain. PMID: 12378018 [PubMed - indexed for MEDLINE] 1691. Science. 2002 Oct 11;298(5592):351-3. Microbiology. Domino effects from battles against microbes. Cohen J. PMID: 12376683 [PubMed - indexed for MEDLINE] 1692. Enferm Infecc Microbiol Clin. 2002 Oct;20(8):415. [Encephalitis as the first manifestation of herpes zoster] [Article in Spanish] Hernández N, del Castillo F, García-Miguel MJ, Baquero-Artigao F. PMID: 12372242 [PubMed - indexed for MEDLINE] 1693. Neurology. 2002 Oct 8;59(7):1015-21. Opioids versus antidepressants in postherpetic neuralgia: a randomized, placebo-controlled trial. Raja SN, Haythornthwaite JA, Pappagallo M, Clark MR, Travison TG, Sabeen S, Royall RM, Max MB. Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA. sraja@jhmi.edu Comment in: J Fam Pract. 2003 Jul;52(7):517-8. Neurology. 2003 Mar 25;60(6):1052-3; author reply 1052-3. BACKGROUND: Tricyclic antidepressants (TCA) provide less than satisfactory pain relief for postherpetic neuralgia (PHN), and the role of opioids is controversial. OBJECTIVE: To compare the analgesic and cognitive effects of opioids with those of TCA and placebo in the treatment of PHN. METHODS: Seventy-six patients with PHN were randomized in a double-blind, placebo-controlled, crossover trial. Each subject was scheduled to undergo three treatment periods (opioid, TCA, and placebo), approximately 8 weeks' duration each. Doses were titrated to maximal relief or intolerable side effects. The primary outcome measures were pain intensity (0 to 10 scale), pain relief (0 to 100%), and cognitive function. Analyses included patients who provided any pain ratings after having received at least a single dose of a study medication. RESULTS: Fifty patients completed two periods, and 44 patients completed all three. Mean daily maintenance doses were morphine 91 mg or methadone 15 mg and nortriptyline 89 mg or desipramine 63 mg. Opioids and TCA reduced pain (1.9 and 1.4) more than placebo (0.2; p < 0.001), with no appreciable effect on any cognitive measure. The trend favoring opioids over TCA fell short of significance (p = 0.06), and reduction in pain with opioids did not correlate with that following TCA. Treatment with opioids and TCA resulted in greater pain relief (38 and 32%) compared with placebo (11%; p < 0.001). More patients completing all three treatments preferred opioids (54%) than TCA (30%; p = 0.02). CONCLUSIONS: Opioids effectively treat PHN without impairing cognition. Opioids and TCA act via independent mechanisms and with varied individual effect. PMID: 12370455 [PubMed - indexed for MEDLINE] 1694. Med Monatsschr Pharm. 2002 Sep;25(9):309-16. [Herpes zoster. Overview, symptoms and treatment] [Article in German] Gross G. Universität Rostock, Medizinische Fakultät, Klinik und Poliklinik für Dermatologie und Venerologie, Augustenstrasse 80-85, 18055 Rostock. PMID: 12369432 [PubMed - indexed for MEDLINE] 1695. Optometry. 2002 May;73(5):295-302. Herpes zoster ophthalmicus. Gurwood AS, Savochka J, Sirgany BJ. The Eye Institute, Pennsylvania College of Optometry, Philadelphia 19141, USA. agurwood@pco.edu BACKGROUND: We examined the literature for the latest information on diagnosis and management of herpes zoster, and compiled a representative database. METHODS: Using search engines and library resources, we reviewed pathology, epidemiology, pathophysiology, differential diagnosis, and management. RESULTS: The varicella zoster virus is a member of the herpes virus family that produces an infection through direct contact with active skin lesions or airborne droplets. The infection resides latent in the trigeminal ganglion until reactivated, often affecting the sensory nerve, skin, eye, and adnexa. CONCLUSION: The varicella zoster virus has the potential to severely disrupt the structures of the eye. Patients less than 50 years of age should be referred for systemic workup to rule out an immunocompromised state. In general, management is often palliative and/or geared toward specific sequelae. PMID: 12363229 [PubMed - indexed for MEDLINE] 1696. Pathol Biol (Paris). 2002 Aug;50(7):452-9. [Herpes and retinal lesions: what's new?] [Article in French] Fardeau C, Slimane H, Lehoang P. Service d'ophtalmologie, Hôpital Pitié-Salpêtrière, Paris, France. christine.fardeau@psl.ap-hop-paris.fr The viral retinitis are linked to infection by herpes simplex virus (HSV), varicella zoster virus (VZV), cytomegalovirus (CMV). When the diagnosis is clinically suspected the antiviral treatment has to be introduced immediately after performing the ocular sampling to try to identify the infectious agent. Despite the various antiherpetic drugs available by intravenous routes and intravitreal injection, the prognostic of the herpetic retinitis remained severe because of the occurrence of retinal detachment, optic neuritis, macular necrosis. Various clinical forms are described: (1) the classical "acute necrotizing retinitis" (2) a form with a slow progression of the necrotizing retinitis (3) occlusive retinal arteritis (4) the highly severe "progressive retinal necrosis". The incidence of the CMV retinitis diminished with the highly antiretroviral therapy; however uveitis may occur with no active CMV retinitis. The various antiherpetic drugs are described with special indications. PMID: 12360699 [PubMed - indexed for MEDLINE] 1697. Curr Neurol Neurosci Rep. 2002 Nov;2(6):477-8. Valacyclovir and famciclovir therapy in herpes zoster. Jubelt B. PMID: 12359099 [PubMed - indexed for MEDLINE] 1698. Am J Clin Dermatol. 2002;3(8):517-24. Corticosteroids for herpes zoster: what do they accomplish? Santee JA. School of Pharmacy, Division of Pharmacy Practice, University of Missouri-Kansas City, 2411 Holmes, Kansas City, MO 64108, USA. santeej@umkc.edu For some patients, herpes zoster infections not only result in acute pain but serious consequences, including postherpetic neuralgia and damage to ocular tissues. Some authors have recommended corticosteroids for the treatment of these acute symptoms and complications. The literature concerning the use of corticosteroids for herpes zoster, however, either provides conflicting results or includes recommendations based on clinical experience rather than clinical trials. The author performed a search of the literature to address the question of whether corticosteroids are well tolerated and effective for the treatment/prevention of the acute pain of herpes zoster, postherpetic neuralgia, and/or the ocular complications resulting from herpes zoster. While smaller trials found oral corticosteroids beneficial for preventing postherpetic neuralgia, larger, better designed trials have not found oral corticosteroids to be more efficacious than placebo in preventing postherpetic neuralgia. Trials investigating the effect of oral corticosteroids for the acute pain of herpes zoster have found that corticosteroids provide a statistically significant improvement. Whether these improvements are clinically significant is uncertain. Thus, oral corticosteroids may confer a slight benefit for initial symptoms as long as the patient is not at risk for complications resulting from corticosteroid therapy. Most trials of topical and injectable corticosteroids are limited by several shortcomings. Therefore, topical and most forms of parenteral corticosteroids have yet to be proven effective for the treatment of acute pain or prevention of complications. Two controlled, blinded trials investigating the use of intrathecal corticosteroid administration for intractable postherpetic neuralgia suggest that corticosteroid administration results in a significant improvement in pain. Despite this, several authors have voiced concern over possible serious adverse events with the intrathecal administration of corticosteroids. Intrathecal corticosteroids may provide a benefit for intractable postherpetic neuralgia, but because of risks of serious complications, this is a last-line option and should only be administered by experienced personnel. PMID: 12358552 [PubMed - indexed for MEDLINE] 1699. Anesthesiology. 2002 Oct;97(4):1009-11. Thoracic motor paralysis secondary to zoster sine herpete. McAllister RK, Borum SE, Mitchell DT, Bittenbinder TM. Department of Anesthesiology, Scott & White Clinic and Memorial Hospital, Scott, Sherwood, and Brindley Foundation, The Texas A&M University Health Science Center College of Medicine, Temple, 76508, U SA. rmcallister@swmail.sw.org PMID: 12357172 [PubMed - indexed for MEDLINE] 1700. Fam Pract. 2002 Oct;19(5):471-5. Herpes zoster and postherpetic neuralgia: incidence and risk indicators using a general practice research database. Opstelten W, Mauritz JW, de Wit NJ, van Wijck AJ, Stalman WA, van Essen GA. Julius Center for General Practice and Patient Oriented Research, University Medical Center Utrecht, PO Box 85060, 3500 AB Utrecht, The Netherlands. w.opstelten@med.uu.nl BACKGROUND: Postherpetic neuralgia (PHN) is a frequent complication of herpes zoster (HZ). Treatment results of this severe and long-lasting pain syndrome are often disappointing. From the point of view of possible prevention and early treatment, it is important to identify HZ patients who have an increased risk of developing PHN. OBJECTIVES: Our goals were to determine the incidence of HZ and PHN in a primary care population and to identify risk indicators for the occurrence of PHN. METHODS: A search for HZ and PHN was conducted in a general practice research database, comprising 22 general practices and representing 49 000 people, over a 5-year period. Potential risk indicators were analysed using multivariate logistic regression. RESULTS: A total of 837 patients had been diagnosed with HZ [incidence 3.4/1000 patients/year, 95% confidence interval (CI) 2.9-3.9]. The risk of developing PHN 1 month after the start of the zoster rash was 6.5% (95% CI 4.9-8.3). This risk was 11.7% (95% CI 8.5-14.9) for patients aged > or =55 years. Independent risk indicators for the occurrence of PHN were age [55-74 years, adjusted odds ratio (OR) 4.2, 95% CI 1.8-9.7; >75 years, OR 10.7, 95% CI 4.6-25.1] and ophthalmic localization (OR 2.3, 95% CI 1.0-4.6). CONCLUSIONS: The risk of developing PHN increases with age. Preventive strategies should focus on patients with herpes zoster aged >55 years and with ophthalmic localization. PMID: 12356697 [PubMed - indexed for MEDLINE] 1701. Dig Dis Sci. 2002 Sep;47(9):1962-4. Visceral varicella zoster after bone marrow transplantation: an obscure cause of an "acute abdomen". O'Loughlin CJ, Karnam US, Barkin JS. University of Miami, School of Medicine/Mount Sinai Medical Center, Division of Gastroenterology, Florida 33140, USA. PMID: 12353837 [PubMed - indexed for MEDLINE] 1702. Am J Hematol. 2002 Oct;71(2):140-1. Allografting of peripheral blood stem cell mobilized from a donor developing herpes zoster virus infection. Imai T, Maeda Y, Fujii N, Takenaka K, Shinagawa K, Ishimaru F, Ikeda K, Niiya K, Harada M. PMID: 12353321 [PubMed - indexed for MEDLINE] 1703. J Infect Dis. 2002 Oct 15;186 Suppl 1:S123-30. An investigation of the steady-state pharmacokinetics of oral valacyclovir in immunocompromised children. Nadal D, Leverger G, Sokal EM, Floret D, Perel Y, Leibundgut K, Weller S. Division of Infectious Diseases, University Children's Hospital of Zurich, CH-8032 Zurich, Switzerland. dnadal@kispi.unizh.ch Valacyclovir was administered to 28 immunocompromised children (ages 5-12 years) to obtain preliminary pharmacokinetic and safety information. Patients were randomized to valacyclovir regimens of 250 mg (9.4-13.3 mg/kg) or 500 mg (13.9-27.0 mg/kg) twice daily or 500 mg (13.2-21.7 mg/kg) 3 times a day. Acyclovir pharmacokinetics were evaluated at steady state. Valacyclovir was rapidly absorbed and converted to acyclovir. Mean (+/-SD) acyclovir peak concentrations from 250 mg and 500 mg valacyclovir were 4.11+/-1.41 and 5.19+/-1.96 microg/mL, respectively. Corresponding single dose area-under-curve values were 12.14+/-6.60 and 14.49+/-4.69h microg/mL. By using historical data for intravenous acyclovir as reference, the overall estimate of acyclovir bioavailability from valacyclovir was 48%, 2- to 4-fold greater than for oral acyclovir. In general, adverse events were not attributable to valacyclovir and were consistent with disease-related expectations and concomitant therapies. Dosage options for using valacyclovir in children are discussed. PMID: 12353197 [PubMed - indexed for MEDLINE] 1704. J Infect Dis. 2002 Oct 15;186 Suppl 1:S91-8. Varicella-zoster virus: atypical presentations and unusual complications. Gnann JW Jr. University of Alabama at Birmingham and Birmingham VA Medical Center, Birmingham, Alabama 35294-2170, USA. Varicella-zoster virus (VZV) is the etiologic agent of varicella (primary infection) and herpes zoster (reactivation of latent infection). Although varicella is most often a relatively benign and self-limited childhood illness, the disease can be associated with a variety of serious and potentially lethal complications in both immunocompetent and immunocompromised persons. One complication of varicella that appears to be increasing in frequency is serious bacterial soft tissue infections caused by group A streptococci. Issues related to management of varicella become especially complex when varicella involves pregnant women or susceptible neonates. Herpes zoster can be associated with a variety of neurologic complications, including a syndrome of delayed contralateral hemiparesis. Neurologic complications of herpes zoster, including chronic encephalitis, occur with increased frequency in AIDS patients. VZV retinitis is a potentially sight-threatening complication that occurs in both immunocompetent and immunocompromised persons. Current knowledge regarding pathogenesis and antiviral therapy is reviewed. PMID: 12353193 [PubMed - indexed for MEDLINE] 1705. J Infect Dis. 2002 Oct 15;186 Suppl 1:S83-90. Consequences and management of pain in herpes zoster. Johnson RW. Pain Management Clinic, Bristol Royal Infirmary, Bristol BS2 8HW, United Kingdom. rwjbristol@aol.com Postherpetic neuralgia (PHN) is a common complication of herpes zoster, particularly in the elderly and in persons with severe symptoms at presentation. Unless varicella vaccination reduces the incidence of herpes zoster and attenuates the risk and/or severity of complications, PHN will continue to result in significant suffering and remain a consumer of health care and related social support resources. Although there have been useful advances in the management of PHN (e.g., the use of the anticonvulsant gabapentin), some cases remain intractable. Prevention remains the preferred strategy, and antiviral drugs are the most well established means of preventing the development of pain. Other interventions require further evaluation (nerve blocks, acute-phase tricyclic antidepressant or anticonvulsant use). Because prevention of PHN requires early recognition and prompt management of patients presenting with herpes zoster, public education and dissemination of information to all health care personnel involved with the disease are essential. PMID: 12353192 [PubMed - indexed for MEDLINE] 1706. J Infect Dis. 2002 Oct 15;186 Suppl 1:S78-82. Understanding pain in herpes zoster: an essential for optimizing treatment. Wood M. Department of Infection and Tropical Medicine, Heartlands Hospital, Birmingham B9 5SS, United Kingdom. m.j.wood@bham.ac.uk After herpes zoster, immunocompetent persons frequently experience chronic pain and considerable suffering. Zoster-associated pain has a complex pathophysiology that begins with viral damage and increased sensitization of peripheral sensory neurons. The enhanced afferent barrage from these neurons sensitizes spinal neurons and leads to loss of synapses from descending inhibitory fibers, resulting in central neuropathic pain and allodynia. Antiviral therapy of acute zoster limits this sequence of pathophysiologic mechanisms. There is no clear consensus regarding the optimal means of determining the benefits of antiviral therapy in the management of pain of herpes zoster. A novel statistical approach utilizing rates of disappearance of pain of differing pathophysiologic mechanisms is proposed. PMID: 12353191 [PubMed - indexed for MEDLINE] 1707. Acta Otorhinolaryngol Belg. 2002;56(3):319-23. Ramsay Hunt syndrome presenting as a cranial polyneuropathy. Xanthopoulos J, Noussios G, Papaioannides D, Exarchakos G, Assimakopoulos D. Department of Otolaryngology, Hippokration General Hospital, Thessaloniki, Greece. Ramsay Hunt syndrome (RHS) is herpes zoster of the facial nerve, frequently associated with VIII cranial nerve involvement, but on rare occasions other cranial nerves are affected as well. We present the case of a 63-year-old woman with RHS with involvement of V, VII, VIII, IX, and XII cranial nerves. The patient showed significant improvement after treatment with acyclovir and prednisolone. RHS should be recognized as a polycranial neuritis characterized by damage to sensory and motor nerves, including the facial nerve and the auditory-vestibular apparatus. Early institution of treatment with antiviral agents may help hasten healing. Involvement of the XIIth cranial nerve has not been reported previously. PMID: 12244896 [PubMed - indexed for MEDLINE] 1708. Lancet. 2002 Aug 31;360(9334):678-82. Contacts with varicella or with children and protection against herpes zoster in adults: a case-control study. Thomas SL, Wheeler JG, Hall AJ. Infectious Disease Epidemiology Unit, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK. Sara.Thomas@lshtm.ac.uk BACKGROUND: Whether exogenous exposure to varicella-zoster-virus protects individuals with latent varicella-zoster virus infection against herpes zoster by boosting immunity is not known. To test the hypothesis that contacts with children increase exposure to varicella-zoster virus and protect latently infected adults against zoster, we did a case-control study in south London, UK. METHODS: From 22 general practices, we identified patients with recently diagnosed zoster, and control individuals with no history of zoster, matched to patients by age, sex, and practice. Participants were asked about contacts with people with varicella or zoster in the past 10 years, and social and occupational contacts with children as proxies for varicella contacts. Odds ratios were estimated with conditional logistic regression. FINDINGS: Data from 244 patients and 485 controls were analysed. On multivariable analysis, protection associated with contacts with a few children in the household or via childcare seemed to be largely mediated by increased access to children outside the household. Social contacts with many children outside the household and occupational contacts with ill children were associated with graded protection against zoster, with less than a fifth the risk in the most heavily exposed groups compared with the least exposed. The strength of protection diminished after controlling for known varicella contacts; the latter remained significantly protective (odds ratio 0.29 [95% CI 0.10-0.84] for those with five contacts or more). INTERPRETATION: Re-exposure to varicella-zoster virus via contact with children seems to protect latently infected individuals against zoster. Reduction of childhood varicella by vaccination might lead to increased incidence of adult zoster. Vaccination of the elderly (if effective) should be considered in countries with childhood varicella vaccination programmes. PMID: 12241874 [PubMed - indexed for MEDLINE] 1709. Presse Med. 2002 Aug 24;31(27):1270. [Herpes zoster of the maxillary branch of the trigeminal nerve] [Article in French] Sterkers Y, Botterel F, Nicolas M, Bourée P. Unité de maladies tropicales et parasitaires CHU 78, rue du Général Leclerc 94275 Le Kremlin-Bicêtre. francoise.botterel@bct.ap-hop-paris.fr PMID: 12238275 [PubMed - indexed for MEDLINE] 1710. Pediatr Infect Dis J. 2002 Jul;21(7):615-7. Chickenpox and the geniculate ganglion: facial nerve palsy, Ramsay Hunt syndrome and acyclovir treatment. Grose C, Bonthius D, Afifi AK. Department of Pediatrics, University of Iowa College of Medicine, Iowa City 52242, USA. charles-grose@uiowa.edu Facial nerve palsy has long been considered to have an infectious etiology. Recent diagnostic analyses in children and adults have provided convincing evidence that reactivation of varicella-zoster virus (VZV), sometimes during infectious mononucleosis, can lead to cranial nerve VII palsy. The site of reactivation from latency is the geniculate ganglion. Virus most likely enters the ganglion during chickenpox, via the sensory branches of the facial nerve located on the ear and tongue. Retrospective reviews suggest that patients with VZV-related facial nerve palsy have poorer outcomes than other cases of Bell's palsy. Therefore treatment with acyclovir is suggested when VZV reactivation i slikely. PMID: 12237590 [PubMed - indexed for MEDLINE] 1711. Arch Phys Med Rehabil. 2002 Sep;83(9):1215-21. Herpes zoster of the head and limbs: electroneuromyographic and clinical findings in 158 consecutive cases. Mondelli M, Romano C, Rossi S, Cioni R. Servizio di EMG, ASL 7, Siena, Italy. m.mondelli@us17.toscana.it OBJECTIVES: To quantify electromyographic and neurographic changes and to correlate them with the clinical data of outpatients with herpes zoster. DESIGN: Prospective case series. SETTING: Outpatient department. PATIENTS: A consecutive, unselected series of 158 outpatient cases (88 women, 70 men; mean age, 64y) of herpes zoster of the head and limbs. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Blink reflex and electromyography and motor and sensory nerve conduction velocities of nerves and muscles corresponding to affected dermatomes. RESULTS: Postherpetic neuralgia (PHN), segmental zoster paresis, and polyneuropathy were found in 31%, 19%, and 2.5% of cases, respectively. Absence or reduction of sensory action potential amplitudes, blink reflex areas, and compound muscle action potential amplitudes were found in 60%, 31%, and 18% of cases, respectively. Sensory and motor conduction velocities and motor and blink reflex latencies were nearly always normal or only slightly slowed. Electromyographic signs of abnormal spontaneous activity were found in 36% of the cases. Electrophysiologic alterations were correlated among themselves, with age, with presence of segmental zoster paresis, and with absence of antiviral therapy. The extent of the skin rash (number of dermatomes affected by herpes zoster) was the only variable predictive of disappearance or improvement of PHN. CONCLUSIONS: Sensory axonal neuropathy, often associated with similar motor involvement, can be shown by classical electrophysiologic methods in herpes zoster. The severity of damage to motor fibers was related to damage to sensory fibers, but no relation was found between peripheral axon damage and PHN. The site of motor system damage may be the ventral roots, plexus, or peripheral nerve. The probability of complications and the severity of sensory and motor peripheral axonal damage were increased in older patients. Appropriate antiviral therapy seems to reduce the incidence of segmental zoster paresis and the severity of damage to the peripheral fibers. A reduced extent of herpetic rash was the only factor to correlate with a good outcome of PHN. PMID: 12235600 [PubMed - indexed for MEDLINE] 1712. J Neurol Neurosurg Psychiatry. 2002 Oct;73(4):457-8. Amelioration of spinal myoclonus with levetiracetam. Keswani SC, Kossoff EH, Krauss GL, Hagerty C. PMCID: PMC1738068 PMID: 12235322 [PubMed - indexed for MEDLINE] 1713. J Dermatol Sci. 2002 Sep;29(3):201-5. Expression of inducible nitric oxide synthase in skin lesions of acute herpes zoster. Lim YJ, Chang SE, Choi JH, Sung KJ, Bahk JH, Do SH, Lee DS. Department of Anesthesiology and Clinical Research Institute, Seoul National University Hospital, 28 Yongon-dong, Chongno-gu, 110-744 Seoul, South Korea. Histopathologically, the skin lesions of acute herpes zoster (AHZ) are characterized by epidermal necrotic vesicles with inflammation. Nitric oxide (NO) is generated from L-arginine by nitric oxide synthase (NOS), and immune inflammation involves the activation of NOS in both effector cells and target cells. NO can cause apoptosis and necrosis of target cells such as keratinocytes. We proposed that a large burst of NO in AHZ may cause the epidermal necrosis. Skin biopsies were taken from 13 patients with AHZ. The expression of inducible-type NOS (iNOS) was examined by immunoperoxidase staining and reverse transcription-polymerase chain reaction (RT-PCR). In the skin specimen of AHZ, moderate-to-strong staining for iNOS was observed in inflammatory cells and necrotic keratinocytes, while weak staining was observed in non-necrotic peripheral keratinocytes. RT-PCR using skin specimen of AHZ corroborated the immunoperoxidase findings, yielding bright bands for iNOS. Normal control skin showed minimal or negative expression both by immunoperoxidase stains and RT-PCR. Increased expression of iNOS is consistent with the hypothesis that high level of NO induced by iNOS may be associated with the epidermal necrosis with inflammation seen in the skin lesions of AHZ. PMID: 12234710 [PubMed - indexed for MEDLINE] 1714. Duodecim. 2002;118(6):645-7. [Necrosis of the nose tip] [Article in Finnish] Pitkäranta A, Hytönen M. HYKS:n korva-, nenä ja kurkkutautien klinikka PL 220, 00029 Helsinki. anne.pitkäranta@hus.fi PMID: 12233008 [PubMed - indexed for MEDLINE] 1715. J Infect Dis. 2002 Oct 1;186(7):888-94. Epub 2002 Sep 13. The molecular epidemiology of varicella-zoster virus: evidence for geographic segregation. Quinlivan M, Hawrami K, Barrett-Muir W, Aaby P, Arvin A, Chow VT, John TJ, Matondo P, Peiris M, Poulsen A, Siqueira M, Takahashi M, Talukder Y, Yamanishi K, Leedham-Green M, Scott FT, Thomas SL, Breuer J. Department of Medical Microbiology, School of Medicine, Queen Mary College, London, United Kingdom. Of 75 varicella-zoster virus (VZV) isolates obtained from patients in Africa, Asia, and the Far East, 74 (98.6%) were found to be positive for a BglI restriction site in gene 54. By contrast, <22% of strains from patients in the United Kingdom and in North and South America were positive for the BglI restriction site. Viruses positive for BglI were significantly more common in zoster occurring in patients of nonwhite origin (P<.05). Irrespective of the country in which the sample was obtained, 98% of strains positive for BglI clustered within a single phylogenetic group, which we termed "group A"; the exception was 1 strain that appeared to be recombinant genotype C/A. We used the BglI site to examine both the spread of type A viruses in the United Kingdom and the patterns of VZV infections within persons from different ethnic groups who grew up in the United Kingdom or abroad. PMID: 12232828 [PubMed - indexed for MEDLINE] 1716. Clin Evid. 2002 Jun;(7):738-46. Postherpetic neuralgia. Lancaster T, Wareham D, Yaphe J. Department of Primary Health Care University of Oxford, Oxford, UK. Update in: Clin Evid. 2003 Jun;(9):890-900. PMID: 12230700 [PubMed - indexed for MEDLINE] 1717. J Eur Acad Dermatol Venereol. 2002 Jul;16(4):357-60. Varicella zoster viraemia during herpes zoster is not associated with neoplasia. Bezold G, Lange M, Pillekamp H, Peter RU. Department of Dermatology, University of Ulm, Germany. BACKGROUND: Shingles are caused by an endogenous or exogenous reinfection with varicella zoster virus (VZV). Up to 50% of individuals with Hodgkin's disease develop herpes zoster; however, no association could be shown between the occurrence of herpes zoster and underlying subclinical malignancies. OBJECTIVE: This study was conducted to investigate whether VZV DNA could be detected by polymerase chain reaction (PCR) in the blood of herpes zoster patients and whether there was an association between VZV viraemia and previous or concurrent neoplasias. METHODS: At least five blood samples from 28 patients with herpes zoster were investigated by internally controlled PCR enzyme-linked immunosorbent assay prior to and during therapy with aciclovir. RESULTS: None of 13 patients, two with a history of neoplasia and two with a neoplasia at the time of the study, showed any signs of viraemia with VZV, and 14 patients had inconsistent viraemia, one with a history of neoplasia and two with neoplasia at the time of the study. In one patient VZV DNA was detected in the blood for 6 days. This patient died soon after from metastatic malignant melanoma. CONCLUSIONS: VZV viraemia may occur during herpes zoster episodes, even in patients without evidence of immunosuppression; however, this viraemia is, in most cases, inconsistent and does not provide any specific information concerning underlying unrecognized malignancies. PMID: 12224692 [PubMed - indexed for MEDLINE] 1718. Eur J Ophthalmol. 2002 Jul-Aug;12(4):267-75. Corneal epithelial keratitis in herpes zoster ophthalmicus: "delayed" and "sine herpete". A non-contact photomicrographic in vivo study in the human cornea. Tabery HM. Department of Ophthalmology, Malmö University Hospital, Sweden. helena.tabery@oftal.mas.lu.se PURPOSE: To investigate the origin of corneal epithelial keratitis occurring without accompanying herpes zoster ophthalmicus (HZO) cutaneous rash. METHODS: Corneal epithelial lesions in seven patients (four with a history of classical HZO with cutaneous rash, one of herpes zoster oticus, and two with no history of herpes zoster, were examined with the slit lamp and photographed by non-contact in vivo photomicrography. The findings were compared with lesions in classical acute HZO. Polymerase chain reaction (PCR) was done in three patients. RESULTS: Slit lamp appearance, morphology at higher magnification, and kinetics of the lesions were indistinguishable from classical acute HZO. PCR was positive for varicella-zoster virus DNA in all three samples. CONCLUSIONS: The findings strongly suggest that HZO typical corneal epithelial lesions occurring in the absence of cutaneous rash are in fact recurrent episodes of virus shedding. PMID: 12219995 [PubMed - indexed for MEDLINE] 1719. Clin J Pain. 2002 Sep-Oct;18(5):297-301. The lidocaine patch 5% effectively treats all neuropathic pain qualities: results of a randomized, double-blind, vehicle-controlled, 3-week efficacy study with use of the neuropathic pain scale. Galer BS, Jensen MP, Ma T, Davies PS, Rowbotham MC. Pain Clinical Research, University of Washington Multidisciplinary Pain Center, Seattle Washington, USA. galer.bradley@endo.com BACKGROUND: Several controlled clinical trials have demonstrated the efficacy and safety of the lidocaine patch 5% (LP) for the treatment of postherpetic neuralgia (PHN). OBJECTIVE: To assess the effects of the LP on distinct neuropathic pain qualities common to all neuropathic pain conditions, the authors analyzed data from one of the vehicle-controlled trials in which the Neuropathic Pain Scale (NPS), the only assessment tool specifically designed to measure the distinct components of neuropathic pain, was administered. METHODS AND RESULTS: To improve the sensitivity of the NPS to treatment effects, only patients who, at the time of enrollment in the study, reported moderate-to-severe pain on the NPS (as defined by a score > or =4/10 reported for at least 6 of the 10 individual NPS items) were included in the analysis. Thus, 96 patients were included in this analysis. After a 3-week, vehicle-controlled study, LP improved all assessed pain qualities to a greater extent than the placebo patch, as measured by the NPS 10, a sum score including all 10 NPS item scores ( = 0.043), and an NPS 8 score, which included scores for all 8 pain descriptors, excluding "unpleasantness" and "global intensity" ( = 0.042). Separate analysis of all 8 items believed not to reflect allodynia (NPS NA; excluding "skin sensitivity" and "surface pain") also demonstrated superiority ( = 0.022), as did analysis of the subitems that are believed not to be primarily related to peripheral pathophysiological events (the "NPS 4": "sharp," "hot," "dull," and "deep" pains; = 0.013). CONCLUSIONS: This study demonstrates that LP reduces the intensity of all common neuropathic pain qualities and thus may be of potential benefit for nonallodynic neuropathic pain states. Furthermore, these findings suggest that peripheral mechanisms may play a role in the pathophysiological development of pain qualities that heretofore have been assumed not to involve peripheral mechanisms, such as "dull," "deep," "sharp," and "burning" pains. PMID: 12218500 [PubMed - indexed for MEDLINE] 1720. Lancet Oncol. 2002 Sep;3(9):523. Vaccination with varicella protects against zoster infection. Ahmad K. PMID: 12217782 [PubMed - indexed for MEDLINE] 1721. Rheumatol Int. 2002 Sep;22(5):213-5. Epub 2002 Jul 16. Pulmonary alveolar microlithiasis after Varicella zoster infection in a patient presenting with antiphospholipid syndrome and discoid lupus. Yilmaz MI, Koc B, Kantarcioglu M, Akinci SB, Ayta H, Bulucu F, Bal S. Department of Internal Medicine, Gulhane School of Medicine, 06018 Etlik, Ankara, Turkey. mahmutiyilmaz@yahoo.com Comment in: Rheumatol Int. 2005 Mar;25(2):152-3. We present a case with diagnosis of pulmonary alveolar microlithiasis that illustrates the appearance of this rare chronic lung disease on conventional chest X-ray, high-resolution CT, and transbronchial lung biopsy. This is the first case reported which developed pulmonary alveolar microlithiasis after Varicella zoster infection in a patient with antiphospholipid antibodies and discoid lupus. PMID: 12215869 [PubMed - indexed for MEDLINE] 1722. Arch Ophthalmol. 2002 Sep;120(9):1219-22. Intravitreal antivirals in the management of patients with acquired immunodeficiency syndrome with progressive outer retinal necrosis. Scott IU, Luu KM, Davis JL. Bascom Palmer Eye Institute, PO Box 016880, Miami, FL 33101, USA. PMID: 12215102 [PubMed - indexed for MEDLINE] 1723. Arch Ophthalmol. 2002 Sep;120(9):1183-8. A relationship between varicella-zoster virus-specific delayed hypersensitivity and varicella-zoster virus-induced anterior uveitis. Kezuka T, Sakai J, Minoda H, Takeuchi M, Keino H, Streilein JW, Usui M. Department of Ophthalmology, Hachioji Medical Center, Tokyo Medical University, 1163, Tate-machi, Hachioji-city, Tokyo, 193-8639, Japan. tkezuka@tokyo-med.ac.jp BACKGROUND: We recently reported that acute retinal necrosis in humans develops in a setting where delayed hypersensitivity (DH) to the varicella-zoster virus (VZV) antigen was absent, implying that virus-specific DH mitigates against acute retinal necrosis. OBJECTIVE: To determine whether a similar correlation exists for patients with anterior uveitis caused by VZV. DESIGN: Using VZV and purified protein derivative (PPD) antigens to evaluate DH, we skin tested patients with acute, VZV-induced anterior uveitis (herpes zoster ophthalmicus [ZO-AU]) (n = 12), those with uveitis caused by VZV in the absence of dermatitis (zoster sine herpete [ZSH-AU]) (n = 3), and age-matched patients whose ophthalmic herpes zoster was unassociated with uveitis as controls (n = 7). Varicella-zoster virus-induced anterior uveitis was diagnosed by polymerase chain reaction methods and serum antibody titration. Serum samples were collected and analyzed for anti-VZV antibody titers. Anterior uveitis activity was assessed clinically. Delayed hypersensitivity skin tests were repeated in patients with zoster sine herpete 3 months after onset, when ocular recovery had taken place. RESULTS: All patients with VZV-induced skin disease alone (control group) displayed intense DH when tested with VZV and PPD antigens. By contrast, only 4 (33%) of 12 patients with ZO-AU had a positive DH to VZV, whereas 11 (91.6%) of these patients displayed positive PPD skin reactions. The clinical intensity of anterior uveitis correlated negatively with VZV DH responses (P<.05). Serum anti-VZV and anti-herpes simplex virus antibody titers were comparable in DH-positive VZV cases and in DH-negative patients with uveitis. Patients with uveitis and ZSH-AU also displayed absent VZV-specific DH, although their PPD responses were normal. MAIN OUTCOME MEASURES: Varicella-zoster virus-specific DH, PPD-specific DH, VZV-specific antibody titration, and intraocular pressure in patients with ZO-AU. CONCLUSIONS: Absence (or loss) of DH reactivity to VZV antigens seems to be a concomitant feature of VZV uveitis of high intensity, implying that virus-specific DH may interfere with the emergence of VZV-induced anterior uveitis, as it does for acute retinal necrosis. CLINICAL RELEVANCE: In a clinical setting, absence of virus-specific DH to anterior uveitis caused by VZV may not only reveal a possible pathogenic mechanism, but a negative DH response may prove useful in diagnosing ZSH-AU in the acute stage. PMID: 12215092 [PubMed - indexed for MEDLINE] 1724. Hunan Yi Ke Da Xue Xue Bao. 2000 Jun 28;25(3):310-1. [Clinical analysis of 134 cases of herpes zoster] [Article in Chinese] Xie ZC. PMID: 12212183 [PubMed - indexed for MEDLINE] 1725. Rev Med Virol. 2002 Sep-Oct;12(5):327-34. Varicella-zoster virus latency in human ganglia. Kennedy PG. Glasgow University Department of Neurology, Institute of Neurological Sciences, Southern General Hospital, Glasgow G51 4TF, Scotland, UK. P.G.Kennedy@clinmed.gla.ac.uk Varicella-zoster virus (VZV) is a human herpesvirus which causes varicella (chickenpox) as a primary infection, and, following a variable period during which it remains in latent form in trigeminal and dorsal root ganglia, reactivates in later life to cause herpes zoster (shingles). VZV is a significant cause of neurological disease including post-herpetic neuralgia which may be persistent and highly resistant to treatment, and small and large vessel encephalitis. VZV infections are more frequent with advancing age and in immunocompromised individuals. An understanding of the mechanisms of latency is crucial in developing effective therapies for VZV infections of the nervous system. Such studies have been hampered by the difficulties in working with the virus and also the lack of a good animal model of VZV latency. It is known that the ganglionic VZV burden during latency is low. Two of the key questions that have been addressed are the cellular site of latent VZV and the identity of the viral genes which are transcribed during latency. There is now a consensus that latent VZV resides predominantly in ganglionic neurons with less frequent infection of non-neuronal satellite cells. There is considerable evidence to show that at least five viral genes are transcribed during latency. Unlike herpes simplex virus-1 latency, viral protein expression has been demonstrated during VZV latency. A precise knowledge of which viral genes are expressed is crucial in devising novel antiviral therapy using expressed genes as therapeutic targets. Whether gene expression at both the transcriptional and translational levels is more extensive than currently reported will require much more work and probably new molecular technology. Copyright 2002 John Wiley & Sons, Ltd. PMID: 12211045 [PubMed - indexed for MEDLINE] 1726. Int J Dermatol. 2002 Aug;41(8):528. Recurrent herpes zoster revisited. Burkhart CN. PMID: 12207778 [PubMed - indexed for MEDLINE] 1727. Emerg Med J. 2002 Sep;19(5):460. An unusual presentation of a lumbar hernia. Hindmarsh A, Mehta S, Mariathas DA. Deptartment of Accident and Emergency, Broomfield Hospital, Chelmsford, CM1 7BU, UK. PMCID: PMC1725948 PMID: 12205008 [PubMed - indexed for MEDLINE] 1728. Prescrire Int. 2002 Aug;11(60):111-2. Gabapentin: new indication. In postherpetic neuralgia when amitriptyline fails. [No authors listed] (1) Postherpetic pain is infrequent, but the incidence increases with age. (2) The reference treatment for postherpetic pain is oral amitriptyline or desipramine. (3) Gabapentin, an antiepileptic agent, is the first drug to be granted specific approval in France for the treatment of postherpetic pain. (4) In two placebo-controlled trials, gabapentin at a dose of between 1 800 and 3 600 mg/day halved the intensity of pain in about one in three patients. In comparison, pain improved in about 50% of patients taking amitriptyline in clinical trials. (5) Both gabapentin and amitriptyline provoke sedation, but dizziness and peripheral oedema are more frequent on gabapentin, while atropinic effects predominate with amitriptyline. (6) Daily treatment is 10 times more costly in France. (7) In practice, the standard treatment of postherpetic pain remains oral amitriptyline or desipramine. Gabapentin is an alternative, given its different safety profile. PMID: 12199264 [PubMed - indexed for MEDLINE] 1729. Med J Aust. 2002 Sep 2;177(5):267-73. 10: Herpes simplex and varicella-zoster virus infections. Dwyer DE, Cunningham AL. Centre for Infectious Diseases and Microbiology Laboratory Service, ICPMR, Westmead Hospital, PO Box 533, Wentworthville, NSW 2145. dominic_dwyer@wmi.usyd.edu.au Any new patient with suspected genital herpes should have diagnostic testing with virus identification. Type-specific serological tests that distinguish between antibodies for type 1 and type 2 herpes simplex virus (HSV) may be useful to determine previous exposure but cannot be used to diagnose recurrences of genital herpes. Initial episodes of genital herpes usually require antiviral therapy, while recurrences may be treated with continuous antiviral suppression (if frequent) or episodic therapy; patient counselling and education (including how to recognise lesions) are essential. Topical or systemic therapy is available for initial and recurrent non-genital herpes simplex. Primary varicella infection (chickenpox) and herpes zoster (shingles) are usually diagnosed clinically, but can be confirmed by detection of varicella-zoster virus antigens or nucleic acid from swabs of lesions or by antibody tests. Antiviral therapy should be considered in chickenpox if disease is complicated or the patient is immunocompromised. In herpes zoster, antiviral therapy should be given within 72 hours of onset to patients aged over 50 years or with severe pain or neurological abnormalities to reduce the likelihood and duration of postherpetic neuralgia. The availability of effective antiviral therapy makes early diagnosis vital PMID: 12197826 [PubMed - indexed for MEDLINE] 1730. Aust Fam Physician. 2002 Aug;31(8):696. Antiherpes zoster treatment. Liberman S. PMID: 12189656 [PubMed - indexed for MEDLINE] 1731. Duodecim. 2001;117(13):1339-41. [A persistent chest pain in a middle-aged woman] [Article in Finnish] Pitkäpaasi M. Riihimäen terveyskeskus Penttilänkatu 5, 11100 Riihimäki. PMID: 12184122 [PubMed - indexed for MEDLINE] 1732. Drugs Aging. 2002;19(7):503-14. Viral skin infections in the elderly: diagnosis and management. Bansal R, Tutrone WD, Weinberg JM. Department of Dermatology, St. Luke's-Roosevelt Hospital Center, 1090 Amsterdam Avenue, New York, NY 10025, USA. Over the past several years, there have been advances in the diagnosis and treatment of cutaneous viral diseases in elderly patients. Herpes zoster is caused by reactivation in adults of the varicella-zoster virus (VZV) that causes chickenpox in children. For many years, aciclovir was the gold standard of antiviral therapy for the treatment of herpes zoster. Famciclovir and valaciclovir are newer antivirals, which offer less frequent administration. Postherpetic neuralgia (PHN) refers to pain lasting 2 months or more after an acute attack of herpes zoster. The pain may be constant or intermittent. The treatment of established PHN may include topical anaesthetics, analgesics, tricyclic antidepressants and anticonvulsants, and nonpharmacological therapy may be used to complement such treatment. Therapeutic strategies to prevent PHN include the use of oral corticosteroids, nerve blocks, and treatment with standard antiviral therapy. The three most recently discovered human herpes viruses (HHV-6, HHV-7 and HHV-8), in common with the other members of the family, may cause a primary infection, establish latent infection in a specific set of cells in their host, and then reactivate if conditions of altered immunity develop. These viruses have been associated with an array of disorders, which are important for the clinician to recognise. Cytomegalovirus (CMV) is a member of the herpesvirus family that is very prevalent worldwide. More than 80% of primary infections and 20% of reactivation-producing symptoms occur in transplant populations. Treatment options include intravenous administration of ganciclovir, foscarnet or cidofovir. Herpes simplex virus (HSV) most commonly affects the genital and perioral regions. In the elderly, HSV infection is typically manifest at the vermilion border of the lip. The main concern of recurrent herpes labialis in the elderly is related to potential autoinoculation of the eye or genital area. Treatment with aciclovir, famciclovir or valaciclovir is indicated for these infections. Molluscum contagiosum is caused by a poxvirus, which produces cutaneous lesions that appear as small, firm, umbilicated papules. Immunocompromised patients often do not respond to the usual destructive therapies, and intravenous or topical cidofovir may be useful in these patients. PMID: 12182687 [PubMed - indexed for MEDLINE] 1733. Bone Marrow Transplant. 2002 Apr;29(8):659-66. Impact of high-dose chemotherapy on antigen-specific T cell immunity in breast cancer patients. Application of new flow cytometric method. Svane IM, Nikolajsen K, Hansen SW, Kamby C, Nielsen DL, Johnsen HE. Department of Oncology, Herlev Hospital/University of Copenhagen, DK-2730 Herlev, Denmark. The present study analyses the influence of high-dose chemotherapy (HD) and autologous stem cell transplantation on natural and vaccine-induced specific immunity in breast cancer patients. Peripheral blood was collected from five breast cancer patients at serial time points in connection with treatment and in a follow-up period of 1 year. The frequencies of CD8+ and CD4+ T cells responsive to cytomegalovirus (CMV), varicella zoster virus (VZV), and tetanus in antigen-activated whole blood were determined by flow cytometric analysis of CD69, TNF alpha, IFN gamma and IL-4 expression. Mononuclear cells were labelled with PKH26 dye and the CMV, VZV, and tetanus toxoid-specific proliferation of T cell subpopulations was analysed by flow cytometry. In none of the patients did the treatment result in loss of overall T cell reactivity for any of the antigens. Prior to chemotherapy 5/5 patients possessed TNF alpha expressing T cells specific for CMV, 4/5 for VZV, and 3/5 for tetanus. One year after stem cell transplantation all patients possessed TNF alpha expressing T cells specific for CMV, VZV and tetanus. The highest percentages of cytokine-responding T cells were seen after stimulation with CMV antigen. In general, the lowest reactivity (close to zero) was measured in G-CSF-mobilised blood at the time of leukapheresis. In spite of a continuously reduced CD4 to CD8 ratio after transplantation, recovery of CD4+ T cells usually occurred prior to CD8+ recovery and often to a higher level. The study demonstrates that natural as well as vaccine-induced specific immunity established prior to HD can be regained after stem cell transplantation. These data indicate that introduction of a preventive cancer vaccination in combination with intensive chemotherapy may be a realistic treatment option. PMID: 12180110 [PubMed - indexed for MEDLINE] 1734. Eur J Pediatr. 2002 Aug;161(8):442-4. Epub 2002 Jun 25. Herpes zoster by reactivated vaccine varicella zoster virus in a healthy child. Uebe B, Sauerbrei A, Burdach S, Horneff G. Department of Paediatrics, University Hospital, Martin-Luther University Halle-Wittenberg, 06097 Halle, Germany. barbara.uebe@medizin.uni-halle.de Varicella can be prevented by vaccination using the live-attenuated Oka vaccine strain of varicella zoster virus (VZV). Only mild breakthrough disease has been reported in seronegative vaccinees when exposed to the wild-type virus. The latent varicella vaccine virus has rarely caused herpes zoster in childhood and adolescence. We report a healthy 2-year-old girl who developed an impressive herpes zoster infection 16 months after vaccination, localised in three cervical dermatoma. As causative virus, VZV vaccine strain was identified by polymerase chain reaction and analysis of restriction fragment length polymorphisms of the amplified products. CONCLUSION: vaccine varicella zoster virus can occasionally reactivate in healthy children and present as herpes zoster. Virus characterisation is necessary to identify the strain and provide information on the incidence of occurrence. PMID: 12172829 [PubMed - indexed for MEDLINE] 1735. Chest. 2002 Aug;122(2):715-7. Use of endoscopic transthoracic sympathicotomy in intractable postherpetic neuralgia of the chest. Matsumoto I, Oda M, Shintani H. Departments of Surgery, Komatsu Municipal Hospital, Komatsu, Japan. naochan@f3.dion.ne.jp Although there are various treatments for postherpetic neuralgia (PHN), none produces definitive effects. We report a case of 72-year-old woman who developed intractable PHN of the chest in which treatment with endoscopic transthoracic sympathicotomy (ETS) produced long-term effective results. When hyperesthesia of the sympathetic nerve participates in PHN, the blocking of sympathetic excitation seems to be effective for PHN suppression. The method using a single resectoscope is safe, accurate, yields excellent results cosmetically, and generates minimal invasion and very little postoperative pain. Although ETS is not always effective for all cases of PHN, it could be a useful method of treating patients with PHN that is resistant to conventional therapies. PMID: 12171855 [PubMed - indexed for MEDLINE] 1736. J Commun Dis. 2001 Jun;33(2):130-5. Presentations of cranial nerve involvement in two patients with Herpes zoster ophthalmicus. Sodhi PK, Goel JL. Maulana Azad Medical College and Allied Guru Nanak Eye Centre, New Delhi-110 002, India. Two cases of Herpes zoster ophthalmicus complicated by motor nerve palsies are being reported. The investigations ruled out other diseases which can affect ocular motor nerves, e.g., diabetes, hypertension, syphilis and malignancy. The cases are being reported because of the rare presentations of Herpes zoster ophthalmicus like isolated internal ophthalmoplegia and VI nerve palsy in Case-1 and absence of iritis with third nerve involvement in Case-2. The probable etiology for occurrence of these uncommon phenomena has been postulated. PMID: 12170933 [PubMed - indexed for MEDLINE] 1737. Otol Neurotol. 2002 Jul;23(4):602-7. Detection of varicella zoster virus DNA in tear fluid and saliva of patients with Ramsay Hunt syndrome. Hiroshige K, Ikeda M, Hondo R. Department of Otolaryngology, Nihon University School of Medicine, 30-1 Oyaguchi, Itabashi-ku, Tokyo 173-8610, Japan. OBJECTIVE: To clarify the dynamics of the reactivation of the varicella zoster virus in Ramsay Hunt syndrome. SUBJECTS AND METHODS: Varicella zoster virus DNA in the tear fluid, submandibular gland saliva, and parotid gland saliva of 15 patients with Ramsay Hunt syndrome was studied. The presence of varicella zoster virus DNA was detected quantitatively by the use of polymerase chain reaction and a microplate hybridization method. RESULTS: Of 102 specimens of the tear fluid and saliva collected from 15 patients, varicella zoster virus DNA was detected in 40 specimens (39%) from 12 patients (80%). The detection rate was 72% in the submandibular saliva, 57% in the parotid saliva, and 27% in the tear fluid. Varicella zoster virus DNA was detected not only in specimens from the affected side but also in specimens from the unaffected side at the same rate of detection, and at nearly the same number of DNA copies. Regarding the parotid saliva, varicella zoster virus DNA was detected in samples collected at an early stage of the disease. In the tear fluid and submandibular saliva, however, the detection rate was high in samples collected 2 weeks after the onset of disease or later. CONCLUSIONS: Secretion of varicella zoster virus DNA into the tear fluid and saliva was confirmed in the patient with Ramsay Hunt syndrome. The increase and decrease in the detection rate and the number of varicella zoster virus DNA copies detected in samples collected at different times was considered to substantiate varicella zoster virus reactivation in Ramsay Hunt syndrome. Varicella zoster virus reactivation was thought to occur in the unaffected side at the same level as in the affected side, and some of the secreted varicella zoster virus DNA was suspected to be derived from the ganglion trigeminale. PMID: 12170168 [PubMed - indexed for MEDLINE] 1738. Masui. 2002 Jul;51(7):777-9. [A case of effective treatment with clonidine ointment for herpetic neuralgia after bone marrow transplantation in a child] [Article in Japanese] Hagihara R, Meno A, Arita H, Hanaoka K. Department of Anesthesiology and Pain Relief Center, The University of Tokyo Hospital, Tokyo 113-8655. We report a case of effective treatment with clonidine ointment for herpetic neuralgia in a child. Clonidine hydrochloride is an alpha 2-agonist. It is generally administered intravenously, intramuscularly, intrathecally and orally. However, there have been only a few reports on transdermal usage. In our department, we have investigated the analgesic effect of topical application of clonidine in adults, and we have obtained sufficient evidence on the effects of clonidine. Therefore, we decided to use clonidine to a child. A 9-year-old child who had undergone BMT and developed herpes zoster was experiencing severe pain, itch, and insomnia. Many drugs were ineffective in relieving the pain, itch, and insomnia. To remove the symptoms, we tried clonidine ointment. Immediate improvement was observed in all the symptoms. Therefore, clonidine ointment was thought to be effective and we decided to prescribe clonidine ointment and amitriptyline hydrochloride. The application of clonidine showed no side effects such as bradycardia and low blood pressure. We conclude that clonidine can be administered to children without causing side effects. PMID: 12166288 [PubMed - indexed for MEDLINE] 1739. Ophthalmology. 2002 Aug;109(8):1532-7. Visual outcome in herpes simplex virus and varicella zoster virus uveitis: a clinical evaluation and comparison. Miserocchi E, Waheed NK, Dios E, Christen W, Merayo J, Roque M, Foster CS. Immunology and Uveitis Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston 02114, USA. PURPOSE: To compare clinical characteristics and outcomes in patients with uveitis caused by herpes simplex virus (HSV) and varicella zoster virus (VZV). DESIGN: Retrospective comparative study. PARTICIPANTS: Forty patients with HSV uveitis and 24 patients with VZV uveitis. METHODS: A retrospective study of 40 patients with HSV and 24 patients with VZV uveitis was performed. The patients were followed between May 1987 and September 1999 (median follow-up time, 46 months). The diagnosis of HSV uveitis was made clinically and serologically, and the diagnosis of VZV uveitis was made clinically. MAIN OUTCOME MEASURES: Clinical presentation of the disease, ocular complications, visual acuity, surgical and medical treatments needed. RESULTS: Both populations were comparable for gender and age at disease onset. The course of the disease tended to be remitting and recurrent in HSV patients and chronic in VZV patients (P = 0.046). The most frequent ocular complication in both groups was secondary glaucoma (54% HSV, 38% VZV). Twenty-five percent of VZV patients developed posterior pole complications (cystoid macular edema, epiretinal membrane, papillitis, retinal fibrosis, and detachment) compared with 8% of HSV patients (P = 0.069). Treatment modalities selected were generally similar in the two groups, although periocular and systemic steroids were required more frequently in HSV patients (60% versus 25%; P = 0.01). Surgical procedures were required with similar frequency in both populations. The percentage of eyes that were legally blind at end of follow-up was also comparable (HSV, 20%; VZV, 21%). The visual outcome was similar in the studied populations. CONCLUSIONS: This study represents the only direct comparison of HSV and VZV uveitis patients reported in the literature. HSV patients were more likely to be treated with periocular and systemic steroids, and VZV patients were more likely to develop posterior pole complications (a finding of borderline significance). Other parameters evaluated in this study were not statistically different in the two patient groups. PMID: 12153807 [PubMed - indexed for MEDLINE] 1740. N Engl J Med. 2002 Aug 1;347(5):340-6. Clinical practice. Herpes zoster. Gnann JW Jr, Whitley RJ. Departments of Medicine, University of Alabama at Birmingham, Birmingham, Ala 35294-2170, USA. Comment in: N Engl J Med. 2003 May 15;348(20):2044-5; author reply 2044-5. N Engl J Med. 2003 May 15;348(20):2044-5; author reply 2044-5. PMID: 12151472 [PubMed - indexed for MEDLINE] 1741. Obstet Gynecol. 2002 Aug;100(2):260-5. Frequency of congenital varicella syndrome in a prospective cohort of 347 pregnant women. Harger JH, Ernest JM, Thurnau GR, Moawad A, Thom E, Landon MB, Paul R, Miodovnik M, Dombrowski M, Sibai B, Van Dorsten P, McNellis D; National Institute of Child Health and Human Development Network of Maternal-Fetal Medicine Units. University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213, USA. jharger@pitt.edu OBJECTIVE: To estimate the rate of congenital varicella zoster virus syndrome in neonates born to women developing varicella zoster virus infections during pregnancy. METHODS: Pregnant women with clinical varicella zoster virus infection were enrolled at ten perinatal centers. Maternal and fetal immunoglobulin (Ig) G and IgM by fluorescent antibody confirmed 74.3% of cases. Specialists examined neonates at 0-6 months, 7-18 months, and 19-30 months after delivery to detect abnormalities of their eyes, hearing, and physical and developmental features. A hierarchical set of criteria was used to define congenital varicella syndrome. A jury of four investigators assigned the classification of all findings. RESULTS: In 362 women enrolled from 1993 to 1996, 15 had herpes zoster, and 347 had primary varicella zoster virus infection. Varicella zoster virus affected 140 women (38.7%) in the first trimester, 122 (33.7%) in the second trimester, and 100 (27.6%) in the third trimester. Five twin pairs were included. Only one case (0.4%) of definite congenital varicella syndrome was found, a 3360-g female infant having a left retinal macular lesion with typical skin scars after maternal varicella at 24 weeks. The maternal blood sample at birth was negative for IgG antibodies to toxoplasmosis and cytomegalovirus. Two cases involved fetal death at 20 weeks and fetal hydrops at 17 weeks after maternal varicella at 11 and 5 weeks, respectively. We found no cases of limb hypoplasia, microcephalus, or cataract. CONCLUSION: The frequency of congenital varicella syndrome is very low (0.4%) in a prospectively studied cohort. Eye examinations of exposed infants had a low yield. PMID: 12151147 [PubMed - indexed for MEDLINE] 1742. Lancet Infect Dis. 2002 Aug;2(8):454. Varicella vaccination reduces risk of herpes zoster. Quirk M. PMID: 12150833 [PubMed - indexed for MEDLINE] 1743. Anesth Analg. 2002 Aug;95(2):503. Frontal and nasal nerve blocks in the treatment of severe pain in acute ophthalmic zoster. Gain P, Thuret G, Chiquet C, Navez ML, Pascal J. PMID: 12145092 [PubMed - indexed for MEDLINE] 1744. Anesth Analg. 2002 Aug;95(2):503; author reply 503-4. ACEI and renal function after vascular surgery. Gayatri P. Comment on: Anesth Analg. 2001 Nov;93(5):1111-5. PMID: 12145091 [PubMed - indexed for MEDLINE] 1745. J Am Acad Dermatol. 2002 Aug;47(2 Suppl):S177-9. Herpes zoster of the penis: an unusual location for a common eruption. Spray A, Glaser DA. Department of Dermatology, St. Louis University School of Medicine, MO 63104, USA. Herpes zoster is an acute vesiculobullous eruption estimated to affect 10% to 20% of the population. The diagnosis usually can be based on clinical features alone, but laboratory studies may be needed for definitive diagnosis, particularly in atypical presentations. PMID: 12140455 [PubMed - indexed for MEDLINE] 1746. J Am Acad Nurse Pract. 2002 Jul;14(7):297-303; quiz 304-6. Herpes zoster ophthalmicus: how is it identified and treated? Temple JJ. Northern Pines Orthopaedic Clinic, Grand Rapids, Minnesota, USA. Temple@medscape.com PURPOSE: To describe herpes zoster ophthalmicus in relation to the anatomy, pathophysiology, course, diagnostic considerations, and management for the primary care provider. DATA SOURCES: Actual case study supplemented with an extensive review of current scientific and psychosocial literature. CONCLUSIONS: Herpes zoster ophthalmicus (HZO) is an extension of a herpes zoster (HZ) infection involving the fifth cranial (trigeminal) nerve, which results from the reactivation of a latent varicella virus among individuals who had contracted a varicella infection sometime within their lifespan. IMPLICATIONS FOR PRACTICE: Due to the vague presenting symptomology of HZO, many patients may be misdiagnosed lessening the chance for prompt diagnosis and therapeutic intervention. Educational awareness, listening to psychosocial concerns of the patients, and immediate referral can decrease potential chronic side effects of the disorder. PMID: 12138524 [PubMed - indexed for MEDLINE] 1747. Neurol India. 2002 Jun;50(2):228-9. Disseminated zoster with polyneuritis cranialis and motor radiculopathy: letter to editor. Mehta J, Mahajan V, Khanna S. PMID: 12134202 [PubMed - indexed for MEDLINE] 1748. J Assoc Physicians India. 2002 Jul;50:977-8. Granulomatous angiitis of the central nervous system associated with herpes zoster. Bhat G, Mathur DS, Saxena GN, Jain S, Singh AP, Bhaduria D. Department of Medicine, SMS Medical College, Jaipur. Granulomatous angiitis of central nervous system (CNS) is a rare inflammatory disease of blood vessels mostly confined to CNS. We describe a case which presented with right sided hemiplegia with aphasia, after herpes zoster ophthalmicus. CT scan and MRI brain showed a large left sided infarct in the left middle cerebral artery (MCA) territory. MRI angiography revealed narrowing and thinning of left internal carotid artery (ICA) and to a lesser extent, left MCA suggestive of granulomatous vasculitis. Herpes zoster is often associated with major CNS involvement and a vascular etiology was previously postulated. Recent pathological reports suggest that cerebral angiitis secondary to herpes virus infection may be more common than realised. PMID: 12126361 [PubMed - indexed for MEDLINE] 1749. J Dermatol. 2002 Jun;29(6):391-3. IL-12 in varicella zoster and herpes simplex virus infection. Horiuchi Y, Nishioka K. PMID: 12126082 [PubMed - indexed for MEDLINE] 1750. J Dermatol. 2002 Jun;29(6):339-42. Wolf's isotopic response: a case of zosteriform lichen planus. Türel A, Oztürkcan S, Sahin MT, Türkdoğan P. Department of Dermatology, Medical Faculty of Celal Bayar University, Manisa, Türkiye. Lichen planus is a lichenoid disorder characterized by shiny, flat papules. In addition to the classical appearance, there are several variants. Zonal or zosteriform lesions have been described. A 25-year-old male with a complaint of increasing numbers of erythematous swellings on his left groin for twenty days was admitted to our out-patient clinic. He had a history of herpes zoster in the same localization which had been treated with topical acyclovir two weeks prior to his admission. Dermatological examination revealed multiple, shiny, erythematous, umblicated papules localized to the left inguinal region in a linear pattern. A biopsy was taken from the lesions. According to the clinical and pathological findings the diagnosis was zosteriform lichen planus. Zosteriform lichen planus is a rare variant of lichen planus; its differentiation from zona zoster and other linear dermatoses is difficult. We presented our case because of its rarity as a variant of lichen planus and its appearance in the area of healed herpes zoster as an isotopic response. PMID: 12126068 [PubMed - indexed for MEDLINE] 1751. Dermatol Clin. 2002 Apr;20(2):267-82. Clinical manifestations of varicella-zoster virus infection. Chen TM, George S, Woodruff CA, Hsu S. Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA. Infections by VZV, the virus that causes chickenpox and herpes zoster, usually are diagnosed by the classic clinical presentations. In immunocompromised patients, however, the atypical presentation can make the diagnosis more challenging. Although varicella typically follows an uncomplicated course in children, adults and immunocompromised patients can develop complications involving several organs; some complications may be fatal. Prevention of disease with the vaccine is ideal. When varicella or zoster infection does occur, proper treatment should be initiated, depending on the age and immune status of the patient. PMID: 12120440 [PubMed - indexed for MEDLINE] 1752. Semin Pediatr Infect Dis. 2002 Jan;13(1):12-21. Antiviral therapy for varicella and herpes zoster. Arvin AM. Department of Pediatrics and Microbiology and Immunology, Stanford University School of Medicine, CA 94305, USA. aarvin@stanford.edu Varicella-zoster virus (VZV) causes 2 clinical illnesses, varicella (chickenpox) and herpes zoster (shingles). The purpose of this review is to describe the role of antiviral therapy in the treatment of VZV infections in healthy and immunocompromised children. Acyclovir is the drug of choice for varicella and herpes zoster. The route of administration may be intravenous or oral, depending on the immunocompetence of the host. The clinical impact of acyclovir therapy is related directly to its use early in the clinical course and to the likely susceptibility of the patient to severe or life-threatening VZV infection. Patients who have the most clinical benefit are otherwise healthy adolescents with varicella infection and high-risk populations of immunocompromised children who have varicella or herpes zoster. The morbidity and mortality of VZV infections are reduced substantially by initiating acyclovir treatment early in the course of the disease. PMID: 12118839 [PubMed - indexed for MEDLINE] 1753. Aten Primaria. 2002 Jun 15;30(1):68-9. [Treatment of post-herpetic neuralgia with colorpuncture] [Article in Spanish] Calvo Sanz JM. PMID: 12106582 [PubMed - indexed for MEDLINE] 1754. J Infect. 2002 May;44(4):220-5. Varicella: a vaccine preventable disease? Watson B. Department of Pediatrics, Albert Einstein Hospital, Division of Disease Control, Philadelphia Department of Public Health, PA, USA. barbara.watson@phil.gov OBJECTIVES: To present a review of varicella disease, vaccine development and implementation of universal vaccination, discuss common questions about the vaccine and the epidemiology of the disease since licensure of the varicella vaccine. METHODS: Review the incidence of complications from varicella disease prior to vaccine licensure, safety of the varicella vaccine from clinical trials and post-marketing surveillance data, the impact of the vaccine on disease incidence where high vaccine coverage has been achieved, and address some barriers to vaccination. Raise issues that developed since 1995. RESULTS: The safety data gathered during the 20-year-gestation period of this vaccine prior to licensure has been confirmed. The vaccine works-in areas where vaccine coverage is over 70%, there has been a decline in disease, most marked in the age group with the best vaccine coverage (the 1-4-year olds), leading to a concern that unexposed susceptible children may reach adulthood and remain susceptible unless better practice of universal vaccination of ALL susceptible is practiced. CONCLUSIONS: Varicella disease has declined in areas with moderate vaccine coverage. Continued implementation of existing vaccine policies will lead to further reductions of varicella morbidity and mortality throughout the USA. Copyright 2002 The British Infection Society. PMID: 12099727 [PubMed - indexed for MEDLINE] 1755. J Infect. 2002 May;44(4):211-9. The effect of vaccination on the epidemiology of varicella zoster virus. Edmunds WJ, Brisson M. Immunisation Division, Colindale, London NW9 5EQ, UK. jedmunds@phls.org.uk Varicella zoster virus (VZV) causes chickenpox (varicella) on primary exposure and can reactivate later in life to cause shingles (zoster). As primary infection is more serious in adults than children, and exposure to the virus might boost the immune response to both chickenpox and shingles, there are two main concerns regarding infant VZV vaccination: that it could lead to an increase in adult disease; and/or that it could lead to a temporary increase in the incidence of shingles. This paper reviews the evidence for such outcomes. The consensus view of mathematical modelling studies is that the overall varicella associated burden is likely to decrease in the long term, regardless of the level of vaccine coverage. On the other hand, recent evidence suggests that an increase in zoster incidence appears likely, and the more effective vaccination is at preventing varicella, the larger the increase in zoster incidence. Targeted vaccination of susceptible adolescents and/or the contacts of high-risk individuals can be effective at preventing disease in these individuals with minimal risk to the community. However, targeted strategies would not prevent most disease (including most severe disease), and will not lead to a long-term reduction in the incidence of zoster. Understanding the mechanisms for maintaining immunity against varicella and zoster is critical for predicting the long-term effects of vaccination. Meanwhile sensitive surveillance of both chickenpox and shingles is essential in countries that have implemented, or are about to implement, varicella vaccination. Copyright 2002 The British Infection Society. PMID: 12099726 [PubMed - indexed for MEDLINE] 1756. Pain. 2002 Jul;98(1-2):119-26. Relief of post-herpetic neuralgia by surgical removal of painful skin. Petersen KL, Rice FL, Suess F, Berro M, Rowbotham MC. Department of Neurology, UCSF Pain Clinical Research Center, University of California-San Francisco, 1701 Divisadero Street, Suite 480, San Francisco, CA 94115, USA. klp@itsa.ucsf.edu We present a case of longstanding PHN treated by skin excision of the area of greatest pain (11.3 x 26.0 cm(2)). The operation reduced pain, eliminated tactile allodynia, and facilitated greatly reduced medication use over a 1-year follow-up period. Fourteen punch biopsies and 10 strips of skin (each 10 mm long) from the excised painful PHN skin were qualitatively assessed by double-label immunofluorescence using antibodies against protein-gene-product 9.5 (PGP9.5), 200 kDa neurofilament protein (NF), calcitonin gene-related peptide (CGRP) and vanilloid receptor-1 (VR-1). Compared with a punch biopsy from mirror image skin, the pattern of cutaneous innervation in PHN skin was consistently and substantially different. The results may explain the anatomical basis of the capsaicin-response test and have implications for our understanding of clinical mechanisms underlying PHN pain. PMID: 12098623 [PubMed - indexed for MEDLINE] 1757. Arch Ophthalmol. 2002 Jul;120(7):989-90. Necrotizing herpetic retinopathy associated with Ramsay Hunt syndrome. Verm AM, Scott IU, Davis JL. Bascom Palmer Eye Institute, 900 NW 17th St, Miami, FL 33136, USA. PMID: 12096978 [PubMed - indexed for MEDLINE] 1758. N Engl J Med. 2002 Jul 4;347(1):26-34. Use of an inactivated varicella vaccine in recipients of hematopoietic-cell transplants. Hata A, Asanuma H, Rinki M, Sharp M, Wong RM, Blume K, Arvin AM. Department of Pediatrics, Stanford University School of Medicine, Stanford, Calif 94305-5208, USA. Comment in: N Engl J Med. 2002 Nov 14;347(20):1624-5; author reply 1624-5. N Engl J Med. 2002 Nov 14;347(20):1624-5; author reply 1624-5. BACKGROUND: The reactivation of varicella-zoster virus from latency causes zoster and is common among recipients of hematopoietic-cell transplants. METHODS: We randomly assigned patients who were scheduled to undergo autologous hematopoietic-cell transplantation for non-Hodgkin's or Hodgkin's lymphoma to receive varicella vaccine or no vaccine. Heat-inactivated, live attenuated varicella vaccine was given within 30 days before transplantation and 30, 60, and 90 days after transplantation. The patients were monitored for zoster and for immunity against varicella-zoster virus for 12 months. RESULTS: Of the 119 patients enrolled, 111 received a transplant. Zoster developed in 7 of 53 vaccinated patients (13 percent) and in 19 of 58 unvaccinated patients (33 percent) (P=0.01). After two patients in whom zoster developed before transplantation were excluded, the respective rates were 13 percent and 30 percent (P=0.02). In vitro CD4 T-cell proliferation in response to varicella-zoster virus (expressed as the mean stimulation index) was greater in patients who received the vaccine than in those who did not at 90 days, after three doses (P=0.04); at 120 days, after all four doses (P<0.001); at 6 months (P=0.004); and at 12 months (P=0.02). The risk of zoster was reduced for each unit increase in the stimulation index above 1.6; a stimulation index above 5.0 correlated with greater than 93 percent protection. Induration, erythema, or local pain at the injection site was observed in association with 10 percent of the doses. CONCLUSIONS: Inactivated varicella vaccine given before hematopoietic-cell transplantation and during the first 90 days thereafter reduces the risk of zoster. The protection correlates with reconstitution of CD4 T-cell immunity against varicella-zoster virus. PMID: 12097537 [PubMed - indexed for MEDLINE] 1759. Eur J Dermatol. 2002 Jul-Aug;12(4):370-2. Erythema multiforme after resolution of herpes zoster by acyclovir. Onishi I, Kishimoto S. Department of Dermatology, Kyoto Min-iren Central Hospital, 16-1 Nishinokyo-Kasuga-cho, Nakagyo-ku, Kyoto 604-8453, Japan. PMID: 12095886 [PubMed - indexed for MEDLINE] 1760. Biochim Biophys Acta. 2002 Jul 18;1587(2-3):287-95. Chemotherapy of varicella-zoster virus by a novel class of highly specific anti-VZV bicyclic pyrimidine nucleosides. Balzarini J, McGuigan C. Rega Institute for Medical Research, Katholieke Universiteit Leuven, Minderbroedersstraat 10, Leuven, Belgium. jan.balzarini@rega.kuleuven.ac.be (E)-5-(2-bromovinyl)-2'-deoxyuridine (BVDU) is a potent inhibitor of herpes simplex virus type 1 (HSV-1) and varicella-zoster virus (VZV). Its mechanism of action is based on a specific conversion to its 5'-mono- and 5'-diphosphate derivative by HSV-1- and VZV-encoded thymidine kinase, and after further conversion to its 5'-triphosphate derivative, inhibition of the viral DNA polymerase and eventual incorporation into the viral DNA. Recently, a new structural class of bicyclic pyrimidine nucleoside analogues (designated BCNAs) with highly specific and selective anti-VZV activity in cell culture has been discovered. The compounds need a long alkyl or alkylaryl side-chain at the base moiety for pronounced biological activity. This property makes these compounds highly lipophilic. They are also endowed with fluorescent properties when exposed to light with short UV wavelength. In striking contrast to BVDU, the members of this class of compounds are active only against VZV, but not against any other virus, including the closely related HSV-1, HSV-2 and cytomegalovirus. The most active compounds inhibit VZV replication at subnanomolar concentrations and are not toxic at high micromolar concentrations. The compounds lose their antiviral activity against thymidine kinase (TK)-deficient VZV strains, pointing to a pivotal role of the viral TK in their activation (phosphorylation). Kinetic studies with purified enzymes revealed that the compounds were recognized by VZV TK as a substrate, but not by HSV-1 TK, nor by cytosolic or mitochondrial TK. VZV TK is able to phosphorylate the test compounds not only to their corresponding 5'-mono- but also to their 5'-diphosphate derivatives. These data may readily explain and rationalize the anti-VZV selectivity of the BCNAs. There is no clear-cut correlation between the antiviral potency of the compounds and their affinity for VZV TK, pointing to a different structure/activity relationship of the eventual antiviral target of these compounds. The compounds are stable in solution and, in contrast to BVDU, not susceptible to degradation by thymidine phosphorylase. The bicyclic pyrimidine nucleoside analogues represent an entirely new class of highly specific anti-VZV compounds that should be further pursued for clinical development. PMID: 12084470 [PubMed - indexed for MEDLINE] 1761. Neurologia. 2002 Jun-Jul;17(6):338-41. [Room tilt illusion: Report of two cases and terminological review] [Article in Spanish] Arjona A, Fernández-Romero E. Hospital de la Cruz Roja Española, Cordoba, Spain. The room tilt illusion is a transient misperception of the visual image as tilted on its side or even upside down; in this case it has been termed acute upside down reversal of vision. We report on two cases of room tilt illusion as manifestation of VIII nerve neuritis (herpes-zoster infection) and cerebellar hemorrhage. Room tilt illusion has been reported in association with vertebrobasilar stroke, migraine, multiple sclerosis, epilepsy and labyrinthine disorders. The pathophysiology of this rare visual illusion has been related to a lesion of the visual or vestibulo-otolith pathways. In animals the neurones of the parieto-insular vestibular cortex areas are multisensory. So, they can respond to somatosensory, optokinetic and visual stimuli. In humans the knowledge about vestibular cortex function and localization is less precise than in animals. However, we propose a disorder of multisensorial vestibular cortex, resulting from a lession of vestibular pathways or association cortex, as mechanism of this phenomenon. PMID: 12084362 [PubMed - indexed for MEDLINE] 1762. MMWR Recomm Rep. 2002 Jun 14;51(RR-8):1-52. Guidelines for preventing opportunistic infections among HIV-infected persons--2002. Recommendations of the U.S. Public Health Service and the Infectious Diseases Society of America. Kaplan JE, Masur H, Holmes KK; USPHS; Infectious Disease Society of America. Division of AIDS, STD, and TB Laboratory Research, National Center for Infectious Diseases, USA. In 1995, the U.S. Public Health Service (USPHS) and the Infectious Diseases Society of America (IDSA) developed guidelines for preventing opportunistic infections (OIs) among persons infected with human immunodeficiency virus (HIV); these guidelines were updated in 1997 and 1999. This fourth edition of the guidelines, made available on the Internet in 2001, is intended for clinicians and other health-care providers who care for HIV-infected persons. The goal of these guidelines is to provide evidence-based guidelines for preventing OIs among HIV-infected adults and adolescents, including pregnant women, and HIV-exposed or infected children. Nineteen OIs, or groups of OIs, are addressed, and recommendations are included for preventing exposure to opportunistic pathogens, preventing first episodes of disease by chemoprophylaxis or vaccination (primary prophylaxis), and preventing disease recurrence (secondary prophylaxis). Major changes since the last edition of the guidelines include 1) updated recommendations for discontinuing primary and secondary OI prophylaxis among persons whose CD4+ T lymphocyte counts have increased in response to antiretroviral therapy; 2) emphasis on screening all HIV-infected persons for infection with hepatitis C virus; 3) new information regarding transmission of human herpesvirus 8 infection; 4) new information regarding drug interactions, chiefly related to rifamycins and antiretroviral drugs; and 5) revised recommendations for immunizing HIV-infected adults and adolescents and HIV-exposed or infected children. PMID: 12081007 [PubMed - indexed for MEDLINE] 1763. Hunan Yi Ke Da Xue Xue Bao. 1999;24(6):Inside back cover. [Effect of valociclovir hydrochloride on patients with herpes zoster] [Article in Chinese] Li C, Liu Z. PMID: 12080735 [PubMed - indexed for MEDLINE] 1764. Ann Rheum Dis. 2002 Jul;61(7):661. Shingles following infliximab infusion. Baumgart DC, Dignass AU. PMCID: PMC1754145 PMID: 12079920 [PubMed - indexed for MEDLINE] 1765. Nervenarzt. 2002 May;73(5):471-4. [Charles Bonnet syndrome in an elderly patient with bilateral vision loss, hyperthyroidism and relative digitalis overdose] [Article in German] Gödecke-Koch T, Schlimme J, Rada D, Emrich HM. Abteilung Klinische Psychiatrie und Psychotherapie, Medizinische Hochschule Hannover, Carl-Neuberg-Strasse 1, 30625 Hannover. Gödecke-Koch.Thomas@MH-Hannover.DE Charles Bonnet syndrome (CBS) is characterized by the presence of visual hallucinations in elderly, mentally healthy people. We report a visually impaired 90-year-old woman suddenly complaining of visual hallucinations, suffering from hyperthyroidism and a relative digitalis overdose. The diagnosis of CBS could be made after the exclusion of an intoxication and other neurological and psychiatric syndromes. In this case, visual hallucinations ceased without specific psychopharmacological therapy. A brief review of this organic hallucinosis, differential diagnosis, especially hyperthyroidism-induced psychosis, and digitoxin-induced psychosis is given and current therapeutic strategies are suggested. PMID: 12078028 [PubMed - indexed for MEDLINE] 1766. Adv Otorhinolaryngol. 2002;60:32-53. Meatal ganglionitis: a pathologic correlate in idiopathic facial paralysis. Gacek RR, Gacek MR. PMID: 12077898 [PubMed - indexed for MEDLINE] 1767. Adv Otorhinolaryngol. 2002;60:1-11. The biology of neurotropic viruses. Gacek RR. PMID: 12077894 [PubMed - indexed for MEDLINE] 1768. Kansenshogaku Zasshi. 2002 May;76(5):347-54. [Long PCR amplification of varicella-zoster virus DNA in clinical specimens from the patients with varicella and herpes zoster] [Article in Japanese] Takayama M, Takayama N. Department of Pediatrics, Tokyo Metropolitan Komagome Hospital. Long PCR amplification of the 7.7 to 33.5 Kbp regions of varicella-zoster virus (VZV) genomic DNA was performed using template DNAs extracted from clinical specimens such as vesicle fluid and crusts which had been obtained from varicella or herpes zoster patients. PCR products of 7.7-14.4 Kbp in length were efficiently amplified from all of the 14 template DNAs of crust specimens. Targets of 18.6-20.0 Kbp DNA could be also amplified from 14 crust samples except one. From all of the 7 samples derived from infected cells, the DNA targets up to 27.2 Kbp in length could be amplified. Whereas, the efficiency of amplification of 27.2 Kbp DNAs from crust samples was somewhat lower (9/14,64%) than that of DNAs from infected cells. In 83% (5/6) of target DNAs from infected cells, amplification of DNA as long as 33.5 Kbp was possible, while only in 40% (2/5) of these from crust specimens. From crust samples, the efficiency of amplification of DNA longer than 20 Kbp tended to decline. We also confirmed that long target DNA was amplifiable directly from vesicle fluid specimens as effective as from crust specimens. Restriction fragment length polymorphism (RFLP) analyses combined with R2-nested PCR of the long PCR products allowed classification of the 14 clinical specimens into 9 groups. Long PCR derived from clinical specimens was demonstrated to be applicable to RFLP analyses and sequencing without laborious test of virus isolation. Furthermore, the long PCR method described here will be useful for studies of the molecular epidemiology of VZV and for investigating variations among VZV isolates. PMID: 12073570 [PubMed - indexed for MEDLINE] 1769. Transplant Proc. 2002 Jun;34(4):1174-7. Atypical generalized zoster with suspicious esophageal involvement and early relapse in an adult renal transplant recepient. Oh KH, Ahn C, Kim YS, Han JS, Kim S, Lee JS, Kim EC, Oh MD, Chung JH. Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea. PMID: 12072307 [PubMed - indexed for MEDLINE] 1770. Eur J Haematol. 2002 Apr;68(4):236-8. Mononucleosis syndrome and acute monocytic leukemia. Tamayose K, Sugimoto K, Ando M, Oshimi K. Department of Hematolgy, Juntendo University School of Medicine, Tokyo, Japan. tamayose@med.juntendo.ac.jp The association of infectious mononucleosis and an immunocompromised host such as occurs in acute leukemia is reported. The most common cause of infectious mononucleosis is Epstein-Barr virus (EBV) and cytomegalovirus (CMV). Patients with mononucleosis syndrome caused by other agents are rare. We report a case of acute monocytic leukemia (AMoL) who developed varicella zoster virus (VZV) mononucleosis syndrome in the bone marrow recovery phase after myelosuppression due to high-dose cytarabine. Mononuclear leukocytes appearing during the mononucleosis syndrome were very similar to the initial leukemic cells. Varicella zoster virus mononucleosis syndrome was confirmed by delayed herpes zoster rash with dermatomal distribution. PMID: 12071940 [PubMed - indexed for MEDLINE] 1771. Semin Respir Infect. 2002 Jun;17(2):121-9. Pneumonia caused by herpesviruses in recipients of hematopoietic cell transplants. Taplitz RA, Jordan MC. Division of Infectious Diseases, Department of Medicine, Oregon Health and Science University, Portland 97201-3098, USA. Viral pulmonary infections are a major cause of morbidity and mortality in recipients of hematopoietic cell transplantation. Members of the herpesviruses-cytomegalovirus, herpes simplex virus, varicella zoster virus, Epstein-Barr virus, as well as some of the more recently described herpesviruses such as HHV-6 and HHV-8-are frequently implicated in causing pulmonary infection in this population. Advances in diagnostic techniques and the use of preventive or preemptive therapies have altered the epidemiology of infections caused by some of the herpesviruses; however, these viruses continue to be a significant cause of morbidity and mortality in hematopoietic cell transplantation. This article provides an overview of pulmonary herpesvirus infections that occur after hematopoietic cell transplantation, with an emphasis on new developments in epidemiology, diagnosis, prophylaxis, and treatment. Copyright 2002, Elsevier Science (USA). All rights reserved. PMID: 12070831 [PubMed - indexed for MEDLINE] 1772. Minerva Pediatr. 2002 Jun;54(3):259-62. Guillain-Barré syndrome after varicella zoster virus infections. A case report. Pavone P, Maccarrone F, Sorge A, Piccolo G, Greco F, Caruso P, Sorge G. Dipartimento di Pediatria, Università degli Studi, Catania, Italy. ppavone@mbox.unict.it The case of a 13 year-old patient affected by Guillain-Barré syndrome developed after varicella zoster virus infection is reported. Cerebrospinal fluid examination and motor and sensory conduction velocity were consistent with GBS. Antibodies against gangliosides GM1 were present; it is likely that some of these may play an important role in the pathogenesis of syndrome after varicella infection. The therapy was carried out with increasing high-doses of immunoglobulins, with full clinical recovery. PMID: 12070486 [PubMed - indexed for MEDLINE] 1773. J Pain Symptom Manage. 2002 Jun;23(6):510-6. Clinical applications for change-point analysis of herpes zoster pain. Desmond RA, Weiss HL, Arani RB, Soong SJ, Wood MJ, Fiddian PA, Gnann JW, Whitley RJ. Medical Statistics Section, Department of Medicine, Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL 35294-3300, USA. Pain is the most frequent and disabling complication of herpes zoster. The analysis of pain severity data is complicated by the nonlinear rate of resolution. Further, three distinct phases characterize pain resolution--acute, subacute, and chronic. Using two clinical trial datasets as the bases for analyses, the rates of baseline pain resolution were computed across each of three phases and compared for age, severity of pain at onset, and number of lesions at baseline. The results defined transition points of 24.4 +/- 3.34 for the subacute phase and 110.3 +/- 11.9 days for the chronic phase. The model demonstrated a treatment effect of valiciclovir (VACV) during the subacute phase as compared to acyclovir (ACV) (P = 0.006) and supports effects of age, baseline pain and number lesions on pain cessation rates in the acute phase. This model verifies three phases of zoster pain and delineates the impact of treatment and other factors on the phase-specific rates of pain cessation. PMID: 12067775 [PubMed - indexed for MEDLINE] 1774. Mayo Clin Health Lett. 2002 Jun;20(6):7. Shingles. Seek early treatment. [No authors listed] PMID: 12066808 [PubMed - indexed for MEDLINE] 1775. Br J Community Nurs. 2002 Jun;7(6):286-7, 290-1. Life after shingles: the management of postherpetic neuralgia. Williams H. Chronic Pain Management, Royal Victoria Infirmary, Newcastle Upon Tyne. Chronic pain may have devastating effects on the physical and psychological well being of many patients (Harden, 1999). Most community nurses are in contact with a number of patients with chronic pain and will be asked for advice and recommendations with regards to its management. Chronic neuropathic pain is a complex and sometimes intractable condition that patients will seek help for, from either GPs or from the community nursing teams. This article will examine one neuropathic pain syndrome - post-herpetic neuralgia - and review the evidence base in relation to treatment strategies, in an attempt to support community staff in the management of this difficult to treat pain syndrome. PMID: 12066061 [PubMed - indexed for MEDLINE] 1776. Ophthalmol Clin North Am. 2002 Mar;15(1):7-15, v. Varicella-zoster virus: mechanisms of pathogenicity and corneal disease. Starr CE, Pavan-Langston D. Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, 243 Charles Street, Boston, MA 02114, USA. christopherstarr@hotmail.com As ophthalmologists, many of our patients suffer from the ravages, both ocular and non-ocular, of the varicella-zoster virus. This article is a comprehensive review of the pathogenetic mechanisms of this ubiquitous virus. We review the basic virology, mechanisms of varicella, zoster, latency, reactivation, and the host immune response to the virus. Herpes zoster ophthalmicus is discussed with special attention to the cornea and mechanisms of viral keratitis. PMID: 12064084 [PubMed - indexed for MEDLINE] 1777. J Am Acad Dermatol. 2002 Jun;46(6):834-9. Rash severity in herpes zoster: correlates and relationship to postherpetic neuralgia. Nagasako EM, Johnson RW, Griffin DR, Dworkin RH. Department of Anesthesiology, University of Rochester School of Medicine and Dentistry, New York, USA. Baseline and follow-up data from 4 samples of immunocompetent patients with herpes zoster who participated in clinical trials of the antiviral agent famciclovir were examined (N = 1778). In both univariate and multivariate analyses, severe rash (ie, >50 lesions, defined as papules, vesicles, or crusted vesicles) was significantly associated with older age, male sex, severe pain, primary involvement of nontrigeminal dermatomes, and a greater number of affected dermatomes. In addition, severe rash predicted the presence of pain 3 months later. The results indicate that severe rash is more common in patients with herpes zoster who are older and who have more severe acute pain and confirm that severe rash is a risk factor for prolonged pain. PMID: 12063479 [PubMed - indexed for MEDLINE] 1778. Jpn J Ophthalmol. 2002 May-Jun;46(3):330-5. Indocyanine green angiographic findings in acute retinal necrosis. Takei H, Ohno-Matsui K, Hayano M, Mochizuki M. Department of Ophthalmology and Visual Science, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan. PURPOSE: To clarify indocyanine green (IA) angiographic features in patients with acute retinal necrosis (ARN). METHODS: Two patients with ARN were examined by fluorescein angiography (FA) and IA, and findings from both were compared. RESULTS: Fundus examination revealed widespread retinal hemorrhages and yellowish-white patches in the periphery, characteristic of ARN. In both cases, FA showed diffuse dye leakage from all retinal veins and the optic disc, and vascular obstruction in the peripheral fundus. In IA, dye leakage was localized, and extravasation of dye was evident only from the lower temporal retinal vein and the lower half of the optic disc. This pattern of indocyanine green dye leakage appeared to be continuous from the optic disc toward the lower temporal retinal vein. Also, IA clearly demonstrated choroidal vascular filling delay in one case in the early phase of the angiogram. CONCLUSIONS: While FA showed diffuse dye leakage from all retinal veins, IA identified only the retinal vessels with the most prominent vascular damage. IA also identified choroidal vascular lesions in these patients with ARN. The information obtained by IA might be useful to detect retinal vasculitis with prominent inflammation and to determine the extent of choroidal inflammation in patients with ARN. PMID: 12063045 [PubMed - indexed for MEDLINE] 1779. Vaccine. 2002 Jun 7;20(19-20):2500-7. Exposure to varicella boosts immunity to herpes-zoster: implications for mass vaccination against chickenpox. Brisson M, Gay NJ, Edmunds WJ, Andrews NJ. Immunisation Division, PHLS Communicable Disease Surveillance Centre, London, UK. mbrisson@phls.org.uk We present data to confirm that exposure to varicella boosts immunity to herpes-zoster. We show that exposure to varicella is greater in adults living with children and that this exposure is highly protective against zoster (Incidence ratio=0.75, 95% CI, 0.63-0.89). The data is used to parameterise a mathematical model of varicella zoster virus (VZV) transmission that captures differences in exposure to varicella in adults living with and without children. Under the 'best-fit' model, exposure to varicella is estimated to boost cell-mediated immunity for an average of 20 years (95% CI, 7-41years). Mass varicella vaccination is expected to cause a major epidemic of herpes-zoster, affecting more than 50% of those aged 10-44 years at the introduction of vaccination. PMID: 12057605 [PubMed - indexed for MEDLINE] 1780. Retina. 2002 Jun;22(3):352-4. Oral valacyclovir in the treatment of acute retinal necrosis syndrome. Aslanides IM, De Souza S, Wong DT, Giavedoni LR, Altomare F, Detorakis ET, Kymionis GD, Pallikaris IG. Department of Ophthalmology, St. Michael's Hospital, University of Toronto, Ontario, Canada. aslanides@hotmail.com PMID: 12055471 [PubMed - indexed for MEDLINE] 1781. Clin J Pain. 2002 May-Jun;18(3):200-2. A novel treatment of postherpetic neuralgia using peppermint oil. Davies SJ, Harding LM, Baranowski AP. The Pain Management Centre, The National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Trust, London, UK. BACKGROUND: Postherpetic neuralgia remains a difficult problem to treat. A number of therapies have been shown to be effective, but some patients have intractable pain. PATIENT: The case of a 76-year-old woman whose pain had been resistant to standard therapies is described. The pattern of quantitative sensory testing results for this patient led the authors to believe that she had an "irritable nociceptor" type of pathophysiology. INTERVENTION: The patient was instructed to apply neat peppermint oil (containing 10% menthol) to her skin, resulting in an almost immediate improvement in her pain. This pain relief persisted for 4-6 hours after application of the oil. RESULTS: The patient was successfully treated with topical peppermint oil. During 2 months of follow-up she has had only a minor side effect, with continuing analgesia. The authors believe this is the first evidence of peppermint oil (or menthol) having a strong analgesic effect on neuropathic pain. The possible mechanisms of action of peppermint oil are discussed. PMID: 12048423 [PubMed - indexed for MEDLINE] 1782. Am J Kidney Dis. 2002 Jun;39(6):1310-2. Primary varicella after transplantation. Scanlon-Kohlroser CA, Fan PY, Primack W, Stoff JS. Division of Renal Medicine and Transplantation Medicine, Department of Medicine and Pediatrics, University of Massachusetts Medical School and Fallon Clinic, Worcester, MA, USA. A 51-year-old white woman 6 months status post cadaveric renal transplant developed a mild case of primary varicella-zoster (VZ). It is hypothesized that the limited nature of her illness was due to infection with vaccine-type VZ virus instead of wild-type VZ. Approximately 1 month prior, she had daily household contact with a child who had developed a rash after immunization with live attenuated varicella vaccine. This case highlights several important questions. Should special precautions be undertaken with renal transplant recipients naive to varicella infection after vaccination of household contacts? Should pretransplant immunization with varicella vaccine be performed routinely in naive patients? Should naive patients transplanted and maintained on immunosuppressive therapy be vaccinated? Until there are clinical trials to answer these questions, it may be instructive to consider the recommendations for pediatric and immunocompromised patients. Copyright 2002 by the National Kidney Foundation, Inc. PMID: 12046047 [PubMed - indexed for MEDLINE] 1783. Br J Plast Surg. 2002 Apr;55(3):264. Painless acyclovir extravasation injury in a diabetic. De Souza BA, Shibu M. PMID: 12041990 [PubMed - indexed for MEDLINE] 1784. Obstet Gynecol. 2002 Apr;99(4):625-8. Postherpetic neuralgia after shingles: an under-recognized cause of chronic vulvar pain. Oaklander AL, Rissmiller JG. Neuropathic Pain Study Group, Departments of Anesthesiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA. BACKGROUND: Vulvar shingles, an uncommon presentation of a common disease, probably affects 1.5 million American women during their lifetime and leaves about 150,000 with postherpetic neuralgia, a chronic neuropathic pain syndrome. Prompt diagnosis and treatment can minimize pain severity and duration. CASES: The case of an 88-year-old woman with sacral shingles is described. Complications led to her demise. A 35-year-old with a 6-year history of disabling vulvar pain and many diagnostic procedures was ultimately diagnosed with postherpetic neuralgia. CONCLUSION: Shingles needs to be included in the differential diagnosis of vulvar rashes because it is a modifiable risk factor for chronic vulvar pain. The possibility of postherpetic neuralgia must be considered in women with unexplained vulvar dysesthesia. PMID: 12039124 [PubMed - indexed for MEDLINE] 1785. J Clin Microbiol. 2002 Jun;40(6):2302-4. Disseminated herpes simplex virus and varicella zoster virus coinfection in a patient taking thalidomide for relapsed multiple myeloma. Curley MJ, Hussein SA, Hassoun PM. Pulmonary and Critical Care Division, New England Medical Center, Boston, Massachusetts 02111, USA. Disseminated herpes simplex virus (HSV) and varicella zoster virus (VZV) have been reported individually in immunosuppressed adults. We present a case of coinfection with disseminated HSV and VZV infection in a patient taking thalidomide for relapsed multiple myeloma. This is the first report of opportunistic infection associated with thalidomide. PMCID: PMC130681 PMID: 12037117 [PubMed - indexed for MEDLINE] 1786. Servir. 1999 May-Jun;47(3):146-52. [Herpes zoster in the elderly] [Article in Portuguese] Veyssier P. Serviço de medicina interna, Centro Hospitalar de Compiègne, França. PMID: 12035152 [PubMed - indexed for MEDLINE] 1787. Acta Otolaryngol. 2002 Apr;122(3):348-52. Swelling of the intratemporal facial nerve in Ramsay Hunt syndrome. Honda N, Yanagihara N, Hato N, Kisak H, Murakami S, Gyo K. Department of Otolaryngology, Ehime University School of Medicine, Japan. nobuhon@m.ehime-u.ac.jp Although Ramsay Hunt syndrome is one of the most important diseases causing peripheral facial palsy, the detailed pathology of the disease in the intratemporal facial nerve remains unclear. The purpose of this study was to increase knowledge of the pathogenesis of the syndrome by means of surgical findings. Between April 1976 and March 1997 we performed subtotal decompression of the facial nerve in 74 patients with severe Ramsay Hunt syndrome. The grade of nerve swelling was assessed using a microscope and recorded in a standardized form. The relationships between nerve swelling, the timing of surgery and the swelling of each segment were analyzed. Pronounced neural swelling, involving the geniculate ganglion and the horizontal segment, was consistent finding in the acute phase. Although the incidence of pronounced swelling of the horizontal segment gradually declined with time after onset, in most cases nerve swelling persisted even beyond the 16th week after onset. These data suggest that diffuse viral neuritis occurs throughout the intratemporal facial nerve. We assume that the viral inflammatory swelling involving the geniculate ganglion and horizontal segment is mostly responsible for the acute facial palsy in the acute phase. PMID: 12030588 [PubMed - indexed for MEDLINE] 1788. Kaohsiung J Med Sci. 2002 Jan;18(1):39-44. Herpes zoster induced neuropathic bladder--a case report. Tsai HN, Wu WJ, Huang SP, Su CM, Chen CC, Wang CJ, Chou YH, Huang CH. Department of Urology, Kaohsiung Medical University, No. 100, Shih-Chuan 1st Rd., Kaohsiung 807, Taiwan. Herpes zoster infection involving the sacral dermatomes has been associated with bladder dysfunction and, although rarely, with acute urinary retention. Less than 150 cases have been reported in the literature. After reviewing our institute's chart records covering a period of time dating from 1991 to 2001, we found that three of our patients had developed acute urinary retention following herpes zoster skin lesions of the S2-4 dermatomes. Herein we report our findings. These three patients had previously been found to have normal voiding status. However, at the time of complaint urodynamic studies revealed detrusor areflexia or detrusor hyporeflexia with decreased sensation of bladder filling. After micturation recovery, repeat urodynamic studies revealed detrusor pressure and bladder sensation recovery. After one to six weeks of treatment, all three patients could void spontaneously without catheterization. We found that, when treated with antiviral medication, supportive analgesics, and temporary urinary drainage, which included urethral catheterization and suprapubic cystostomy, acute urinary retention associated with herpes zoster has a generally favorable prognosis. In other words, we found that in spite of its rarity, herpes zoster induced neuropathic bladder dysfunction is reversible when treated appropriately. PMID: 12017982 [PubMed - indexed for MEDLINE] 1789. J Chemother. 2002 Apr;14(2):220-2. Varicella pneumonia: another 'steroid responsive' pneumonia? Ahmed R, Ahmed QA, Adhami NA, Memish ZA. Department of Critical Care Medicine, King Fahad National Guard Hospital, Riyadh, Kingdom of Saudi Arabia. Varicella-zoster virus (VZV) pneumonitis remains an often-fatal complication of VZV infection. Antiviral agents and supportive care are widely accepted therapies. Cautious use of corticosteroids in life-threatening VZV pneumonitis may be justified. Appropriate patient selection factors are as yet unidentified and the decision to commence corticosteroid therapy in this setting is clinical. PMID: 12017381 [PubMed - indexed for MEDLINE] 1790. Nephron. 2002 May;91(1):164-6. Evaluation of valaciclovir dosage reduction in continuous ambulatory peritoneal dialysis patients. Stathoulopoulou F, Dhillon S, Thodis H, Stathakis C, Vargemezis V. School of Pharmacy, University of London, UK. fsc@otenet.gr In continuous ambulatory peritoneal dialysis (CAPD) patients, acyclovir-induced neurotoxicity is reported to be associated with high serum drug levels even when following the recommended reduced doses for this renal failure population. In view of the high oral bioavailability of valaciclovir (the L-valyl ester of acyclovir) the risk of neurotoxicity becomes more prominent. The present study was conducted in 12 CAPD patients who were administered a single oral dose of 500 mg valaciclovir. Acyclovir was analyzed by high-performance liquid chromatography. Relative pharmacokinetic parameters were estimated based on acyclovir concentrations at 8, 12 and 24 h post-dose. High inter-patient variations were observed with acyclovir apparent total clearance 7.238 +/- 4 l/h and half-life (T1/2) 22.27 +/- 16.82 h. However, dosage simulations confirmed supratherapeutic acyclovir concentrations for all participants when following the recommended dose of 1,000 mg valaciclovir/24 h for varicella zoster infections. Copyright 2002 S. Karger AG, Basel PMID: 12021536 [PubMed - indexed for MEDLINE] 1791. Bull Soc Pathol Exot. 2002 Mar;95(1):27-30. [Peripheral neuropathies revealing HIV infection at the Hospital Center of Bobo-Dioulasso (Burkina Faso)] [Article in French] Millogo A, Sawadogo AB, Sawadogo AP, Lankoandé D. Service de médecine interne, Centre hospitalier national Souro Sanou, BP 676, Bobo-Dioulasso, Burkina Faso. athanase_millogo@hotmail.com Several peripheral neuropathies are associated with human immuno-deficiency virus (HIV) infection. In Africa, certain diseases are of particular importance. In the present work, we report peripheral neurological involvement as revealing signs of HIV infection within the internal medicine unit of a large city over a 2-year period. All adult subjects with a positive HIV serology revealed by a peripheral neuropathy observed in the National Hospital Centre of Bobo-Dioulasso over a two-year period (1 January 1999 and 31 December 2000) were included in the study. 46 cases of peripheral neuropathies revealing HIV infection were screened. Peripheral facial paralysis concerned 25 patients, 15 women and 10 men, in the early stages of HIV infection. The average age was 34 years. For 80% of the patients, he CD4 count was over 200. 5/10 cases of polyneuropathy occurred at the early stage of the HIV infection. Herpes zoster occurred in the early stages in 5/7 cases. 3/4 cases of polyradiculopathy occurred at a later stage with CD4 count under 200. Our study indicates clearly that isolated peripheral facial paralysis, sensitive polyneuropathy, herpes zoster and polyradiculopathy in young adults should lead to HIV testing. PMID: 12012959 [PubMed - indexed for MEDLINE] 1792. J Am Acad Dermatol. 2002 May;46(5):771-4. Visceral zoster as the presenting feature of disseminated herpes zoster. Stratman E. Department of Dermatology, Marshfield Clinic, Marshfield, WI 54449, USA. Visceral dissemination of herpes zoster may follow cutaneous dissemination in immunocompromised patients. The skin is not necessarily the only organ affected and may not even be the presenting organ. Immunohistochemical stains available for routine paraffin-embedded tissue biopsy specimens allow for rapid diagnosis of varicella zoster virus. We describe a patient in whom gastric dissemination of herpes zoster was proven by immunohistochemistry. Unexplained hepatitis, pancreatitis, gastritis, or complaints of abdominal pain in immunocompromised patients with herpes zoster should prompt a high degree of suspicion for visceral zoster and immediate treatment with intravenous acyclovir. PMID: 12004322 [PubMed - indexed for MEDLINE] 1793. Isr Med Assoc J. 2002 Apr;4(4):262-4. Acquired neurogenic abdominal wall weakness simulating abdominal hernia. Kesler A, Galili-Mosberg R, Gadoth N. Department of Neurology, Meir General Hospital, Kfar Saba, Israel. PMID: 12001699 [PubMed - indexed for MEDLINE] 1794. Eur J Orthod. 2002 Apr;24(2):205-14. Unilateral primary or secondary retention of permanent teeth, and dental malformations. Becktor KB, Bangstrup MI, Rølling S, Kjaer I. Department of Orthodontics, School of Dentistry, University of Copenhagen, Denmark. The purpose of the present investigation was to describe the dentition in subjects with local primary or secondary unilateral retention of two or more permanent teeth, and to elucidate the aetiology by comparing the regions of retention with the innervation pattern of the jaws. The material comprised radiographic dental orthopantomograms (OTP) from 12 patients with an age range of 6-18 years (six females and six males). The locations of retention and the dental morphology in the affected regions were analysed. Comparison with contralateral teeth was undertaken and the innervation pattern of the affected field was considered. Varying degrees of dental root malformation were found to be associated with primary and secondary retention. More pronounced root malformations were observed in subjects with several affected teeth. A connection between unilateral retained permanent teeth and temporary or permanent disruption of the nerve supply to the affected region is suggested. PMID: 12001558 [PubMed - indexed for MEDLINE] 1795. Rinsho Shinkeigaku. 2001 Oct;41(10):695-7. [A case of Vernet's syndrome due to varicella-zoster virus infection] [Article in Japanese] Doi H, Segawa F, Koyano S, Suzuki Y, Kuroiwa Y. Department of Neurology, Yokohama City University School of Medicine. We report a 73-year-old man who suffered from an acute onset of dysphagia, cough, hoarseness and left facial and occipital pain. On the 44 days of illness, he was admitted to our clinic. A neurological examination revealed left IX, X and XI cranial nerve palsy. The diagnosis of Vernet's syndrome due to varicella-zoster virus (VZV) infection was made, based on the high titers of VZV antibody in serum. Magnetic resonance imaging revealed a unique nodular lesion with gadolinium enhancement at the medial side of the left jugular foramen. Clinical symptoms improved with intravenous high dose pulse methylprednisolone therapy. The clinical course suggests that the inflammation extended from the left X cranial nerve ganglion. PMID: 11993191 [PubMed - indexed for MEDLINE] 1796. J Dermatol. 2002 Mar;29(3):178-9. Zosteriform angiolymphoid hyperplasia with eosinophilia. Dowlati B, Nabai H, Mehregan DR, Mehregan DA, Khaleel J. PMID: 11990257 [PubMed - indexed for MEDLINE] 1797. J Clin Pathol. 2002 May;55(5):399; author reply 399. Vaccination to prevent varicella and shingles. Katona SJ. Comment on: J Clin Pathol. 2001 Oct;54(10):743-7. PMCID: PMC1769640 PMID: 11986353 [PubMed - indexed for MEDLINE] 1798. J Clin Pathol. 2002 May;55(5):397-8. Oesophagobronchial fistula caused by varicella zoster virus in a patient with AIDS: a unique case. Moretti F, Uberti-Foppa C, Quiros-Roldan E, Fanti L, Lillo F, Lazzarin A. Institute of Infectious and Tropical Diseases, University of Brescia, 25123 Brescia, Italy. francescamoretti@libero.it Human herpesvirus oesophagitis in human immunodeficiency virus positive patients is caused by cytomegalovirus and herpes simplex virus; no cases of oesophagitis and oesophagobrochial fistula as a result of varicella zoster virus (VZV) have been reported to date. This report describes the case of a patient with a 2-3 mm deep oesophageal ulcer whose viral culture was positive for VZV. The patient was treated with acyclovir with resolution of the symptomatology. After the end of the induction treatment, because of the onset of fever and fits of coughing during eating, the patient underwent oesophagography, which showed an ulcer with an oesophagobronchial fistula in the middle and lower third of the oesophagus. This case report stresses the role of VZV infection as a possible cause of oesophagobronchial fistula, a rare but benign condition in patients with AIDS. PMCID: PMC1769657 PMID: 11986352 [PubMed - indexed for MEDLINE] 1799. JAMA. 2002 May 1;287(17):2211; author reply 2211-2. Varicella vaccine and shingles. Brisson M, Edmunds WJ, Gay NJ, Miller E. Comment on: JAMA. 2002 Feb 6;287(5):606-11. PMID: 11980518 [PubMed - indexed for MEDLINE] 1800. Bone Marrow Transplant. 2002 Apr;29(7):595-8. Ganciclovir is effective for prophylaxis and treatment of human herpesvirus-6 in allogeneic stem cell transplantation. Tokimasa S, Hara J, Osugi Y, Ohta H, Matsuda Y, Fujisaki H, Sawada A, Kim JY, Sashihara J, Amou K, Miyagawa H, Tanaka-Taya K, Yamanishi K, Okada S. Department of Developmental Medicine (Pediatrics) D-5, Osaka University Graduate School of Medicine, Osaka, Japan. Human herpesvirus 6 (HHV-6) infection and disease are serious complications of allogeneic hematopoietic stem cell transplantation (allo-SCT). Ganciclovir (GCV) is effective against HHV-6 in vitro but the antiviral susceptibility of HHV-6 has not been well characterized in vivo. We retrospectively compared the HHV-6 reactivation rate in pediatric allo-SCT recipients with and without GCV prophylaxis. The HHV-6 reactivation rate at 3 weeks after allo-SCT in patients without prophylactic GCV administration was significantly higher than that in those receiving prophylactic GCV (11/28 vs 0/13, P < 0.01). Five of 36 patients without prophylactic GCV showed clinical manifestations including skin rash, interstitial pneumonitis, persistent thrombocytopenia, enterocolitis and thrombotic microangiopathy, respectively. HHV-6-associated symptoms were observed in one of the 13 patients receiving prophylactic GCV. This patient showed fever, diarrhea and graft rejection concomitantly with a sudden increase of HHV-6 DNA copy number. Patients who received GCV for treatment of HHV-6 infection showed an improvement in symptoms and/or decrease of HHV-6 copy number. Thus, GCV is effective for treating HHV-6 disease after allo-SCT in vivo. PMID: 11979309 [PubMed - indexed for MEDLINE] 1801. J Fam Pract. 2002 Feb;51(2):121-8. Treatment of postherpetic neuralgia: a systematic review of the literature. Alper BS, Lewis PR. Department of Family & Community Medicine, University of Missouri-Columbia School of Medicine, Columbia, MO 65212, USA. alperb@health.missouri.edu Comment in: J Fam Pract. 2002 Jun;51(6):514. ACP J Club. 2002 Sep-Oct;137(2):52. OBJECTIVES: We wanted to determine whether any treatment had been shown to reduce pain or disability from postherpetic neuralgia (PHN), a common sequela of herpes zoster in elderly patients. STUDY DESIGN: We undertook a systematic review of English-language randomized controlled trials (RCTs) of treatments of PHN with evaluation periods longer than 24 hours. DATA SOURCES: We systematically searched MEDLINE, Current Contents, and the Cochrane Library. We also searched reference lists of identified trials and reviews and contacted content experts. OUTCOMES MEASURED: Two reviewers independently evaluated RCTs for methodologic quality and data extraction. Outcomes of primary focus were pain and quality of life. RESULTS: Twenty-seven RCTs met inclusion criteria and were reviewed. Six trials of tricyclic antidepressants found evidence for clinically meaningful effects over 6 weeks. All other treatments were evaluated in no more than 2 trials meeting our inclusion criteria. Topical capsaicin 0.075%, gabapentin, and controlled-release oxycodone were shown to be effective, but the clinically meaningful benefit is difficult to quantify. Intrathecal methylprednisolone and possibly bupivacaine sympathetic blocks are helpful in refractory cases. Other treatments evaluated, including topical lidocaine, had no evidence or inconsistent evidence of benefit. CONCLUSIONS: No single best treatment for PHN is known. Tricyclic antidepressants, topical capsaicin, gabapentin, and oxycodone are effective for alleviating PHN; however, long-term, clinically meaningful benefits are uncertain and side effects are common. Patients with PHN refractory to these therapies may benefit from intrathecal methylprednisolone. Little evidence is available regarding treatment of PHN of less than 6 months' duration. PMID: 11978209 [PubMed - indexed for MEDLINE] 1802. J Pharm Sci. 2002 May;91(5):1343-50. Systemic absorption of topical lidocaine in normal volunteers, patients with post-herpetic neuralgia, and patients with acute herpes zoster. Campbell BJ, Rowbotham M, Davies PS, Jacob P 3rd, Benowitz NL. Division of Drug Delivery and Disposition, School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA. Topical lidocaine has been recently marketed as a new treatment for post-herpetic neuralgia. The aim of our study was to characterize the absorption profile of and systemic exposure to lidocaine from patch and gel formulations in normal volunteers, patients with post-herpetic neuralgia, and patients with acute herpes zoster. The bioavailability of lidocaine from the patch formulation averaged 3%, and was similar after single and repeated doses. Systemic exposure to lidocaine and monoethylglycinexylidide (MEGX), the primary active metabolite of lidocaine, after application of lidocaine gel or patches was minimal in normal volunteers, patients with post-herpetic neuralgia, and patients with acute herpes zoster. Considering the benefit versus risk of topical lidocaine, systemic absorption and toxicity of lidocaine seems not to be a significant risk. Copyright 2002 Wiley-Liss, Inc. and the American Pharmaceutical Association PMID: 11977110 [PubMed - indexed for MEDLINE] 1803. Klin Oczna. 2001;103(4-6):207-15. [Ophthalmic complications in the course of opportunistic infections--part I] [Article in Polish] Raczyńska K, Ulewicz-Filipowicz J, Owczuk R. Kliniki Chorób Oczu AM w Gdańsku. One of the most important problem of contemporary medicine appears to be constantly increasing number of patients with opportunistic infections. The situation is mainly due to world epidemic of AIDS. The progress in transplantology, huge number of immunocompromised patients during oncological and hematological treatment as well as prolongation of life time in children with congenital immunodeficiencies are successive conditions for the development of opportunistic infection. Pathogens infecting immunocompromised individuals have very low virulence, but in these persons disease is often very severe and potentially lethal. Main agents responsible for opportunistic infections are: Toxoplasma gondii, Cytomegalovirus hominis, Herpes simplex virus, Varicella-zoster virus and fungi. In the paper we describe clinical symptoms, diagnostic methods and therapies of ocular toxoplasmosis and viral infections. Knowledge of diagnosing methods and treatment of opportunistic infections which, when untreated, may quickly lead to vision loss, is necessary in contemporary ophthalmological practice. PMID: 11975020 [PubMed - indexed for MEDLINE] 1804. Kansenshogaku Zasshi. 2002 Mar;76(3):216-9. [Four cases of pediatric Ramsay Hunt syndrome] [Article in Japanese] Takayama N, Takayama M. Department of Pediatrics, Tokyo Metropolitan Komagome Hospital. Four cases of the Ramsay Hunt syndrome were admitted to our hospital during the two years from February 1997 to January 1999. Though one of the 4 patients had been immunized with varicella vaccine, the causative virus was not a vaccine strain but a wild-type strain. These patients were not suffering from underlying diseases. Because the number of pediatric zoster patient without underlying diseases who visited our clinic between 1981 and 1999 was 35 cases, the Ramsay Hunt syndrome turned out not to be extremely rare even among children having no underlying diseases. The prognosis of the Ramsay Hunt syndrome is assumed to be good if the treatment begins at the early stage. To begin the treatment at the early stage, it is necessary to confirm the diagnosis with virological examinations. PMID: 11974892 [PubMed - indexed for MEDLINE] 1805. Hautarzt. 2002 Mar;53(3):223-4. [4th International Conference on Varicella, Herpes Zoster and Postherpetic Neuralgia (PHN). 3-5 March 2001, La Jolla, California, USA] [Article in German] Lilie HM, Wassilew SW. Dermatologische Klinik, Klinikum Krefeld, Lutherplatz 40, 47805 Krefeld. lilie@klinikum-krefeld.de PMID: 11974596 [PubMed - indexed for MEDLINE] 1806. Pain. 2002 Apr;96(3):410-1. Comment on Rice ASC, Maton S, the Postherpetic Neuralgia Study Group (UK), gabapentin in postherpetic neuralgia: a randomized, double blind, placebo-controlled study. Gehling M, Tryba M. Comment on: Pain. 2001 Nov;94(2):215-24. Pain. 2001 Nov;94(2):149-58. Pain. 2001 Nov;94(2):131-2. PMID: 11973022 [PubMed - indexed for MEDLINE] 1807. Pain. 2002 Apr;96(3):409-10; author reply 411-2. Comment on Rice ASC, Maton S, the Postherpetic Neuralgia Study Group (UK), gabapentin in postherpetic neuralgia: a randomized, double blind, placebo-controlled study. Bowsher D. Comment on: Pain. 2001 Nov;94(2):215-24. PMID: 11973021 [PubMed - indexed for MEDLINE] 1808. Clin Lymphoma. 2002 Mar;2(4):238-41. Testicular lymphoma: a literature review and report of a case with a zoster-like cutaneous recurrence. Ingram RM, Williams ME, Fintel WA, Ross M. Division of Hematology/Oncology and Adult Stem Cell Transplantation Program, University of Virginia Health System, Charlottesville, VA 22908, USA. rmi8n@virginia.edu Testicular lymphoma accounts for approximately 1% of all cases of non-Hodgkin's lymphoma. This distinct clinical entity can have an aggressive course with a high rate of systemic relapse. We describe a unique case of a diffuse large B-cell lymphoma, T-cell-rich variant with cutaneous dermatomal zosteriform recurrence presenting as neuralgia. This case represents a unique pattern of treatment failure in this aggressive extranodal lymphoma. PMID: 11970763 [PubMed - indexed for MEDLINE] 1809. Ostomy Wound Manage. 2002 Mar;48(3):24-7. Healing shingles with moist occlusive dressings. Lee SK. PMID: 11968892 [PubMed - indexed for MEDLINE] 1810. Medicina (B Aires). 2002;62(1):53-4. [Abdominal distension due to herpes zoster] [Article in Spanish] Barroso FA. Cátedra de Neurología, Facultad de Ciencias Médicas, Universidad Nacional de Rosario, Rosario, Argentina. fabiobarroso@uol.com.ar A case is reported in which an abdominal protrusion appeared in relation with a zosteric eruption at 11th dorsal dermatome. The motor deficit in zoster is unusual (2-3% in the reported series) and generally recognized when the extremities are affected. The frequency with which the abdominal muscles are involved is estimated to be around 0.17%, according to a clinical series. The aim of this report is to draw attention to the abdominal wall paresis that can result when zoster involves the caudal dorsal dermatomyotomes. This in turn, leads to abdominal distension which needs to be differentiated from other causes. PMID: 11965851 [PubMed - indexed for MEDLINE] 1811. Nurs Times. 2000 Dec 14-2001 Jan 3;96(50):36-7. Shingles: diagnosis and treatment. Scott F. Virology Department, Barts and The London NHS Trust. PMID: 11965804 [PubMed - indexed for MEDLINE] 1812. Transplant Proc. 2002 Feb;34(1):77. Prevalence of past varicella zoster virus infection in candidates for kidney transplantation: vaccination in seronegative patients. Crespo JF, Górriz JL, Avila A, Sancho A, Gavela E, Caño A, Zanón V, Pallardó LM. Department of Nephrology and Preventive Medicine, Hospital Universitario Dr Peset, Valencia, Spain. PMID: 11959193 [PubMed - indexed for MEDLINE] 1813. Med Klin (Munich). 2002 Mar 15;97(3):123-7. [Laboratory diagnosis of herpes zoster: virology or serology?] [Article in German] Sauerbrei A, Sommer M, Eichhorn U, Wutzler P. Institut für Antivirale Chemotherapie, Friedrich-Schiller-Universität Jena. Andreas.Sauerbrei@med.uni-jena.de BACKGROUND: The diagnosis of herpes zoster is mostly based on clinical findings. In atypical cases, rapid and reliable virological diagnostics is necessary because effective antiviral chemotherapy is available. PATIENTS AND METHODS: The meaningfulness and practicability of conventional diagnostic methods mostly used such as antigen staining, virus isolation and detection of virus-specific antibodies were compared with polymerase chain reaction (PCR) in 100 patients with zoster. RESULTS: PCR using oligonucleotides selected from the open reading frames 28 and 29 of the varicella-zoster virus (VZV) genome showed the highest sensitivity of 94% and a specificity of 100%. Direct immunofluorescent antigen staining carried out within few hours had a sensitivity of 82% and a specificity of 70%. However, results could only be obtained in 71% of the cases. On the basis of serologic parameters, an active VZV infection was detected in 61% of the patients. Virus culture frequently regarded as "gold standard" was successful in 20%. There was a strong dependence on the time of collecting specimens and the immunocompetence of the patients. CONCLUSIONS: The study shows that the PCR has to be considered the method of choice for the diagnostics of zoster with an atypical course. Serological methods can only be recommended to confirm the diagnosis retrospectively. PMID: 11957786 [PubMed - indexed for MEDLINE] 1814. AIDS. 2002 May 3;16(7):1045-9. Aseptic meningitis and optic neuritis preceding varicella-zoster progressive outer retinal necrosis in a patient with AIDS. Franco-Paredes C, Bellehemeur T, Merchant A, Sanghi P, DiazGranados C, Rimland D. Division of Infectious Diseases, Department of Medicine, Veterans Affairs Medical Center, Emory University School of Medicine, 69 Butler Street, Atlanta, GA 30303, USA. Varicella-Zoster Virus (VZV) is the second most common ocular pathogen in patients with HIV infection. VZV retinitis is estimated to occur in 0.6% of patients with HIV infection and may occur in one of two clinical syndromes. The first is the acute retinal necrosis syndrome, which also may be seen in immunocompetent hosts. The second clinical syndrome occurs in patients with CD4 cell counts typically < 50 x 10(6)/l and is termed progressive outer retinal necrosis. VZV retinitis has been reported to occur simultaneously with other VZV central nervous system manifestations such as encephalitis and myelitis in HIV-infected patients. In addition, VZV retrobulbar optic neuritis heralding VZV retinitis has recently been described in HIV-infected patients who had suffered a recent episode of dermatomal herpes zoster. Herein we report the case of an HIV-infected individual who presented with VZV meningitis and retrobulbar optic neuritis that preceded the onset of progressive outer retinal necrosis. We also review of the literature of seven additional reported cases of retrobulbar optic neuritis preceding the onset of VZV retinitis. PMID: 11953471 [PubMed - indexed for MEDLINE] 1815. Clin Exp Dermatol. 2002 Mar;27(2):132-4. Drug eruption secondary to aciclovir with recall phenomenon in a dermatome previously affected by herpes zoster. Carrasco L, Pastor MA, Izquierdo MJ, Fariña MC, Martín L, Fortes J, Requena L. Department of Dermatology, Fundación Jiménez Díaz, Universidad Autónoma, Avda. Reyes Católicos No. 2, 28040-Madrid, Spain Comment in: Clin Exp Dermatol. 2004 May;29(3):323; author reply 324. Classically, recall dermatitis refers to chemotherapy-induced reactivation of skin damage caused by radiotherapy months, or even years, earlier. The concept of recall dermatitis has now been extended to include radiation recall dermatitis induced by other drugs, ultraviolet radiation, extravasation of drugs, and allergic contact dermatitis. We now describe recall dermatitis along the residual cutaneous lesions of a previous thoracic herpes zoster in a patient who developed a drug eruption after oral administration of aciclovir. The most striking feature consisted of confluent linear erythema along the dermatomes previously involved by the herpes zoster episode. Histopathologic study demonstrated small foci of spongiosis, vacuolar changes involving the basal layer of the epidermis and single necrotic keratinocytes scattered within the epidermis. The papillary dermis appeared oedematous and with dilated blood capillaries surrounded by a sparse inflammatory infiltrate composed mainly of lymphocytes. Serial sections failed to demonstrate cytologic changes of herpes varicella zoster infection. We interpreted this case as an example of recall dermatitis because the widespread cutaneous eruption secondary to aciclovir was more intense in skin previously compromised by herpes varicella zoster infection. To the best of our knowledge, recall dermatitis has not been described before at the site of previous involvement by herpes zoster. PMID: 11952706 [PubMed - indexed for MEDLINE] 1816. J Eur Acad Dermatol Venereol. 2002 Jan;16(1):53-7. Early diagnosis of herpes zoster by polymerase chain reaction. Lilie HM, Wassilew SW, Wolff MH. Dermatology Department, Klinikum Krefeld, Germany. lilie@klinikum-krefeld.de BACKGROUND: Herpes zoster is a common disease caused by the varicella-zoster virus. The use of virostatic agents as early as possible is necessary in shortening zoster-associated pain. OBJECTIVES: Rapid diagnosis is necessary for the optimal efficacy of antiviral therapy. The diagnosis in the early stage of infection is often difficult. METHODS: In the present study skin biopsies of patients with herpes zoster and unclear skin changes were analysed by detecting viral DNA using the polymerase chain reaction (PCR) in order to amplify open reading frames (ORF) 14, 29 and 63. RESULTS: Varicella-zoster virus DNA could be detected with PCR of all three ORF not only from blisters but also from erythematous skin. CONCLUSIONS: PCR is the method of choice for the viral diagnosis in herpes zoster before blister eruption. PMID: 11952291 [PubMed - indexed for MEDLINE] 1817. Drugs Exp Clin Res. 2001;27(5-6):199-208. Evaluation of efficacy and tolerance of neuramide in the treatment of herpes zoster and postherpetic neuritis. Varotti C, Rafanelli A. University of Bologna, Department of Clinical and Experimental Specialist Medicine, Clinical Dermatology Section, Bologna, Italy. Ninety-two patients suffering from herpes zoster were enrolled in a double-blind controlled study aimed at evaluating the efficacy and tolerance of the drug neuramide. Neuramide (N) and placebo (P) were administered to patients intramuscularly twice daily for 28 days as follows: group N + N (patients always treated with neuramide); group N + P (patients treated with neuramide for 1 week, then with placebo); group P + N (patients treated with placebo for 1 week, then with neuramide); group P + P (patients always treated with placebo). During the first week, all patients were also treated with standardized doses of acyclovir. The presence and extent of clinical symptoms were evaluated during the first 4 weeks, while the appearance, degree and duration of postherpetic neuralgia were evaluated both during treatment and over a 6-month follow-up period. There were no significant differences between the four groups of patients when subjective parameters (such as pain and paresis at the lesion site) were examined. However, clinical examination at the end of treatment showed that treatment with neuramide was therapeutic. Indeed, the times for recovery and for regeneration of epithelium were significantly shorter when neuramide was administered for 3 weeks of the treatment period. Furthermore, the change from vesicles to crusts was significantly faster in the neuramide group than in the placebo group. Postherpetic neuritis occurred in the first months of follow-up. However, in groups N + P and P + P, the symptoms lasted throughout the 6-month observation period, while in the other groups this period was shorter. Indeed, there were significant differences (p < 0.05) in terms of the above complications between the following groups: N + N and N + P; N + N and P + P; N + P and P + N; P + N and P + P. No significant differences were observed between the N + N and P + N, or N + P and P + P groups. Taken together, these data demonstrate that neuramide treatment for at least 3 weeks significantly reduces the risk of postherpetic neuritis development. PMID: 11951578 [PubMed - indexed for MEDLINE] 1818. N Engl J Med. 2002 Apr 11;346(15):1127. Images in clinical medicine. Herpes zoster ophthalmicus followed by contralateral hemiparesis. Nogueira RG, Sheen VL. Brigham and Women's Hospital, Boston, MA 02115, USA. PMID: 11948272 [PubMed - indexed for MEDLINE] 1819. Haematologica. 2002 Apr;87(4):444-6. Clinical characteristics of and risk factors for herpes zoster after hematopoietic stem cell transplantation. Leung AY, Yuen KY, Cheng VC, Lie AK, Liang R, Kwong YL. PMID: 11940491 [PubMed - indexed for MEDLINE] 1820. Ann Dermatol Venereol. 2002 Feb;129(2):251-4. [Post zoster pain] [Article in French] Paul C, Donskoff C, Michel C. Service de Dermatologie, Hôpital E. Muller, 68100 Mulhouse, France. PMID: 11937971 [PubMed - indexed for MEDLINE] 1821. Pain. 2002 Mar;96(1-2):9-12. Intractable postherpetic itch and cutaneous deafferentation after facial shingles. Oaklander AL, Cohen SP, Raju SV. Neuropathic Pain Study Group, Department of Anesthesiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA. aoaklander@partners.org Some patients develop chronic itch from neurological injuries, and shingles may be a common cause. Neuropathic itch can lead to self-injury from scratching desensate skin. A 39-year-old woman experienced severe postherpetic itch, but no postherpetic neuralgia, after ophthalmic zoster. Within 1 year, she had painlessly scratched through her frontal skull into her brain. Sensory testing and skin biopsies were performed on itchy and normal scalp to generate preliminary hypotheses about mechanisms of neuropathic itch. Quantitation of epidermal neurites in PGP9.5-immunolabeled skin biopsies demonstrated loss of 96% of epidermal innervation in the itchy area. Quantitative sensory testing indicated severe damage to most sensory modalities except itch. These data indicate that in this patient, severe postherpetic itch was associated with loss of peripheral sensory neurons. Possible mechanisms include electrical hyperactivity of hypo-afferented central itch-specific neurons, selective preservation of peripheral itch-fibers from neighboring unaffected dermatomes, and/or imbalance between excitation and inhibition of second-order sensory neurons. PMID: 11932056 [PubMed - indexed for MEDLINE] 1822. Scand J Infect Dis. 2002;34(2):112-4. Polymorphism of the IL-10 gene is associated with susceptibility to herpes zoster. Haanpää M, Nurmikko T, Hurme M. Department of Neurology and Rehabilitation, Tampere University Hospital, Finland. Herpes zoster (HZ) is induced by diseases or medical treatments leading to a decrease in cell-mediated immunity, but in most cases it appears without any detectable, predisposing condition. We report here that susceptibility to HZ is genetically determined. The promoter region of the IL-10 gene contains 3 single-nucleotide polymorphisms (G/A at -1082, C/T at -819 and C/A at -592) which form 3 haplotypes, GCC, ACC and ATA. These haplotypes are known to differ in terms of their effect on the transcription of the IL-10 gene. In a cohort of 60 HZV patients, the number of carriers of the ATA haplotype was 32 (53%), while in blood donors the frequency was 151/400 (38%) (p < 0.05). PMID: 11928840 [PubMed - indexed for MEDLINE] 1823. Retina. 2002 Apr;22(2):225-8. A case of a five-year-old boy with acute retinal necrosis. Iino Y, Tanaka M, Hatano N, Kiyokawa M, Takebayashi H, Shinohara I, Kobayashi Y, Ninomiya H. Department of Ophthalmology, Juntendo University, Urayasu Hospital, Chiba, Japan. PMID: 11927861 [PubMed - indexed for MEDLINE] 1824. An Esp Pediatr. 2002 Apr;56(4):366-8. [Meningitis as a neurological complication of herpes zoster] [Article in Spanish] Jiménez Moya A, García Hernández T, Vélez De Guevara TP, Santana Rodríguez C, Romero Escós D, Herrera Martín M. PMID: 11927087 [PubMed - indexed for MEDLINE] 1825. Aust Fam Physician. 2002 Mar;31(3):217-23. Eye signs in systemic disease. Stawell RJ, Hall AJ. Alfred Hospital and Ocular Immunology Clinic, Royal Victorian Eye and Ear Hospital, Victoria. BACKGROUND: The eye provides clues to the diagnosis of many systemic diseases and many important complications of these diseases occur in the eye. OBJECTIVE: To review the important ocular pathology seen in some systemic diseases. The ocular manifestations of a small number of these diseases will be discussed in detail. DISCUSSION: Examination of the eye should be a routine and important part of a general examination in certain systemic diseases. PMID: 11926152 [PubMed - indexed for MEDLINE] 1826. Nihon Kokyuki Gakkai Zasshi. 2002 Jan;40(1):77-80. [An adult patient with varicella-zoster pneumonia while under inhaled steroid treatment] [Article in Japanese] Yasuo M, Yamamoto H, Maruyama Y. Department of Respiratory Medicine, Komoro Kousei General Hospital, 2-31 Yora-cho, Komoro, Nagano 384-8588, Japan. Bronchial asthma had been diagnosed in a 33-year-old man, and he had then been treated with a moderate dose of inhaled steroids (fluticason propionate 400 micrograms/day). On year later, he was admitted to our hospital complaining of sore throat, fever, loss of appetite, and skin eruptions. Despite the administration of Acyclovir for three days, varicella pneumonia was diagnosed. Computed tomography of the chest and bronchoscopic examination revealed characteristic findings: nodules with surrounding ground-glass attenuation and multiple vesicles with an ulcerativelesion on the bronchial mucosa, respectively. The demonstration of varicella-zoster virus DNA in a bronchoalveolar lavage specimen by the polymerase chain reaction technique was useful in the formulation of a definitive diagnosis. PMID: 11925924 [PubMed - indexed for MEDLINE] 1827. Masui. 2002 Mar;51(3):293-5. [The development of methicillin-resistant Staphylococcus aureus sepsis in a patient with herpes zoster during treatment with continuous epidural infusion] [Article in Japanese] Suzuki T, Takemura H, Shida K, Higuchi H, Ohtsuka N, Masuda Y. Department of Anesthesiology, School of Medicine, Showa University, Tokyo 142-8666. A 79-year-old man with herpes zoster was referred to our hospital for pain control. He was a survivor of the atomic bombing of Hiroshima, and had a history of cerebral infarction and hypertension. A cervical epidural catheter was placed for continuous analgesic infusion. After 20 days of catheterization, he gradually developed a high fever and confusion, and complained of nausea and headaches. An urgent blood examination revealed a white blood cell count of 15,200 mm-3 and a C-reactive protein of 32.4 mg.dl-1. The catheter was removed and antibiotic therapy was started. Repeated magnetic resonance imaging could not confirm epidural abscess formation. The bacterial culture of the cerebrospinal fluid was negative, but the cultures of the blood, the catheter tip, and the nasal cavity swab were positive for methicillin-resistant Staphylococcus aureus. Although intravenous vancomycin was administered, systemic inflammation persisted. The patient consecutively suffered varied disorders such as acute renal failure, disseminated intravascular coagulation, and gastrointestinal bleeding. Although symptomatic treatment had been prolonging his life, 58 days after the catheter removal, the patient suddenly developed cerebellopontine infarction, which made mechanical ventilation necessary. He remained unconscious until his death 117 days after the catheter removal. We discussed the possible pathogenetic mechanisms of the present case. PMID: 11925898 [PubMed - indexed for MEDLINE] 1828. J Investig Dermatol Symp Proc. 2001 Dec;6(3):183-7. Varicella-zoster virus: a re-emerging infection. LaGuardia JJ, Gilden DH. Department of Neurology, University of Colorado Health Sciences Center, Denver 80262, USA. Varicella-zoster virus (VZV) causes chickenpox (varicella), becomes latent in cranial nerve and dorsal root ganglia, and can reactivate many years later to produce shingles (zoster) and postherpetic neuralgia (PHN). Elderly and immunocompromised individuals are also at risk for complications of VZV reactivation involving the central nervous system (CNS), including myelitis, large-vessel encephalitis/granulomatous arteritis, small-vessel encephalitis, meningoencephalitis, and ventriculitis. Peripheral nervous system (PNS) complications range from zoster and postherpetic neuralgia to postinfectious polyneuritis (Guillain-Barre syndrome, GBS). These complications can occur with or without cutaneous manifestations. An increase in elderly and immunocompromised individuals will likely result in a higher prevalence of these conditions; therefore, VZV can be seen as a "re-emerging" infection of the early twenty-first century. In this review, we summarize our experience and the existing literature on CNS and PNS complications of VZV reactivation. Special attention is paid to reports of complications without rash, as these entities are more difficult to diagnose. PMID: 11924825 [PubMed - indexed for MEDLINE] 1829. J Int Med Res. 2002 Jan-Feb;30(1):56-65. Clinical correlates of prolonged pain in Japanese patients with acute herpes zoster. Kurokawa I, Kumano K, Murakawa K; Hyogo Prefectural PHN Study Group. Department of Dermatology, Hyogo Prefectural Tsukaguchi Hospital, Hyogo, Japan. ikuro@alles.or.jp To determine which risk factors are relevant to the occurrence of post-herpetic neuralgia in Japanese patients with acute herpes zoster, correlations between the prolongation of pain and various disease factors were examined in 263 adult patients presenting within 10 days of the onset of rash at 17 institutions in the Hyogo region of Japan. All patients in whom pain persisted for more than 3 months were over 60 years of age. The pain also tended to be more prolonged in those with clustered vesicles, disturbed sleep and hypanaesthesia. Other factors such as underlying disease states, critically involved regions, scar tissue, generalized rash and allodynia were not relevant to the duration of pain. Although decreased pain persistence was observed in patients in whom acyclovir therapy was initiated within 72 h of the onset of symptoms in comparison with those in whom it was initiated after this time, the difference between the two groups of patients was not statistically significant. Our results suggest that advanced age, the presence of clustered vesicles, and disturbed sleep and hypanaesthesia influence the prolongation of herpes zoster pain. PMID: 11921500 [PubMed - indexed for MEDLINE] 1830. Int J Impot Res. 2001 Dec;13(6):352-3. Herpes zoster producing temporary erectile dysfunction. Rix GH, Carroll DN, MacFarlane JR. Department of Urology, Queen Margaret Hospital NHS Trust, Dunfermline, Fife, UK. ghrix@hotmail.com Varicella Zoster affecting the sacral dermatomes is a rare but well recognised cause of urinary retention. Only one case of erectile dysfunction associated with Varicella Zoster has previously been described, which was longstanding, but no cases of transient erectile dysfunction following Zoster infection are recorded. We present one such case. PMID: 11918252 [PubMed - indexed for MEDLINE] 1831. Dermatol Nurs. 2001 Feb;13(1):51, 54-5. Shingles update: common questions in caring for a patient with shingles. Madison LK. Cleveland Clinic Foundation, Cleveland, Ohio, USA. Varicella zoster virus (VZV) is a herpes virus that can cause two distinct clinical diseases, chickenpox and shingles. Primary infection of varicella, often called chickenpox, results in a generalized eruption of a vesicular exanthematous rash which is usually seen in children and is highly contagious. This virus (VZV) can then become latent and later reactivate causing herpes zoster, commonly known as shingles. Shingles is usually a localized phenomenon often seen in adults and is usually less contagious. The following is a discussion of infection control questions most commonly asked regarding the care of a patient with shingles. PMID: 11917300 [PubMed - indexed for MEDLINE] 1832. Clin Geriatr Med. 2002 Feb;18(1):89-101, vi. Skin infections and infestations in geriatric patients. Elgart ML. Department of Dermatology, The George Washington University Medical Center, Washington, DC, USA. mervynelgart@sprintmail.com Geriatric patients develop infections, but many have a different appearance from what usually is expected. The difference depends on the age and immune status of the patient and the virulence of the organism. Differences may make recognition more difficult. Therapy may require different doses. Examples of the more common infections are detailed in this article. PMID: 11913741 [PubMed - indexed for MEDLINE] 1833. J Pediatr Ophthalmol Strabismus. 2002 Mar-Apr;39(2):123-4. Central retinal artery occlusion in herpes zoster ophthalmicus. Ahn M, Cho NC. Department of Ophthalmology, Chonbuk National University Medical School, Chonju, South Korea. PMID: 11911544 [PubMed - indexed for MEDLINE] 1834. J Formos Med Assoc. 2002 Jan;101(1):73-5. Natural killer cell deficiency associated with Hodgkin's lymphoma: a case report. Yang CM, Yang YH, Lin YT, Lu MY, Chiang BL. Department of Pediatrics, National Taiwan University Hospital, 7 Chung Shan South Road, Taipei, Taiwan. Natural killer (NK) cells are large granular lymphocytes that play important roles in immunity against viral infection. NK cell deficiency is associated with recurrent episodes of severe herpes group virus reactivation. Few cases of NK cell deficiency have been reported. Here, we report the case of a Taiwanese girl who had suffered from severe atopic dermatitis since infancy, and recurrent episodes of herpes virus reactivation since the age of 3 years old. NK cell deficiency was diagnosed based on the finding of persistently low NK cell counts in peripheral blood. Hodgkin's lymphoma developed when she was 6 years old. The present case suggests that NK cell deficiency may be an important risk factor in the development of Hodgkin's lymphoma. PMID: 11911042 [PubMed - indexed for MEDLINE] 1835. Hautarzt. 2001 Dec;52(12):1111-4. [Post-zoster granuloma with detection of varicella zoster virus DNA in the granulomas] [Article in German] Gutzmer R, Kiehl P, Hausmann M, Kapp A, Weiss J. Dermatologische Klinik und Poliklinik der Medizinische Hochschule, Ricklinger Strasse 5, 30449 Hannover. rgutzmer@gmx.de Granulomatous skin changes following herpes zoster are uncommon and their pathogenesis is unclear. We demonstrated varicella-zoster virus in the granuloma tissue of an immunocompromised patient with postherpetic granulomas and use this finding as basis for discussing the pathogenesis of these lesions. PMID: 11910864 [PubMed - indexed for MEDLINE] 1836. J Cutan Med Surg. 2001 Sep-Oct;5(5):409-16. Reduction of postherpetic neuralgia in herpes zoster. Vander Straten M, Carrasco D, Lee P, Tyring SK. Department of Dermatology, University of Texas Medical Branch, UTMB Center for Clinical Studies, 2060 Space Park Drive, Galveston, TX 77058, USA. BACKGROUND: Persons 50 years of age and older are not only at increased risk of developing herpes zoster, they are also more likely to suffer the long-term morbidity of postherpetic neuralgia (PHN). PHN is pain persisting after the rash of herpes zoster has healed. PHN affects at least 40% of all herpes zoster patients over age 50 and over 75% of herpes zoster patients over age 75; PHN is the single most common neurologic condition in elderly patients. OBJECTIVE: The objective of this review is to evaluate interventions that may reduce or even eliminate PHN. No single therapy has been consistently effective for PHN. The most effective approach appears to be with the use of antiviral therapy early in the course of herpes zoster. The goals of ongoing studies in herpes zoster are to develop interventions that will further reduce the symptoms of PHN and/or to eliminate PHN by prophylaxis using the varicella vaccine. CONCLUSIONS: Reduction of PHN can best be achieved with the use of antiviral medication early in the course of herpes zoster; other classes of drugs are minimally effective in treating established PHN. Widespread use of the varicella vaccine may lead to secondary reductions in PHN in the distant future. PMID: 11907852 [PubMed - indexed for MEDLINE] 1837. Pathology. 2002 Feb;34(1):88-93. Meningoencephalomyelitis with vasculitis due to varicella zoster virus: a case report and review of the literature. McKelvie PA, Collins S, Thyagarajan D, Trost N, Sheorey H, Byrne E. Department of Anatomical Pathology, St Vincent's Hospital, Fitzroy, Victoria, Australia. mckelvpa@svhm.org.au Varicella zoster virus (VZV) encephalitis is associated with large or small vessel vasculopathy. We report the case of a 67-year-old woman with a history of non-Hodgkin's lymphoma and cancers of the breast and colon, who presented with a zosteriform rash and Brown-Sequard syndrome. Despite 10 days therapy with intravenous acyclovir, meningoencephalitis developed and the patient died 15 days after onset of neurological symptoms. Autopsy showed meningoencephalomyelitis with necrotising vasculitis of leptomeningeal vessels, which is a rare complication of VZV, and we review the literature of the nine similar published cases. Polymerase chain reaction of cerebrospinal fluid for VZV was negative 6 days after onset of neurological symptoms, but became positive by day 10. Only one multinucleated giant cell with intranuclear Cowdry type A inclusions was seen within an endothelial cell in a leptomeningeal vessel involved by vasculitis. PMID: 11902456 [PubMed - indexed for MEDLINE] 1838. Biosci Rep. 2001 Aug;21(4):419-44. Keratitis. Sharma S. Jhaveri Microbiology Centre, Hyderabad Eye Research Foundation, L. V. Prasad Eye Institute, AP, India. savitri@lvpeye.stph.net Corneal inflammation or keratitis is a significant cause of ocular morbidity around the world. Fortunately, the majority of the cases are successfully managed with medical therapy, but the failure of therapy does occur, leading to devastating consequences of either losing the vision or the eye. This review attempts to provide current information on most, though not all, aspects of keratitis. Corneal inflammation may be ulcerative or nonulcerative and may arise because of infectious or noninfectious causes. The nonulcerative corneal inflammation may be confined to the epithelial layer or to the stroma of the cornea or may affect both. For clarity, this section has been divided into nonulcerative superficial keratitis and nonulcerative stromal keratitis. While the former usually includes hypersensitivity responses to microbial toxins and unknown agents, the latter can be either infectious or noninfectious. In the pathogenesis of ulcerative keratitis, microorganisms such as bacteria, fungi, parasites (Acanthamoeba), or viruses play an important role. Approximately, 12.2% of all corneal transplantations are done for active infectious keratitis. Available world literature pertaining to the incidence of microbial keratitis has been provided special place in this review. On the other hand, noninfectious ulcerative keratitis can be related to a variety of systemic or local causes, predominantly of autoimmune origin. PMID: 11900320 [PubMed - indexed for MEDLINE] 1839. Curr Neurol Neurosci Rep. 2001 Nov;1(6):526-32. Herpes zoster infection and postherpetic neuralgia. Tenser RB. Division of Neurology, Pennsylvania State University College of Medicine, 500 University Drive, Hershey, PA 17033, USA. rtenser@psu.edu Varicella-zoster virus (VZV), the cause of chicken pox, establishes latent infection in sensory ganglia. Reactivation results in zoster (shingles), sometimes complicated by encephalitis (myelitis). Postherpetic neuralgia (PHN) is the major morbidity of zoster. PHN typically increases in frequency with age. The VZV vaccine, which was developed for children, may be effective in enhancing VZV immune reactivity and decreasing zoster in adults. Early antiviral treatment may be effective in decreasing PHN onset. Several other medications may be useful in treating established PHN. A recent report discussed intrathecal steroid use. PMID: 11898565 [PubMed - indexed for MEDLINE] 1840. Brain Dev. 2002 Mar;24(2):106-8. Unilateral occlusion of the middle cerebral artery after varicella-zoster virus infection. Ueno M, Oka A, Koeda T, Okamoto R, Takeshita K. Division of Child Neurology, Institute of Neurological Sciences, Faculty of Medicine, Tottori University, 36-1 Nishi-machi, Yonago 683-8504, Japan. mueno@grape.med.tottori-u.ac.jp We report a 4-year-old child who developed hemiplegia 6 months after varicella-zoster virus (VZV) infection. Cerebral angiography showed complete occlusion of the right middle cerebral artery with basal moyamoya vessels. Elevation of anti-VZV antibody in the cerebrospinal fluid indicated central nervous system involvement. The association between VZV cerebral angitis and unilateral occlusion of right middle cerebral artery is discussed. PMID: 11891103 [PubMed - indexed for MEDLINE] 1841. Transplantation. 2002 Feb 27;73(4):608-11. Disseminated varicella infection in adult renal allograft recipients: four cases and a review of the literature. Fehr T, Bossart W, Wahl C, Binswanger U. Division of Nephrology, Department of Internal Medicine, University Hospital, Zurich, Switzerland. Disseminated varicella-zoster (VZV) infection is a rare complication after renal allotransplantation in adults. We report four patients, among them one with combined VZV and cytomegalovirus infection. The main complications were hepatitis, pneumonitis, and disseminated intravascular coagulation. A review of the literature from 1981 to 2000 revealed 34 additional cases of disseminated varicella infection in adult renal allograft recipients with an overall mortality of 34%. Among these patients 82% suffered from primary varicella, 18% had a reactivation. High-dose acyclovir therapy combined with reduction of immunosuppression lead to reduction of mortality from 53% before 1990 to 22% after 1990. No immunosuppressive drug is significantly associated with a higher risk of disseminated VZV infection. Immunization against VZV in adults is still a matter of controversy. Whereas passive immunization is performed only for prophylactic but not therapeutic purpose, active immunization is routinely performed in children and may also be recommended for adults before renal transplantation. PMID: 11889440 [PubMed - indexed for MEDLINE] 1842. Clin Infect Dis. 2002 Apr 1;34(7):885-94. Epub 2002 Feb 19. Do the benefits of varicella vaccination outweigh the long-term risks? A decision-analytic model for policymakers and pediatricians. Rothberg M, Bennish ML, Kao JS, Wong JB. Division of Clinical Decision Making, Informatics and Telemedicine, Department of Medicine, New England Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA. Although varicella vaccine is recommended for infants, many physicians and parents have withheld vaccination from infants because of concerns about the vaccine's long-term efficacy. We used a decision-analytic Markov model to examine the effects of decreasing vaccine efficacy on individuals and society. The model incorporated published data on age-specific incidence, morbidity, and mortality rates, as well as data on shifting disease burden from childhood to adulthood as vaccine compliance increases. The effects of 2 vaccination strategies---vaccinating infants at age 12 months and waiting to vaccinate until children are 10 years of age---were compared with the effects of no vaccination. If the efficacy of the vaccine were to decrease by 75%, then 50% compliance with vaccination at age 12 months would save 1800 life-years and 12,800 quality-adjusted life-years annually in the United States. The quality-adjusted life expectancy of individuals vaccinated at age 12 months would be 63 h longer than that of nonvaccinated individuals and would increase to 79 h as vaccination compliance increases and the burden of chickenpox shifts to adulthood. Varicella vaccination of infants at age 12 months appears to be beneficial, even if the efficacy of the vaccine declines substantially. PMID: 11880952 [PubMed - indexed for MEDLINE] 1843. Singapore Med J. 2001 Oct;42(10):485-6. Herpes zoster ophthalmicus and the superior orbital fissure syndrome. Yong VK, Yip CC, Yong VS. The Eye Institute, Department of Ophthalmology, Tan Tock Seng Hospital, Singapore. Vernon_Yong@ttsh.com.sg Herpes Zoster Ophthalmicus (HZO) is not an uncommon condition in the elderly and the immunocompromised. The common ocular manifestations include blepharoconjunctivitis, keratitis and uveitis. Dramatic presentations like orbital apex syndrome and superior orbital fissure syndromes occur rarely in patients with herpes zoster meningo-encephalitis. We report a patient with herpes zoster meningo-encephalitis and the superior orbital fissure syndrome (SOFS). PMID: 11874154 [PubMed - indexed for MEDLINE] 1844. Braz Dent J. 2002;13(1):49-52. Systemic and oral alterations in Brazilian patients with cutaneous herpes zoster. Gonzaga HF, Jorge MA, Gonzaga LH, Barbosa CA, Chaves MD. Research Center-Center of Higher Education of Dracena-CESD, Dracena, SP, Brazil. herongonzaga@terra.com.br Herpes zoster (HZ) is a virotic disease caused by Herpesvirus varicellae. The objective of this study was to determine the factors that trigger the disease, and the systemic and oral alterations present in Brazilian patients with herpes zoster. A total of 30 patients with HZ and 100 control patients with other diseases were studied. Of the 30 patients with HZ, 13 were male (43.3%) and 17 were female (56.7%), with an average age of 43.2 (range 3-78). The patients were submitted to general clinical, dermatological and intraoral examinations. Only 50% of the HZ patients reported emotional stress at the onset of the disease. A total of 3.7% of the patients were positive for HIV and 11.1% for systemic malignant neoplasm. Cutaneous lesions were found on the thorax (68.3%), face (20%), lower limbs (10%) and upper limbs (6.7%). Specific oral involvement such as oral HZ was not found. The presence of the disease may indicate a non-diagnosed malignant neoplasm and/or association with AIDS. PMID: 11870963 [PubMed - indexed for MEDLINE] 1845. Cutis. 2002 Feb;69(2):143-4. Metameric motor paresis following abdominal herpes zoster. Molinero J, Nagore E, Obón L, Miquel FJ, Aliaga A. Department of Dermatology, Hospital General Universitario, Valencia, Spain. Motor neuropathy is an uncommon complication that may follow an outbreak of herpes zoster (HZ). About half of the reported cases have involved the cranial nerves, typically the facial nerve. The remaining cases have affected the nerves of the extremities. Interestingly, motor weakness of the thoracic segments is strikingly rare, even though this is where HZ most frequently occurs. The dermatologic literature reports only exceptions to this occurence. We report a new case of motor paresis following HZ infection in an abdominal location, where this complication can be easily misdiagnosed as abdominal herniation. PMID: 11868978 [PubMed - indexed for MEDLINE] 1846. Md Med. 2002 Winter;3(1):10-2. The legacy of Chinese herbal medicine. Ralph RA. PMID: 11868484 [PubMed - indexed for MEDLINE] 1847. Anesth Analg. 2002 Mar;94(3):694-700; table of contents. Spinal cord stimulation in postherpetic neuralgia and in acute herpes zoster pain. Harke H, Gretenkort P, Ladleif HU, Koester P, Rahman S. Department of Anesthesia and Pain Therapy, Klinikum Krefeld, Krefeld, Germany. We studied the effects of spinal cord stimulation (SCS) on postherpetic neuralgia (PHN). Data of 28 patients were prospectively investigated over a median period of 29 (quartiles 9--39) mo. In addition, four patients with acute herpes zoster (HZ) pain were studied simultaneously. After intractable pain for more than 2 yr, long-term pain relief was achieved in 23 (82%) PHN patients (median, 70 yr) during SCS treatment confirmed by a median decrease from 9 to 1 on the visual analog scale (P < 0.001). In five cases with serious comorbidity, the initial pain alleviation could not be stabilized. Spontaneous improvement was always confirmed or excluded by SCS inactivation tests at quarterly intervals. Eight patients discontinued SCS permanently because of complete pain relief after stimulation periods of 3--66 mo, whereas 2 reestablished SCS because of recrudescence after 2 and 6 mo. Considerable impairments in everyday life, objectified by the pain disability index, were also significantly improved (P < 0.001). In 4 patients with acute HZ pain, SCS was promptly effective and after periods of 2.5 (quartiles 2--3) months the pain had subsided. SCS seems to offer a therapeutic option for pharmacological nonresponders. IMPLICATIONS: In many patients with postherpetic neuralgia and acute herpes zoster pain is not satisfactorily alleviated with pharmacological approaches. We report on 23 of 28 patients with postherpetic neuralgia and 4 of 4 with acute herpes zoster whose chronic pain was improved by electrical spinal cord stimulation. PMID: 11867400 [PubMed - indexed for MEDLINE] 1848. Herpes. 2001 Mar;8(1):8-11. Potential for immunotherapy in the treatment of herpesvirus infections. Bernstein DI. Children's Hospital Medical Center, Division of Infectious Diseases, Cincinnati, Ohio 45229, USA. dib@chmcc.org The concept of using immunotherapy to treat recurrent herpesvirus infections dates back to the 1930s, although many of the initial studies were seriously flawed. Since the late-1980s, however, the use of the guinea pig model of genital herpes has allowed investigators to evaluate carefully several vaccine and immunomodulatory strategies for the control of recurrent herpesvirus infections. These investigations have clearly shown that both approaches can significantly decrease recurrence rates of genital herpes, and the most effective routes, adjuvants and treatment regimens have been identified. Similar strategies have also been shown to decrease herpes simplex virus (HSV)-1 recurrences in animal models of ocular infection. To date, only moderate success has been reported for human trials, although the optimum strategies that were identified in the animal models have not yet been evaluated. PMID: 11867010 [PubMed - indexed for MEDLINE] 1849. CRNA. 2000 Nov;11(4):173-9. Clinical applications of acupuncture in anesthesia practice. Reilly MP. Audie Murphy Division, South Texas Veterans Health Care System, University of Texas Health Science Center, San Antonio, USA. The most widely successful use of acupuncture in Western medicine has been in the treatment of chronic and intractable pain syndromes. Thus, it is especially important for the nurse anesthetist who is the practice of chronic pain management to be familiar with this treatment choice. This article provides the nurse anesthetist with basic information about the practice of acupuncture, the patient who may ask for acupuncture, application of segmental acupuncture techniques, and legislative and licensure issues. PMID: 11866024 [PubMed - indexed for MEDLINE] 1850. Nephrol Dial Transplant. 2002 Mar;17(3):508-10. A 67-year-old kidney transplant patient with headache of uncertain origin. Ostermann ME, Gyawali P, Snowden SA, Eastwood JB, Streather CP. St George's Hospital, Department of Renal Medicine, London, UK. marlies@ostermann.freeserve.co.uk PMID: 11865103 [PubMed - indexed for MEDLINE] 1851. An Esp Pediatr. 2002 Mar;56(3):269-70. [Ramsay-Hunt syndrome] [Article in Spanish] Alcalá Minagorre P, Zubiaur Cantalapiedra A, Ronda Pérez JM, Herrero Galiana A, López Bru D, Flores Serrano J. PMID: 11864532 [PubMed - indexed for MEDLINE] 1852. Ann Otol Rhinol Laryngol. 2002 Feb;111(2):103-14. The three faces of vestibular ganglionitis. Gacek RR, Gacek MR. Department of Surgery, University of South Alabama College of Medicine, Mobile 36688-0002, USA. We present temporal bone and clinical evidence that common syndromes of recurrent vertigo are caused by a viral infection of the vestibular ganglion. In the present series, histopathologic and radiologic changes in the vestibular ganglion and meatal ganglion were consistent with a viral inflammation of ganglion cells in cases of Meniere's disease, benign paroxysmal positional vertigo, and vestibular neuronitis. Clinical observations of multiple neuropathies involving cranial nerves V, VII, and VIII on the same side in patients with recurrent vertigo are best explained by a cranial polyganglionitis caused by a neurotrophic virus, which is reactivated by a stressful event later in life. The reactivation of the latent virus may manifest as one of the above vertigo syndromes, depending on the part of the vestibular ganglion that is inflamed, the type and strain of the virus, and host resistance. PMID: 11860061 [PubMed - indexed for MEDLINE] 1853. Vaccine. 2002 Feb 22;20(11-12):1593-602. Immunogenicity of a recombinant varicella-zoster virus gE-IE63 fusion protein, a putative vaccine candidate against primary infection and zoster reactivation. Jacquet A, Haumont M, Massaer M, Garcia L, Mazzu P, Daminet V, Grégoire D, Jacobs P, Bollen A. Department of Applied Genetics, Institut de Biologie et de Médecine Moléculaires, Université Libre de Bruxelles, Rue des Professeurs Jeener et Brachet 12, B-6041 Gosselies, Belgium. ajacquet@sga.ulb.ac.be The varicella-zoster virus (VZV) envelope glycoprotein E (gE) and immediate early protein 63 (IE63) are well known targets for specific humoral and cell-mediated immune responses during VZV infection and latency, respectively. The present study evaluated the immunogenicity of an engineered chimeric recombinant gE-IE63 (recgE-IE63) protein secreted from CHO cells, wherein a soluble form of gE, deleted of its anchor and cytoplasmic domains was fused to IE63. Guinea pig vaccinations with adjuvanted recgE-IE63 elicited a strong and specific humoral immune response directed to each counterpart. Sera from recgE-IE63-immunized animals neutralized cell-free VZV. This neutralizing capacity was dependent only on the recgE moiety as serum depletions on recgE-immobilized sepharose totally abolished VZV neutralization. The cell-mediated immune response induced by recgE-IE63 was evaluated in lymphoproliferation assays. An antigen-specific proliferative response was demonstrated after lymphocyte stimulation with recIE63 but not with recgE. We conclude that recombinant chimeric recgE-IE63 induced both humoral and cell-mediated immune responses and thus could constitute a putative subunit vaccine candidate against VZV primary infection and zoster reactivation. PMID: 11858867 [PubMed - indexed for MEDLINE] 1854. J Med Virol. 2002 Apr;66(4):567-70. Detection of varicella-zoster virus DNA in throat swabs of patients with herpes zoster and on air purifier filters. Suzuki K, Yoshikawa T, Tomitaka A, Suzuki K, Matsunaga K, Asano Y. Department of Dermatology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan. arisu@daidohpior.jp Zoster patients are considered to be less contagious than those with varicella because their infectious lesions are localized. However, it is not known when the spread of varicella-zoster virus (VZV) from zoster patients begins, how long it continues, and how far the virus spreads from the zoster patients. Twelve cases of hospitalized zoster patients were studied. The polymerase chain reaction (PCR) was used to detect VZV DNA in samples taken from the surface of their eruptions, throats, and the air purifier filters in their rooms. In all patients, VZV DNA was detected in the samples from eruptions. VZV DNA was detected in 8 of 12 patients from the throats. VZV DNA was detected for 9 of 12 patients from the filter samples. This study shows the possibility of a wide distribution of VZV DNA to the environment from infected patients. VZV may be excreted from cutaneous eruptions or from the throats of patients. Copyright 2002 Wiley-Liss, Inc. PMID: 11857538 [PubMed - indexed for MEDLINE] 1855. J Med Virol. 2002 Apr;66(4):506-11. Multiplex detection of herpesviruses in tear fluid using the "stair primers" PCR method: prospective study of 93 patients. Robert PY, Traccard I, Adenis JP, Denis F, Ranger-Rogez S. Department of Ophthalmology, CHRU Dupuytren, Limoges, France. Human herpesviruses can infect the eye and be excreted subsequently in tears. The aim of the present study was to use a multiplex PCR to detect herpesviruses (HSV-1, -2, VZV, CMV, EBV, HHV-6) in tears from normal subjects and from patients with pathological conditions (acute herpes, zoster, papillary conjunctivitis, and dry eye). Schirmer test strips were used to collect tear fluid from 93 patients, sampling both eyes. DNA was then extracted from the 186 samples by chromatography, and viral DNA amplified using a commercialised multiplex "stair primer" method. Thirty-four samples (18.3%) contained Taq inhibitors. The multiplex test gave positive results for HSV and VZV in tear fluid from patients with acute dendritic keratitis (3 patients) and acute ocular zoster (4 patients) and was, therefore, considered effective in testing samples from patients with acute lesions. HSV-1 and HSV-2 were found in two samples from patients with metaherpetic corneal scarring. Among 28 cases of dry eye, two were positive for HHV-6, the latter being associated with EBV in one patient. HHV-6 was also found in 4 out of 54 cases of papillary conjunctivitis. This raised occurrence of HHV-6 in dry eye or papillary conjunctivitis, suggests new clinical patterns for HHV-6 latency or reactivation. Detection of EBV in 1 out of 80 healthy eyes confirms previous evidence that lacrimal glands constitute potentially a site for latent-phase EBV. Copyright 2002 Wiley-Liss, Inc. PMID: 11857529 [PubMed - indexed for MEDLINE] 1856. Jpn J Ophthalmol. 2002 Jan-Feb;46(1):70-3. Varicella-zoster viral antigen identified in iridocyclitis patient. Nakashizuka H, Yamazaki Y, Tokumaru M, Kimura T. Department of Ophthalmology, Nihon University School of Medicine, Tokyo, Japan. BACKGROUND: The varicella-zoster virus (VZV) antigen has not been identified immunohistologically in iridocyclitis due to VZV. CASE: A 65-year-old woman diagnosed with iridocyclitis and secondary glaucoma underwent trabeculectomy. Samples of aqueous humor and juxtacanalicular and iris tissue were obtained for immunohistological and polymerase chain reaction (PCR) study. OBSERVATIONS: Slit-lamp microscopy revealed ciliary injection, corneal epithelial edema, mutton fat precipitates, flare, cells, and progressive iris atrophy in the right eye. Subsequently, scant eruptions on her right upper eyelid appeared and disappeared within a week. Although a diagnostic increase in the complement fixation antibody titer to VZV was not observed, we started medical treatment for VZV, on suspicion of iridocyclitis due to VZV. Despite medical treatment, the ratio of peripheral anterior synechia was greater than 60% and iris atrophy progressed in parallel. The intraocular pressure in the right eye remained above 30 mm Hg at 6 months after the first visit, so trabeculectomy was performed. VZV-specific DNA was detected in the aqueous humor by the PCR study. Immunohistological examination demonstrated numerous VZV antigen-positive cells in the iris stroma, in particular, vascular endothelial cells. CONCLUSION: To our knowledge, this is the first report of the detection of VZV antigen in the iris of an iridocyclitis patient. PMID: 11853717 [PubMed - indexed for MEDLINE] 1857. Clin J Oncol Nurs. 2002 Jan-Feb;6(1):55-8, 61. Herpes zoster. Treating postherpetic neuralgia. Baldwin PD. Patbalwin2@hotmail.com. PMID: 11842491 [PubMed - indexed for MEDLINE] 1858. Pediatr Infect Dis J. 2002 Feb;21(2):178-9. Herpes zoster during varicella. Baptist EC, Noonan KM. Comment on: Pediatr Infect Dis J. 2001 Sep;20(9):915-6. PMID: 11840094 [PubMed - indexed for MEDLINE] 1859. Semin Arthritis Rheum. 2002 Feb;31(4):256-63. Viral infections and antiphospholipid antibodies. Uthman IW, Gharavi AE. Department of Internal Medicine, Faculty of Medicine, American University of Beirut, Beirut, Lebanon. iuthman@aub.edu.lb OBJECTIVE: To study the relationship between viral infections and the induction of antiphospholipid (aPL) antibodies. METHODS: We reviewed the medical literature from 1968 until 2000 using MEDLINE and the key words virus, infection, antiphospholipid, and anticardiolipin. RESULTS: Anticardiolipin antibodies and/or lupus anticoagulant were associated with a number of viral infections, including hepatitis C virus, human immunodeficiency virus, cytomegalovirus, varicella zoster, Epstein-Barr virus, adenovirus, and parvovirus B. In many instances, the presence of these antibodies was associated with thrombosis. CONCLUSION: The clinical significance of finding aPL antibodies in patients with viral infections remains unknown. In some patients, these antibodies may be transient and disappear within 2 or 3 months. In other susceptible individuals, they may persist and raise the question of whether infections may trigger the development of aPL antibodies in autoimmune diseases. Copyright 2002, Elsevier Science (USA). All rights reserved. PMID: 11836658 [PubMed - indexed for MEDLINE] 1860. Ann Neurol. 2002 Feb;51(2):273-4. Cranial nerve palsies: herpes simplex virus type 1 and varizella-zoster virus latency. Theil D, Derfuss T, Strupp M, Gilden DH, Arbusow V, Brandt T. PMID: 11835389 [PubMed - indexed for MEDLINE] 1861. J Vasc Interv Radiol. 2002 Feb;13(2 Pt 1):209-10. Reactivation of herpes zoster after liver biopsy. Levy JM, Smyth SH. Department of Radiology, University of Arizona School of Medicine, Tucson, Arizona, USA. jlevy@esmil.net A patient developed reactivation of herpes zoster infection (shingles) after a routine liver biopsy. Reactivation of herpes is often related to trauma. This entity should be considered when patients report postbiopsy pain inappropriate to the procedure. If the typical rash of shingles develops, antiviral therapy should be considered. PMID: 11830629 [PubMed - indexed for MEDLINE] 1862. J Refract Surg. 2002 Jan-Feb;18(1):79-80. Presumed reactivation of herpes zoster ophthalmicus following laser in situ keratomileusis. Jarade EF, Tabbara KF. Eye Center and The Eye Foundation for Research in Ophthalmology, Riyadh, Saudi Arabia. PURPOSE: To report a case of herpes zoster ophthalmicus reactivation following laser in situ keratomileusis (LASIK) for myopia. METHODS: A 54-year-old healthy male underwent uneventful bilateral LASIK for the correction of myopia and astigmatism (-5.75 -3.00 x 20 degrees right eye, -5.50 -3.00 x 170 degrees left eye). Two months following LASIK, an epithelial dendritic lesion appeared in the lower third of the corneal flap of the left eye with vesiculoulcerative lesions of the lateral side of the tip of the nose. RESULTS: The patient was treated with topical and oral antiviral agents and had complete recovery of the lesions in 10 days. CONCLUSIONS: Herpes zoster reactivation may occur following LASIK. Reactivation of herpes zoster in this case could have been coincidental, or secondary to LASIK and the subsequent use of topical corticosteroids following LASIK. PMID: 11828912 [PubMed - indexed for MEDLINE] 1863. Paediatr Drugs. 2002;4(1):9-19. Viral diseases of the skin: diagnosis and antiviral treatment. Trizna Z. Department of Dermatology, Health Sciences Center, Texas Tech University, Mail Drop #9400, 3601 4th Street, Lubbock, TX 79416, USA. zoltan.trizna@ttmc.ttuhsc.edu Viral diseases in children can present with characteristic mucocutaneous manifestations. This article focuses, from a practical clinical point of view, on the laboratory and clinical diagnoses, and treatment of pediatric dermatological diseases that have specific antiviral therapies: herpes virus infections (including varicella), papillomavirus infections and molluscum contagiosum. Special issues, such as viral infections in pregnancy, therapy of viral infections in immunosuppressed children, as well as special problems associated with the epidemiology of genital herpes and papillomavirus infections in adolescents are discussed. The antivirals discussed in detail include: aciclovir, valaciclovir, famciclovir, penciclovir, cidofovir, foscarnet and the immune response modulator, imiquimod. Since these antiviral drugs generally have not been evaluated in children, caution should be exercised with their usage. PMID: 11817982 [PubMed - indexed for MEDLINE] 1864. J Dermatol. 2001 Dec;28(12):728-33. Prolonged herpes zoster in a patient infected with the human immunodeficiency virus. Matsuo K, Honda M, Shiraki K, Niimura M. Department of Dermatology, The Jikei University School of Medicine, Tokyo, Japan. In 1983, varicella zoster virus (VZV) disease was first recognized in the context of infection with the human immunodeficiency virus (HIV). Since that time, there have been many reports discussing the occurrence and clinical manifestations of hepes zoster in HIV-infected patients. We describe the development of prolonged herpes zoster in a patient with acquired immunodeficiency syndrome (AIDS) over the course of 104 days. Viral isolates at the three different clinical stages of the skin lesions were sensitive in vitro to acyclovir, and supposed to be a same strain by polymerase chain reaction (PCR) analysis. We also discuss an effective treatment for prolonged cases of zoster. PMID: 11804069 [PubMed - indexed for MEDLINE] 1865. Vaccine. 2002 Jan 15;20(7-8):1113-25. The cost-effectiveness of varicella vaccination in Canada. Brisson M, Edmunds WJ. Immunisation Division, PHLS Communicable Disease Surveillance Center, 61 Colindale Avenue, NW9 5EQ, London, UK. mbrisson@phls.org.uk A deterministic realistic age-structured model was used to predict the impact of vaccination on the incidence of varicella and zoster. Unit costs, estimated from literature, were applied to the predicted health outcomes. Various vaccination programs were investigated and a sensitivity analysis was performed. Assuming no impact of vaccination on zoster, varicella vaccination is estimated to cost 45,000 dollars, 51,000 dollars and 18,000 dollars per life-year gained from the health payer's perspective for infant, infant with catch-up campaign, and preteen programs, respectively. From the societal perspective, mass infant varicella vaccination was estimated to be highly cost saving in Canada. Importantly, infant varicella vaccination could result in a short- to medium-term increase of zoster incidence and thus cause vaccination to be highly cost-ineffective (118,000 dollars per life-year gained) under the health payer's perspective. From a health payer's perspective the preteen vaccination is the only strategy that is deemed cost-effective. The cost-effectiveness of infant vaccination rests heavily on the unknown relationship between varicella and zoster. PMID: 11803072 [PubMed - indexed for MEDLINE] 1866. Ann Otol Rhinol Laryngol. 2002 Jan;111(1):68-76. Audiological assessment in Ramsay Hunt syndrome. Kaberos A, Balatsouras DG, Korres SG, Kandiloros D, Economou C. Department of Otolaryngology, Tzanion General Hospital, Piraeus, Greece. Ramsay Hunt syndrome is known to cause symptoms and signs of vestibulocochlear dysfunction, including sensorineural hearing loss. The present study investigates the audiological features of a group of 15 patients with this syndrome. A complete otolaryngological, neurologic, and audiological workup was performed in every patient, including auditory brain stem response measurements and recording of transiently evoked otoacoustic emissions. In most patients, some degree of hearing loss was evident, and abnormal latencies and interpeak latencies of the auditory brain stem response, or even absence of the waves, were observed. Transiently evoked otoacoustic emissions were present in only 6 cases, and caloric tests showed unilateral weakness in the majority of the patients. In all of the performed tests, abnormalities were present only on the affected side. The audiological data suggested cochlear or retrocochlear involvement or involvement at more than one site along the auditory pathway. PMID: 11800372 [PubMed - indexed for MEDLINE] 1867. J Virol. 2002 Feb;76(4):1971-9. Phylogenetic analysis of varicella-zoster virus: evidence of intercontinental spread of genotypes and recombination. Muir WB, Nichols R, Breuer J. School of Medicine, Queen Mary College, University of London, London E1 1BB, England. A heteroduplex mobility assay was used to identify variants of varicella-zoster virus circulating in the United Kingdom and elsewhere. Within the United Kingdom, 58 segregating sites were found out of the 23,266 examined (0.25%), and nucleotide diversity was estimated to be 0.00063. These are an order of magnitude smaller than comparable estimates from herpes simplex virus type 1. Sixteen substitutions were nonsynonymous, the majority of which were clustered within surface-expressed proteins. Extensive genetic correlation between widely spaced sites indicated that recombination has been rare. Phylogenetic analysis of varicella-zoster viruses from four continents distinguished at least three major genetic clades. Most geographical regions contained only one of these three strains, apart from the United Kingdom and Brazil, where two or more strains were found. There was minimal genetic differentiation (one or fewer substitutions in 1,895 bases surveyed) between the samples collected from Africa (Guinea Bissau, Zambia) and the Indian subcontinent (Bangladesh, South India), suggesting recent rapid spread and/or low mutation rates. The geographic pattern of strain distribution would favor a major influence of the former. The genetic uniformity of most virus populations makes recombination difficult to detect. However, at least one probable recombinant between two of the major strains was found among the samples originating from Brazil, where mixtures of genotypes co-occur. PMCID: PMC135920 PMID: 11799191 [PubMed - indexed for MEDLINE] 1868. Ann Rheum Dis. 2002 Feb;61(2):102. Case Number 22: An interesting case of herpes zoster in rheumatoid arthritis. Campalani E, Meenagh GK, Finch MB. Department of Rheumatology, Royal Victoria Hospital, Grosvenor Road, Belfast BT12 6BA, UK. PMCID: PMC1753990 PMID: 11796393 [PubMed - indexed for MEDLINE] 1869. Pain. 2002 Jan;95(1-2):187-9. Human "autotomy". Bowsher D. Pain Research Institute, Clinical Sciences Building, University Hospital Aintree, Liverpool L9 7AL, UK. pri@liv.ac.uk We describe two cases of self-injurious behaviour. One was a man with central post-stroke pain with maximal pain in the tip of the nose, who excavated his ala nasae--in which he subsequently continued to experience phantom pain. The second case a man who, following ophthalmic herpes zoster and possibly mild postherpetic neuralgia. He subsequently scratched his anaesthetic forehead down to the bone, while denying he experienced any pain. We would describe the first case as one of true autotomy; but the second as destruction of an anaesthetic part of the body. The implications for human and animal physiopathology are discussed. PMID: 11790481 [PubMed - indexed for MEDLINE] 1870. Nervenarzt. 2001 Dec;72(12):955-7. [Unusual manifestation of zoster sine herpete as unilateral caudal cranial nerve syndrome] [Article in German] Terborg C, Förster G, Sliwka U. Neurologische Klinik, Friedrich-Schiller-Universität Jena, Philosophenweg 3, 07743 Jena. christoph.terborg@med.uni-jena.de Multiple lower cranial nerve palsies are a rare complication following varicella zoster virus (VZV) reactivation, especially if typical herpetic eruptions are lacking. We report a case of a 45-year-old, immunocompetent male with unilateral involvement of the cranial nerves VIII, IX, X, and XI without skin lesions. Cerebrospinal fluid (CSF) studies revealed mononuclear pleocytosis with intrathecal antibody synthesis against VZV, while polymerase chain reaction (PCR) did not detect VZV or HSV (herpes simplex virus). The patient almost completely recovered after aciclovir administration. VZV reactivation without rash (zoster sine herpete) may lead to multiple cranial nerve palsies. PCR is a useful tool to detect VZV-DNA in CSF, but negative results do not exclude a reactivation. In case of multiple cranial nerve palsies of unknown etiology with mononuclear pleocytosis in CSF tumors of the skull base, meningitis tuberculosis, and meningeosis have to be excluded, and antiviral therapy should be discussed. PMID: 11789442 [PubMed - indexed for MEDLINE] 1871. Tohoku J Exp Med. 2001 Sep;195(1):61-3. Acute abdominal pain preceding cutaneous manifestations of varicella zoster infection after allogeneic bone marrow transplantation. Itoh M, Kawaguchi S, Yago K, Shimada H, Muro H. Department of Internal Medicine, Shizuoka General Hospital, Japan. itomitsu-kyt@umin.ac.jp The current communication describes clinical findings in two recipients of allogeneic bone marrow transplantation (BMT) with varicella zoster virus infection who complained of acute severe abdominal pain preceding cutaneous manifestations. Physical examination, laboratory data and gastroscopic findings were nonspecific. In these cases, acyclovir was very effective for the symptoms. Varicella zoster virus infection should be suspected in BMT recipients who have rebellant acute abdominal pain but no characteristic skin eruptions. PMID: 11780725 [PubMed - indexed for MEDLINE] 1872. Clin Experiment Ophthalmol. 2001 Dec;29(6):433-4. Failure of antiretroviral therapy to control Varicella zoster retinitis. Ramsay A, Young S, Lightman S. Department of Clinical Ophthalmology, Institute of Ophthalmology, Moorfields Eye Hospital, London, UK. The term necrotizing herpetic retinopathies encompasses a spectrum of diseases which includes cytomegalovirus (CMV) retinitis, acute retinal necrosis (ARN) and Varicella zoster retinitis (VZR). Varicella zoster retinitis is a rapidly progressive, necrotizing condition most commonly reported in patients with AIDS. A case of vitreous biopsy-proven VZR is reported in a patient with AIDS that progressed despite immune recovery on highly active antiretroviral therapy (HAART) to a viral load < 50 copies/mL and a CD4 count of 230 cells/microL. This is in contrast to CMV retinitis in which maintenance therapy appears unnecessary once the CD4 count rises and the viral load falls on HAART. Patients with VZR and AIDS should therefore be monitored for reactivation of retinal disease despite HAART-induced remission. PMID: 11778817 [PubMed - indexed for MEDLINE] 1873. Clin Experiment Ophthalmol. 2001 Dec;29(6):429-32. Multifocal chorioretinal atrophy associated with herpes zoster ophthalmicus. McKelvie PA, Francis IC, Watson S, Nuovo G. Department of Anatomical Pathology, St Vincent's Hospital, Fitzroy, Victoria, Australia. mckelvpa@svhm.org.au A 73-year-old woman developed multiple depigmented lesions in the fundus 4-6 months after an episode of acute Herpes zoster ophthalmicus. Post-mortem examination of the globe 15 years after this acute episode confirmed multiple old chorioretinal scars probably due to vasculitis of the short posterior ciliary arteries and branches. Patchy old infarcts were also noted in the iris. PMID: 11778816 [PubMed - indexed for MEDLINE] 1874. Clin Experiment Ophthalmol. 2001 Dec;29(6):406-10. Uveitis in Herpes zoster ophthalmicus. Thean JH, Hall AJ, Stawell RJ. Department of Ophthalmology, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia. jthean@hotmail.com BACKGROUND: Herpes zoster ophthalmicus (HZO) is a common condition occurring mostly in healthy people. Approximately 50% of HZO patients develop ocular complications, with iridocyclitis occurring in about 43%. This study aimed to identify the clinical features of uveitis secondary to HZO. METHOD: A retrospective case study was performed of consecutive patients with HZO and secondary uveitis seen in the past 10 years at the Royal Victorian Eye and Ear hospital as well as those seen in the private clinics of two ocular immunology consultants. The information collected included the time relationship between onset of rash and uveitis, duration and treatment of the uveitis, and rate and nature of ocular complications. RESULTS: Thirty-four patients fulfilled the enrolment criteria. The age range was from 24 to 83 years with an average age of 62.5 years. Of these, 28 patients (82%) were immunocompetent and six patients (18%) had underlying immunosuppression from various causes. Twenty-three patients had a uniphasic episode of uveitis and 11 patients (32%) had a chronic relapsing course of uveitis. The duration of the uveitis was variable, ranging from 1 week to 3 years, with 68% of episodes resolving within 2 months. Nineteen patients (56%) developed secondary glaucoma. Five of these patients (26%) required trabeculectomies to control their intraocular pressures. Three patients (9%) had bilateral ocular involvement and five patients (15%) had a reduction in final Snellen visual acuity of more than two lines. CONCLUSION: In this study, most patients were immunocompetent individuals. The course of the uveitis was generally uniphasic in nature and of a relatively short duration. There was a high incidence of secondary glaucoma with 15% of all patients requiring surgical intervention. The visual loss in the five patients was not directly related to the uveitis and secondary glaucoma but to other complications associated with HZO. PMID: 11778812 [PubMed - indexed for MEDLINE] 1875. Expert Opin Pharmacother. 2002 Jan;3(1):51-8. Valacyclovir in the treatment of genital herpes and herpes zoster. Baker DA. Division of Infectious Diseases, Department of Obstetrics/Gynaecology, State University of New York at Stony Brook, Stony Brook, New York 11794-8091, USA. Genital herpes is prevalent and sometimes debilitating. Likewise, herpes zoster ('shingles') can be painful and often disabling. The treatment of these conditions has been advanced over the past two decades by the introduction of guanosine nucleoside antivirals such as valacyclovir (Valtrex), Glaxo Wellcome), the highly bioavailable prodrug of acyclovir (Zovirax), Glaxo Wellcome). This review describes the pharmacology, pharmacokinetics, clinical efficacy and tolerability of valacyclovir and considers its clinical attributes in the context of those of the antivirals, acyclovir and famciclovir (Famvir), SmithKline Beecham). The data demonstrate that valacyclovir is more effective than placebo and as effective as other antivirals in the episodic and suppressive treatment of recurrent genital herpes. Valacyclovir is the only antiviral shown to be effective with a short (3-day) course in the episodic treatment of recurrent genital herpes, as well as with once-daily dosing for daily suppressive therapy. In herpes zoster, valacyclovir is as effective as famciclovir and more effective than either placebo or acyclovir at facilitating cutaneous healing and healing of zoster-associated pain and post-herpetic neuralgia. Valacyclovir is well tolerated, with convenient dosing frequencies for the treatment of genital herpes or herpes zoster, it also has the option for use as a short course therapy in the episodic treatment of recurrent genital herpes, all of which are important benefits in the management of these conditions. PMID: 11772333 [PubMed - indexed for MEDLINE] 1876. Percept Mot Skills. 2001 Oct;93(2):329-32. Cell-mediated immune hypersensitivity is stronger in the left side of the body than the right in healthy young subjects. Dane S, Erdem T, Gümüştekin K. Department of Physiology, Faculty of Medicine, Atatürk University, Erzurum, Turkey. More frequent appearance of herpes zoster infection on the left side of the body has been noted. In women, breast cancer occurs more frequently on the left side. It has been suggested that the left neocortex is involved in neuroimmunomodulation via the dopaminergic system. In this study, our purpose was to investigate the possible difference in cell-mediated hypersensitivity between right and left body sides using the tuberculin test with 22 male and 36 female healthy high school students. In the present study, the cell-mediated hypersensitivity was higher in the left side of the body than the right. This difference was slightly more apparent in the girls and may be related to brain asymmetry in neuroimmunomodulation. PMID: 11769884 [PubMed - indexed for MEDLINE] 1877. Can Fam Physician. 2001 Nov;47:2299-304. Varicella zoster virus. Recent advances in management. Rajan P, Rivers JK. Division of Dermatology, University of British Columbia, Vancouver Hospital and Health Sciences Centre. OBJECTIVE: To provide an update on strategies for managing varicella zoster virus (VZV) and for preventing and treating established postherpetic neuralgia (PHN). QUALITY OF EVIDENCE: Treatment guidelines are based on randomized clinical trials. Recommendations concerning other aspects of VZV management (e.g., vaccination) are based mainly on expert opinion. MAIN MESSAGE: Varicella and herpes zoster caused by VZV can give rise to serious morbidity and mortality and should be treated. For preventing chickenpox, safe and effective immunization is widely recommended. Treating varicella-exposed seronegative pregnant women requires special attention because the virus can harm expectant mothers, fetuses, and newborns. The antiviral drugs, acyclovir, valacyclovir, and famciclovir, have been approved for treating herpes zoster and have a role in reducing the duration of PHN. Established PHN can be managed with analgesics, tricyclic antidepressants, and other agents. CONCLUSION: Vaccination and antiviral and other systemic agents can substantially reduce the morbidity associated with VZV infection. PMCID: PMC2018456 PMID: 11768928 [PubMed - indexed for MEDLINE] 1878. Geriatrics. 2001 Dec;56(12):18-24. Herpetic neuralgia. Use of combination therapy for pain relief in acute and chronic herpes zoster. Bajwa ZH, Ho CC. Harvard Medical School, USA. Herpes zoster (shingles) is a localized infection that begins in the dorsal root ganglla of the cranial or spinal nerves and spreads as a rash over the corresponding dermatome. It usually is caused by reactivation of latent varicella-zoster virus remaining from childhood chicken pox. Postherpetic neuralgia (PHN) is a chronic neuropathic pain syndrome that occurs as a complication of shingles, most commonly in older persons. Acute zoster and PHN can be severe conditions associated with impaired sleep, decreased appetite, depression, anxiety disorder, and diminished libido. Management of zoster-related pain should begin as soon as possible after the onset of symptoms. Combination therapy--including antiviral, antidepressant, corticosteroid, opioid, and topical agents--provides the most effective analgesia. PMID: 11766559 [PubMed - indexed for MEDLINE] 1879. J Eur Acad Dermatol Venereol. 2001 Sep;15(5):473-5. Granulomatous folliculitis as a manifestation of post-herpetic isotopic response. Schena D, Barba A, Chieregato C. Department of Dermatology, Verona University, Italy. We report a case of postherpetic granulomatous folliculitis in a 52-year-old female. The several cutaneous granulomatous eruptions following herpes zoster reported in the literature include annular, sarcoid and tuberculoid granuloma, granulomatous vasculitis and granulomatous folliculitis. The mechanism of granuloma formation is probably triggered by a delayed hypersensitivity response to the virus. PMID: 11763396 [PubMed - indexed for MEDLINE] 1880. J Eur Acad Dermatol Venereol. 2001 Sep;15(5):445-7. Wolf's isotopic response: a case of zosteriform lichen planus on the site of healed herpes zoster. Shemer A, Weiss G, Trau H. Department of Dermatology, Chaim Shea Medical Center, Tel Hashomer, Israel. Based on histological findings, the patient had lichen planus. The clinical picture suggests Wolf's isotopic response on the site of healed herpes zoster. These conditions taken into account lead to the diagnosis of zosteriform lichen planus. Lichenoid papules in a dermatomal arrangement are extremely rare. The clinical, dermoscopic and histological features of this case are described. PMID: 11763387 [PubMed - indexed for MEDLINE] 1881. J Eur Acad Dermatol Venereol. 2001 Sep;15(5):430-2. Dermatological immune restoration syndrome: does it exist? Handa S, Bingham JS. Department of Genitourinary and HIV Medicine, St. Thomas' Hospital, London, UK. Dermatological conditions are often an early clue to HIV infection and are common. As the disease progresses patients develop a dominant Th-2 immunological response that may facilitate the development of a number of skin conditions. With antiretroviral therapy the Th-1 response is restored and some skin problems regress. But, paradoxically, some cutaneous conditions may worsen, such as herpes zoster, mucocutaneous herpes, eosinophilic folliculitis and mycobacterial infections. This may be because immune restoration of a host's immunity causes recognition of silent or latent infection and results in development of the condition. PMID: 11763384 [PubMed - indexed for MEDLINE] 1882. Bull Soc Belge Ophtalmol. 2000;(278):27-32. Diplopia from skew deviation in Ramsey-Hunt syndrome. A case report. Verhulst E, Van Lammeren M, Dralands L. Department of Ophthalmology, UZ Leuven Kapucijnenvoer 33, 3000 Leuven Belgium. OBJECT: Presentation of a 34-year-old pregnant woman with skew deviation due to peripheral vestibular dysfunction caused by herpes zoster oticus. METHODS: A multidisciplinary approach (neuroophthalmology, otorhinolaryngology, neuroradiology) revealed the diagnosis of Ramsey-Hunt syndrome. CASE REPORT: The patient presented with painful herpes zoster vesicles of the left ear, associated with a rotatory vertigo and hearing loss. Otorhinolaryngological examination showed a unilateral peripheral vestibular loss, a nystagmus towards the unaffected right side, no facial nerve dysfunction and a left perception hearing loss, mainly in the frequencies between 2-6 KHz. The patient was treated with Zovirax IV. Neuroradiological examination (MRI without contrast) revealed no abnormalities. Vertical diplopia from skew deviation was noted +/- 10 days after onset of herpes zoster oticus. Neuroophthalmological and orthoptic examination showed a comitant right hypertropia of 6 diopters and a spontaneous nystagmus to the right. CONCLUSION: Skew deviation can be caused by a sudden unilateral cochleo-vestibular loss as described by A.B. Safran. (4,6,7,8). PMID: 11761557 [PubMed - indexed for MEDLINE] 1883. J Pediatr Ophthalmol Strabismus. 2001 Nov-Dec;38(6):363-6. Extraocular muscle and facial paresis in herpes zoster ophthalmicus. Pandey PK, Chaudhuri Z, Sharma P. Department of Ophthalmology, Guru Nanak Eye Centre, New Delhi, India. PMID: 11759776 [PubMed - indexed for MEDLINE] 1884. Ann Nucl Med. 2001 Oct;15(5):455-8. [18F]-FDG uptake in soft tissue dermatome prior to herpes zoster eruption: an unusual pitfall. Kerrou K, Montravers F, Grahek D, Younsi N, Perniceni T, Godeberge P, Canuel C, De Gramont A, Talbot JN. Service de médecine nucléaire, Hôpital Tenon, Paris. khaldoun.kerrou@egp.ap-hop-paris.fr Authors report on a case of [18F]-fluorodeoxyglucose ([18F]-FDG) uptake in the soft tissue of a patient referred for [18F]-FDG coincidence detection emission tomography (CDET) in a search for recurrence of colorectal cancer. A herpes zoster eruption occurred in the same site within two days, but was spontaneously resolved. To the best of our knowledge this is the first description of a false positive [18F]-FDG result in relation to a viral infection of soft tissue. It shows that interpretation of subcutaneous foci has to be cautious in patients with or without a past history of herpes zoster even in pain-free areas and prior to skin eruption. PMID: 11758954 [PubMed - indexed for MEDLINE] 1885. Retina. 2001;21(6):674-7. Retinitis syphilitica in an HIV-positive patient following acute retinal necrosis syndrome. Freigassner PS, Schuhmann G, Ardjomand N, El Shabrawi Y, Haas A. Department of Ophthalmology, University Eye Clinic of Graz, Austria. petra.freigassner@kfunigraz.ac.at PMID: 11756898 [PubMed - indexed for MEDLINE] 1886. Skin Therapy Lett. 2001 Nov;6(12):1-2, 5. Famiciclovir therapy (famvir) for herpes simplex and herpes zoster infections. Tyring S. Departments of Dermatology and Microbiology/Immunology, The University of Texas Medical Branch at Galveston, Texas, USA. Genital herpes simplex and herpes zoster infections are common afflictions that are associated with significant morbidity and a decreased quality of life. Famciclovir (Famvir, Novartis) is an orally administered prodrug of the antiviral agent penciclovir. Its unique pharmacokinetic profile makes it an efficacious, convenient and well-tolerated alternative to the traditionally prescribed acyclovir. Famciclovir is used for the acute treatment and suppressive therapy of recurrent genital herpes as well as for herpes zoster and its debilitating comorbidities. Famiciclovir allows patients to manage or prevent symptoms, thereby significantly improving their quality of life. Its favorable safety profile makes it a good treatment choice for the elderly as well as for immunocompromised patients, including those infected with HIV. PMID: 11753535 [PubMed - indexed for MEDLINE] 1887. J Clin Virol. 2002 Feb;24(1-2):37-43. CV-1 and MRC-5 mixed cells for simultaneous detection of herpes simplex viruses and varicella zoster virus in skin lesions. Huang YT, Hite S, Duane V, Yan H. Department of Pathology, University Hospitals of Cleveland, Case Western Reserve University, 2085 Adelbert Road, Cleveland, OH 44106, USA. yth@po.cwru.edu BACKGROUND: Culture for varicella zoster virus (VZV) is relatively insensitive. Herpes simplex viruses (HSV) culture methods, which rely on primary rabbit kidney (pRK), mink lung (Mv1Lu) or the ELVIS HSV culture system fail to detect VZV. Culture of atypical vesicular skin lesions should be able to detect both HSV and VZV. OBJECTIVES: In this study, we evaluated the sensitivity of a newly developed mixture of CV-1/MRC-5 cells for the concurrent detection of both HSV and VZV. STUDY DESIGN: The CV-1/MRC-5 mixed cells were compared with pRK cells and Mv1Lu cells for the detection of HSV and to MRC-5 and A-549 cells for the detection of VZV. Fresh clinical samples submitted for HSV culture, VZV culture, and/or direct immunofluorescent assay (DFA) as well as frozen clinical samples previously positive for VZV were used for these comparisons. RESULTS: This preliminary study suggest that CV-1/MRC-5 mixed cells are as sensitive as pRK and Mv1Lu cells for the detection of HSV and appear to be more sensitive than MRC-5 and A-549 cells for the detection of VZV. Although the sample size is small, pre-CPE staining with VZV specific monoclonal antibody (Mab) at day 2 post-inoculation may provide a rapid detection of VZV with these mixed cells, but not with MRC-5 or A549 cells. In addition, culture of VZV in mixed cells from fresh clinical specimens appears to be as sensitive as antigen detection by DFA. Finally, 1% of specimens from skin lesions submitted for HSV culture grew VZV, highlighting the importance of culturing for both VZV and HSV, particularly in the case of atypical lesions. CONCLUSION: CV-1/MRC-5 mixed cells are highly sensitive for the simultaneous culture of HSV and VZV. The ability to detect either HSV or VZV from skin lesions is important for patient management. PMID: 11744427 [PubMed - indexed for MEDLINE] 1888. Skin Res Technol. 2001 Nov;7(4):219-22. Thermal imaging in acute herpes zoster or post-zoster neuralgia. Ammer K, Schartelmueller T, Melnizky P. Ludwig Boltzmann Research Institute for Physical Diagnostics, Hanuschkrankenhaus, Vienna, Austria. kammer1950@aol.com BACKGROUND/AIMS: Asymmetry of normal skin temperature patterns has been reported in patients with herpetic disorders. The aim of the study was to describe the temperature distribution in patients suffering from acute herpes zoster or post-herpetic neuralgia. METHODS: Biographic data, including age, gender and time of onset of the skin lesions, were recorded. The distribution of pain was investigated by pain mapping, and the intensity of pain and dysesthesia was quantified by a visual analogue scale. Infrared thermal images of the affected body regions were performed in all possible views using either an Agema 870 or a NEC San-ei Thermotracer. RESULTS: The mean temperature difference between the affected and the unaffected sides of the body in all patients was 0.52+/-0.30 degrees C. Higher temperatures were detected in early cases with a disease duration of 1-9 days (mean temperature difference: 0.62+/-0.36 degrees C) than in patients with pain scores greater than 79 (mean temperature difference: 0.48+/-0.33 degrees C). Only 6 of 57 patients presented with a temperature difference between the affected side and contralateral side of less than 0.2 degrees C. CONCLUSION: Thermal asymmetry of the skin is a common finding in patients with acute herpes. However, the thermal patterns seem to correlate better with the duration of the disease than with the intensity of pain. PMID: 11737816 [PubMed - indexed for MEDLINE] 1889. Pediatr Infect Dis J. 2001 Sep;20(9):915-6. Herpes zoster during varicella. Lau BH, Lin MI, Lin HC. Department of Pediatrics, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan. laukawei@kimo.com.tw Comment in: Pediatr Infect Dis J. 2002 Feb;21(2):178-9. Pediatr Infect Dis J. 2003 Mar;22(3):295-6. A 4-year-old boy had varicella infection. Two days later vesicular lesions clustered within the left 10th thoracic dermatome. Varicella-zoster virus IgM antibody in serum was positive. He was diagnosed with varicella infection combined with herpes zoster. This is the first case report in the medical literature. PMID: 11734778 [PubMed - indexed for MEDLINE] 1890. Pediatr Infect Dis J. 2001 Aug;20(8):775-8. Seroprevalence of varicella-zoster virus immunoglobulin G antibodies in Swiss adolescents and risk factor analysis for seronegativity. Heininger U, Braun-Fahrländer C, Desgrandchamps D, Glaus J, Grize L, Wutzler P, Schaad UB; SCARPOL Team. University Children's Hospital, Basel, Switzerland. Ulrich.Heininger@unibas.ch BACKGROUND: Little is known about the seroprevalence of anti-varicella-zoster virus (VZV) serum antibodies in adolescents in Switzerland as in most other European countries. METHODS: Serum specimens from 13- to 15-year-old students from eight urban and rural areas in Switzerland, obtained as part of an allergy risk assessment study project (SCARPOL), were available for analysis of IgG antibodies against VZV by enzyme-linked immunosorbent assay (ELISA) and confirmation by fluorescent antibody staining of membrane antigen in a subcohort. Serum specimens and comprehensive sociodemographic data had been collected during two study periods between 1992 and 1995. RESULTS: Data and serum specimens were available from 1709 and 1788 subjects, respectively. Seroprevalence of anti-VZV antibodies as measured by ELISA was 95.5% (95% confidence interval, 94.5 to 96.4). When serum specimens that were indeterminate by ELISA were tested by FAMA, seroprevalence was 96.5% (95% confidence interval, 95.7 to 97.4). After logistic regression analysis, the number of siblings was the only factor that significantly influenced the presence of VZV antibodies (90.1% in those with no siblings, >96% with 1 or more siblings), whereas residence (urban vs. rural), parental education, nationality and gender did not. CONCLUSIONS: Seroprevalence of anti-VZV serum antibodies is comparatively high among Swiss adolescents. Individuals who grow up without siblings have a significant risk of evading natural VZV infection in childhood, and they therefore form a potential target group for varicella immunization in Switzerland. PMID: 11734740 [PubMed - indexed for MEDLINE] 1891. Audiol Neurootol. 2001 Sep-Oct;6(5):259-62. HSV-1 not only in human vestibular ganglia but also in the vestibular labyrinth. Arbusow V, Theil D, Strupp M, Mascolo A, Brandt T. Department of Neurology, Klinikum Grosshadern, Ludwig Maximilians University, Munich, Germany. varbusow@nro.med.uni-muenchen.de Reactivation of herpes simplex virus type 1 (HSV-1) in the vestibular ganglion (VG) is the suspected cause of vestibular neuritis (VN). Recent studies reported the presence of HSV-1 DNA not only in human VGs but also in vestibular nuclei, a finding that indicates the possibility of viral migration to the human vestibular labyrinth. Distribution of HSV-1 DNA was determined in geniculate ganglia, VGs, semicircular canals, and macula organs of 21 randomly obtained human temporal bones by nested PCR. Viral DNA was detected in 48% of the labyrinths, 62% of the VGs, and 57% of the geniculate ganglia. The potential significance of this finding is twofold: (1) Inflammation in VN could also involve the labyrinth and thereby cause acute unilateral vestibular deafferentation. (2) As benign paroxysmal positional vertigo often occurs in patients who have had VN, it could also be a sequel of viral labyrinthitis. Copyright 2001 S. Karger AG, Basel PMID: 11729328 [PubMed - indexed for MEDLINE] 1892. Rev Neurol. 2001 Sep 16-30;33(6):599-600. [Brachial plexopathy in varicella of the adults. A case report] [Article in Spanish] Martínez-Salio A, Penas M, Blanco A, Miranda P, Porta-Etessam J, Posada I. Comment on: Rev Neurol. 2001 Jan 1-15;32(1):15-8. PMID: 11727250 [PubMed - indexed for MEDLINE] 1893. Clin Neurol Neurosurg. 2001 Dec;103(4):260-1. Transverse myelitis caused by Varicella. Celik Y, Tabak F, Mert A, Celik AD, Aktuğlu Y. PMID: 11714576 [PubMed - indexed for MEDLINE] 1894. Enferm Infecc Microbiol Clin. 2001 Nov;19(9):443-4. [Vesicular rash in a healthy five-month-old baby] [Article in Spanish] García-Bujalance S, Baquero-Artigao F, Jesús García De Miguel M. Servicio de Microbiología y Parasitología. Hospital La Paz. Madrid. PMID: 11709124 [PubMed - indexed for MEDLINE] 1895. Int J Clin Pharmacol Res. 2001;21(1):15-9. Analgesic effects of flecainide on postherpetic neuralgia. Ichimata M, Ikebe H, Yoshitake S, Hattori S, Iwasaka H, Noguchi T. Department of Anesthesiology, Oita Medical University, Oita-gun, Japan. Sodium channel blockers have been reported to be effective in relieving neuropathic pain. However, although intravenous lidocaine has proved to be effective, in some patients oral mexiletine fails to produce adequate pain relief. In this study, we investigated the analgesic effect of flecainide, a long-lasting antitachyarrhythmic drug, on postherpetic neuralgia. Twenty patients with postherpetic neuralgia received an intravenous infusion of flecainide and 15 (75%) of those who achieved pain relief subsequently received oral flecainide. The patients were assessed using a 100 mm visual analog scale 1 month after treatment. Significant improvement compared with the pretreatment reading was found. This study suggests that the action of flecainide in blocking the sodium channel is potent and long-lasting and that, like the intravenous formulation, the oral formulation has a stable analgesic effect on postherpetic neuralgia. PMID: 11708571 [PubMed - indexed for MEDLINE] 1896. Bone Marrow Transplant. 2001 Oct;28(7):689-92. Long-term low-dose acyclovir against varicella-zoster virus reactivation after allogeneic hematopoietic stem cell transplantation. Kanda Y, Mineishi S, Saito T, Saito A, Yamada S, Ohnishi M, Chizuka A, Niiya H, Suenaga K, Nakai K, Takeuchi T, Makimoto A, Tanosaki R, Kami M, Tanaka Y, Fujita S, Watanabe T, Kobayashi Y, Tobinai K, Takaue Y. Stem Cell Transplant Unit, National Cancer Center Hospital, University of Tokyo, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan. To evaluate the efficacy of long-term administration of acyclovir as prophylaxis against varicella-zoster virus (VZV) reactivation, we analyzed the medical records of 86 consecutive adult patients who obtained engraftment after allogeneic hematopoietic stem cell transplantation from January 1996 to March 2000. We started long-term low-dose (400 mg/day) oral administration of acyclovir in June 1999, and this was continued until the end of immunosuppressive therapy after transplantation. There was no breakthrough reactivation of VZV in patients receiving acyclovir. Five patients who were receiving cyclosporine or prednisolone developed VZV reactivation after discontinuing acyclovir. With this prophylaxis, the cumulative incidence of VZV reactivation at 1 year after transplantation decreased from 33% to 10% (P = 0.025). On multivariate analysis, the use of long-term acyclovir was identified as a significant independent parameter for the development of VZV reactivation. These findings suggest the efficacy of long-term prophylaxis with low-dose acyclovir. Resumption of acyclovir upon restarting immunosuppressive therapy might be important for the further prevention of VZV reactivation. The benefit of long-term low-dose acyclovir should be confirmed prospectively. PMID: 11704792 [PubMed - indexed for MEDLINE] 1897. Int J Dermatol. 2001 Aug;40(8):542-3. Recurrent herpes zoster. Bansal R. PMID: 11703533 [PubMed - indexed for MEDLINE] 1898. Int J Dermatol. 2001 Aug;40(8):535-8. A randomized parallel trial of topical aspirin-moisturizer solution vs. oral aspirin for acute herpetic neuralgia. Balakrishnan S, Bhushan K, Bhargava VK, Pandhi P. Department of Pharmacology and Dermatology, Postgraduate Institute of Medical Education and Research, Chandigarh-160 012, India. BACKGROUND: In this study, the efficacy of oral aspirin vs. topical aspirin in moisturizer (Vaseline Intensive Care Lotion) was studied in an open, randomized, parallel trial in patients with acute herpetic neuralgia. METHODS: Thirty patients were evaluated in the trial, with 15 in each group. The patients were randomized to receive either oral aspirin, 375-750 mg three times a day, or 75 mg topical aspirin/mL of moisturizer (5-10 mL, depending on the extent of involvement), three times a day, for 21 days. Pain was assessed daily by means of a self-rating visual analog scale and physician assessment. In addition, the skin and plasma levels of aspirin were measured in both groups. RESULTS: The mean time to onset of pain relief was 44 min with topical aspirin and 110 min with oral aspirin. The mean duration of pain relief after a single application of topical aspirin was 5.4 h, whereas it was 3.5 h with oral aspirin. The mean visual analog scale scores for pain with oral aspirin decreased from 68.2 +/- 6.1 on day zero to 43.1 +/- 8.7 on day 21, which was not significant compared with the baseline score. With topical aspirin, the baseline pain score was 77.5 +/- 3.7 and decreased to 6.8 +/- 3 on day 21 (P < 0.001 compared to the baseline score and compared to oral aspirin). The mean plasma and skin levels of aspirin following oral administration were 16.21 +/- 1.1 microg/mL and 1.97 +/- 0.3 microg/mm2, respectively. After topical administration, the mean plasma level of aspirin was 2.29 +/- 0.5 microg/mL (P < 0.01 vs. oral aspirin) and the skin level was 5.96 +/- 0.4 microg/mm2 (P < 0.05 vs. oral aspirin). Treatment tolerance was excellent in both groups. CONCLUSIONS: This trial has demonstrated that topical aspirin in moisturizer is clearly superior to oral aspirin in relieving the pain of acute herpetic neuralgia, and that the analgesic activity of aspirin is largely due to its local effect. PMID: 11703529 [PubMed - indexed for MEDLINE] 1899. Int J Dermatol. 2001 Aug;40(8):521-4. Molluscum contagiosum in herpes zoster scars. Nico MM, Bergonse FN, Godoy AM. Dermatology Department, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil. PMID: 11703525 [PubMed - indexed for MEDLINE] 1900. Br J Ophthalmol. 2001 Nov;85(11):1390-1. Varicella zoster virus immune recovery stromal keratitis in a patient with AIDS. Naseri A, Margolis TP. PMCID: PMC1723762 PMID: 11702739 [PubMed - indexed for MEDLINE] 1901. Dermatology. 2001;203(3):273-5. Reactive perforating collagenosis after disseminated zoster. Zanardo L, Stolz W, Landthaler M, Vogt T. PMID: 11701990 [PubMed - indexed for MEDLINE] 1902. Epidemiol Infect. 2001 Oct;127(2):315-25. Multiple sclerosis and varicella zoster virus infection: a review. Marrie RA, Wolfson C. Montreal Neurological Institute, Quebec. We have evaluated the epidemiological evidence for an aetiological role of varicella zoster virus (VZV) infection in the development of multiple sclerosis (MS). A MEDLINE search of the English language literature for 1965-99 identified 40 studies. These studies were categorized as seroepidemiological (13), case-control (23), historical cohort (2) or ecological (2). One study used both case-control and historical cohort methodologies. Studies were then classified according to methodological rigour, using criteria derived from published guidelines for the epidemiological study of MS. There was a large variability in the quality of evidence. The five studies with the best methodology failed to show an increased risk of MS associated with varicella or zoster infections. At the present time there is insufficient evidence to support an important aetiological role of VZV infection in the development of MS. PMID: 11693509 [PubMed - indexed for MEDLINE] 1903. Epidemiol Infect. 2001 Oct;127(2):305-14. Epidemiology of varicella zoster virus infection in Canada and the United Kingdom. Brisson M, Edmunds WJ, Law B, Gay NJ, Walld R, Brownell M, Roos L, De Serres G. PHLS CDSC, and City University, London. Many countries are currently studying the possibility of mass vaccination against varicella. The objective of this study was to provide a comprehensive picture of the pre-vaccine epidemiology of the varicella zoster virus (VZV) to aid in the design of immunization programs and to adequately measure the impact of vaccination. Population-based data including physician visit claims, sentinel surveillance and hospitalization data from Canada and the United Kingdom were analysed. The key epidemiological characteristics of varicella and zoster (age specific consultation rates, seasonality, force of infection, hospitalization rates and inpatient days) were compared. Results show that the overall epidemiology of varicella and zoster is remarkably similar between the two countries. The major difference being that, contrary to Canada, the epidemiology of varicella seems to be changing in the United Kingdom with an important decrease in the average age at infection that coincides with a significant increase in children attending preschool. Furthermore, differences exist in the seasonality between the United Kingdom and Canada, which seem to be primarily due to the school calendar. These results illustrate that school and preschool contact patterns play an important role in the dynamics of varicella. Finally, our results provide baseline estimates of varicella and zoster incidence and morbidity for VZV vaccine effectiveness and cost-effectiveness studies. PMID: 11693508 [PubMed - indexed for MEDLINE] 1904. Pain. 2001 Nov;94(2):215-24. Gabapentin in postherpetic neuralgia: a randomised, double blind, placebo controlled study. Rice AS, Maton S; Postherpetic Neuralgia Study Group. Pain Research Group, Department of Anaesthetics, Imperial College School of Medicine, Chelsea and Westminster Hospital Campus, 369 Fulham Road, London SW10 9NH, UK. a.rice@ic.ac.uk Comment in: Pain. 2002 Apr;96(3):410-1. Pain. 2002 Apr;96(3):409-10; author reply 411-2. A multicentre double blind, randomised, placebo controlled 7-week study evaluated the efficacy and safety of gabapentin 1800 or 2400 mg/day in treating postherpetic neuralgia. Three hundred and thirty-four men and women aged at least 18 years (mean 73) received gabapentin 1800 or 2400 mg daily or placebo in three divided doses with a forced titration schedule. The primary outcome measure was change in average daily pain diary score (baseline week v final week). Secondary outcomes included mean weekly sleep interference score; Short Form-McGill Pain Questionnaire (SF-MPQ); Clinician and Patient Global Impression of Change (CGIC/PGIC); Short Form-36 Health Survey (SF-36). From week 1, pain scores showed a significantly greater improvement with gabapentin: the final difference v baseline was -34.5% for the 1800 mg dose, -34.4% for the 2400 mg dose compared with -15.7% for the placebo group. The difference vs. placebo was 18.8% for the 1800 mg dose (95% confidence interval 10.9-26.8%; P<0.01) and 18.7% for the 2400 mg dose (10.7-26.7%; P<0.01). Sleep interference diaries showed a similar pattern. There were significant differences in favour of gabapentin for number of patients reporting >50% reduction in their pain intensity, in the CGIC and PGIC, in the sensory and total scores of the SF-MPQ (both doses), in the visual analogue scale of pain of the SF-MPQ (2400 mg only) and in the vitality, bodily pain and mental health domains of the SF-36. Overall gabapentin was well tolerated. The most common adverse events were dizziness and somnolence, particularly during the titration phase. Thus, this study confirms the role of gabapentin as an efficacious and well-tolerated treatment for postherpetic neuralgia. PMID: 11690735 [PubMed - indexed for MEDLINE] 1905. Virology. 2001 Oct 25;289(2):218-23. Varicella-Zoster virus gene expression in latently infected rat dorsal root ganglia. Kennedy PG, Grinfeld E, Bontems S, Sadzot-Delvaux C. Glasgow University Department of Neurology, Institute of Neurological Sciences, Southern General Hospital, Glasgow, G51 4TF, Scotland, United Kingdom. P.G.Kennedy@clinmed.gla.ac.uk Latent infection of human ganglia with Varicella-Zoster virus (VZV) is characterized by a highly restricted pattern of viral gene expression. To enhance understanding of this process we used in situ hybridization (ISH) in a rat model of VZV latency to examine expression of RNA corresponding to eight different VZV genes in rat dorsal root ganglia (DRG) at various times after footpad inoculation with wild-type VZV. PCR in situ amplification was also used to determine the cell specificity of latent VZV DNA. It was found that the pattern of viral gene expression at 1 week after infection was different from that observed at the later times of 1 and 18 months after infection. Whereas multiple genes were expressed at 1 week after infection, gene expression was restricted at the later time points when latency had been established. At the later time points after infection the RNA transcripts expressed most frequently were those for VZV genes 21, 62, and 63. Gene 63 was expressed more than any other gene studied. While VZV DNA was detected almost exclusively in 5-10% of neurons, VZV RNA was detected in both neurons and nonneuronal cells at an approximate ratio of 3:1. A newly described monoclonal antibody to VZV gene 63-encoded protein was used to detect this protein in neuronal nuclei and cytoplasm in almost half of the DRG studied. These results demonstrate that (1) this rat model of latency has close similarities in terms of viral gene expression to human VZV latency which makes it a useful tool for studying this process and its experimental modulation and (2) expression of VZV gene 63 appears to be the single most consistent feature of VZV latency. Copyright 2001 Academic Press. PMID: 11689044 [PubMed - indexed for MEDLINE] 1906. Ann Ital Med Int. 2001 Jan-Mar;16(1):50-3. Herpes zoster infection and Ogilvie's syndrome in non-Hodgkin's lymphoma with hypogammaglobulinemia. Giunta R, Marfella MA, Maffei A, Lucivero G. VI Division di Medicina Interna ed Immunoallergologia, Dipartimento di Gerontologia, Geriatria e Malattie del Metabolismo, Seconda Università degli Studi di Napoli. The case of a 43-year-old male with non-Hodgkin's lymphoma (stage IV B), and hypo-IgG and IgM, who developed acute colonic pseudo-obstruction or Ogilvie's syndrome during chemotherapy, is presented. The simultaneous occurrence of a unilateral segmental vesicular rash indicative of herpes zoster infection suggests an etiopathogenetic relationship between the colonic pseudo-obstruction and herpetic involvement of the motor celiac sympathetic ganglia. The rapid resolution of the abdominal dilation and the functional recovery from the colonic pseudo-obstruction after anti-viral therapy is also consistent with the diagnostic hypothesis. PMID: 11688352 [PubMed - indexed for MEDLINE] 1907. Ugeskr Laeger. 2001 Oct 15;163(42):5835-6. [Pupillary paresis. A rare complication of Varicella zoster eye infection] [Article in Danish] Hallas P. Kalundborg Sygehus, kirurgisk afdeling. hallas@rocketmail.com Pupillary paralysis and paresis of the peripheral facial nerve on the left side was found in a 68-year-old man with concussion and herpes zoster ophthalmicus on the left eye. Post mortem examination showed no sign of intracranial hemorrhage. The cause of death was pulmonary oedema and aspiration. The neurological signs were probably caused by herpes zoster affection of the oculomotor and optic nerves in association with the facial nerve paresis induced by zoster. PMID: 11685858 [PubMed - indexed for MEDLINE] 1908. Clin Lab Haematol. 2001 Aug;23(4):253-4. Inappropriate antidiuretic hormone secretion, abdominal pain and disseminated varicella-zoster virus infection: an unusual and fatal triad in a patient 13 months post Rituximab and autologous stem cell transplantation. McIlwaine LM, Fitzsimons EJ, Soutar RL. Department of Haematology, Western Infirmary, Glasgow, UK. We report a case of varicella-zoster virus (VZV) infection associated with severe abdominal pain, inappropriate antidiuretic hormone (ADH) secretion (SIADH) and death, 13 months post-autologous peripheral blood stem cell transplantation (PBSCT). This unusual clinical triad has been reported twice in the setting of allogeneic bone marrow transplantation, however it has not been reported after autologous transplantation and never so long after transplantation. We speculate as to why this occurred, as early recognition might have altered the clinical outcome. PMID: 11683787 [PubMed - indexed for MEDLINE] 1909. Ann Emerg Med. 2001 Nov;38(5):592-5. Documented arterial gas embolism after spinal epidural injection. MacLean CA, Bachman DT. Department of Emergency Medicine, Maine Medical Center, Portland, ME 04102, USA. maclec@mail.mmc.org We report the case of a 90-year-old man with syncope, arrhythmia, cardiac ischemia, and neurologic deficit after undergoing spinal epidural injection for control of pain related to post-herpetic neuralgia. The diagnosis of arterial gas embolus was made after air was identified in the left ventricle of the heart on an abdominal computed tomographic scan. Emergency physicians should consider and rapidly diagnose this rare but potentially fatal complication of spinal epidural puncture. PMID: 11679875 [PubMed - indexed for MEDLINE] 1910. J Infect. 2001 Aug;43(2):135-9. Outcome of varicella pneumonitis in immunocompetent adults requiring treatment in a high dependency unit. Jones AM, Thomas N, Wilkins EG. Department of Infectious Diseases, North Manchester General Hospital, Delaunay's Arch, Delaunay's Road, Crumpsall, Manchester, UK. andmarkj@hotmail.com OBJECTIVES: The incidence of varicella infection is increasing in adults, where primary pneumonitis is the main complication. Little information exists concerning treatment of those patients who require admission to a high dependency unit (HDU) facility. A study was performed to examine the risk factors for developing varicella pneumonitis (VP), to document disease progression and assess prognosis for patients with VP requiring HDU admission. METHODS: A 10-year retrospective casenote review of patients admitted to the Regional Infectious Diseases Unit HDU. Varicella pneumonitis (VP) was defined as diffuse nodular shadowing on a chest X-ray (CXR) of a patient with a classical chickenpox rash. Severe pneumonitis was defined as an hypoxaemia index (pO2 in mmHG/FiO2) of less than 150 at any time during hospital stay. All patients were treated with intravenous acyclovir at a dose of 10 mg/kg. RESULTS: A total of 33 patients were admitted to the HDU with VP over the study period, 30 were included in the study. Annual admission rates remained constant. Most patients (76.7%) had at least one recognised risk factor for severe VP: smoking 18/30, pregnancy 9/30, chronic lung disease 7/30. Twelve (40%) patients had severe VP, eight (26.7%) required assisted ventilation. The presence of greater than one risk factor (p < 0.02) was associated with progression to severe VP. There was one death: a 63-year-old man with a long history of chronic airflow limitation whose treatment had included domicillary long-term oxygen therapy. Nine (30%) patients developed secondary bacterial pneumonia; all recovered with appropriate antibiotic treatment. The period of stay in HDU for the majority of patients was short (mean 4.5 days). CONCLUSIONS: The prognosis for severe adult VP with current available treatment is good. The only predictor on admission for severe VP is the presence of more than one recognised risk factor for developing VP. Copyright 2001 The British Infection Society. PMID: 11676521 [PubMed - indexed for MEDLINE] 1911. Arch Ophthalmol. 2001 Oct;119(10):1550-2. Retinal periphlebitis as zoster sine herpete. Noda Y, Nakazawa M, Takahashi D, Tsuruya T, Saito M, Sekine M. Department of Ophthalmology, Hirosaki University School of Medicine, 5 Zaifu-cho, Hirosaki, 036-8562, Japan. mitsuru@cc.hirosaki-u.ac.jp PMID: 11594964 [PubMed - indexed for MEDLINE] 1912. Geriatrics. 2001 Oct;56(10):33-8, 41. Skin and soft tissues. Management of four common infections in the nursing home patient. O'Donnell JA, Hofmann MT. Department of Medicine, Division of Infectious Diseases, MCP Hahnemann School of Medicine and University, Medical College of Pennsylvania Hospital, Philadelphia, USA. Common skin and soft tissue infections in nursing home patients include herpes zoster, cellulitis, pressure ulcer infections, and scables. Treatment of shingles with an oral antiviral should be started within 24 hours of symptom onset. Dissemination and bacterial superinfection require antibiotic therapy. Use of corticosteroids to prevent post-herpetic neuralgia remains controversial. Cellulitis is most often caused by Staphylococcus aureus and beta-hemolytic streptococci (groups A and B). Therapy for cellulitis is empiric; gram-negative bacilli should be covered in diabetic patients. Most pressure ulcers never become infected; for those that do, empiric therapy should cover S aureus, gram-negative bacilli, and anaerobes. Topical treatment of scables with 5% permethrin cream or 1% lindane lotion is recommended. PMID: 11641861 [PubMed - indexed for MEDLINE] 1913. Clin Radiol. 2001 Nov;56(11):926-32. Facial nerve palsy: evaluation by contrast-enhanced MR imaging. Kinoshita T, Ishii K, Okitsu T, Okudera T, Ogawa T. Department of Radiology, Sendai City Hospital, Japan. AIM: The purpose of this study was to investigate the value of contrast-enhanced magnetic resonance (MR) imaging in patients with peripheral facial nerve palsy. MATERIALS AND METHODS: MR imaging was performed in 147 patients with facial nerve palsy, using a 1.0 T unit. All of 147 patients were evaluated by contrast-enhanced MR imaging and the pattern of enhancement was compared with that in 300 control subjects evaluated for suspected acoustic neurinoma. RESULTS: The intrameatal and labyrinthine segments of the normal facial nerve did not show enhancement, whereas enhancement of the distal intrameatal segment and the labyrinthine segment was respectively found in 67% and 43% of patients with Bell's palsy. The geniculate ganglion or the tympanic-mastoid segment was enhanced in 21% of normal controls versus 91% of patients with Bell's palsy. Abnormal enhancement of the non-paralyzed facial nerve was found in a patient with bilateral temporal bone fracture. CONCLUSION: Enhancement of the distal intrameatal and labyrinthine segments is specific for facial nerve palsy. Contrast-enhanced MR imaging can reveal inflammatory facial nerve lesions and traumatic nerve injury, including clinically silent damage in trauma. Copyright 2001 The Royal College of Radiologists. PMID: 11603897 [PubMed - indexed for MEDLINE] 1914. Ann N Y Acad Sci. 2001 Sep;941:200-5. Therapy of T cell lymphomas with pentostatin. Kurzrock R. Department of Bioimmunotherapy, University of Texas, M. D. Anderson Cancer Center, Houston 77030, USA. rkurzroc@mdanderson.org Pentostatin is a highly lymphocytotoxic agent active in hairy cell leukemia. Several studies also suggest significant activity in T cell lymphomas manifested in the skin. Herein, we will review the studies of pentostatin in these lymphomas and our most recent trial of this agent in heavily pretreated patients with cutaneous and peripheral T cell lymphomas. Overall, the data suggest that pentostatin has significant antitumor activity in these patients, with response rates ranging from 33% to over 70%. Approximately one-third of the responses are complete. The most common side effects include granulocytopenia, nausea, and renal insufficiency. CD4 suppression occurs and may result in an increased risk of herpes zoster infection. Although prolonged remissions have been seen, most responses are short-lived. These observations suggest that further exploration of this agent, in combination with other drugs active in T cell lymphomas, is warranted in this group of diseases. PMID: 11594574 [PubMed - indexed for MEDLINE] 1915. Rofo. 2001 Oct;173(10):920-3. [CT-guided thoracal sympathicolysis for the treatment of peripheral arterial occlusive disease and chronic thoracal pain syndromes in 6 patients] [Article in German] Finkenzeller T, Techert J, Lenhart M, Link J, Feuerbach S. Abteilung Röntgendiagnostik, Klinikum der Universität Regensburg, Germany. CT-guided thoracal sympathicolysis for the treatment of peripheral arterial occlusive disease and chronic thoracal pain syndromes in 6 patients. PURPOSE: Retrospective evaluation of the safety and effectivity of CT-guided percutaneous thoracal sympathicolysis (CT-TSL) in the treatment of patients with peripheral arterial occlusive disease (PAOD) of the upper limb and chronic thoracal pain syndromes. Comparison of our own experience with literature reports. MATERIAL AND METHODS: Between 6/96 and 12/99, 4 patients with PAOD of the upper limb and two with chronic thoracal pain syndromes caused by herpes zoster were treated by unilateral CT-TSL. RESULTS: 18, 21 and 32 months after the intervention 3 out of 4 patients treated for PAOD reported subjective improvements, and one remained unchanged. Two patients treated for pain syndromes showed no long-term benefit of the procedure. There were no serious complications. CONCLUSION: The CT-TSL is an alternative method in the treatment of PAOD in patients who are unsuitable for treatment by revascularization. PMID: 11588680 [PubMed - indexed for MEDLINE] 1916. Expert Opin Pharmacother. 2001 Aug;2(8):1283-7. Current treatment practice of herpes zoster. Heald PW. Yale University School of Medicine, New Haven, Connecticut, USA. peter.heald@yale.edu The management of herpes zoster infection has been impacted by the development of oral and iv. antiviral therapies. There are clinical and historical features that help optimise the particular therapy course for a given patient. Additionally, there are common features of management in all patients with herpes zoster. In this review an understanding of the pathogenesis of herpes zoster is utilised as a starting point for the development of a rational approach to therapy. Clinical findings that impact decision making are emphasised and the appropriate goals for therapy are discussed. PMID: 11584996 [PubMed - indexed for MEDLINE] 1917. Cutis. 2001 Sep;68(3):179-82. Reflex sympathetic dystrophy syndrome following herpes zoster. Querol I, Cisneros T. Departments of Dermatology and Rehabilitation, Hospital Reina Sofía de Tudela, Tudela, Spain. iqueroln@posta.unizar.es Reflex sympathetic dystrophy syndrome (RSDS), or algodystrophy, is a poorly understood, painful syndrome that consists of multiple symptoms, including vasomotor instability, swelling, and chronic pain involving an extremity. Although RSDS following herpes zoster is classically recognized, only a few well-documented cases of this complication have been reported to date. We present the case of a 63-year-old white woman with characteristic signs and symptoms of RSDS in the left upper limb that appeared 3 weeks after she had a typical herpes zona involving the left C5-C6 dermatomes. Early diagnosis and treatment with physiotherapy, intranasal salmon calcitonin, and oral calcium achieved a progressive improvement of the disease, which healed without sequelae in a brief time. PMID: 11579780 [PubMed - indexed for MEDLINE] 1918. J Emerg Nurs. 2001 Oct;27(5):519-20. A woman with unilateral eye pain and malaise. Molitor L. Emergancy Department, Shands at AGH, Gainesville, FL, USA. LMolitorge@aol.com PMID: 11577300 [PubMed - indexed for MEDLINE] 1919. J Clin Pathol. 2001 Oct;54(10):743-7. Vaccination to prevent varicella and shingles. Breuer J. Department of Virology, St Bartholomew's and the Royal London School of Medicine and Dentistry, Queen Mary and Westfield College, 37 Ashfield Street, London E1 1BB, UK. j.breuer@mds.qmw.ac.uk Comment in: J Clin Pathol. 2002 May;55(5):399; author reply 399. Vaccination of healthy children against varicella using the live attenuated Oka vaccine has been available in Japan and south Korea for several years. In 1996, a programme of universal vaccination of children to prevent varicella was introduced in the USA and other countries, including Canada, Germany, and Sweden, have licensed the vaccine for use in healthy children. This article reviews the origin of the Oka vaccine and the evidence for vaccine safety and efficacy in children and adults. Universal vaccination of children and targeted vaccination of groups at risk of severe varicella are discussed. The possible use of the Oka vaccine to prevent zoster is reviewed, and initiatives to develop new varicella zoster virus vaccines are outlined. PMCID: PMC1731286 PMID: 11577118 [PubMed - indexed for MEDLINE] 1920. Pain. 2001 Oct;94(1):113-9. Acute pain in herpes zoster: the famciclovir database project. Dworkin RH, Nagasako EM, Johnson RW, Griffin DR. Department of Anesthesiology, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Box 604, Rochester, NY 14642, USA. robert_dworkin@urmc.rochester.edu The results of a considerable number of recent prospective studies have demonstrated that greater acute pain severity in herpes zoster patients is associated with a significantly greater risk of developing postherpetic neuralgia (PHN). Only a few studies have examined the relationships between acute pain severity and demographic characteristics and clinical features of patients with herpes zoster, however, and the results of these studies have been inconsistent. To clarify these relationships, data from 1778 herpes zoster patients studied within 72 h of rash onset in four clinical trials of the antiviral agent famciclovir were examined. Univariate and multivariate analyses indicated that greater acute pain severity was significantly associated with greater age, female sex, greater rash severity, the presence of a prodrome, and primary involvement of non-trigeminal dermatomes. These results demonstrate that three of the established risk factors for PHN - older age, greater rash severity, and the presence of a prodrome - are also associated with more severe acute pain assessed soon after rash onset in patients with herpes zoster. The results of this study are consistent with the recommendation that herpes zoster patients who are older, who have had a prodrome, or who have severe rash or severe acute pain should be targeted for interventions designed to prevent PHN. PMID: 11576750 [PubMed - indexed for MEDLINE] 1921. J Am Board Fam Pract. 2001 Sep-Oct;14(5):392-4. Ramsay Hunt syndrome in a patient with human immunodeficiency virus infection. Sobn AJ, Tranmer PA. Department of Family Medicine, University of Illinois at Chicago, 60612, USA. PMID: 11572547 [PubMed - indexed for MEDLINE] 1922. Hautarzt. 2001 Sep;52(9):817-9. [Bilateral, asymmetric herpes zoster (herpes zoster duplex asymmetricus)] [Article in German] Csontos Z, Sebök B, Karg E, Schneider I. I. Chirurgische Klinik der Medizinischen Universität Pécs. A 73-year-old female patient presented with asymmetric herpes zoster. She was treated successfully with systemic immunostimulants, vitamin B1 tablets and topical etheric acetyl-salicylic acid solution. No underlying malignancy, immunodeficiency or other systemic diseases could be detected. PMID: 11572075 [PubMed - indexed for MEDLINE] 1923. Int Dent J. 2001 Aug;51(4):273-6. Post-extraction complications seen at a referral dental clinic in Dar Es Salaam, Tanzania. Simon E, Matee M. AIM: To investigate the types and magnitude of post extraction complications. SETTING: A referral hospital in Dar es Salaam, Tanzania. SUBJECTS: All dental patients who had their teeth extracted at the Muhimbili Medical Centre dental outpatient clinic during the study period (May September 1999). A total of 3,818 extractions were performed under local anaesthetic in 3,732 patients. METHOD: Oral examination of all patients who reported back with post-extraction problems. RESULTS: The frequency of post extraction complications was low (1.1 per cent), and was mainly due to; infected sockets (48.7 per cent), followed by bleeding sockets (41.0 per cent) and retained roots (10.3 per cent). There were eight 'other' complications suffered by 11 patients: necrotising fasciitis (n=l), herpes zoster (n=l), Ludwig's angina (n=l), infections of the submandibular (n=l), parapharyngeal (n=2), masticator (n=2) and submasseteric spaces (n =2), and reaction to local anaesthesia (2ml of 2 per cent lignocaine hydrochloride) (n=1). CONCLUSION: The results of this study indicate that post-extraction complications are few, mostly minor, self-limiting and easily treatable. The study does not support routine antibiotic prophylaxis or special pre-extraction procedures, even in this patient population with poor oral hygiene and high HIV seroprevalence. PMID: 11570541 [PubMed - indexed for MEDLINE] 1924. Cancer Chemother Pharmacol. 2001 Jul;47 Suppl:S10-5. Oral therapy with proteolytic enzymes decreases excessive TGF-beta levels in human blood. Desser L, Holomanova D, Zavadova E, Pavelka K, Mohr T, Herbacek I. Institute of Cancer Research, University of Vienna, Austria. ldesser@hotmail.com Therapy with oral proteolytic enzymes (OET) with combination drug products containing papain, bromelain, trypsin, and chymotrypsin has been shown to be beneficial in clinical settings such as radiotherapy-induced fibrosis, bleomycin pneumotoxicity and immunosuppression in cancer, all of which are nowadays known to be accompanied by excessive transforming growth factor-beta (TGF-beta) production. It has been demonstrated that proteolytic enzymes reduce TGF-beta levels in serum by converting the protease inhibitor alpha2 macroglobulin (alpha2M) from the "slow" form into the "fast" form, whereby the "fast" form binds and inactivates TGF-beta irreversibly. In this study we have investigated the effect of OET on the concentration of TGF-beta1 in serum of patients with rheumatoid arthritis (RA) (n = 38), osteomyelofibrosis (OMF) (n = 7) and herpes zoster (HZ) (n = 7). Seventy-eight healthy volunteers served as controls. TGF-beta1 levels in serum were assessed by enzyme-linked immunosorbent assay (ELISA). We have demonstrated that in healthy volunteers and in patients there exists a correlation between active and latent TGF-beta1 in serum (r=0.8021; P<0.0001). Treatment with OET had no significant effect on TGF-beta1 concentration in healthy volunteers or patients with a normal level of TGF-beta1. In patients with elevated TGF-beta1 concentration (> 50 ng/ml serum), OET reduced TGF-beta1 in RA (P < 0.005), in OMF (P < 0.05) and in HZ (P < 0.05). Conclusion: These results support the concept that OET is beneficial in diseases characterized in part by TGF-beta1 overproduction. PMID: 11561866 [PubMed - indexed for MEDLINE] 1925. Eur J Pain. 2001;5(3):333-9. Opioids in non-cancer pain: a life-time sentence? Dellemijn PL. Department of Neurology and Neurophysiology, Saint Joseph Hospital, P.O. Box 7777, 5500 MB Veldhoven, Netherlands. NEI@sjz.nl There is continuing reluctance to prescribe strong opioids for the management of chronic non-cancer pain due to concerns about side-effects, physical tolerance, withdrawal and addiction. Randomized controlled trials have now provided evidence for the efficacy of opioids against both nociceptive and neuropathic pain. However, there is considerable variability in response rates, possibly depending on the type of pain, the type of opioid and its route of administration, the time to follow-up, compliance and the development of tolerance. Five patients were selected with nociceptive or neuropathic pain in whom other pharmacological or physical therapies had failed to provide satisfactory pain relief. They received transdermal fentanyl (starting dose 25 microg/h) for at least 6 weeks. Transdermal fentanyl dosage was titrated upwards as required. Transdermal fentanyl provided adequate pain relief in patients with nociceptive pain (diabetic ulcer, osteoporotic vertebral fracture, ankylosing spondylitis) or neuropathic pain with a nociceptive component (radicular pain due to disc protrusion, herpetic neuralgia). The duration of treatment ranged from 6 weeks to 6 months for four cases. In the case of ankylosing spondylitis, treatment was carried out for 2 years, stopped and then restarted successfully. There were no withdrawal effects or addictive behaviour on treatment cessation, regardless of duration of the treatment. In conclusion, strong opioids may provide prolonged effective pain relief in selected patients with nociceptive and neuropathic non-cancer pain. Transdermal fentanyl treatment can often be temporary and can easily be stopped following adequate pain relief without withdrawal effects or any evidence of addictive behaviour. Copyright 2001 European Federation of Chapters of the International Association for the Study of Pain. PMID: 11558990 [PubMed - indexed for MEDLINE] 1926. Acta Derm Venereol. 2001 Jun-Jul;81(3):212-3. Zoster in childhood after inapparent varicella. Lagarde C, Steen AE, Bieber T, Steen KH. PMID: 11558884 [PubMed - indexed for MEDLINE] 1927. Antimicrob Agents Chemother. 2001 Oct;45(10):2771-4. Acyclovir for treatment of postherpetic neuralgia: efficacy and pharmacokinetics. Acosta EP, Balfour HH Jr. Department of Clinical Pharmacology, University of Alabama at Birmingham, Birmingham, AL 35294-0019, USA. EAcosta@uab.edu Postherpetic neuralgia is the most common complication of herpes zoster (shingles) in the immunocompetent host. Its mechanism is incompletely understood, but one postulate is that continuous replication of varicella-zoster virus (VZV) in nerve tissues may be responsible for the pain. If this is so, antiviral treatment could be advantageous. To test this hypothesis, we performed a randomized, double-blind, placebo-controlled trial of intravenous acyclovir (10 mg/kg every 8 h [q8h]) for 14 days, followed by oral acyclovir (800 mg q6h) for 42 days in 10 subjects (median age, 71 years) who had experienced at least 6 months of severe pain (median duration of postherpetic neuralgia before enrollment, 3.2 years). Intensive and sparse pharmacokinetic sampling occurred during both dosing phases of the study. One- and two-compartment models were fitted to the oral and intravenous concentration-time data, respectively. The four men and four women assigned to acyclovir during either or both dosing phases tolerated it well. Pharmacokinetic results were similar to those previously reported in younger individuals. The mean oral clearance and elimination half-life following oral dosing were 1.47 liters/h/kg and 2.78 h, respectively. Total clearance and terminal half-life following intravenous administration were 0.16 liters/h/kg and 3.67 h, respectively. Only 1 of 10 participants reported definite improvement in the severity of postherpetic pain, and treatment had no effect on titers of humoral antibody to VZV. We concluded that 56 days of intravenous and oral acyclovir therapy were well tolerated but had little or no effect on the clinical course of postherpetic neuralgia. PMCID: PMC90729 PMID: 11557467 [PubMed - indexed for MEDLINE] 1928. Nippon Rinsho. 2001 Sep;59(9):1738-42. [Herpes zoster and post-herpetic neuralgia] [Article in Japanese] Hashizume K. Department of Anesthesiology, Nara Medical University. Pain associated with herpes zoster arise from the virul neuritis of the suffered trigeminal or spinal dorsal ganglion. Prolonged neuritis makes an irreversible nerve injury and continuous pain impulse develops a central sensitization. A post-herpetic neuralgia is thought to be a neuropathic pain due to the irreversible nerve injury and sensitization. It is important to treat herpetic pain completely before the development of the post-herpetic neuralgia, because there are few effective therapies to cure post-herpetic neuralgia. A sympathetic nerve block increases the nerve blood flow supply, and may improve the nerve injury. It is also known that some sympathetic mechanisms relate to the development of the sensitization. A sensory nerve block reduces pain impulse to the dorsal horn, and may interfere the sensitization. A cortico-steroid administrated with a nerve block can reduce the neuritis, and may improve the nerve injury. PMID: 11554045 [PubMed - indexed for MEDLINE] 1929. Masui. 2001 Aug;50(8):904-7. [Usefulness of epidural administration of ketamine for relief of postherpetic neuralgia] [Article in Japanese] Mizuno J, Sugimoto S, Ikeda M, Ikeda M, Machida K, Mikawa Y. Department of Anesthesia, Kochi Prefectural Aki Hospital, Aki 784-0027. Four patients with postherpetic neuralgia had their pain alleviated by epidural administration of ketamine. No oral non-steroidal anti-inflammatory drugs and anti-depressant drugs were effective in all cases. Lidocaine or bupivacaine was administered epidurally to all four patients. When these patients stated that they did not feel pain reduced, they received epidural infusion of ketamine at doses from 5 mg to 20 mg with lidocaine or bupivacaine and their postherpetic neuralgia was controlled. Therefore with these cases, we suspect that epidural administration of ketamine, an antagonist for N-methyl-D-aspartic acid receptor, could be an effective and useful alternative treatment in a patient with refractory postherpetic neuralgia. PMID: 11554028 [PubMed - indexed for MEDLINE] 1930. Cutis. 2001 Aug;68(2):120-2. Concurrent herpes simplex type 1 and varicella-zoster in the V2 dermatome in an immunocompetent patient. De Vivo C, Bansal MG, Olarte M, Grossman ME. Department of Medicine, Columbia University College of Physicians & Surgeons, New York, New York, USA. A unique feature of herpesviruses is their ability to establish latent infection within the nervous system by colonizing peripheral sensory ganglia, which results in subsequent episodic outbreaks of infection triggered by precipitating events. Despite the latent nature of both herpes simplex virus type 1 (HSV-1) and varicella-zoster virus (VZV) within these sensory ganglia, simultaneous outbreaks of these viruses are uncommon. This is generally attributed to the differing reactivation features of these 2 viruses. Four cases of concurrent HSV-1 and VZV infection are described in the literature. We report concurrent infection of HSV-1 and VZV within the same V2 dermatome in an immunocompetent patient. PMID: 11534912 [PubMed - indexed for MEDLINE] 1931. J Virol. 2001 Oct;75(19):9483-92. Varicella-zoster Virus gB and gE coexpression, but not gB or gE alone, leads to abundant fusion and syncytium formation equivalent to those from gH and gL coexpression. Maresova L, Pasieka TJ, Grose C. Department of Microbiology, University of Iowa, Iowa City, Iowa, USA. Varicella-zoster virus (VZV) is distinguished from herpes simplex virus type 1 (HSV-1) by the fact that cell-to-cell fusion and syncytium formation require only gH and gL within a transient-expression system. In the HSV system, four glycoproteins, namely, gH, gL, gB, and gD, are required to induce a similar fusogenic event. VZV lacks a gD homologous protein. In this report, the role of VZV gB as a fusogen was investigated and compared to the gH-gL complex. First of all, the VZV gH-gL experiment was repeated under a different set of conditions; namely, gH and gL were cloned into the same vaccinia virus (VV) genome. Surprisingly, the new expression system demonstrated that a recombinant VV-gH+gL construct was even more fusogenic than seen in the prior experiment with two individual expression plasmids containing gH and gL (K. M. Duus and C. Grose, J. Virol. 70:8961-8971, 1996). Recombinant VV expressing VZV gB by itself, however, effected the formation of only small syncytia. When VZV gE and gB genes were cloned into one recombinant VV genome and another fusion assay was performed, extensive syncytium formation was observed. The degree of fusion with VZV gE-gB coexpression was comparable to that observed with VZV gH-gL: in both cases, >80% of the cells in a monolayer were fused. Thus, these studies established that VZV gE-gB coexpression greatly enhanced the fusogenic properties of gB. Control experiments documented that the fusion assay required a balance between the fusogenic potential of the VZV glycoproteins and the fusion-inhibitory effect of the VV infection itself. PMCID: PMC114515 PMID: 11533210 [PubMed - indexed for MEDLINE] 1932. Am J Ophthalmol. 2001 Sep;132(3):421-3. Progressive outer retinal necrosis and acute retinal necrosis in fellow eyes of a patient with acquired immunodeficiency syndrome. Gariano RF, Berreen JP, Cooney EL. Department of Ophthalmology and Visual Science, Yale University Eye Center, 330 Cedar Street, New Haven, CT 06520, USA. ray.gariano@yale.edu PURPOSE: To describe an unusual concurrence of acute retinal necrosis and progressive outer retinal necrosis in fellow eyes of a patient with acquired immunodeficiency syndrome (AIDS). METHODS: Interventional case report. In a 37-year-old man with AIDS and herpes zoster keratitis in the right eye, progressive outer retinal necrosis developed in the right eye and acute retinal necrosis developed in the left eye. RESULTS: Disparate presentations of retinitis persisted in each eye, and retinal detachment and vision loss ensued in both eyes despite antiviral therapy. CONCLUSION: Distinct features of acute retinal necrosis and progressive outer retinal necrosis do not necessarily reflect systemic factors, and they may be variant manifestations of the same underlying infection. PMID: 11530066 [PubMed - indexed for MEDLINE] 1933. JAAPA. 2000 Aug;13(8):21-2. Tingling rash in an older man. Newman K, Herman L. New York Institute of Technology PA Program, Old Westbury, NY, USA. PMID: 11521613 [PubMed - indexed for MEDLINE] 1934. Indian J Pediatr. 2001 Jul;68(7):649-54. Anti-herpes viruses agents. Abdel-Haq NM, Asmar BI. Devision of Infectious Diseases, Children's Hospital of Michigan, Wayne State University, School of Medicine, Detroit, Michigan, USA. Antiviral agents with demonstrated efficacy are currently available for the management of infections in children caused by the herpes viruses including herpes simples type 1 (HSV1) and type 2 (HSV2), varicella-zoster virus (VZV), and cytomegalovirus (CMV). Recently, progress has been made in the development of newer agents with enhanced activity against these viruses including resistant strains. This review focuses on the activity, clinical pharmacology, and clinical indications of antiviral agents used in the treatment of infections caused by the different herpes viruses in children. PMID: 11519289 [PubMed - indexed for MEDLINE] 1935. Mt Sinai J Med. 2001 Sep-Oct;68(4-5):339-41. Zosteriform Darier's disease versus acantholytic dyskeratotic epidermal nevus. Goldberg EI, Lefkovits AM, Sapadin AN. Department of Dermatology, State University at Stony Brook, Stony Brook, NY, USA. Patients with keratotic lesions distributed in a unilateral, linear, zosteriform or localized pattern and revealing histologic features of dyskeratotic acantholysis have been reported. There is still some controversy regarding the appropriate nosologic placement of this entity. Some believe it represents a localized form of Darier s disease, while others argue it is a variant of epidermal nevus. We report a case of a 42-year-old physician who presented with a 15-year history of an asymptomatic eruption that had been diagnosed as "chronic zoster." Physical exam revealed hyperkeratotic papules and plaques in a dermatomal distribution. The controversy regarding the correct nosologic placement of such a patient is discussed. PMID: 11514923 [PubMed - indexed for MEDLINE] 1936. Stat Med. 2001 Aug 30;20(16):2429-39. Phase specific analysis of herpes zoster associated pain data: a new statistical approach. Arani RB, Soong SJ, Weiss HL, Wood MJ, Fiddian PA, Gnann JW, Whitley R. Biostatistics Unit, Comprehensive Cancer Center, University of Alabama at Birmingham, 35294-3300, USA. Comment in: Stat Med. 2006 Jan 30;25(2):359-60. Herpes zoster or shingles is a frequent occurrence in both elderly individuals and immunocompromised hosts. The pain associated with herpes zoster is the most debilitating complication of the disease. It can be described as acute pain and post-herpetic neuralgia or zoster associated pain (ZAP). The latter definition encompasses pain from the onset of disease through its resolution and provides a convenient analytic tool for evaluation of antiviral therapy. A heuristic examination of ZAP historical data suggests the existence of three phases of pain resolution: the acute, subacute and chronic phases. The subacute and chronic phases comprise the post-herpetic neuralgia (PHN) stage. Common analytic methods, such as a Kaplan-Meier survival function or a Cox's model, have been used to assess the pain. However, such approaches do not adequately allow for phase comparison. Notably, in the clinical trial setting the comparison of specific treatment effects on the latter stages of pain are of the greatest medical relevance since this is the most debilitating phase of the illness. In order to incorporate the phase-specific information in the modelling of time to cessation of ZAP, we assumed the hazard function was a stepwise constant. Utilizing the full likelihood function, we obtained the maximum likelihood estimate for the transition times (that is, change-points), and other parameters of medical importance. The standard error of the change-point estimates were obtained through a bootstrapping method. The asymptotic properties of the parameter estimates are also discussed. Hence, the rates of pain resolution across all phases can be examined in order to precisely define the existence of multiple phases. In addition, the covariates effect can be examined across phases and populations, thereby allowing us to translate potential efficacy of a standard therapy to different populations. These results can be utilized in the design of clinical trials or in targeting the outcome for a specific phase while controlling for the effect of other variables. Copyright 2001 John Wiley & Sons, Ltd. PMID: 11512133 [PubMed - indexed for MEDLINE] 1937. Presse Med. 2001 Jul 7-13;30(23):1151-4. [Varicella zoster virus infection after bone marrow transplant. Unusual presentation and importance of prevention] [Article in French] Ladrière M, Bibes B, Rabaud C, Delaby P, May T, Canton P. Service de Maladies infectieuses et tropicales, Centre Hospitalier Universitaire de Nancy. BACKGROUND: Leukemeia and lymphoproliferative disease are associated with a high risk of varicela-zoster virus (VZV) infection. Although infrequent, visceral involvement can be fatal. We report two cases of patients presenting severe VZV infection after bone marrow transplantation. CASE REPORTS: The first patient was a 42-year old man who received an allogeneic bone marrow transplantation for chronic myelogenous leukemia. A severe graft-versus-host reaction occurred. Three months after discontinuing VZV prophylaxis, VZV transverse myelitis was diagnosed, leading to death despite prompt treatment with acyclovir. The second patient was a 42-year-old woman treated with autologous bone marrow transplantation for lymphoma. She developed acute viral pancreatitis one month after discontinuing VZV prophylaxis. Recovery was achieved with intravenous treatment. DISCUSSION: These two cases illustrate the potential gravity of VZV infection after bone marrow transplantation. These observations point to the need for revisiting the duration of VZV prophylaxis. PMID: 11505833 [PubMed - indexed for MEDLINE] 1938. Hernia. 2001 Jun;5(2):99-100. Abdominal-wall pseudohernia secondary to herpes zoster. Zuckerman R, Siegel T. Department of Surgery, Mary Imogene Bassett Hospital, One Atwell Road, Cooperstown, NY 13326, USA. rszmd@att.net We present a case of a 78-year-old woman with abdominal-wall muscle paralysis following cutaneous herpes zoster in the T12-L1 dermatomes. An EMG confirmed paralysis, and a CT scan ruled out fascial defect. The paralysis had completely resolved 1 year later. A review of the literature regarding these unusual sequelae of herpes zoster is presented. PMID: 11505658 [PubMed - indexed for MEDLINE] 1939. Med Pediatr Oncol. 2001 Aug;37(2):145-7. Noncutaneous varicella-zoster virus (VZV) infection with fatal liver failure in a child with acute lymphoblastic leukemia (ALL). Müller I, Aepinus C, Beck R, Bültmann B, Niethammer D, Klingebiel T. University Children's Hospital, Department of Hematology and Oncology, Tübingen, Germany. PMID: 11496356 [PubMed - indexed for MEDLINE] 1940. Curr Opin Microbiol. 2001 Aug;4(4):442-9. Varicella-zoster virus: molecular virology and virus-host interactions. Arvin AM. G-312, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, USA. aarvin@stanford.edu Cosmid-based mutagenesis and methods to examine varicella-zoster virus (VZV) tropism for differentiated human cells in vivo provide new information about molecular mechanisms of VZV infection. How specific VZV gene products contribute to viral replication has been further defined, and effects of VZV on expression of cellular genes have been demonstrated. PMID: 11495809 [PubMed - indexed for MEDLINE] 1941. J Ir Dent Assoc. 2001;47(2):46-58. Non-odontogenic toothache. Murphy E, Merrill RL. Section of Orofacial Pain and Oral Medicine, UCLA School of Dentistry, Los Angeles, California, USA. PMID: 11494946 [PubMed - indexed for MEDLINE] 1942. Can Fam Physician. 2001 Jul;47:1368-70, 1377-9. Varicella. To be [vaccinated] or not to be: that is the question! [Article in English, French] Sullivan-Bentz M. Comment in: Can Fam Physician. 2001 Oct;47:1961. PMCID: PMC2018538 PMID: 11494921 [PubMed - indexed for MEDLINE] 1943. Auris Nasus Larynx. 2001 Aug;28(3):223-6. Acyclovir improves recovery rate of facial nerve palsy in Ramsay Hunt syndrome. Kinishi M, Amatsu M, Mohri M, Saito M, Hasegawa T, Hasegawa S. Department of Otorhinolaryngology, Head and Neck Surgery, Kobe University School of Medicine, Kusunoki-cho 7-5-1, Chuo-ku, Kobe 650-0017, Japan. kinishi@med.kobe-u.ac.jp OBJECTIVE: Although the antiviral agent, acyclovir, is currently employed for the treatment in Ramsay Hunt syndrome, the benefit of acyclovir on facial nerve is still unknown and remains controversial. This study was designed to evaluate the effect of acyclovir in facial nerve recovery in Ramsay Hunt syndrome. METHODS: To evaluate drug effect on facial nerve function, evaluation of the facial voluntary movement and nerve excitability testing were performed. We have used an infusion therapy of acyclovir in combination with a high dose of steroid (AS), which was started within 7 days of onset of facial nerve palsy in 91 patients with Ramsay Hunt syndrome. The results were compared with those of 47 patients whose therapy was steroid alone started within 7 days of onset. RESULTS: Out of 91 patients treated with AS, nerve exitability was good in 68 (75%), while it was poor in 17 and absent in six. Of 47 patients treated with steroid alone, nerve exitability was good in 25 (53%), while it was poor in 11 and absent in 11. There was statistically significant difference between AS and steroid therapy in the posttreatment degree of nerve function. Complete recovery to grade I in facial voluntary movement was attained in 82 of 91 patients (90%) in the AS therapy, while out of 47 patients treated with steroid alone complete recovery to grade I was attained in only 30 (64%). A statistically significant difference in the recovery rate of facial nerve function was induced between AS and steroid therapy. CONCLUSION: The AS therapy was proved to keep good degree of nerve function indicated with nerve excitability testing and improve recovery rate of facial nerve in Ramsay Hunt syndrome. Based on this study, we now believe that the AS therapy is an advisable treatment modality to improve the recovery rate of facial nerve function in Ramsay Hunt syndrome. PMID: 11489365 [PubMed - indexed for MEDLINE] 1944. Jpn J Ophthalmol. 2001 Jul-Aug;45(4):425-8. Optic neuropathy and central retinal vascular obstruction as initial manifestations of acute retinal necrosis. Kang SW, Kim SK. Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea. BACKGROUND: The purpose of this brief communication is to alert ophthalmologists that optic neuropathy may herald acute retinal necrosis (ARN). CASE: A previously healthy 54-year-old man exhibited optic neuropathy as an initial presentation of ARN, 8 weeks after varicella-zoster dermatitis. OBSERVATIONS: Central retinal vascular obstruction developed subsequently in his left eye. Later, the classic presentation of ARN appeared in his contralateral eye. Systemic acyclovir therapy stopped the progression of retinitis and resulted in healing of retinal lesions in his right eye. CONCLUSIONS: This case suggests that optic neuropathy, especially with preceding herpetic dermatitis, should be suspected as the prodrome of ARN. PMID: 11485778 [PubMed - indexed for MEDLINE] 1945. J Virol. 2001 Sep;75(17):8224-39. Mutational analysis of the repeated open reading frames, ORFs 63 and 70 and ORFs 64 and 69, of varicella-zoster virus. Sommer MH, Zagha E, Serrano OK, Ku CC, Zerboni L, Baiker A, Santos R, Spengler M, Lynch J, Grose C, Ruyechan W, Hay J, Arvin AM. Department of Pediatrics, Stanford University School of Medicine, Stanford, CA 94305-5208, USA. marvman@stanford.edu Varicella-zoster virus (VZV) open reading frame 63 (ORF63), located between nucleotides 110581 and 111417 in the internal repeat region, encodes a nuclear phosphoprotein which is homologous to herpes simplex virus type 1 (HSV-1) ICP22 and is duplicated in the terminal repeat region as ORF70 (nucleotides 118480 to 119316). We evaluated the role of ORFs 63 and 70 in VZV replication, using recombinant VZV cosmids and PCR-based mutagenesis to make single and dual deletions of these ORFs. VZV was recovered within 8 to 10 days when cosmids with single deletions were transfected into melanoma cells along with the three intact VZV cosmids. In contrast, VZV was not detected in transfections carried out with a dual deletion cosmid. Infectious virus was recovered when ORF63 was cloned into a nonnative AvrII site in this cosmid, confirming that failure to generate virus was due to the dual ORF63/70 deletion and that replication required at least one gene copy. This requirement may be related to our observation that ORF63 interacts directly with ORF62, the major immediate-early transactivating protein of VZV. ORF64 is located within the inverted repeat region between nucleotides 111565 and 112107; it has some homology to the HSV-1 Us10 gene and is duplicated as ORF69 (nucleotides 117790 to 118332). ORF64 and ORF69 were deleted individually or simultaneously using the VZV cosmid system. Single deletions of ORF64 or ORF69 yielded viral plaques with the same kinetics and morphology as viruses generated with the parental cosmids. The dual deletion of ORF64 and ORF69 was associated with an abnormal plaque phenotype characterized by very large, multinucleated syncytia. Finally, all of the deletion mutants that yielded recombinants retained infectivity for human T cells in vitro and replicated efficiently in human skin in the SCIDhu mouse model of VZV pathogenesis. PMCID: PMC115067 PMID: 11483768 [PubMed - indexed for MEDLINE] 1946. Cutis. 2001 Jul;68(1):21-3. Childhood herpes zoster. Papadopoulos AJ, Birnkrant AP, Schwartz RA, Janniger CK. New Jersey Medical School, 185 S Orange Ave, Newark, NJ 07103-2714, USA. Comment in: Cutis. 2003 Jan;71(1):86; author reply 86. Herpes zoster (HZ) in childhood is rather unusual. This reactivation of chickenpox, the primary varicella-zoster virus (VZV) infection that lies dormant within sensory ganglia, is seen with increased frequency in otherwise healthy children who acquire chickenpox either in utero or within the first year of life. Our patient is a good example of this; he was exposed to chickenpox at the age of 3 months (by his 2 siblings) and developed HZ at 6 years of age. PMID: 11480141 [PubMed - indexed for MEDLINE] 1947. Dent Update. 2001 May;28(4):181-6, 188. Viral infections of the oral mucosa and perioral region. McIntyre GT. Dundee Dental Hospital and School, Dundee. Viral infections of the oral mucosa and perioral region are commonly encountered in the practice of dentistry. The accurate and timely diagnosis of such infections, coupled with the institution of appropriate treatment, can often permit quick resolution of the condition with minimal discomfort and anxiety for the patient (and carers) and prevent the spread of infection to others, especially immunocompromised individuals. This article outlines the clinical presentation and appropriate management of common viral infections of the oral mucosa and perioral region. PMID: 11476033 [PubMed - indexed for MEDLINE] 1948. Ann Hematol. 2001 Jun;80(6):361-4. Virus-associated hemophagocytic syndrome due to rubella virus and varicella-zoster virus dual infection in patient with adult idiopathic thrombocytopenic purpura. Takeoka Y, Hino M, Oiso N, Nishi S, Koh KR, Yamane T, Ohta K, Nakamae H, Aoyama Y, Hirose A, Fujino H, Takubo T, Inoue T, Tatsumi N. Department of Clinical Hematology, Osaka City University Medical School, Japan. A 26-year-old woman with idiopathic thrombocytopenic purpura (ITP) was admitted to our hospital because of fever and rash. Blood tests revealed thrombocytopenia, liver dysfunction, coagulopathy, and hyperferritinemia. Bone marrow examination revealed many atypical lymphocytes and some histiocytes with hemophagocytosis. On admission she was diagnosed with rubella virus-associated hemophagocytic syndrome (VHAS), but on laboratory examination, she was seropositive for varicella-zoster virus (VZV)-IgM as well as rubella virus-IgM. She was therefore diagnosed with dual infection by rubella virus and VZV. Her simultaneous rubella virus and VZV infection may have been related to the VAHS pathogenesis. She was treated with prednisolone and gamma globulin therapy and recovered completely. PMID: 11475151 [PubMed - indexed for MEDLINE] 1949. Ann Dermatol Venereol. 2000 Oct;127(Spec No 1):A129-35. [Varicella and zona. Epidemiology, physiopathology, diagnosis, clinical course, treatment] [Article in French] [No authors listed] PMID: 11474510 [PubMed - indexed for MEDLINE] 1950. J Clin Microbiol. 2001 Aug;39(8):2856-9. Quantitation of varicella-zoster virus DNA in patients with Ramsay Hunt syndrome and zoster sine herpete. Furuta Y, Ohtani F, Sawa H, Fukuda S, Inuyama Y. Department of Otolaryngology, CREST, JST, Hokkaido University School of Medicine, Sapporo, Japan. yfuruta@med.hokudai.ac.jp Varicella-zoster virus (VZV) reactivation causes facial nerve palsy in Ramsay Hunt syndrome (RHS) and zoster sine herpete (ZSH) with and without zoster rash, respectively. In the present study, we analyzed the VZV DNA copy number in saliva samples from 25 patients with RHS and 31 patients with ZSH using a TaqMan PCR assay to determine differences in the viral load between the two diseases. VZV copy number in saliva peaked near the day of the appearance of zoster in patients with RHS. Consequently, VZV DNA was less frequently detected in patients with RHS who exhibited facial palsy several days after the appearance of zoster. These findings suggest that the VZV load in saliva samples reflects the kinetics of viral reactivation in patients with RHS. In addition, VZV DNA was equally detected in saliva from patients with RHS and ZSH, and there was no significant difference in the highest viral copy number between patients with RHS and those with ZSH. The VZV load does not appear to reflect a major difference between RHS and ZSH. PMCID: PMC88250 PMID: 11474003 [PubMed - indexed for MEDLINE] 1951. J Int Med Res. 2001 May-Jun;29(3):198-203. Varicella zoster virus antigens in the epidermis of patients with herpes zoster before and after treatment with acyclovir: an immunohistochemical study. Kurokawa I, Yamamoto M, Kurata T. Department of Dermatology, Hyogo Prefectural Tsukaguchi Hospital, Japan. ikuro@alles.or.jp Using a monoclonal antibody to varicella zoster virus (VZV), an immunohistochemical study was performed before and after treatment with acyclovir (750 mg/day intravenously for 5 - 7 days) to investigate the distribution of VZV antigens in the epidermis of four in-patients with herpes zoster, and to correlate their presence with clinical manifestations of the disease. Biopsy specimens were obtained from epidermal lesions on admission to hospital prior to acyclovir administration, and again following treatment. In all cases, VZV antigens were found extensively in the erythematous and vesicular lesions before treatment, but they were not detected 5 - 7 days later in the ulcerative, crusted or pigmented lesions after acyclovir therapy. Further controlled studies will be necessary to compare the distribution of epidermal VZV antigens in acyclovir-treated patients with that in a placebo group to determine whether the loss of VZV antigens was due to acyclovir or to a natural decrease over time. PMID: 11471857 [PubMed - indexed for MEDLINE] 1952. Neurology. 2001 Jul 24;57(2):351-4. Acute, chronic, and recurrent varicella zoster virus neuropathy without zoster rash. Fox RJ, Galetta SL, Mahalingam R, Wellish M, Forghani B, Gilden DH. Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, USA. The authors report three patients with acute, chronic, and recurrent neuropathy associated with varicella zoster virus (VZV) infection but without zoster rash. CSF of all three patients contained VZV immunoglobulin G antibody, but not herpes simplex virus. In two patients, serum/CSF ratios of VZV immunoglobulin G were reduced compared to normal ratios for immunoglobulin G and albumin, and one patient also had VZV immunoglobulin M in CSF. All three patients received antiviral therapy and improved. The diagnosis of nervous system infection by VZV may be confirmed by the presence of antibody to VZV in CSF even without detectable VZV DNA. PMID: 11468330 [PubMed - indexed for MEDLINE] 1953. Duodecim. 1998;114(5):475-80. [Facial neuralgias] [Article in Finnish] Murros K. Keski-Suomen keskussairaala, neurologian yksikkö 40620 Jyväskylä. PMID: 11466940 [PubMed - indexed for MEDLINE] 1954. Arch Ophthalmol. 2001 Jul;119(7):1044-9. Evidence for antigen-specific immune deviation in patients with acute retinal necrosis. Kezuka T, Sakai J, Usui N, Streilein JW, Usui M. Department of Ophthalmology, Tokyo Medical University, 6-7-1, Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan. tkezuka@tokyo-med.ac.jp BACKGROUND: Because experimental acute retinal necrosis (ARN) induced by herpes simplex virus in mice develops only if mice fail to acquire virus-specific delayed hypersensitivity (DH), although they produce antiviral antibodies (ie, anterior chamber-associated immune deviation), we sought to determine whether a similar inverse correlation exists for patients with varicella-zoster virus (VZV)-induced ARN. DESIGN: Patients with acute, VZV-induced ARN and age-matched control subjects were skin tested with VZV and purified protein derivative antigens to evaluate DH. Varicella-zoster virus-induced ARN was diagnosed using polymerase chain reaction and intraocular antibody quotient. Serum samples were collected and analyzed for anti-VZV and anti-herpes simplex virus antibody titers. Acute retinal necrosis activity was assessed clinically, and DH skin tests were repeated 3 months after onset when ocular recovery had taken place. RESULTS: Whereas controls displayed intense DH when tested with VZV and purified protein derivative antigens, a subset of patients with ARN displayed absent VZV-specific DH (although their purified protein derivative responses were normal). Patients with the most severe ARN had the lowest DH responses to VZV antigens. Serum anti-VZV antibody titers were higher in patients with ARN than in controls, and antiviral titer correlated inversely with the intensity of anti-VZV DH responses. Varicella-zoster virus-specific DH responses were restored in patients who recovered from ARN. CONCLUSION: Varicella-zoster virus-ARN develops in a setting where DH reactivity to viral antigens is absent, implying that virus-specific DH might ameliorate the severity of ARN. CLINICAL RELEVANCE: Linking virus-specific DH to vulnerability to ARN in individuals infected with VZV might reveal an underappreciated pathogenic mechanism. PMID: 11448326 [PubMed - indexed for MEDLINE] 1955. Pediatr Infect Dis J. 2001 Jul;20(7):641-5. Incidence and hospitalization rates of varicella and herpes zoster before varicella vaccine introduction: a baseline assessment of the shifting epidemiology of varicella disease. Coplan P, Black S, Rojas C, Shinefield H, Ray P, Lewis E, Guess H. Merck Research Laboratories, Blue Bell, PA 19422, USA. paul_coplan@merck.com BACKGROUND: A 15-year postmarketing evaluation of the impact of varicella vaccine on the age distribution of varicella disease is being conducted at Kaiser Permanente Medical Care Program, Northern California (KPMCP). We report on a baseline assessment of the age-specific incidence and hospitalization rates of varicella and herpes zoster that was conducted before vaccine introduction. METHODS: To assess the annual incidence of varicella, a telephone survey was conducted in a random sample of approximately 8,000 youths 5 to 19 years of age. The annual incidence of hospitalizations for varicella and herpes zoster in 1994 was assessed with the use of the computerized database at KPMCP. RESULTS: Varicella annual incidence was 10.3% in 5- to 9-year-olds, 1.9% in 10- to 14-year-olds and 1.2% in the 15- to 19-year age groups, respectively. Hospitalization rates among the entire KPMCP membership were 2.6 and 2.1 per 100,000 person years for varicella and zoster, respectively. Varicella incidence in the 15- to 19-year age group was higher among African-Americans than among Caucasians. CONCLUSIONS: Varicella rates were similar in the 5- to 9- and 10- to 14-year age groups to rates from other published studies conducted in 1972 to 1978, 1980 to 1988 and 1990 to 1992; however, the rate in 15- to 19-year-olds was 2 to 4 times higher than published rates in the same age category. PMID: 11465834 [PubMed - indexed for MEDLINE] 1956. Anesthesiology. 2001 Jul;95(1):259-61. Drug-induced liver disease during continuous epidural block with bupivacaine. Yokoyama M, Ohashi I, Nakatsuka H, Mizobuchi S, Toda Y, Matsumi M, Morita K, Hirakawa M. Department of Anesthesiology and Resuscitology, Okayama University Medical School, Japan. masayoko@cc.okayama-u.ac.jp PMID: 11465567 [PubMed - indexed for MEDLINE] 1957. MMW Fortschr Med. 2001 May 31;143(22):50. [Controlling herpes zoster. End end to bullae] [Article in German] [No authors listed] PMID: 11460405 [PubMed - indexed for MEDLINE] 1958. Rev Clin Esp. 2001 May;201(5):281-2. [Ramsay-Hunt syndrome] [Article in Spanish] Plaza Mayor G, López Estebaranz JL, López Lafuente J, de los Santos Granados G. Unidad de Otorrinolaringología, Fundación Hospital Alcorcón, Madrid. PMID: 11458801 [PubMed - indexed for MEDLINE] 1959. FDA Consum. 2001 May-Jun;35(3):21-5. Shingles. Zamula E. PMID: 11458545 [PubMed - indexed for MEDLINE] 1960. J Gen Virol. 2001 Aug;82(Pt 8):1959-63. Multimeric humanized varicella-zoster virus antibody fragments to gH neutralize virus while monomeric fragments do not. Drew PD, Moss MT, Pasieka TJ, Grose C, Harris WJ, Porter AJ. University of Aberdeen, Department of Molecular and Cell Biology, Institute of Medical Sciences, Foresterhill, Aberdeen AB25 2ZD, UK. Murine monoclonal antibody 206 (MAb mu206) binds to gH, the varicella-zoster virus (VZV) fusogen, neutralizing the virus in vitro in the absence of complement and inhibiting cell-to-cell spread and egress of VZV in cultured cells. We have humanized this antibody to generate MAb hu206 by complementarity determining region grafting. MAb hu206 retained binding and in vitro neutralizing activity, as well as cross-reactivity with ten different VZV strains. Single-chain antibody fragments (scAb) derived from MAb hu206 were produced in Escherichia coli. These scAb retained the binding properties of the whole antibody. However, monomeric scAb exhibited markedly reduced neutralizing activity compared to the bivalent parental MAb hu206. Shortening the peptide linker joining the V(H) to the V(kappa) domain from 14 to 5 or even 0 residues encouraged multimerization and increased neutralizing efficacy. The fact that Fab fragments enzymatically generated from whole MAb hu206 lost their neutralizing potency lent support to the proposal that valency is important for VZV neutralization at this epitope. PMID: 11458003 [PubMed - indexed for MEDLINE] 1961. J Microbiol Immunol Infect. 2001 Jun;34(2):138-42. Comparative study of the efficacy and safety of valaciclovir versus acyclovir in the treatment of herpes zoster. Lin WR, Lin HH, Lee SS, Tsai HC, Huang CK, Wann SR, Chen YS, Chiang SC, Yen MY, Liu YC. Department of Medicine, Kaohsiung Veterans General Hospital, Taiwan, ROC. Acyclovir, a specific and selective inhibitor of the replication of Herpesviridae family, has well-documented efficacy and tolerability in the treatment of herpes zoster. Its limited oral bioavailability and short half-life, however, necessitates frequent dosing. Valaciclovir, the l-valyl ester of acyclovir, could be rapidly converted to acyclovir after oral administration, resulting in a three- to five-fold increase in acyclovir bioavailability compared with oral acyclovir in humans. Valaciclovir allows less frequent dosing and maintains the safety profiles of the parent drug. During the period from October 1996 through May 1998, a randomized, prospective study was performed in the Kaohsiung Veterans General Hospital to compare the safety and efficacy of valaciclovir with acyclovir in the treatment of herpes zoster in Taiwanese patients. Patients presenting with herpes zoster within 72 h after the onset of rash were enrolled and randomized to receive one of the following treatments: 1000 mg valaciclovir three times daily for 7 days or acyclovir 800 mg five times daily for 7 days. Patients were followed up for 29 days beginning with the start of therapy. A total of 57 patients were enrolled and randomized to receive valaciclovir (n = 32) or acyclovir (n = 25). Five patients in the valaciclovir group and three in the acyclovir group did not complete the study. The intent-to-treat analysis (57 patients) showed that valaciclovir significantly accelerated the resolution of herpes zoster-associated pain compared with acyclovir; on day 29, the valaciclovir group was 23% superior to the acyclovir group. There was no clinically significant difference in the nature, frequency or severity of adverse events between these two groups, although one and three adverse events were reported in the acyclovir and valaciclovir group, respectively. Thus, we conclude that in the management of herpes zoster, valaciclovir accelerates the resolution of pain and offers a simpler dosing, and maintains the favorable safety profile of acyclovir. PMID: 11456360 [PubMed - indexed for MEDLINE] 1962. Dermatology. 2001;202(4):336-8. Zosteriform metastatic skin cancer: report of three cases and review of the literature. Kikuchi Y, Matsuyama A, Nomura K. Department of Dermatology, Aomori Prefectural Central Hospital, Aomori, Japan. kiku1227@cc.hirosaki-ac.jp BACKGROUND: Metastatic skin cancer is a rare complication of internal malignancies. Patients who do develop skin metastases seldom present with a zosteriform distribution. OBJECTIVE: To elucidate the characteristics of zosteriform metastatic skin cancer, 15 cases from the medical literature and 3 cases seen in our clinic were reviewed clinically and histopathologically. METHODS: The age and sex of each patient, site of the primary tumor, pathology of primary and metastatic lesions, location of the skin cancer and presence of pain were determined for the 18 cases of zosteriform skin cancer. RESULTS: The most frequent site of the primary tumor was the breast (4 cases), ovary or lung (3 cases each), prostate, bladder or stomach (2 cases each) and uterus or colon (1 case each). The most common site of the skin metastases was the chest wall (8 cases) and abdominal wall (7 cases). The histology of the primary lesion was compatible with adenocarcinoma (10 cases), transitional cell carcinoma or serous papillary cystadenocarcinoma (2 cases each) and ductal carcinoma (1 case). Eleven cases developed on the nearest covering skin and/or on the same side as the primary tumor. Eleven patients complained of pain. Seven cases were treated as herpes zoster with antiviral agents. CONCLUSION: Approximately 50% of cases of metastatic skin cancer developed on the nearest skin covering and on the same side as the primary tumor. This evidence may be useful when trying to pinpoint the location of the primary tumor. One third of patients with skin metastases were misdiagnosed and their lesions were treated initially as herpes zoster. When a band-like eruption is seen in patients with internal malignancies, the possibility of metastatic skin lesions should be considered. A skin biopsy is necessary to confirm the diagnosis. Copyright 2001 S. Karger AG, Basel PMID: 11455149 [PubMed - indexed for MEDLINE] 1963. Dermatology. 2001;202(4):302-7. Acute herpes zoster neuralgia: retrospective analysis of clinical aspects and therapeutic responsiveness. Haas N, Holle E, Hermes B, Henz BM. Department of Dermatology and Allergy, Charité, Campus Virchow, Humboldt University, Berlin, Germany. norb.haas@charite.de BACKGROUND: Although the efficacy of modern antiviral agents for the treatment of herpes zoster is unquestioned, their ability to affect the associated pain remains controversial. OBJECTIVE: We have therefore evaluated the inpatient hospital records of 550 patients with herpes zoster with regard to pain-related clinical aspects and therapeutic responsiveness. METHODS: Intensity of pain was quantified by calculating a daily pain equivalence index (PEI) on the basis of different classes of pain medication and the number of tablets used in each category. RESULTS: The mean age of patients was 66.7 years, cranial segments were predominantly involved (55%), 64% of patients suffered from associated diseases and 77% experienced herpes-related pain. The PEI was 0.90 in the entire patient population, with significantly higher values in women and in patients with 3 or more associated diseases. It was lower in sacral and cranial nerve involvement, and it decreased rapidly in patients prior to discharge from hospital. Although there were significant differences in hospital stay between patients who received aciclovir and those who did not (mean 20.3 vs. 23.8 days), and for high- versus low-dose oral or intravenous administration, no significant differences were noted between the two groups for initial PEI values and during the course of observation, irrespective of the route of administration or the dose of aciclovir and the individual patient's PEI value. The groups were otherwise closely similar with regard to basic demographic and clinical data. 23.3% predominantly aged female patients with more associated diseases than the total patient population had a persistently elevated PEI and stayed in hospital beyond 21 days (mean 35.1 days), representing patients who went on to postherpetic neuralgia. CONCLUSION: These data further delineate clinical aspects of acute herpes zoster neuralgia, underline the unsolved therapeutic problems associated with this condition despite otherwise effective antiviral treatment, and characterise a subgroup of patients at risk to develop postherpetic neuralgia. Copyright 2001 S. Karger AG, Basel PMID: 11455141 [PubMed - indexed for MEDLINE] 1964. J Dermatol. 2001 Apr;28(4):208-16. The effects of famciclovir and epidural block in the treatment of herpes zoster. Ahn HJ, Lim HK, Lee YB, Hwang SM, Lee WS, Ahn SK, Choi EH. Department of Dermatology, Yonsei University Wonju College of Medicine, 162 Ilsan-Dong, Wonju, Kangwon-Do 220-701, Republic of Korea. In our previous study, we concluded that an epidural blockade combined with intravenous acyclovir is very effective in treating the acute pain in herpes zoster and postherpetic neuralgia. We evaluated the efficacy of oral famciclovir and epidural blockade on the pain of herpes zoster, compared to acyclovir administered intravenously and epidural blockade. For this purpose, we examined a new group treated with famciclovir and epidural blockade to compare with the group treated with acyclovir and epidural blockade in our previously study. The changes in the intensity of pain, the number of days required for relief of pain, and the total duration of pain were checked. We compared the days required for relief of pain (DRP) and the total duration of pain (TDP) of this group with those of the previous studied group treated with acyclovir and epidural blockade. DRP was significantly less, but TDP was similar. DRP and TDP were significantly lower, if the patients were treated within 7 days of symptom onset. The patients had a shorter DRP regardless of pain type than the previously studied group treated with acycolvir and epidural blockade. For the severe and moderate pain grades, there was a shorter DRP from 100 to 10. TDP was not significantly different for the groups regardless of pain type or grade. We believe that famciclovir and epidural blockade are very effective in treating the pain of herpes zoster, with a view to shortening the period of acute pain, providing similar effects on the prevention of postherpetic neuralgia, and being convenient to administer, compared to intravenous acyclovir and epidural blockade in our previous study. PMID: 11449672 [PubMed - indexed for MEDLINE] 1965. J Dermatol. 2001 Apr;28(4):200-7. A specific thrombin inhibitor, argatroban, alleviates herpes zoster-associated pain. Fujii K, Kanno Y, Konishi K, Ohgou N. Department of Dermatology, Kobe City General Hospital, Minatojima-Nakamachi, 4-6, Kobe 650-0046, Japan. We report the result of a randomized, controlled, open trial of anti-thrombin therapy for herpes zoster-associated pain. Fifty-five herpes zoster patients within 8 days after the onset of skin lesion were enrolled in the trial. Patients were treated with an optimal dose of oral acyclovir (4000 mg/day for 7 days) with or without intravenous administration of a specific anti-thrombin agent, argatroban (10 mg/day, three times a week). Administration of argatroban reduced pain intensity at the 4th through 21st day after the initiation of treatment as determined by visual analogue scale (Mann-Whitney U test, p < 0.05). It also shortened the median time to cessation of analgesic use (14 days vs. 24 days, p = 0.02, logrank test), although it did not significantly reduce the median time to cessation of pain (21 days vs. 43 days, p = 0.07, logrank test). None of the enrolled patients showed evidence of adverse effects including hemorrhagic diathesis. The results suggested that relatively low doses of argatroban are effective in reducing herpes zoster-associated pain. Up-regulation of prothrombin expression by the vascular endothelial and sweat gland epithelial cells in the active skin lesion and transient elevation of plasma thrombin-antithrombin III complex levels in a proportion of patients suggest a lesional generation of thrombin in herpes zoster. This may be relevant to the beneficial effects of the anti-thrombin treatment on the resolution of herpes zoster-associated pain. PMID: 11449671 [PubMed - indexed for MEDLINE] 1966. Ocul Immunol Inflamm. 2001 Jun;9(2):125-30. Central retinal vein occlusion due to herpes zoster as the initial presenting sign in a patient with acquired immunodeficiency syndrome (AIDS). Biswas J, Deka S, Padmaja S, Madhavan HN, Kumarasamy N, Solomon S. Medical and Vision Research Foundation, Chennai, India. mrf@sankaranethralaya.org Central retinal vein occlusion (CRVO) due to herpes zoster has rarely been reported. Varicella zoster virus is a common opportunistic infection in patients with AIDS. This case report is about a 40-year-old man with herpes zoster ophthalmicus and central retinal vein occlusion of the right eye who is HIV-positive. Although the lesion resolved following treatment with intravenous acyclovir and oral steroid, the patient subsequently developed florid disc neovascularization and vitreous hemorrhage. The paper highlights CRVO as the initial presentation in an AIDS patient with herpes zoster ophthalmicus. PMID: 11449328 [PubMed - indexed for MEDLINE] 1967. Intern Med. 2001 Jun;40(6):552. Guillain-Barré syndrome associated with herpes zoster. Wakasugi K, Imaizumi T, Nishimura Y, Fujimoto H, Ayabe M, Shoji H, Iijima H. First Department of Internal Medicine, Kurume University. PMID: 11446688 [PubMed - indexed for MEDLINE] 1968. Lancet. 2001 Jun 30;357(9274):2101-2. Molecular diagnosis of visceral herpes zoster. de Jong MD, Weel JF, van Oers MH, Boom R, Wertheim-van Dillen PM. Patients with disseminated herpes zoster may present with severe abdominal pain that results from visceral involvement of varicella-zoster-virus infection. In the absence of cutaneous eruptions of herpes zoster, visceral herpes zoster is extremely difficult to diagnose. This diagnostic difficulty has the potential to cause devastating delays in treatment. We report a case series of four patients with visceral herpes zoster in whom large concentrations of DNA from varicella zoster virus were detectable in blood by PCR before signs of infection appeared on the skin, thus enabling early diagnosis and treatment. PMID: 11445106 [PubMed - indexed for MEDLINE] 1969. Am J Trop Med Hyg. 2001 Mar-Apr;64(3-4):131-6. Effect of climatic factors and population density on varicella zoster virus epidemiology within a tropical country. Lolekha S, Tanthiphabha W, Sornchai P, Kosuwan P, Sutra S, Warachit B, Chup-Upprakarn S, Hutagalung Y, Weil J, Bock HL. Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. rasll@mahidol.ac.th Blood samples were collected from healthy subjects, aged 9 months-29 years in urban and rural communities from 4 distinct regions in Thailand, to determine the seroprevalence rate of varicella-zoster virus (VZV) antibody and its relationship with demographic, climatic, and socioeconomic factors. The overall seroprevalence rate was 52.8% and increased from 15.5% in the 9-month to 4-year-old group to 75.9% in the 20-29 year-olds. The age-adjusted seroprevalence was significantly higher in the cooler than in the warmer regions. In the warmer regions only, the age-specific seroprevalence was significantly higher in the urban population than in the rural population. In Thailand, climate is the main determinant of VZV seroprevalence. The delayed onset of natural immunity is more marked in warmer climate areas. Population density is a secondary determinant; in the warmer areas, the pattern of adolescent and adult susceptibility was greater in rural than in urban areas. PMID: 11442207 [PubMed - indexed for MEDLINE] 1970. Ned Tijdschr Tandheelkd. 2001 Jun;108(6):223-8. [Vesiculobullous lesions of the oral mucosa] [Article in Dutch] Spijkervet FK, Vissink A, Raghoebar GM, van der Waal I. Uit de kliniek voor Mondziekten, Kaakchirurgie en Bijzondere Tandheelkunde van het Academisch Ziekenhuis Groningen. In general practice, the dentist can be confronted with a vesiculobullous lesion of the oral mucosa. In many cases the lesion can be classified as recurrent herpes labialis, but many other causes can induce a vesiculobullous lesion of the oral mucosa and perioral skin as well. This article gives an overview of the various vesiculous and bullous lesions of the oral mucous membranes. Special attention is given to the possible causes and their treatment. PMID: 11441714 [PubMed - indexed for MEDLINE] 1971. Ir J Med Sci. 2001 Jan-Mar;170(1):69-70. Coma secondary to aciclovir neurotoxicity. Loughrey J, Coleman P, Donohue J, Marsh B. Department of Anaesthesia and Intensive Care Medicine, Master Misercordiae Hospital, Dublin, Ireland. jloughrey@eircom.net PMID: 11440418 [PubMed - indexed for MEDLINE] 1972. South Med J. 2001 Jun;94(6):655. Choreiform movements in dialysis patient taking valacyclovir and famciclovir. Maru MC, Fialkow RZ, Haria DM. PMID: 11440337 [PubMed - indexed for MEDLINE] 1973. Scand J Infect Dis. 2001;33(5):398-9. Varicella-zoster virus meningitis and cerebrospinal fluid HIV RNA. Moling O, Rossi P, Rimenti G, Vedovelli C, Mian P. Comment on: Scand J Infect Dis. 2000;32(3):263-9. PMID: 11440237 [PubMed - indexed for MEDLINE] 1974. Am J Ophthalmol. 2001 Jul;132(1):117-20. Progressive outer retinal necrosis syndrome in a lymphoma patient with good visual outcome. Foster RE, Petersen MR, Neuss MN, Osher RH. Cincinnati Eye Institute, Cincinnati, Ohio 45242, USA. refcei@cintieye.com PURPOSE: To report an HIV-negative lymphoma patient who developed progressive outer retinal necrosis syndrome and who had a good visual outcome after treatment with two-drug antiviral therapy and intravenous immunoglobulin. METHODS: Case report. RESULTS: A 43-year-old man with small lymphocytic lymphoma was diagnosed with progressive outer retinal necrosis in his left eye. Treatment was initiated with intravenous foscarnet and ganciclovir as well as intravenous gammaglobulin at a dose of 0.5 gm/kg per day for 5 days. On the second hospital day he was started on decadron 4 mg orally four times daily. No further posterior retinitis progression was observed despite severe immunosuppression. Visual acuity remained stable at 20/30 with 10 months' follow-up. CONCLUSIONS: The benefit of using gammaglobulin in progressive outer retinal necrosis is unknown. Given the rapid improvement seen in this patient's retinitis, it may be reasonable to consider the use of gammaglobulin in other cases of infectious retinitis in immunocompromised patients. PMID: 11438070 [PubMed - indexed for MEDLINE] 1975. Ann Rheum Dis. 2001 Jul;60(7):719. A case of shingles mimicking carpal tunnel syndrome. Wilson H, Hamilton J, Madhok R. PMCID: PMC1753747 PMID: 11436859 [PubMed - indexed for MEDLINE] 1976. J Dermatol. 2001 May;28(5):256-8. Palpable purpura at the site of previous herpes zoster in association with mixed cryoglobulinemia and hepatitis C virus infection. Cecchi R, Giomi A, Paoli S. Department of Dermatology, Spedali Riuniti, 51100, Pistoia, Italy. A 70-year-old woman affected with chronic active hepatitis C and mixed cryoglobulinemia presented a palpable purpura on her abdominal skin in a metameric configuration, fourteen months after a herpes zoster in the same site. Histopathology showed a small vessel leukocytoclastic vasculitis in the superficial dermis. Post-zoster eruptions are variable, and their spectrum is still expanding, although the pathogenesis remains to be elucidated. Perhaps our case represents an isomorphic reaction, because this palpable purpura, probably related to HCV infection, occurred several months after herpes zoster. PMID: 11436363 [PubMed - indexed for MEDLINE] 1977. Rinsho Shinkeigaku. 2001 Jan;41(1):56-9. [A case with trigeminal herpes zoster manifesting a long lesion of the spinal trigeminal nucleus and tract on MR T2-weighted image] [Article in Japanese] Nagane Y, Utsugisawa K, Yonezawa H, Tohgi H. Department of Neurology, Iwate Medical University Morioka, Japan. We reported a 53-year-old man with the right trigeminal herpes zoster with preceding neuralgia (preherpetic neuralgia) in the right upper cervical nerve area. He developed dysesthesia and scapular pain in the right second cervical nerve area. 5 days later, herpes zoster emerged in the area of the right maxillary division of trigeminal nerve. Furthermore, he developed paralysis on the right facial muscle on the 12th day after the onset of scapular pain. Neurological examination revealed decrease in superficial sensation accompanied by pain and dysesthesia in the areas innervated by the right maxillary division of trigeminal nerve and the right second cervical nerve, and the right peripheral facial nerve palsy. Any rash was not observed in the right second cervical nerve area throughout the course. The cerebrospinal fluid showed a mild mononuclear pleocytosis. The antibody titer for varicella zoster virus (VZV) was elevated in both cerebrospinal fluid and blood serum. T2-weighted magnetic resonance (MR) image revealed a continuously long high-signal lesion corresponding to the right spinal trigeminal nucleus and tract, extending from the lower pons to the second cervical segment of the spinal cord. This lesion could have resulted from a centripetal migration of VZV from the Gasser ganglion to the spinal trigeminal nucleus and tract, which was probably related to the preherpetic neuralgia in the upper cervical nerve area without rash. PMID: 11433769 [PubMed - indexed for MEDLINE] 1978. J Cataract Refract Surg. 2001 Jun;27(6):805-10. Consultation section. Cataract surgery problem. [No authors listed] PMID: 11432391 [PubMed - indexed for MEDLINE] 1979. Aust Fam Physician. 2001 May;30(5):417. Transmission of chickenpox from Varicella zoster vaccination is possible. To E. PMID: 11432009 [PubMed - indexed for MEDLINE] 1980. Hautarzt. 2001 Jun;52(6):554-73. [Therapy of varicella zoster and herpes simplex virus-induced diseases. 2: References for implementing and indications for virustatic therapy] [Article in German] Mahler V, Schuler G. Dermatologische Universitätsklinik, Erlangen. PMID: 11428090 [PubMed - indexed for MEDLINE] 1981. Clin Diagn Lab Immunol. 2001 Jul;8(4):850-1. Spinal cord involvement in uncomplicated herpes zoster. Steiner I, Steiner-Birmanns B, Levin N, Hershko K, Korn-Lubetzki I, Biran I. Department of Neurology, Hadassah University Hospital, Jerusalem, Israel. isteiner@md2.huji.ac.il We prospectively evaluated herpes zoster patients during the acute phase of the disease for central nervous system involvement. Of 24 patients with spinal zoster, 13 (54%) had spinal cord abnormality, which was asymptomatic in 12 of the 13. Age but not lack of acyclovir treatment was associated with such involvement. In all but 2, neurological involvement resolved within 6 months. Although the mechanism responsible for the neurological abnormalities is unknown, findings may support the hypothesis that zoster is associated with spread of viral infection into the spinal cord and therefore support the possibility that zoster is due to active viral replication in the ganglion. PMCID: PMC96158 PMID: 11427442 [PubMed - indexed for MEDLINE] 1982. Masui. 2001 May;50(5):548-51. [Treatment with stellate ganglion block, continuous epidural block and ulnar nerve block of a patient with postherpetic neuralgia who developed complex regional pain syndrome (CRPS)] [Article in Japanese] Mizuno J, Sugimoto S, Ikeda M, Kamakura T, Machida K, Kusume S. Department of Anesthesia, Kochi Prefectural Aki Hospital, Aki 784-0027. We present a case of a 46-year-old female patient with systemic lupus erythematosus who developed herpes zoster of the right eighth cervical nerve. Her whole right forearm, hand and the first through fifth fingers were coated with some gel and protected against pain. She had been suffering from continuous and spasmodic burning pain, hyperalgesia, allodynia, drop in skin temperature, sudmotor disturbance, edema, constructure of the joints, muscle atrophy and bone atrophy of her right upper extremity probably due to postherpetic neuralgia (PHN) associated with complex regional pain syndrome (CRPS). She received right stellate ganglion block (SGB), continuous cervical epidural block and right ulnar nerve block. Reduction of pain and edema as well as improvement in mobility of each joint of her right upper extremity was observed. We suspect that SGB, continuous cervical epidural block and ulnar nerve block are effective and useful alternative treatments in a patient with PHN associated with CRPS of the eighth cervical nerve. PMID: 11424478 [PubMed - indexed for MEDLINE] 1983. Pediatr Transplant. 2001 Jun;5(3):153-9. Varicella-zoster infection in pediatric solid-organ transplant recipients: a hospital-based study in the prevaricella vaccine era. Pandya A, Wasfy S, Hébert D, Allen UD. The Department of Pediatrics, Divisions of Infectious Diseases,The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada. We reviewed 58 cases of varicella-zoster infection that occurred between 1988 and 1998 in 47 pediatric solid-organ transplant recipients. The median age of patients at the time of admission with varicella-zoster infection was 8.0 yr (range 1-17 yr). The median interval between transplantation (Tx) and varicella-zoster virus (VZV) infection was 1.6 yr (range 0.06-9.3 yr). Varicella infection occurred at a rate of one case for every seven transplant recipients. Among the 58 cases of VZV infection, 53% were varicella while 47% were herpes-zoster. Varicella infection occurred despite treatment with varicella-zoster immune globulin (VZIG) in 17 of 31 cases of varicella infection. However, the disease was generally mild with severe disease occurring in only two patients. One patient (1.7%) died as a result of bacterial sepsis. There was no significant relationship between VZV infection and specific immune suppressants. Episodes of rejection were more likely to be temporally associated with the occurence of herpes zoster than with varicella infection (p = 0.02). The data generated provide useful background information in our population in the prevaricella vaccine era. PMID: 11422816 [PubMed - indexed for MEDLINE] 1984. Int J Dermatol. 2001 Mar;40(3):191-2. Two cases of reactive perforating collagenosis arising at the site of healed herpes zoster. Lee HN, Lee DW, Lee JY, Cho BK. Department of Dermatology, College of Medicine, The Catholic University of Korea, Seoul, South Korea. PMID: 11422523 [PubMed - indexed for MEDLINE] 1985. Am J Med Sci. 2001 Jun;321(6):372-80. Zoster in patients infected with HIV: a review. Vafai A, Berger M. Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. abv4@cdc.gov Varicella-zoster virus (VZV), a member of the human herpesvirus family, causes childhood chickenpox (varicella), becomes latent in sensory ganglia, and reactivates years later in immunocompromised and elderly persons to produce shingles (herpes zoster). Early in the AIDS epidemic, zoster was noted in adults and children infected with HIV. Severe and debilitating zoster-associated dermatological, ophthalmic, and neurological complications may occur in patients infected with HIV. Antiviral therapy can modify the duration of zoster and alleviate its attendant complications. Varicella vaccine may boost the immunity and prevent virus reactivation. VZV immune globulin (VZIG) prevents or modifies clinical illness in persons who have been exposed to varicella or zoster. PMID: 11417752 [PubMed - indexed for MEDLINE] 1986. Virology. 2001 Jun 20;285(1):42-9. VZV gB endocytosis and Golgi localization are mediated by YXXphi motifs in its cytoplasmic domain. Heineman TC, Hall SL. Division of Infectious Diseases and Immunology, St. Louis University School of Medicine, St. Louis, Missouri 63110-0250, USA. heinemtc@slu.edu The cytoplasmic domains of many membrane proteins contain sorting signals that mediate their endocytosis from the plasma membrane. VZV gB contains three consensus internalization motifs within its cytoplasmic domain: YMTL (aa 818-821), YSRV (aa 857-860), and LL (aa 841-842). To determine whether VZV gB is internalized from the plasma membrane, and whether these motifs are required for its endocytosis, we compared the internalization of native gB to that of gB containing mutations in each of the predicted internalization motifs. VZV gB present on the surface of transfected cells associated with clathrin and was efficiently internalized to the Golgi apparatus within 60 min at 37 degrees C. VZV gB containing the mutation Y857 failed to be internalized, while gB-Y818A was internalized but did not accumulate in the Golgi. These data indicate that the internalization of VZV gB, and its subsequent localization to the Golgi, is mediated by two tyrosine-based sequence motifs in its cytoplasmic domain. Copyright 2001 Academic Press. PMID: 11414804 [PubMed - indexed for MEDLINE] 1987. Acta Derm Venereol. 2001 Jan-Feb;81(1):59-60. Famciclovir in treatment of acute herpes zoster: results of two post-marketing surveillance studies in Germany. Engst R, Schiewe U, Höbel W, Machka K, Meister W. PMID: 11411921 [PubMed - indexed for MEDLINE] 1988. Pain. 2001 Jul;93(1):1-5. Zoster-associated pain and neural dysfunction. Rowbotham MC, Petersen KL. Department of Neurology, University of California, UCSF Pain Clinical Research Center, 1701 Divisadero Street, Suite 480, San Francisco, CA 94115, USA. mcrwind@ista.ucsf.edu PMID: 11406332 [PubMed - indexed for MEDLINE] 1989. Arch Dermatol. 2001 Jun;137(6):789-90. A population-based estimate of the prevalence of postherpetic neuralgia after herpes zoster. Bigby M. Department of Dermatology, Harvard Medical School and Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215, USA. PMID: 11405773 [PubMed - indexed for MEDLINE] 1990. Hautarzt. 2001 May;52(5):464-71; quiz 471. [Therapy of varicella zoster and herpes simplex virus-induced diseases. 1: Virustatic agents] [Article in German] Mahler V, Schuler G. Dermatologische Universitätsklinik, Hartmannstrasse 14, 91052 Erlangen. Vera.Mahler@derma.med.uni-erlangen.de PMID: 11405170 [PubMed - indexed for MEDLINE] 1991. MMW Fortschr Med. 2001 May 17;143(20):14. [Post-zoster neuralgia. Local acetylsalicylic acid stops pain for 5 hours] [Article in German] Koch HJ, Raschka C. Psychiatrische Universitatsklinik RegensburgUniversitatsstrabetae 84 D-93053 Regensburg. PMID: 11400601 [PubMed - indexed for MEDLINE] 1992. J Emerg Med. 2001 Jul;21(1):67-8. Scalp necrosis and visual loss due to giant cell arteritis. Bhatti MT. Department of Ophthalmology, University of Florida College of Medicine, Gainesville, FL 32610-0284, USA. PMID: 11399393 [PubMed - indexed for MEDLINE] 1993. Ann Dermatol Venereol. 2001 Apr;128(4):497-501. [Herpes zoster: incidence study among "sentinel" general practitioners] [Article in French] Czernichow S, Dupuy A, Flahault A, Chosidow O. Unité d Biostatisique et Informatique Médicale, Hôpital Tenon, Paris, France. INTRODUCTION: Herpes zoster is a frequent disease but its incidence in France is unknown. METHODS: We conducted a postal survey among the general practitioners of the "Sentinel" network. The incidence of acute herpes zoster was extrapolated from the number of cases diagnosed during the year 1998, by the general practitioners who answered the questionnaire. The general practitioners were also surveyed on their prescriptions and attitude. RESULTS: Among the 1,368 "Sentinel" general practitioners, 744 (54.4 p. 100) participated in the survey. The incidence in 1998 was 3.2 cases for 1,000 inhabitants (95 p. 100 confidence interval: 3.0 - 3.4). For acute herpes zoster, 73 p. 100 of the patients have been given an oral antiviral drug, and 63 p. 100 an antalgic. Among the 605 reported herpes zoster cases, 111 (18.4 p. 100) subsequently had chronic pain. DISCUSSION: The estimated incidence is comparable to the incidence from others developed countries. To be interpreted, this estimation has to be discussed according to the sample of population that was studied and the representativity of the "Sentinelles" general practitioners who participated the survey. PMID: 11395646 [PubMed - indexed for MEDLINE] 1994. Microbios. 2001;105(411):111-8. Detection of herpes simplex and varicella zoster viruses in clinical specimens using direct immunofluorescence and cell culture assays. Meqdam MM, Todd D, Al-Abosi M. Department of Applied Biology, Jordan University of Science and Technology, Irbid. Patients (33 in toto) with a clinical diagnosis of herpes infections (simplex, zoster or chickenpox) were investigated for the presence of herpes simplex virus (HSV) and varicella zoster virus (VZV) in skin samples, using direct immunofluorescence and cell culture assays. Five patients with nonherpetic vesiculobullous disorders were included as negative controls. Of the 33 patients, nineteen (57.6%) were positive for HSV or VZV and fourteen (42.4%) were negative. Five controls were all negative for HSV or VZV. Of the nineteen positive patients, HSV was isolated from eight (42.1%) patients, by both direct immunofluorescence and cell culture assays. VZV was isolated from eleven (57.9%) patients, eleven (100%) by direct immunofluorescence assay, and six (54.5%) by cell culture assays. HSV was isolated from one patient clinically diagnosed as chickenpox (VZV), but otherwise the positive laboratory results were concordant with the clinical diagnosis. For epidemiological studies, atypical cases and immunocompromised patients the clinical diagnosis should be confirmed in the laboratory. PMID: 11393748 [PubMed - indexed for MEDLINE] 1995. No To Hattatsu. 2001 May;33(3):270-5. [Interleukin-6 in the cerebrospinal fluid of two patients with herpes zoster meningitis] [Article in Japanese] Ohfu M, Masuzaki M, Inoue S, Inoue T, Yasumoto S, Ogawa A, Tomoda Y, Tsuru N, Mitsudome A. Department of Pediatrics, Chikushi Hospital, Fukuoka University, Chikushi, Fukuoka. Interleukin-6 (IL-6) levels in the cerebrospinal fluid (CSF) and serum were measured in two immuno-competent children with herpes zoster meningitis, who had vesicles, fever, headache and vomiting before admission. The causative agent was identified as varicella zoster virus (VZV) by detecting an increased antibody index in the serum and specific DNA (by polymerase chain reaction) in the CSF. Both patients fully recovered after treatment with acyclovir. The CSF IL-6 levels were high (260.1 pg/ml, 106.1 pg/ml) at the acute stage and thereafter showed a rapid recovery. The serum IL-6 levels were normal. The increased IL-6 level in the CSF may reflect intrathecal inflammatory response following invasion of VZV into the central nervous system. PMID: 11391972 [PubMed - indexed for MEDLINE] 1996. Am J Dermatopathol. 2001 Jun;23(3):216-20. Zosteriform and epidermotropic metastatic primary cutaneous squamous cell carcinoma. Kato N, Aoyagi S, Sugawara H, Mayuzumi M. Department of Dermatology and Clinical Research Institute, National Sapporo Hospital, Kikusui 4-2, Shiroishi-ku, 003-0804 Sapporo, Japan. kato@sap-cc.go.jp The first case of primary cutaneous squamous cell carcinoma (SCC) to cause zosteriform and epidermotropic metastasis to skin is reported. The patient is a 72-year-old Japanese woman. A cutaneous SCC appeared on the lateral side of her right knee and was removed. After dissection of the right inguinal lymph nodes, which revealed metastases, and irradiation of the right inguinal region, the patient presented with slightly pruritic and painful erythematous papules on the right hip and small brownish papules and vesicles with crusts on the anterior side of the right thigh. The eruptions were in a zosteriform distribution along the right L1 to L3 dermatomes. Histologically neoplastic squamous cell nests were observed in the epidermis, below the epidermal-dermal junction, and within lymphatic vessels in the deeper reticular dermis. We postulate that neoplastic cells with the ability to fuse with adjacent squamous epithelium may have been carried beneath the basal lamina or to the epidermis via dermal lymphatic backflow, resulting in epidermotropic metastasis. PMID: 11391102 [PubMed - indexed for MEDLINE] 1997. Clin Infect Dis. 2001 Jul 1;33(1):62-9. Epub 2001 Jun 5. Characteristics of patients with herpes zoster on presentation to practitioners in France. Chidiac C, Bruxelle J, Daures JP, Hoang-Xuan T, Morel P, Leplège A, El Hasnaoui A, de Labareyre C. Department of Infectious and Tropical Diseases-AIDS Reference Center, University Claude Bernard, Lyon, France. christian.chidiac@chu-lyon.fr There have been many epidemiological studies of chickenpox but only a few of herpes zoster. We report data from an observational study, conducted in France during a 1-year period, of 9038 patients who presented with acute herpes zoster (n = 8103) or postherpetic neuralgia (PHN; n = 935) at the office practices of 4635 general practitioners or dermatologists. The incidence of herpes zoster in France was found to be similar to that in the literature: from 1.4 to 4.8 cases per 1000 population per year. The patient profiles and clinical patterns were delineated, as well as the management decisions made according to the type of treating physician. The impact of herpes zoster on quality of life was evaluated on the basis of the Medical Outcome Study Short Form 36 (MOS SF 36) scale, which is widely used for assessing quality of life in the field of health. This study provides reference data on the substantial deterioration in quality of life associated with herpes zoster and PHN. PMID: 11389496 [PubMed - indexed for MEDLINE] 1998. Curr Opin Ophthalmol. 2001 Jun;12(3):191-5. Viral causes of the acute retinal necrosis syndrome. Walters G, James TE. Eye Department, St James's University Hospital, Leeds, UK. Acute retinal necrosis has been described as a clinical entity for nearly 30 years. Acute retinal necrosis is a potentially visually devastating necrotizing vaso-occlusive retinitis affecting both healthy and immunocompromised patients. Acute retinal necrosis is caused by the herpes group of viruses, mainly varicella zoster, herpes simplex types 1 and 2, and, rarely, cytomegalovirus. Recently, polymerase chain reaction techniques have enabled detection of very small amounts of viral DNA from intra-ocular fluid samples. This can help in both the diagnosis of atypical cases of retinitis and uveitis and directing treatment in cases of acute retinal necrosis. PMID: 11389345 [PubMed - indexed for MEDLINE] 1999. J Pediatr Ophthalmol Strabismus. 2001 May-Jun;38(3):174-6. Herpes zoster ophthalmicus. Ang LP, Au Eong KG, Ong SG. Singapore National Eye Centre, Singapore. PMID: 11386651 [PubMed - indexed for MEDLINE] 2000. Arch Virol Suppl. 2001;(17):1-178. Immunity and Prevention of Herpes Zoster. Proceedings of an international conference. Osaka, Japan, March 8-10, 1999. [No authors listed] PMID: 11386248 [PubMed - indexed for MEDLINE] 2001. Ned Tijdschr Tandheelkd. 2001 Feb;108(2):71. [Shooting pains in the temporal region due to infection with herpes zoster] [Article in Dutch] Kaptein ML, Langeveld-Wildschut EG. Afdeling Dermatologie van het Ziekenhuis Hilversum. PMID: 11383284 [PubMed - indexed for MEDLINE] 2002. Am J Med. 2001 Jun 1;110(8):662-3. Human immunodeficiency virus-associated immune reconstitution disease. Jacobson MA. Comment on: Am J Med. 2001 Jun 1;110(8):605-9. PMID: 11382378 [PubMed - indexed for MEDLINE] 2003. Am J Med. 2001 Jun 1;110(8):605-9. Herpes zoster as an immune reconstitution disease after initiation of combination antiretroviral therapy in patients with human immunodeficiency virus type-1 infection. Domingo P, Torres OH, Ris J, Vazquez G. Department of Internal Medicine, Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain. Comment in: Am J Med. 2001 Jun 1;110(8):662-3. BACKGROUND: Initiation of combination antiretroviral therapy may be followed by inflammatory reactions. We studied the epidemiology of herpes zoster infection among patients with human immunodeficiency virus (HIV) infection who were treated with combination antiretroviral therapy. SUBJECTS AND METHODS: Of 316 patients who initiated combination antiretroviral therapy, 24 (8%) were treated for herpes zoster within 17 weeks of starting therapy. The characteristics of these cases were compared with those of a control group of 96 HIV-1-infected patients, who were matched by age, sex, plasma HIV-1 RNA concentration and CD4 cell counts, and length of follow-up. RESULTS: The incidence of herpes zoster associated with combination antiretroviral therapy was 9 episodes per 100 patient-years. There were no significant differences between cases and controls in age, sex, years of HIV infection, history of herpes zoster, previous acquired immune deficiency syndrome, or baseline mean CD4 and CD8 cell counts before beginning combination antiretroviral therapy. However, patients who developed herpes zoster had a significantly greater mean (+/- SD) increase in the number of CD8 cells than did controls (347 +/- 269 vs. 54 +/- 331 cells/mL, P = 0.0006). In a multivariate analysis, the only factor that was associated with the development of herpes zoster was the increase in CD8 cells from before initiation of combination antiretroviral therapy to 1 month before development of herpes zoster (odds ratio 1.3 per percentage increase; 95% confidence interval: 1.1 to 1.5; P = 0.0002). CONCLUSION: The initiation of combination antiretroviral therapy in HIV-1-infected patients was often associated with the development of herpes zoster, especially in those in whom the number of CD8 cells increased after therapy. PMID: 11382367 [PubMed - indexed for MEDLINE] 2004. Hautarzt. 2001 Apr;52(4):359-76. [Infections with varicella zoster virus] [Article in German] Kempf W, Lautenschlager S. Dermatologische Klinik, Universitätsspital Zürich, Gloriastrasse 31, 8091 Zürich, Schweiz. wkempf@hotmail.com/kempf@derm.unizh.ch PMID: 11382132 [PubMed - indexed for MEDLINE] 2005. Hautarzt. 2001 Apr;52(4):335-8. [Bilateral asymmetric herpes zoster in adolescence] [Article in German] Bloss G, Ebisch MA, Kunz M, Gross G. Klinik und Poliklinik für Dermatologie und Venerologie der Universität Rostock, Augustenstrasse 80, 18055 Rostock. Zoster is a frequent disease of adulthood with a distinct age-dependent increase after 60. In contrast during childhood or adolescence zoster only rarely occurs. Certain risk factors such as hematologic malignancies are associated with early appearance. The typical clinical manifestation is unilateral, equally involving thoracic dermatomes. A 16-year-old patient presented with zoster in bilateral asymmetrical distribution, with trigeminal and thoracic dermatomes simultaneously affected. Despite the clinical findings and the unusual localization, there was no history, clinical nor laboratory signs of an immune suppression or any other underlying disease. Careful follow-up examinations are necessary in order to recognize systemic, especially hematologic, malignancies. PMID: 11382126 [PubMed - indexed for MEDLINE] 2006. Gastrointest Endosc. 2001 Jun;53(7):809-10. Varicella zoster gastritis 3 years after bone marrow transplantation for treatment of acute leukemia. Rivera-Vaquerizo PA, Gómez-Garrido J, Vicente-Gutiérrez M, Blasco-Colmenarejo M, Mayor-López J, Pérez-Flores R. Department of Gastroenterology, Albacete General Hospital, Albacete, Spain. PMID: 11375599 [PubMed - indexed for MEDLINE] 2007. Am J Gastroenterol. 2001 May;96(5):1627-30. Demonstration of varicella-zoster virus infection in the muscularis propria and myenteric plexi of the colon in an HIV-positive patient with herpes zoster and small bowel pseudo-obstruction (Ogilvie's syndrome). Pui JC, Furth EE, Minda J, Montone KT. Department of Pathology, Hospital of the University of Pennsylvania, Philadelphia, 19104, USA. Gastrointestinal symptomatology as a complication of herpes zoster (HZ) is extremely rare, with the majority of reported cases showing only temporal or radiological evidence of GI tract involvement by varicella zoster virus (VZV) infection. We present the first case of documented direct VZV infection in the muscularis propria of the gut presenting as intestinal pseudo-obstruction (Ogilvie's syndrome). The patient was a 34-yr-old HIV+ man who developed small bowel pseudo-obstruction in association with disseminated cutaneous HZ. A partial ileocolectomy specimen demonstrated a focal ulcer in the terminal ileum. Immunohistochemistry against VZV gpI demonstrated diffuse staining of the muscularis propria and myenteric plexi throughout the length of the specimen. Viral particles consistent with Herpesviridae were shown to be present ultrastructurally. We postulate that the viral infection in the neuronal plexi and muscularis propria caused muscle injury leading to pseudo-obstruction. PMID: 11374712 [PubMed - indexed for MEDLINE] 2008. Arch Pathol Lab Med. 2001 Jun;125(6):770-80. Varicella-Zoster virus infections of the nervous system: clinical and pathologic correlates. Kleinschmidt-DeMasters BK, Gilden DH. Department of Pathology, The University of Colorado Health Sciences Center, Denver, CO 80262, USA. BK.DeMasters@UCHSC.edu BACKGROUND: Diseases that present with protean manifestations are the diseases most likely to pose diagnostic challenges for both clinicians and pathologists. Among the most diverse disorders caused by a single known toxic, metabolic, neoplastic, or infectious agent are the central and peripheral nervous system complications of varicella-zoster virus (VZV). METHODS: The pathologic correlates of the neurologic complications of VZV infection, as well as current methods for detecting viral infections, are discussed and presented in pictorial format for the practicing pathologist. RESULTS: Varicella-zoster virus causes chickenpox (varicella), usually in childhood; most children manifest only mild neurologic sequelae. After chickenpox resolves, the virus becomes latent in neurons of cranial and spinal ganglia of nearly all individuals. In elderly and immunocompromised individuals, the virus may reactivate to produce shingles (zoster). After zoster resolves, many elderly patients experience postherpetic neuralgia. Uncommonly, VZV can spread to large cerebral arteries to cause a spectrum of large-vessel vascular damage, ranging from vasculopathy to vasculitis, with stroke. In immunocompromised individuals, especially those with cancer or acquired immunodeficiency syndrome, deeper tissue penetration of the virus may occur (as compared with immunocompetent individuals), with resultant myelitis, small-vessel vasculopathy, ventriculitis, and meningoencephalitis. Detection of the virus in neurons, oligodendrocytes, meningeal cells, ependymal cells, or the blood vessel wall often requires a combination of morphologic, immunohistochemical, in situ hybridization, and polymerase chain reaction (PCR) methods. The PCR analysis of cerebrospinal fluid remains the mainstay for diagnosing the neurologic complications of VZV during life. CONCLUSIONS: Varicella-zoster virus infects a wide variety of cell types in the central and peripheral nervous system, explaining the diversity of clinical disorders associated with the virus. PMID: 11371229 [PubMed - indexed for MEDLINE] 2009. Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 1998 Aug;20(4):264-6. [Clinical trial of recombinant alpha-2a interferon in the treatment of herpes zoster] [Article in Chinese] Liu Y, Wang J, Li S. PUMC Hospital, CAMS and PUMC, Beijing 100730. OBJECTIVE: A clinical trial on 74 patients with herpes zoster was conducted to observe the efficacy and side effects of recombinant alpha-2a interferon. METHODS: All patients were divided into two groups, including forty-four patients in interferon-treated group and 30 patients in controlled group. The interferon-treated group was treated with i.m. recombinant alpha-2a-interferon in a daily dose of one million unit for 6 days. The controlled group was treated with vitamin B12 and vitamin B1 in conventional dose for 6 days. RESULTS: The duration of scarring, pain relieving, cure and course of disease in interferon-treated group was significantly shorter than that in controlled group (P < 0.01). There was no postherpetic neuralgia in interferon-treated group and there were postherpetic neuralgia in 9 cases of controlled group (P > 0.05). Side effects were mild in interferon-treated group. CONCLUSIONS: It seems that recombinant alpha-2a-interferon may be recommended as a good medicine for herpes zoster. PMID: 11367689 [PubMed - indexed for MEDLINE] 2010. BETA. 1999;12(4):71-4. Open clinical trials for HIV/AIDS treatments. Townley D. Community Consortium of the UCSF AIDS Program, San Francisco General Hospital, CA. AIDS: Open clinical trials for HIV/AIDS treatments are described. All listings are taken from the Trials Search database, the American Foundation for AIDS Research web site, and the AIDS Clinical Trials Information Service site. Internet addresses and telephone numbers are included. The criteria and study design for each trial is described, and telephone numbers for further information on enrolling in each trial is included. PMID: 11367265 [PubMed - indexed for MEDLINE] 2011. BETA. 1998 Oct:5. FDA approves fomivirsen, famciclovir, and Thalidomide. Food and Drug Administration. Highleyman L. AIDS: The FDA has recently approved three new drugs. Fomivirsen (Vitravene), developed by Isis Pharmaceuticals, was approved as a treatment for cytomegalovirus (CMV) retinitis. The drug prevents CMV replication by binding with the virus' genetic material. It is the first drug using antisense technology to win approval and is injected into the eye weekly or every other week. Famciclovir (Famvir) was approved for the treatment of HIV-related herpes simplex virus (HSV) infection. It is the first oral anti-HSV drug to be approved for use in people with HIV-related herpes. Thalidomide (Synovir), developed by Celgene, has received limited approval for the treatment of leprosy. It has also been used successfully in trials involving AIDS-related wasting and recurrent aphthous ulcers, although it has not been approved for these conditions. PMID: 11365993 [PubMed - indexed for MEDLINE] 2012. AIDS Patient Care STDS. 1998 Jan;12(1):61-2. HIV/AIDS case histories: diagnostic problems. Varicella-zoster encephalitis. Edgar M, Heier L. Department of Pathology, Cornell University Medical College, USA. PMID: 11361888 [PubMed - indexed for MEDLINE] 2013. J Tradit Chin Med. 2001 Mar;21(1):78-80. Acupuncture treatment of herpes zoster. Hu J. Institute of Acupuncture and Moxibustion, China Academy of Traditional Chinese Medicine, Beijing 100700. PMID: 11360548 [PubMed - indexed for MEDLINE] 2014. J Tradit Chin Med. 2001 Mar;21(1):34-6. Clinical observation on therapeutic effect of Ji De Sheng She Yao tablet on 16 cases with AIDS complicated by herpes zoster. Huang Y, Zhang L, Liu G, Huang W, Jia X, Naomi M. Xiyuan Hospital, China Academy of Traditional Chinese Medicine, Xiyuan, Haidian District, Beijing 100091. PMID: 11360536 [PubMed - indexed for MEDLINE] 2015. Aust Endod J. 2000 Apr;26(1):19-26. Neuropathic orofacial pain part 1--prevalence and pathophysiology. Vickers ER, Cousins MJ. Department of Anaesthesia and Pain Management, University of Sydney, Royal North Shore Hospital. rvickers@med.usyd.edu.au Neuropathic pain is defined as "pain initiated or caused by a primary lesion or dysfunction in the nervous system". Neuropathic orofacial pain has previously been known as "atypical odontalgia" (AO) and "phantom tooth pain". The patient afflicted with neuropathic oral/orofacial pain may present to the dentist with a persistent, severe pain, yet there are no clearly identifiable clinical or radiographic abnormalities. Accordingly, multiple endodontic procedures may be instigated to remove the likely anatomical source of the pain, yet the pain persists. There have been few studies and limited patient numbers investigating the condition. Two retrospective studies revealed the incidence of persistent pain following endodontic treatment to be 3-6% and 5% of patients; one author with wide experience in assessing the condition estimated its prevalence at 125,000 individuals in the USA alone. In one study, 50% of neuropathic orofacial pain patients reported persistent pain specifically following endodontic treatment. Patients predisposed to the condition may include those suffering from recurrent cluster or migraine headaches. Neuropathic pain states include postherpetic neuralgia (shingles) and phantom limb/stump pain. The aberrant developmental neurobiology leading to this pain state is complex. Neuropathic pain serves no protective function, in contrast to physiological pain that warns of noxious stimuli likely to result in tissue damage. The relevant clinical features of neuropathic pain include: (i) precipitating factors such as trauma or disease (infection), and often a delay in onset after initial injury (days-months), (ii) typical complaints such as dysaesthesias (abnormal unpleasant sensations), pain that may include burning, and paroxysmal, lancinating or sharp qualities, and pain in an area of sensory deficit, (iii) on physical examination there may be hyperalgesia, allodynia and sympathetic hyperfunction, and (iv) the pathophysiology includes deafferentation, nerve sprouting, neuroma formation and sympathetic efferent activity. PMID: 11359293 [PubMed - indexed for MEDLINE] 2016. Am J Nephrol. 2001 Mar-Apr;21(2):162-4. Neurotoxicity of valacyclovir in peritoneal dialysis: a pharmacokinetic study. Izzedine H, Mercadal L, Aymard G, Launay-Vacher V, Martinez V, Issad B, Deray G. Department of Nephrology, Pitié-Salpêtrière Hospital, Paris, France. hassan.izzedine@psl.ap-hop-paris.fr Valacyclovir is an effective oral agent for the treatment of herpes virus infection, however, the pharmacokinetics of the drug are altered in renal failure. It is increasingly recognized that dose adjustment of oral valacyclovir in renal failure is necessary to avoid neurotoxicity. We studied this drug in a continuous ambulatory peritoneal dialysis (CAPD) and immunocompromised patient. She developed neurotoxicity with an adjustment dosage of valacyclovir for a cutaneous zoster infection. The elimination half-time (15 h) was similar to that reported for end-stage renal disease patients, while the steady-state volume of distribution (85 l) and the area under the curve concentration (127 mg/l.h) were greater. The mean CAPD dialysance was only 5.27 ml/min with less than 1% of an administered dose being recovered in the 24-hour dialysate. 48 h after interrupting treatment, she recovered normal neurological status and 500 mg of valacyclovir every 2 days was effective and well tolerated. Copyright 2001 S. Karger AG, Basel PMID: 11359026 [PubMed - indexed for MEDLINE] 2017. Mayo Clin Health Lett. 2001 May;19(5):4. Steroid shots may help pain after shingles. [No authors listed] PMID: 11349633 [PubMed - indexed for MEDLINE] 2018. Leuk Lymphoma. 2000 Oct;39(3-4):421-6. Varicella zoster meningitis preceeded by thrombophlebitis in a patient with Hodgkin's disease. Saif MW, Hamilton JM, Allegra CJ. Medicine Branch, National Cancer Institute, National Naval Medical Center, Bethesda, MD 20889, USA. saifw@mail.nih.gov Varicella zoster (V-Z) infections are common among patients with hematological malignancies, particularly Hodgkin's disease (HD). The common denominator in both HD and V-Z infections is immunosuppression. Most of V-Z infections occur in patients with HD during the remission period, who have mixed cellularity sub-type, with stage III disease and who have received combined chemo-radiation therapy. Involvement of the central nervous system usually manifests as post-herpetic neuralgia or encephalitis. Angiitis has also been found in association with V-Z infections. The authors describe a case of HD who developed V-Z meningitis preceeded by superficial thrombophlebitis of upper extremities during the period of active chemotherapy. PMID: 11342324 [PubMed - indexed for MEDLINE] 2019. Arch Virol Suppl. 2001;(17):49-56. Comparison of DNA sequence and transactivation activity of open reading frame 62 of Oka varicella vaccine and its parental viruses. Gomi Y, Imagawa T, Takahashi M, Yamanishi K. Kanonji Institute, The Research Foundation for Microbial Diseases of Osaka University, Kagawa, Japan. When nucleotide sequences of Oka vaccine and its parental viruses of varicella-zoster virus (VZV) were compared in 5 open reading frames (ORFs) including glycoprotein C (gC) and 4 immediate-early genes, mutations were detected only in gene 62 which is one of the immediate-early genes. Compared with its parental virus, the vaccine virus contained 15 nucleotide substitutions. With the differentiation method using the simplified restriction-enzyme fragment length polymorphism analysis by Nae I and Bss HII, which was established based on the sequence analysis data in this study, the Oka vaccine virus could be distinguished from its parental virus. Studies of the regulatory activities of the ORF62 gene product (IE62) in a transient assay indicate the IE62 of the parental virus had a stronger transactivational activity than that of the vaccine virus against immediate-early, early and late gene promoters. These data suggest that gene 62 might have an important role for attenuation of VZV. This is the first report in which many substitutions of nucleotides in gene 62 of Oka vaccine virus was found, compared with that of Oka parental virus. PMID: 11339550 [PubMed - indexed for MEDLINE] 2020. Arch Virol Suppl. 2001;(17):41-8. Biologic and geographic differences between vaccine and clinical varicella-zoster virus isolates. Larussa PS, Gershon AA. Division of Pediatric Infectious Diseases, College of Physsicians & Surgeons, Columbia University. New York, New York 10032, USA. Vaccine and wild-type strains of varicella-zoster virus differ both in their biologic characteristics and in the clinical manifestations of infection caused by each strain. The biologic differences described for the vaccine strain (temperature sensitivity and host cell preference) probably reflect the methods used to adapt the wild-type strain to the in vitro growth conditions imposed during the attenuation process in cell culture. In addition, restriction fragment polymorphisms have been described that reflect geographic strain variations between the parental virus used to develop the vaccine strain and other wild-type strains. These polymorphisms have been exploited as tools for the identification and differentiation of vaccine and wild-type strains in clinical studies. Infection with the wild-type strain results in the typical extensive rash of varicella, frequent transmission to other susceptible contacts, establishment of latency, and in some individuals, reactivation with the clinical picture of zoster. Infection with the vaccine strain results in the development of a protective immune response, minimal rash in a minority of individuals, rare transmission to other susceptible contacts, and a greatly reduced risk of zoster. PMID: 11339549 [PubMed - indexed for MEDLINE] 2021. Arch Virol Suppl. 2001;(17):27-39. Varicella-zoster virus with a lost gE epitope: evidence for immunological pressure by the human antibody response. Padilla JA, Grose C. Department of Microbiology & Pediatrics, University of Iowa, Iowa City, USA. The varicella-zoster virus (VZV) genome contains about 70 open reading frames (ORF). ORF 68 codes for glycoprotein gE, formerly called gpl, which is the predominant VZV glycoprotein; gE is a typical type 1 transmembrane protein with 623 amino acids. Recently, a variant virus was discovered which has a mutation in gE codon 150; this mutation converts an aspartic acid into an asparagine residue. PMID: 11339548 [PubMed - indexed for MEDLINE] 2022. Arch Virol Suppl. 2001;(17):173-8. Varicella-zoster virus immunity and prevention: a conference perspective. Straus SE. Laboratory of Clinical Investigation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland 20892-1882, USA. This report offers a concise overview of the VZV Conference, highlighting recent developments in the field and speculating on areas of greatest opportunity and need for future work. The goal of eradicating VZV disease will be facilitated by a multifaceted research agenda directed at a fuller comprehension of how the virus replicates, spreads and persists, and how it eludes host immune responses. PMID: 11339547 [PubMed - indexed for MEDLINE] 2023. Arch Virol Suppl. 2001;(17):17-25. Investigation of varicella-zoster virus variation by heteroduplex mobility assay. Barrett-Muir W, Hawrami K, Clarke J, Breuer J. Department of Medical Microbiology, St Bartholomews and the Royal London Hospitals Medical Schools, Queen Mary and Westfield College, UK. Heteroduplex mobility assays of 37 regions were performed on ten UK isolates of varicella zoster virus, four from cases of zoster, and six from cases of chickenpox. The variation between isolates was found to be 0.061%, which is at least five times lower than any other member of the human herpesvirus family. Fifteen of the 37 regions tested had 29 single nucleotide polymorphisms, and over half the polymorphisms were located in four gene fragments. Of the 29 SNPs, eleven were non-synonymous and these were clustered in six genes. Isolates from a child and her mother to whom she had transmitted the virus, were identical at every locus tested. All other viruses could be distinguished by a combination of SNPs and length polymorphisms of the repeat regions R1, R2 and R5. PMID: 11339546 [PubMed - indexed for MEDLINE] 2024. Arch Virol Suppl. 2001;(17):161-72. Immunization of the elderly to boost immunity against varicella-zoster virus (VZV) as assessed by VZV skin test reaction. Takahashi M, Kamiya H, Asano Y, Shiraki K, Baba K, Otsuka T, Hirota T, Yamanishi K. The Research Foundation for Microbial Diseases of Osaka University, Suita, Japan. The utility of the VZV skin test in detecting individual susceptibility to varicella and zoster was determined. Its specificity particularly with regard to herpes simplex was also established. The VZV skin test was negative or weakly positive during the early stage of herpes zoster, and strongly positive during recovery from that disease. A small-scale clinical trial to immunize elderly individuals has been performed for the purpose of preventing herpes zoster, and, perhaps, severe post-herpetic neuralgia as well. Sixty individuals > or = 50 years old were screened for VZV antibodies by IAHA test and were given a VZV skin test for cell-mediated immunity. All were seropositive, but eight were skin-test negative. Thirty-seven individuals including the eight with negative skin tests were immunized with one dose of varicella vaccine (3.0 x 10(4) PFU/dose). After 5-7 weeks, the skin test reaction showed increased positivity, with a change in score from (-) to (+, ++) in 7/8 subjects, from (+) to (++, +++) in 3/5 subjects, and from (++) to (+++) in 6/10 subjects. Enhancement of the VZV antibody titer (defined as twofold or greater) was observed in all 15 vaccine recipients with a prevaccination titer of < or = 1:16, and in 19 of 24 subjects with a prevaccination titer of > or = 1:32. These results indicate that giving live varicella vaccine with a high viral titer can induce a good boost immunity particularly cell-mediated immunity to VZV in the elderly. PMID: 11339545 [PubMed - indexed for MEDLINE] 2025. Arch Virol Suppl. 2001;(17):151-60. Use of varicella vaccines to prevent herpes zoster in older individuals. Levin MJ. Department of Pediatrics, University of Colorado School of Medicine, Denver 80262, USA. It is likely that the frequency and severity of herpes zoster in older people is the result of an age-related decline in varicella-zoster virus-specific T-cell mediated immunity. Numerous trials of vaccines to boost these responses have demonstrated their safety and immunogenicity. Both live attenuated and inactivated vaccines have been studied. Persistence of booster responses is dose-related, and the half-life of some boosted measures of T-cell mediated immunity exceeds 5 years. Although these trials have been hampered by uncertainty about the critical immune responses to evaluate, the stage is set for a double-blind, placebo-controlled trial of sufficient size to determine efficacy. Such a trial is now underway. PMID: 11339544 [PubMed - indexed for MEDLINE] 2026. Arch Virol Suppl. 2001;(17):135-42. Varicella zoster virus in human and rat tissue specimens. Annunziato PW, Lungu O, Panagiotidis C. Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York, New York, USA. The limited supple of appropriate tissues for study has been an impediment to investigations of varicella zoster virus (VZV) latency. Human dorsal root ganglia (DRG) harboring latent virus are not plentiful and are not amenable to manipulation for studying the events surrounding the establishment, maintenance, and cessation of latency. An alternative to studies in human DRG is the rat model of latency, which appears to provide a reliable method of investigating VZV latency. Other alternatives include studies in other human tissues involved in VZV pathogenesis. In order to improve our understanding of the establishment and cessation of latency, we performed comparative immunohistochemical analysis of chickenpox and zoster skin lesions. This analysis revealed that during primary infection and reactivation productive VZV infection occurs in a variety of cell types and that the major VZV DNA binding protein, ORF29p, is present in peripheral axons early during the course of chickenpox. VZV latency was studied in the rat model by in situ hybridization and compared with similar studies performed in human DRG containing latent virus, confirming that VZV DNA persists in the same sites in DRG of the two species. PMID: 11339542 [PubMed - indexed for MEDLINE] 2027. Arch Virol Suppl. 2001;(17):109-19. Pathway of viral spread in herpes zoster: detection of the protein encoded by open reading frame 63 of varicella-zoster virus in biopsy specimens. Iwasaki T, Muraki R, Kasahara T, Sato Y, Sata T, Kurata T. Department of Pathology, National Institute of Infectious Diseases, Tokyo, Japan. Reactivation of varicella-zoster virus (VZV) in the dorsal root or trigeminal ganglia causes herpes zoster. The pathway of viral spread from the ganglia to the skin and also within the skin is not yet completely understood. Histological studies have revealed that each skin lesion in herpes zoster progresses sequentially through the stages of erythema, vesicles, pustules and finally ulceration. An immunohistochemical study of the early skin lesions of herpes zoster demonstrated a high incidence of hair follicle involvement and the main localization of the virus at the isthmus. This evidence suggests that VZV initially spreads from the ganglia through myelinated nerves, which predominantly end around the isthmus of hair follicles. To further investigate the viral spread within the skin, we analyzed the sequential appearance of the immediate early proteins encoded by ORF 63 of VZV (IE63), using an anti-IE63 antibody raised by immunization of rabbits with a recombinant protein. This antibody could detect IE63 in a western blot analysis of infected cells and also in immunohistochemical analysis of the skin lesions of herpes zoster. IE63 initially appeared in the nuclei of the follicular epithelial cells and basal or parabasal epidermal cells. Later, the nuclei and cytoplasm of cells in the epidermis and hair follicles became positive. IE63 remained in the virus-infected cells even during their degeneration. When we examined the hair follicles in the early erythematous lesions, cells positive for IE63 were predominantly distributed around the isthmus. In addition, some lymphocytes around the blood vessels were also positive for IE63, but these cells were seldom positive for the structural antigen. Thus, these observations suggest that VZV arriving through myelinated nerves infects not only permissive cells, but also non-permissive cells in the involved skin of herpes zoster. PMID: 11339540 [PubMed - indexed for MEDLINE] 2028. Arch Virol Suppl. 2001;(17):1-6. The current status of live attenuated varicella vaccine. Gershon AA. Department of Pediatrics, Columbia University College of Physicians & Surgeons, New York, New York 10032, USA. This manuscript reviews the means by which live attenuated varicella vaccine offers protection against varicella and zoster. It is accepted that although varicella is usually a mild illness, complications leading to morbidity and mortality are significant and the disease is worth preventing. The vaccine offers close to 100% protection from severe chickenpox and 90% protection from illness. Waning of immunity after vaccination, particularly in children, has not been a significant problem. Ways in which vaccination may decrease the incidence and severity of zoster include the following. Vaccine virus may be less likely to establish latency and to be able to reactivate than wild type virus. In addition, by selective immunization of certain hosts such as HIV-infected children whose, immune systems are still relatively intact and individuals with latency due to wild type virus to boost the cell-mediated immune response to the virus, zoster may be decreased. Varicella vaccine is predicted to have a major impact on the epidemiology of varicella and zoster in countries with high vaccine uptake. PMID: 11339539 [PubMed - indexed for MEDLINE] 2029. Neurologia. 2001 Mar;16(3):112-7. [Neurologic complications of herpes zoster. A retrospective study in 100 patients] [Article in Spanish] Sánchez-Guerra M, Infante J, Pascual J, Berciano J, Polo J. Servicio de Neurología. Hospital Universitario Marqués de Valdecilla, Santander. INTRODUCTION AND OBJECTIVES: The neurologic complications associated with herpes zoster are infrequent except for postherpetic neuralgia. The aim of this study was to review the clinical profile and the distribution of these complications in a retrospective series of patients. PATIENTS AND METHOD: A retrospective analysis of the last 100 patients admitted with the diagnosis of herpes zoster with neurologic complications to our center from 1992 to 1999 by the Departments of Internal Medicine and Neurology was performed. The characteristics of the complications other than postherpetic neuralgia are reported. RESULTS: Aside from the 88 patients with postherpetic neuralgia, the 12 remaining patients presented other complications: seven different peripheral neuropathies, including three with Ramsay-Hunt syndrome, two meningitis, one encephalitis and one myelitis. In addition, one patient had ophthalmic herpes zoster with cerebral vasculopathy as ipsilateral Wallenberg's syndrome. Nine patients (75%) were males, four (25%) were under the age of 20 years and seven older than 60 years and only three were immunodepressed. The CSF was abnormal in six out of the eight patients in whom it was studied with lymphocytic pleocytosis being shown on analysis without qualitative or quantitative alteration in intrathecal synthesis of IgG. In the immunosuppressed patients the serology in the CSF of the varicela zoster virus was negative. All patients demonstrated regressive evolution following treatment with acyclovir. CONCLUSIONS: Neurologic complications other than postherpetic neuralgia occurred in 12% of the patients of this series, there was male predominance and peripheral neuropathies were the most frequent complications. Serology of the varicela zoster virus in immunosuppressed patients may be negative. In this series the prognosis was mainly satisfactory. PMID: 11333780 [PubMed - indexed for MEDLINE] 2030. MMW Fortschr Med. 2001 Mar 29;143(13):16-8. [Neuralgia after herpes zoster. Dealing with the trouble at the (nerve) roots] [Article in German] Eiden P. PMID: 11332012 [PubMed - indexed for MEDLINE] 2031. Dermatol Online J. 2001 Feb;7(1):6. Kissing bugs (Triatoma) and the skin. Vetter R. Department of Entomlogy, University of California Riverside, USA. Kissing bugs (Family Reduviidae) can be the source of nocturnal dermatologic wounds in the mid to southern latitudes in the United States. The insects are obligate blood feeders and though the bites may be asymptomatic, a variety of dermatologic eruptions or death from anaphylaxis can result. The various dermatologic forms of the bite can be mistaken for herpes zoster, erythema multiforme and the ubiquitous catch-all diagnoses of "spider-bite." PMID: 11328627 [PubMed - indexed for MEDLINE] 2032. J Perinatol. 2001 Mar;21(2):141-6. Congenital varicella-zoster virus infection after maternal subclinical infection: clinical and neuropathological findings. Mustonen K, Mustakangas P, Valanne L, Professor MH, Koskiniemi M. Department of Neuropediatrics, North Karelia Central Hospital, 80210 Joensuu, Finland. OBJECTIVE: It is known that varicella-zoster virus (VZV) can cause asymptomatic infections, but it has not been described that congenital infection can be caused by maternal subclinical infection. The purpose of this study is to evaluate clinical and neuropathologic findings of infants with neonatal seizures and cerebrospinal fluid (CSF) VZV antibodies, but no maternal clinical VZV infection during the pregnancy. STUDY DESIGN: Screening of 201 neonates were studied for congenital viral infections, because of neurologic problems of unknown origin. Antibodies to 16 different microbes were investigated from the CSF and the serum of the neonates, as well as from the first trimester and postpartum serum of their mothers. Clinical symptoms and signs as well as neuropathology of those infants with antibodies to VZV in CSF were evaluated in this study. RESULTS: Four neonates with antibodies to VZV in CSF were identified and CSF findings were reported earlier. Their mothers had laboratory evidence of infection, based on a significant rise in serum VZV antibody level during pregnancy in three mothers, and a constantly high antibody level to VZV in one mother. All four children had seizures and abnormalities in muscular tone during the neonatal period, but no typical manifestations of a congenital VZV infection. One child died at the age of 4 months. At autopsy, neuropathologic examination showed foci of astrocytic hyperplasia and hypertrophy but no specific signs of viral infection. CONCLUSION: Maternal subclinical VZV infection can cause congenital infection with neurologic symptoms and signs in the child. PMID: 11324362 [PubMed - indexed for MEDLINE] 2033. J Calif Dent Assoc. 2000 Dec;28(12):911-21. Herpesvirus-induced diseases: oral manifestations and current treatment options. Birek C. Faculty of Dentistry, University of Manitoba, Canada. The dentist is often the first health professional to be contracted by patients who develop acute orofacial symptoms of viral conditions such as shingles (varicella zoster) or herpetic gingivostomatitis. The diagnosis, treatment, and management of virally induced oral diseases is a challenge inasmuch as their presentation is atypical and may be complicated by immunosuppression. However, an increasing body of knowledge regarding the manifestations of viral infections in immunocompromised patients and the advances achieved in antiviral drug therapy during the past several years should make the task less daunting for the dentist. In this paper, the natural history, typical and atypical oral manifestations, diagnosis, current treatment options, and advances in the prevention of common herpesvirus-induced diseases are reviewed, with particular attention to primary and recurrent varicella zoster virus and herpes simplex type 1 infections. PMID: 11323945 [PubMed - indexed for MEDLINE] 2034. Pain. 2001 May;92(1-2):139-45. The density of remaining nerve endings in human skin with and without postherpetic neuralgia after shingles. Oaklander AL. Department of Neurological Surgery, Johns Hopkins Medical Institutions, Boston, MA, USA. aoaklander@partners.org Erratum in: Pain 2001 Dec;94(3):325. The mechanisms of chronic neuropathic pain are not well understood. Postherpetic neuralgia (PHN), which occurs in some patients after shingles (herpes zoster), was used to investigate the neural determinants of chronic pain. Skin biopsies were obtained from 38 adults with or without PHN at least 3 months after healing of shingles on the torso. Vertical sections were immunolabeled against PGP9.5, a pan-axonal marker, to measure the density of remaining nerve endings in skin previously affected by shingles. All axons that end in the epidermis are nociceptors, neurons that transmit pain messages. The densities ranged between 2 and 3976 neurites/mm2 skin surface, but the overlap between subjects and without PHN was small. Of 19 subjects without PHN, 17 had more than 670 neurites/mm2 skin surface area (mean +/- SEM = 1569 +/- 230), and 18 of 19 subjects with PHN had 640 or fewer neurites/mm2 (mean +/- SEM = 367 +/- 92). PHN may be a 'phantom-skin' pain associated with loss of nociceptors. This threshold of approximately 650 neurites/mm2 skin surface was not detected in previous studies that used summary statistics. It implies that the absence of pain after shingles may require the preservation of a minimum density of primary nociceptive neurons, and that the density of epidermal innervation may provide an objective correlate for the presence or absence of PHN pain. PMID: 11323135 [PubMed - indexed for MEDLINE] 2035. An Med Interna. 2000 Nov;17(11):618-9. [Myelitis after varicella zoster virus (VZV) primi-infection: report of a case] [Article in Spanish] Ameneiros Lago E, Cerecedo Pérez MJ, de la Fueute R, Macías Arribi M. PMID: 11322043 [PubMed - indexed for MEDLINE] 2036. J Pediatr Gastroenterol Nutr. 2001 Feb;32(2):207-8. Systemic absorption with complications during topical tacrolimus treatment for orofacial Crohn disease. Russell RK, Richardson N, Wilson DC. Department of Paediatric Gastroenterology and Nutrition, Royal Hospital for Sick Children, Edinburgh, Scotland, UK. richardkrussell71@hotmail.com Comment in: J Pediatr Gastroenterol Nutr. 2001 Nov;33(5):633. PMID: 11321395 [PubMed - indexed for MEDLINE] 2037. Ophthalmology. 2001 May;108(5):869-76. Herpes simplex virus type 2 as a cause of acute retinal necrosis syndrome in young patients. Van Gelder RN, Willig JL, Holland GN, Kaplan HJ. Department of Ophthalmology and Visual Sciences, Washington University Medical School, St. Louis, Missouri. PURPOSE: To determine the causative virus in acute retinal necrosis (ARN) syndrome in a series of patients by calculation of modified Witmer coefficients. DESIGN: Noncomparative case series. PARTICIPANTS: Ten patients with ARN syndrome from four medical centers. METHODS: Aqueous samples, vitreous samples, or both were collected prospectively during surgery from patients with a clinical diagnosis of ARN syndrome. Serologic measures of intraocular and serum antibodies to potentially causative viruses were measured by enzyme-linked immunosorbent assay. MAIN OUTCOME MEASURES: Modified Witmer coefficients (immunoglobulin G and immunoglobulin A) for herpes simplex virus types 1 (HSV-1) and 2 (HSV-2), varicella zoster virus (VZV), and cytomegalovirus (CMV), as well as adenovirus type 2, were calculated from aqueous or vitreous samples, or both. RESULTS: Intraocular antibody measurements were strongly suggestive of a single diagnosis in 9 of 10 patients tested. Modified Witmer coefficients demonstrated intraocular antibody production to HSV in five patients and antibodies to VZV in four patients, and the measurement was inconclusive in one patient. No patients were positive for adenovirus or CMV. Strain-specific antibody titers demonstrated that all HSV-positive patients were reactive only to HSV-2. Herpes simplex virus type 2 was found predominantly in younger patients with ARN syndrome (mean age, 21.2 +/- 10 years; range, 17-39 years), whereas VZV was more commonly seen in older patients (mean age, 40.8 +/- 12.2 years; range, 29-58 years; P = 0.033). Immunoglobulin A testing confirmed immunoglobulin G testing in all patients examined. CONCLUSIONS: Although VZV is thought to be the most common cause of ARN syndrome, HSV-2 is an important cause of ARN syndrome, particularly in younger patients. Because infection with HSV-2 has important medical ramifications, these results suggest that determination of a causal agent should be considered in some cases of ARN syndrome. PMID: 11320015 [PubMed - indexed for MEDLINE] 2038. Arch Ophthalmol. 2001 Apr;119(4):608-10. Optic chiasm, optic nerve, and retinal involvement secondary to varicella-zoster virus. Greven CM, Singh T, Stanton CA, Martin TJ. Wake Forest University Eye Center, Medical Center Boulevard, Winston-Salem, NC 27157-1033. cgreven@wfubmc.edu Immunocompromised patients are known to be at risk for varicella-zoster virus reactivation, often in atypical manners. We describe a 30-year-old man with simultaneous involvement of the retina, optic chiasm, and optic nerve with varicella-zoster virus who had a bitemporal visual field defect. PMID: 11296030 [PubMed - indexed for MEDLINE] 2039. Clin Infect Dis. 2001 May 15;32(10):1481-6. Epub 2001 Apr 17. Herpes zoster in older adults. Schmader K. Center for the Study of Aging and Human Development and Division of Geriatrics, Department of Medicine, Duke University Medical Center, Durham, NC, USA. schma001@mc.duke.edu Herpes zoster (HZ) strikes millions of older adults annually worldwide and disables a substantial number of them via postherpetic neuralgia (PHN). Key age-related clinical, epidemiological, and treatment features of zoster and PHN are reviewed. HZ is caused by renewed replication and spread of varicella-zoster virus (VZV) in sensory ganglia and afferent peripheral nerves in the setting of age-related, disease-related, and drug-related decline in cellular immunity to VZV. VZV-induced neuronal destruction and inflammation causes the principal problems of pain, interference with activities of daily living, and reduced quality of life in elderly patients. Recently, attempts to reduce or eliminate HZ pain have been bolstered by the findings of clinical trials that antiviral agents and corticosteroids are effective treatment for HZ and that tricyclic antidepressants, topical lidocaine, gabapentin, and opiates are effective treatment for PHN. Although these advances have helped, PHN remains a difficult condition to prevent and treat in many elderly patients. PMID: 11317250 [PubMed - indexed for MEDLINE] 2040. Clin Infect Dis. 2001 May 15;32(10):1414-22. Epub 2001 Apr 18. A predictive model of varicella-zoster virus infection after autologous peripheral blood progenitor cell transplantation. Offidani M, Corvatta L, Olivieri A, Mele A, Brunori M, Montanari M, Rupoli S, Scalari P, Leoni P. Department of Hematology, Ancona University School of Medicine, Ancona, Italy. clinemat@popcsi.unian.it Varicella-zoster virus (VZV) frequently causes severe infections in patients who have undergone bone marrow transplantation. The frequency of, characteristics of, and risk factors for this infection were studied in 164 patients undergoing autologous peripheral blood progenitor cell transplantation (PBPCT). Twenty-six patients (15.8%) developed VZV infection, and the actuarial risk was 10% at 1 year. No patient had visceral dissemination or died because of VZV, although one-third of the patients developed postherpetic neuralgia. By multivariate analysis, a CD4(+) lymphocyte count of <200 cells/microL (P<.0001; odds ratio [OR], 2.0) and a CD8(+) lymphocyte count of <800 cells/microL (P=.0073; OR, 2.0) at day 30 after transplantation were factors associated with VZV infection. Patients with both these adverse factors had an actuarial risk of VZV of 48% at 1 year. Patients with deficiency in both CD4(+) and CD8(+) lymphocytes are at high risk of VZV infection. These patients should be considered as candidates for preventive therapy, but whether for antiviral therapy or vaccination remains to be investigated. PMID: 11317241 [PubMed - indexed for MEDLINE] 2041. Br J Ophthalmol. 2001 May;85(5):576-81. Famciclovir for ophthalmic zoster: a randomised aciclovir controlled study. Tyring S, Engst R, Corriveau C, Robillard N, Trottier S, Van Slycken S, Crann RA, Locke LA, Saltzman R, Palestine AG; Collaborative Famciclovir Ophthalmic Zoster Research Group. University of Texas Medical Branch, Galveston, TX, USA. AIMS: To compare the efficacy and safety of famciclovir with aciclovir for the treatment of ophthalmic zoster. METHODS: Randomised, double masked, aciclovir controlled, parallel group in 87 centres worldwide including 454 patients with ophthalmic zoster of trigeminal nerve (V(1)) comprised the intent to treat population. Oral famciclovir 500 mg three times daily or oral aciclovir 800 mg five times daily for 7 days. Assessments included day 0 (screening), days 3 and 7 (during treatment), days 10, 14, 21, 28 and monthly thereafter, up to 6 months (follow up). Proportion of patients who experienced ocular manifestations, severe manifestations and non-severe manifestations; loss of visual acuity was the main outcome measure. RESULTS: The percentage of patients who experienced one or more ocular manifestations was similar for famciclovir (142/245, 58.0%) and aciclovir (114/196, 58.2%) recipients, with no significant difference between groups (OR 0.99; 95% CI 0.68, 1.45). The percentage of patients who experienced severe and non-severe manifestations was similar between groups, with no significant difference. The prevalence of individual ocular manifestations was comparable between groups. There was no significant difference between groups for visual acuity loss. CONCLUSION: Famciclovir 500 mg three times daily was well tolerated and demonstrated efficacy similar to aciclovir 800 mg five times daily. PMCID: PMC1723970 PMID: 11316720 [PubMed - indexed for MEDLINE] 2042. J Clin Pediatr Dent. 2001 Winter;25(2):107-12. Oral manifestations of infections of infections due to varicella zoster virus in otherwise healthy children. Kolokotronis A, Louloudiadis K, Fotiou G, Matiais A. Department of Oral Medicine and Pathology, Dental School of Aristotle University of Thessaloniki, 54006 Thessaloniki, Greece. Varicella zoster virus (VZV) causes varicella (or chickenpox) and establishes latency in nerve ganglia after the primary infection. The reactivation of virus later in life can cause mono- or polyneuropathy. The cranial nerves most commonly involved are five (herpes zoster or shingles), six, seven eight, nine and ten. In the present study we describe the oral lesions associated with VZV infections in normal children. In a 3 year period we examined 62 children, age 2 to 13 years old with diagnosed varicella and a 4 year old boy with herpes zoster at the 3rd branch of the trigeminal nerve. According to the clinical picture of varicella, the disease was defined as: (1) group A mild cases; (2) group B moderate cases; (3) group C severe. The manifestations of varicella were: mild varicella 19 children, moderate 26 children and severe 17 children. The results of the present study indicate that the prevalence of oral manifestations of varicella is related to the severity of the disease. In 17 severe cases, oral lesions were always present and the number was between 5 to 30. From 26 moderate cases, oral lesions were observed in 23 and the number was between 2 to 10. From 19 mild cases, oral lesions were present only in 6 cases and their number was 1 or 2. Often varicella's oral lesions resemble manifestations of other entities, and this may cause differential diagnostics problems. PMID: 11314207 [PubMed - indexed for MEDLINE] 2043. Vaccine. 2001 Apr 30;19(23-24):3076-90. The epidemiology of herpes zoster and potential cost-effectiveness of vaccination in England and Wales. Edmunds WJ, Brisson M, Rose JD. Department of Economics, City University, Northampton Square, EC1 0HB, London, UK. jedmunds@phls.org.uk The epidemiology of herpes zoster and post-herpetic neuralgia (PHN) was quantified from a variety of data sources and the potential cost-effectiveness of vaccination assessed. The annual incidence and severity of zoster increases sharply with age, as measured by physician consultation and hospitalisation rates, average length of stay, average proportion of cases developing PHN and the age-specific case-fatality ratio. Combining these data with information on health related quality of life results in an estimated loss of 20000 quality adjusted life years (QALYs) annually in England and Wales from herpes zoster (17400 due to PHN). The current cost of treating herpes zoster associated disease is estimated to be 47.6m pounds annually. Since both the health and economic burden are high, vaccination of the elderly is expected to be cost-effective under most scenarios, the attractiveness of immunisation increasing with age due to the increased burden of disease in the very elderly. PMID: 11312002 [PubMed - indexed for MEDLINE] 2044. Eur Neurol. 2001;45(3):189-90. Internal ophthalmoplegia as a presenting sign of herpes zoster ophthalmicus. Assal F, Frank HG, von Gunten S, Chofflon M, Safran AB. Department of Neurology, University Hospital, Geneva, Switzerland. fredericassal@hotmail.com PMID: 11306868 [PubMed - indexed for MEDLINE] 2045. Infect Dis Clin North Am. 2001 Mar;15(1):65-81, viii. Live-attenuated varicella vaccine. Gershon AA. Department of Pediatrics, Columbia University College of Physicians & Surgeons, New York, New York, USA. aag1@columbia.edu This article reviews the history and development of live attenuated varicella vaccine from its early days in Japan to its widespread use throughout the world. The vaccine has proven extremely safe after immunization of as many as 10 million healthy children and adults in the United States alone. The vaccine is also highly immunogenic and offers close to 100% protection from severe chickenpox and 90% protection from illness. It is expected to have a major impact on the epidemiology of varicella and zoster in countries with high vaccine uptake. PMID: 11301823 [PubMed - indexed for MEDLINE] 2046. Clin Microbiol Infect. 2001 Feb;7(2):91-3. Herpes zoster in non-hospitalized children. Socan M. Center for Communicable Diseases, Institute of Public Health, Trubarjeva 2, 1000 Ljubljana, Slovenia. maja.socan@ivz-rs.si PMID: 11298150 [PubMed - indexed for MEDLINE] 2047. Rev Neurol. 2001 Jan 1-15;32(1):15-8. [Segmental motor paralysis caused by the varicella zoster virus. Clinical study and functional prognosis] [Article in Spanish] Cruz-Velarde JA, Muñoz-Blanco JL, Traba A, Nevado C, Ezpeleta D. Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España. Comment in: Rev Neurol. 2001 Sep 16-30;33(6):599-600. INTRODUCTION: Segmental motor paralysis of the limbs (SMP) complicates 2-3% of the cases of cutaneous herpes zoster. Viral invasion and inflammation of the motor neurons of the anterior horn cells by the varicella-zoster virus (VVZ) causes clinical weakness at the same time and site as the cutaneous eruption. OBJECTIVES: To analyze the clinical findings, complementary investigations and functional prognosis of patients with SMP at brachial plexus and lumbosacral levels. PATIENTS AND METHODS: We made a retrospective study of 10 patients with SMP admitted to the Hospital Universitario Gregorio Maranon de Madrid during 1989-1999, aged between 38 and 84 years (6 women, 4 men). Neurological examination was done, including muscle balance, complementary studies including microbiology (serum and CSF serology, viral PCR-ADN), neurophysiology using MNR of the spine and plexuses and functional prognosis on the NDS, NSS and RANKIN scales. RESULTS: There is a close relationship between dermatome and myotome involvement (90%). The brachial and lumbosacral plexuses were equally affected (50%). Plasma and CSF VVZ serology was positive in 50% of the cases, permitting diagnosis of a patient with no cutaneous lesions (zoster sine herpete). Denervation of the myotomes involved and the paraspinal muscles was shown on neurophysiological studies. In most cases there was functional improvement, with complete functional recovery in 80% of the cases after 12 months. CONCLUSIONS: VVZ should be considered amongst the aetiologies of SMP, even in the absence of cutaneous lesions (zoster sine herpete). The SMP coincides in time and place with the dermatome lesions. In most patients there is complete functional recovery within 12 months. PMID: 11293092 [PubMed - indexed for MEDLINE] 2048. FASEB J. 2001 Apr;15(6):1037-43. Infection by human varicella-zoster virus confers norepinephrine sensitivity to sensory neurons from rat dorsal root ganglia. Kress M, Fickenscher H. Institut für Physiologie und Experimentelle Pathophysiologie, Friedrich-Alexander-Universität Erlangen-Nürnberg, D-91054 Erlangen, Germany. kress@physiologie1.uni-erlangen.de Varicella-zoster virus (VZV) is a widespread human herpes virus causing chicken pox on primary infection and persisting in sensory neurons. Reactivation causes shingles, which are characterized by severe pain and often lead to postherpetic neuralgia. To elucidate the mechanisms of VZV-associated hyperalgesia, we elaborated an in vitro model for the VZV infection of sensory neurons from rat dorsal root ganglia. Between 35 and 50% of the neurons showed strong expression of the immediate-early virus antigens IE62 and IE63 and the late glycoprotein gE. When the intracellular calcium concentration was monitored microfluorometrically for individual cells after infection, the sensitivity to GABA or capsaicin was similar in controls and in VZV-infected neurons. However, the baseline calcium concentration was increased. Neurons became de novo sensitive to adrenergic stimulation after VZV infection. Norepinephrine-responsive neurons were more frequent and calcium responses to norepinephrine were significantly higher after infection with wild-type isolates than with the attenuated vaccine strain OKA. The adrenergic agonists phenylephrine and isoproterenol had similar efficacy. We suggest that the infection with wild-type VZV isolates confers norepinephrine sensitivity to sensory neurons by using alpha(1)- and/or beta(1)-adrenergic receptors providing a model for the pathophysiology of the severe pain associated with the acute reactivation of VZV. PMID: 11292665 [PubMed - indexed for MEDLINE] 2049. Cancer Invest. 2001;19(1):13-22. A randomized, double-blind trial of famciclovir versus acyclovir for the treatment of localized dermatomal herpes zoster in immunocompromised patients. Tyring S, Belanger R, Bezwoda W, Ljungman P, Boon R, Saltzman RL; Colaborative Famciclovir Immunocompromised Study Group. University of Texas Medical Branch, Galveston, TX 77555, USA. styring@utmb.edu In this randomized, double-blind, multicenter, acyclovir-controlled study, the efficacy and safety of famciclovir were evaluated for the treatment of herpes zoster in patients who were immunocompromised following bone marrow or solid organ transplantation or oncology treatment. A total of 148 patients, 12 years or older with clinical evidence of localized herpes zoster, received either oral famciclovir, 500 mg three times daily, or acyclovir, 800 mg five times daily, for 10 days. Famciclovir was equivalent to acyclovir with respect to the numbers of patients reporting new lesion formation while on therapy (77% vs. 73%, respectively). There were no significant differences between the groups in the time to cessation of new lesion formation, full crusting, complete healing of lesions, or loss of acute phase pain. Treatment with famciclovir was well tolerated, with a safety profile comparable to that of acyclovir. Thus oral famciclovir is a convenient, effective, and well-tolerated regimen for immunocompromised patients with herpes zoster. PMID: 11291551 [PubMed - indexed for MEDLINE] 2050. BMJ. 2001 Apr 7;322(7290):860-1. Postherpetic neuralgia. Treatment with amitriptyline is cheaper than with aciclovir. Marshall T. Comment on: BMJ. 2000 Sep 30;321(7264):794-6. PMID: 11290647 [PubMed - indexed for MEDLINE] 2051. BMJ. 2001 Apr 7;322(7290):861. Postherpetic neuralgia. Why burden the pain clinic? Greer R, Severn A. Comment on: BMJ. 2000 Sep 30;321(7264):778-9. PMID: 11290645 [PubMed - indexed for MEDLINE] 2052. BMJ. 2001 Apr 7;322(7290):859-60. Postherpetic neuralgia. Findings differ from earlier results. Bowsher D. Comment on: BMJ. 2000 Sep 30;321(7264):794-6. PMCID: PMC1120019 PMID: 11290641 [PubMed - indexed for MEDLINE] 2053. BMJ. 2001 Apr 7;322(7290):860. Postherpetic neuralgia. Pathogenesis of postherpetic neuralgia should be determined. Breuer J, Scott F, Leedham-Green M. Comment on: BMJ. 2000 Sep 30;321(7264):794-6. PMID: 11290628 [PubMed - indexed for MEDLINE] 2054. Semin Immunol. 2001 Feb;13(1):27-39. Immune evasion as a pathogenic mechanism of varicella zoster virus. Abendroth A, Arvin AM. Centre for Virus Research, Westmead Millenium Institute, NSW, 2145, Australia. Varicella zoster virus (VZV) is a human herpesvirus that causes varicella (chickenpox) during primary infection, establishes latency in dorsal root ganglia and may reactivate years later, producing herpes zoster. VZV must evade antiviral immunity during three important stages of viral pathogenesis, including the cell-associated viremia characteristic of primary infection, persistence in dorsal root ganglia during latency and the initial period of VZV reactivation. Our observations about the immunomodulatory effects of VZV document its capacity to interfere with adaptive immunity mediated by CD4 as well as CD8 T cells, ensuring the survival of the virus in the human population from generation to generation. Copyright 2001 Academic Press. PMID: 11289797 [PubMed - indexed for MEDLINE] 2055. Am J Dermatopathol. 2001 Apr;23(2):146-8. Herpesvirus infection of seborrheic keratoses. Googe PB, King R. Knoxville Dermatopathology Laboratory, Knoxville, Tennessee 37319, USA. We present three examples of patients with seborrheic keratoses complicated by necrotizing herpesvirus infection. Two patients had localized cutaneous herpetic infections, and the third patient had a generalized cutaneous herpesvirus infection. Two of the lesions were thought to be squamous cell carcinoma. The third was clinically identified as inflamed seborrheic keratosis. Herpesvirus infection was not clinically suspected in two of the patients. The histologic changes were similar in all cases. Epidermal proliferation was accompanied by hyperkeratosis and pseudo horn cyst formation. Extensive keratinocyte necrosis was present along with balloon degeneration of keratinocytes, herpetic viral inclusions, and multinucleated giant cells. Viral lesions of molluscum contagiosum and human papillomavirus have been observed in benign skin proliferations. Nevertheless, we were unable to find descriptions of herpesvirus involvement in seborrheic keratosis in a Medline search. Necrotic seborrheic keratoses should be carefully examined for the possibility of herpesvirus infection, a condition that may be improved by prompt medical intervention as demonstrated in one of our cases. PMID: 11285412 [PubMed - indexed for MEDLINE] 2056. Can Fam Physician. 2001 Mar;47:493, 503-4. Ophthaproblem. Herpes zoster. Baxter S, Sharma S. Department of Ophthalmology, Queen's University, Kingston, Ont. PMCID: PMC2018397 PMID: 11281080 [PubMed - indexed for MEDLINE] 2057. N Engl J Med. 2001 Mar 29;344(13):1021; author reply 1021-2. Intrathecal methylprednisolone for postherpetic neuralgia. Srinivasan B. Comment on: N Engl J Med. 2000 Nov 23;343(21):1514-9. PMID: 11280324 [PubMed - indexed for MEDLINE] 2058. N Engl J Med. 2001 Mar 29;344(13):1020; author reply 1021-2. Intrathecal methylprednisolone for postherpetic neuralgia. Niebergall H, Priebe HJ. Comment on: N Engl J Med. 2000 Nov 23;343(21):1514-9. PMID: 11280323 [PubMed - indexed for MEDLINE] 2059. N Engl J Med. 2001 Mar 29;344(13):1020; author reply 1021-2. Intrathecal methylprednisolone for postherpetic neuralgia. Lewis G. Comment on: N Engl J Med. 2000 Nov 23;343(21):1514-9. PMID: 11280322 [PubMed - indexed for MEDLINE] 2060. N Engl J Med. 2001 Mar 29;344(13):1020-1; author reply 1021-2. Intrathecal methylprednisolone for postherpetic neuralgia. Zetlaoui PJ, Cosserat J. Comment on: N Engl J Med. 2000 Nov 23;343(21):1514-9. PMID: 11280321 [PubMed - indexed for MEDLINE] 2061. N Engl J Med. 2001 Mar 29;344(13):1019; author reply 1021-2. Intrathecal methylprednisolone for postherpetic neuralgia. Nelson DA, Landau WM. Comment on: N Engl J Med. 2000 Nov 23;343(21):1514-9. PMID: 11280320 [PubMed - indexed for MEDLINE] 2062. N Engl J Med. 2001 Mar 29;344(13):1019-20; author reply 1021-2. Intrathecal methylprednisolone for postherpetic neuralgia. Lampe JB, Hindinger C, Reichmann H. Comment on: N Engl J Med. 2000 Nov 23;343(21):1514-9. N Engl J Med. 2000 Mar 2;342(9):635-45. PMID: 11280319 [PubMed - indexed for MEDLINE] 2063. J Assoc Physicians India. 2000 Dec;48(12):1222. Post herpes zoster galactorrhoea. Samanta BB. PMID: 11280239 [PubMed - indexed for MEDLINE] 2064. Am J Nurs. 2001 Mar;101(3):22-3. The lidocaine patch. Pasero C, McCaffery M. PMID: 11279991 [PubMed - indexed for MEDLINE] 2065. Eur J Dermatol. 2001 Mar-Apr;11(2):108-11. Detection of cutaneous varicella zoster virus infections by immunofluorescence versus PCR. Bezold GD, Lange ME, Gall H, Peter RU. Department of Dermatology, University of Ulm, Oberer Eselsberg 40, 89081 Ulm, Germany. Detection of localized, clinically atypical cutaneous infections with varicella zoster virus (VZV) has proven difficult, as serum antibody tests sometimes are not sensitive and specific enough for that purpose. Therefore immunofluorescence and an internally controlled PCR for VZV are compared for sensitivity. Detection of PCR products was done by ELISA, and if positive, additionally by agarose gel electrophoresis. Of 60 samples 44 were PCR-positive by ELISA (44 = 100%), of which 37 (84%) were also positive on the agarose gel. Thirty-four samples (77%) were positive by immunofluorescence. No sample was positive by immunofluorescence and negative by PCR. A combination of immunofluorescence and PCR with agarose gel analysis detected 42 samples out of 44 positive by PCR ELISA (95%). These results demonstrate that immunofluorescence is a suitable, fast and inexpensive method for routine diagnostics. Additional sensitivity can be achieved by screening immunofluorescence-negative samples by PCR, which is extremely sensitive but time-consuming and labor-intensive. PMID: 11275804 [PubMed - indexed for MEDLINE] 2066. J Assoc Physicians India. 1998 Apr;46(4):337-40. Herpes zoster and post-herpetic neuralgia--a clinical trial of aspirin in chloroform for anodyne. Kochar DK, Agarwal RP, Joshi A, Kumawat BL. Department of Medicine, Neurology Section, Sardar Patel Medical College, Bikaner-334 003, India. Comment in: J Assoc Physicians India. 1999 Apr;47(4):460-1. Pain associated with Herpes Zoster (HZ) and Post-herpetic Neuralgia (PHN) has been a challenging task to manage with ease. Topical aspirin dissolved in chloroform is an effective means of reducing pain due to HZ and PHN in most patients. The locus of pain origin and analgesia induced by topical aspirin is supposed to be at cutaneous free nerve ending pain receptors. The present study was conduced in fifty two patients of HZ and PHN. Pain intensity before and after the application of drug was measured with help of Sort Form McGill Pain Questionnaire (SE-MPQ). Most of the patients experienced relief of pain within 1-5 minutes after the aspirin-chloroform application. Maximum relief was achieved in about 30-40 minutes and persisted for 5-6 hrs. In the beginning 3-4 applications were required but frequency decreased gradually as the pain abated. PMID: 11273312 [PubMed - indexed for MEDLINE] 2067. J Assoc Physicians India. 1998 Apr;46(4):333-4. Zoster associated pain. Khadilkar SV. PMID: 11273311 [PubMed - indexed for MEDLINE] 2068. Transplant Proc. 2001 Feb-Mar;33(1-2):1816-7. Major infectious complications after kidney transplantation. Karakayali H, Emiroğlu R, Arslan G, Bilgin N, Haberal M. Başkent University Faculty of Medicine, Bahçelievler, Ankara, Turkey. PMID: 11267526 [PubMed - indexed for MEDLINE] 2069. Postgrad Med. 2001 Mar;109(3):31-2. Postherpetic pain control with concomitant illness? Belgrade M. University of Minnesota Medical School-Minneapolis, USA. PMID: 11265360 [PubMed - indexed for MEDLINE] 2070. Lin Chuang Er Bi Yan Hou Ke Za Zhi. 1998 Nov;12(11):490-2. [Diagnosis and treatment of Ramsay Hunt syndrome (a report of 39 cases)] [Article in Chinese] Guo Y, Wu W, Xie D. Department of Otolaryngology, Second Affiliated Hospital, Hunan Medical University, Changsha 410011. Thirty-nine cases with Ramsay Hunt syndrome were presented, in which 23 cases were firmly diagnosed early, and others were misdiagnosed to be Bell's palsy in 9 cases, sudden sensorineural hearing loss in 5, herpes zoster pharyngitis in 1 and acute suppurative otitis media in 1, respectively. All patients were treated with prednisone or dexamethasone for 3 weeks. The results of treatment were as follows: complete recovery in 27 cases, residual facial paralysis in 12 patients, in which 11 had sensorineural hearing loss. We concluded that: 1. When patients present idiopathic facial paralysis associated with objective sensorineural hearing loss, Hunt syndrome should be suspected even in the absence of vesicles. 2. Treatment with steroid and antiviral agent is needed. There is no significant difference in the effects between oral and intravenous steroid therapy. 3. The poor prognosis may relate with severe facial paralysis accompanying severe hearing loss. 4. Acoustic stapedius reflex in patients with mild or no hearing loss is useful for defining the involved sites and evaluating the prognosis. PMID: 11263220 [PubMed - indexed for MEDLINE] 2071. Infection. 2001 Jan-Feb;29(1):37-9. Varicella zoster virus infection associated with erythema multiforme in children. Prais D, Grisuru-Soen G, Barzilai A, Amir J. Dept. of Pediatrics C, Schneider Children's Medical Center of Israel, Petah Tiqva. daprais@hotmail.com BACKGROUND: Erythema multiforme (EM) is a vesiculobullous disorder with variable manifestations which predominantly affects the skin. It is regarded as a hypersensitivity disorder which is triggered by multiple factors such as infection, drugs and food. Varicella zoster virus (VZV) has rarely been reported as an etiological agent, despite its high incidence as a pathogen in childhood. PATIENTS: We describe two children in whom EM preceded VZV infection. In the first, a 5-year-old boy, EM was followed 3 days later by a classical disseminated varicella eruption. The diagnosis was reached by clinical, epidemiological and serological means. The second patient was a 13-year-old boy with EM which was followed 2 weeks later by Ramsay-Hunt syndrome. The diagnosis was confirmed by skin biopsy, positive serology and viral culture. CONCLUSION: The association of EM and VZV infection is probably more common than reported. In clinical cases of EM, VZV should be included in the list of possible causative agents. PMID: 11261757 [PubMed - indexed for MEDLINE] 2072. Pediatr Transplant. 2001 Feb;5(1):44-50. Pretransplant varicella vaccination is cost-effective in pediatric renal transplantation. Olson AD, Shope TC, Flynn JT. Division of Pediatric Gastroenterology, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, USA. olsona@centocor.com Because of the severe complications that may result from varicella zoster virus (VZV) infection following renal transplantation (Tx), transplanted varicella-susceptible children exposed to varicella are typically given varicella zoster immunoglobulin (VZIG) as prophylaxis or are admitted and treated with parenteral acyclovir if VZIG prophylaxis fails. As both VZIG and hospitalization are costly, prevention of varicella infection by vaccination could potentially result in significant cost savings in addition to decreasing morbidity and mortality. To test this hypothesis, we developed a decision-analysis model to evaluate the cost-effectiveness of vaccinating patients with chronic renal failure (CRF) against varicella prior to renal transplant. Under baseline assumptions, vaccination for varicella pretransplant was a cost-effective strategy, with a cost of $211 per patient vaccinated compared with $1,828 per patient not vaccinated. The magnitude of cost savings from vaccination was sensitive to variations in the cost of varicella vaccine, the percentage of patients hospitalized for treatment with acyclovir, and the percentage of patients exposed to varicella infection. One- and two-way sensitivity analyses confirmed that vaccination was the dominant cost-effective strategy under all conditions examined. We conclude that vaccination for varicella pretransplant is cost-effective for patients with CRF, and that the magnitude of cost savings is sensitive to the cost of hospitalization, the percentage of patients exposed to varicella, and the cost of varicella vaccination. Pending results of ongoing studies of the safety and efficacy of VZV vaccine in children with CRF, we recommend that VZV vaccine be given to all children with CRF. PMID: 11260488 [PubMed - indexed for MEDLINE] 2073. Nervenarzt. 2001 Feb;72(2):69-77. [Gabapentin therapy for pain] [Article in German] Block F. Neurologische Klinik der RWTH Aachen. fblock@post.klinkum.rwth-aachen.de Gabapentin, which has been approved for add-on therapy of focal seizures, is increasingly used for treatment of neuropathic pain. Its analgesic effect is supposed to be due to reduction of glutamatergic transmission, improvement of GABAergic transmission and to binding to voltage-dependent calcium channels. Experimental studies demonstrated an ameliorating effect of gabapentin on neuropathic pain. Placebo-controlled studies revealed an efficacy of gabapentin against pain in diabetic neuropathy and postherpetic neuralgia and in prophylaxis of migraine. Case reports show an analgesic effect of gabapentin in trigeminus neuralgia and in reflex sympathetic dystrophy. The main adverse events are dizziness, ataxia and somnolence. Controlled studies, which compare the efficacy of gabapentin with that of the respective reference drug, are needed to evaluate its importance in treatment of pain. PMID: 11256157 [PubMed - indexed for MEDLINE] 2074. Am J Med. 2001 Mar;110(4):329-30. Late infections after blood progenitor cell transplantation in patients with multiple myeloma. Steingrimsdottir H, Gruber A, Kalin M, Björkholm M. Comment on: Am J Med. 1999 Feb;106(2):191-7. PMID: 11247597 [PubMed - indexed for MEDLINE] 2075. Masui. 2001 Feb;50(2):160-3. [Preliminary report: the efficacy of clonidine hydrochloride ointment for postherpetic neuralgia] [Article in Japanese] Meno A, Arita H, Hanaoka K. Department of Anesthesiology and Pain Relief Center, University of Tokyo Hospital, Tokyo 113-8655. The combination of clonidine hydrochloride, alpha 2-agonist, and opioid is useful for relieving the pain due to surgical procedures or cancer. The routes of administrations used are intravenous, intramuscular as well as intrathecal, epidural and transmucosal. However, transdermal clonidine has not been reported. We, therefore, investigated the analgesic effect of local administration of clonidine ointment. Ten patients with postherpetic neuralgia (PHN) were selected randomly. They were requested to fill out a questionnaire after applying clonidine ointment (150 micrograms/ointment 1 g) to the painful area. Items included in the questionnaire were: effectiveness, visual analog scale (VAS) before and after the administration of clonidine ointment, onset time, with or without allodynia and effectiveness to allodynia in the former case, side effects, and patients' background. Analysis of the answers indicates that clonidine ointment produced a satisfactory effect in nine patients. Onset time was within a few minutes in most patients. No patients suffered any side effects. Specific mechanism of effectiveness or the site affected has not been confirmed in this study, but considering the quick onset, it is presumed that the site where the ointment was applied was the very site that was affected. Clonidine hydrochloride ointment was effective in relieving the symptoms of PHN. PMID: 11244770 [PubMed - indexed for MEDLINE] 2076. Pediatr Dent. 2001 Jan-Feb;23(1):44-50. Prevalence of orodental findings in HIV-infected Romanian children. Flaitz C, Wullbrandt B, Sexton J, Bourdon T, Hicks J. Division of Oral and Maxillofacial Pathology, Departments of Stomatology and Pediatric Dentistry, University of Texas-Houston Health Science Center, Dental Branch. cflaitz@mail.db.uth.tmc.edu BACKGROUND: Romania, the pediatric AIDS capital of the world, has tremendous unmet dental care needs for children and adolescents with HIV infection. The purpose of this study was to assess the prevalence of orodental conditions in symptomatic HIV-positive children from Constanta, Romania. METHODS: The children underwent dental examinations and treatment at Constanta Municipal Hospital by a volunteer team of dental healthcare professionals from the United States. Oral lesions and dental caries were recorded during an 8-day period prior to initiating comprehensive dental care. RESULTS: The study population consisted of 173 children (88 males; 85 females) with a mean age of 8.8 years (range 6 to 12 years). The primary HIV risk factor was contaminated needle reuse and/or blood products (88%). The most common oral and perioral lesions included: candidiasis (29%), ulcers (15%), salivary gland disease (9%), necrotizing ulcerative gingivitis/periodontitis (5%), linear gingival erythema (4%), labial molluscum contagiosum (3%), oral warts (2%), hairy leukoplakia (2%), and herpes zoster (1%). One or more oral/perioral lesions occurred in 55% of the children. Severe dental caries was noted in the majority of children (dfs/dft 16.9/3.7 and DMFS/DMFT 8.1/3.1). Over-retention of primary teeth (25%) and delayed eruption (42%) were common. Postoperative complications included delayed clotting (common) and thrombocytopenia-induced bleeding disorders (4%). CONCLUSIONS: The oral healthcare needs of Romanian HIV-infected children are considerable, with the majority living with persistent, symptomatic oral disease. PMID: 11242731 [PubMed - indexed for MEDLINE] 2077. Prenat Diagn. 2001 Feb;21(2):121-4. Fetal varicella-herpes zoster syndrome in early pregnancy: ultrasonographic and morphological correlation. Petignat P, Vial Y, Laurini R, Hohlfeld P. Department of Gynecology and Obstetrics, CHUV, Lausanne, Switzerland. ppetignat@hotmail.com We report a case of an intrauterine fetal infection by the varicella-herpes zoster virus following maternal varicella at 17 weeks' amenorrhea. Prenatal diagnosis of fetal infection was confirmed by serology and fetal damage by ultrasonography. Autopsy of the fetus showed multiorgan manifestation with disseminated foci of necrosis and microcalcifications, encephalitis and unilateral segmental skin scarring with an underlying hypoplastic fixed lower limb. The placenta showed a multifocal chronic villitis with multinucleated giant cells. The lesions included segmental anomalies and multiorgan damage. Copyright 2001 John Wiley & Sons, Ltd. PMID: 11241539 [PubMed - indexed for MEDLINE] 2078. Int J STD AIDS. 2001 Feb;12(2):79-83. Varicella zoster virus-associated neurological disease in HIV-infected patients. Brown M, Scarborough M, Brink N, Manji H, Miller R. Department of Sexually Transmitted Diseases, Windeyer Institute of Medical Sciences, Royal Free and University College Medical School, University College London, UK. Varicella zoster virus (VZV) is an uncommon but well recognized cause of neurological disease in HIV-infected patients. Analysis of cerebrospinal fluid (CSF) using the polymerase chain reaction (PCR) in HIV-infected patients presenting with neurological disease has increasingly allowed diagnosis of VZV-associated pathology. We report clinical, radiological and virological data from 15 consecutive patients with VZV-associated neurological disease. Clinical presentation was varied, including meningo-encephalitis in 9 and isolated cranial nerve palsies in 6. VZV deoxyribonucleic acid (DNA) was detected by PCR in CSF of 11/15; pleocytosis was present in only 6/15, raised protein in 11/15. Magnetic resonance imaging (MRI) appearances were focal signal abnormalities in 8, meningeal enhancement in 2 and normal in 2. With specific anti-VZV therapy 10 patients recovered fully. The predictive value of PCR on CSF for diagnosis of VZV-associated neurological disease should take into account the patient's clinical presentation, concurrent infections and response to anti-VZV therapy. PMID: 11236108 [PubMed - indexed for MEDLINE] 2079. J Assoc Physicians India. 2001 Feb;49:286-7. Herpes zoster-induced myocarditis in a patient with diabetes mellitus. Kundu AK. Department of Medicine, NRS Medical College, Calcutta 700 014. Myocarditis as a complication of herpes zoster is very rare. I present the case of a middle-aged adult male with diabetes mellitus complicated by myocarditis following herpes zoster infection, the second reported case in Indian literature so far. PMID: 11225150 [PubMed - indexed for MEDLINE] 2080. Pediatr Infect Dis J. 2001 Feb;20(2):226-8. Herpes simplex mimicking herpes zoster in a child immunized with varicella vaccine. Takayama N, Takayama M, Takita J. Department of Pediatrics, Tokyo Metropolitan Komagome Hospital, Japan. takyamnd-k@komagome-hospital.bunkyo.tokyo.jp A 5-year-old boy had zosteriform vesicular lesions 4 years after immunization with varicella vaccine. PCR analyses of DNA extracted from the crusts revealed herpes simplex virus type 1 infection. Virologic examinations should be performed before the vesicular lesion is attributed to the varicella-zoster virus vaccine strain. PMID: 11224851 [PubMed - indexed for MEDLINE] 2081. Gastroenterol Hepatol. 2001 Jan;24(1):47. [Fulminant infection caused by varicella herpes zoster in patient with Crohn disease undergoing treatment with azathioprine] [Article in Spanish] Vergara M, Brullet E, Campo R, Calvet X, Blanch L. Comment on: Gastroenterol Hepatol. 2000 Jan;23(1):7-8. PMID: 11219139 [PubMed - indexed for MEDLINE] 2082. Epidemiol Infect. 2000 Dec;125(3):651-69. Modelling the impact of immunization on the epidemiology of varicella zoster virus. Brisson M, Edmunds WJ, Gay NJ, Law B, De Serres G. PHLS Communicable Disease Surveillance Centre, London. The objective of this study was to develop and apply a dynamic mathematical model of VZV transmission to predict the effect of different vaccination strategies on the age-specific incidence and outcome of infection. To do so a deterministic realistic age-structured model (RAS) was used which takes account of the increased potential for transmission within school aged groups. Various vaccine efficacy scenarios, vaccine coverages and vaccination strategies were investigated and a sensitivity analysis of varicella incidence predictions to important parameters was performed. The model predicts that the overall (natural and breakthrough) incidence and morbidity of varicella would likely be reduced by mass vaccination of 12-month-old children. Furthermore, adding a catch-up campaign in the first year for 1-11 year olds seems to be the most effective strategy to reduce both varicella incidence and morbidity (in the short and long term), though with the possible detrimental effect of increasing the incidence of zoster. PMID: 11218215 [PubMed - indexed for MEDLINE] 2083. AIDS. 2001 Jan 26;15(2):223-9. Herpes zoster and HIV-1 infection in a rural Ugandan cohort. Morgan D, Mahe C, Malamba S, Okongo M, Mayanja B, Whitworth J. Medical Research Council Programme on AIDS/Uganda Virus Research Institute, Entebbe. OBJECTIVE: To compare the rates and clinical features of herpes zoster in HIV-positive and HIV-negative individuals in a cohort in rural Uganda; to report the incidence of herpes zoster in the HIV-positive group in relation to seroconversion and CD4 cell counts and to determine whether it is indicative of a more rapid progression to death. DESIGN: A prospective population-based cohort. METHODS: The cohort comprised 107 prevalent and 144 incident (with documented dates of seroconversion) participants with HIV infection and 231 HIV-negative controls who were reviewed routinely every 3 months. RESULTS: The mean rate of herpes zoster was 53.6/1000 person-years in HIV-positive and 4.4 in HIV-negative participants. The cumulative incidence of a first episode of herpes zoster was 7.6% at 2 years, 12.6% at 4 years and 24.0% at 6 years after seroconversion; the incidence rate was 35.6/1000 person-years. There was no evidence of a significant effect of age, gender, period from seroconversion or CD4 cell count on this incidence rate. Herpes zoster was an indicator of HIV-1 infection in this population but not an indicator of more rapid progression to death after adjusting for CD4 cell count and age. CONCLUSIONS: The rates, including the cumulative incidence after seroconversion and the clinical presentation of herpes zoster, were similar to those reported from industrialized countries. Although an indicator of HIV-1 infection in this population, herpes zoster was unrelated to CD4 cell count or period from seroconversion and did not lead to a faster disease progression. PMID: 11216931 [PubMed - indexed for MEDLINE] 2084. Masui. 2000 Nov;49(11):1204-9. [Relief of subacute herpetic pain and postherpetic neuralgia with repeated application of 10% lidocaine cream] [Article in Japanese] Iseki M, Mitsuhata H, Miyazaki T, Toriumi E, Yoshino K. Department of Anesthesiology, Juntendo University School of Medicine, Tokyo 113-0033. Analgesic efficacy of repeated application of a lidocaine cream formula was investigated in herpes zoster patients with subacute pain with no further improvement after continued treatment since their acute stage (S-HZ group, n = 23), and in patients to whom past treatments had not provided adequate pain relief (PHN group, n = 28). In both groups, visual analog scale (VAS) values decreased significantly from their corresponding values before the present treatment with few cases of side effects and complete disappearances of the pain in 21.6% of all the patients. The results indicate that the repeated application of the lidocaine cream is a safe and effective treatment method. Significantly higher effectiveness was achieved in the S-HZ group in terms of the difference in the VAS values between before and after the treatment, effectiveness in improving the activities of daily life, and overall efficacy evaluation. PMID: 11215225 [PubMed - indexed for MEDLINE] 2085. Rev Belge Med Dent. 2000;55(3):149-238. [Nosologic descriptions of lesions of the oral mucosa] [Article in French] Reychler H, Mahy P, Thoné M. Service de stomatologie et de chirurgie maxillo-faciale Université Catholique de Louvain Cliniques Universitaires Saint-Luc 15 avenue Hippocrate 1200 Bruxelles. This article describes extensively and systematically oral mucosa diseases. Macroscopical aspects are particularly described in order to give the dentist all important elements of differential diagnosis. This nosological description is based on a clinical approach: white and pigmented lesions are distinguished from ulcerated and benign so as malignant tumoral lesions. Specifically on the oral mucosa located lesions and oral mucosa lesions of systemic diseases are described. PMID: 11210657 [PubMed - indexed for MEDLINE] 2086. Rev Neurol. 2000 Dec 16-31;31(12):1252-6. [Infectious and metabolic nervous system complications of systemic cancer] [Article in Spanish] Ortiz N. Sección de Neurología, Hospital Universitari Sant Joan, Reus, Tarragona, España. nortizc@galenics.com OBJECTIVE: To review the incidence and causes of the infections and metabolic diseases of the nervous system in patients with systemic neoplasias. DEVELOPMENT: Patients with immunodeficiency, particularly those with hematological neoplasias and persons treated with immunosuppressive drugs have a considerable tendency to infection due to opportunist germs. Infections of the nervous system are relatively rare (0.02%-1%) and the commonest neoplasms are lymphomas, especially those of Hodgkin type and lymphosarcomas. The most frequent infections are caused by the herpes virus, meningitis due to Listeria monocytogenes and the meningitis due to fungi (Aspergillus, Candida and Cryptococcus). Cerebral abscesses, although rarer, are relatively common and are caused by gram negative bacteria, fungi and toxoplasmosis. In recent years there has been a notable increase in the number of patients diagnosed as having progressive multifocal leukoencephalopathy due to the possibility of carrying out studies to detect the DNA of the JC virus by polymerase chain reaction techniques. Empirical treatment of patients with neurological infections and systemic cancer should be started following the guidelines for immunodepressed patients. The metabolic complications of these patients are mainly due to hormone overproduction, hydroelectrolytic changes and vitamin deficits, which in general cause alterations of mental function of the confusion state type. CONCLUSION: In all patients with an infection or metabolic complication involving the nervous system, the presence of a systemic neoplasm makes it necessary to vary both the diagnostic approach and the empirical therapeutic measures taken. PMID: 11205570 [PubMed - indexed for MEDLINE] 2087. Contact Dermatitis. 2001 Feb;44(2):104. Allergic contact dermatitis from benzocaine ointment during treatment of herpes zoster. Roos TC, Merk HF. Department of Dermatology, University Clinic of the RWTH Achen, Germany. PMID: 11205383 [PubMed - indexed for MEDLINE] 2088. Cutis. 2001 Jan;67(1):43-6. Recurrent disseminated herpes zoster and cytomegalic perianal ulcer: a case report and review of the literature. Barbarulo AM, Metha N, Bucalo B, Rendon MI. Cleveland Clinic, Fort Lauderdale, Florida, USA. We describe a patient with lymphocytic leukemia who developed multiple, disseminated, vesiculopustular eruptions in combination with perianal ulcer. Four years earlier, she had a herpes zoster (HZ) infection involving the ophthalmic division of her left trigeminal nerve with subsequent postherpetic neuralgia that was treated with steroids. After the studies, we concluded that the patient had a recurrent disseminated HZ infection and perianal ulcer caused by cytomegalovirus (CMV). PMID: 11204603 [PubMed - indexed for MEDLINE] 2089. J Eur Acad Dermatol Venereol. 2000 Jul;14(4):317-9. A case of herpes zoster misdiagnosed and treated as unstable angina pectoris. Ozdemir R, Tuncer C, Güven A, Sezgin AT. PMID: 11204530 [PubMed - indexed for MEDLINE] 2090. Am Fam Physician. 2001 Jan 15;63(2):257-68. Common infections in older adults. Mouton CP, Bazaldua OV, Pierce B, Espino DV. The University of Texas Health Science Center at San Antonio, 78284-7795, USA. mouton@uthscsa.edu Infectious diseases account for one third of all deaths in people 65 years and older. Early detection is more difficult in the elderly because the typical signs and symptoms, such as fever and leukocytosis, are frequently absent. A change in mental status or decline in function may be the only presenting problem in an older patient with an infection. An estimated 90 percent of deaths resulting from pneumonia occur in people 65 years and older. Mortality resulting from influenza also occurs primarily in the elderly. Urinary tract infections are the most common cause of bacteremia in older adults. Asymptomatic bacteriuria occurs frequently in the elderly; however, antibiotic treatment does not appear to be efficacious. The recent rise of antibiotic-resistant bacteria (e.g., methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococcus) is a particular problem in the elderly because they are exposed to infections at higher rates in hospital and institutional settings. Treatment of colonization and active infection is problematic; strict adherence to hygiene practices is necessary to prevent the spread of resistant organisms. PMID: 11201692 [PubMed - indexed for MEDLINE] 2091. Acta Derm Venereol. 2000 Sep-Oct;80(5):391-2. Zosteriform metastasis of occult bronchogenic carcinoma. Bianchi L, Orlandi A, Carboni I, Costanzo A, Chimenti S. PMID: 11200850 [PubMed - indexed for MEDLINE] 2092. J Endod. 2000 Aug;26(8):469-71. Zebra. XIX. Part 2. Oral herpes zoster. Rauckhorst AJ, Baumgartner JC. Department of Endodontology, Oregon Health Sciences University School of Dentistry, 611 S.W. Campus Drive, Portland, OR 97201, USA. PMID: 11199782 [PubMed - indexed for MEDLINE] 2093. Health News. 2001 Jan;7(1):6. New treatment for postherpetic neuralgia. [No authors listed] PMID: 11198414 [PubMed - indexed for MEDLINE] 2094. J Perinatol. 2000 Dec;20(8 Pt 1):548-54. The congenital varicella syndrome. Sauerbrei A, Wutzler P. Institute for Antiviral Chemotherapy, Friedrich-Schiller University Jena, H. Winzeulaer Strasse 10, D-07745 Jena, Germany. Maternal varicella during the first two trimesters of pregnancy may cause the congenital varicella syndrome (CVS). After infection in the first 20 weeks' gestation, the incidence is estimated to be about 2%. To date, nearly 100 infants born with signs of CVS have been reported in the literature, more than three quarters of them during the last two decades. The characteristic symptoms consist of skin lesions in dermatomal distribution (76%), neurologic defects (60%), eye diseases (51%), and skeletal anomalies (49%). About 30% of infants born with these lesions died in the first months of life. The diagnosis of CVS should be established by the appearance of maternal varicella, the presence of typical clinical symptoms as well as the laboratory evidence of in utero varicella-zoster virus (VZV) infection. In the reviewed infants, intrauterine VZV-infection has been proved in about 60%. Passive immunization may reduce the risk of fetal infection but there is no evidence to prevent fetal viremia. Up to now, there are no controlled studies concerning antiviral chemotherapy in preventing CVS. PMID: 11190597 [PubMed - indexed for MEDLINE] 2095. N Engl J Med. 2001 Jan 4;344(1):65-6. Guillain-Barré syndrome after reactivation of varicella-zoster virus. Roccatagliata L, Uccelli A, Murialdo A. Comment on: N Engl J Med. 2000 Mar 2;342(9):635-45. PMID: 11187118 [PubMed - indexed for MEDLINE] 2096. Vestn Otorinolaringol. 2000;(6):35. [Severe course of herpes zoster oticus] [Article in Russian] Zagaĭnova NS, Artem'eva AE. PMID: 11187076 [PubMed - indexed for MEDLINE] 2097. Arq Bras Cardiol. 2000 Dec;75(6):523-30. Pseudo-myocardial infarction during an episode of herpes zoster. [Article in English, Portuguese] Franken RA, Franken M. Faculdade de Ciências Médicas, Santa Casa de São Paulo, São Paulo, SP, Brazil. The patient arrived at the emergency unit with a history of acute myocardial infarction, for which she was treated. Without improvement in the pain, the patient developed heart failure and underwent a hemodynamic study, which showed normal coronary arteries and extensive ventricular impairment. During evolution, the clinical findings improved and herpes zoster appeared on the right shoulder. In a few months the clinical findings subsided, and the findings of the electrocardiogram, chest X-ray, and ventricular function were normal. The patient is currently asymptomatic. PMID: 11175476 [PubMed - indexed for MEDLINE] 2098. J Am Acad Dermatol. 2001 Feb;44(2 Suppl):391-4. Persistent verrucous varicella as the initial manifestation of HIV infection. Zampogna JC, Flowers FP. University of Florida, College of Medicine, Gainsville, USA. Clinical presentations of varicella-zoster virus (VZV) infection may vary widely among healthy and immunocompromised patients. In addition, the recurrence of VZV infection with cutaneous manifestations in both of these populations is more common than was once believed. Most cases of verrucous varicella infection have been reported in patients with documented immunosuppression (most commonly HIV/AIDS). We present an unusual case of persistent verrucous varicella, which was the initial manifestation of HIV infection, in a previously "healthy" 3-year-old girl with a strong family history of Wiskott-Aldrich Syndrome. Current research, therapeutic options, and differential diagnoses with regard to VZV infection are briefly reviewed. PMID: 11174425 [PubMed - indexed for MEDLINE] 2099. Mol Diagn. 2000 Dec;5(4):279-84. Detection of herpes simplex virus and varicella-zoster virus in clinical swabs: frequent inhibition of PCR as determined by internal controls. Bezold G, Volkenandt M, Gottlöber P, Peter RU. Department of Dermatology, University of Ulm, Oberer Eselsberg 40, 89081 Ulm, Germany. BACKGROUND: PCR-based detection of microorganisms is widely used for diagnostic purposes. Most routine PCR applications do not control for inhibition of PCR, thus leading to false-negative results. METHODS AND RESULTS: One hundred eighteen swab samples obtained from skin and mucosa were investigated for the presence of herpes simplex virus (HSV), varicella-zoster virus (VZV), and the control gene betaglobin by internally controlled PCR with purified and unpurified DNA in parallel. With unpurified DNA, inhibition of PCR was detected in 23% of betaglobin PCRs, 25% of VZV PCRs, and 16% of HSV PCRs versus 3% each for purified DNA. Approximately 20% of the samples with positive results for HSV or VZV had negative or inhibited results using unpurified DNA. CONCLUSION: These results indicate that PCR from clinical swab specimens should be performed exclusively with internal controls because the positive control alone cannot exclude PCR inhibition in individual samples. Purification of DNA will decrease, but not exclude, PCR inhibition. PMID: 11172491 [PubMed - indexed for MEDLINE] 2100. Acta Ophthalmol Scand. 2000 Dec;78(6):651-5. Morphology of epithelial keratitis in herpes zoster ophthalmicus. A non-contact photomicrographic in vivo study in the human cornea. Tabery HM. Department of Ophthalmology, Malmö University Hospital, Sweden. PURPOSE: To investigate the in vivo morphology of epithelial changes in acute herpes zoster keratitis. METHODS: 10 patients with acute disease. In 7, systemic acyclovir treatment was started at presentation, in 2 < or = 24 hours before, 1 was not treated. The corneae were examined with the slit lamp, followed intermittently for 3-30 days, and photographed at intervals ranging between 1 to 7 days. RESULTS: All but one patient had epithelial changes at presentation; all developed new ones. The smallest discernible entities were abnormal cells of about 10-15 microm in diameter, singular or grouped. Larger foci measured about 100-200 microm. 2 patients showed pseudodendrites at presentation, and further 3/9 observed > or = 2 weeks developed them. Some lesions showed white surface plaques. No ulcerations were observed. Healing occurred < or = 10-22 days after the onset of symptoms. CONCLUSIONS: The study seemed to have followed the natural course of the disease. The rapidly changing morphology in the absence of ulcerative features indicated successive damage counteracted by reparative forces. PMID: 11167225 [PubMed - indexed for MEDLINE] 2101. Am J Ophthalmol. 2001 Jan;131(1):25-9. Longitudinal analysis of varicella-zoster virus DNA on the ocular surface associated with herpes zoster ophthalmicus. Zaal MJ, Völker-Dieben HJ, Wienesen M, D'Amaro J, Kijlstra A. Department of Ophthalmology, University Hospital Vrije Universiteit, Amsterdam, The Netherlands. mjw.zaal@azu.nl PURPOSE: Longitudinal analysis of varicella-zoster virus DNA on the ocular surface of patients with herpes zoster ophthalmicus. METHODS: Clinical specimens were obtained from the bulbar conjunctival surface with a cotton-tipped swab at weekly intervals for 6 consecutive weeks from 21 patients with acute ophthalmic zoster with a skin rash duration of less than 7 days. All patients received oral valacyclovir 1000 mg three times daily for 10 days without additional corticosteroids. The swabs were analyzed by means of polymerase chain reaction for the presence of varicella-zoster virus and herpes simplex virus type 1 DNA. Conjunctival swabs were also obtained from a control group of 20 patients with cataract. RESULTS: On inclusion, varicella-zoster virus DNA was present on the ocular surface of 19 of the 21 patients. Six varicella-zoster virus DNA-positive patients had no signs of ocular inflammation. All control swabs were negative for both varicella-zoster virus and herpes simplex virus DNA. The duration of varicella-zoster virus DNA detection from rash onset varied from 2 to 34 days. The number of days between the onset of herpes zoster skin rash and the latest positive varicella-zoster virus DNA test was significantly longer in patients whose age was equal to or above the median age of 66 years than in the younger patients (Mann-Whitney test: P =.0004). At 6-week follow-up, all conjunctival swabs were negative for varicella-zoster virus DNA. However, at that time, the eyes of seven patients were still inflamed. CONCLUSION: The duration of varicella-zoster virus DNA shedding in herpes zoster ophthalmicus is highly variable and age dependent, and is probably related to the host immune response. PMID: 11162975 [PubMed - indexed for MEDLINE] 2102. Virology. 2001 Feb 1;280(1):1-6. Identification and mapping of single nucleotide polymorphisms in the varicella-zoster virus genome. Faga B, Maury W, Bruckner DA, Grose C. Department of Microbiology, University of Iowa, Iowa City, Iowa 52242, USA. PMID: 11162813 [PubMed - indexed for MEDLINE] 2103. J Antimicrob Chemother. 2001 Feb;47 Suppl T1:1-8. Herpes zoster--predicting and minimizing the impact of post-herpetic neuralgia. Johnson R. Pain Management Clinic, Department of Anaesthesia, Bristol Royal Infirmary, Marlborough Street, Bristol BS2 8HW, UK. robert.johnson@ubht.swest.nhs.uk Herpes zoster results from reactivation of latent varicella-zoster virus in the dorsal root ganglia and is frequently associated with severe pain. Most patients suffer acute pain during the rash phase, and in many, prodromal pain or discomfort also precedes the rash. The pain of herpes zoster gradually resolves with time, but may persist after the acute disease as post-herpetic neuralgia for weeks, months or even years. Post-herpetic neuralgia, the most common complication of herpes zoster, often results in significant morbidity and healthcare resource usage. Early treatment with oral antivirals has been shown to accelerate the resolution of postherpetic neuralgia, with therapeutic effects particularly evident in the over-50 age group, where pain generally persists for longer. Progressively increasing life expectancy of the population translates to increasing numbers of cases of herpes zoster. The socio-economic gains associated with active management, including use of oral antivirals where indicated, to speed resolution of pain and post-herpetic neuralgia, readily justify additional cost. PMID: 11160029 [PubMed - indexed for MEDLINE] 2104. Dermatol Clin. 2001 Jan;19(1):23-34. Antiviral agents. Brown TJ, Vander Straten M, Tyring SK. Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, Texas, USA. The potential severity of many viral infections and the lack of appropriate treatment for these diseases have been a source of endless frustration and helplessness for clinicians. The newly developed field of antiviral therapy is expanding at an astounding rate, with new discoveries each day. Although physicians are not yet able to cure many of the viral infections, such as HSV, HIV, and CMV, a means of controlling them is available. It is hoped that the research and investigations currently under way will lead to a future era of antiviral drugs that will be able to eradicate these diseases. PMID: 11155584 [PubMed - indexed for MEDLINE] 2105. Clin J Pain. 2000 Dec;16(4):345-51. Risk and prognostic factors of postherpetic neuralgia and focal sensory denervation: a prospective evaluation in acute herpes zoster ophthalmicus. Zaal MJ, Völker-Dieben HJ, D'Amaro J. University Hospital Vrije Universiteit, Amsterdam, The Netherlands. mjw.zaal@azvu.nl OBJECTIVES: To determine the general risk and the prognostic factors of postherpetic neuralgia and focal sensory denervation in ophthalmic zoster disease. STUDY DESIGN: A prospective clinical study. SETTING: An ophthalmic practice participating in an eye-care network. PATIENTS: A cohort of 81 immunocompetent adult patients with herpes zoster ophthalmicus and referred by their general practitioner during the acute phase of the disease. METHODS: Various acute phase clinical parameters were determined via patient history and regular ophthalmic examinations. At a 2-month follow-up, the intensity of postherpetic neuralgia, rated on a 4-point verbal scale, and focal sensory denervation was determined. Skin tactile sensation within the ophthalmic dermatomes was tested with use of a cotton-wool tip, and corneal sensitivity was measured with use of a Cochet-Bonnet esthesiometer by comparing each eye. Statistical analysis was performed via chi2 analysis or Fisher exact test to identify prognostic factors of postherpetic neuralgia and focal sensory denervation at a 2-month follow-up. RESULTS: At a 2-month follow-up, pain of varying intensity was reported by 38 participants (47%). Of these patients, 25 patients (31%) rated their pain as mild, 8 patients (10%) rated their pain as moderate pain, and 5 patients (6%) rated their pain as severe. At that time, focal loss of normal skin or corneal sensation was detected in 49 patients (60%). Patient age, acute neuralgia score, manifestation and extent of acute skin rash, signs of ocular inflammation, and nontrigeminal cranial nerve involvement were all associated with prolonged pain and tactile sensory loss. CONCLUSIONS: The severity of acute skin rash, based on a specific manifestation of cutaneous herpes zoster eruptions, and the extent of infection to other neural pathways were clearly associated with postherpetic neuralgia and focal sensory denervation at a 2-month follow-up. These findings suggest that the inability of the immune system to control the spread of replicating varicella-zoster virus in the initial phase of the disease is an important factor in the pathogenesis of chronic zoster-related neuropathy. PMID: 11153792 [PubMed - indexed for MEDLINE] 2106. Bone Marrow Transplant. 2000 Dec;26(11):1193-7. Monitoring four herpesviruses in unrelated cord blood transplantation. Tanaka N, Kimura H, Hoshino Y, Kato K, Yoshikawa T, Asano Y, Horibe K, Kojima S, Morishima T. Department of Pediatrics, Nagoya University School of Medicine, Japan. Cord blood transplantation, which has lower risk of graft-versus-host disease than bone marrow transplantation, might have higher risk of infections. A system to quantify four herpesviruses, CMV, human herpesvirus 6 (HHV6), EBV, varicella-zoster virus using the real-time PCR assay was established and applied for prospective viral load monitoring in three recipients undergoing cord blood transplantation. CMV and HHV6 were detected in peripheral blood from all three recipients, while EBV was detected in two. Varicella-zoster virus was not detected at all. At the peak of HHV6 or CMV, each patient showed virus-related symptoms. During the pre-transplant period, CMV DNA was detected in two recipients who later developed CMV-related diseases. These observations indicate that our system is not only useful for managing herpesviruses infections in transplant recipients, but also a powerful method for clarifying the relationships between the viral load and clinical symptoms. PMID: 11149730 [PubMed - indexed for MEDLINE] 2107. Endocrinol Metab Clin North Am. 2000 Dec;29(4):813-29. Ophthalmologic emergencies in the patient with diabetes. Wipf JE, Paauw DS. Department of Medicine, University of Washington, Seattle, Washington, USA. jwipf@u.washington.edu Diabetes is associated with many emergent ophthalmologic conditions. The management of patients with diabetes requires careful monitoring for visual symptoms and frequent physical examination for signs of retinopathy. Randomized studies have documented a significant reduction in the development of new retinopathy and the progression of existing retinopathy with tight control of diabetes. Photocoagulation laser therapy is helpful in preserving vision in severe nonproliferative retinopathy, for proliferative retinopathy, and for clinically significant macular edema. Vascular events include arterial and venous occlusions and cranial nerve palsies; important diagnostic clues are visual symptoms and the findings of ocular and neurologic examinations. Life-threatening infections associated with diabetes include endophthalmitis and mucormycosis, which require prompt diagnosis to prevent blindness or systemic infection. Herpes zoster infection, which is common in older patients and in patients with immunosuppression, may affect the trigeminal nerve and cause anterior uveitis and keratitis. Patients with zoster and skin vesicles on the face need emergent ophthalmologic evaluation and treatment because untreated ocular infection and inflammation may lead to scarring and synechiae formation in the anterior chamber, resulting in vision loss. PMID: 11149164 [PubMed - indexed for MEDLINE] 2108. Dermatology. 2000;201(4):321-5. Mucocutaneous manifestations in Japanese HIV-positive hemophiliacs. Shimizu S, Chen KR, Tagami H, Hanabusa H. Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan. satoko.shimizu@nifty.ne.jp BACKGROUND: Although various mucocutaneous manifestations have been reported in patients infected with HIV by sexual transmission or intravenous drug use, the prevalence and characteristics of skin disorders in HIV-positive hemophiliacs coinfected with hepatitis C virus (HCV) have rarely been described. OBJECTIVE: The purpose of this study was to clarify the characteristics of skin disorders in HIV-positive hemophiliacs and to identify differences in comparison with other HIV-positive groups. METHODS: A prospective study of the prevalence of mucocutaneous manifestations in 110 Japanese hemophiliacs (53 HIV-positive hemophiliacs including 24 AIDS and 57 HIV-negative hemophiliacs) was performed from July 1997 to July 1998. RESULT: None of the hemophiliacs developed Kaposi's sarcoma or sexually transmitted skin diseases. Eosinophilic folliculitis was observed in 3 AIDS patients. The incidence of folliculitis, common warts, seborrheic dermatitis, generalized eczema, oral candidiasis and herpes zoster was higher in HIV-positive than in HIV-negative hemophiliacs (p < 0.05). Although anti-HCV antibody was positive in all HIV-positive hemophiliacs, HCV-related dermatoses such as lichen planus and porphyria cutanea tarda were not observed. CONCLUSION: Although Kaposi's sarcoma and sexually transmitted skin diseases such as molluscum contagiosum, condyloma, and scabies are frequently associated with HIV, they were not found in the HIV-positive hemophiliacs in our study. HIV infection-related mucocutaneous manifestations are influenced not only by the presence of HIV but also by other factors such as the mode of transmission and sexual habit. Copyright 2000 S. Karger AG, Basel PMID: 11146342 [PubMed - indexed for MEDLINE] 2109. Strahlenther Onkol. 2000 Nov;176(11):513-6. Herpes zoster in breast cancer patients after radiotherapy. Dunst J, Steil B, Furch S, Fach A, Bormann G, Marsch W. Department of Radiotherapy, Martin-Luther University Halle-Wittenberg, Germany. juergen.dunst@medizin.uni-halle.de PURPOSE: We have studied the incidence of herpes zoster in patients with adjuvant radiotherapy for breast cancer with special emphasis on possible correlations with other prognostic factors or survival. PATIENTS AND METHODS: From 1/1985 through 12/1993, 1,155 breast cancer patients received postoperative radiotherapy with curative intent in our department. After mastectomy 961 patients were irradiated and after breast-preserving treatment 194 patients. The age ranged from 34 to 79 years, the median follow-up was 3.1 years (range: 0.3 to 12.4 years). There were 443 women (38%) pre- and 712 (62%) postmenopausal. 21% had T3- to T4-tumors, 55% had axillary lymph node involvement, and 65% received additional systemic hormonal and/or cytotoxic therapy. In case of postmastectomy radiotherapy, the lateral chest wall and lymphatics (axilla, parasternal and supraclavicular nodes) were irradiated with an anterior photon field to 50 Gy (axilla 44 Gy) and most of the chest wall with an electron field to 44 Gy in 2-Gy fractions. After breast-preservation, the breast was irradiated via tangential fields with 6- to 8-MV photons up to 50 Gy plus 8 Gy electron boost to the tumor bed. Most of the patients were followed routinely in the department for 2 to 5 years. The frequency of zoster was determined retrospectively by reviewing the patients' records. RESULTS: A zoster after radiotherapy occurred in 41/1,155 patients (3.7%), mostly within the first 2 years after completion of radiotherapy. All infections remained localized and there was no evidence for systemic infections. Type of treatment (mastectomy vs breast-preservation) had no impact on the frequency of herpes zoster (36/961 patients after mastectomy and 5/194 patients after breast-preservation). There was also no correlation with other prognostic factors such as age, menopausal status, stage of disease or the use of adjuvant chemotherapy, nor was the occurrence of zoster linked to the degree of acute skin reaction in the radiation field. Moreover, patients with zoster had the same prognosis as compared to patients without zoster with regard to local control and survival. CONCLUSIONS: The observed frequency of zoster (about 4% of patients after postoperative radiotherapy) in this retrospective study suggests that the risk of developing zoster in this patient group may be 3- to 5-fold higher as compared to the incidence in the general population. However, the occurrence of zoster was not linked to prognosis and treatment response. PMID: 11143525 [PubMed - indexed for MEDLINE] 2110. J Neurosurg. 2000 Dec;93 Suppl 3:165-8. Treatment of postherpetic trigeminal neuralgia with the gamma knife. Urgosík D, Vymazal J, Vladyka V, Liscák R. Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic. urgo@zero.cz OBJECT: Postherpetic neuralgia is a syndrome characterized by intractable pain. Treatment of this pain has not yet been successful. Patients with postherpetic neuralgia will therefore benefit from any progress in the treatment strategy. The authors performed gamma knife radiosurgery (GKS) as a noninvasive treatment for postherpetic trigeminal neuralgia (TN) and evaluated the success rate for pain relief. METHODS: Between 1995 and February 1999, six men and 10 women were treated for postherpetic TN; conservative treatment failed in all of them. The median follow up was 33 months (range 8-34 months). The radiation was focused on the root of the trigeminal nerve in the vicinity of the brainstem (maximal dose 70-80 Gy in one fraction, 4-mm collimator). The patients were divided into five groups according to degree of pain relief after treatment. A successful result (excellent, very good, and good) was reached in seven (44%) patients and radiosurgery failed in nine (56%). Pain relief occurred after a median interval of 1 month (range 10 days-6 months). No radiation-related side effects have been observed in these patients. CONCLUSIONS: These results suggest that GKS for postherpetic TN is a relatively successful and safe method that can be used in patients even if they are in poor condition. In case this method fails, other treatment options including other neurosurgical procedures are not excluded. PMID: 11143238 [PubMed - indexed for MEDLINE] 2111. Schweiz Med Wochenschr. 2000;Suppl 125:89S-91S. [Advantage of screening for for infection in suddden and progressive hearing loss] [Article in French] Gagnebin J, Maire R. Service d'ORL et de chirurgie cervico-faciale, CHUV, Lausanne. Joel.Gagnebin@chuv.hospvd.ch OBJECTIVE: The aim of this retrospective study was to assess the advantage of systematic screening for infection in patients presenting with sudden or progressive sensorineural hearing loss. METHOD: 175 patients were included. 102 patients presented with unilateral sudden sensorineural hearing loss and 73 with progressive sensorineural hearing loss. Serologies tested were herpes simplex and zoster (IgM and IgG titres), Lyme disease (ELISA), syphilis (FTA-abs and MHA-TP) and HIV. RESULTS: Screening for infection was negative in 172 patients. 2 patients had positive serology for Lyme disease and one for syphilis. The case of serological syphilis was finally diagnosed as latent syphilis after ruling out neurosyphilis. Both cases of suspected Lyme disease were later invalidated by Western blot and lumbar puncture (2 false positives). CONCLUSION: Screening for infection was positive only in 1/175 patients (0.6%), rendering diagnosis of latent syphilis possible. These results suggest that, on grounds of cost-effectiveness, testing for infection should be limited to and focused on patients with a positive clinical evaluation. PMID: 11141952 [PubMed - indexed for MEDLINE] 2112. J Pain Symptom Manage. 2000 Dec;20(6):449-58. Antidepressants and anticonvulsants for diabetic neuropathy and postherpetic neuralgia: a quantitative systematic review. Collins SL, Moore RA, McQuayHJ, Wiffen P. Pain Research, Nuffield Department of Anaesthetics, University of Oxford, Oxford Radcliffe Hospital, Headington, United Kingdom. To determine the relative efficacy and adverse effects of antidepressants and anticonvulsants in the treatment of diabetic neuroapathy and postherpetic neuralgia, published reports were identified from a variety of electronic databases, including Medline, EMBASE, the Cochrane Library and the Oxford Pain Relief Database, and from two previously published reviews. Additional studies were identified from the reference lists of retrieved reports. The relative benefit (RB) and number-needed-to-treat (NNT) for one patient to achieve at least 50 % pain relief was calculated from available dichotomous data, as was the relative risk (RR) and number-needed-to-harm (NH) for minor adverse effects and drug related study withdrawal. In diabetic neuropathy, 16 reports compared antidepressants with placebo (491 patient episodes) and three compared anticonvulsants with placebo (321). The NNT for at least 50 % pain relief with antidepressants was 3.4 (95 % confidence interval 2.6-4. 7) and with anticonvulsants 2. 7 (2. 2-3. 8). In postherpetic neuralgia, three reports compared antidepressants with placebo (145 patient episodes) and one compared anticonvulsants with placebo (225), giving an NNT with antidepressants of 2.1 (1. 7-3) and with anticonvulsants 3.2 (2.4-5). There was little difference in the incidence of minor adverse effects with either antidepressants or anticonvulsants compared with placebo, with 1VH (minor) values of about 3. For drug-related study withdrawal, antidepressants had an NNH (major) of 17 (11-43) compared with placebo, whereas with anticonvulsants there was no significant difference from placebo. Antidepressants and anticonvulsants had the same efficacy and incidence of minor adverse effects in these tzoo neuropathic pain conditions. There was no evidence that selective serotonin reuptake inhibitors (SSRIs) were better than older antidepressants, and no evidence that gabapentin was better than older anticonvulsants. In these trials patients were more likely to stop taking antidepressants than anticonvulsants because of adverse effects. PMID: 11131263 [PubMed - indexed for MEDLINE] 2113. J Med Virol. 2001 Jan;63(1):64-6. Rapid contamination of the environments with varicella-zoster virus DNA from a patient with herpes zoster. Yoshikawa T, Ihira M, Suzuki K, Suga S, Tomitaka A, Ueda H, Asano Y. Department of Paediatrics, Fujita Health University School of Medicine, Toyoake, Japan. tetsushi@med.nagota-u.ac.jp Patients with zoster are considered to be less contagious than varicella patients because their infection is localised. It is not known, however, when and for how long a spread of varicella-zoster virus (VZV) from a zoster patient begins and continues and the extent of virus spread from the patient. The polymerase chain reaction (PCR) was used to detect VZV DNA in samples obtained from the hands and throat of a patient with zoster and from her room environments including surfaces of the back of a chair, the door handle, the table and the air conditioner filter. VZV DNA was detected on the surfaces of the back of the seat and the table and in peripheral blood mononuclear cells (PBMCs) and serum on Day 4 of the illness. VZV DNAemia persisted for 4 days until Day 7 of the illness. It was also detected in samples collected from throat and the air conditioner filter on Days 6 and 7 of the illness respectively. All of the surfaces, that were examined in her home environment, were contaminated with VZV DNA by Day 7 of the illness. The present study showed rapid and wide spread of VZV DNA in the environment even from a patient with zoster. PMID: 11130889 [PubMed - indexed for MEDLINE] 2114. J Med Virol. 2001 Jan;63(1):52-6. Nested multiplex polymerase chain reaction for the diagnosis of cutaneous herpes simplex and herpes zoster infections and a comparison with electronmicroscopy. Jain S, Wyatt D, McCaughey C, O'Neill HJ, Coyle PV. Regional Virus Laboratory, Royal Victoria Hospital, Belfast, United Kingdom. Herpes simplex virus (HSV) and varicella zoster virus (VZV) are common causes of cutaneous and mucocutaneous vesicular eruptions. Laboratory diagnostic techniques include Tzanck smears, electronmicroscopy, antigen detection and viral culture. This paper describes a nested multiplex polymerase chain reaction with respective sensitivities of 0.0001, 0.01 and 0.1 TCID50 for VZV, HSV-1 and HSV-2. The assay was used in (a) a salvage capacity for slides already processed for electronmicroscopy, and (b) as a front-line assay for prospectively processed specimens. Sixty-two glass slides with vesicle lymph/scrapings from 58 patients with suspected cutaneous herpetic lesions were examined. The clinical presentations were described as atypical/not specified (24), VZV (20) or HSV (18), and involved eruptions from diverse anatomical sites, including the genitalia. Of the 62 specimens, 6 and 38 were positive by electronmicroscopy and multiplex PCR respectively, giving a comparative sensitivity of 16% for electronmicroscopy. Nested multiplex PCR identified 15 VZV and 20 HSV-1 infections. Where the clinical details indicated either HSV or VZV (38/62), nested multiplex PCR was statistically likely to be reactive (26/38 vs. 9/24) (chi2 P = 0.000004) whereas electronmicroscopy was not (4/38 vs. 2/24) (chi2 P= 0.77). Where the clinical details indicated VZV (20/62) or HSV (18/62), nested multiplex PCR was statistically more likely to confirm VZV (10/20 vs. 5/42) (chi2 P= 0.001) or HSV (9/18 vs. 11/44) (chi2 P = 0.05) respectively. Two suspected HSV and 6 suspected VZV infections were shown to be VZV and HSV respectively by nested multiplex PCR. PMID: 11130887 [PubMed - indexed for MEDLINE] 2115. Sante. 2000 Sep-Oct;10(5):311-3. [Uveitis in patients with HIV infection] [Article in French] Mwanza JC, Kayembe DL. Service d'ophtalmologie, Cliniques universitaires de Kinshasa, République démocratique du Congo. jcmwanza@hotmail.com We carried out a retrospective analysis of 581 patients with uveitis seen over an 11-year period, to determine the prevalence of HIV infection in these patients and to look for associated diseases and the possible causes of uveitis in HIV-infected patients. All patients underwent routine eye examination and most also underwent a general examination and complementary tests. The prevalence of HIV infection was 14.3% (89 patients). Anterior uveitis (62%) was the most frequent, followed by posterior uveitis (22%), panuveitis (12%) and intermediate uveitis (4%). Associated conditions or causes were identified in 88% of the HIV-infected patients, with herpes zoster ophthalmicus the most frequent (43 %), followed by tuberculosis (16%), CMV infection (12%) and toxoplasmosis (10%). Thus, uveitis in HIV-infected patients is frequently associated with opportunistic infections. PMID: 11125336 [PubMed - indexed for MEDLINE] 2116. Transplant Proc. 2000 Nov;32(7):1952-3. Primary varicella virus in adult renal transplant recipients: case reports. Ishikawa N, Tanabe K, Shimmura H, Tokumoto T, Toma H. Department of Urology, Tokyo Women's Medical University, Tokyo, Japan. PMID: 11120016 [PubMed - indexed for MEDLINE] 2117. Vaccine. 2000 Nov 22;19(7-8):916-23. The postmarketing safety profile of varicella vaccine. Sharrar RG, LaRussa P, Galea SA, Steinberg SP, Sweet AR, Keatley RM, Wells ME, Stephenson WP, Gershon AA. Worldwide Product Safety and Epidemiology, Merck Research Laboratories, BLB-30, PO Box 4, West Point, PA 19486, USA. sharrar@merck.com The postmarketing safety profile of varicella vaccine was evaluated by analyzing selected adverse experience reports temporally associated with the administration of the vaccine. There were 7963 reports voluntarily submitted to Merck for an overall reporting rate of 5.0 per 10000 doses of vaccine distributed. A varicella zoster virus (VZV) identification program detected the presence of the Oka vaccine strain in three individuals with an immune deficiency - two with pneumonia and one with hepatitis - and in three instances of secondary transmission from vaccinees with vesicular lesions to susceptible household contacts. The Oka vaccine strain was present in 23 patients and wild-type VZV was present in 15 patients with herpes zoster. Vesicular rashes that occurred within 2 weeks of vaccination were more likely to contain the presence of wild-type VZV, while vesicular rashes that occurred more than 2 weeks post-vaccination were more likely to contain the Oka vaccine strain. Eleven patients were hospitalized with complications of breakthrough varicella infection. PMID: 11115716 [PubMed - indexed for MEDLINE] 2118. Nursing. 2000 Nov;30(11):98. Varicella-zoster virus. Sheff B. St. Elizabeth's Medical Center, Brighton, Mass., USA. PMID: 11111670 [PubMed - indexed for MEDLINE] 2119. Ned Tijdschr Geneeskd. 2000 Nov 18;144(47):2257. [Diagnostic image (12). Ramsay Hunt syndrome] [Article in Dutch] van der Meer JW. Academisch Ziekenhuis, afd. Inwendige Geneeskunde, Nijmegen. A 17-year-old woman developed a unilateral facial paralysis with vesicles in the left ear and in the throat. This combination is known as Ramsay Hunt syndrome. PMID: 11109470 [PubMed - indexed for MEDLINE] 2120. Praxis (Bern 1994). 2000 Oct 26;89(43):1759-60. [Herpes zoster] [Article in German] Zimmermann I. Medizinische Universitäts-Poliklinik, Departement Innere Medizin, Kantonsspital Basel. PMID: 11103622 [PubMed - indexed for MEDLINE] 2121. Nat Med. 2000 Dec;6(12):1299-300. Varicella vaccine revisited. LaRussa P, Steinberg SP, Shapiro E, Vazquez M, Gershon AA. Comment on: Nat Med. 2000 Apr;6(4):451-4. PMID: 11100089 [PubMed - indexed for MEDLINE] 2122. Ophthalmology. 2000 Dec;107(12):2129-30. Diagnosing and treating herpetic anterior uveitis. Cunningham ET Jr. PMID: 11097582 [PubMed - indexed for MEDLINE] 2123. Int J Dermatol. 2000 Oct;39(10):766-8. Wolf's isotopic response: Trichophyton rubrum folliculitis appearing on a herpes zoster scar. Tüzün Y, Işçimen A, Göksügür N, Demirkesen C, Tüzün B. Department of Dermatology, Istanbul University Cerrahpaşa Medical Faculty, Turkey. ytuzun@superonline.com Comment in: Int J Dermatol. 2003 Aug;42(8):664-6. PMID: 11095197 [PubMed - indexed for MEDLINE] 2124. J Virol. 2000 Dec;74(24):11893-8. Varicella-zoster virus gene expression in latently infected and explanted human ganglia. Kennedy PG, Grinfeld E, Bell JE. Glasgow University Department of Neurology, Southern General Hospital, Glasgow, United Kingdom. P.G.Kennedy@clinmed.gla.ac.uk A consistent feature of varicella-zoster virus (VZV) latency is the restricted pattern of viral gene expression in human ganglionic tissues. To understand further the significance of this gene restriction, we used in situ hybridization (ISH) to detect the frequency of RNA expression for nine VZV genes in trigeminal ganglia (TG) from 35 human subjects, including 18 who were human immunodeficiency virus (HIV) positive. RNA for VZV gene 21 was detected in 7 of 11 normal and 6 of 10 HIV-positive subjects, RNA for gene 29 was detected in 5 of 14 normal and 11 of 11 HIV-positive subjects, RNA for gene 62 was detected in 4 of 10 normal and 6 of 9 HIV-positive subjects, and RNA for gene 63 was detected in 8 of 17 normal and 12 of 15 HIV-positive subjects. RNA for VZV gene 4 was detected in 2 of 13 normal and 4 of 9 HIV-positive subjects, and RNA for gene 18 was detected in 4 of 15 normal and 5 of 15 HIV-positive subjects. By contrast, RNAs for VZV genes 28, 40, and 61 were rarely or never detected. In addition, immunocytochemical analysis detected the presence of VZV gene 63-encoded protein in five normal and four HIV-positive subjects. VZV RNA was also analyzed in explanted fresh human TG and dorsal root ganglia from five normal human subjects over a period of up to 11 days in culture. We found a very different pattern of gene expression in these explants, with transcripts for VZV genes 18, 28, 29, 40, and 63 all frequently detected, presumably as a result of viral reactivation. Taken together, these data provide further support for the notion of significant and restricted viral gene expression in VZV latency. PMCID: PMC112472 PMID: 11090189 [PubMed - indexed for MEDLINE] 2125. J Virol. 2000 Dec;74(24):11464-71. Analysis of individual human trigeminal ganglia for latent herpes simplex virus type 1 and varicella-zoster virus nucleic acids using real-time PCR. Cohrs RJ, Randall J, Smith J, Gilden DH, Dabrowski C, van Der Keyl H, Tal-Singer R. Departments of Neurology, University of Colorado Health Sciences Center, Denver, Colorado 80262, USA. Herpes simplex virus type 1 (HSV-1) and varicella-zoster virus (VZV) establish latent infections in the peripheral nervous system following primary infection. During latency both virus genomes exhibit limited transcription, with the HSV-1 LATs and at least four VZV transcripts consistently detected in latently infected human ganglia. In this study we used real-time PCR quantitation to determine the viral DNA copy number in individual trigeminal ganglia (TG) from 17 subjects. The number of HSV-1 genomes was not significantly different between the left and right TG from the same individual and varied per subject from 42.9 to 677.9 copies per 100 ng of DNA. The number of VZV genomes was also not significantly different between left and right TG from the same individual and varied per subject from 37.0 to 3,560.5 copies per 100 ng of DNA. HSV-1 LAT transcripts were consistently detected in ganglia containing latent HSV-1 and varied in relative expression by >500-fold. Of the three VZV transcripts analyzed, only transcripts mapping to gene 63 were consistently detected in latently infected ganglia and varied in relative expression by >2,000-fold. Thus, it appears that, similar to LAT transcription in HSV-1 latently infected ganglia, VZV gene 63 transcription is a hallmark of VZV latency. PMCID: PMC112425 PMID: 11090142 [PubMed - indexed for MEDLINE] 2126. Med Pregl. 2000 May-Jun;53(5-6):309-12. [Otogenic herpes zoster--the Ramsay-Hunt syndrome] [Article in Croatian] Dankuc D, Milosević D, Komazec Z. Klinika za bolesti uva, grla i nosa, Klinicki centar, Novi Sad. INTRODUCTION: Herpes zoster is a viral disease caused by a specific neurotropic virus-varicella zoster, similar to varicella virus, but not identical. Herpes zoster oticus was described by Letulle in 1882 and Körner in 1884, but particularly studied by Ramsay Hunt who reported it as a herpetic disease of ganglion geniculi in 1907. Herpes zoster oticus associated with facial nerve paralysis is most commonly called the Ramsay-Hunt syndrome. MATERIAL AND METHODS: In this work, cases of herpes zoster oticus associated with facial nerve paralysis are shown. At the ORL Clinic in Novi Sad, in the period from 1996-1997, 5 cases with Ramsay-Hunt syndrome were treated. The diagnostic procedure involved analysis of anamnestic data, clinical examination, complete cochleovestibular investigation with electronystagmography (ENG), topodiagnostic investigation of facial nerve (Schirmer's test, stapedial reflex, electrogustometry), electromyographic investigation (EMG), laboratory and virusologic investigations. According to many statistical data, paralysis of facial nerve due to herpes zoster is after Bell's paralysis the most common cause of the disease. The efflorescence of auricula, face and neck, which are typical manifestations of the disease, may precede facial nerve paralysis for about a week or more, and therefore may be disregarded and misdiagnosed with Bell's paralysis. The peripheral paralysis of this nerve in herpes zoster has an unfavorable course. More than 75% of patients have consequences of paralysis (paresis, hemispasm, synkinesia etc.). Regarding the unfavorable recovery period in herpes zoster, we managed our patients accordingly. CONCLUSION: Herpes zoster oticus is a common cause of peripheral facial nerve paralysis. The clinical course is not as favorable as in Bell's paralysis. It may be associated with sensorineural hearing disorder, vertigo and paralysis of other cranial nerves. The therapeutic procedures in Ramsay-Hunt syndrome include administration of conservative therapy and surgical intervention. We performed surgery in 2 and conservative therapy in 3 patients. Facial nerve decompression is indicated in persistent paralyses, or in cases without clear clinical signs of recovery after 6 weeks-2 months from the onset of the disease. The site of decompression is determined by topodiagnostic investigations. PMID: 11089377 [PubMed - indexed for MEDLINE] 2127. N Engl J Med. 2000 Nov 23;343(21):1563-5. A new treatment for postherpetic neuralgia. Watson CP. Comment on: N Engl J Med. 2000 Nov 23;343(21):1514-9. PMID: 11087888 [PubMed - indexed for MEDLINE] 2128. N Engl J Med. 2000 Nov 23;343(21):1514-9. Intrathecal methylprednisolone for intractable postherpetic neuralgia. Kotani N, Kushikata T, Hashimoto H, Kimura F, Muraoka M, Yodono M, Asai M, Matsuki A. Department of Anesthesiology, University of Hirosaki School of Medicine, Japan. Comment in: N Engl J Med. 2001 Mar 29;344(13):1020-1; author reply 1021-2. N Engl J Med. 2000 Nov 23;343(21):1563-5. N Engl J Med. 2001 Mar 29;344(13):1020; author reply 1021-2. N Engl J Med. 2001 Mar 29;344(13):1020; author reply 1021-2. N Engl J Med. 2001 Mar 29;344(13):1019-20; author reply 1021-2. N Engl J Med. 2001 Mar 29;344(13):1019; author reply 1021-2. N Engl J Med. 2001 Mar 29;344(13):1021; author reply 1021-2. BACKGROUND: There is no effective treatment for intractable postherpetic neuralgia. Because there is evidence that postherpetic neuralgia has an inflammatory component, we assessed treatment with intrathecally administered methylprednisolone to reduce pain in patients with this disorder. METHODS: We enrolled 277 patients who had had intractable postherpetic neuralgia for at least one year, 270 of whom were followed for two years. The patients were randomly assigned to receive intrathecal methylprednisolone and lidocaine (3 ml of 3 percent lidocaine with 60 mg of methylprednisolone acetate, 89 patients), lidocaine alone (3 ml of 3 percent lidocaine, 91 patients), or no treatment (90 patients) once per week for up to four weeks. Each weekly dose was injected into the lumbar intrathecal space. Pain was evaluated before randomization, at the end of the treatment period, and then four weeks, one year, and two years later. Samples of cerebrospinal fluid were obtained for measurement of interleukin-8 before and at the end of the treatment period. RESULTS: There was minimal change in the degree of pain in the lidocaine-only and control groups during and after the treatment period. In the methylprednisolone-lidocaine group, the intensity and area of pain decreased, and the use of the nonsteroidal antiinflammatory drug diclofenac declined by more than 70 percent four weeks after the end of treatment. No complications related to intrathecal methylprednisolone were observed. Before treatment, the concentrations of interleukin-8 in the cerebrospinal fluid were inversely related to the duration of neuralgia in all the patients (r=-0.49, P<0.001). In the patients who received methylprednisolone, interleukin-8 concentrations decreased by 50 percent, and this decrease correlated with the duration of neuralgia and with the extent of global pain relief (P<0.001 for both comparisons). CONCLUSIONS: The results of this trial indicate that the intrathecal administration of methylprednisolone is an effective treatment for postherpetic neuralgia. PMID: 11087880 [PubMed - indexed for MEDLINE] 2129. Indian Pediatr. 2000 Nov;37(11):1239-41. Oral acyclovir in varicella zoster virus infections in children with acute lymphoblastic leukemia. Jain Y, Lodha R, Tomar S, Arya LS, Kabra SK. Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110 029, India. PMID: 11086306 [PubMed - indexed for MEDLINE] 2130. Pediatr Neurol. 2000 Oct;23(4):345-8. Acute hemiplegia associated with herpes zoster infection in children: report of one case. Hung PY, Lee WT, Shen YZ. Department of Pediatrics; National Taiwan University Hospital;, Taipei, Taiwan. Herpes zoster infection has been rarely reported to cause angiitis of the central nervous system in children. We describe a 4-year, 8-month-old female with acute hemiplegia and central facial palsy 6 weeks after she had had zoster ophthalmicus. The findings of magnetic resonance angiography, the clinical picture, and a preceding history of herpes zoster ophthalmicus suggested zoster vasculitis. Herpes zoster vasculitis is thus another consideration when examining a child with acute hemiplegia and a recent herpes zoster infection. PMID: 11068169 [PubMed - indexed for MEDLINE] 2131. Pharmacoeconomics. 2000 Aug;18(2):95-104. Antiviral therapies for herpes zoster infections. Are they economically justifiable? Smith KJ, Roberts MS. Mercy Hospital of Pittsburgh, Pennsylvania, USA. ksmith@mercy.pmhs.org Antiviral treatment of herpes zoster is controversial because of uncertain benefits and relatively high costs. Most studies show that antiviral therapy lessens acute herpes zoster symptoms and postherpetic neuralgia (PHN). Current clinical recommendations support antiviral treatment of severely symptomatic herpes zoster in all adults, and mild herpes zoster in those 50 or 60 years of age or older. However, it is unclear if these recommended strategies are cost effective. Published studies of herpes zoster costs and the effect of antiviral therapy on costs and quality of life have significant variation in study design and results, as well as many shortcomings in the data. Thus, definitive economic recommendations cannot be made based on the present data. Another approach, which we have used, is to develop a 'reference case' analysis using decision-analysis techniques and the available data to estimate the incremental cost effectiveness of antiviral treatment in patients of differing age and herpes zoster severity. In the baseline analysis, parameter values and assumptions were consistently slightly biased against antiviral use. Effectiveness was measured in quality-adjusted life years (QALYs). We assumed that antiviral treatment did not change PHN risk, but decreased PHN duration in patients older than 50 years. PHN risk increased with age and with acute herpes zoster severity as seen in published data. Mild acute herpes zoster was assumed to have a utility value of 0.9 and severe acute herpes zoster a value of 0.7 on a scale where 0 = death and 1 = perfect health. Treating mildly symptomatic acute herpes zoster cost $US89,200/QALY gained in 40-year-olds, $US47,700/QALY in 60-year-olds and $US40,700/QALY in 70-year-olds (1995 values). Results were most sensitive to variation of antiviral costs (baseline $US134), but changes in acute symptom relief, PHN risk, duration, costs and utility, and antiviral effect on PHN duration increased costs/QALY above $US50,000 in 60- and 70-year-olds in extremes of parameter ranges. However, no variation resulted in treatment of mild illness in 40-year-olds to fall below $US50,000/QALY gained. Treatment of severe acute herpes zoster cost $US29,700, $US18,000 and $US16,500/QALY gained in 40-, 60- and 70-year-olds, respectively. Results were sensitive to variation of antiviral costs (> $US225) and acute symptom relief (< 21%) in 40-year-olds. Based on this analysis, antiviral therapy of herpes zoster seems economically justifiable for mildly symptomatic acute herpes zoster in patients aged 50 years and older, and for severely symptomatic acute herpes zoster in all adults. PMID: 11067653 [PubMed - indexed for MEDLINE] 2132. Orthop Nurs. 2000 Jan-Feb;19(1):59-62. Shingles update: common questions in caring for a patient with shingles. Madison LK. Cleveland Clinic Foundation, Ohio, USA. Varicella zoster virus (VZV) is a herpes virus that can cause two distinct clinical diseases, chickenpox and shingles. Primary infection of varicella, often called chickenpox, results in a generalized eruption of a vesicular exanthematous rash which is usually seen in children and is highly contagious. This virus (VZV) can then become latent and later reactivate causing herpes zoster, commonly known as shingles. Shingles is usually a localized phenomenon often seen in adults and is usually less contagious. The following is a discussion of infection control questions most commonly asked regarding the care of a patient with shingles. PMID: 11062626 [PubMed - indexed for MEDLINE] 2133. Curr Rev Pain. 2000;4(6):429-36. The cancer patient with chronic pain due to herpes zoster. Modi S, Pereira J, Mackey JR. Cross Cancer Institute, 11560 University Avenue, Edmonton, Alberta T6G 1Z2, Canada. shanumod@cancerboard.ab.ca Postherpetic neuralgia (PHN) is the most common complication of herpes zoster, and as such has been an area of extensive medical research for the past three decades. The patients at highest risk for PHN include those older than 50 years, those with severe acute cases of zoster, and those with shingles in a trigeminal distribution. As persons with malignancy are at a high risk for developing zoster itself, PHN is a complication that will be faced by many of these patients and their caregivers. This article reviews the available treatments and preventative measures for this debilitating condition. PMID: 11060588 [PubMed - indexed for MEDLINE] 2134. Biol Reprod. 2000 Nov;63(5):1396-402. Selection of peptides targeting the human sperm surface using random peptide phage display identify ligands homologous to ZP3. Eidne KA, Henery CC, Aitken RJ. Western Australian Institute for Medical Research & Keogh Institute for Medical Research, QEII Medical Centre, Nedlands, Perth 6009, Australia. keidne@waimr.uwa.edu.au Analysis of the surface architecture of human spermatozoa is a necessary step in the development of new approaches to contraception and resolving the causes of human infertility. In this study we have utilized phage display technology to identify peptides that bind with high affinity to the surface of human spermatozoa. Fifteen- and twelve-mer random peptide phage display libraries were screened against paraformaldehyde-fixed spermatozoa and a number of sperm-binding peptides were identified. One peptide, M6, displayed a high level of affinity for the sperm surface and showed sequence homology with a dominant human ZP3 epitope (hZP 25-33). This peptide bound preferentially to the equatorial and post acrosomal domains of the sperm head and exhibited contraceptive activity by virtue of its capacity to impair the fusion of acrosome-reacted spermatozoa with the vitelline membrane of the oocyte. A similar form of contraceptive activity was also observed within an unrelated peptide, K6, derived from screening the 12-mer library. These results indicate that phage display technology is a powerful tool for developing reagents capable of targeting the human sperm surface, providing insights into the composition of this structure and the identity of targets susceptible to contraceptive attack and pathological disruption. PMID: 11058544 [PubMed - indexed for MEDLINE] 2135. AIDS Patient Care STDS. 2000 Oct;14(10):527-8. Herpes zoster in an HIV-negative man on ritonavir. Miller KD, Piscitelli SC, Davey RT Jr. PMID: 11054935 [PubMed - indexed for MEDLINE] 2136. Br J Haematol. 2000 Sep;110(4):874-5. Sight-threatening varicella zoster virus infection after fludarabine treatment. Chee YL, Culligan DJ, Olson JA, Molyneaux P, Kurtz JB, Watson HG. Department of Haematology, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, UK. y.chee@abdn.ac.uk Varicella zoster virus (VZV) infection involving the posterior segment of the eye after fludarabine treatment has not previously been described. Two patients, who had completed fludarabine treatment 3 and 18 months previously, presented with visual loss that had been preceded by a recent history of cutaneous zoster. The use of the polymerase chain reaction (PCR) for VZV DNA from ocular specimens allowed rapid confirmation of clinical diagnosis and treatment with a good outcome in one patient. With the increasing use of fludarabine and other purine analogues, an awareness of such complications is important because of their potentially sight-threatening consequences. PMID: 11054072 [PubMed - indexed for MEDLINE] 2137. J Dermatol. 2000 Sep;27(9):621-2. Lichen simplex chronicus after herpes zoster. Akyol M, Polat M, Ozçek S, Marufihah M. PMID: 11052242 [PubMed - indexed for MEDLINE] 2138. Pain. 2000 Nov;88(2):125-33. Capsaicin evoked pain and allodynia in post-herpetic neuralgia. Petersen KL, Fields HL, Brennum J, Sandroni P, Rowbotham MC. Department of Neurology, UCSF Pain Clinical Research Center, University of California, San Francisco, 94115, USA. klp@itsa.ucsf.edu The hypothesis that the pain and allodynia associated with post-herpetic neuralgia (PHN) is maintained by a combination of input from preserved primary afferent nociceptors and sensitization of central pain transmitting neurons was examined in 17 subjects with PHN. Pain, allodynia, thermal sensory function, cutaneous innervation, and response to controlled application of 0.075% capsaicin were measured. Compared to mirror-image skin, applying capsaicin on a 9 cm(2) area of PHN skin significantly increased overall PHN pain and allodynia in 11 of 17 subjects. These 'capsaicin responders' were characterized by higher average daily pain, higher allodynia ratings, and relatively preserved sensory function at baseline compared to the non-responders. In three of the 'capsaicin responders' the area of allodynia expanded into previously non-allodynic and non-painful skin that had normal sensory function and cutaneous innervation. These observations support the hypothesis that allodynia in some PHN patients is a form of chronic secondary hyperalgesia maintained by input from intact and possibly 'irritable' primary afferent nociceptors to a sensitized CNS. PMID: 11050367 [PubMed - indexed for MEDLINE] 2139. Bone Marrow Transplant. 2000 Oct;26(7):795-6. Varicella zoster meningoencephalitis following treatment for dermatomal zoster in an alloBMT patient. Tauro S, Toh V, Osman H, Mahendra P. Bone Marrow Transplant Unit, University Hospital Birmingham NHS Trust, Birmingham, UK. Herpes zoster infections are frequently observed after allogeneic bone marrow transplantation (alloBMT). In the majority of cases, the infection is restricted to specific dermatomes and responds to oral acyclovir, without visceral dissemination. We report the case of a 40-year-old male who developed dermatomal herpetic infection 8 months post alloBMT. The herpetic rash responded well to treatment with high-dose oral acyclovir. However, within a week of cessation of therapy, the patient re-presented with dermatomal zoster and meningoencephalitis. Although the cutaneous lesions resolved with intravenous acyclovir, clinical features of meningoencephalitis persisted, along with evidence of varicella zoster virus (VZV) DNA in cerebrospinal fluid (CSF). A satisfactory response to treatment was observed only after the addition of intravenous foscarnet to acyclovir. Based on our experience with this patient, we suggest that in a subset of alloBMT recipients, late dermatomal herpes zoster infections may respond only partially to treatment with standard oral acyclovir. The use of oral acyclovir preparations with higher bioavailability (valacyclovir) or intravenous acyclovir early on may prevent the considerable morbidity associated with disseminated zoster infection. Bone Marrow Transplantation (2000) 26, 795-796. PMID: 11042663 [PubMed - indexed for MEDLINE] 2140. Plast Reconstr Surg. 2000 Oct;106(5):1218-9. Zoster following immediate transverse rectus abdominis myocutaneous breast reconstruction. Skoll PJ, Hudson DA. PMID: 11039401 [PubMed - indexed for MEDLINE] 2141. Jpn J Ophthalmol. 2000 Sep-Oct;44(5):561-4. Acute retinal necrosis following contralateral herpes zoster ophthalmicus. Nakanishi F, Takahashi H, Ohara K. Department of Ophthalmology, Nippon Medical School, Tokyo, Japan. BACKGROUND: A case report of contralateral acute retinal necrosis (ARN) following herpes zoster ophthalmicus. CASE: A 61-year-old male patient developed iridocyclitis and well-demarcated creamy-white retinal lesions at the nasal periphery in the right eye 1 month after herpes zoster ophthalmicus in the left eye. The patient had undergone surgery for primary lung cancer, and had subsequent intracranial metastasis of the tumor. OBSERVATIONS: The clinical diagnosis of ARN was supported by polymerase chain reaction investigation of the aqueous humor resulting in positive for varicella-zoster virus. Retinal lesions disappeared after systemic treatment with acyclovir, corticosteroids, and acetylsalicylate. No retinal detachment developed. CONCLUSIONS: We propose a careful ophthalmic follow-up for herpes zoster ophthalmicus patients because of the possibility of acute retinal necrosis developing in the contralateral eye. PMID: 11033138 [PubMed - indexed for MEDLINE] 2142. Jpn J Ophthalmol. 2000 Sep-Oct;44(5):550-4. Optic neuritis in herpes zoster ophthalmicus. Wang AG, Liu JH, Hsu WM, Lee AF, Yen MY. Department of Ophthalmology, National Yang-Ming University, Taipei Veterans General Hospital, Republic of, Taipei, Taiwan, China. BACKGROUND: Optic neuritis in herpes zoster ophthalmicus (HZO) has been reported rarely. We report two cases of HZO optic neuritis with detailed magnetic resonance imaging study and treatment responses. CASES: One patient presented with anterior optic nerve involvement, and the second presented with retrobulbar optic neuritis. Contrast enhanced T(1)-weighted images were obtained in these 2 patients. Intravenous acyclovir and oral prednisolone were given simultaneously. OBSERVATIONS: Magnetic resonance imaging revealed peripheral enhancement of the optic nerve sheath complex on T(1)-weighted scan. Both patients recovered their vision within 3 months following the start of treatment. CONCLUSIONS: Magnetic resonance imaging is helpful for the diagnosis of HZO optic neuritis. Systemic acyclovir and steroid are effective in the treatment of HZO optic neuritis. PMID: 11033135 [PubMed - indexed for MEDLINE] 2143. J Neurovirol. 2000 Oct;6(5):410-7. A single tube PCR assay for simultaneous amplification of HSV-1/-2, VZV, CMV, HHV-6A/-6B, and EBV DNAs in cerebrospinal fluid from patients with virus-related neurological diseases. Yamamoto T, Nakamura Y. Department of Clinical Pathology, Showa University Fujigaoka Hospital, Yokohama, Japan. Cerebrospinal fluid (CSF) specimens from 27 patients with encephalitis, meningitis, and other neurological diseases were studied for the presence of herpes simplex virus types 1 and 2 (HSV-1/-2), varicella-zoster virus (VZV), cytomegalovirus (CMV), human herpesviruses 6A and 6B (HHV-6A/-6B) and Epstein-Barr virus (EBV) DNA using the polymerase chain reaction (PCR) method. The DNAs were amplified using two sets of consensus primer pairs in a single tube, bringing simultaneous amplification of the herpesviruses. The PCR products were analyzed by agarose gel electrophoresis, and Southern blot hybridization with virus-type specific probes, thus allowing discrimination between the different types of herpesviruses to be made. Each virus-specific probe was highly specific for identifying the PCR product. Thirty CSF specimens from 13 patients with encephalitis and 10 specimens from 10 patients with meningitis, respectively, were examined using this method. Eight patients with encephalitis and six with meningitis were positive for different herpesviruses, including patients with coinfections (HSV-1/-2 and VZV, VZV and CMV). Among four CSF specimens from four patients with other neurological disorders, dual amplification of CMV and EBV was present. Since identification of the types of herpesviruses in this system requires a very small amount of CSF, and is completed with one PCR, it is useful for routine diagnosis of herpesvirus infections in diagnostic laboratories. The viruses responsible for central nervous system infection are easily detected with various coinfection and serial patterns of herpesviruses, by this consensus primer-based PCR method. This may give an insight into the relationship between virus-related neurological diseases (VRNDS) and herpesvirus infections. PMID: 11031694 [PubMed - indexed for MEDLINE] 2144. Arch Fam Med. 2000 Sep-Oct;9(9):863-9. Antiviral therapy for herpes zoster: randomized, controlled clinical trial of valacyclovir and famciclovir therapy in immunocompetent patients 50 years and older. Tyring SK, Beutner KR, Tucker BA, Anderson WC, Crooks RJ. Department of Dermatology, University of Texas Medical Branch, Galveston, TX 77555, USA. OBJECTIVE: To compare the efficacy and safety of valacyclovir hydrochloride and famciclovir for the treatment of herpes zoster. DESIGN: A double-blind, randomized, controlled, multicenter clinical trial in which patients received 7 days of treatment and were followed up for 24 weeks. SETTINGS: Patients reported directly to specialist centers or were referred from primary care centers. PATIENTS: There were 597 otherwise healthy immunocompetent outpatients, aged 50 years and older, who presented within 72 hours of onset of zoster rash. INTERVENTIONS: Treatment with valacyclovir hydrochloride (1 g 3 times daily) or famciclovir (500 mg 3 times daily) for 7 days. MAIN OUTCOME MEASURES: Resolution of zoster-associated pain and postherpetic neuralgia, rash healing, and treatment safety. RESULTS: Intent-to-treat analysis did not detect statistically significant differences for valacyclovir vs famciclovir on resolution of zoster-associated pain (hazard ratio, 1. 02; 95% confidence interval, 0.84-1.23; P =.84). Furthermore, no differences were evident between treatments on rash healing rates and on a range of analyses of postherpetic neuralgia. Safety profiles for valacyclovir and famciclovir were similar, with headache and nausea being the more common adverse events. CONCLUSIONS: Valacyclovir treatment is comparable to famciclovir treatment in speeding the resolution of zoster-associated pain and postherpetic neuralgia. Current wholesale prices indicate that valacyclovir is the more cost-effective treatment for herpes zoster ($83.90 vs $140.70 per course). PMID: 11031393 [PubMed - indexed for MEDLINE] 2145. Mt Sinai J Med. 2000 Sep;67(4):336-8. Herpes zoster. Sapadin AN, Rudikoff D. PMID: 11021787 [PubMed - indexed for MEDLINE] 2146. Health News. 2000 Jan;6(1):6. Blocking shingles pain. [No authors listed] PMID: 11019661 [PubMed - indexed for MEDLINE] 2147. Nippon Jibiinkoka Gakkai Kaiho. 2000 Aug;103(8):928-36. [Detection of varicella-zoster virus DNA in tear fluid and saliva of patients with Ramsay Hunt syndrome] [Article in Japanese] Hiroshige K, Ikeda M, Hondo R. Department of Otolaryngology, Nihon University School of Medicine, Tokyo. Ramsay Hunt syndrome develops when the varicella-zoster virus (VZV) is reactivated. In the present study, we examined the secretion kinetics of VZV DNA in the tear fluid, submandibular gland saliva and parotid gland saliva of 15 patients with Ramsay Hunt syndrome. The presence of VZV DNA was detected using PCR and a microplate hybridization method. Hybridization signals were measured using the fluorescence density of an enzymatic reaction product using fluoroscan and a system involving streptavidin-conjugated beta-galactosidase. The results were converted into numerical values and used to estimate the number of virus DNA copies. VZV DNA was detected in the tear fluid, submandibular gland saliva and parotid gland saliva of the Ramsay Hunt syndrome patients. The rate of VZV DNA detection in the submandibular gland saliva was 72%, and the detection rate in the parotid gland saliva was 57%. The detection rate in the tear fluid was 27%, which is significantly lower than other two detection rates. Regarding the submandibular gland saliva and the parotid gland saliva, the VZV DNA was detected in samples collected at a comparatively early stage of onset. In the tear fluid, the detection rate increased significantly in samples collected 2 weeks after onset or later. Thus, differences in the detection rate were observed depending on the type of secretory gland and the timing of the sample collection. The VZV DNA in the tear fluid is thought to derive from the ganglion trigeminale. The increase and decrease in the number of VZV DNA copies detected in samples collected at different times is considered to substantiate VZV reactivation in Ramsay Hunt syndrome. PMID: 11019589 [PubMed - indexed for MEDLINE] 2148. Clin J Pain. 2000 Sep;16(3):188-92. Amitriptyline and fluphenazine in the treatment of postherpetic neuralgia. Graff-Radford SB, Shaw LR, Naliboff BN. UCLA Pain Management Center, Los Angeles, California, USA. BACKGROUND: Postherpetic neuralgia (PHN) is a vexing problem occurring in 10 to 20 percent of people with from herpes zoster (shingles). Anecdotal reports show that fluphenazine enhances the effects of amitriptyline for the treatment of PHN. The aim of this study was to determine, in a controlled manner, whether this was the case. METHODS: In a double-blind placebo-controlled study, 49 patients with PHN were randomly assigned to four treatment groups: Group 1, amitriptyline; Group 2, amitriptyline and fluphenazine; Group 3, fluphenazine; Group 4, a placebo. An active placebo was used to mimic the anticholinergic side effects of dry mouth. The study lasted 8 weeks, with weekly progress evaluations with use of visual analog scales (VAS), the McGill Pain Questionnaire (MPQ), and a side-effects scale. RESULTS: A statistically significant decrease was seen in pain in Groups 1 and 2, and no significant changes were seen in Groups 3 and 4. There was no significant difference when fluphenazine was added to amitriptyline. CONCLUSION: These data support the effectiveness of amitriptyline in treatment of PHN, but do not support the addition of fluphenazine. PMID: 11014390 [PubMed - indexed for MEDLINE] 2149. BMJ. 2000 Sep 30;321(7264):794-6. Prevalence of postherpetic neuralgia after a first episode of herpes zoster: prospective study with long term follow up. Helgason S, Petursson G, Gudmundsson S, Sigurdsson JA. Arbaer Health Care Centre, IS-110 Reykjavik, Iceland. S.Helgason sh@centrum.is Comment in: BMJ. 2001 Apr 7;322(7290):860. BMJ. 2000 Sep 30;321(7264):778-9. BMJ. 2001 Apr 7;322(7290):860-1. BMJ. 2001 Apr 7;322(7290):859-60. OBJECTIVE: To estimate the frequency, duration, and clinical importance of postherpetic neuralgia after a single episode of herpes zoster. DESIGN: Prospective cohort study with long term follow up. SETTING: Primary health care in Iceland. PARTICIPANTS: 421 patients with a single episode of herpes zoster. MAIN OUTCOME MEASURES: Age and sex distribution of patients with herpes zoster, point prevalence of postherpetic neuralgia, and severity of pain at 1, 3, 6, and 12 months and up to 7.6 years after the outbreak of zoster. RESULTS: Among patients younger than 60 years, the risk of postherpetic neuralgia three months after the start of the zoster rash was 1.8% (95% confidence interval 0.59% to 4.18%) and pain was mild in all cases. In patients 60 years and older, the risk of postherpetic neuralgia increased but the pain was usually mild or moderate. After three months severe pain was recorded in two patients older than 60 years (1.7%, 2.14% to 6.15%). After 12 months no patient reported severe pain and 14 patients (3.3%) had mild or moderate pain. Seven of these became pain free within two to seven years, and five reported mild pain and one moderate pain after 7.6 years of follow up. Sex was not a predictor of postherpetic neuralgia. Possible immunomodulating comorbidity (such as malignancy, systemic steroid use, diabetes) was present in 17 patients. CONCLUSIONS: The probability of longstanding pain of clinical importance after herpes zoster is low in an unselected population of primary care patients essentially untreated with antiviral drugs. PMCID: PMC27491 PMID: 11009518 [PubMed - indexed for MEDLINE] 2150. BMJ. 2000 Sep 30;321(7264):778-9. The management of post-herpetic neuralgia. Cunningham AL, Dworkin RH. Comment in: BMJ. 2001 Apr 7;322(7290):861. Comment on: BMJ. 2000 Sep 30;321(7264):794-6. PMCID: PMC1118597 PMID: 11009498 [PubMed - indexed for MEDLINE] 2151. Cutis. 2000 Sep;66(3):221-3. Herpes zoster in the medically healthy child and covert severe child abuse. Gupta MA, Gupta AK. Department of Psychiatry, University of Western Ontario, London, Canada. Herpes zoster is associated with depressed cell-mediated immunity and occurs rarely in the medically healthy nonimmunocompromised child. We report 4 cases of childhood-onset herpes zoster in the absence of a medical disorder. All 4 patients reported experiencing severe, chronic child abuse when the herpes zoster first appeared. It is possible that the severe chronic psychologic stress resulting from the abuse depressed the patients' cell-mediated immune status and thereby predisposed them to herpes zoster. Our findings suggest that the clinician's suspicion should be heightened for the possibility of covert child abuse and secondary stress when managing an otherwise apparently healthy child with herpes zoster. PMID: 11006859 [PubMed - indexed for MEDLINE] 2152. J Accid Emerg Med. 2000 Sep;17(5):366. Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. Oral acyclovir in acute cutaneous herpes zoster. Terry P, Buttress S. PMCID: PMC1725467 PMID: 11005412 [PubMed - indexed for MEDLINE] 2153. J Assoc Physicians India. 1999 Feb;47(2):254. Landry Guillain Barre syndrome--an unusual association with herpes zoster. Mehndiratta MM, Gupta M. PMID: 10999110 [PubMed - indexed for MEDLINE] 2154. Curr Rev Pain. 2000;4(3):219-26. Postherpetic neuralgia in the cancer patient. Lojeski E, Stevens RA. Department of Anesthesiology, Northwestern University Medical School, 251 East Huron Street, Chicago, IL 60611, USA. ewloje@yahoo.com Postherpetic neuralgia (PHN) is the most common and devastating complication of acute herpes zoster (HZ). HZ occurs more frequently in the patient with human immunodeficiency virus (HIV) and with certain leukemias and lymphomas. PHN occurs more frequently in the elderly, in patients with severe pain in the acute stage, and in patients with lesions in the ophthalmic branch of the trigeminal nerve. Pain from PHN is often debilitating and difficult to treat. A wide variety of therapeutic approaches have been advocated over the years, but most are not very effective. Early aggressive treatment of HZ with antiviral drugs may be the most important step in prophylaxis against PHN. This article reviews the current knowledge of the pathogenesis and treatment of PHN. PMID: 10998737 [PubMed - indexed for MEDLINE] 2155. Curr Rev Pain. 2000;4(1):7-11. The role of stress in the development of herpes zoster and postherpetic neuralgia. Livengood JM. Vanderbilt University Hospital, Psychological Services, Vanderbilt Pain Control Center, 1211 21st Avenue South, Nashville, TN 37212, USA. janice.livengood@mcmail.vanderbilt.edu Chronic pain is a multidimensional experience produced by multiple influences. This article examines the intervening role of psychologic and physiologic stress in the development and pathogenesis of prolonged herpes zoster and postherpetic neuralgia. PMID: 10998709 [PubMed - indexed for MEDLINE] 2156. Immunobiology. 2000 Aug;202(2):204-11. Successful IL-2 therapy for relapsing herpes zoster infection in a patient with idiopathic CD4+ T lymphocytopenia. Warnatz K, Draeger R, Schlesier M, Peter HH. Department of Internal Medicine, University Hospital Freiburg, Germany. warnatz@mm61.ukl.uni-freiburg.de Idiopathic CD4+ T lymphocytopenia (ICL) has been defined by the center of disease control as a rare cause of immunodeficiency with a variable clinical course and an unknown aetiology. Here we describe a 65-year old patient with relapsing generalized herpes zoster infection due to ICL and a severe panlymphocytopenia. In vitro assays revealed an enhanced activation of CD8+ T cells and an increased sensitivity of activated CD4+ T cells for cell death. The clinical outcome was substantially improved after starting the patient on a subcutaneous therapy with IL-2. PMID: 10993296 [PubMed - indexed for MEDLINE] 2157. Acta Virol. 2000 Apr;44(2):61-5. Comparison of virus isolation and various polymerase chain reaction methods in the diagnosis of mucocutaneous herpesvirus infection. Nogueira ML, Amorim JB, Oliveira JG, Bonjardim CA, Ferreira PC, Kroon EG. Departamento de Microbiologia, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil. We compared two polymerase chain reaction (PCR) assays (simple and multiplex) and viral isolation to detect herpes simplex virus 1 (HSV-1) and varicella-zoster virus (VZV) in 15 clinical specimens from 13 patients with mucocutaneous herpetic infections. HSV-1 or VZV DNA was detected in 13 specimens by simple PCRs (HSV-1 or VZV PCR) and in 12 specimens by multiplex PCR. On the other hand, viral isolation was positive for 9 specimens only. The PCR protocols used in this study are not only more sensitive and faster than the traditional viral isolation and conventional PCR protocols but also can distinguish rapidly HSV-1 from VZV. We propose the PCRs described here for rapid and precise identification of etiological agents of mucocutaneous herpetic infections. PMID: 10989695 [PubMed - indexed for MEDLINE] 2158. Med Lett Drugs Ther. 1999 Dec 3;41(1067):113-20. Drugs for non-HIV viral infections. [No authors listed] PMID: 10984212 [PubMed - indexed for MEDLINE] 2159. Acta Anaesthesiol Scand. 2000 Sep;44(8):910-8. Prevention of post-herpetic neuralgia: acyclovir and prednisolone versus epidural local anesthetic and methylprednisolone. Pasqualucci A, Pasqualucci V, Galla F, De Angelis V, Marzocchi V, Colussi R, Paoletti F, Girardis M, Lugano M, Del Sindaco F. Department of Anesthesiology and Intensive Care, University of Udine, Italy. A.Pasqualucci@med.uniud.it Comment in: Acta Anaesthesiol Scand. 2000 Sep;44(8):903-5. BACKGROUND: Treatment of herpes zoster (HZ) includes the use of acyclovir with or without steroids. An alternative therapy is the epidural administration of local anesthetics with or without steroids. This trial compared the efficacy of these two treatment regimens in the prevention of post-herpetic neuralgia (PHN). METHODS: Six hundred adults over 55 years of age with a rash of less than 7 days duration, and severe pain due to HZ, were enrolled and randomized to receive either intravenous acyclovir (10 mg/kg three times daily) for 9 days+prednisolone (60 mg per day with progressive reduction) for 21 days, or 6-12 ml bupivacaine (0.25%) every 6-8 or 12 h+methylprednisolone 40 mg every 3-4 days by epidural catheter during a period ranging from 7 to 21 days. Efficacy was evaluated at 1, 3, 6 and 12 months. PHN was assessed as pain and/or allodynia, and "abnormal sensations" (hypoesthesia, burning, itching, etc.). Statistical analysis was performed based on the intent-to-treat population. RESULTS: In the 485 patients who completed the study, the incidence of pain after 1 year was 22.2% (51 patients of 230) after acyclovir+steroids, and 1.6% (4 patients of 255) after epidural analgesia+steroids. The incidence of abnormal sensations was 12.2% (28 patients) after acyclovir+steroids, and 4.3% (11 patients) in group B. CONCLUSIONS: Epidural administration of local anesthetic and methylprednisolone is significantly more effective in preventing PHN at 12 months compared to intravenous acyclovir and prednisolone. PMID: 10981565 [PubMed - indexed for MEDLINE] 2160. Acta Anaesthesiol Scand. 2000 Sep;44(8):903-5. Prevention of post-herpetic neuralgia: can it be achieved? Johnson RW. Comment on: Acta Anaesthesiol Scand. 2000 Sep;44(8):910-8. PMID: 10981563 [PubMed - indexed for MEDLINE] 2161. Neurology. 2000 Sep 12;55(5):708-10. Early diagnosis of zoster sine herpete and antiviral therapy for the treatment of facial palsy. Furuta Y, Ohtani F, Mesuda Y, Fukuda S, Inuyama Y. Department of Otolaryngology, Hokkaido University School of Medicine, Sapporo, Japan. yfuruta@med.hokudai.ac.jp The effect of antiviral agents on recovery from facial palsy in patients with zoster sine herpete (ZSH; varicella zoster virus reactivation without zoster) has not been evaluated because ZSH is difficult to diagnose early after onset. In this study, all 13 patients who received acyclovir-prednisone treatment within 7 days of onset, as confirmed by a positive PCR result, showed complete recovery. PCR-based early diagnosis of ZSH and antiviral therapy elicited an excellent outcome for recovery from facial palsy due to ZSH. PMID: 10980741 [PubMed - indexed for MEDLINE] 2162. Ocul Immunol Inflamm. 2000 Jun;8(2):115-8. Herpes zoster sine herpete presenting with hyphema. Akpek EK, Gottsch JD. Cornea and External Diseases Service, The Wilmer Eye Institute, Johns Hopkins University, School of Medicine, Baltimore, Maryland 21287-9238, USA. PURPOSE: To report a case of herpes zoster sine herpete presenting with hyphema. METHODS: A 69-year-old man was referred for traumatic hyphema and corneal edema in his left eye after a sandblast exposure three weeks previously. Slit-lamp examination demonstrated hyphema, anterior chamber inflammation, mid-dilated pupil, impaired corneal sensation, and high intraocular pressure, without any facial skin lesions. Iris fluorescein angiography revealed tortuosity and extensive occlusion of iris vessels. The patient was treated with oral acyclovir and intensive topical steroids with a presumed diagnosis of severe herpes zoster uveitis. RESULTS: Clinical findings improved dramatically within several days. Typical sectorial iris atrophy with pupillary sphincter dysfunction and complete loss of corneal sensation developed after the resolution of intraocular inflammation. CONCLUSION: Herpes zoster should be considered in patients with uveitis and hyphema even in the absence of typical skin rash. PMID: 10980684 [PubMed - indexed for MEDLINE] 2163. JAMA. 2000 Sep 13;284(10):1271-9. Postlicensure safety surveillance for varicella vaccine. Wise RP, Salive ME, Braun MM, Mootrey GT, Seward JF, Rider LG, Krause PR. Division of Epidemiology, Office of Biostatistics and Epidemiology, Center for Biologics Evaluation and Research, Food and Drug Administration, 1401 Rockville Pike, FDA CBER HFM-225, Rockville, MD 20852-1448, USA. rpwise@cber.fda.gov Erratum in: JAMA 2000 Dec 27;284(24):3129. CONTEXT: Since its licensure in 1995, the extensive use of varicella vaccine and close surveillance of the associated anecdotal reports of suspected adverse effects provide the opportunity to detect potential risks not observed before licensure because of the relatively small sample size and other limitations of clinical trials. OBJECTIVES: To detect potential hazards, including rare events, associated with varicella vaccine, and to assess case reports for clinical and epidemiological implications. DESIGN AND SETTING: Postlicensure case-series study of suspected vaccine adverse events reported to the US Vaccine Adverse Event Reporting System (VAERS) from March 17, 1995, through July 25, 1998. MAIN OUTCOME MEASURES: Numbers of reported adverse events, proportions, and reporting rates (reports per 100,000 doses distributed). RESULTS: VAERS received 6574 case reports of adverse events in recipients of varicella vaccine, a rate of 67.5 reports per 100,000 doses sold. Approximately 4% of reports described serious adverse events, including 14 deaths. The most frequently reported adverse events were rashes, possible vaccine failures, and injection site reactions. Misinterpretation of varicella serology after vaccination appeared to account for 17% of reports of possible vaccine failures. Among 251 patients with herpes zoster, 14 had the vaccine strain of varicella zoster virus (VZV), while 12 had the wild-type virus. None of 30 anaphylaxis cases was fatal. An immunodeficient patient with pneumonia had the vaccine strain of VZV in a lung biopsy. Pregnant women occasionally received varicella vaccine through confusion with varicella zoster immunoglobulin. Although the role of varicella vaccine remained unproven in most serious adverse event reports, there were a few positive rechallenge reports and consistency of many cases with syndromes recognized as complications of natural varicella. CONCLUSION: Most of the reported adverse events associated with varicella vaccine are minor, and serious risks appear to be rare. We could not confirm a vaccine etiology for most of the reported serious events; several will require further study to clarify whether varicella vaccine plays a role. Education is needed to ensure appropriate use of varicella serologic assays and to eliminate confusion between varicella vaccine and varicella zoster immunoglobulin. JAMA. 2000;284:1271-1279 PMID: 10979114 [PubMed - indexed for MEDLINE] 2164. J Clin Microbiol. 2000 Sep;38(9):3187-9. Diagnosis of varicella-zoster virus infections in the clinical laboratory by LightCycler PCR. Espy MJ, Teo R, Ross TK, Svien KA, Wold AD, Uhl JR, Smith TF. Mayo Clinic and Foundation, Rochester, Minnesota 55905, USA. Varicella-zoster virus (VZV) causes vesicular dermal lesions which are clinically evident as varicella (primary infection) or zoster (reactivated) diseases. The LightCycler system (Roche Molecular Biochemicals) is a newly developed commercially available system designed to rapidly perform PCR with real-time detection of PCR products using a fluorescence resonance energy transfer. We compared the detection of VZV from dermal specimens by shell vial cell culture (MRC-5) and by LightCycler PCR. Of 253 specimens, VZV was detected in 23 (9.1%) by shell vial cell cultures and 44 (17.4%) by LightCycler PCR directed to a nucleic acid target sequence in gene 28. Twenty-one of 44 (47.7%) specimens were exclusively positive by LightCycler PCR; the shell vial cell culture assay was never positive when DNA amplification was negative (specificity, 100%). VZV DNA was detected in 39 of 44 (88.6%) specimens positive during cycles 10 through 30 of the LightCycler PCR. These VZV DNA-positive specimens (cycles 10 to 30) and 5 of 11 other PCR positive specimens (cycles 31 to 36) were confirmed by another LightCycler PCR directed to another (gene 29) target of the viral genome. For routine laboratory practice, all specimens yielding amplified DNA to the VZV gene 28 target can be considered positive results. The increased sensitivity (91%) of the LightCycler PCR for detection of VZV, rapid turnaround time for reporting results, virtual elimination of amplicon carryover contamination, and equivalent costs compared to shell vial cell culture for detection of VZV indicate the need for implementation of this technology for routine laboratory diagnosis of this viral infection. PMCID: PMC87350 PMID: 10970354 [PubMed - indexed for MEDLINE] 2165. J Clin Microbiol. 2000 Sep;38(9):3156-60. Improved identification and differentiation of varicella-zoster virus (VZV) wild-type strains and an attenuated varicella vaccine strain using a VZV open reading frame 62-based PCR. Loparev VN, Argaw T, Krause PR, Takayama M, Schmid DS. Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, Atlanta, Georgia 30333, USA. A new method was developed to identify and differentiate varicella-zoster virus (VZV) wild-type strains from the attenuated varicella Oka vaccine strain. The PCR technique was used to amplify a VZV open reading frame (ORF) 62 region. A single specific amplicon of 268 bp was obtained from 71 VZV clinical isolates and several laboratory strains. Subsequent digestion of the VZV ORF 62 amplicons with SmaI enabled accurate strain differentiation (three SmaI sites were present in amplicons of vaccine strain VZV, compared with two enzyme cleavage sites for all other VZV strains tested). This method accurately differentiated the Oka vaccine strain from wild-type VZV strains circulating in countries representing all six populated continents. Moreover, the assay more reliably distinguished wild-type Japanese strains from the vaccine strain than did previously described methods. PMCID: PMC87343 PMID: 10970349 [PubMed - indexed for MEDLINE] 2166. J Formos Med Assoc. 2000 Aug;99(8):659-62. Home-based patient-controlled epidural analgesia with bupivacaine for patients with intractable herpetic neuralgia. Tsai YC, Wang LK, Chen BS, Chen HP. Department of Anesthesia, Medical College and Hospital, National Cheng Kung University, Tainan, Taiwan. This clinical report is based on retrospective observation of the outcome and effects of patient-controlled epidural analgesia (PCEA) with bupivacaine infusion administered at home to five patients with intractable herpetic neuralgia. All patients had severe pain (9 or 10 visual analogue scale [VAS]points) confined to the affected dermatomes, which was refractory to medication. The interval between zoster onset and PCEA application ranged from 27 to 60 days (mean, 37.2 d). The average daily amount of bupivacaine used was 36.5 to 91.2 mg (mean +/- standard deviation, 62.4 +/- 19.7 mg). The duration of PCEA therapy ranged from 10 to 28 days (18.4 +/- 7.6 d). One patient developed drug tolerance. All treatments resulted in effective and satisfactory pain relief (VAS, 0-3), with increase in physical activities to normal levels and easing of sleep and appetite impairment. No deleterious effects were found during PCEA therapy. After discontinuation of PCEA, two patients did not complain of pain but still had slight paresthesia, one of them required low-dose antidepressant for 17 days; three patients continued to have occasional sharp pain (VAS, 2-3) and required low-dose antidepressant and analgesic as-needed for one to six months. These results suggest that PCEA with bupivacaine infusion provides effective pain relief in patients with intractable herpetic neuralgia and is a feasible and effective home treatment modality with limited side effects. PMID: 10969513 [PubMed - indexed for MEDLINE] 2167. Harv Womens Health Watch. 2000 Sep;8(1):5. Shingles vaccine trial underway. [No authors listed] PMID: 10966601 [PubMed - indexed for MEDLINE] 2168. Clin Ter. 2000 May-Jun;151(3):177-8. [Some light at the end of the tunnel in the prevention and treatment of herpetic neuritis] [Article in Italian] Navazio F. Dipartimento di biologia molecolare, Università della California, Berkeley 94720-3200, USA. PMID: 10958051 [PubMed - indexed for MEDLINE] 2169. Eur J Pain. 2000;4(2):221. Re: Headley, PM "NMDA antagonists: unequal to the task or unequal to each other--or both?". Eisenberg E, Kleiser A, Dortort A, Haim T, Yarnitsky D. PMID: 10957703 [PubMed - indexed for MEDLINE] 2170. Neuroradiology. 2000 Jul;42(7):526-8. MRI in human immunodeficiency virus-associated cerebral vasculitis. Berkefeld J, Enzensberger W, Lanfermann H. Institut für Neuroradiologie, Klinikum der Johann-Wolfgang-Goethe Universität, Frankfurt am Main, Germany. Berkefeld@em.uni-frankfurt.de Cerebral ischaemia caused by inflammatory vasculopathies has been described as complication of human immunodeficiency virus (HIV) infection. Imaging studies have shown ischaemic lesions and changes of the vascular lumen, but did not allow demonstration of abnormalities within the vessel wall itself. Two HIV-infected men presented with symptoms of a transient ischaemic attack. Initial MRI of the first showed no infarct; in the second two small lacunar lesions were detected. In both cases, multiplanar 3-mm slice contrast-enhanced T1-weighted images showed aneurysmal dilatation, with thickening and contrast enhancement of the wall of the internal carotid and middle cerebral (MCA) arteries. These findings were interpreted as indicating cerebral vasculitis. In the first patient the vasculopathy progressed to carotid artery occlusion, and he developed an infarct in the MCA territory, but then remained neurologically stable. In the second patient varicella zoster virus (VZV) infection was the probable cause of vasculitis. The clinical deficits and vasculitic MRI changes regressed with antiviral and immunosuppressive therapy. PMID: 10952187 [PubMed - indexed for MEDLINE] 2171. Clin Exp Rheumatol. 2000 Jul-Aug;18(4):541-2. Microscopic perineuritis. An unexpected finding of post-herpetic neuralgia in a temporal artery biopsy. Hernández-Rodríguez J, Cid MC, Grau JM. PMID: 10949744 [PubMed - indexed for MEDLINE] 2172. Am J Nurs. 2000 Aug;100(8):25. The HIV floor. On a student nursing rotation. Davis M. Yale University School of Nursing, New Haven, CT, USA. PMID: 10949566 [PubMed - indexed for MEDLINE] 2173. Acta Neurol Scand. 2000 Aug;102(2):94-8. Apolipoprotein E (APOE) phenotype and APOE concentrations in multiple sclerosis and acute herpes zoster. Pirttilä T, Haanpää M, Mehta PD, Lehtimäki T. Institute for Basic Research in Developmental Disabilities, Staten Island, NY, USA. tuula.pirttila@kuh.fi OBJECTIVES: There are three major isoforms of apolipoprotein E (apoE), namely apoE2, apoE3, and apoE4, that are products of three alleles (epsilon2,epsilon3,epsilon4) at a single gene locus on chromosome 19. It is well known that the presence of apoE4 increases the risk for the development of Alzheimer's disease and atherosclerosis. The aim of the study was to examine if apoE polymorphism or apoE levels contribute to the severity of the disease in patients with multiple sclerosis or the outcome of nerve damage in patients with herpes zoster infection. MATERIAL AND METHODS: We examined apoE phenotype of 105 MS patients and 41 patients with herpes zoster. We also measured serum and cerebrospinal fluid (CSF) levels of apoE from 93 patients with definite MS using enzyme linked immunosorbent assay. RESULTS: There were no differences in apoE allele frequencies in MS or herpes zoster patients compared to the allele frequencies of controls. The levels of serum or CSF apoE did not differ from those of age-matched controls, nor did they correlate with the disease activity. CONCLUSION: We conclude that apoE does not contribute to the activity of MS or the outcome of herpes zoster. PMID: 10949525 [PubMed - indexed for MEDLINE] 2174. Pol Arch Med Wewn. 1999 Oct;102(4):893-7. [Factors causing renal failure in patients with disseminated lupus erythematosus: description of three cases] [Article in Polish] Wanic-Kossowska M, Kozioł L, Bajew L, Roszkowiak B, Czekalski S. Klinika Nefrologii Akademii Medycznej, K. Marcinkowskiego w Poznaniu. We describe three cases of patients with systemic lupus erythematosus in which additional infections: mycotic, bacterial and viral deteriorated renal function and patients needed the dialysis treatment. The patients with autoimmunologic disorders are very sensitive for different infections which need rapid diagnosis and intensive treatment. PMID: 10948714 [PubMed - indexed for MEDLINE] 2175. Paediatr Drugs. 2000 Jul-Aug;2(4):291-7. Varicella zoster infection in HIV-infected children. Rongkavilit C, Mitchell CD, Nachman S. Division of Pediatric Infectious Diseases, University of Miami School of Medicine, Florida, USA. PMID: 10946417 [PubMed - indexed for MEDLINE] 2176. J Pain Symptom Manage. 2000 Jul;20(1):50-8. Allodynia and pinprick hypesthesia in acute herpes zoster, and the development of postherpetic neuralgia. Haanpää M, Laippala P, Nurmikko T. Department of Neurology, University of Tampere, Tampere, Finland. Sensory loss and allodynia are hallmark signs of postherpetic neuralgia (PHN). We set out to investigate how frequently these signs are present in patients with acute herpes zoster (HZ) and what their prognostic value might be. We assessed pain, mechanical allodynia, and sensitivity to pinprick in 113 immunocompetent patients with HZ of a median duration of 5 days. Follow-up visits took place at 2 weeks, 6 weeks, 3 months, and 6 months. When first seen, 87 (77%) patients reported ongoing pain and 48/107 (45%) had allodynia. Twenty-eight (25%) patients had pain at 3 months (and were considered to have developed PHN), while 14 (12%) patients had pain at 6 months. Allodynia tended to subside quickly in most patients. Reduced sensitivity to pinprick was less common. Mechanical allodynia and pinprick hypesthesia were strongly associated with the development of PHN. They merit addition to the list of potential risk factors for PHN although they cannot be used as a predictive rule for an individual patient. By contrast, lack of allodynia in the early stages of HZ predicts good recovery by three months. PMID: 10946169 [PubMed - indexed for MEDLINE] 2177. Dermatol Clin. 2000 Jul;18(3):497-508, x. Cutaneous (non-HIV) infections. Callahan EF, Adal KA, Tomecki KJ. Department of Dermatology, Cleveland Clinic Foundation, Ohio, USA. Cutaneous infections continue to represent a large proportion of inpatient dermatology. Though most infectious skin diseases do not warrant hospitalization, some do and can rapidly become fatal if not treated promptly. A selected group of infections are reviewed--primary cutaneous infections, exotoxin-mediated syndromes, and systemic infections--that warrant hospitalization. Dermatologists play a critical role in the synthesis of patient history and appreciation of morphologic skin disease, which, when coupled with appropriate lab tests, may help to establish a diagnosis allowing for the timely implementation of effective and targeted therapy. PMID: 10943544 [PubMed - indexed for MEDLINE] 2178. Clin Orthop Relat Res. 2000 Aug;(377):112-8. Zoster paresis of the shoulder. Case report and review of the literature. Yaszay B, Jablecki CK, Safran MR. Stanford University School of Medicine, CA, USA. More than 95% of people in the United States are infected with the varicella zoster virus at some time in life, and this infection usually is manifested as chicken pox during childhood. The virus then establishes a latent infection of sensory ganglia, from which it may reactivate many years later to cause herpes zoster (shingles), a cutaneous painful rash along a dermatomal distribution. Less commonly, the varicella zoster virus may result in myotomal motor weakness or paralysis in addition to a painful dermatomal rash. A case of unilateral left C5-C6 segmental paresis attributable to herpes zoster in an otherwise healthy individual and a current review of the literature are presented. A case of zoster paresis of the shoulder muscles is presented to remind the orthopaedic community that this diagnosis may be confused with other diagnoses, including rotator cuff tear, and should be considered in the differential diagnosis of shoulder pain and shoulder girdle muscle weakness. PMID: 10943192 [PubMed - indexed for MEDLINE] 2179. Haematologica. 2000 Aug;85(8):894-5. Fatal visceral varicella-zoster infection following rituximab and chemotherapy treatment in a patient with follicular lymphoma. Bermúdez A, Marco F, Conde E, Mazo E, Recio M, Zubizarreta A. PMID: 10942955 [PubMed - indexed for MEDLINE] 2180. Ann Neurol. 2000 Aug;48(2):254-6. Ramsay Hunt syndrome in children. Hato N, Kisaki H, Honda N, Gyo K, Murakami S, Yanagihara N. Department of Otolaryngology, Ehime University School of Medicine, Onsengun, Japan. In a retrospective study, 52 children were diagnosed with Ramsay Hunt syndrome. The facial palsy was milder and complete recovery of the function was achieved in 78.6% of patients. Associated cranial neuropathies were less common in children than in adults. The timing of vesicle appearance tended to be delayed in children. In preschool children, Ramsay Hunt syndrome was rare, although the frequency has recently increased. The syndrome is relatively common in older children. This study suggested that vaccination can prevent or reduce the occurrence of Ramsay Hunt syndrome. PMID: 10939578 [PubMed - indexed for MEDLINE] 2181. J Med Virol. 2000 Sep;62(1):46-51. Low induction of varicella-zoster virus-specific secretory IgA antibody after vaccination. Terada K, Niizuma T, Yagi Y, Miyashima H, Kataoka N, Sadahiro T. Department of Pediatrics, Kawasaki Medical School, Kurashiki, Okayama, Japan. kihei@med.kawasaki-m.ac.jp Breakthrough after varicella vaccination occurs in approximately 2. 6% approximately 18.6% of immunocompetent children, but the reason has not been demonstrated clearly. As a first defense, specific secretory IgA antibody on the mucosa plays an important role in preventing invasion of microorganisms. To examine induction of varicella-zoster virus (VZV) specific secretory IgA after natural infection and vaccination and its booster mechanisms, 143 salivary samples were tested by ELISA. The VZV-secretory IgA values were significantly higher in the matched children after natural chickenpox than in those after vaccination, although the total secretory IgA did not differ between them. Two (7%) of the vaccinees lacked the sIgA antibody. In the elderly and in immunocompromised children, the VZV-secretory IgA values were no lower than those in healthy children, and they did not lack VZV-secretory IgA. The doctors and nurses taking care of patients with chickenpox had higher values than the other groups as did individuals who had had herpes zoster recently. VZV-secretory IgA was thought to be stimulated by exogenous and reactivated endogenous VZV to neutralize VZV with weak activity. These results suggest that low or no induction of VZV-secretory IgA antibody after vaccination may be one of the possible explanations for a breakthrough. Copyright 2000 Wiley-Liss, Inc. PMID: 10935988 [PubMed - indexed for MEDLINE] 2182. J Med Virol. 2000 Sep;62(1):42-5. Reactivation of varicella-zoster virus in delayed facial palsy after dental treatment and oro-facial surgery. Furuta Y, Ohtani F, Fukuda S, Inuyama Y, Nagashima K. Department of Otolaryngology, Hokkaido University School of Medicine, Sapporo, Japan. yfuruta@med.hokudai.ac.jp In rare cases, acute peripheral facial palsy occurs several days after dental treatment and oro-facial surgery. Surgical procedures have been known to trigger reactivation of varicella-zoster virus (VZV) and herpes simplex virus type 1 (HSV-1). The present study examined eight patients who exhibited delayed facial palsy after dental treatment or oro-facial surgery. Ramsay Hunt syndrome was diagnosed in three patients and varicella-zoster virus (VZV) reactivation without zoster lesions (zoster sine herpete) was diagnosed in three patients either by PCR or serological assay. Therefore, VZV reactivation was detected in 75% (6 of 8) of patients who exhibited delayed facial palsy after dental or oro-facial treatment. The results suggest that VZV reactivation is a major cause of delayed facial palsy after dental treatment or oro-facial surgery. Copyright 2000 Wiley-Liss, Inc. PMID: 10935987 [PubMed - indexed for MEDLINE] 2183. J Med Virol. 2000 Sep;62(1):37-41. Rapid strip assay for detection of anti-herpes simplex virus antibodies: application to prediction of varicella-zoster virus reactivation in patients with acute peripheral facial palsy. Ohtani F, Furuta Y, Horal P, Bergström T. Department of Otolaryngology, Hokkaido University School of Medicine, Sapporo, Japan. Varicella-zoster virus (VZV) reactivation causes acute peripheral facial palsy in the majority (88%) of patients who lack anti-herpes simplex virus (HSV) antibodies, suggesting that an absence of anti-HSV antibodies is a reliable serological marker for the diagnosis of VZV reactivation in patients who are diagnosed initially as idiopathic peripheral facial palsy (Bell's palsy) [Furuta et al., 2000] Clinical Infectious Diseases]. A simple and rapid immunoassay for detection of anti-HSV antibodies based on HSV type 1 glycoprotein D was developed by modifying the conventional Western blot technique. The assay was evaluated by comparing the results with those of conventional Western blot. In total, 100 sera obtained from patients with acute peripheral facial palsy were tested and judged blindly by two investigators. Twenty-four of 26 HSV-seronegative sera were obtained from patients with VZV reactivation (Ramsay Hunt syndrome or zoster sine herpete). The sensitivity of the assay was over 95% and the specificity was 100%. The two investigators agreed on the diagnosis in 99 of the 100 sera. These results indicate that the rapid strip assay is applicable to prediction of VZV reactivation in patients diagnosed clinically with Bell's palsy before zoster lesions appear or PCR using saliva samples indicates VZV reactivation. Copyright 2000 Wiley-Liss, Inc. PMID: 10935986 [PubMed - indexed for MEDLINE] 2184. Am J Ophthalmol. 2000 Jun;129(6):809-10. Zoster sine herpete with bilateral ocular involvement. Nakamura M, Tanabe M, Yamada Y, Azumi A. Department of Ophthalmology, Kobe University School of Medicine, Kobe, Japan. mxn15@psu.edu PURPOSE: To report a case of zoster sine herpete with bilateral ocular involvement. METHOD: Case report. RESULTS: A 65-year-old man showed bilateral iridocyclitis with sectoral iris atrophy and elevated intraocular pressure unresponsive to steroid treatment. No cutaneous eruption was manifest on the forehead. A target region of varicella-zoster virus DNA sequence was amplified from the aqueous sample from the left eye by polymerase chain reaction. Bilateral iridocyclitis resolved promptly after initiation of systemic and topical acyclovir treatment. Secondary glaucoma was well controlled by bilateral trabeculectomy. CONCLUSIONS: Zoster sine herpete should be considered and polymerase chain reaction performed on an aqueous sample to detect varicella-zoster virus DNA for rapid diagnosis whenever anterior uveitis accompanies the characteristic iris atrophy, even in the case of bilateral involvement. PMID: 10926998 [PubMed - indexed for MEDLINE] 2185. N Engl J Med. 2000 Jul 20;343(3):222-3. Herpes zoster. Breton G, Bricaire F, Caumes E. PMID: 10928869 [PubMed - indexed for MEDLINE] 2186. N Engl J Med. 2000 Jul 20;343(3):221-2; author reply 223. Herpes zoster. Dworkin RH, Galer BS, Rowbotham MC. PMID: 10928867 [PubMed - indexed for MEDLINE] 2187. N Engl J Med. 2000 Jul 20;343(3):221; author reply 223. Herpes zoster. Carver A, Payne R, Foley K. PMID: 10928866 [PubMed - indexed for MEDLINE] 2188. Pain. 2000 Aug;87(2):121-9. The role of sympathetic nerve blocks in herpes zoster and postherpetic neuralgia. Wu CL, Marsh A, Dworkin RH. The Johns Hopkins Hospital, Department of Anesthesiology and Critical Care Medicine, Division of Pain Medicine, 550 N. Broadway, Suite 301, Baltimore, MD 21205, USA. chwu@jhmi.edu The most common complication of herpes zoster in immunocompetent patients is postherpetic neuralgia (PHN). Sympathetic blocks have been traditionally used for patients with herpes zoster and PHN with three different therapeutic goals: pain relief during acute herpes zoster, pain relief during PHN, and prevention of PHN by treating patients with acute zoster. The role of sympathetic blocks in herpes zoster and PHN remains controversial due to methodologic shortcomings in published studies and the limited current understanding of the role of the sympathetic nervous system in mediating pain. Current theories of the pathophysiology of PHN, the role of the sympathetic nervous system in herpes zoster and PHN, and published studies investigating use of sympathetic nerve blocks in herpes zoster and PHN are reviewed. PMID: 10924805 [PubMed - indexed for MEDLINE] 2189. Mayo Clin Proc. 1999 Oct;74(10):983-98. Varicella zoster viral disease. Liesegang TJ. Department of Ophthalmology, Mayo Clinic Jacksonville, FL 32224, USA. Herpes zoster is cause of considerable morbidity, especially among elderly patients, with a suggestion of a slight increase in incidence among female patients. Substantial research on the biology of the varicella zoster virus has led to advances in our knowledge of the pathophysiology of the disease along with more successful therapy for the acute episodes of herpes zoster. Ophthalmic zoster is more common than zoster in other cranial nerves and is associated with pronounced suffering. This article reviews the epidemiology, biology, and latency of herpes zoster, discusses the pathophysiology of the disease, and describes treatment options with antivirals and corticosteroids. The pathophysiology and treatment options for postherpetic neuralgia are also addressed. The varicella vaccine is now available, and initial results suggest that this may lessen the effect of herpes zoster in the future. PMID: 10918864 [PubMed - indexed for MEDLINE] 2190. Bone Marrow Transplant. 2000 Jul;26(2):231-3. Inappropriate antidiuretic hormone secretion, abdominal pain and disseminated varicella-zoster virus infection: an unusual triad in a patient 6 months post mini-allogeneic peripheral stem cell transplant for chronic myeloid leukemia. Szabó F, Horvath N, Seimon S, Hughes T. Royal Adelaide Hospital, Department of Haematology and Bone Marrow Transplantation, Australia. Severe abdominal pain followed by inappropriate antidiuretic hormone secretion (SIADH) preceding by several days the skin manifestation of varicella-zoster virus (VZV) infection in an immunocompromised patient is described. This is a rare presentation of a severe infection described previously only once in a chronic myeloid leukemia (CML) patient 5 months post allo-BMT during immunosuppressive treatment with cyclosporin A. This is the first case described in the setting of non-myeloablative preparation with fludarabine and melphalan and followed by donor leukocyte infusion (DLI) 2 and 4 months post allo-BMT. The influence of these factors on development of VZV virus infection is discussed. We also highlight the high incidence and high mortality in VZV infection in immunocompromised patients as well as the frequent atypical presentation. PMID: 10918438 [PubMed - indexed for MEDLINE] 2191. Pediatr Infect Dis J. 2000 Jul;19(7):648-53. Role of varicella-zoster virus in stroke syndromes. Moriuchi H, Rodriguez W. Department of Infectious Diseases, Children's National Medical Center, Washington, DC, USA. hiromori@net.nagasaki-u.ac.jp PMID: 10917224 [PubMed - indexed for MEDLINE] 2192. J Tradit Chin Med. 2000 Mar;20(1):36-7. Twenty-three cases of postherpetic neuralgia treated by acupuncture. Wu J, Guo Z. Second Affiliated Hospital of Nanjing University of Traditional Chinese Medicine. PMID: 10921168 [PubMed - indexed for MEDLINE] 2193. Ophthalmology. 2000 Aug;107(8):1507-11. Comparison of the efficacy and safety of valaciclovir and acyclovir for the treatment of herpes zoster ophthalmicus. Colin J, Prisant O, Cochener B, Lescale O, Rolland B, Hoang-Xuan T. Department of Ophthalmology, Hospital Morvan, Brest, France. OBJECTIVE: To compare the efficacy and safety of valaciclovir and acyclovir in immunocompetent patients with herpes zoster ophthalmicus. DESIGN: A multicenter, randomized, double-masked study. PARTICIPANTS: One hundred ten immunocompetent patients with herpes zoster ophthalmicus diagnosed within 72 hours of skin eruption were treated; 56 were allocated to the valaciclovir group and 54 to the acyclovir group. METHODS: Patients randomized to the valaciclovir group received two 500-mg tablets of valaciclovir three times daily and one tablet of placebo twice daily. Patients in the acyclovir group received one 800-mg tablet of acyclovir five times daily and one tablet of placebo three times daily for 7 days. MAIN OUTCOME MEASURES: Main outcome measures included the frequency, severity, and duration of ocular complications, patient reports of zoster-associated pain, and the outcome of skin lesions. Tolerance was also assessed on the incidence and types of adverse effects and changes in laboratory parameters. The analysis was mainly descriptive and performed on an intent-to-treat basis. RESULTS: Ocular complications of herpes zoster ophthalmicus were similar in the valaciclovir and acyclovir treatment groups. The main complications were conjunctivitis (54% and 52%, respectively), superficial keratitis (39% and 48%, respectively for punctate keratitis; 11% in each group for dendritic keratitis), stromal keratitis (13% in each group), and uveitis (13% and 17%, respectively). The long-term outcomes of these ocular complications were favorable and similar in both treatment groups. Pain duration and severity and outcome of skin lesions were similar between groups. Most patients reported prodromal pain. After 1 month, 25% of patients in the valaciclovir group and 31% in the acyclovir group still reported pain. The percentage of patients experiencing postherpetic neuralgia decreased during follow-up. The tolerance to acyclovir and valaciclovir was comparable and considered good. The most frequent adverse events were vomiting and edema of the eyelids or face (3%-5%). Three serious adverse events not linked to the study drugs occurred. CONCLUSIONS: Valaciclovir is as effective as acyclovir in preventing ocular complications of herpes zoster ophthalmicus, including conjunctivitis, superficial and stromal keratitis, and pain. Tolerability of the two drugs is similar, but the dosing schedule of valaciclovir is simpler. PMID: 10919899 [PubMed - indexed for MEDLINE] 2194. Harefuah. 1999 Feb 15;136(4):278-80, 339. [Ramsay Hunt syndrome--differential diagnosis, pathogenesis and therapy] [Article in Hebrew] Aframian D, Ben-Oliel R, Sharav Y. Dept. of Oral Diagnosis, Hebrew University-Hadassah School of Dental Medicine, Jerusalem. Ramsay Hunt syndrome is caused by infection of the geniculate ganglion of the seventh cranial nerve by varicella-zoster virus. A case in an 82-year-old woman is described. She presented with oral lesions, right facial palsy and an eruption and pain in her right ear. Oral examination revealed small circumscribed erosions on the right anterior two-thirds of the tongue, with loss of taste. There were also lesions on her right palate. Early diagnosis and treatment are important as immediate treatment is more likely to prevent irreversible complications affecting the facial and other cranial nerves involved. PMID: 10914218 [PubMed - indexed for MEDLINE] 2195. J R Soc Med. 2000 Jun;93(6):334-5. Pain management in herpes zoster ophthalmicus. Dahlmann A. Comment on: J R Soc Med. 2000 Apr;93(4):191-2. PMCID: PMC1298046 PMID: 10911838 [PubMed - indexed for MEDLINE] 2196. Zh Nevrol Psikhiatr Im S S Korsakova. 2000;100(6):58-9. [Neuritis of the facial nerve and its connection with herpes viruses] [Article in Russian] Dekonenko EP, Leont'eva IIa, Martynenko IN, Mitrofanova IV, Sokolova MV, Karavanov AS, Prytkova MI, Sokolova MM, Idrisova ZhR. PMID: 10900691 [PubMed - indexed for MEDLINE] 2197. Ceylon Med J. 1999 Dec;44(4):177-8. Neonatal herpes zoster infection. Jayawardene DR. Department of Paediatrics, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka. PMID: 10895271 [PubMed - indexed for MEDLINE] 2198. Rev Neurol (Paris). 2000 Jul;156(6-7):658-60. [Ischemic cerebral vascular accident and zoster infection] [Article in French] Rahmeh F, Labouret P, Attout H, Ziegler F. Service de Neurologie, Centre Hospitalier de Belfort. Herpes zoster is uncommonly followed by cerebral infarction. The pathophysiological mechanism remains uncertain. Outcome is favorable after early specific treatment. We report the case of a 70-year-old woman who developed right hemiparesis with aphasia 15 days after thoracic herpes zoster. The herpes zoster induced cerebral vasculitis was hypothesized as no other etiology could be identified after detailed assessment of the cerebral infarction including brain MRI and cerebrospinal fluid study, and as the clinical course responded to antiviral therapy. PMID: 10891802 [PubMed - indexed for MEDLINE] 2199. Oncology (Williston Park). 2000 Jun;14(6 Suppl 2):41-2. Infectious complications of pentostatin therapy. Vose JM, Cabanillas F, O'Brien S, Dang N, Drapkin R, Foss F. Department of Internal Medicine, University of Nebraska Medical Center, Omaha, USA. Managing the infectious complications associated with pentostatin (Nipent), used alone or in combination with other agents in patients with low-grade lymphomas, poses a significant problem for clinicians. Since there is limited experience with these therapies, definitive treatment recommendations concerning prophylaxis cannot be made. The panel members discussed the use of valacyclovir (Valtrex) to provide prophylaxis for herpes zoster, trimethoprim/sulfamethoxazole for Pneumocystis, and acyclovir (Zovirax) for varicella zoster. They also considered combinations of pentostatin with agents such as interferon, rituximab (Rituxan), and chlorambucil (Leukeran) and their effect on the immune system. The biology of B and T cells was discussed, with an emphasis on clinical application. PMID: 10887644 [PubMed - indexed for MEDLINE] 2200. Postgrad Med. 2000 Jun;107(7):107-8, 113-4, 117-8. Acute and chronic herpes zoster. An ancient scourge yields to timely therapy. Landow K. University of Southern California School of Medicine, Los Angeles, USA. drlandow@anv.net With the US population aging steadily, herpes zoster represents a growing contributor to diminished quality of life. Dermatologic manifestations appear as immunity declines with age but rarely pose a significant threat, except in instances when ocular structures are involved. Pain is of more concern, because it usually accompanies and may even precede and persist after acute eruptions. In most young patients, pain is transient and bearable. Unfortunately, in the elderly--who are at highest risk for herpes zoster--pain is often more prolonged and more intense. In spite of a wide spectrum of interventions, palliative efforts remain rather ineffectual. At present, intervening as early as possible, ideally within 48 to 72 hours of disease onset, offers the greatest chance of minimizing neurologic sequelae. Inoculation with varicella vaccine in patients between ages 55 and 65 may prove to boost cell-mediated immunity sufficiently so that recrudescence of the varicella virus can be relegated to the annals of history. PMID: 10887450 [PubMed - indexed for MEDLINE] 2201. Drugs. 2000 Jun;59(6):1317-40. Valaciclovir: a review of its use in the management of herpes zoster. Ormrod D, Goa K. Adis International Limited, Mairangi Bay, Auckland, New Zealand. demail@adis.co.nz Varicella zoster virus (VZV), the pathogen responsible for herpes zoster, belongs to the herpesvirus family and is sensitive to the antiviral drug aciclovir. However, the low oral bioavailability of aciclovir has to some extent limited its efficacy in the treatment of herpes zoster and has prompted the development of the more readily absorbed oral prodrug valaciclovir. In a large comparative study valaciclovir, (1000 mg 3 times daily for 7 days) was at least as effective as aciclovir (800 mg 5 times daily for 7 days) in controlling the symptoms of acute herpes zoster. Importantly, valaciclovir alleviated zoster-associated pain and postherpetic neuralgia significantly faster than aciclovir. A 14-day regimen of valaciclovir showed no significant advantage over the 7-day regimen. A smaller trial in Japanese patients focusing primarily on the cutaneous (rash) signs of herpes zoster confirmed the similar efficacy of valaciclovir and aciclovir in the 7-day regimen. This study did not follow all patients for a formal analysis of postherpetic neuralgia. Valaciclovir and aciclovir demonstrated similar efficacy for the control of cutaneous lesions and ocular complications in patients with zoster ophthalmicus. Preliminary results of a large controlled trial indicate that valaciclovir 1000 mg 3 times daily and famciclovir (the prodrug of penciclovir) 500 mg 3 times daily are of similar efficacy in speeding resolution of acute herpes zoster rash and shortening the duration of postherpetic neuralgia. Starting treatment later than 72 hours after rash onset did not significantly reduce the beneficial effect of valaciclovir on duration of zoster-associated pain (a continuum of pain that encompasses both acute pain and postherpetic neuralgia) in a large observational study, suggesting that valaciclovir might be effective when given later than previously thought. However, valaciclovir should ideally be given as soon as possible after symptoms appear. With the recommended regimen for the treatment of herpes zoster (1000 mg 3 times daily for 7 days) valaciclovir was well tolerated, with nausea and headache being the most commonly reported adverse events. The adverse events profile of the agent was similar to that seen with aciclovir or famciclovir. CONCLUSION: The efficacy of valaciclovir for the treatment of herpes zoster has been confirmed and extended by follow-up studies in herpes zoster ophthalmicus, in Japanese patients, and in the wider primary care setting. Valaciclovir is at least equivalent to, and better in certain parameters than, aciclovir and appears to have similar efficacy to famciclovir 500 mg 3 times daily. Valaciclovir is a well tolerated first-line therapy with an established place in the treatment of immunocompetent patients with herpes zoster. PMID: 10882165 [PubMed - indexed for MEDLINE] 2202. Pediatr Int. 2000 Jun;42(3):275-9. Herpes zoster in immunocompetent and immunocompromised Japanese children. Takayama N, Yamada H, Kaku H, Minamitani M. Department of Pediatrics, Tokyo Metropolitan Komagome Hospital, Japan. takyamnd-k@komagome-hospital.bunkyo.tokyo.jp BACKGROUND: To confirm epidemiological features of herpes zoster among children with or without immunosuppression, herpes zoster patients who had presented to this hospital were retrospectively investigated. METHODS: Medical records were reviewed for the 92 cases of pediatric herpes zoster patients diagnosed during the period from 1981 to 1998. The age at onset of herpes zoster and of varicella, the interval between varicella and zoster, the dermatomal distribution of herpes zoster and complications were compared between immunocompetent and immunocompromised children. RESULTS: The mean age at onset of zoster in immunocompetent children was 8.5 +/- 4.0 years and in immunosuppressed children was 9.7 +/- 3.8 years. The age at onset of varicella was significantly lower (1.6 +/- 1.8 years) in immunocompetent than in immunosuppressed children (4.6 +/- 2.7 years). The interval between varicella and zoster was 6.2 +/- 3.2 years in immunocompetent children. More than 80% of patients with acute leukemia or malignant lymphoma had herpes zoster within 2 years after diagnosis of malignancy. Lesions of herpes zoster were most frequently found in the thoracic nerve regions. Five of 11 zoster patients with cutaneous dissemination, three of five zoster patients having aseptic meningitis and three of four patients complicated facial palsy were children without underlying disease. CONCLUSIONS: The present study confirmed that varicella in the first year of life was a risk factor in immunocompetent children, as reported previously. Herpes zoster in children without immunosuppression was found not to be as mild as generally accepted. PMID: 10881585 [PubMed - indexed for MEDLINE] 2203. Scand J Infect Dis. 2000;32(3):263-9. Neurological complications of varicella-zoster virus infection in adults with human immunodeficiency virus infection. De La Blanchardiere A, Rozenberg F, Caumes E, Picard O, Lionnet F, Livartowski J, Coste J, Sicard D, Lebon P, Salmon-Cèron D. Department of Internal Medicine, CHU Cochin-AP.HP, Université Paris, France. Comment in: Scand J Infect Dis. 2001;33(5):398-9. This multicentre retrospective study describes the clinical features and prognostic significance of Varicella-zoster virus (VZV)-associated neurological complications. The study was performed in patients with human immunodeficiency virus (HIV) infection, hospitalized for VZV neurological complications, confirmed in every case by positive VZV polymerase chain reaction (PCR) in cerebrospinal fluid (CSF). Between 1990 and 1995, 34 HIV-infected patients were included in the study. At diagnosis, 59% had AIDS, with a median CD4 count of 11 x 10(9)/l. A past history of zoster was noted in 35% of cases. A concomitant herpes zoster rash and/or acute retinal necrosis were noted in 71% and 12% of patients, respectively. The predominant neurological manifestations were encephalitis (13), myelitis (8), radiculitis (7) and meningitis (6). The mean CSF white blood cell count was 126/mm3 and the mean CSF protein concentration was 2.3 g/l. Interferon-alpha level was increased in 36% of patients. VZV was isolated from CSF cultures in 2/6 cases. Magnetic resonance imaging was abnormal, demonstrating encephalitis lesions. After intravenous antiviral therapy, complete recovery was obtained in 18 cases (53%), serious sequelae were observed in 10 cases (29%) and 6 patients died (18%). Severe symptoms and a low CD4 cell count appeared to be associated with death or sequelae. In conclusion, VZV should be considered as a possible cause of encephalitis, myelitis, radiculitis or meningitis in HIV-infected patients, especially in patients with a history of or concomitant herpes zoster or acute retinal necrosis. VZV-PCR in the CSF may allow rapid diagnosis and early specific antiviral treatment. PMID: 10879596 [PubMed - indexed for MEDLINE] 2204. Neurol India. 2000 Jun;48(2):189-90. Herpes zoster cervical myelitis in an immunocompetent subject. Mehndiratta MM, Bansal J, Gupta M, Puri V. PMID: 10878792 [PubMed - indexed for MEDLINE] 2205. J Clin Microbiol. 2000 Jul;38(7):2568-73. Quantitation of varicella-zoster virus DNA in whole blood, plasma, and serum by PCR and electrochemiluminescence. de Jong MD, Weel JF, Schuurman T, Wertheim-van Dillen PM, Boom R. Section of Clinical Virology, Department of Medical Microbiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands. M.D.deJong@AMC.UVA.NL We describe a highly sensitive assay for quantitation of varicella-zoster virus (VZV) DNA in blood, involving PCR amplification, solution hybridization with Tris-(2, 2'-bipyridine)-ruthenium(II) chelate-labeled probes, and measurement by electrochemiluminescence (ECL). Extraction and amplification efficiencies were monitored by the inclusion of internal control (IC) DNA, mimicking the VZV target, in the DNA extraction. Viral DNA load was calculated from the ratio of VZV and IC ECL signals. The lower limit of sensitivity was 20 VZV DNA copies/ml of plasma or serum and 80 copies/ml of whole blood. In reconstruction experiments, expected and calculated VZV DNA loads were in excellent accordance. Blood specimens from 42 VZV-infected patients were tested for the presence of VZV DNA and showed detection rates of 86% in patients with varicella and 81% in patients with herpes zoster. In specimens obtained during the first week after onset of the rash, detection rates were 100 and 89%, respectively. Viral DNA was detected in all immunocompromised patients with herpes zoster, emphasizing the risk of disseminated disease in this patient group. VZV DNA load was similar in patients with varicella and multidermatomal herpes zoster and lower in patients with unidermatomal zoster. Despite the cell-associated nature of the virus, VZV DNA was detected in serum and plasma at high copy numbers, and at similar frequencies compared to whole-blood specimens. Quantitation of VZV DNA in blood is of potential importance for diagnosis and clinical management of VZV-infected patients. Plasma and serum provide convenient matrices for this purpose. PMCID: PMC86970 PMID: 10878045 [PubMed - indexed for MEDLINE] 2206. J Eur Acad Dermatol Venereol. 2000 Jan;14(1):59-60. Typical varicella zoster (ophthalmicus) in an HIV-infected person. Sehgal VN, Kumart S, Jain S, Bhattacharya SN. Sehgal Nursing Home, Dermato-Venereology (SKIN/VD) Centre, Delhi, India. drsehgal@ndf.vsnl.net.in A typical varicella zoster (ophthalmicus) in an incidentally HIV-infected person is reported in a young man. It was characterized by tense, grouped, vesiculobullous eruptions on a brick-red base. The diagnosis was substantiated by demonstration of swollen epidermal (balloon) cells with a nucleus/several nuclei containing inclusion bodies. Reticular degeneration was apparent. PMID: 10877254 [PubMed - indexed for MEDLINE] 2207. J Eur Acad Dermatol Venereol. 2000 Jan;14(1):23-33. Factors influencing pain outcome in herpes zoster: an observational study with valaciclovir. Valaciclovir International Zoster Assessment Group (VIZA). Decroix J, Partsch H, Gonzalez R, Mobacken H, Goh CL, Walsh L, Shukla S, Naisbett B. Mouscron, Cabinet de Dermatologie, Belgium. AIM OF THE STUDY: An observational study with valaciclovir was conducted to assess clinical outcome in herpes zoster, especially pain and associated neurological signs and symptoms in relation to a series of demographic and disease characteristics discernible at presentation. The safety and acceptability of valaciclovir for treatment of zoster was assessed in a wide variety of primary care and clinic referral settings. METHODS: In total, 1897 immunocompetent adults with clinically diagnosed, localized acute herpes zoster were enrolled in this international, open-label study of valaciclovir. All subjects received treatment with oral valaciclovir (1000 mg three times daily) for 7 days from entry to the study and were asked to record the presence of zoster-associated pain and abnormal sensations throughout treatment and 6 months' follow-up. They were seen frequently in clinic to verify subjective assessments and for evaluation of rash healing. Safety and tolerability were assessed by adverse event monitoring. RESULTS: Overall, 1191 subjects (63%) were aged > or = 50 years, and 203 (11%) had ophthalmic zoster. Cessation of zoster-associated pain was significantly faster in the younger age group; median times to loss of zoster-associated pain were 23 days and 9 days in the > or = 50 and < 50 years age groups, respectively. Similarly, abnormal sensations resolved significantly more rapidly in the younger subjects; the median duration of abnormal sensations was 31 days in the > or = 50 year olds and 16 days in those aged < 50 years. In cases of ophthalmic zoster, the rate of pain resolution was not different from those with zoster in other dermatomes (median duration of pain 18 vs. 16 days). However, abnormal sensations persisted significantly longer in subjects with ophthalmic zoster than in those with zoster at other sites (47 vs. 22 days). In addition to advancing age, subjects suffering moderate to severe prodromal pain or acute pain during the rash phase were at significantly greater risk of zoster-associated pain and abnormal sensations persisting for longer. Subjects with concomitant neurological disorders were also more likely to develop prolonged abnormal sensations. Valaciclovir treatment was well tolerated, and adverse events were rare and generally mild. CONCLUSION: This study confirmed the prognostic importance of advancing age and the intensity of prodromal or acute pain as risk factors for prolonged zoster-associated pain and persisting abnormal sensations in the affected dermatome. Ophthalmic zoster and pre-existing neurological disorders are also identified as highly significant risk factors for prolonged abnormal sensations in herpes zoster. PMID: 10877249 [PubMed - indexed for MEDLINE] 2208. Acta Derm Venereol. 2000 Mar-Apr;80(2):150. Cutaneous lesions of multicentric reticulohistiocytosis developing in herpes zoster lesions. Verma KK, Mittal R. PMID: 10877143 [PubMed - indexed for MEDLINE] 2209. Semin Oncol. 2000 Apr;27(2 Suppl 5):64-6. Pentostatin (Nipent) in T-cell lymphomas. Kurzrock R. Department of Bioimmunotherapy, The University of Texas M.D. Anderson Cancer Center, Houston 77030, USA. Pentostatin (Nipent; SuperGen, San Ramon, CA), which is highly lymphocytotoxic, is an active agent in hairy cell leukemia. We therefore initiated a trial of this agent in T-cell lymphomas. Pentostatin was administered at a dose of 3.75 or 5.0 mg/m2/d intravenously for 3 days every 3 weeks to heavily pretreated patients with cutaneous and peripheral T-cell lymphomas. To date, there are 24 evaluable patients in the trial. Seventeen of these individuals have responded (complete or partial remission). The most common toxicities included granulocytopenia, nausea, renal insufficiency, CD4 suppression, and delayed herpes zoster. Pentostatin is an active agent in this group of diseases and merits further exploration. PMID: 10877055 [PubMed - indexed for MEDLINE] 2210. Semin Oncol. 2000 Apr;27(2 Suppl 5):41-3. A phase I and II study of pentostatin (Nipent) with cyclophosphamide for previously treated patients with chronic lymphocytic leukemia. Weiss MA. Department of Medicine, Memorial Sloan-Kettering Cancer Center, and Cornell University Medical College, New York, NY 10021, USA. Purine analogs and alkylating agents are the most active drugs in the treatment of patients with chronic lymphocytic leukemia (CLL). Although fludarabine is the most widely tested purine analog in CLL, myelosuppression has limited its use in combination chemotherapy regimens. Because pentostatin (Nipent; SuperGen, San Ramon, CA), a related purine analog with proven activity in CLL, has less myelosuppression, we postulated that it would prove advantageous and could be more readily combined with alkylating agents. We are conducting a phase I/II trial of combination chemotherapy with pentostatin and cyclophosphamide for previously treated patients with CLL. Patients need to have Rai high-risk disease or "active" intermediate-risk disease. The treatment regimen consists of a fixed dose of pentostatin (4 mg/m2) combined with an increasing dose of cyclophosphamide. We plan to treat cohorts of three patients each at cyclophosphamide dose levels of 600, 900, 1,200, 1,500, and 2,000 mg/m2. Cycles will be repeated every 21 days. If unacceptable toxicity is encountered at one dose level, then three additional patients (total of six patients) will be accrued to that dose level before further dose escalations will be permitted. A second instance of unacceptable toxicity will close that dose level and identify the preceding level as the phase II dose. Additional patients will be accrued to the phase II dose level to better assess response. Supportive measures include the use of granulocyte colony-stimulating factor (5 microg/kg/d) to limit neutropenia. Sulfamethoxazole/trimethoprim will be given as prophylaxis against Pneumocystis carinii pneumonia and acyclovir will be administered as prophylaxis for herpes zoster. Response will be assessed according to standard criteria, and flow cytometry and fluorescent in situ hybridization will be used to assess for minimal residual disease in patients with trisomy 12. PMID: 10877051 [PubMed - indexed for MEDLINE] 2211. Jpn J Infect Dis. 2000 Apr;53(2):47-55. Development of a live varicella vaccine--past and future. Takahashi M. The Research Foundation for Microbial Diseases at Osaka University, Osaka, Japan. michiaki@biken.osaka-u.ac.jp. Background of the development of a live varicella vaccine, including studies on the attenuation of measles and polioviruses, and transformation experiments of cultured hamster and human cells with conditional lethal mutants of adenovirus and herpes simplex virus were described. Varicella-zoster virus (Oka strain) was passaged in guinea pig cells, and the resulting virus (vaccine virus) was found to have a higher affinity to guinea pig cells. It was recently proved that variations of base sequence occurred exclusively in gene 62 (immediate-early gene) in comparison of vaccine Oka virus and parent Oka virus. This variation is presumed to have occurred during passage in guinea pig cells. Live varicella vaccine (Oka strain) has increasingly been used throughout the world. It was also found in a preliminary study that giving the vaccine to the elderly enhanced humoral and cell-mediated immunity, leading to a prevention of post herpetic neuralgia. A large field trial is now going on in the United States to immunize the elderly for the purpose of prevention of herpes zoster, particularly post herpetic neuralgia. PMID: 10871914 [PubMed - indexed for MEDLINE] 2212. Biol Blood Marrow Transplant. 2000;6(3):219-30. Varicella-Zoster virus: pathogenesis, immunity, and clinical management in hematopoietic cell transplant recipients. Arvin AM. Infectious Disease Division, Stanford University School of Medicine, California 94305-5208, USA. arvinam@stanford.edu New information about the mechanisms of varicella-zoster virus (VZV) pathogenesis and the host response to the virus has improved our understanding of the threat that VZV reactivation may pose after hematopoietic cell transplantation (HCT). Antiviral therapy compensates for some of the deficiencies in VZV immunity in HCT recipients, and inactivated varicella vaccine may be useful for the early reconstitution of adaptive immunity to VZV after HCT. PMID: 10871147 [PubMed - indexed for MEDLINE] 2213. Clin J Pain. 2000 Jun;16(2 Suppl):S90-100. Prospects for the prevention of postherpetic neuralgia in herpes zoster patients. Dworkin RH, Perkins FM, Nagasako EM. Department of Anesthesiology, University of Rochester School of Medicine and Dentistry, New York 14642, USA. robert_dworkin@urmc.rochester.edu OBJECTIVE: Herpes zoster is a common and painful disease that is caused by reactivation of the varicella-zoster virus. Herpes zoster pain that persists after healing of the acute infection is termed postherpetic neuralgia (PHN), a chronic pain syndrome that is often refractory to all treatment. The prevalence of PHN is expected to increase substantially in the coming decades, because the incidence of herpes zoster and the risk of PHN will both increase as the population ages. Although the results of recent studies provide a basis for improved treatment of patients with PHN, as many as half of all PHN patients do not obtain relief of their pain. Research on the development of improved treatments is continuing, but it has not been generally recognized that an equally important goal should be the design of interventions to prevent PHN. The prevention of PHN would lead to major reductions in disability, suffering, and the use of health care resources. DESIGN: The results of recent studies that have identified risk factors for the development of PHN and have implicated several peripheral and central mechanisms in its pathophysiology are reviewed. OUTCOME MEASURES: These risk factors and mechanisms of PHN provide a basis for hypothesizing that combining antiviral therapy with analgesic treatment beginning as soon as possible after the onset of herpes zoster would reduce the risk of PHN beyond that achieved by antiviral therapy alone. CONCLUSIONS: This treatment approach would be expected to reduce the risk of PHN in herpes zoster patients by attenuating acute pain and thereby preventing the initiation of central mechanisms of chronic pain. PMID: 10870747 [PubMed - indexed for MEDLINE] 2214. Am J Med. 2000 Apr 15;108(6):520-1. Zoster gangrenosum: necrotizing fasciitis as a complication of herpes zoster. Sewell GS, Hsu VP, Jones SR. PMID: 10866590 [PubMed - indexed for MEDLINE] 2215. Geriatr Nurs. 2000 May-Jun;21(3):132-5; quiz 136. Herpes zoster and postherpetic neuralgia in the elderly. Lee VK, Simpkins L. University of Virginia Health System, Charlottesville, USA. This article describes herpes zoster (HZ), its cause, diagnosis, treatment, and associated complications. Postherpetic neuralgia (PHN), the most common complication of HZ, is the primary focus of the discussion. PHN is defined broadly as chronic pain that persists after the characteristic vesicular rash of HZ has resolved. PMID: 10864692 [PubMed - indexed for MEDLINE] 2216. Am J Ind Med. 2000 Jul;38(1):108-11. A study of post-traumatic shingles as a work related injury. Foye PM, Stitik TP, Nadler SF, Chen B. Physical Medicine and Rehabilitation, UMDNJ: New Jersey Medical School, Newark, New Jersey 07103-2499, USA. foyepm@umdnj.edu BACKGROUND: After chicken pox, the herpes varicella-zoster (HVZ) virus may remain dormant in the dorsal root ganglion until later reactivation causes shingles, characterized by painful dysesthesias and cutaneous vesicular eruptions along a unilateral dermatome. Shingles as a work-related injury has not been previously addressed in the medical literature. Case History We present a 50-year old female hospital employee who, while working, sustained an acute, traumatic hyperextension injury to her right wrist, hand, and fingers. Although she initially responded to treatment for flexor tendinitis, she suddenly developed shingles in the right C5-C6 dermatomes. She was treated with famcyclovir and her skin lesions resolved, but post-herpetic neuralgia persisted. CONCLUSIONS: It was felt that her shingles was causally related to her occupational injury since trauma (previously reported to precipitate shingles) was her only risk factor and the timing and location of the lesions corresponded closely to the occupational injury. In addition to appropriately diagnosing and treating their patients, workers' compensation physicians often must determine if a particular condition was caused by the original work-related incident. Clinicians who treat trauma patients and injured workers should be aware of post-traumatic shingles and understand the causal relationship of this uncommon but clinically important phenomenon. Copyright 2000 Wiley-Liss, Inc. PMID: 10861772 [PubMed - indexed for MEDLINE] 2217. Ophthalmology. 2000 Jun;107(6):1164-70. Anterior uveitis with sectoral iris atrophy in the absence of keratitis: a distinct clinical entity among herpetic eye diseases. Van der Lelij A, Ooijman FM, Kijlstra A, Rothova A. Department of Ophthalmology, University Medical Centre, Utrecht, The Netherlands. OBJECTIVE: To determine the cause and describe the clinical features of unilateral anterior uveitis with sectoral atrophy of the iris in the absence of associated keratitis. DESIGN: Retrospective, observational case series. PARTICIPANTS: Thirty-one patients with unilateral anterior uveitis with sectoral iris atrophy and without (previous) keratitis. METHODS: The patients were selected from our database of 592 patients with anterior uveitis. MAIN OUTCOME MEASURES: We reviewed the clinical data on the 31 patients and the results of diagnostic anterior chamber fluid analysis for 24 of the 31 patients. Specifically, production of local antibodies against herpes simplex virus (HSV) and varicella zoster virus (VZV) was determined and the polymerase chain reaction was performed to demonstrate the DNA of HSV, VZV, and cytomegalovirus (CMV) in the aqueous samples. RESULTS: Main clinical characteristics of anterior uveitis with iris atrophy included unilateral involvement with a prolonged course and recurrent exacerbations in all cases. Elevated intraocular pressure during intraocular inflammation occurred in 90% of patients (28 of 31). Visual outcome was favorable because 29 of 31 patients (94%) retained a visual acuity of 20/32 or more. The causal agent was identified as HSV in 83% (20 of 24) and VZV in 13% (3 of 24) and was inconclusive in one case. The patients with HSV uveitis were younger than those with VZV uveitis (mean age at onset 34 and 65 years, respectively; P = 0.0056). CONCLUSIONS: Unilateral anterior uveitis with sectoral atrophy of the iris without associated (previous) keratitis is a distinct entity among herpetic eye diseases. Recurrent unilateral anterior uveitis with iris atrophy and/or elevated intraocular pressure has most likely been caused by HSV. PMID: 10857838 [PubMed - indexed for MEDLINE] 2218. Drugs. 2000 May;59(5):1113-26. Treatment of postherpetic neuralgia: an update. Kanazi GE, Johnson RW, Dworkin RH. University of Rochester School of Medicine and Dentistry, New York 14642, USA. Postherpetic neuralgia (PHN) is a chronic pain syndrome that is often refractory to treatment and can last for years, causing physical and social disability, psychological distress, and increased use of the healthcare system. In this paper we provide an update on recent developments in the treatment of PHN. We emphasise the results of recent studies that provide an evidence-based approach for treating PHN that was not available until very recently. In randomised, controlled clinical trials, the topical lidocaine patch, gabapentin, and controlled release oxycodone have been shown to provide superior pain relief in patients with PHN when compared with placebo. It has also recently been demonstrated that the tricyclic antidepressant nortriptyline provides equivalent analgesic benefit when compared with amitriptyline, but is better tolerated. Based on these results, nortriptyline can now be considered the preferred antidepressant for the treatment of PHN, although desipramine may be used if the patient experiences unacceptable sedation from nortriptyline. The topical lidocaine patch, gabapentin and controlled release oxycodone all appear to be as effective as tricyclic antidepressants in the treatment of patients with PHN, and the results of these recent studies suggest that each of these treatments should be considered early in the course of treatment. Additional controlled trials are needed to compare the efficacy and tolerability of these 4 treatments- tricyclic antidepressants, gabapentin, the topical lidocaine patch and controlled release opioid analgesics--used singly and in various combinations in the treatment of patients with PHN. PMID: 10852643 [PubMed - indexed for MEDLINE] 2219. Br J Haematol. 2000 May;109(2):328-9. Paroxysmal cold haemoglobinuria in an adult with chicken pox. Papalia MA, Schwarer AP. Clinical Haematology and Bone Marrow Transplant Unit, Alfred Hospital, Melbourne, Victoria, Australia. Paroxysmal cold haemoglobinuria (PCH) is an autoimmune disorder characterized by intravascular haemolysis causing haemoglobinuria. It is due to a biphasic haemolysin known as the Donath-Landsteiner antibody, which binds specifically to the P antigen of red blood cells at low temperatures, leading to complement activation and red cell lysis at 37 degrees C. PCH is a rare disease which predominantly affects the paediatric population, occurring mostly during viral infections. We report on what is possibly the first case of PCH in an adult to be precipitated by chicken pox infection. PMID: 10848819 [PubMed - indexed for MEDLINE] 2220. J Cutan Pathol. 2000 May;27(5):255-7. Giant cell lichenoid dermatitis within herpes zoster scars in a bone marrow recipient. Córdoba S, Fraga J, Bartolomé B, García-Díez A, Fernández-Herrera J. Department of Dermatology, Hospital Universitario de la Princesa, Madrid, Spain. Cutaneous lesions arising in herpes zoster (HZ) scars are rare. We report a 34-year-old woman with acute lymphoblastic leukemia underwent allogenic bone marrow transplant (BMT). Ten days after the BMT, she developed clusters of vesicles over the right neck, scapula, shoulder and chest. She was treated with intravenous acyclovir and foscarnet. One month after the vesiculous episode of HZ she showed 5 mm to 2 cm clustered flat violaceous lichenoid papules and confluent plaques within the HZ scars. Histopathologic examination revealed a inflammatory infiltrate present in the papillary dermis with granulomatous aggregated formed by histiocytes, multinucleated giant cells and lymphocytes. She was treated with topic steroids with significant improvement. Pathologic findings are similar to those of an unusual lichenoid reaction named "giant cell lichenoid dermatitis". We present the first reported case of giant cell lichenoid dermatitis at the sites of HZ scars. PMID: 10847551 [PubMed - indexed for MEDLINE] 2221. Eye (Lond). 2000 Apr;14 ( Pt 2):251-2. Herpes zoster ophthalmicus presenting as contralateral disc swelling. Mearza AA, Chan JH, Gair E, Jagger J. PMID: 10845031 [PubMed - indexed for MEDLINE] 2222. J R Soc Med. 2000 Apr;93(4):191-2. Ophthalmic zoster sine herpete. Goon P, Wright M, Fink C. Department of Diagnostic Virology, St Mary's Hospital, London, UK. Comment in: J R Soc Med. 2000 Jun;93(6):334-5. PMCID: PMC1297976 PMID: 10844885 [PubMed - indexed for MEDLINE] 2223. Trop Doct. 2000 Jan;30(1):33-5. Claw hand as a complication of herpes zoster. Matondo P, Lungu G, Njobvu P. Department of Medicine, University Teaching Hospital, Lusaka, Zambia. pmatondo@zamnet.zm PMID: 10842523 [PubMed - indexed for MEDLINE] 2224. J Infect Dis. 2000 Jun;181(6):1897-905. Epub 2000 Jun 5. Epidemiology of primary varicella and herpes zoster hospitalizations: the pre-varicella vaccine era. Lin F, Hadler JL. Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Connecticut, USA. To determine the epidemiology and costs of hospitalization with primary varicella and herpes zoster in the prevaccine era and the usefulness of hospital discharge data to determine the population impact of vaccination on these conditions, statewide hospital discharge data in Connecticut from 1986 to 1995 were analyzed. Annual hospitalizations for herpes zoster were 4-fold higher than for primary varicella (16.1 vs. 4.1/100,000). Overall, 69% and 83%, respectively, had no underlying immunosuppressive conditions. Regarding primary varicella, 53% of patients were aged <15 years, there was a marked winter-spring seasonality, and Hispanics and blacks were 4.1 and 2.6 times more likely than whites to be hospitalized. Regarding herpes zoster, 66.9% of patients were aged >64 years, and there was no seasonality. The mean patient charges in 1995 were $12,819 for primary varicella and $15,583 for herpes zoster. Analysis of population-based hospital discharge data is a feasible means of monitoring the impact of varicella immunization on severe morbidity due to primary varicella and herpes zoster. PMID: 10837168 [PubMed - indexed for MEDLINE] 2225. Nippon Ganka Gakkai Zasshi. 2000 May;104(5):354-62. [Expression of the varicella zoster virus thymidine kinase and cytokines in patients with acute retinal necrosis syndrome] [Article in Japanese] Sato M, Abe T, Tamai M. Department of Ophthalmology, Tohoku University School of Medicine, Sendai, Japan. PURPOSE: Acute retinal necrosis (ARN) is caused by varicella zoster virus (VZV) infection. In this study, we investigated the activity of this virus and expressions of some cytokines. PATIENTS AND METHODS: The expression of VZV thymidine kinase and some cytokines were investigated by reverse transcriptase-polymerase chain reaction (RT-PCR) in 9 eyes of 8 patients with ARN. RESULTS: Thymidine kinase expression was observed in all samples except one. Several cytokines, such as interferon (IFN) gamma, tumor necrosis factor (TNF) alpha, interleukin (IL)-1 beta, IL-6, and transforming growth factor (TGF) beta 1 were observed in the samples. Among these cytokines, a statistically significant expression of IFN gamma was observed in the samples of ARN, when compared to those of proliferative vitreoretinopathy (PVR) or other uveitis. The expression of IFN gamma also decreased during successive follow-ups. CONCLUSION: These cytokines may play an important role in the immune response in ARN. PMID: 10835891 [PubMed - indexed for MEDLINE] 2226. Semin Cutan Med Surg. 2000 Mar;19(1):62-8. Common and unusual cases seen by an inpatient dermatology consult service. Jones DA, Johnson RA. Dermatology Residency Training Program, Harvard Medical School, Boston, MA, USA. This article describes common consult requests and presents case studies from the dermatology consult service of an academic hospital. PMID: 10834605 [PubMed - indexed for MEDLINE] 2227. J Laryngol Otol. 2000 Mar;114(3):212-3. Herpes zoster oticus following mandibular block. Maini S, Preece M. Department of Otolaryngology, Royal Gwent Hospital, Newport, UK. Although a few cases of facial palsy following mandibular nerve block and dental surgery have been described, it would appear that herpes zoster oticus following dental surgery has not been documented. It is possible that the latent virus may be activated by the mandibular nerve block and dental surgical interventions. Two cases of herpes zoster oticus, both following inferior alveolar nerve block anaesthesia for dental treatment are presented. PMID: 10829113 [PubMed - indexed for MEDLINE] 2228. Acta Virol. 1999 Dec;43(6):337-40. No acute varicella-zoster virus replication in peripheral blood mononuclear cells during postherpetic neuralgia. Schünemann S, Mainka C, Wolff MH. Institute of Microbiology and Virology, University of Witten/Herdecke, Germany. Patients suffering from postherpetic neuralgia (PHN) were investigated whether varicella-zoster virus (VZV) DNA or RNA could be detected in their peripheral blood mononuclear cells (PBMCs). Altogether 16 samples were tested by standard polymerase chain reaction (PCR) for open reading frame (ORF) 14 and ORF 29, standard and nested PCR for ORF 63, and isothermal transcription-based nucleic acid amplification (NASBA) for ORF 63 and ORF 68. By these methods neither VZV DNA nor VZV RNA could be detected. The obtained results are in contrast to those of other authors (Vafai et al., 1988; Mahalingam et al., 1995) but support the hypothesis of Bennett (1994) and Kost and Straus (1996) proposing that PHN is not caused by acute VZV replication but a consequence of neuronal damage accompanying replication of VZV in ganglia during zoster episodes. PMID: 10825921 [PubMed - indexed for MEDLINE] 2229. Clin Infect Dis. 1999 Apr;28(4):736-9. Herpes zoster in the elderly: issues related to geriatrics. Schmader K. Department of Medicine, Duke University Medical Center, Durham Veterans Affairs Medical Center, North Carolina, USA. keschma@acpub.duke.edu This article reviews specific clinical and research issues of herpes zoster related to geriatric medicine. Salient epidemiological and clinical issues include the increasing probability of zoster and postherpetic neuralgia with aging, age-related decline in immunity to varicella-zoster virus, the functional and psychosocial impact of zoster on the quality of life of the elderly, illness behavior in elderly patients with zoster, and varicella-zoster virus transmission and control in the nursing home. The role of antiviral therapy, corticosteroids, and analgesics; the measurement and analysis of pain, health-related quality of life, and functional status; and development of the varicella vaccine in the management of zoster in the elderly are also emphasized. Fertile research opportunities exist within these areas for investigators interested in infectious diseases, geriatrics, and other zoster-related disciplines. PMID: 10825029 [PubMed - indexed for MEDLINE] 2230. J Dermatol. 2000 Apr;27(4):252-7. Herpes zoster infection complicated by motor paralysis. Akiyama N. Department of Rehabilitation Medicine, Nippon Medical School, Kanagawa, Japan. We reviewed a total of 1,432 patients diagnosed with cutaneous herpes zoster at Hyogo College of Medicine Hospital between 1989 and 1997 for epidemiologic assessment and outcome in patients with zoster paralysis referred for rehabilitation. Of the 1,432 herpes zoster patients (624 males and 808 females, mean age 54.3 years), 12 were referred to our department of rehabilitation medicine for muscle weakness: one had myelitis, and eleven others had lower motor neuron damage. Except for one 43-year-old man with myelodysplastic syndrome, all the lower motor neuron deficit patients were over 60 years of age. Involved myotomes were more widespread than involved dermatomes in eight patients. Electromyography in four patients demonstrated denervation of involved muscles. Five patients experienced complete or near complete recovery from their muscle weakness. The muscle weakness related to herpes zoster was occasionally diagnosed by electromyography as motor neuron damage. Manifestations of motor neuron complications were not noticed but might in fact be more common than was the clinical muscle weakness. PMID: 10824489 [PubMed - indexed for MEDLINE] 2231. Acta Neurol Scand Suppl. 1999;173:25-35; discussion 48-52. Treatment options in postherpetic neuralgia. Bonezzi C, Demartini L. Department of Anesthesia, Fondazione Salvatore Haugeri IRCCS, Pavia, Italy. Postherpetic neuralgia (PHN) is a separate disease entity that represents a complication of acute herpes zoster. PHN, involving aberrant somatosensory processing in the peripheral and/or central nervous system, is considered to be a chronic neuropathic pain, frequently unresponsive to all treatment modalities. Despite the clinical trial data demonstrating successful pain relief with several drug regimens, the pharmacologic management of neuropathic pain is difficult, particularly in PHN. Response to therapy is generally inhomogeneous. Some patients experience long-term pain control with either topical or oral monotherapy with antidepressants, anticonvulsants, or opioids. Other PHN patients, such as those suffering pain due to central nervous system lesions, are extraordinarily refractory to all measures. This article will review current treatments--tricyclic antidepressants, anticonvulsants, local anesthetics, clonidine, N-methyl-D-aspartate (NMDA)-antagonists, and opioids and focus on mechanism-based pharmacologic interventions. Pharmacologic approaches can be classified into three groups: 1) drugs that act topically in the affected skin area; 2) drugs that act on nerve excitability and conduction in sensory axons; and 3) drugs that act on neural damage related synaptic changes. This last group is the only pain treatment option related to central denervation. To date, the treatment of PHN has relied on the use of tricyclic antidepressants (TCAs), which represent the most comprehensively studied medications for this pain syndrome. Clinical data indicate that TCAs are effective analgesics in approximately 50% of patients; these drugs have been recommended as first-line agents for all neuropathic pain syndromes except trigeminal neuralgia, but are frequently contraindicated or poorly tolerated in elderly patients with PHN. If monotherapy fails, a mechanism- and/or symptom-based multidrug regimen can be used. There is also consistent support for intravenous and topical lidocaine, intravenous ketamine, carbamazepine, and opioids. Gabapentin, a new anticonvulsant, can be considered a first-line oral medication for PHN based on the efficacy and safety results of a recently completed double-blind trial. In addition to positive effects on PHN, sleep, mood, and overall quality of life were significantly improved. PMID: 10819089 [PubMed - indexed for MEDLINE] 2232. Int J Dermatol. 2000 Jan;39(1):77-8. Verrucous varicella zoster virus lesions associated with acquired immunodeficiency syndrome. Kimya-Asadi A, Tausk FA, Nousari HC. PMID: 10819618 [PubMed - indexed for MEDLINE] 2233. Br J Dermatol. 2000 Jan;142(1):182-3. Zosteriform metastasis of colonic carcinoma. Ahmed I, Holley KJ, Charles-Holmes R. PMID: 10819547 [PubMed - indexed for MEDLINE] 2234. Br J Dermatol. 2000 Jan;142(1):180-2. Zosteriform relapse of B-cell lymphoma. Au WY, Chan AC, Kwong YL. PMID: 10819546 [PubMed - indexed for MEDLINE] 2235. Clin Otolaryngol Allied Sci. 2000 Apr;25(2):139-42. Herpes zoster oticus treated with acyclovir and prednisolone: clinical manifestations and analysis of prognostic factors. Ko JY, Sheen TS, Hsu MM. Department of Otolaryngology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan. kjycln@ha.mc.ntu.edu.tw Herpes zoster oticus is a cranial polyneuropathy with facial nerve involvement as its main feature. The prognosis of the facial palsy is usually poor. Thirty patients with herpes zoster oticus suffering from facial palsy were admitted for parenteral acyclovir and oral prednisolone. Multiple regression analysis of improvement of facial palsy showed three significant covariates: age, multiple nerve palsies, and the initial grading of the palsy. The recovery of the facial palsy treated with acyclovir and prednisolone was good, and possibility of a good outcome was greater when the initial grade of the palsy was higher. Multiple nerve palsies and age had negative effects on the improvement. PMID: 10816219 [PubMed - indexed for MEDLINE] 2236. AIDS Patient Care STDS. 1999 Sep;13(9):513-6. Viral folliculitis. Weinberg JM, Turiansky GW, James WD. Department of Dermatology, St. Luke's-Roosevelt Hospital Center, New York, New York, USA. jwein@bway.net Viral folliculitis is an infrequently reported entity. We describe two patients with viral folliculitides, including a case of herpetic sycosis caused by herpes simplex (HSV) and a case of herpes zoster (HZ) without blisters. Clinicians should consider viral etiologies in the differential diagnosis of superficial infectious folliculitis, especially those cases refractory to antibacterial or antifungal therapy. PMID: 10813030 [PubMed - indexed for MEDLINE] 2237. Vaccine. 2000 Jun 15;18(25):2915-20. Comparison of a live attenuated and an inactivated varicella vaccine to boost the varicella-specific immune response in seropositive people 55 years of age and older. Levine MJ, Ellison MC, Zerbe GO, Barber D, Chan C, Stinson D, Jones M, Hayward AR. Department of Pediatrics/Pediatric Infectious Diseases, University of Colorado School of Medicine, Denver 80262, USA. myron.levin@uchsc.edu Healthy, varicella-zoster virus (VZV)-seropositive subjects, aged 55-89 years (mean age 66 years), received either 4000 PFU of live, attenuated VZV vaccine (n=85) or an equal volume of this vaccine that was heat-inactivated (n=82). Both vaccines significantly boosted VZV antibody (enzyme immunoassay) and gamma-interferon production by peripheral blood mononuclear cells stimulated by VZV antigen. These responses returned to baseline by 12 months. Circulating mononuclear cells that proliferated in response to VZV antigen were significantly more numerous (responder cell frequency assay) after either vaccine, and persisted with a half-life of 17. 5-21.3 months. There were no differences in immune response to either vaccine in this older age cohort. PMID: 10812235 [PubMed - indexed for MEDLINE] 2238. Vaccine. 2000 Jun 15;18(25):2775-8. Analysis of varicella vaccine breakthrough rates: implications for the effectiveness of immunisation programmes. Brisson M, Edmunds WJ, Gay NJ, Law B, De Serres G. PHLS CDSC, Colindale, London, UK. mbrisson@phls.nhs.uk The objective of this study was to quantify key parameters describing varicella zoster virus (VZV) vaccine efficacy. To do so a mathematical model was developed to represent breakthrough cases as a function of time after vaccination in vaccine efficacy trials. Efficacy parameter sets were identified by fitting the predicted annual number of breakthrough infections with that observed in three clinical trials chosen to represent the plausible range of vaccine efficacy. Results suggest that varicella vaccination seems to result in a high proportion of individuals who are initially totally protected (97% for the base-case). However, individuals lose full protection relatively rapidly (3% per year for the base-case). Once total protection has waned individuals have a high probability of developing a breakthrough infection if exposed to varicella (73% of the probability in unvaccinated susceptibles for the base-case). Results also highlight that vaccine efficacy parameters should be estimated concurrently to take into account dependencies between parameters. PMID: 10812218 [PubMed - indexed for MEDLINE] 2239. Bone Marrow Transplant. 2000 May;25(9):1003-5. Acute abdomen without cutaneous signs of varicella zoster virus infection as a late complication of allogeneic bone marrow transplantation: importance of empiric therapy with acyclovir. Yagi T, Karasuno T, Hasegawa T, Yasumi M, Kawamoto S, Murakami M, Uosima N, Nakamura H, Hiraoka A, Masaoka T. Fifth Department of Internal Medicine, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan. Two patients complained of severe abdominal pain as the first sign of varicella zoster virus infection about 1 year after allogeneic BMT. In case 1, eruptions, found on the face and chest on admission, became vesicular and dispersed on the third hospital day. Though acyclovir (ACV) was immediately started, he died on the fourth day. In case 2, skin rash was never observed during the clinical course. Laparotomy on the third hospital day revealed many hemorrhagic spots on the liver surface and mucous membrane of the upper GI tract, indicating disseminated visceral disease. Empiric therapy with ACV was successful. PMID: 10800071 [PubMed - indexed for MEDLINE] 2240. Graefes Arch Clin Exp Ophthalmol. 2000 Mar;238(3):222-7. Intraocular antibody production in intraocular inflammation. Liekfeld A, Schweig F, Jaeckel C, Wernecke KD, Hartmann C, Pleyer U. Department of Ophthalmology, Charité, Humboldt University, Berlin, Germany. BACKGROUND: The production of intraocular antibodies is considered a specific marker for active infectious uveitis. The aim of our study was to evaluate the diagnostic value of aqueous humor analysis in consecutive patients referred to a tertiary clinical center. METHODS: We analyzed 91 paired aqueous humor/serum samples from 89 patients with intraocular inflammation. In 71 patients aqueous humor analysis was used as a positive or negative confirmation of the suspected cause, whereas in 18 patients the clinical diagnosis was completely uncertain. A modified micro-ELISA technique was used to detect intraocular IgG production against Toxoplasma gondii, varicella zoster virus, herpes simplex virus and cytomegalovirus. Statistical analysis was performed using the "Cohen's kappa" test. RESULTS: Specific intra-ocular antibody production could be detected in 12 (66.7%) of 18 patients with uncertain diagnosis. Subsequently initiated therapy led to clinical improvement in 10 patients, whereas 2 patients remained unchanged. In 2 (2.8%) of 71 patients aqueous humor analysis led to revision of the initially suspected etiology and to a change of therapy. Statistical analysis showed a significant accordance of diagnosis and aqueous humor analysis (P<0.01). CONCLUSION: In patients with infectious uveitis, analysis of intraocular synthesis of specific antibodies is a valuable tool to establish the etiology rapidly and allows initiation of targeted antimicrobial treatment. PMID: 10796036 [PubMed - indexed for MEDLINE] 2241. J Fr Ophtalmol. 2000 Apr;23(4):391-3. [Pain and zona ophthalmica] [Article in French] Lagoutte F. Clinique Thiers, 330 bis, avenue Thiers, 33100 Bordeaux, France. Pain before and during Herpes Zoster is well known. A new antiviral therapy is suggested. Post-herpetic neuralgia remains more difficult to treat. PMID: 10794992 [PubMed - indexed for MEDLINE] 2242. Am Fam Physician. 2000 Apr 15;61(8):2437-44, 2447-8. Management of herpes zoster (shingles) and postherpetic neuralgia. Stankus SJ, Dlugopolski M, Packer D. Eisenhower Army Medical Center, Fort Gordon, Georgia 30905, USA. Herpes zoster (commonly referred to as "shingles") and postherpetic neuralgia result from reactivation of the varicella-zoster virus acquired during the primary varicella infection, or chickenpox. Whereas varicella is generally a disease of childhood, herpes zoster and post-herpetic neuralgia become more common with increasing age. Factors that decrease immune function, such as human immunodeficiency virus infection, chemotherapy, malignancies and chronic corticosteroid use, may also increase the risk of developing herpes zoster. Reactivation of latent varicella-zoster virus from dorsal root ganglia is responsible for the classic dermatomal rash and pain that occur with herpes zoster. Burning pain typically precedes the rash by several days and can persist for several months after the rash resolves. With postherpetic neuralgia, a complication of herpes zoster, pain may persist well after resolution of the rash and can be highly debilitating. Herpes zoster is usually treated with orally administered acyclovir. Other antiviral medications include famciclovir and valacyclovir. The antiviral medications are most effective when started within 72 hours after the onset of the rash. The addition of an orally administered corticosteroid can provide modest benefits in reducing the pain of herpes zoster and the incidence of postherpetic neuralgia. Ocular involvement in herpes zoster can lead to rare but serious complications and generally merits referral to an ophthalmologist. Patients with postherpetic neuralgia may require narcotics for adequate pain control. Tricyclic antidepressants or anticonvulsants, often given in low dosages, may help to control neuropathic pain. Capsaicin, lidocaine patches and nerve blocks can also be used in selected patients. PMID: 10794584 [PubMed - indexed for MEDLINE] 2243. Virology. 2000 May 10;270(2):278-85. Varicella-zoster virus infection of a human CD4-positive T-cell line. Zerboni L, Sommer M, Ware CF, Arvin AM. Department of Pediatrics, Stanford University School of Medicine, Stanford, CA 94305-5208, USA. zerboni@leland.stanford.edu Varicella-zoster virus (VZV) is a human alpha-herpesvirus that causes varicella (chickenpox) at primary infection and may reactivate as herpes zoster. VZV is a T-lymphotropic virus in vivo. To investigate the T-cell tropism of VZV, we constructed a recombinant virus expressing green fluorescent protein (VZV-GFP) under the CMV IE promoter. Coculture of VZV-GFP-infected fibroblasts with II-23 cells, a CD4-positive human T-cell hybridoma, resulted in transfer of virus to II-23 cells. II-23 cells are susceptible to VZV-GFP infection as demonstrated by expression of immediate/early (IE62), early (ORF4), and late (gE) genes. Recovery of infectious virus was limited, with only 1 to 3 in 10(6) cells releasing infectious virus by plaque assay, indicating that transfer of virus results in a limited productive infection. In vitro infection of II-23 cells will be useful for further analysis of VZV tropism for T-lymphocytes. Copyright 2000 Academic Press. PMID: 10792986 [PubMed - indexed for MEDLINE] 2244. J Neurol. 2000 Mar;247(3):218-9. Bickerstaff's brainstem encephalitis associated with shingles. Tagawa Y, Yuki N. PMID: 10787119 [PubMed - indexed for MEDLINE] 2245. J Assoc Physicians India. 1999 Jul;47(7):745. Acute cerebellar ataxia following herpes zoster ophthalmicus. Hiran S, Pipersania R, Khan AH, Sethi SK, Vishwanathan KA. Dept. of Medicine, JLN Hospital and RC Bhilai. PMID: 10778605 [PubMed - indexed for MEDLINE] 2246. Eur J Cancer Prev. 2000 Feb;9(1):59-64. Medical history and risk of Hodgkin's and non-Hodgkin's lymphomas. Tavani A, La Vecchia C, Franceschi S, Serraino D, Carbone A. Istituto di Ricerche Farmacologiche Mario Negri, Milano, Italy. tavani@irfmn.mnegri.it The relationship between a history of selected medical conditions and risk of lymphomas was investigated in a hospital-based case-control study conducted in Northern Italy on 429 incident, histologically confirmed cases of non-Hodgkin's lymphoma (NHL), 158 cases of Hodgkin's disease (HD) and 1157 controls admitted to hospitals for acute conditions. The odds ratios (OR) for NHL were above unity in patients with a history of infectious mononucleosis (OR 2.9), herpes zoster (OR 1.8), pyelonephritis (OR 4.9), tuberculosis (OR 1.8), malaria (OR 1.9), any chronic bacterial diseases (OR 1.7), rheumatoid arthritis (OR 1.7) and psoriasis (OR 2.5). With reference to HD, the ORs were 4.0 for infectious mononucleosis, 2.9 for herpes zoster, 3.3 for pyelonephritis, 2.3 for tuberculosis, 1.4 for chronic bacterial diseases, 2.4 for rheumatoid arthritis, 2.7 for psoriasis and 2.1 for diabetes. The association of NHL and HD with herpes zoster was restricted to the first ten years since the onset of the disease. The relationships between NHL and mononucleosis (OR 12.9), malaria (OR 2.8) and psoriasis (OR 14.0) were stronger for cases aged > or = 60 years, and that with tuberculosis (OR 3.5) was stronger for younger cases. For HD, the positive association was stronger for cases aged > or = 40 years for herpes zoster (OR 3.8) and diabetes (OR 2.6). An increased risk of NHL was found in association with poliomyelitis (OR 1.6) (restricted to cases aged > or = 60 years, OR 4.0) and BCG immunizations (OR 1.6), but not with vaccination against smallpox, tetanus and diphtheria; increased risks of HD were found in relation to poliomyelitis and BCG immunization in cases aged > or = 40 years (OR respectively 2.5 and 2.1), or > or = 50 years (OR 4.3 and 2.2). Thus, our results confirm the association between a history of several chronic infectious and inflammatory diseases and the risk of NHL or HD, and are compatible with a role of chronic immunological alterations in the aetiology of lymphomas. PMID: 10777011 [PubMed - indexed for MEDLINE] 2247. Presse Med. 2000 Mar 25;29(11):584-8. [Rapid diagnosis of the type of meningitis (bacterial or viral) by the assay of serum procalcitonin] [Article in French] Viallon A, Pouzet V, Zéni F, Tardy B, Guyomarc'h S, Lambert C, Page Y, Bertrand JC. Service d'Urgence et Réanimation médicales, Hôpital Bellevue, CHU de Saint-Etienne. alain.viallon@univ-st-etienne.fr OBJECTIVE: It has been shown that serum procalcitonin (PCT) can be used to differentiate bacterial from viral meningitis in children in all cases. The aim of this study was to demonstrate the interest of PCT in the management of suspected meningitis in adults. PATIENTS AND METHODS: We conducted a prospective study including 179 consecutive patients admitted to the emergency department for suspected meningitis. All samples were taken at patient admission. The discriminant potential between bacterial and viral meningitis was studied for cerebrospinal fluid parameters (cytology, protein, glucose, lactate) and serum parameters (C reactive protein, PCT). RESULTS: Thirty-two patients had bacterial meningitis, 90 had viral meningitis and meningitis was ruled out in 57. Among all studied parameters, the most discriminant for distinguishing between bacterial and viral meningitis in 100% of the cases proved to be serum procalcitonin with a threshold value of 0.93 ng/ml. CONCLUSION: Serum procalcitonin is an interesting parameter in the emergency department for management of meningitis suspicion in adults. PMID: 10776411 [PubMed - indexed for MEDLINE] 2248. Nippon Rinsho. 2000 Apr;58(4):951-6. [Pain treatment of herpes zoster] [Article in Japanese] Hirata K, Higa K. Department of Anesthesiology, School of Medicine, Fukuoka University. Reactivation of varicella-zoster virus causes herpes zoster, which accompanies severe pain in most patients. Treatment of pain is mandatory in herpes zoster. Pain caused by herpes zoster is classified as acute herpetic pain and postherpetic neuralgia. The mechanisms and treatments for the two pains are different. Acute herpetic pain is inflammatory and nociceptive one. Treatment for acute herpetic pain includes antiviral drugs, non-steroidal anti-inflammatory drugs, opioids, and sympathetic nerve blockade. Postherpetic neuralgia is a neuropathic pain and requires antidepressants, anticonvulsants, and anti-arrhythmic drugs to relieve the pain. Topical application of capsaicin and local anesthetics may benefit some patients with postherpetic neuralgia. PMID: 10774222 [PubMed - indexed for MEDLINE] 2249. Nippon Rinsho. 2000 Apr;58(4):928-32. [Prophylaxis and treatment of alpha herpesvirus infection--vaccine] [Article in Japanese] Kimura H. Department of Pediatrics, Nagoya University School of Medicine. Vaccines for human alpha herpesviruses were reviewed. To prevent recurrent genital herpes, inactivated virion vaccines, subunit vaccines, live vectored vaccines, genetically-attenuated live virus vaccines, and DNA vaccines have been developed for herpes simplex virus(HSV). Although clinical studies of these vaccines were reported, successful results have not been confirmed. Further improvements in target genes, adjuvants, and vaccine strategies are necessary for clinically useful HSV vaccines. To prevent varicella, a live attenuated vaccine(Oka strain) was developed in Japan and is now widely used in the world. PMID: 10774218 [PubMed - indexed for MEDLINE] 2250. Nippon Rinsho. 2000 Apr;58(4):918-21. [Transplantation associated alpha herpes virus infection] [Article in Japanese] Masaoka T. Osaka Medical Center for Cancer and Cardiovascular Diseases. Immunosuppression after organ or bone marrow transplantation changes its severity with the time lapse. After bone marrow transplantation, HSV infection occurs in early period and VZV infection, in intermediate period. Aciclovir prophylaxis is effective for preventing HSV in early period and also for elevating the compliance of drug intake. It delays onset of VZV infection on the other hand. VZV infection is usually very severe if it is occurred early, before 100 days after transplant. There was some case of VZV infection with severe abdominal pain without any skin involvement. The incidence of VZV infection in bone marrow recipients was 29%. Even in stable period it caused considerable mental problems in some patient. PMID: 10774216 [PubMed - indexed for MEDLINE] 2251. Nippon Rinsho. 2000 Apr;58(4):895-900. [Alphaherpesvininae--dermatology] [Article in Japanese] Honda M, Niimura M. Jikei University School of Medicine. The subfamily alphaherpesuvirinae contains herpes simplex virus(HSV) and varicella-zoster virus(VZV) in the Dermatology. HSV infectious diseases are herpetic gingivostomatitis, herpes labialis, facial herpes simplex, Kaposi's varicelliform eruption, genital herpes, lumbosacral herpes simplex, and herpetic whitlow. The primary form of VZV infection is varicella, and the reactivation form is herpes zoster. These infectious diseases in the dermatological clinics usually occur in adult. In this paper we mention clinical manifestations and treatment. PMID: 10774212 [PubMed - indexed for MEDLINE] 2252. Nippon Rinsho. 2000 Apr;58(4):890-4. [Clinical manifestations of the subfamily alpha-herpesvirinae in childhood] [Article in Japanese] Suga S, Asano Y. Department of Pediatrics, Fujita Health University School of Medicine. Herpes simplex virus(HSV) and varicella-zoster virus(VZV) belonging to the subfamily of alpha-herpesvirinae have the capacity to establish latent infection in neural tissues and to reactivate from these sites. HSV infection is characterized by a vesicular eruption, fever, and other constitutional symptoms but frequently inapparent both in primary and recurrent infections. However, the infection produces a wide spectrum of illness ranging from the trivial fever blisters to the most severe fatal sporadic encephalitis and neonatal infection. In contrast, VZV develops varicella, a common contagious disease of childhood during primary infection and zoster by reactivation of latent virus acquired during varicella. In normal children, the systemic symptoms of both diseases are mild, whereas serious complications are often observed in children with deficiencies in cell-mediated immunity. Acyclovir has been the drug of choice for treatment of severe infection with HSV and VZV for approximately 2 decades. Now, two new agents, valacyclovir and famciclovir will supplant acyclovir for certain indications. PMID: 10774211 [PubMed - indexed for MEDLINE] 2253. J Dermatol. 2000 Mar;27(3):166-9. Granuloma annulare in herpes zoster scars. Ohata C, Shirabe H, Takagi K, Kawatsu T. Department of Dermatology, Osaka Teishin Hospital, Japan. A 54-year-old Japanese female developed granuloma annulare twice in herpes zoster scars. Soon after the second event, she developed ulcerative colitis, which was well controlled by sulfonamides and corticosteroid suppository. She had no history of diabetes mellitus. There was no recurrence of granuloma annulare by June of 1999. Granuloma annulare might have contributed to the complications of ulcerative colitis, although this had not been noticed before. PMID: 10774142 [PubMed - indexed for MEDLINE] 2254. Dermatology. 2000;200(2):173-5. Varicella-zoster virus vasculitis: a case of recurrent varicella without epidermal involvement. Uhoda I, Piérard-Franchimont C, Piérard GE. Department of Dermatology, Regional Medical Center, Huy, Belgium. New types of diseases due to the varicella-zoster virus (VZV) are increasingly recognized. A case of cutaneous VZV vasculitis without epidermal involvement is presented. The patient received chemotherapy for a large B cell lymphoma. He presented a few painless papules on one hand and in the axilla. A lymphocytic vasculitis was evidenced. Immunohistochemistry revealed the presence of VZV in endothelial cells and dermal dendrocytes. Nerves and keratinocytes were free of the virus infection. Such a presentation probably represents a mild form of recurrent varicella with prominent but limited vascular involvement. Copyright 2000 S. Karger AG, Basel. PMID: 10773714 [PubMed - indexed for MEDLINE] 2255. J Assoc Physicians India. 1999 Apr;47(4):460-1. Topical aspirin-chloroform in the treatment of zoster associated pain. Khilnani G. Comment on: J Assoc Physicians India. 1998 Apr;46(4):337-40. PMID: 10778545 [PubMed - indexed for MEDLINE] 2256. Br J Dermatol. 2000 Mar;142(3):588-9. Seasonal variation in herpes zoster infection. Gallerani M, Manfredini R. PMID: 10777280 [PubMed - indexed for MEDLINE] 2257. Int J STD AIDS. 2000 Apr;11(4):254-6. Herpes zoster and HIV infection in Tanzania. Naburi AE, Leppard B. Regional Dermatology Training Centre, Kilimanjaro Christian Medical Centre, Moshi, Tanzania. Two hundred consecutive patients with herpes zoster attending the skin clinic at the Kilimanjaro Christian Medical Centre (KCMC) were examined and checked for HIV infection. They ranged in age from 10 months to 86 years with the majority in their 20s and 30s. The dermatomes involved were thoracic (97), trigeminal (50), cervical (37), lumbar (19) and sacral (3). Six (3%) had more than one dermatome involved and 2 (1%) had disseminated disease. Only 2 (1%) had severe ulceration of the skin and all healed in less than 4 weeks. In children under the age of 10 years and in adults between the ages of 20 and 49 years virtually 100% were HIV positive; even in the age group 50-59 more than three-quarters were HIV positive. We conclude that the presence of herpes zoster at any site is a good indication that the patient is HIV positive except in the teens and the very elderly. PMID: 10772090 [PubMed - indexed for MEDLINE] 2258. Am J Dermatopathol. 2000 Apr;22(2):144-50. Herpes incognito. Resnik KS, DiLeonardo M. Institute for Dermatopathology, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA. Can a microscopist suspect that telltale histopathologic changes of infection by herpesvirus (varicella, zoster, or simplex) are nearby even when no diagnostic epithelial changes are present in the sections being studied? Punch-biopsy specimens from three patients are presented; in two of those cases herpesvirus infection was not even a clinical consideration. The initial histopathologic sections from these patients did not show changes of herpesvirus infection, but step sections revealed focal diagnostic changes. Atypical lymphocytes were present in each of these cases. When atypical lymphocytes are found in concert with a pattern of an inflammatory-cell infiltrate that does not conform precisely to any well-defined entity, a microscopist should consider that the findings may represent changes near infection by herpesvirus. In addition, we reviewed every case we diagnosed as herpesvirus infection over an 18-month period and found that in just over two thirds of those specimens (32 out of 45 cases), atypical lymphocytes accompanied the characteristic epithelial changes induced by herpesvirus. PMID: 10770435 [PubMed - indexed for MEDLINE] 2259. Neurologia. 2000 Feb;15(2):85-6. [The use of corticosteroids in the treatment of neuropathic pain of acute herpes zoster] [Article in Spanish] González Martínez F. Comment on: Neurologia. 1998 Jun-Jul;13(6):311-2. Neurologia. 1999 Mar;14(3):139-40. PMID: 10769538 [PubMed - indexed for MEDLINE] 2260. Eur Neurol. 2000;43(3):182-4. Cervical myelopathy following lumbar herpes zoster. Pozzessere G, Petrucci AF, Rossi P, Venuto F, D'Alessio C, Colonnese C, Bianco F. Istituto di Clinica delle Malattie Nervose e Mentali, Università degli Studi di Roma 'La Sapienza', Roma, Italia. pozzessere@uniroma1.it PMID: 10765061 [PubMed - indexed for MEDLINE] 2261. J Paediatr Child Health. 2000 Apr;36(2):108-13. Congenital and neonatal varicella in Australia. Forrest J, Mego S, Burgess M. National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), Royal Alexandra Hospital for Children, Westmead, New South Wales, Australia. jillf@nch.edu.au OBJECTIVE: To establish the incidence and severity of congenital and neonatal varicella in Australia. METHODOLOGY: Demographic and clinical details were obtained by postal questionnaire regarding cases notified to the Australian Paediatric Surveillance Unit by over 930 participating clinicians in 1995-97 inclusive. RESULTS: Seven cases of congenital varicella (1: 107 000 pregnancies/year) followed maternal infection at 8-26 weeks: five had defects, two did not. Four of the seven infants with congenital varicella developed herpes zoster in the first 15 months of life. Forty-four infants had neonatal varicella (1: 17 000 pregnancies/year). CONCLUSION:: There is an ongoing, albeit low, incidence of congenital and neonatal varicella in Australia. PMID: 10760005 [PubMed - indexed for MEDLINE] 2262. J Psychosom Res. 2000 Jan;48(1):51-7. Psychiatric symptoms and distress differ between patients with postherpetic neuralgia and peripheral vestibular disease. Clark MR, Heinberg LJ, Haythornthwaite JA, Quatrano-Piacentini AL, Pappagallo M, Raja SN. Department of Psychiatry and Behavioral Sciences, The Johns Hopkins Medical Institutions, Baltimore, MD 21287-5371, USA. mrclark@jhmi.edu OBJECTIVE: No previous studies have investigated the psychiatric characteristics of patients with postherpetic neuralgia (PHN). Similarly, no studies have been performed on patients with different chronic somatic symptoms due to a defined medical disease to compare the characteristics of psychiatric morbidity associated with each etiology. METHODS: After completing the subscales of the Symptom Checklist 90-R, a psychiatrist administered the Diagnostic Interview Schedule to all subjects. The psychiatric comorbidity in 35 patients with pain due to PHN was compared with a control group of 34 patients with the nonpainful aversive symptom of vertigo due to a peripheral vestibular disorder that caused unilateral hypofunction. RESULTS: PHN patients had significantly more symptoms of major depression and somatization disorder. No significant differences were found between groups for psychiatric diagnoses. Patients with PHN reported significantly less acutely distressing somatic symptoms. CONCLUSION: These results suggest that the psychiatric symptoms of patients with PHN are distinct from nonspecific acute distress and may be related to the experience of suffering from chronic neuropathic pain. Patients with PHN may not meet criteria for a psychiatric diagnosis, but their psychiatric comorbidity places them at substantial risk for increased pain, suicidal ideation, sustained disability, and the numerous complications of excessive medical evaluation and treatment. Patients with PHN should be evaluated specifically for psychiatric symptoms to reduce potential negative consequences through appropriate treatment. PMID: 10750630 [PubMed - indexed for MEDLINE] 2263. Lakartidningen. 2000 Mar 8;97(10):1114-20. [Diagnosis of Ramsey Hunt syndrome is both simple and difficult. The viral attack is more extensive than expected earlier] [Article in Swedish] Hydén D, Roberg M. Oronkliniken, Universitetssjukhuset, Linköping. dag.hyden@lio.se In Ramsay Hunt's syndrome (herpes zoster of the head and neck in combination with facial palsy), the vesicles often appear on the external ear (herpes zoster oticus) but they can also be found on the exterior of the neck. Serologically verified cases without vesicles occur (zoster sine herpeticum). Complications from the eighth cranial nerve (hearing loss and vertigo) are common. MR and PCR studies show a more extensive viral attack than was earlier believed to be the case. Due to the risk of remaining cranial nerve dysfunctions, as exemplified in a case report, antiviral treatment is indicated, in severe cases combined with corticosteroids. The potential value of varicella vaccination to reduce zoster complications is discussed. PMID: 10750383 [PubMed - indexed for MEDLINE] 2264. Cornea. 2000 Mar;19(2):135-9. Penetrating keratoplasty for varicella-zoster virus keratopathy. Tanure MA, Cohen EJ, Grewal S, Rapuano CJ, Laibson PR. Cornea Service, Wills Eye Hospital, Jefferson Medical College, Philadelphia, Pennsylvania 19107, USA. PURPOSE: To examine and report the results of penetrating keratoplasty performed in patients with varicella-zoster virus keratopathy. METHODS: The authors retrospectively reviewed the records of 15 patients who had penetrating keratoplasty for varicella-zoster virus keratopathy from January 1989 through December 1998 on the Cornea Service at Wills Eye Hospital. RESULTS: Twelve patients had a preoperative diagnosis of herpes zoster ophthalmicus, and three, of varicella. Four eyes had lateral tarsorrhaphies performed in conjunction with penetrating keratoplasty. Three eyes had endothelial rejection episodes that responded well to treatment with topical steroids. One eye had a regraft 1 month after primary failure, and this second graft also failed because of recurrent neurotrophic keratopathy. Three eyes that had repeated penetrating keratoplasty for graft failure had clear grafts at the last examination. At an average follow-up time of 50 months, 13 (86.7%) grafts remained clear, and the best corrected visual acuity was 20/100 or better in eight (53.3%) eyes. Five patients had decreased visual acuity because of retinal diseases. CONCLUSION: Although varicella-zoster virus keratopathy is an uncommon indication for penetrating keratoplasty, effective visual rehabilitation can be achieved in these patients. Careful postoperative management, frequent lubrication, and lateral tarsorrhaphies to protect the corneal surface are major factors in the successful outcome of these cases. PMID: 10746442 [PubMed - indexed for MEDLINE] 2265. J Fam Pract. 2000 Mar;49(3):255-64. Does treatment of acute herpes zoster prevent or shorten postherpetic neuralgia? Alper BS, Lewis PR. Pennsylvania State University/Good Samaritan Hospital Family and Community Medicine Residency Program, Lebanon, USA. alper@earthlink.net Comment in: ACP J Club. 2000 Sep-Oct;133(2):56. OBJECTIVE: Our goal was to determine if any treatment of acute herpes zoster alters the incidence or duration of postherpetic neuralgia (PHN), a common sequela in elderly patients. SEARCH STRATEGY: We systematically searched MEDLINE and The Cochrane Library. We also examined the reference lists of identified trials and reviews. SELECTION CRITERIA: We included all randomized controlled trials of treatments of zoster published in English that included assessment of pain at any time after rash healing. DATA COLLECTION/ANALYSIS: Forty-two trials met inclusion criteria, and 2 reviewers independently evaluated them for methodologic quality and the statistical and clinical significance of results. MAIN RESULTS: Four placebo-controlled trials of oral acyclovir with 692 patients provided marginal evidence for reduction in pain incidence at 1 to 3 months following zoster onset. Famciclovir significantly reduced duration but not incidence of PHN in one placebo-controlled trial of 419 patients. Valacyclovir significantly reduced duration but not incidence of PHN in one acyclovir-controlled trial of 1141 patients. Steroids had no effect on PHN. Amitriptyline for 90 days reduced pain incidence at 6 months in one placebo-controlled trial of 80 patients. A single trial of percutaneous electrical nerve stimulation (PENS) in 50 patients suggested a decrease in pain incidence at 3 and 6 months compared with famciclovir. CONCLUSIONS: There is limited evidence that current interventions prevent or shorten PHN. Famciclovir and valacyclovir have been shown to reduce the duration of PHN in single published trials. Well-designed and larger trials of amitriptyline and PENS should be conducted. PMID: 10735485 [PubMed - indexed for MEDLINE] 2266. Bone Marrow Transplant. 2000 Mar;25(6):657-64. Varicella-zoster infection after allogeneic bone marrow transplantation: incidence, risk factors and prevention with low-dose aciclovir and ganciclovir. Steer CB, Szer J, Sasadeusz J, Matthews JP, Beresford JA, Grigg A. Bone Marrow Transplant Service, Royal Melbourne Hospital, Melbourne, Australia. We examined the incidence of herpes varicella-zoster virus (VZV) infection in 151 patients undergoing allogeneic BMT between August 1990 and September 1997 and who survived at least 3 months. Median follow-up was 17 (range 3.3-80.7) months. Herpes simplex virus antibody positive (HSV+) patients received aciclovir 1200 mg p.o. daily or 750 mg i.v. daily, in divided doses from day 0 to engraftment. Ganciclovir (5 mg/kg i.v. three times per week) was given in CMV+ patients (or if the donor was CMV+) from engraftment to day 84. Ganciclovir was continued or recommenced if a dose of greater than 20 mg of prednisone was used for the treatment of GVHD otherwise aciclovir was recommenced. In HSV+ patients not receiving ganciclovir, aciclovir 600 mg p.o. daily in divided doses was given until at least 6 months after BMT. Thirty-two patients developed VZV infection from 4.1 to 28 months after transplant. The estimated cumulative incidence of VZV was 13% (95% confidence interval 6-19%) at 12 months, 32% (22-42%) at 24 months and 38% (27-50%) at 28 months, with no further cases beyond that time. No patient developed VZV whilst receiving aciclovir or ganciclovir (P < 0.0001). However, there was a rapid onset of VZV following cessation of antiviral therapy (33% (20-46%) at 1 year post cessation). The presence of GVHD and the prior duration of antiviral prophylaxis were significant and independent risk factors for the development of VZV. Age, underlying disease, conditioning therapy or donor type were not. We conclude that 3-6 months of low-dose aciclovir and ganciclovir are effective at delaying the onset of VZV after allogeneic BMT, but may not affect the overall incidence of infection. Prolonged prophylaxis may be warranted in patients at high risk of infection, for example those patients with GVHD. PMID: 10734301 [PubMed - indexed for MEDLINE] 2267. Rev Prat. 1999 Dec 15;49(20):2208-16. [Varicella-zoster virus] [Article in French] Saint-Léger E, Fillet AM. Service de virologie Groupe hospitalier La Pitié-La Salpêtrière, Paris. Varicella-zoster virus, an ubiquitous human pathogen, causes vesicular rash during varicella, the primary infection of the host and zoster corresponding to reactivation. The symptoms could be various, nervous systems and lung being involved. Usually mild, varicella could be severe in immunocompromised patients, during pregnancy for the mother and the foetus, for the newborn and also for adults. Post herpetic neuralgia in old patient is the main complication of zoster. Various methods for virological diagnosis (culture, cytology, serology, PCR) with different sensibilities and specificities depending mainly of sample type are available. Various antiviral drugs are available, acyclovir being the reference one. PMID: 10731804 [PubMed - indexed for MEDLINE] 2268. Drugs. 2000 Feb;59(2):245-9; discussion 250-1. Lidocaine patch 5%. Comer AM, Lamb HM. Adis International Limited, Mairangi Bay, Auckland, New Zealand. demail@adis.co.nz Lidocaine patch 5% comprises a soft, stretchy adhesive patch (l0 by 14 cm) containing 5% lidocaine (700 mg) for the topical treatment of pain associated with postherpetic neuralgia (PHN). Lidocaine provides analgesic relief by blocking neuronal sodium channels. In clinical trials (conducted over 12 hours to 24 days) involving patients with allodynia associated with PHN, treatment with lidocaine patch 5% resulted in a significant reduction in pain intensity and increased pain relief compared with vehicle patch. Lidocaine patch 5% was associated with few adverse events, the most frequent being mild skin redness or irritation at the application site which occurred with a similar incidence with lidocaine and vehicle patch. PMID: 10730547 [PubMed - indexed for MEDLINE] 2269. Can Commun Dis Rep. 1999 Jun 1;25(11):100-4. Direct costs attributed to chickenpox and herpes zoster in British Columbia--1992 to 1996. [Article in English, French] Nowgesic E, Skowronski D, King A, Hockin J. Laboratory Centre for Disease Control (LCDC), Health Canada, Ottawa, Ont. PMID: 10726371 [PubMed - indexed for MEDLINE] 2270. Eur J Dermatol. 2000 Apr-May;10(3):226-7. Psoriasis guttate acuta triggered by varicella zoster virus infection. Ito T, Furukawa F. Department of Dermatology, Hamamatsu University School of Medicine, 3600 Handa-cho, Hamamatsu, 431-3192, Japan. itoutai@hama-med.ac.jp A 23-year-old man had small desquamative erythematous lesions, round or oval in shape, spread over his entire body, and diagnosed as psoriasis guttate acuta because of clinical and pathological findings. Three weeks before the lesions had started, he was diagnosed as having varicella by his family physician. The psoriatic lesions appeared at the same sites where previously lesions of varicella had appeared. Therefore, VZV infection was regarded as a trigger in this case. We speculate that genetic factors and the change of skin condition are basically involved in the pathogenesis of psoriasis guttate. In addition, one more factor as a trigger is needed to cause the lesions of psoriasis. VZV infection might change the skin condition and induce subsequent immunological disregulation. PMID: 10725825 [PubMed - indexed for MEDLINE] 2271. J Paediatr Child Health. 2000 Feb;36(1):76-7. Neonatal chickenpox. Isaacs D. Department of Immunology and Infectious Diseases, New Children's Hospital, Westmead, NSW, Australia. davidi@nch.edu.au PMID: 10723697 [PubMed - indexed for MEDLINE] 2272. Clin Infect Dis. 2000 Mar;30(3):529-33. High prevalence of varicella-zoster virus reactivation in herpes simplex virus-seronegative patients with acute peripheral facial palsy. Furuta Y, Ohtani F, Kawabata H, Fukuda S, Bergström T. Department of Otolaryngology, Hokkaido University School of Medicine, Sapporo 060-8638, Japan. yfuruta@med.hokudai.ac.jp Varicella-zoster virus (VZV) and herpes simplex virus (HSV) are considered to be the major causes of acute peripheral facial palsy (APFP). One hundred and forty-two patients with APFP were analyzed by serological assays and polymerase chain reaction analysis. Ramsay Hunt syndrome was diagnosed in 21 patients. Of the remaining 121 patients clinically diagnosed with Bell's palsy, VZV reactivation without zoster (zoster sine herpete) was detected in 35 patients (29%). The prevalence of antibodies to HSV among patients with Bell's palsy was significantly higher than the prevalence among those with VZV reactivation (Ramsay Hunt syndrome or zoster sine herpete). In contrast, a high incidence (88%) of VZV reactivation among HSV-seronegative patients with APFP was observed. Our data indicate that VZV is one of the major etiologic agents of clinically diagnosed Bell's palsy and that VZV reactivation causes APFP in most patients who lack antibodies to HSV. PMID: 10722439 [PubMed - indexed for MEDLINE] 2273. Acta Derm Venereol. 2000 Jan-Feb;80(1):55. Bullous herpes zoster. Veraldi S, Carrera C, Gianotti R, Caputo R. PMID: 10721839 [PubMed - indexed for MEDLINE] 2274. Leuk Lymphoma. 2000 Mar;37(1-2):229-32. Lymphomatous skin infiltration at the site of previous varicella zoster virus infection in a patient with T cell lymphoma. Paydaş S, Sahin B, Yavuz S, Tuncer I, Gönlüşen G. Department of Oncology, Cukurova University Faculty of Medicine, Balcali, Adana, Turkey. sepay@mail.cu.edu.tr Cutaneous infiltrations in hemopoietic neoplasias are not uncommon. They are generally localized on the legs, arms, back, anterior chest, scalp and face. In rare cases specific infiltration of neoplastic cells is localized in the site of herpes zoster and herpes simplex scars. In this report a case with T cell lymphoma in leukemic phase with skin infiltration in the previous Varicella Zoster Virus (VZV) site of infection is reported and literature is reviewed. PMID: 10721792 [PubMed - indexed for MEDLINE] 2275. Anesthesiology. 2000 Mar;92(3):691-8. Heterogenous patterns of sensory dysfunction in postherpetic neuralgia suggest multiple pathophysiologic mechanisms. Pappagallo M, Oaklander AL, Quatrano-Piacentini AL, Clark MR, Raja SN. Department of Neurology, Hospital for Joint Diseases, New York, New York, USA. BACKGROUND: Postherpetic neuralgia (PHN) is considered by some investigators to be predominantly a deafferentation-type central pain syndrome; others suggest that activity of remaining peripheral nociceptors plays a critical role. The authors investigated the sensory dysfunction in subjects with PHN of varying duration and at different sites to gain further insight into the mechanisms responsible for the clinical features of neuropathic pain. In addition, the relationships between ongoing pain and pain evoked by mechanical and thermal stimuli were compared in patients with trigeminal and truncal PHN, to determine if the pathophysiologic mechanisms differed among subjects. METHODS: In 63 subjects with PHN, quantitative sensory testing was performed in the region of maximum allodynia or ongoing pain and the corresponding contralateral site. The intensity of ongoing pain was recorded. Sensory thresholds for warmth, coolness, heat pain, and cold pain were determined. Pain induced by various mechanical stimuli (dynamic, static, punctate) was rated using a numerical rating scale of 0-10. RESULTS: The mean rating of ongoing PHN pain was 7.3 +/- 2.0 (mean +/- SD). Allodynia induced by one or more mechanical stimuli was observed in 78% of subjects. A smaller subset (40%) had hyperalgesia to heat or cold stimuli. In subjects with duration of PHN of < or = 1 yr duration, but not in those with duration of > 1 yr, the intensity of ongoing pain correlated with intensity of allodynia induced by dynamic stimuli. Deficits in thresholds for heat and cold pain were observed in the affected region of subjects with PHN in the thoracic dermatomes (P < 0.005), but not in the trigeminal distribution. No relationship was observed between the thermal deficits and ongoing pain or mechanical allodynia in the groups of subjects with either trigeminal or thoracic PHN. CONCLUSION: Despite a common cause, the patterns of sensory abnormalities differ between subjects. Particular differences were noted between groups with facial or truncal PHN and between groups with recent or more chronic PHN. The observations suggest that the relative contributions of peripheral and central mechanisms to the pathophysiology of pain differ among subjects and may vary over the course of PHN. PMID: 10719948 [PubMed - indexed for MEDLINE] 2276. J Infect. 1999 Nov;39(3):209-12. Is VZV reactivation a common cause of unexplained unilateral pain? Results of a prospective study of 57 patients. McKendrick MW, Care CC, Kudesia G, Bates CJ, Oxley MK, Eley A. Dept. of Infection and Tropical Medicine, Royal Hallamshire Hospital, Sheffield, UK. OBJECTIVE: Pain is a common reason for patients to present to a doctor. Many patients with zoster have seen their doctor with pain during the days before the rash and zoster sine herpete is well described. If early varicella zoster virus (VZV) reactivation could be identified confidently, it could provide an opportunity for early antiviral intervention. This prospective study was performed to assess how often patients presenting to their general practitioner with unilateral pain of no obvious clinical cause proved to have evidence of VZV reactivation. METHODS: Fifty-seven patients were recruited and followed for 28 days; laboratory testing included VZV polymerase chain reaction (PCR) from peripheral blood mononuclear cells, VZV IgG, IgA and IgM. The control group consisted of 81 blood donors. RESULTS: Only two study patients developed the rash of zoster. There was no significant difference in PCR or serological responses between the study group and control group. Clinical characteristics did not enable identification of patients presenting to their doctor with unilateral pain who had prodromal zoster. CONCLUSION: There was no evidence on clinical or laboratory tests used in this study to support the view that reactivation of VZV is a common cause of unexplained unilateral pain. PMID: 10714797 [PubMed - indexed for MEDLINE] 2277. Nippon Ganka Gakkai Zasshi. 2000 Feb;104(2):97-102. [Uveitis associated with zoster sine herpete. Diagnosis and clinical findings] [Article in Japanese] Kashiwase M, Sakai J, Usui M. Department of Ophthalmology, Tokyo Medical University, Japan. PURPOSE: Zoster sine herpete (ZSH) causes solely neurologic symptoms without the eruption that is evident in herpes zoster ophthalmicus. It is occasionally complicated by acute granulomatous uveitis. We examined patients suspected of ZSH for detection of the varicella-zoster virus (VZV) genome, and discussed its clinical appearance. MATERIALS AND METHODS: Nine patients were presumed to have ZSH. All manifested acute granulomatous iridocyclitis and high intraocular pressure without eruption. A polymerase chain reaction (PCR) analysis of the aqueous humor was performed. RESULTS: Five patients were positive for VZV DNA. They showed mutton-fat keratic precipitates and high intraocular pressure in the early stage. Pigmentation in the anterior chamber angle, pigmented keratic precipitates, and finally sectoral iris atrophy were observed in the recovery stage. These clinical findings were common to ZSH. CONCLUSIONS: The ocular lesions in ZSH were shown to have distinctive characteristics, and PCR is useful to determine etiological agents in the early stage of disease. PMID: 10714158 [PubMed - indexed for MEDLINE] 2278. Arch Neurol. 2000 Mar;57(3):427. Association of varicella-zoster virus with cervical artery dissection in 2 cases. Constantinescu CS. Comment in: Arch Neurol. 2000 Nov;57(11):1658-9. Comment on: Arch Neurol. 1999 Jul;56(7):851-6. PMID: 10714677 [PubMed - indexed for MEDLINE] 2279. Biol Blood Marrow Transplant. 2000;6(1):44-9. Varicella zoster virus infections following allogeneic bone marrow transplantation: frequency, risk factors, and clinical outcome. Koc Y, Miller KB, Schenkein DP, Griffith J, Akhtar M, DesJardin J, Snydman DR. Department of Medicine, New England Medical Center, Boston, Massachusetts, USA. Reactivation of varicella zoster virus (VZV) is a common event in patients undergoing allogeneic bone marrow transplantation (BMT) and may lead to life-threatening complications. We retrospectively analyzed the incidence, clinical outcome, and risk factors for VZV infections occurring within the first 5 years of transplantation in 100 consecutive adults undergoing allogeneic BMT between 1992 and 1997. Forty-one patients (41%) developed VZV reactivation a median of 227 days (range 45-346 days) post-transplantation. Twelve percent of VZV reactivation occurred in the first 100 days and 88% within the first 24 months. Among those who survived for 2 or more years after transplantation (n = 47), 59% developed VZV infection. Forty percent of patients with VZV reactivation required admission with a mean hospital stay of 7.2 days. Two patients developed encephalitis, and 1 died despite antiviral therapy. The most frequent complications were post-herpetic neuralgia and peripheral neuropathy (68%). Thoracic dermatomal zoster represented 41% of the infections; disseminated cutaneous involvement was observed in 17% of patients. No clinical or epidemiologic risk factors were associated with recurrence. Administration of ganciclovir for prevention of cytomegalovirus infection delayed the onset of VZV infection beyond 4 months (P = .06). In a further subset analysis, patients with a limited chronic graft-versus-host disease (GVHD) had a lower estimated incidence of VZV reactivation compared with those with extensive chronic GVHD (P = .11). We conclude that complications from reactivation of VZV infection are common and associated with considerable morbidity and mortality in patients undergoing allogeneic BMT. PMID: 10707998 [PubMed - indexed for MEDLINE] 2280. Vaccine. 2000 Apr 3;18(19):2049-54. Humoral immunoresponse to varicella-zoster virus pernasally coadministered with Escherichia coli enterotoxin in mice. Tsuji T, Shiraki K, Sato H, Yue-Mea J, Honma Y, Yoshikawa T, Asano Y. Department of Microbiology, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan. It is evaluated whether Escherichia coli enterotoxin is useful for induction of immunity to varicella-zoster virus (VZV) as a mucosal adjuvant in mice. When a commercially available live varicella vaccine (Oka strain) and toxin were administered simultaneously via a nasal route three times at 2 or 6 month intervals, an antibody neutralizing VZV was detected in half or all of the mice vaccinated, respectively. The antibody specific to the vaccine strain of VZV reacted to five proteins, molecular weights of which were 110 K, 100 K, 62 K, 54 K and 46 K. These proteins were composed of glycosylated products of all kinds of glycoproteins. These results suggest that although a nasal administration of the vaccine without the adjuvant has little immunogenicity in mice, the simultaneous administration of the live vaccine and the toxin over a long period induces a specific humoral immunity to VZV. PMID: 10706968 [PubMed - indexed for MEDLINE] 2281. Otolaryngol Head Neck Surg. 2000 Mar;122(3):463. Trigeminal herpes zoster/chocolate-vanilla tongue. Braverman I, Uri N, Greenberg E. Department of Otolaryngology-Head and Neck Surgery, Carmel Medical Center, Haifa, Israel. PMID: 10699831 [PubMed - indexed for MEDLINE] 2282. J Dermatol Sci. 2000 May;23(1):63-72. Characterization of acyclovir susceptibility and genetic stability of varicella-zoster viruses isolated during acyclovir therapy. Ida M, Kageyama S, Sato H, Kamiyama T, Toyomoto T, Ozaki T, Kajita Y, Morohashi M, Shiraki K. Department of Virology, Toyama Medical and Pharmaceutical University, 2630 Sugitani, Toyama, Japan. We have characterized the susceptibility and genetic stability of varicella-zoster viruses (VZV) isolated from skin lesions of three patients with herpes zoster and six patients with varicella treated with conventional short-term acyclovir (ACV) administration. The susceptibilities to ACV of the serial isolates from the patients were examined, and there was no significant difference in the susceptibility to ACV among the isolates before and during the ACV treatment, indicating that conventional short-term ACV treatment did not generate ACV-resistant VZV infections. Polymerase chain reaction (PCR) analyses of these as well as seven thymidine kinase-deficient VZV strains derived from in vitro ACV treatment were carried out to examine their genomic stability. Five regions containing tandem direct reiterations (R1-R5) were amplified by PCR and compared, and the region containing the Pst I-site was also examined. PCR analyses demonstrated that the R1, R5 and the Pst I-sites were stable and useful in epidemiological studies even after ACV treatment. The R2, R3 and R4 sites were far less stable in these experimental conditions. In this paper we discuss the results of the PCR analyses with regard to the dynamics of VZV population in patients with VZV infection treated with conventional short-term ACV administration. PMID: 10699766 [PubMed - indexed for MEDLINE] 2283. N Engl J Med. 2000 Mar 2;342(9):635-45. Neurologic complications of the reactivation of varicella-zoster virus. Gilden DH, Kleinschmidt-DeMasters BK, LaGuardia JJ, Mahalingam R, Cohrs RJ. Department of Neurology, University of Colorado Health Sciences Center, Denver 80262, USA. don.gilden@uchsc.edu Erratum in: N Engl J Med 2000 Apr 6;342(14):1063. Comment in: N Engl J Med. 2001 Mar 29;344(13):1019-20; author reply 1021-2. N Engl J Med. 2001 Jan 4;344(1):65-6. PMID: 10699164 [PubMed - indexed for MEDLINE] 2284. West J Med. 2000 Jan;172(1):10. More on herpes zoster lesions. Litvinoff J. Comment on: West J Med. 1999 May;170(5):263. PMCID: PMC1070707 PMID: 10695432 [PubMed - indexed for MEDLINE] 2285. Rinsho Ketsueki. 2000 Jan;41(1):20-4. [Varicella-zoster virus infection after hematopoietic stem cell transplantation] [Article in Japanese] Akiyama H, Inoue T, Okoshi Y, Mori S, Ohashi K, Maeda Y, Sasaki T, Okuyama Y, Hiruma K, Sakamaki H. Hematology Division, Tokyo Metropolitan Komagome Hospital. Of 264 patients aged 15 years or more who underwent hematopoietic stem cell transplantation between 1989 and September 1998 at the Tokyo Metropolitan Komagome Hospital, 47 were infected by the varicella-zoster virus (VZV). In 2 patients, visceral disease preceded cutaneous dissemination. One of these patients exhibited gastrointestinal symptoms followed by disseminated skin rash 6 days later. In the other patient, epigastralgia developed and was followed by seizures secondary to meningitis; the appearance of a skin rash 5 days after these initial symptoms yielded the diagnosis. Early diagnosis and treatment of VZV infection are important, especially for patients who present with visceral symptoms suspected to be due to VZV. PMID: 10695394 [PubMed - indexed for MEDLINE] 2286. Pediatr Infect Dis J. 2000 Feb;19(2):169-70. Herpes zoster in healthy children immunized with varicella vaccine. Takayama N, Takayama M, Takita J. Department of Pediatrics, Tokyo Metropolitan Komagome Hospital, Japan. takyamndk@komagome-hospital.bunkyo.tokyo.jp PMID: 10694011 [PubMed - indexed for MEDLINE] 2287. No To Shinkei. 2000 Jan;52(1):43-7. [A case of herpes zoster encephalitis with Ramsay-Hunt syndrome, herpes zoster generalisatus and acute pancreatitis] [Article in Japanese] Nakane S, Honda H, Hamasaki S, Shirabe S, Nakamura T. First Department of Internal Medicine, Nagasaki University School of Medicine, Japan. We describe here a 71-year-old man who had herpes zoster encephalitis. He developed high fever, headache and disturbance of consciousness on 1st, May, 1998. On admission, neurological examination revealed disturbance of consciousness with restlessness and meningeal signs. Brain MRI (T 1 and T 2 weighted images) demonstrated high signal lesions in the left temporal lobe and cerebellar vermis. VSV encephalitis was diagnosed based on CSF pleocytosis, high serum and CSF titers of VZV antibody and EEG abnormality. During hospitalization, Ramsay-Hunt syndrome, herpes zoster generalisatus and acute pancreatitis developed. To our knowledge, the characteristic combination of the clinical signs in this case is very rare. We discussed the pathogenic mechanisms of these conditions, and this case was considered to have VZV encephalitis, and to be associated with right facial nerve palsy and pancreatitis, in spite of the absence of immunological deficiency. PMID: 10689690 [PubMed - indexed for MEDLINE] 2288. Vaccine. 2000 Feb 25;18(16):1700-6. Vaccination of immunocompetent elderly subjects with a live attenuated Oka strain of varicella zoster virus: a randomized, controlled, dose-response trial. Trannoy E, Berger R, Holländer G, Bailleux F, Heimendinger P, Vuillier D, Creusvaux H. Pasteur Mérieux Connaught (PMC), Lyon, France. After primary infection in childhood, varicella zoster virus (VZV) remains latent in the dorsal route ganglia. Its reactivation later in life can lead to a zoster episode. VZV-specific, T-cell-mediated immunity (VZV-CMI) is likely to be important in preventing symptomatic reactivation. As CMI declines with age, a vaccine enhancing VZV-CMI might be effective in decreasing the incidence or severity of zoster in elderly subjects. A randomized, double blind controlled trial assessing CMI responses of elderly subjects immunized with a live attenuated, VZV-Oka vaccine was conducted. Two hundred healthy volunteers (55-75 years of age) received either a single injection of the VZV vaccine (PMC), containing 3200 (Oka 3200), 8500 (Oka 8500), or 41,650 (Oka 41650) PFU of live VZV, or a pneumococcus vaccine control group (Pneumo 23((R)). The immune response to VZV was assessed by measuring the T-cell response to VZV antigens, i.e. proliferation (stimulation index, SI), precursor cell frequency (PCF), cytokine secretion, and antibody titers. Six weeks post-vaccination, VZV-specific SI (adjusted mean values) was significantly greater (P<0.0001) in the 3 vaccine groups (with SI=5. 6 for Oka 3200; SI=5.0 for Oka 8500, and SI=7.2 for Oka 41,650) than in the control group (SI=2.9). The increase in PCF was striking, with 72.4, 91.2 and 85.1 precursors per million cells respectively in these 3 vaccine groups, vs 26.3 in the control group. No significant IL-4 secretion was observed in any subject, whereas the presence of IFN-gamma secretion was found to correlate with good responder status. The increase of these CMI parameters did not depend upon the titer of virus injected. Geometric mean titers of VZV antibodies increased in all vaccine groups and remained unchanged in the control group. Nevertheless, no correlation between the antibody response and the cell-mediated response was found. Live attenuated VZV vaccine caused a significant increase in VZV-CMI in a healthy, elderly population. No relationship between vaccine dose and the intensity of the specific response was found. PMID: 10689152 [PubMed - indexed for MEDLINE] 2289. Am J Ophthalmol. 2000 Feb;129(2):166-72. Viral causes of the acute retinal necrosis syndrome. Ganatra JB, Chandler D, Santos C, Kuppermann B, Margolis TP. Francis I. Proctor Foundation, and the Department of Ophthalmology, University of California at San Francisco, 94143-0944, USA. PURPOSE: The primary goal of this study was to determine the viral cause of the acute retinal necrosis syndrome in 28 patients (30 eyes). A secondary goal was to investigate possible associations between viral cause and patient age, and viral cause and central nervous system disease. METHODS: A retrospective case series in which we reviewed the laboratory results and clinical histories of 28 patients (30 eyes) diagnosed with acute retinal necrosis syndrome, from whom vitreous or aqueous specimens were received, for diagnostic evaluation using previously described polymerase chain reaction-based assays. RESULTS: Varicella-zoster virus, herpes simplex virus, and cytomegalovirus (CMV) DNA were detected in aqueous and/or vitreous specimens from 27 of 28 patients (29 of 30 eyes with a clinical history of acute retinal necrosis syndrome). No sample was positive for DNA from more than one virus. Varicella-zoster virus DNA was detected in 13 patients (15 eyes). Median age was 57 years. Herpes simplex virus type 1 DNA was detected in seven patients (seven eyes). Median age was 47 years. Six of these patients had a history of herpes simplex virus encephalitis. Herpes simplex virus type 2 DNA was detected in six patients (six eyes). Median age was 20 years. Three of these patients had a likely history of meningitis. Cytomegalovirus DNA was detected in one patient who was immunosuppressed iatrogenically. No viral DNA was detected in one patient from whom a sample was taken after 6 weeks of acyclovir therapy. CONCLUSIONS: The data suggest that varicella-zoster virus or herpes simplex virus type 1 cause acute retinal necrosis syndrome in patients older than 25 years, whereas herpes simplex virus type 2 causes acute retinal necrosis in patients younger than 25 years. A history of central nervous system infection in a patient with acute retinal necrosis syndrome suggests that herpes simplex virus is likely to be the viral cause. PMID: 10682968 [PubMed - indexed for MEDLINE] 2290. J Virol Methods. 2000 Feb;84(2):169-73. Serological diagnosis of varicella-zoster virus in sera with antibody-capture enzyme-linked immunosorbent assay of IgM. Oladepo DK, Klapper PE, Percival D, Vallely PJ. Cortecs Diagnostics, Deeside, UK. Evaluation was made of three enzyme-linked immunosorbent assay (ELISA) formats; varicella-zoster virus (VZV) indirect ELISA; VZV IgM capture using biotin and VZV IgM capture using peroxidase, for the detection of VZV-specific IgM antibodies in human sera. It was observed that there was no significant difference in sensitivity of detection using the three formats but there were important practical differences in the number of steps and hence time for assay completion between the three assay formats. All assays showed some cross-reactivity with sera containing anti-HSV1 antibodies. PMID: 10680966 [PubMed - indexed for MEDLINE] 2291. Intern Med. 2000 Jan;39(1):80-1. Bilateral facial palsy following trigeminal zoster with zoster oticus. Hamano T, Takano A, Miyao S, Teramoto J, Wanibe S. PMID: 10674857 [PubMed - indexed for MEDLINE] 2292. Bone Marrow Transplant. 2000 Jan;25(2):167-72. Incidence, risk factors and outcome of varicella-zoster virus infection in children after haematopoietic stem cell transplantation. Leung TF, Chik KW, Li CK, Lai H, Shing MM, Chan PK, Lee V, Yuen PM. Division of Haematology and Oncology, Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong. We report a retrospective analysis of VZV infection after haematopoietic stem cell transplantation (HSCT) in children. Thirty-three (30%) of the total 109 children who were transplanted during a 7 year period developed post-transplant VZV infection. Twenty-four of these 33 (73%) children had VZV infection within 1 year following HSCT. The cumulative incidences of post-transplant VZV infection at 1 and 5 years were 26% and 45%, respectively. The positive and negative predictive values of pretransplant VZV serology in recipients on the development of HZ following HSCT were 39% and 88%, respectively. Pretransplant VZV seropositivity in recipients was the only risk factor for post-transplant herpes zoster (HZ) infection on multivariate analysis. All patients responded to acyclovir. The median duration of VZV infection was 5 days. Three (11%) and one (3%) children with HZ developed visceral dissemination and post-herpetic neuralgia, respectively. No mortality was directly attributed to VZV infection. VZV infection remains a major cause of morbidity in children after HSCT. Further studies are warranted to evaluate the potential use of VZV vaccine in these children. Bone Marrow Transplantation (2000) 25, 167-172. PMID: 10673675 [PubMed - indexed for MEDLINE] 2293. Kyobu Geka. 2000 Feb;53(2):136-40. [Ineffective and recurrent cases of thoracoscopic sympathectomy for hyperhidrosis and intractable pain] [Article in Japanese] Hoshina K, Amemiya R, Asato Y, Hishikawa S, Nemoto K, Kiyoshima M, Kohno S, Shida D, Tanaka R, Suzuki A, Yoshimi F, Koizumi S. Department of Surgery, Ibaraki Prefectural Central Hospital and Cancer Center, Japan. We reported the cases of thoracoscopic sympathectomy, that is, six cases of hyperhidrosis, three of post herpetic neuralgia, and four of reflex sympathetic dystrophy, including recurrent or incompletely resected or ineffective ones. Recently this procedure for hyperhidrosis had been performed frequently because of its effectiveness, less pain, early discharge and cosmetic aspect. For an ineffective case of hyperhidrosis abdominal respiration which emphasized the exhalation and using an upper abdomen decreased the sweating. The balance of autonomic nerve system, toward parasympathetic dominant, was thought to be improved by conscious respiration. The decrease of sweating right after the operation in a case of incomplete resection indicated that intraoperative maneuver could restrict the sympathetic nerve. This procedure for a pain control could be less effective than that for hyperhidrosis, so an adequate preoperative informed consent was thought to be necessary. PMID: 10667025 [PubMed - indexed for MEDLINE] 2294. J Laryngol Otol. 1999 Oct;113(10):914-5. Delayed facial palsy after middle-ear surgery due to reactivation of varicella-zoster virus. Gyo K, Honda N. Department of Otolaryngology, Ehime University Hospital, Japan. Viral reactivation is thought to be an important cause of post-operative facial palsy of delayed onset. We present an unusual case of Ramsay-Hunt syndrome that occurred as a consequence of middle-ear surgery by triggering varicella-zoster virus reactivation. As a pathognomonic auricular eruption was not seen, the patient was initially misdiagnosed as iatrogenic facial palsy. Clinical features, diagnosis and management are discussed. PMID: 10664708 [PubMed - indexed for MEDLINE] 2295. Arch Virol. 2000;145(1):85-97. Stability of a varicella-zoster virus glycoprotein E epitope. Vafai A, Forghani B, Kilpatrick D, Ling J, Shankar V. Biologics Branch, Scientific Resources Program, Centers for Disease Control and Prevention, Public Health Service, U.S. Department of Health and Human Services, Atlanta, Georgia, USA. The epitope stability of a varicella-zoster virus (VZV) glycoprotein E (gE) was analyzed with monoclonal antibodies (mAbs) in cells infected with different passages of various VZV strains and isolates. The gE-specific mAbs recognized same antigenic sites (epitopes) in VZV isolates with various passage history. All VZV strains and virus-isolates reacted with an anti-gE monoclonal antibody by immunoprecipitation, or indirect fluorescent antibody staining test. Sera from VZV seropositive individuals reacted with a truncated VZV gE glycoprotein, designated TgpI-511. Also, human mononuclear cells (MNCs) stimulated with TgpI-511 glycoprotein were shown to produce VZV-specific antibodies in vitro. The results demonstrated the stability of these gE epitopes tested in this study in TgpI-511 and among the VZV-isolates obtained from different passages. These results also suggest that VZV glycoproteins as well as live attenuated or killed varicella vaccines containing these epitopes could be used as therapeutic booster vaccines in adults and the elderly to prevent zoster. PMID: 10664408 [PubMed - indexed for MEDLINE] 2296. Hautarzt. 1999 Dec;50(12):873-8. [Virologic diagnosis of herpes zoster] [Article in German] Sauerbrei A, Sommer M, Wutzler P. Institut für Antivirale Chemotherapie, Friedrich-Schiller-Universität Jena. Diagnosis of herpes zoster needs to be rapid when effective antiviral chemotherapy is being considered. Patients with atypical clinical features can often only be diagnosed by virological methods. In the present study, vesicle specimens of 100 patients with zoster were analysed by detecting viral DNA using polymerase chain reaction (PCR). The findings were compared with those obtained by traditional virological and serological methods. PCR results confirmed the clinical diagnosis of zoster in 95%. Primers selected from varicella-zoster virus (VZV) gene 28 proved to be most sensitive. The sensitivity of virus culture was 20% (specificity 100%) and of direct immunofluorescent VZV-specific antigen staining in vesicle samples 82% (specificity 76%). There was a serological response to specific IgM and IgA antibodies in 48% within four days after the onset of rash. These findings suggest that PCR is the method of choice for rapid laboratory diagnosis of zoster. PMID: 10663022 [PubMed - indexed for MEDLINE] 2297. Br J Ophthalmol. 2000 Feb;84(2):193-8. Variable R1 region in varicella zoster virus in fulminant type of acute retinal necrosis syndrome. Abe T, Sato M, Tamai M. Department of Ophthalmology, Tohoku University School of Medicine, Sendai, Japan. BACKGROUND/AIMS: Varicella zoster virus (VZV) is a causative agent in acute retinal necrosis (ARN) syndrome. However, in spite of aggressive antiviral therapy, clinical characteristics among patients have varied. Different viral strains were examined to determine their respective role in producing clinical characteristics. The viral strains were also compared with those of previously reported ones. METHODS: To differentiate VZV strains R1 and R5, variable regions of VZV were amplified by nested polymerase chain reaction (PCR) in 11 eyes of 10 patients. Sequence analysis was also performed. RESULTS: Four cases had strains diverted only at the tip of the 3' end of the R1 variable region, similar to that of the H-N3 strain, which was previously reported. Conversely, other cases were diverted to other regions. Interestingly, some of the latter cases showed multiple PCR products in the R1 region that were generated by the truncation of either the 5' or 3' R1 region. Final visual acuities of these patients were less than 0.2. The former cases showed final visual acuities more than 0.4. Only two variants were from the R5 region. No patient had the same viral strain as the European Dumas type. CONCLUSION: These results showed that variable VZV strains participated in ARN. Using PCR of the R1 variable region, it was estimated that patients with a more fulminant type of ARN may have diverse viruses with extensive replication in the affected eyes. PMCID: PMC1723368 PMID: 10655197 [PubMed - indexed for MEDLINE] 2298. Antiviral Res. 1999 Dec 31;44(3):145-54. Herpes zoster: focus on treatment in older adults. Whitley RJ, Gnann JW. Department of Pediatrics, The University of Alabama at Birmingham, Children's Hospital, 35233, USA. rwhitley@peds.uab.edu PMID: 10651066 [PubMed - indexed for MEDLINE] 2299. Semin Pediatr Neurol. 1999 Dec;6(4):278-87. Human herpesviruses and neurological disorders of childhood. Bale JF Jr. Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, USA. The human herpesviruses, a group of DNA viruses that includes herpes simplex viruses types 1 and 2, varicella zoster virus, cytomegalovirus, Epstein-Barr virus, and human herpes viruses types 6, 7, and 8, cause substantial neurological morbidity among infants and children. This review describes the biology of these viruses and summarizes the clinical manifestations and therapy of the diseases that result from childhood infection with these important pathogens. PMID: 10649836 [PubMed - indexed for MEDLINE] 2300. Mayo Clin Health Lett. 2000 Jan;18(1):4. New skin patch calms pain following shingles. [No authors listed] PMID: 10646332 [PubMed - indexed for MEDLINE] 2301. Bratisl Lek Listy. 1999 Sep;100(9):515-8. [Recurrent eruptions of herpes zoster] [Article in Czech] Cerny Z. Department of Infectious Diseases, Medical Faculty, Masaryk University, Brno, Czech Republic. zcerny@med.muni.cz BACKGROUND: Repeated eruptions of herpes zoster are frequently detected in immunocompromised patients, but rarely may occur also in immunocompetent persons. While detailed analyses of repeated manifestations of this disease in the literature are scarce, experience with a small group of affected persons is presented. AIMS OF THE STUDY: To search for the nature of herpes zoster relapses occurrence and to use it in treatment quality improvement. METHODS: Analysis and processing of clinical documentation of the first and repeated eruptions of herpes zoster in 12 patients. Study of sex and age, presence of accompanying diseases, duration of the interval from the first eruption to the relapse, localization, complications and relation to antiviral therapy. RESULTS: The interval between the first and repeated manifestation ranged from 1 week to 30 years. The male to female ratio was 10/2. In 3 patients the disease was accompanied by malignancy, in 3 by diabetes mellitus and in 1 by proved immunodeficiency. The most frequent eruption localization was intercostal space. In 6 patients the relapse was localized at the same site, in 6 of them at different. Early relapses in the same localization appeared in immunodeficient persons and also in persons after the first attack treatment with acyklovir. Primary manifestation was accompanied by complications in 42%, repeated in 92%. CONCLUSIONS: Early herpes zoster relapses following shortly after the primary attack treated with acyklovir should be considered as a manifestation of immunity disorder requiring immediate treatment with other antiviral drug. Late relapses can be treated with acyclovir. (Tab. 2, Fig. 2, Ref. 22.) PMID: 10645043 [PubMed - indexed for MEDLINE] 2302. J Virol. 2000 Feb;74(4):2005-10. Varicella-zoster virus proteins in skin lesions: implications for a novel role of ORF29p in chickenpox. Annunziato PW, Lungu O, Panagiotidis C, Zhang JH, Silvers DN, Gershon AA, Silverstein SJ. Departments of Pediatrics, College of Physicians and Surgeons, Columbia University, New York, New York, USA. paa5@columbia.edu Skin biopsy samples from varicella-zoster virus (VZV)-infected patients examined by immunohistochemistry demonstrated VZV replication in nonepithelial cell types. ORF29p, a nonstructural nuclear protein, was found in nerves of two of six patients with chickenpox. In tissue culture, ORF29p was secreted by VZV-infected fibroblasts. Extracellular ORF29p can be taken up through endocytosis by human neurons, implying a novel role for this protein in pathogenesis. PMCID: PMC111678 PMID: 10644373 [PubMed - indexed for MEDLINE] 2303. J Virol. 2000 Feb;74(4):1900-7. Modulation of major histocompatibility class II protein expression by varicella-zoster virus. Abendroth A, Slobedman B, Lee E, Mellins E, Wallace M, Arvin AM. Departments of Pediatrics and Microbiology & Immunology, Stanford University School of Medicine, Stanford, California 94305-5208, USA. We sought to investigate the effects of varicella-zoster virus (VZV) infection on gamma interferon (IFN-gamma)-stimulated expression of cell surface major histocompatibility complex (MHC) class II molecules on human fibroblasts. IFN-gamma treatment induced cell surface MHC class II expression on 60 to 86% of uninfected cells, compared to 20 to 30% of cells which had been infected with VZV prior to the addition of IFN-gamma. In contrast, cells that were treated with IFN-gamma before VZV infection had profiles of MHC class II expression similar to those of uninfected cell populations. Neither IFN-gamma treatment nor VZV infection affected the expression of transferrin receptor (CD71). In situ and Northern blot hybridization of MHC II (MHC class II DR-alpha) RNA expression in response to IFN-gamma stimulation revealed that MHC class II DR-alpha mRNA accumulated in uninfected cells but not in cells infected with VZV. When skin biopsies of varicella lesions were analyzed by in situ hybridization, MHC class II transcripts were detected in areas around lesions but not in cells that were infected with VZV. VZV infection inhibited the expression of Stat 1alpha and Jak2 proteins but had little effect on Jak1. Analysis of regulatory events in the IFN-gamma signaling pathway showed that VZV infection inhibited transcription of interferon regulatory factor 1 and the MHC class II transactivator. This is the first report that VZV encodes an immunomodulatory function which directly interferes with the IFN-gamma signal transduction via the Jak/Stat pathway and enables the virus to inhibit IFN-gamma induction of cell surface MHC class II expression. This inhibition of MHC class II expression on VZV-infected cells in vivo may transiently protect cells from CD4(+) T-cell immune surveillance, facilitating local virus replication and transmission during the first few days of cutaneous lesion formation. PMCID: PMC111668 PMID: 10644363 [PubMed - indexed for MEDLINE] 2304. J Virol. 2000 Feb;74(4):1864-70. Infection of human T lymphocytes with varicella-zoster virus: an analysis with viral mutants and clinical isolates. Soong W, Schultz JC, Patera AC, Sommer MH, Cohen JI. Medical Virology Section, Laboratory of Clinical Investigation, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland 20892, USA. Varicella-zoster virus (VZV) disseminates in the body in peripheral blood mononuclear cells during chickenpox. Up to 1 in 10,000 mononuclear cells are infected during the viremic phase of the disease. We developed an in vitro system to infect human mononuclear cells with VZV by using umbilical cord blood. In this system, 3 to 4% of T cells were infected with VZV. VZV mutants unable to express certain genes, such as open reading frame 47 (ORF47) or ORF66, were impaired for growth in T cells, while other mutants showed little difference from parental virus. VZV unable to express ORF47 was even more impaired for spread from umbilical cord blood cells to melanoma cells in vitro. Early-passage clinical isolates of VZV infected T cells at a similar rate to the Oka vaccine strain; however, the clinical isolates were more efficient in spreading from infected T cells to melanoma cells. This in vitro system for infecting human T cells with VZV should be useful for identifying cellular and viral proteins that are important for virus replication in T cells and for the spread of virus from T cells to other cells. PMCID: PMC111664 PMID: 10644359 [PubMed - indexed for MEDLINE] 2305. Dermatology. 1999;199(4):361-4. Simultaneous reactivation of herpes simplex virus and varicella-zoster virus in a patient with idiopathic thrombocytopenic purpura. Nikkels AF, Frère P, Rakic L, Fassotte M, Evrard B, De Mol P, Piérard GE. Department of Dermatopathology, University Medical Center of Liège, Belgium. af.nikkels@chu.ulg.ac.be Simultaneous reactivation of distinct Herpesviridae with development of clinical manifestations is exceptional. We report a 48-year-old woman suffering from idiopathic thrombocytopenic purpura. As the disease remained refractory to corticosteroids, immunoglobulins and splenectomy, a cure of vinblastine was administered. An atypical stomatitis developed few days later. Immunohistochemistry on a Tzanck smear and a biopsy evidenced a Herpes simplex virus type 1 (HSV-1) infection. The patient presented simultaneously a single necrotic lesion on the abdomen. Immunohistochemistry on a skin biopsy revealed the presence of the varicella-zoster virus (VZV) gE, gB and IE63 proteins. Intravenous aciclovir was initiated. The present case of simultaneous clinical infections by HSV-I and VZV underlines the importance of complementary viral identification testing in the event of unusual clinical presentations. Copyright 2000 S. Karger AG, Basel PMID: 10640851 [PubMed - indexed for MEDLINE] 2306. Dev Ophthalmol. 1999;31:192-209. Management of ocular manifestations in patients with acquired immunodeficiency syndrome. Pivetti-Pezzi P, Accorinti M. Servizio Speciale di Immunovirologia Oculare, Università di Roma La Sapienza, Roma, Italia. uveiti.piv.@iol.it PMID: 10641209 [PubMed - indexed for MEDLINE] 2307. J Altern Complement Med. 1999 Dec;5(6):553-65. Evaluating herbal medicine for the management of Herpes zoster in human immunodeficiency virus-infected patients in Kampala, Uganda. Homsy J, Katabira E, Kabatesi D, Mubiru F, Kwamya L, Tusaba C, Kasolo S, Mwebe D, Ssentamu L, Okello M, King R. Traditional and Modern Health Practitioners Together Against AIDS (THETA), Kampala, Uganda. Comment in: J Altern Complement Med. 2000 Feb;6(1):1-2. OBJECTIVE: This study was carried out to evaluate the potential effectiveness of herbal treatments used for herpes zoster (HZ) by a great number of people living with acquired immunodeficiency syndrome (PLWAs) in Uganda. SETTING: Kampala, Uganda. Clinics of indigenous traditional healers, at the Department of Medicine of Mulago Hospital, Makerere University, and at The AIDS Support Organization (TASO) Clinic, providing primary care to people living with HIV and AIDS. DESIGN, PATIENTS, AND PARTICIPANTS: Nonrandomized, nonplacebo controlled, observational study in two phases. Inclusion criteria included HIV seropositivity and a recent HZ attack. In phase 1, 52 patients were enrolled, treated, and followed for up to 3 months at three healers' clinics, and compared to 52 TASO Clinic controls receiving ambulatory care. Phase 2 was similar in design to phase 1, but lasted longer (6-month follow-up) and involved 154 hospital outpatients treated with herbal medicine and 55 TASO controls. In both phases, healer patients were given herbal treatment according to healers' prescriptions, while controls received either symptomatic treatment or acyclovir. RESULTS: Healer patients and controls experienced similar rates of resolution of their HZ attacks. Fewer healer patients than controls experienced superinfection in phase 1 (18% versus 42%, p < 0.02) and fewer healer patients showed keloid formation in either phase. This difference was not statistically significant. In both phases, zoster-associated pain resolved substantially faster among healer patients with a higher degree of significance in phase 2 where the progression of pain over time could be seen because of the longer follow-up (phase 1: maximum p value (pmax) < pmax < 0.02 at 1 month, pmax < 0.005 at 2 months, pmax < 0.0001 at 3 months). CONCLUSION: Herbal treatment is an important local and affordable primary care alternative for the management of HZ in HIV-infected patients in Uganda and similar settings. PMID: 10630349 [PubMed - indexed for MEDLINE] 2308. Diagn Microbiol Infect Dis. 1999 Nov;35(3):205-8. Evaluation of light diagnostics SimulFluor HSV/VZV immunofluorescence assay. Scicchitano LM, Shetterly B, Bourbeau PP. Division of Laboratory Medicine, Geisinger Medical Center, PennState Geisinger Medical Laboratories, Danville, PA 17822-0131, USA. In this study, we evaluated the Light Diagnostics SimulFluor HSV/VZV Immunofluorescence (SIM) assay. A total of 167 specimens yielded 21 VZV and 55 HSV true positive test results. The sensitivity/specificity of the SIM assay for VZV and HSV were, respectively, 100/98 and 62/99. These results were comparable to the results for the predicate devices used in this study. The SIM assay offers the potential for the simultaneous, direct detection of HSV and VZV from a single slide well. PMID: 10626130 [PubMed - indexed for MEDLINE] 2309. Rev Prat. 1999 Nov 15;49(18):2035-40. [Varicella and zona: epidemiology, physiopathology, diagnosis, course, treatment] [Article in French] Zeller V, Caumes E, Bricaire F. Service de maladies infectieuses et tropicales, groupe hospitalier La Pitié-La Salpêtrière, Paris. PMID: 10626492 [PubMed - indexed for MEDLINE] 2310. Neurol India. 1999 Dec;47(4):294-9. Non-compressive myelopathy: clinical and radiological study. Prabhakar S, Syal P, Singh P, Lal V, Khandelwal N, Das CP. Departments of Neurology and Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India. Comment in: Neurol India. 1999 Dec;47(4):253-4. Fifty seven patients (42 males and 15 females) with non-compressive myelopathy were studied from 1997 to 1999. Acute transverse myelitis (ATM) was the commonest (31) followed by Vit B12 deficiency myelopathy (8), primary progressive multiple sclerosis (5), hereditary spastic paraplegia (3), tropical spastic paraplegia (2), subacute necrotising myelitis (1), radiation myelitis (1), syphilitic myelitis (1) and herpes zoster myelitis (1). 4 cases remained unclassified. In the ATM group, mean age was 30.35 years, antecedent event was observed in 41.9% case, 25 cases had symmetrical involvement and most of the cases had severe deficit at onset. CSF study carried out in 23 patients of ATM revealed rise in proteins (mean 147.95mg%, range 20-1200 mg/dL) and pleocytosis (mean 20.78/cumm, range 0-200 mm3). Oligoclonal band (OCB) was present in 28% of cases of ATM. The most common abnormality detected was a multisegment hyperintense lesion on T2W images, that occupied the central area on cross section. In 6 patients hyperintense signal was eccentric in location. MRI was normal in 4 cases of ATM. Thus ATM is the leading cause of non-compressive myelopathy. Clinical features combined with MRI findings are helpful in defining the cause of ATM. PMID: 10625902 [PubMed - indexed for MEDLINE] 2311. Time. 1999 Sep 20;154(12):86. Stealthy virus. Nash JM. PMID: 10620925 [PubMed - indexed for MEDLINE] 2312. Clin Infect Dis. 2000 Jan;30(1):229-30. Herpes zoster oticus with pontine lesion: segmental brain-stem encephalitis. Mizock BA, Bartt R, Agbemazdo B. Department of Medicine, Cook County Hospital, Chicago, IL 60612, USA. bmizock@earthlink.net PMID: 10619773 [PubMed - indexed for MEDLINE] 2313. Prog Retin Eye Res. 2000 Jan;19(1):69-85. Treatment of viral diseases of the cornea and external eye. Kaufman HE. Department of Ophthalmology, LSU Eye Center, Louisiana State University Medical Center School of Medicine, New Orleans 70112, USA. Ocular virus infections remain an important cause of corneal and external disease. Herpes simplex, the most important, is easily treated when it is confined to the epithelium. New studies indicate that herpetic stromal disease and iritis are effectively treated with a combination of corticosteroid and antiviral without additional risk. Recurrences of ocular herpetic disease can be reduced with acyclovir given orally; the benefit seems to be greatest in patients who have had at least one episode of stromal keratitis. Herpes zoster can be treated with either acyclovir or famciclovir, but to be effective, treatment must be initiated within 72 hours of onset. Early treatment reduces the risk of post-herpetic neuralgia and may reduce the risk of ocular complications. Adenovirus infection (epidemic keratoconjunctivitis) is often spread by the ophthalmologist. New medications such as cidofovir appear to be effective against the adenoviruses in non-human systems and may have some effect in man, although previously, drugs that appeared to have an effect in vitro have proven to be ineffective in the clinical setting. PMID: 10614681 [PubMed - indexed for MEDLINE] 2314. Rinsho Shinkeigaku. 1999 Sep;39(9):958-60. [A case of zoster sine herpete with involvement of the unilateral IX, X and XI cranial and upper cervical nerves] [Article in Japanese] Funakawa I, Terao A, Koga M. Department of Internal Medicine, Kawasaki Medical School, Okayama. We describe a case of unilateral IX, X and XI cranial and upper cervical nerve palsies involving zoster sine herpete (ZSH). A 63-year-old man experienced nausea, loss of appetite and general fatigue. On 4 days of illness, dysphagia, dysarthria and difficulty in elevation of his right arm appeared. Neurological examination showed the right curtain sign, a nasal voice and a decreased right gag reflex. He could hardly elevate his right arm laterally. Needle electromyography revealed positive sharp waves in his right trapezius muscle. Although no skin lesion was detected, anti-varicella-zoster virus antibodies were positive in both serum and cerebrospinal fluid. Acyclovir and a steroid were ineffective for these symptoms. Although case reports of unilateral IX, X and XI cranial nerve palsies with ZSH is very rare, ZSH should be kept in mind in the differential diagnosis of multiple cranial nerve palsies. PMID: 10614162 [PubMed - indexed for MEDLINE] 2315. Ann Dermatol Venereol. 1999 Nov;126(11):870-3. [Facial herpes zoster] [Article in French] Fouchard N, Saiag P. Hôpital François Quesnay, 2, boulevard Sully, 78201 Mantes-la-Jolie Cedex. PMID: 10612873 [PubMed - indexed for MEDLINE] 2316. Altern Med Rev. 1999 Dec;4(6):429-35. Integrative approach to the treatment of postherpetic neuralgia: a case series. Hui F, Cheng A, Chiu M, Vayda E. Objective: To determine if the addition of alternative therapy to conventional medicine enhances the treatment of pain in postherpetic neuralgia (PHN). Methodology: A review of literature from 1988-1998 was conducted on the MEDLINE database, searching for information on the current treatment of PHN. The literature review found that although many medications have been used to reduce the pain of PHN, no treatments have been completely successful in decreasing pain. Data on pain reduction in PHN following treatment with a multifaceted alternative therapy combined with conventional treatment were compiled from a group of patients in the principal investigator's family medicine practice. Results: The alternative therapy employed in this study, combined with selected medications, showed an average pain reduction of 72.1 percent. There was a 77-percent average pain reduction in patients with herpes zoster (HZ) onset of more than one year and a 68-percent reduction in patients with HZ onset between one month and one year. Almost two-thirds of the 56 PHN patients reported pain reductions of between 75 and 100 percent. Conclusion: These preliminary data suggest the combination of alternative therapy and selected conventional medications provides good pain relief for most patients presenting with PHN. Randomized trials with appropriate control groups are needed to validate the effectiveness of this therapy in the treatment of PHN. PMID: 10608916 [PubMed - indexed for MEDLINE] 2317. Pediatr Infect Dis J. 1999 Dec;18(12):1112-3. Natural varicella-zoster virus reactivation shortly after varicella immunization in a child. Kohl S, Rapp J, La Russa P, Gershon AA, Steinberg SP. Department of Pediatrics, University of California, San Francisco, USA. PMID: 10608641 [PubMed - indexed for MEDLINE] 2318. Acta Derm Venereol. 1999 Nov;79(6):495. Post-herpes zoster scar sarcoidosis. Barrazza V. Comment on: Acta Derm Venereol. 1999 Jan;79(1):95. PMID: 10598782 [PubMed - indexed for MEDLINE] 2319. J Laryngol Otol. 1999 Jun;113(6):573-7. Herpes and the head and neck: the difficulties in diagnosis. Whallett EJ, Pahor AL. Department of Otolaryngology, City Hospital, Birmingham, UK. A case of primary herpes of the head and neck is presented. The exact source of infection and the precise diagnosis proved difficult to establish, but evidence tended to support a diagnosis of varicella zoster infection as opposed to a herpes simplex infection, though a dual infection was not ruled out. Herpes simplex has specific clinical features which usually make its distinction from varicella zoster clear cut. In this case we relied heavily on laboratory investigations to improve the accuracy of our diagnosis since the clinical characteristics were blurred. Unlike varicella zoster there has been little written about herpes simplex infections specifically affecting the ear, face and neck. PMID: 10605593 [PubMed - indexed for MEDLINE] 2320. J Laryngol Otol. 1999 Jul;113(7):670-1. An extreme and unusual variant of Ramsay Hunt syndrome. De S, Pfleiderer AG. Ear, Nose and Throat Department, Edith Cavell Hospital, Peterborough, UK. Ramsay Hunt syndrome is characterized by facial nerve paralysis, herpetic vesicles in or around the ear and pain often associated with vestibulocochlear nerve involvement. It is thought to be a cranial polyneuropathy caused by the herpes zoster virus. We present an extreme and unusual variant of this disease with involvement of VIIth, VIIIth, Xth, XIth and XIIth cranial nerves as well as C2-4 sensory dermatomes and profound systemic upset which caused some diagnostic uncertainty. PMID: 10605568 [PubMed - indexed for MEDLINE] 2321. Ophthalmology. 1999 Dec;106(12):2322-4. Successful treatment of crocodile tears by injection of botulinum toxin into the lacrimal gland: a case report. Riemann R, Pfennigsdorf S, Riemann E, Naumann M. Department of Otorhinolaryngology/Head and Neck Surgery, University of Würzburg, Germany. randolf@mail.uni-wuerzburg.de OBJECTIVE: Pathologic lacrimation (crocodile tears) is a rare but stigmatizing symptom after facial nerve paralysis. The aim of this pilot study was to examine whether botulinum toxin injection into the lacrimal gland is effective in reducing pathologic tear secretion. DESIGN: Case report. INTERVENTION: One patient who had crocodile tears after a zoster oticus infection received a botulinum toxin injection (2.5 mouse units) into the lacrimal gland. TESTING: Before injection, 1 week, 1 month, and 6 months after injection, patient's lacrimation was assessed by a Schirmer test. RESULTS: The lacrimation of the injected eye was reduced after 1 week and equal after 1 month when compared to the healthy side. After 6 months, hyperlacrimation reoccurred. No side effects were observed. CONCLUSION: Intraglandular injection of botulinum toxin into the lacrimal gland may serve as a sufficient therapy for crocodile tears. PMID: 10599665 [PubMed - indexed for MEDLINE] 2322. Contrib Microbiol. 1999;3:173-92. Experience with live-attenuated varicella-zoster vaccines. LaRussa P. Columbia University, College of Physicians and Surgeons, New York, N.Y., USA. psll@columbia.edu PMID: 10599530 [PubMed - indexed for MEDLINE] 2323. Contrib Microbiol. 1999;3:158-72. Approaches to the treatment of varicella-zoster virus infections. Whitley RJ. Department of Pediatrics, University of Alabama at Birmingham, USA. Rwhitley@peds.uab.edu PMID: 10599529 [PubMed - indexed for MEDLINE] 2324. Contrib Microbiol. 1999;3:150-7. Diagnosis of varicella-zoster virus-associated diseases with special emphasis on infections in the immunocompromised host. Wolff MH, Schünemann S, Rahaus M, Schmidt A. Institute of Microbiology and Virology, University of Witten/Herdecke, Germany. mhwolff@uni-wh.de PMID: 10599528 [PubMed - indexed for MEDLINE] 2325. Contrib Microbiol. 1999;3:141-9. Infections during pregnancy. Wutzler P, Sauerbrei A. Institute for Antiviral Chemotherapy, Friedrich-Schiller University Jena, Erfurt, Germany. PMID: 10599527 [PubMed - indexed for MEDLINE] 2326. Contrib Microbiol. 1999;3:128-40. Postherpetic neuralgia. Watson CP. Department of Medicine, University of Toronto, Ont., Canada. PMID: 10599526 [PubMed - indexed for MEDLINE] 2327. Contrib Microbiol. 1999;3:111-27. Shingles (zoster). Lilie HM, Wassilew SW. Dermatologische Klinik, Klinikum Krefeld, Deutschland. lilie@klinikum-krefeld.de PMID: 10599525 [PubMed - indexed for MEDLINE] 2328. Contrib Microbiol. 1999;3:86-95. Viremic stages of different varicella-zoster virus-associated diseases. Schünemann S, Wolff MH, Rahaus M. Institute of Microbiology and Virology, University of Witten/Herdecke, Germany. schueni@uni-wh.de PMID: 10599523 [PubMed - indexed for MEDLINE] 2329. Contrib Microbiol. 1999;3:76-85. Epidemiology of varicella infections. Flisser A, Tapia-Conyer R. Instituto Nacional de Diagnostico y Referencia Epidemiologicos, SSA, México. flisser@servidor.unam.mx PMID: 10599522 [PubMed - indexed for MEDLINE] 2330. Contrib Microbiol. 1999;3:61-75. Varicella-zoster virus: latency and reactivation. Lungu O, Annunziato PW. Department of Microbiology, Columbia University, College of Physicians and Surgeons, New York, N.Y., USA. o14@columbia.edu PMID: 10599521 [PubMed - indexed for MEDLINE] 2331. Contrib Microbiol. 1999;3:43-60. Role of glycoproteins in varicella-zoster virus infection. Gershon MD, Gershon AA. Department of Anatomy and Cell Biology, Columbia University College of Physicians and Surgeons, New York, N.Y., USA. aag1@columbia.edu PMID: 10599520 [PubMed - indexed for MEDLINE] 2332. J Neurol Sci. 1999 Nov 15;170(1):19-23. Bell's palsy and herpes viruses: to (acyclo)vir or not to (acyclo)vir? Steiner I, Mattan Y. Laboratory of Neurovirology, Department of Neurology, Hadassah University Hospital, P.O. Box 12000, Jerusalem, Israel. isteiner@md2.huji.ac.il The majority of peripheral seventh cranial nerve palsy cases remain without an identified etiology and will eventually be diagnosed as idiopathic or Bell's palsy. Some features of this condition may be characteristic of a viral infection. Indeed, several herpes viruses have been implicated as potential causative pathogens. Besides varicella-zoster virus, shown to cause Bell's palsy under the Ramsay-Hunt syndrome, recent years have seen an increased interest and focus on the possible herpes simplex virus type 1 (HSV-1) etiology in idiopathic facial paralysis. We review the clinical, biological and virological basis for the potential herpetic cause of Bell's palsy and the rational for antiviral therapy in this condition. PMID: 10540031 [PubMed - indexed for MEDLINE] 2333. Neurobiology (Bp). 1999;7(2):103-8. Topical acetylsalicylic acid versus lidocaine for postherpetic neuralgia: results of a double-blind comparative clinical trial. Tajti J, Szok D, Vécsei L. Department of Neurology, Albert Szent-Györgyi Medical University, Szeged, Hungary. A double-blind comparative clinical trial was performed with topical aspirin versus lidocaine for the treatment of 40 patients with postherpetic neuralgia. The percentage improvement following topical aspirin application was 72.2 +/- 19.9 S.D., while with lidocaine it was 72.8 +/- 25.3 S.D. These results suggest that the effect of topical treatment with aspirin is as good as that with lidocaine, since there was no significant difference (P = 0.778) between the two drugs in respect of pain reduction and accordingly the topical application of acetylsalicylic acid can be equally recommended. PMID: 10591045 [PubMed - indexed for MEDLINE] 2334. Chem Immunol. 1999;73:120-36. Immunopathogenesis of viral ocular infections. Hendricks RL. Department of Ophthalmology, University of Pittsburgh School of Medicine, Eye and Ear Institute, Pittsburgh, Pa., USA. hendricksrr@msx.upmc.edu PMID: 10590577 [PubMed - indexed for MEDLINE] 2335. Clin Infect Dis. 1999 Dec;29(6):1524-8. Spectrum of opportunistic infections and malignancies in patients with human immunodeficiency virus infection in South Korea. Oh MD, Park SW, Kim HB, Kim US, Kim NJ, Choi HJ, Shin DH, Lee JS, Choe K. Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, 110-744, South Korea. To determine the frequency and types of major opportunistic diseases in patients with HIV infection in South Korea, we reviewed the medical records of 173 HIV-infected patients. The patients were seen from 1985 to 1998 at a referral hospital for AIDS in South Korea. Most patients (85%) were male, and 107 (62%) were infected by heterosexual contacts. CD4+ lymphocyte counts at presentation were <200/microL in 27% of the patients. Tuberculosis was the most frequent opportunistic infection (25% of patients), followed by candidiasis (21%), herpes zoster (20%), Pneumocystis carinii pneumonia (10%), cytomegalovirus disease (9.8%). There were no cases of toxoplasmosis. Kaposi's sarcoma developed in 3 patients (1.7%), and non-Hodgkin's lymphoma, in 2 (1.2%). Eleven patients (6.4%) developed peripheral neuropathy, and 8 (4.6%) had HIV encephalopathy. Tuberculosis was the single most important HIV-related infection in South Korean patients. PMID: 10585807 [PubMed - indexed for MEDLINE] 2336. Anesth Analg. 1999 Dec;89(6):1585-6. No alternative to antiviral drugs for acute herpes zoster. Dworkin RH. Comment on: Anesth Analg. 1998 Oct;87(4):911-4. PMID: 10589658 [PubMed - indexed for MEDLINE] 2337. J Pain Symptom Manage. 1999 Nov;18(5):311-3. Postherpetic neuralgia in a patient with a lesion involving the dorsal horn of the cervical spinal cord. Innocenti P, Romaniello A, Zucchi R, Leandri M, Cruccu G. PMID: 10584451 [PubMed - indexed for MEDLINE] 2338. Br J Dermatol. 1999 Sep;141(3):587-9. Dermatotmal chronic cutaneous graft-versus-host disease at the site of prior herpes zoster. Lacour JP, Sirvent N, Monpoux F, Perrin C, Castanet J, Michel G, Boutte P. PMID: 10583085 [PubMed - indexed for MEDLINE] 2339. Ann Intern Med. 1999 Nov 2;131(9):712-3. Famciclovir and postherpetic neuralgia. Bassett KL, Green CJ, Wright JM. Comment on: Ann Intern Med. 1995 Jul 15;123(2):89-96. PMID: 10577337 [PubMed - indexed for MEDLINE] 2340. Postgrad Med. 1999 Nov;106(6):127-32, 135-40. Following the clues to neuropathic pain. Distribution and other leads reveal the cause and the treatment approach. Belgrade MJ. Fairview Pain Management Center, Fairview-University Medical Center, Minneapolis, MN 55454, USA. mbelgra1@fairview.org Neuropathic pain can seem enigmatic at first because it can last indefinitely and often a cause is not evident. However, heightened awareness of typical characteristics, such as the following, makes identification fairly easy: The presence of certain accompanying conditions (e.g., diabetes, HIV or herpes zoster infection, multiple sclerosis) Pain described as shooting, stabbing, lancinating, burning, or searing Pain worse at night Pain following anatomic nerve distribution Pain in a numb or insensate site The presence of allodynia Neuropathic pain responds poorly to standard pain therapies and usually requires specialized medications (e.g., anticonvulsants, tricyclic antidepressants, opioid analgesics) for optimal control. Successful pain control is enhanced with use of a systematic approach consisting of disease modification, local or regional measures, and systemic therapy. PMID: 10576007 [PubMed - indexed for MEDLINE] 2341. J Infect Dis. 1999 Dec;180(6):1784-9. Zoster incidence in human immunodeficiency virus-infected hemophiliacs and homosexual men, 1984-1997. District of Columbia Gay Cohort Study. Multicenter Hemophilia Cohort Study. Engels EA, Rosenberg PS, Biggar RJ. Viral Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD 20822, USA. engelse@exchange.nih.gov Zoster is an important clinical problem for human immunodeficiency virus type 1 (HIV)-infected patients. Risk factors for zoster and trends in incidence in HIV-infected hemophiliacs and homosexual men (n=1218) were examined. From 1984 to 1997, 174 zoster cases were identified (average yearly incidence, 2.5%). Prior zoster episodes were associated with increased risk for a subsequent episode (relative risk [RR], 4.30; 95% confidence interval [CI], 3.11-5.95). Among hemophiliacs, children and adolescents had the highest zoster risk, and zoster risk declined with age (RR, 0.80 per decade; 95% CI, 0.68-0.93). These findings suggest that HIV-infected persons do not produce or maintain adequate booster responses after varicella zoster virus exposure. Zoster risk was relatively constant when CD4 cell counts >200 cells/mm3 but increased steeply below this level. During the 14 years of follow-up, zoster incidence declined 9% per year. This trend occurred despite decreasing CD4 cell counts and was unexplained by zidovudine or acyclovir use. PMID: 10558932 [PubMed - indexed for MEDLINE] 2342. J Neurovirol. 1999 Oct;5(5):445-8. The problems of latent varicella zoster virus in human ganglia: precise cell location and viral content. Mahalingam R, Kennedy PG, Gilden DH. Department of Neurology, University of Colorado, Health Sciences Center, Denver 80262, USA. PMID: 10568880 [PubMed - indexed for MEDLINE] 2343. Arch Dermatol. 1999 Nov;135(11):1359-64. The effects of epidural blockade on the acute pain in herpes zoster. Hwang SM, Kang YC, Lee YB, Yoon KB, Ahn SK, Choi EH. Department of Dermatology, Yonsei University Wonju College of Medicine, South Korea. OBJECTIVE: To evaluate the relief of acute pain and possible preventive effects on postherpetic neuralgia through the use of an epidural blockade in the acute stage of herpes zoster. DESIGN: Prospective, nonrandomized, comparative clinical trial. SETTING: A dermatologic clinic in a university hospital. PATIENTS: Sixty-five consecutive patients with pain due to acute herpes zoster were treated for a 7-day hospitalization period from July 1, 1996, through June 30, 1997. INTERVENTION: The consecutive patients were divided into 2 groups. Group A consisted of 30 patients who were seen from July 1, 1996, through December 31, 1996, and who were treated with intravenous acyclovir (5 mg/kg) for 7 days. Group B consisted of 35 patients who were seen from January 1, 1997, through June 30, 1997, and who were treated with intravenous acyclovir (5 mg/kg) and an epidural blockade for 7 days. The changes in the intensity of pain and the total duration of pain in both groups were assessed for 12 to 18 months. MAIN OUTCOME MEASURES: The number of days required for relief of pain and the total duration of pain. RESULTS: The mean +/- SD number of days required for relief of pain, which was rated on a scale of 100 (worst pain) to 0 (no pain), was significantly fewer in group B than in group A: it took 2.6 +/- 1.1 days to go from 100 to 50 on the relief-of-pain scale in group B, but 3.8 +/- 1.1 days in group A (P = .03), and 12.5 +/- 6.4 days to go from 100 to 10 in group B, but 20.1 +/- 14.6 days in group A (P = .04). The duration of late residual pain was significantly shorter in group B (5.9 +/- 5.8 days) than in group A (11.9 +/- 7.5 days) (P = .03). The total duration of pain was also significantly shorter in group B (18.5 +/- 9.3 days) than in group A (31.6 +/- 17.6 days) (P = .04). CONCLUSIONS: We believe that an epidural blockade combined with an antiviral agent is a very effective treatment modality for the pain of acute herpes zoster, and we recommend its use for the prevention of postherpetic neuralgia, with a view to shortening the total duration of pain, especially late residual pain. PMID: 10566834 [PubMed - indexed for MEDLINE] 2344. Acta Paediatr. 1999 Oct;88(10):1161-2. An immunocompetent child with herpes zoster following post-exposure prophylaxis of varicella by oral acyclovir. Maeda A, Hisakawa H, Wakiguchi H, Kurashige T. Department of Pediatrics, Kochi Medical School, Nankoku, Japan. Akihiko.Maeda@mtc.ki.se PMID: 10565468 [PubMed - indexed for MEDLINE] 2345. Prescrire Int. 1999 Jun;8(41):75-6. Valaciclovir in herpes zoster ophthalmicus: new indication. An empty clinical assessment file. [No authors listed] (1) Valaciclovir, a metabolic precursor of aciclovir, improves the bioavailability of the active compound. It is licensed for the prevention of ocular complications of herpes zoster ophthalmicus in immunocompetent subjects. (2) The clinical file on valaciclovir in this indication is very thin. Only two (uninterpretable) trials have been done, both versus aciclovir. Note that oral aciclovir has also been assessed inadequately in this indication. (3) Over 10% of patients treated with valaciclovir in the two trials had nausea or headache. PMID: 10558445 [PubMed - indexed for MEDLINE] 2346. New Microbiol. 1999 Oct;22(4):309-14. Acyclovir treatment prevents varicella-zoster virus replication in PBMC during viremia. Wolff MH, Schünemann S. Institute of Microbiology and Virology, University of Witten/Herdecke, Germany. The most effective antiviral therapy of varicella and zoster has become acyclovir. Using polymerase chain reaction specific for VZV ORF 14, ORF 29, ORF 63 as well as nucleic acid sequence-based amplification (ORF 63, ORF 68) we tested PBMC of patients with VZV-associated diseases for the presence of viral DNA and RNA, respectively. In PBMC of patients treated with acyclovir neither DNA nor RNA was detectable already one day after the onset of therapy. In three blood sample pairs from zoster patients we were able to detect viral nucleic acid before but not after acyclovir treatment. These results confirm clinical and epidemiological data. It can be concluded that treatment with acyclovir prevents VZV replication in peripheral blood mononuclear cells. PMID: 10555200 [PubMed - indexed for MEDLINE] 2347. Aust N Z J Obstet Gynaecol. 1999 Aug;39(3):371. Herpes zoster during pregnancy near term: to treat or not to treat? Thami GP, Kanwar AJ. Department of Dermatology and Venereology, Government Medical College Hospital, Chandigarh, India. PMID: 10554957 [PubMed - indexed for MEDLINE] 2348. Hautarzt. 1999 Oct;50(10):706-14. [Infections with herpes simplex and varicella zoster virus in pregnancy: clinical manifestations in mother, fetus and newborn--therapeutic options] [Article in German] Rappersberger K. Universitätsklinik für Dermatologie, Abteilung für Allgemeine Dermatologie, Wien. Infections with herpes simplex virus (HSV) type I and type II and varicella/zoster-virus (VZV) are lifelong. The life cycle of the virus - primary infection-latency-endogenous reactivation - determines the clinical features of the diseases, i. e. primary infection and recurrences. During pregnancy, infections with HSV and VZV may induce severe maternal illness that occasionally runs a lethal course. With viremia placental transmission of the virus may occur infecting the fetus and possibly causing spontaneous abortion, stillbirth and congenital malformations. The occurrence of such malformations is best documented for the "fetal varicella syndrome". Maternal varicella and genital herpes simplex within the perinatal period represent a tremendous risk for the newborn to be infected during delivery; such infection may cause life threatening diseases that have a lethal outcome in more than 50% of affected children. We describe the life cycle of HSV/VZV in infected individuals and the peculiar clinical features of maternal infections during pregnancy. The epidemiological and clinical characteristics of the infected fetus and newborn are highlighted and prophylactic and therapeutic possibilities are discussed. PMID: 10550356 [PubMed - indexed for MEDLINE] 2349. Adv Exp Med Biol. 1999;458:159-65. Therapeutic approaches to the management of herpes zoster. Whitley RJ, Gnann JW Jr. Department of Pediatrics, Microbiology and Medicine, University of Alabama at Birmingham 35233-0011, USA. The past several years have provided exciting advances in the management of herpes zoster in the normal host. In spite of these advances, a significant portion of zoster patients still have persistent complications from this disease. Persistent pain is the most debilitating sequela and it occurs in at least 15% of individuals over 50 years of age. Future research efforts must embrace alternative approaches for pain control. PMID: 10549388 [PubMed - indexed for MEDLINE] 2350. Adv Exp Med Biol. 1999;458:167-74. Management of varicella-zoster virus infections in children. Arvin AM. Department of Pediatrics, Stanford University School of Medicine, California 94305, USA. The introduction of varicella vaccine for immunization of healthy children is expected to have a gradual impact on the incidence of VZV infections in the population but antiviral therapy remains an important intervention in clinical practice. The efficacy of aciclovir for treatment of primary and recurrent VZV infections in children has reduced the morbidity and mortality of these illnesses in immunocompromised children dramatically. Oral aciclovir is an effective and useful for the management of varicella in healthy children and adolescents. PMID: 10549389 [PubMed - indexed for MEDLINE] 2351. Adv Exp Med Biol. 1999;458:149-57. Valaciclovir update. Bell AR. Glaxo Wellcome Research and Development, Greenford, Middlesex, United Kingdom. PMID: 10549387 [PubMed - indexed for MEDLINE] 2352. Adv Exp Med Biol. 1999;458:135-47. Famciclovir/penciclovir. Sacks SL, Wilson B. Department of Pharmacology and Therapeutics, Faculty of Medicine, University of British Columbia, Canada. PMID: 10549386 [PubMed - indexed for MEDLINE] 2353. J Clin Virol. 1999 Sep;14(1):31-6. Laboratory diagnosis of herpes zoster. Sauerbrei A, Eichhorn U, Schacke M, Wutzler P. Institute for Antiviral Chemotherapy, Friedrich-Schiller University Jena, Erfurt, Germany. sauerbre@zmkh.ef.uni-jena.de Virological diagnosis of zoster should be rapid when effective antiviral chemotherapy is being considered. In the present study, vesicle specimens of 100 patients with zoster were analysed by detecting viral DNA using polymerase chain reaction (PCR). The findings were compared with those obtained by traditional virological and serological methods. PCR results confirmed the clinical diagnosis of zoster in 95%. Primers selected from varicella-zoster virus (VZV) gene 28 proved to be most sensitive. The sensitivity of virus culture was 20% (specificity 100%), of direct immunofluorescent VZV-specific antigen staining in vesicle samples 82% (specificity 76%), and in 48% there was a serological response to specific IgM and IgA antibodies within 4 days after the onset of rash. These findings suggest that PCR is the method of choice for rapid laboratory diagnosis of zoster. PMID: 10548128 [PubMed - indexed for MEDLINE] 2354. Retina. 1999;19(5):468-70. Progressive outer retinal necrosis in a human immunodeficiency virus-negative patient. Doi M, Matsui K, Akamine T, Sasoh M, Uji Y, Taniguchi H. Department of Ophthalmology, Mie University School of Medicine, Tsu, Japan. PMID: 10546952 [PubMed - indexed for MEDLINE] 2355. Nippon Rinsho. 1999 Nov;57 Suppl:260-3. [Varicella-zoster virus] [Article in Japanese] Takayama M. Department of Virology 1, National Institute of Infectious Diseases. PMID: 10635829 [PubMed - indexed for MEDLINE] 2356. Epilepsia. 1999;40 Suppl 6:S51-6; discussion S73-4. Postherpetic neuralgia: role of gabapentin and other treatment modalities. Beydoun A. Department of Neurology, University of Michigan Medical School, Ann Arbor 48109, USA. Postherpetic neuralgia (PHN) is a chronic and painful condition that may occur after a herpes zoster infection. The frequency of PHN after untreated zoster varies widely. Age is the most important risk factor for development of PHN. The condition occurs in an estimated 50% of patients older than 50 years. The pain of PHN can be severe and debilitating and is frequently associated with allodynia. Although in most patients pain remits within the first year, it may persist for a lifetime. Tricyclic antidepressants (TCAs), topical agents, opioids, and gabapentin, a structural gamma-amino butyric acid (GABA) analogue, are the only agents that have demonstrated efficacy in randomized clinical trials for treatment of both the shooting and the burning form of pain associated with PHN. TCAs are among the most commonly used classes of agents for treating PHN and are effective in a significant proportion of patients. However, various adverse events can limit treatment. These side effects tend to be more acute in the elderly, the population most likely to suffer from PHN. Topical agents have led to mild to moderate improvement in patients with PHN but are usually ineffective as monotherapy for this condition. Until recently, carbamazepine was the only antiepileptic drug evaluated for the treatment of PHN. Over the past few years, however, gabapentin has received increasing attention as a useful treatment for neuropathic pain. Gabapentin lacks significant drug-drug interactions and has a favorable safety profile, which makes it particularly useful for treatment of PHN. PMID: 10530683 [PubMed - indexed for MEDLINE] 2357. Clin Infect Dis. 1999 Sep;29(3):684-5. Management of progressive outer retinal necrosis with cidofovir in a human immunodeficiency virus-infected patient. Schliefer K, Gümbel HO, Rockstroh JK, Spengler U. Department of General Internal Medicine, University of Bonn, Germany. k.schliefer@uni-bonn.de PMID: 10530469 [PubMed - indexed for MEDLINE] 2358. J Clin Epidemiol. 1999 Nov;52(11):1047-53. Are health states "timeless"? The case of the standard gamble method. Bala MV, Wood LL, Zarkin GA, Norton EC, Gafni A, O'Brien BJ. Centocor, Inc., Malvern, Pennsylvania, USA. The standard gamble method, as currently recommended for use in health care program evaluation, provides an individual's preference score or "utility weight" for living in a given health state for the rest of the individual's life. Many researchers interpret this value as a time-independent or "timeless" one and order health states on a scale of zero (death) to one (full health), regardless of the time spent in the health state. This article examines whether preference scores for a severe pain health state are "timeless," or in other words whether the utility independence assumption is satisfied. Our study results suggest that for the majority of respondents, the preference scores are not independent of time. PMID: 10526998 [PubMed - indexed for MEDLINE] 2359. Presse Med. 1999 Sep 25;28(28):1518. [Treatment of herpes zoster infections in patients infected with HIV] [Article in French] Breton G, Bricaire F, Caumes E. Comment on: Presse Med. 1999 Mar 6;28(9):473-5. PMID: 10526558 [PubMed - indexed for MEDLINE] 2360. Arch Neurol. 1999 Oct;56(10):1292-4. The pathology of shingles: Head and Campbell's 1900 monograph. Oaklander AL. Department of Anesthesiology, Massachusetts General Hospital, Harvard Medical School, Boston 02114, USA. Shingles (herpes zoster) and postherpetic neuralgia, a chronic neuropathic pain syndrome that can persist after the shingles lesions heal, were studied by eminent neurologists of the 19th century. Autopsy studies were used to establish sensory neural pathways in the peripheral and central nervous systems. More recently, zoster and postherpetic neuralgia have served as models for the study of the pathogenesis and treatment of neuropathic pain. Postherpetic neuralgia has the cardinal clinical features of all neuropathic pain syndromes, including sensory abnormalities, ongoing pain, and allodynia (touch-induced pain). Unlike most other neuropathic pain syndromes, such as trigeminal neuralgia or nerve root compressions, shingles has a well-defined pathogenesis and onset, as well as visible lesions, and is therefore uniquely suitable for study. PMID: 10520948 [PubMed - indexed for MEDLINE] 2361. Med Pregl. 1999 Mar-May;52(3-5):125-8. [Reactivation of herpes zoster infection by varicella-zoster virus] [Article in Croatian] Cvjetković D, Jovanović J, Hrnjaković-Cvjetković I, Brkić S, Bogdanović M. Klinika za infektivne bolesti, Medicinski fakultet, Novi sad. HISTORY: There has been considerable interest in varicella-zoster virus in the middle of the twentieth century. Virus isolation in 1958 had made it possible to find out the complete DNA sequence of the varicella-zoster virus. Molecular identify of the causative agents of varicella and shingles had been proved. ETIOPATHOGENESIS AND HISTOPATHOLOGY: Varicella-zoster virus is a member of the Herpesviridae family. After primary infection which results in varicella, the virus becomes latent in the cerebral or posterior root ganglia. Some of these individuals develop shingles after several decades because of virus reactivation. It is caused by decline of cellular immune response. Circumstances such as old age, hard work, using of steroids or malignancies contribute to the appearance of shingles. Histopathological findings include degenerative changes of epithelial cells such as ballooning, multinucleated giant cells and eosinophilic intranuclear inclusions. EPIDEMIOLOGY: Shingles occur sporadically, mainly among the elderly who have had varicella. There is no seasonal appearance of shingles. Individuals suffering from shingles may be sometimes contagious for susceptible children because of enormous amount of virus particles in vesicle fluid. CLINICAL FEATURES: Clinically, shingles is characterized at first by pain or discomfort in involved dermatome, usually without constitutional symptoms. Local edema and erythema appear before developing of rash. Maculopapular and vesicular rash evolves into crusts. The most commonly involved ganglia are: lumbar, thoracic, sacral posterior root ganglia, then geniculate ganglion of the VIIth cranial nerve and the trigeminal ganglion. The most common complication, postherpetic neuralgia, may last for as long as two or three weeks, sometimes even one year or more. Other complications that may be seen in shingles, but more rarely, are ocular (keratitis, iridocyclitis, secondary glaucoma, loss of sight), neurological (various motor neuropathies, encephalitis, Guillain-Barre syndrome), secondary bacterial infection of vesicles. Immunocompromised patients often develop more severe disease lasting up to two weeks, skin lesions are more numerous and often with hemorrhagic base and there is a high possibility for cutaneous dissemination and visceral involvement including viral pneumonia, encephalitis and hepatitis. Chronic shingles may also be found in immunocompromised hosts, particularly in those with a diagnosis of HIV infection. In patients with HIV infection, shingles is often characterised by radicular pain and itching several days before appearance of skin lesions. Those patients may have two or more dermatomes involved and recurrences of shingles cannot be quite infrequent in those patients. But visceral involvement is rarer than in other immunocompromised patients. Shingles may occur in the second half of pregnancy and usually have a mild course. However, congenital abnormalities has been described in few cases. DIAGNOSIS: The diagnosis of shingles is usually made by history and physical examination. Exceptionally, for example in zoster sine herpete and atypical forms of shingles, virus isolation and serological tests must be used. DIFFERENTIAL DIAGNOSIS: Some other diseases may cause similar skin lesions and rash (varicella, erysipelas, impetigo, enteroviral infections, herpes simplex infections). These diseases are excluded by using detailed history taking and physical examination, laboratory findings, virus isolation and commercially available serological tests. THERAPY: The vast majority of immunocompetent persons with shingles should be treated only by symptomatic therapy. Predominantly it is directed toward reduction of fever and avoiding secondary bacterial skin infection in immunocompetent hosts. Acute neuritis and post-herpetic neuralgia require administration of various analgesics, even like amitriptyline hydrochloride and fluphenazine hydrochloride. Acyclovir therapy is limited to ophthal PMID: 10518396 [PubMed - indexed for MEDLINE] 2362. Can Commun Dis Rep. 1999 Aug;25 Suppl 6:7-19. Varicella-zoster virus disease. [Article in English, French] [No authors listed] PMID: 10516794 [PubMed - indexed for MEDLINE] 2363. J Oral Maxillofac Surg. 1999 Oct;57(10):1249-51. Herpes zoster infection of the maxilla: case report. Owotade FJ, Ugboko VI, Kolude B. Department of Oral/Maxillofacial Surgery and Oral Pathology, Obafemi Awolowo University, Ile-Ife, Nigeria. PMID: 10513873 [PubMed - indexed for MEDLINE] 2364. Environ Health Perspect. 1999 Oct;107(10):835-41. Environmental chemical exposures and risk of herpes zoster. Arndt V, Vine MF, Weigle K. Department of Epidemiology, University of Ulm, Ulm, Germany. This study investigated whether residence in Aberdeen, North Carolina, the location of the Aberdeen pesticides dumps site (a national priority list Superfund site containing organochlorine pesticides, volatile organic compounds, and metals), is associated with immune suppression as indicated by a higher incidence of herpes zoster and recent occurrences of other common infectious diseases. Study participants included 1,642 residents, 18-64 years of age, who responded to a telephone survey concerning potential occupational and recreational exposures to pesticides and other chemicals, lifetime history of herpes zoster (shingles), and the recent occurrence of other common infectious diseases. Stratified and logistic regression analyses were used to compare the cumulative incidence of herpes zoster among Aberdeen residents and residents of nearby communities. There was little evidence of an overall increased risk of herpes zoster among Aberdeen residents during the period 1951-1994 [relative risk (RR), 1.3; 95% confidence interval (CI), 0.8-2.1]. However, an elevated risk of herpes zoster was noted consistently among Aberdeen residents of younger ages as compared to residents of the nearby communities. The RR was 2.0 (CI, 1.0-4.0) among those 18-40 years of age and was not affected by controlling for potential confounders. The RR of herpes zoster was also consistently elevated in all age groups for the period before 1985. No differences were noted between residents of Aberdeen and those of the nearby communities with respect to the recent occurrence of other common infectious diseases. These results support the plausibility of an association between exposure to the Aberdeen pesticides dumps site and immune suppression and the potential use of herpes zoster as a marker of immune suppression in studies of environmental chemical exposures. PMCID: PMC1566619 PMID: 10504152 [PubMed - indexed for MEDLINE] 2365. J Med Virol. 1999 Nov;59(3):412-4. Simultaneous treatment of cytomegalovirus and varicella zoster infections in a renal transplant recipient with ganciclovir: use of viral load to monitor response to treatment. Aitken C, Hawrami K, Miller C, Barrett Muir W, Yaqoob M, Breuer J. Department of Medical Microbiology and Virology, St. Barts and the Royal London Hospitals, London, United Kingdom. Disseminated zoster occurring simultaneously with cytomegalovirus (CMV) disease in a renal transplant recipient is potentially life threatening. We describe the use of intravenous ganciclovir to treat both infections. The efficacy of treatment was assessed clinically and by the measurement of CMV viral load using the hybrid capture (Murex version 2) and varicella zoster (VZV) viral load using an in-house assay. Results from this case suggest that clinical resolution in severe viral infections such as described below may be related to early control of viraemia. PMID: 10502276 [PubMed - indexed for MEDLINE] 2366. J Gen Virol. 1999 Sep;80 ( Pt 9):2433-6. Behavioural changes in the rat following infection with varicella-zoster virus. Fleetwood-Walker SM, Quinn JP, Wallace C, Blackburn-Munro G, Kelly BG, Fiskerstrand CE, Nash AA, Dalziel RG. Department of Veterinary Pathology, Royal (Dick) School of Veterinary Studies, University of Edinburgh, Summerhall, UK. Following the establishment of a chronic varicella-zoster virus infection in the rat, behavioural allodynia and hyperalgesia were observed in the injected, but not the contralateral hind limb up to 33 days post-infection. This model may prove useful in investigating mechanisms involved in the establishment of post-herpetic neuralgia. PMID: 10501498 [PubMed - indexed for MEDLINE] 2367. Neurology. 1999 Sep 22;53(5):1128-9. Stroke after zoster ophthalmicus in a 12-year-old girl with protein C deficiency. Cadavid D, Pearl PL, Dubovsky EC, Angiolillo A, Vezina LG. Department of Neurology, Children's National Medical Center, George Washington University School of Medicine, Washington, DC 20010, USA. A 12-year-old girl who had zoster ophthalmicus 10 months earlier presented with hemiparesis and corresponding basal ganglionic infarction related to middle cerebral artery branch thrombosis ipsilateral to the zoster. Hematologic evaluation disclosed protein C deficiency. This represents the first zoster-associated stroke reported in childhood associated with protein C deficiency, with extension of the latency period between zoster and infarction, previously reported to be 6 months. PMID: 10496280 [PubMed - indexed for MEDLINE] 2368. Pediatr Infect Dis J. 1999 Sep;18(9):842-3. Possible role of varicella vaccine in preventing herpes zoster. Brunell PA. National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA. PMID: 10493357 [PubMed - indexed for MEDLINE] 2369. Lancet. 1999 Sep 11;354(9182):953-4. Neuropathic pain. Marples IL, Murray P. Comment on: Lancet. 1999 Jun 5;353(9168):1959-64. PMID: 10489984 [PubMed - indexed for MEDLINE] 2370. Mayo Clin Proc. 1999 Sep;74(9):923-6. 37-year-old man with back pain. Montori VM, Rho JP, Bauer BA. Mayo Graduate School of Medicine, Mayo Clinic Rochester, Minn 55905, USA. PMID: 10488797 [PubMed - indexed for MEDLINE] 2371. Cornea. 1999 Sep;18(5):511-31. Varicella-zoster virus eye disease. Liesegang TJ. Mayo Clinic Jacksonville, Florida 32224, USA. tliesegang@mayo.edu PURPOSE: To review the epidemiology, biology, systemic and ocular features, and treatment options for varicella zoster disease, including postherpetic neuralgia. METHODS: Literature search and review of author's experience with patients with varicella and herpes zoster ophthalmicus. RESULTS: In recent years there has been an increase in the knowledge about the biology, latency, and epidemiology of the varicella-zoster virus. The clinical features are correlated with the pathologic changes. The pathophysiologic mechanisms and treatment of postherpetic neuralgia are reviewed. Treatment options with antiviral therapy and corticosteroids are offered. Initial experience with the varicella vaccine is encouraging. CONCLUSIONS: The laboratory and clinical studies have enhanced our knowledge of the varicella-zoster virus and increased our ability to treat this infection and the aftermath. We are still far short of providing adequate therapy for patients who experience the severe forms of the disease. PMID: 10487424 [PubMed - indexed for MEDLINE] 2372. Lupus. 1999;8(7):545-51. Treatment of membranous lupus nephritis with nephrotic syndrome by sequential immunosuppression. Chan TM, Li FK, Hao WK, Chan KW, Lui SL, Tang S, Lai KN. Division of Nephrology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China. The optimal therapy for pure membranous lupus nephritis (MLN) with nephrotic syndrome remains controversial. While the risk of progressive renal deterioration may be small, persistent heavy proteinuria leads to the complications of oedema, hypoalbuminaemia, hyperlipidaemia, hypercoagulability, and venous thrombosis. We examined prospectively the efficacy and tolerability of a sequential immunosuppressive regimen in a cohort of 20 patients with nephrotic syndrome due to pure MLN (WHO Class Va and Vb). Initial therapy comprised prednisolone (0.8 mg/kg/d p.o.) and cyclophosphamide (2-2. 5 mg/kg/d p.o.). Prednisolone dosage was gradually tapered to 10 mg/d at 6 months, when cyclophosphamide was replaced by azathioprine (2 mg/kg/d p.o.) as maintenance therapy. Within 12 months of therapy 11(55%) patients had complete remission (CR), 7(35%) patients achieved partial remission (PR) (proteinuria reduced from 6.2+/-4.0 to 2.0+/-1.7 g/24 h, P<0.01), and 2 patients failed to respond. Improvements in proteinuria and serum albumin level were observed after 3-6 months of treatment. Non-responders had lower baseline serum albumin compared to complete responders. Renal function remained stable during follow-up for 73.5+/-48.9 months. 8 patients had disease relapse at 47+/-15 months. Early complications ( 80%), except for the children under 5 years of age. The FSW had the highest prevalence of HSV-2 infections, 80%, followed by guerrilla fighters, truck drivers, port workers, pregnant women, children, and the Rashaidas. Positivity for antibodies against CMV was > 90% in all studied populations. The prevalence of VZV infections was surprisingly low in the tribe of Rashaida, 44% compared to more than 90% in the other adult groups tested for VZV (P = 0.0001). CONCLUSION: The study shows that the prevalence of HSV-2 in the risk group of FSW was high, which could partly be explained by their sexual behaviours. HSV-2 was particularly low in the Rashaida group and, as expected, in the children. The low prevalence of VZV observed in the Rashaida is of importance since it makes them vulnerable to infection with varicella during their inevitable integration with the other tribes in their society. PMID: 10073414 [PubMed - indexed for MEDLINE] 2472. Pediatr Rev. 1999 Mar;20(3):103, 105-6. Index of suspicion. Case 3. Diagnosis: HIV infection. Stille CJ. Connecticut Children's Medical Center, Hartford, USA. PMID: 10073075 [PubMed - indexed for MEDLINE] 2473. Can J Neurol Sci. 1999 Feb;26(1):29-32. Herpes zoster and multiple sclerosis. Ross RT, Cheang M, Landry G, Klassen L, Doerksen K. Section of Neurology, University of Manitoba and Health Sciences Centre, Winnipeg, Canada. BACKGROUND: Clinical experience suggests that young multiple sclerosis patients may have herpes zoster (HZ) earlier and more often than the general population. As there is evidence of a relationship between varicella zoster virus (VZV) and MS, a study of HZ and MS was undertaken. METHODS: Eight hundred and twenty-nine patient-members of the Manitoba Chapter of the Canadian Multiple Sclerosis Society were surveyed by mail. Six hundred and thirty-three (76%) responded. Questions included: age at diagnosis of MS, history of HZ (yes, no, probably), number of episodes of HZ and age at each occurrence, date of birth, and sex of respondent. The controls were consecutive patients with other neurological diseases (OND) attending local neurological or neurosurgical clinics, plus practice-based and population-based surveys of herpes zoster without reference to any other disease. The OND controls were assessed at the time of their outpatient visits. RESULTS: In the MS group with a positive/probable history of HZ, the HZ/MS rate was 106/633 (16.8%); in the practice-based survey the rate was 192/3534 (5.4%); and among the patients with OND it was 42/616 (6.8%). The HZ occurred at an earlier age in the MS group. The majority of male patients had HZ prior to the diagnosis of MS. The date of diagnosis is more likely to be a precise memory as opposed to the onset of symptoms. More than one attack of HZ was also more common in the MS group. CONCLUSIONS: This survey adds to the evidence that patients with MS have a unique relationship with the herpes zoster virus. PMID: 10068804 [PubMed - indexed for MEDLINE] 2474. Ugeskr Laeger. 1999 Feb 8;161(6):794-6. [Complications in two children with acute lymphatic leukemia caused by vaccination against varicella zoster virus] [Article in Danish] Christensen CL, Poulsen A, Böttiger B, Kirk M, Andersen HK, Schmiegelow K. H:S Righospitalet, klinisk mikrobiologisk afdeling, København. Complications in two varicella zoster virus (VZV) vaccinated children with leukemia in remission are reported. Case I presented with varicella on day 30 after vaccination, with a relapse on day 49 and development of zoster on day 70. VZV was detected in vesicles by PCR on days 49 and 70. Case II presented with varicella on day 32 after vaccination, and VZV was detected in vesicles and nasal secretion. The manifestations were mild and responded to treatment. PCR methods were directed toward the R5 and PS regions. The virus from the two children was unambiguously identified as the Oka vaccine strain. The majority of Danish field strains had only one copy of the 112 basepair repeat element in the R5 region, but two, four and presumably higher copy numbers were also seen. All Danish field strains had the Pst1 cleavage site in the PS region. PMID: 10068350 [PubMed - indexed for MEDLINE] 2475. Ter Arkh. 1998;70(12):63-5. [Neuralgia and zovirax treatment of patients with herpes zoster] [Article in Russian] Dekonenko EP, Shishov AS, Kupriianova LV, Rudometov IuP, Bagrov FI. AIM: To estimate the occurrence of postherpetic neuralgia (PHN) arising after acute period of herpes zoster (HZ) and determination of zovirax efficiency in PHN prevention. MATERIALS AND METHODS: Of a total of 102 patients with HZ aged 17-89 years, 20 patients aged 26-83 years were given zovirax. RESULTS: Acute pain syndrome in PHN was observed in more that one-third of HZ patients. Patients over 60 years of age were more predisposed to PHN. Zovirax reduced the duration of acute rash and its healing, decreased the number of patients with zoster-associated pain and PHN patients. CONCLUSION: Zovirax is effective and safe in preventing PHN in HZ patients. PMID: 10067257 [PubMed - indexed for MEDLINE] 2476. Clin Infect Dis. 1999 Feb;28(2):412-3. Varicella-Zoster virus infection associated with acute liver failure. Vartian CV. Comment on: Clin Infect Dis. 1998 Jul;27(1):209-10. PMID: 10064269 [PubMed - indexed for MEDLINE] 2477. J Dermatol. 1999 Jan;26(1):1-10. Follow-up of clinical efficacy of iontophoresis therapy for postherpetic neuralgia (PHN). Ozawa A, Haruki Y, Iwashita K, Sasao Y, Miyahara M, Sugai J, Matsuyama T, Iizuka M, Kawakubo Y, Nakamori M, Ohkido M. Department of Dermatology, Tokai University School of Medicine, Kanagawa, Japan. A great variety of therapies have been attempted for PHN, including pharmacotherapy and physical therapy. However, there has been no decisive treatment, and reports of the clinical efficacy of all available therapies have been rather controversial. Almost all studies conducted so far have looked only at short-term therapeutic efficacy, and only a few investigators have conducted long-term observations or studies on long-term outcome. We followed up the clinical efficacy of iontophoresis therapy using lidocaine and methylprednisolone in 197 PHN patients. Monitoring conducted for an average of 4 years after completion of the treatment showed that pain remained unchanged or improved compared to pain observed upon completion of the treatment in 90.4% of patients. Although 42.6% of patients were still continuing some treatment, 90.9% were found to be able to take care of themselves. Findings obtained were reviewed and discussed from various viewpoints. Our findings showed that iontophoresis therapy is not only effective at the end of the treatment, but its efficacy is maintained over a long period of time, indicating that it is clinically very useful for the treatment of PHN. PMID: 10063205 [PubMed - indexed for MEDLINE] 2478. Antiviral Res. 1999 Jan;40(3):155-66. Emergence of resistance to acyclovir and penciclovir in varicella-zoster virus and genetic analysis of acyclovir-resistant variants. Ida M, Kageyama S, Sato H, Kamiyama T, Yamamura J, Kurokawa M, Morohashi M, Shiraki K. Department of Virology, Toyama Medical and Pharmaceutical University, Sugitani, Japan. We have characterized the differential actions of acyclovir and penciclovir against varicella-zoster virus (VZV) in cell culture by comparing the frequency of appearance of resistant viruses followed by their characterization. Cells were infected with cell-free virus and the cultures were successively treated with increasing concentrations of acyclovir or penciclovir. Drug-resistant viruses were selected in the presence of 6 microg/ml of acyclovir or penciclovir. The emergence frequency of resistant viruses was significantly higher following acyclovir exposure than following penciclovir exposure (Fisher's exact test, P<0.0001), possibly reflecting virus growth differences under these experimental conditions. Based on antiviral drug susceptibility and thymidine kinase (TK) activity assays, 11 acyclovir-resistant variants from seven experiments using three virus strains (Kawaguchi strain, Oka varicella vaccine strain and a clinical isolate from a zoster patient) were found to be TK-deficient. Sequence analysis of TK-deficient variants of the Kawaguchi strain revealed deletions that caused frameshifts, resulting in premature termination in the TK gene. PMID: 10027650 [PubMed - indexed for MEDLINE] 2479. Ann Dermatol Venereol. 1998 Sep;125(9):630-6. [Management of varicella-zoster virus infections] [Article in French] [No authors listed] PMID: 10026092 [PubMed - indexed for MEDLINE] 2480. Arch Neurol. 1999 Feb;56(2):241-3. Adult-onset MELAS presenting as herpes encephalitis. Sharfstein SR, Gordon MF, Libman RB, Malkin ES. Department of Neurology, Long Island Jewish Medical Center, Long Island Campus for the Albert Einstein College of Medicine, New Hyde Park, NY 11042, USA. OBJECTIVE: To report an unusual presentation of mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS) manifested in late life with a clinical picture of herpes simplex encephalitis. DESIGN: Case report. SETTING: Clinical neurology department in a tertiary care hospital. CASE DESCRIPTION: A 55-year-old woman developed aphasia and delirium during ophthalmic herpes zoster infection treated with oral prednisone and ophthalmic steroids, which was followed by progressive cognitive decline without acute neurologic events for 5 years. At age 60, the patient presented with new onset of seizures, hemiparesis, and hemianopsia. Subsequently she developed cortical blindness, multiple traumatic soft tissue injuries from falls, acute psychosis, and severe dementia with periods of agitation. She died in a nursing home in March 1997, 6 years after initial presentation. RESULTS: Magnetic resonance imaging scan of the brain showed hyperintensity on T2-weighted images involving temporal, parietal, and occipital lobes bilaterally as well as mild atrophy of brainstem and cerebellum. Single photon emission computed tomographic imaging showed hypoperfusion of temporal, parietal, and occipital lobes. Results of video electroencephalographic monitoring showed periodic lateralizing epileptiform discharges in temporal and occipital areas. The serum lactate level was normal in May 1996 and elevated in October 1996. The creatine kinase level was elevated with a 100% MM fraction in August 1991 and normal in March 1996. Results of repeated cerebrospinal fluid analyses indicated elevated protein levels. Analysis of DNA was diagnostic of MELAS by mitochondrial DNA point mutation at position 3243. The results of autopsy showed moderate cerebral, cerebellar, and brainstem atrophy with signs of infarction in temporal and parietal lobes bilaterally. CONCLUSIONS: The clinical presentation as well as age at onset of MELAS are highly variable. Onset of mitochondrial disorders can be provoked by febrile illness when there is mismatch between energy requirements and availability. In the differential diagnosis of herpes encephalitides, MELAS syndrome should be considered. PMID: 10025431 [PubMed - indexed for MEDLINE] 2481. QJM. 1998 Nov;91(11):788-9. Self-limiting abdominal wall herniation and constipation following herpes zoster infection. Healy C, McGreal G, Lenehan B, McDermott EW, Murphy JJ. PMID: 10024942 [PubMed - indexed for MEDLINE] 2482. Am J Gastroenterol. 1999 Feb;94(2):424-6. Shingles during the course of treatment with 6-mercaptopurine for inflammatory bowel disease. Korelitz BI, Fuller SR, Warman JI, Goldberg MD. Department of Medicine, Lenox Hill Hospital, and The NYU School of Medicine, New York, New York 10021, USA. OBJECTIVE: Our aim was to study the frequency, severity, and outcome of patients with Crohn's disease and ulcerative colitis treated with 6-mercaptopurine (6MP) who developed shingles during treatment, and to recommend management. While varicella can be severe in young people immunocompromised by steroids, the incidence of herpes zoster in older people with inflammatory bowel disease (IBD) and whether its severity is influenced by 6MP and azathioprine are unknown. METHODS: Data were collected from our IBD Center on 550 patients with IBD to identify those who developed shingles while on 6MP, its severity, the dose and duration of 6MP, and the management of the 6MP. RESULTS: Twelve of 550 patients with IBD treated with 6MP developed shingles. In two with herpes zoster ophthalmicus the pain was prolonged, and one patient developed encephalitis which was brief and uncomplicated; in nine patients the course was benign. Acyclovir should be the treatment of choice even though it was available in only three cases. CONCLUSIONS: Shingles occurs more often in IBD patients treated with 6MP than in those who are not, but the course is usually benign and there has been no mortality. The 6MP should be stopped temporarily until severity is established but if the underlying disease warrants further treatment the 6MP should be restarted. PMID: 10022640 [PubMed - indexed for MEDLINE] 2483. Front Biosci. 1999 Feb 15;4:D200-11. Latency of varicella zoster virus; a persistently perplexing state. Kinchington PR. Departments of Ophthalmology and of Molecular Genetics and Biochemistry, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA. Varicella zoster virus (VZV) is the herpesvirus which causes the childhood disease varicella, also known as chickenpox, and the adult disease herpes zoster, also known as shingles. These distinct diseases are separated by a lengthy period of latency, often lasting decades, in which the virus resides within the ganglia of the host. VZV latency and reactivation from it have, for the most part, been extraordinarily difficult to examine. This is due to the lack of a good animal model for the VZV latent state, the inability to experimentally reactivate VZV under any circumstances and the caveats and problems encountered in examining human ganglionic tissue. However, insights into features of the molecular events of VZV latency have been gleaned from its pathogenesis and from recent advances in molecular probing of human and animal ganglia. Evidence suggests that the latent VZV genome may express transcripts unlike those of closely related herpesviruses, and some evidence suggests an unusual site for the establishment of VZV latency. In this review, the current evidence for events occurring during the VZV latent state will be discussed, from a view of its pathogenesis as well as its molecular biology. PMID: 9989948 [PubMed - indexed for MEDLINE] 2484. J Oral Pathol Med. 1999 Feb;28(2):49-53. Oral lesions in children with perinatally acquired human immunodeficiency virus infection. Nicolatou O, Theodoridou M, Mostrou G, Velegraki A, Legakis NJ. Department of Oral Pathology and Surgery, School of Dentistry, University of Athens, Greece. Fifteen vertically HIV-infected children aged between 2 and 12 years were followed up for 1 year, weekly to monthly, to study the incidence of oral lesions. At the time of first examination, oral candidiasis (OC) was observed in nine children. Seven children presented with the erythematous type only and two with pseudomembranous oral candidiasis. Four cases of cheilitis were seen in association with the erythematous forms of oral candidiasis. One erythematous candidiasis progressed to pseudomembranous form. A second case of erythematous OC, after multiple recurrences in the form of erythematous OC, recurred as pseudomembranous OC. Another case of erythematous OC and one of pseudomembranous OC presented after multiple recurrences as a persistent, adherent pseudomembranous OC. An orofacial herpes-zoster infection, a hairy leukoplakia and a necrotic lingual ulcer were observed as second lesions and in association with oral candidiasis in three children. Erythematous oral candidiasis was the most frequent oral HIV-related lesion, was observed in different stages of HIV-infection, and in some cases progressed to pseudomembranous candidiasis. A different, selectively resistant, Candida clone was isolated in three cases of recurrent candidiasis. PMID: 9950249 [PubMed - indexed for MEDLINE] 2485. Health News. 1999 Jan 5;5(1):1-2. Pain after shingles. [No authors listed] PMID: 9932537 [PubMed - indexed for MEDLINE] 2486. Neurology. 1999 Jan 1;52(1):193-5. Herpes varicella zoster encephalitis in immunocompromised patients. Weaver S, Rosenblum MK, DeAngelis LM. Department of Neurology, Albany Medical Center, NY, USA. The authors describe specific MRI features that suggest the diagnosis of varicella zoster encephalitis. MRI initially revealed discrete, subcortical, nonenhancing lesions that coalesced and developed enhancement. Gray matter involvement was seen later. Autopsy revealed spherical lesions of demyelination and hemorrhagic cavitation confirmed as varicella zoster encephalitis. Characteristic MR features may suggest the diagnosis of varicella zoster encephalitis, enabling definitive diagnostic testing and early institution of antiviral treatment. PMID: 9921876 [PubMed - indexed for MEDLINE] 2487. Rinsho Byori. 1998 Nov;Suppl 108:65-73. [Laboratory diagnosis of viral infections. 3. Exanthema and muco- cutaneous infections] [Article in Japanese] Morishima T. PMID: 9921233 [PubMed - indexed for MEDLINE] 2488. Am J Otol. 1999 Jan;20(1):26-30. Delayed facial palsy after tympanomastoid surgery. Vrabec JT. Department of Otolaryngology, University of Texas Medical Branch, Galveston 77555-0521, USA. OBJECTIVES: The purpose of this report is to provide data on the incidence of delayed facial palsy (DFP) after tympanomastoid surgery, compare incidence among various otologic and neurotologic procedures, and discuss the possible etiology. STUDY DESIGN: The study design was a retrospective case review. SETTING: The study was conducted at a tertiary referral center. PATIENTS: The records of 486 patients with normal facial function before tympanomastoid surgery were reviewed. INTERVENTION: Patients underwent tympanomastoid surgery. OUTCOME MEASURES: Delayed facial palsy was defined as facial palsy occurring more than 72 hours after surgery. RESULTS: Seven of 486 (1.4%) patients had DFP after tympanomastoid surgery. In two patients, the DFP was caused by a postoperative wound infection. Facial palsy in the other five patients likely was caused by viral reactivation. CONCLUSIONS: Published data for otologic surgery suggest a rising incidence of DFP with increased manipulation of the sensory branches of the facial nerve. Viral reactivation is postulated to be an important contributing mechanism in the development of DFP. A number of viruses could potentially cause this phenomenon, but observations in this study implicate the varicella zoster virus. Patients with a history of viral reactivation may be at greater risk for development of this complication. PMID: 9918167 [PubMed - indexed for MEDLINE] 2489. Can Commun Dis Rep. 1998 Dec 15;24(24):193-8. Varicella-zoster virus disease and epidemiology: seeking better control strategies--Part 1. [Article in English, French] Bentsi-Enchill A. Division of Immunization, Bureau of Infectious Diseases, LCDC, Ottawa, ON. Erratum in: Can Commun Dis Rep 1999 Sep 1;25(17):152. PMID: 9916347 [PubMed - indexed for MEDLINE] 2490. ORL J Otorhinolaryngol Relat Spec. 1999 Jan-Feb;61(1):10-5. Blink reflex excitability recovery curves in patients with dysfunctions after facial nerve palsy. Nakamura K, Kashima K, Koike Y. Department of Otolaryngology, University of Tokushima School of Medicine, Tokushima, Japan. nakamura@clin.med.tokushima-u.ac.jp The blink reflex excitability recovery curves were studied in 12 patients with postparalytic facial dysfunctions (PPFD) and 12 healthy control subjects. The inhibitory effects of the conditioning stimuli on the ipsilateral R2 and contralateral R2 responses observed in control subjects were significantly less in patients with PPFD. The enhanced recovery of the R2 responses was similar on the affected side and unaffected side in the patients. These results indicate that patients with PPFD have an increased excitability of central interneurons which mediate the R2 pathway. It is suggested that not only changes in the peripheral facial nerve but also changes in the central nervous system may contribute to the onset of PPFD. PMID: 9892863 [PubMed - indexed for MEDLINE] 2491. J Immunol. 1999 Jan 1;162(1):560-7. Comparison of primary sensitization of naive human T cells to varicella-zoster virus peptides by dendritic cells in vitro with responses elicited in vivo by varicella vaccination. Jenkins DE, Yasukawa LL, Bergen R, Benike C, Engleman EG, Arvin AM. Department of Pediatrics, Stanford University School of Medicine, CA 94305, USA. Dendritic cells (DC) are potent APC during primary and secondary immune responses. The first objective of this study was to determine whether human DC mediate in vitro sensitization of naive CD4+ T cells to epitopes of the immediate early 62 (IE62) protein of varicella zoster virus (VZV). The induction of CD4+ T cell proliferative responses to eight synthetic peptides representing amino acid sequences of the VZV IE62 protein was assessed using T cells and DC from VZV-susceptible donors. The second objective was to compare in vitro responses of naive T cells with responses to VZV peptides induced in vivo after immunization with varicella vaccine. T cell proliferation was induced by three peptides, P1, P4, and P7, in 71-100% of the donors tested before and after vaccination using DC as APC. Monocytes were effective APC for VZV peptides only after immunization. Two peptides, P2 and P8, induced naive T cell proliferation less effectively and were also less immunogenic for T cells from vaccinated or naturally immune donors. T cell recognition of specific peptides was concordant between naive, DC-mediated responses, and postvaccine responses using monocytes as APC in 69% of comparisons (p = 0.05; chi2); the predictive value of a positive response to an IE62 peptide before immunization for T cell sensitization in vivo was 82%. These observations indicate that primary T cell responses detected in vitro using DC as APC may be useful to characterize the potential immunogenicity of viral protein epitopes in vivo. PMID: 9886433 [PubMed - indexed for MEDLINE] 2492. J Infect Dis. 1998 Nov;178 Suppl 1:S1-112. Proceedings of the 3rd International Conference on the Varicella-Zoster Virus. Palm Beach Gardens, Florida, USA. 9-11 March 1997. [No authors listed] PMID: 9874603 [PubMed - indexed for MEDLINE] 2493. AJNR Am J Neuroradiol. 1998 Nov-Dec;19(10):1897-9. Multifocal varicella-zoster virus leukoencephalitis in a patient with AIDS: MR findings. Aygun N, Finelli DA, Rodgers MS, Rhodes RH. Department of Radiology, MetroHealth Medical Center/Case Western Reserve University School of Medicine, Cleveland, OH 44109, USA. We describe a patient with AIDS who presented with an acute encephalitis caused by infection with varicella-zoster virus. The hemorrhagic, necrotizing encephalitis had an unusual MR appearance, with innumerable discrete, small, targetlike lesions in the right cerebral hemisphere, which were coalescent in the posterior temporal, parietal, and occipital regions. Of the several known disease patterns of varicella-zoster viral infection in the CNS, this histopathologic pattern of multifocal leukoencephalitis is rare. It is important to recognize, as effective antiviral drug treatments are available. PMID: 9874543 [PubMed - indexed for MEDLINE] 2494. Am J Health Syst Pharm. 1998 Dec 15;55(24 Suppl 4):S4-8. A cost-effectiveness model for analyzing two varicella vaccination strategies. Gayman J. Department of Pharmaceutical Services, Palmetto Richland Memorial Hospital, Columbia, SC 29203, USA. jayne.gayman@rmh.edu A model for estimating the cost-effectiveness of a program for vaccinating employees at a health care institution against varicella zoster virus (VZV) was studied. Three outcomes of varicella vaccination--cost-effectiveness, reduction in employee infections, and reduction in patient exposures--were stratified to estimate the incremental costs of vaccinating three employee groups. The groups consisted of all employees (vaccinate-all group), employees providing direct patient care (direct care group), and employees working in high-risk patient care areas (high-risk group). Two strategies for employee vaccination were used: screen (by antibody titer testing) and then vaccinate, and vaccination alone. A model was used to estimate the various outcomes of the vaccination program. The model supported the screen, then vaccinate strategy of vaccinating employees, at a cost savings of about $50 per employee. Vaccination of all employees prevented 35 employee infections and 674 patient exposures for every 10,000 potentially susceptible employees. The cost of preventing one employee infection was about $15,000, and the cost of preventing one patient exposure was about $775. An employee vaccination program is a good investment in preventing patient exposures to VZV and may be cost-effective compared with only screening employees. PMID: 9872686 [PubMed - indexed for MEDLINE] 2495. Clin Infect Dis. 1998 Dec;27(6):1525-7. Acyclovir-resistant herpes zoster in human immunodeficiency virus-infected patients: results of foscarnet therapy. Breton G, Fillet AM, Katlama C, Bricaire F, Caumes E. Department of Infectious and Tropical Diseases, Hôpital Pitié Salpétrière, Paris, France. We retrospectively studied 18 consecutive cases of acyclovir-resistant zoster. All the patients had chronic skin lesions that failed to heal despite treatment with intravenous acyclovir (30 mg/[kg.d]) in 15 cases and oral acyclovir (4 g/d) in three cases for > 10 days. The mean CD4+ cell count was 20 x 10(6)/L. The mean number of previous zoster episodes was 1.53. Fifteen of the 16 patients evaluable for previous acyclovir treatment had received the drug. Thirteen patients were treated with intravenous foscarnet (200 mg/[kg.d]) for a mean of 17.8 days. Complete healing was observed in 10 (77%) of the 13 treated patients. Zoster relapsed after cessation of foscarnet therapy in five of the 10 responding patients. The median time to relapse was 110 days. Four patients died of varicella-zoster virus-associated visceral complications. These results show that acyclovir-resistant zoster has a poor prognosis but responds well to foscarnet therapy. PMID: 9868672 [PubMed - indexed for MEDLINE] 2496. Clin Infect Dis. 1998 Dec;27(6):1514-6. Potent antiretroviral therapy does more than just decrease viral load. Daar ES. Comment on: Clin Infect Dis. 1998 Dec;27(6):1510-3. PMID: 9868669 [PubMed - indexed for MEDLINE] 2497. Clin Infect Dis. 1998 Dec;27(6):1510-3. High incidence of herpes zoster in patients with AIDS soon after therapy with protease inhibitors. Martínez E, Gatell J, Morán Y, Aznar E, Buira E, Guelar A, Mallolas J, Soriano E. Infectious Diseases Unit, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clínic, Barcelona, Spain. Comment in: Clin Infect Dis. 1998 Dec;27(6):1514-6. A high incidence of herpes zoster was noticed among patients with AIDS, shortly after addition of a protease inhibitor to their baseline treatment with nucleoside analogue reverse-transcriptase inhibitors. Within a median follow-up of 64 weeks (range, 34-103 weeks), 14 patients (7%) had a first episode or a recurrence of herpes zoster (6.2 episodes per 100 patient-years). No episodes of zoster were diagnosed before week 4. Twelve episodes (86%) occurred between weeks 4 and 16. The risk of zoster was independent of age, sex, type of protease inhibitor, and CD4+ lymphocyte count and viral load at baseline and month 1. A CD8+ lymphocyte proportion at baseline of > 66% (hazard ratio [HR], 10.6; 95% confidence interval [CI], 3.4-33.1) and an increase in CD8+ lymphocyte proportion at month 1 of > 5% (HR, 32; 95% CI, 8.1-126.4) were independently associated with the risk of herpes zoster. These data might be clinically useful for determining transient prophylaxis for those patients at high risk. PMID: 9868668 [PubMed - indexed for MEDLINE] 2498. Praxis (Bern 1994). 1998 Nov 19;87(47):1614-8. [Hypotension in acyclovir therapy] [Article in German] Wolters H, Mayer A, Gerhardt U, Hohage H. Medizinische Poliklinik, Universität Münster. A 51 year old man developed Herpes zoster on the right arm (C5/C6) treated subsequently with aciclovir infusions (500 mg, 3/day). Ten months before hospital admission he did have a radical resection of a epi-oro-hypopharyngeal carcinoma (T4/N1/G2, M0; lymphangiosis carcinomatosa) as well as a partial laryngeal resection for a recurrence 3 months later and removal of a cervical lymph node metastasis after two further months. During aciclovir treatment the patient experienced repeated bradycardia with hypotension verifiable with the tilt-table test. The bradycardias could not be further characterized by ECC. Neither sonography nor CT-scans gave an indication for infiltration of the cervical course of the vagus or glossopharyngeal nerves. Serum catecholamines were, however, markedly reduced. After cessation of aciclovir the bradycardias and hypotensive episodes disappeared. A final tilt-table test was unremarkable. A reversible autonomic neuropathy induced by aciclovir seems a possible explanation. PMID: 9865134 [PubMed - indexed for MEDLINE] 2499. Arch Phys Med Rehabil. 1998 Dec;79(12):1560-4. Neuropathic pain in Charcot-Marie-Tooth disease. Carter GT, Jensen MP, Galer BS, Kraft GH, Crabtree LD, Beardsley RM, Abresch RT, Bird TD. Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, USA. OBJECTIVES: To determine the frequency and extent to which subjects with Charcot-Marie-Tooth (CMT) disease report pain and to compare qualities of pain in CMT to other painful neuropathic conditions. STUDY DESIGN: Descriptive, nonexperimental survey, using a previously validated measurement tool, the Neuropathic Pain Scale (NPS). PARTICIPANTS: Participants were recruited from the membership roster of a worldwide CMT support organization. MAIN OUTCOME MEASURES: NPS pain descriptors reported in CMT were compared with those reported by subjects with postherpetic neuralgia (PHN), complex regional pain syndrome, type 1 (CRPS-1), also known as reflex sympathetic dystrophy, diabetic neuropathy (DN), and peripheral nerve injury (PNI). RESULTS: Of 617 CMT subjects (40% response rate), 440 (71%) reported pain. with the most severe pain sites noted as low back (70%), knees (53%), ankles (50%), toes (46%), and feet (44%). Of this group, 171 (39%) reported interruption of activities of daily living by pain; 168 (38%) used non-narcotic pain medication and 113 (23%) used narcotics and/or benzodiazepines for pain. The use of pain description was similar for CMT, PHN, CRPS-1, DN, and PNI in terms of intensity and the descriptors hot, dull, and deep. CONCLUSIONS: Neuropathic pain is a significant problem for many people with CMT. The frequency and intensity of pain reported in CMT is comparable in many ways to PHN, CRPS-1, DN. and PNI. Further studies are needed to examine possible pain generators and pharmacologic and rehabilitative modalities to treat pain in CMT. PMID: 9862301 [PubMed - indexed for MEDLINE] 2500. Am J Chin Med. 1998;26(3-4):375-81. Effect of Ganoderma lucidum on postherpetic neuralgia. Hijikata Y, Yamada S. Tokyo Hijikata Clinic, Osaka, Japan. Administration of hot water soluble extracts of Ganoderma lucidum (GI) (36 to 72 g dry weight/day) decreased pain dramatically in two patients with postherpetic neuralgia recalcitrant to standard therapy and two other patients with severe pain due to herpes zoster infection. PMID: 9862025 [PubMed - indexed for MEDLINE] 2501. Clin Exp Dermatol. 1998 May;23(3):116-8. Zosteriform cutaneous metastases from squamous cell carcinoma of the stump of an amputated arm. Cuq-Viguier L, Viraben R. Service de Dermatologie, Hôpital La Grave, Toulouse, France. The clinical appearance of skin metastases varies over a wide morphologic spectrum, cutaneous metastases mimicking herpes zoster being rare. We now report the case of an 83-year-old male with zosteriform cutaneous metastases secondary to a squamous cell carcinoma (SCC) which developed in the stump of an amputated arm. The pathogenesis is speculative, but in this case, the zosteriform distribution might well be explained by perineural lymphatic invasion and spread. PMID: 9861739 [PubMed - indexed for MEDLINE] 2502. Infection. 1998 Nov-Dec;26(6):359-63. A prognostic score for postherpetic neuralgia in ambulatory patients. Meister W, Neiss A, Gross G, Doerr HW, Höbel W, Malin JP, von Essen J, Reimann BY, Witke C, Wutzler P. SmithKline Beecham Pharma GmbH, München, Germany. The main objective was to develop a scoring system for easy use by the physician in daily clinical practice in deciding the appropriate treatment for his herpes zoster patient. Data from 635 patients who did not receive antiviral therapy were included in this analysis. Of these, 131 developed postherpetic neuralgia (PHN). Of the 29 variables tested univariately in this study, 15 showed a significant correlation with the incidence of PHN, but only six proved to contribute to the overall predictive power in the multivariate approach. Using two independent approaches, the model showed a very satisfactory performance in the validation sample. Patients without acute pain rarely developed PHN. In those with acute pain, being female, being over 50 years of age, having more than 50 lesions, having lesions of a hemorrhagic nature, having cranial or sacral localisation of the rash or having pain in the prodromal phase proved to be significant, multivariate factors. An easy-to-use scoring system used in a risk graph is proposed. These data should be useful in the individual treatment decision as well as in the design and analysis of therapeutic trials in herpes zoster. PMID: 9861560 [PubMed - indexed for MEDLINE] 2503. Nervenarzt. 1998 Nov;69(11):1015-8. [Delirium during oral therapy of herpes zoster with acyclovir. Case report and brief review of central nervous system side-effects of acyclovir] [Article in German] Braun JS, Apel I, Schäffer S, Schumacher M, Berger M. Abteilung für Psychiatrie und Psychotherapie, Albert-Ludwigs-Universität, Freiburg. In differential diagnosis of a delir also adverse effects of medicaments have to be taken into account beside other causes. We report a case of an agitated delir with nocturnal disturbance of consciousness, confusion, restlessness and sleeplessness. This delir existed exclusively during the therapy of a cutaneous herpes zoster with zovirax-pills which can only be explained by a causal connection--after exclusion of other causes. As a so far undescribed predisposition for neurotoxicity of oral therapy with acyclovir signs of vascular encephalopathy were found in the patient's cranial magnetic resonance imaging. The central nervous side effects of acyclovir were summarized shortly. PMID: 9859124 [PubMed - indexed for MEDLINE] 2504. Invest Ophthalmol Vis Sci. 1998 Dec;39(13):2659-65. Analysis of immunoregulatory cytokines in ocular fluid samples from patients with uveitis. Ongkosuwito JV, Feron EJ, van Doornik CE, Van der Lelij A, Hoyng CB, La Heij EC, Kijlstra A. Department of Ophthalmology, Academic Medical Centre, University of Amsterdam, The Netherlands. Comment in: Invest Ophthalmol Vis Sci. 1999 Sep;40(10):2462-3. PURPOSE: To investigate the T-helper cell cytokine profiles in two well-defined clinical uveitis entities caused by an infectious mechanism. METHODS: Cytokines (interleukin [IL]-2, IL-4, IL-6, IL-10, and interferon [IFN]-gamma) were measured in ocular fluid samples obtained from patients with herpes simplex- or varicella-zoster virus-induced acute retinal necrosis (ARN; n = 17) and toxoplasma chorioretinitis (n = 27) using enzyme-linked immunosorbent assay techniques. The data were compared with data for 51 control samples taken during cataract surgery (n = 10), vitrectomy in diabetic retinopathy (n = 10), eye bank eyes (n = 10) and with samples from patients with "autoimmune" uveitis (n = 21). RESULTS: Interleukin-6 was detected in 44 of 51 control samples and 43 of 44 eyes of patients with uveitis. The highest levels in the control samples were detected in 9 of 10 vitreous samples from patients with diabetic retinopathy (mean, 648 pg/ml). In 8 of 10 samples taken from patients during cataract surgery and in 7 of 10 eye bank eyes the amount of IL-6 was significantly lower (mean, 10 pg/ml and 136 pg/ml, respectively). Interleukin-6 levels in patients with ARN (mean, 1436 pg/ml) were significantly higher than in those with toxoplasma chorioretinitis (mean, 272 pg/ml). Interleukin-2 was detected in one of the samples from patients with toxoplasma chorioretinitis (1105 pg/ml) and in three samples from the control subjects suffering from Fuchs' heterochromic anterior uveitis (mean, 752 pg/ml). No IL-4 (<2 pg/ml) was detected either in patient or control samples. Interferon-gamma could be detected in 7 of 17 ARN patients (range, 277-3483 pg/ml), in 13 of 27 samples from patients with toxoplasma chorioretinitis (range, 12-250 pg/ml), and in 1 of 21 of the samples from control subjects with uveitis (31 pg/ml) but was absent in nonuveitic control samples. Interleukin-10 was detected in 10 of 17 ARN patients (range, 29-3927 pg/ml), in 13 of 27 samples from patients with toxoplasma chorioretinitis (range, 4-67 pg/ml), and in only 3 of 51 control samples (6 pg/ml, 16 pg/ml, and 20 pg/ml). CONCLUSIONS: Various immunoregulatory cytokines (IL-6, IL-10, and IFN-gamma) were detected in ocular fluid samples from patients with uveitis. A separate role for either a T-helper type 1 or T-helper type 2 response in the pathogenesis of clinical uveitis could not be proven. PMID: 9856775 [PubMed - indexed for MEDLINE] 2505. Ned Tijdschr Geneeskd. 1998 Sep 5;142(36):1977-9. [Chickenpox: varicella pneumonia in adults] [Article in Dutch] Aerts JG, Tan KY, Rietveld AP. Sint Fransiscus Gasthuis, Rotterdam. Two patients, a man aged 33 years and a woman aged 30, suffered from a varicella zoster induced pneumonia. In adults a varicella zoster infection may be accompanied by a very severe pneumonia. In one patient mechanical ventilation was necessary. A chest X-ray and blood gas analysis must be made in adults suffering from a varicella zoster virus infection who have pulmonary complaints. In case of abnormalities in one of these two examinations the patient must be observed in a clinical setting. The pneumonia can be treated with aciclovir. PMID: 9856194 [PubMed - indexed for MEDLINE] 2506. Clin Geriatr Med. 1999 Feb;15(1):103-12, vii. The painful eye: external and anterior segment causes. Cutarelli PE, Aronsky MA. Department of Ophthalmology, University Hospitals of Cleveland and Case Western Reserve University, Cleveland, Ohio, USA. When a patient presents to a medical practitioner with a painful eye, the initial history is extremely valuable in determining the cause of the complaint. The patient should be questioned specifically about the onset and duration of symptoms; description of the pain; exacerbating and mitigating factors; associated pruritus, discharge, or photophobia; and any previous occurrences. It is important to inquire about the patient's past medical history, past ocular history (including surgeries, trauma, contact lens wear, and family history of glaucoma), systemic and ocular medications, and allergies. A careful examination of the patient's skin, face, eyelids, conjunctiva, sclera, cornea, and anterior chamber should be performed. In this article, the authors describe a variety of external diseases and anterior segment causes of a painful eye, many of which can be diagnosed from the initial history. The article works systematically, beginning externally with the eyelids and conjunctiva and progressing internally toward the cornea and anterior chamber. PMID: 9855661 [PubMed - indexed for MEDLINE] 2507. Ann Biol Clin (Paris). 1998 Nov-Dec;56(6):717-8. [Value of PCR for the early diagnosis of atypical zoster] [Article in French] Bellagra N, Lengrand F, Dewilde A, Catteau B, Hober D, Wattré P. Laboratoire de virologie, Institut Gernez-Rieux, CHU de Lille. PMID: 9853031 [PubMed - indexed for MEDLINE] 2508. J Infect Dis. 1998 Nov;178 Suppl 1:S109-12. Use of a live attenuated varicella vaccine to boost varicella-specific immune responses in seropositive people 55 years of age and older: duration of booster effect. Levin MJ, Barber D, Goldblatt E, Jones M, LaFleur B, Chan C, Stinson D, Zerbe GO, Hayward AR. Department of Pediatrics, University of Colorado School of Medicine, Denver 80262, USA. Varicella-zoster virus (VZV)-specific T cell immunity was measured in 130 persons > or = 55 years of age 6 years after they received a live attenuated VZV vaccine. Circulating T cells, which proliferated in vitro in response to VZV antigen, were enumerated (VZV responder cell frequency assay). Six years after the booster vaccination, the VZV-responding cell frequency (1/61,000 circulating cells) was still significantly (P < .05) improved over the baseline measurements (1/70,000) and appears to have diminished the expected decline in frequency as these vaccinees aged (to 1/86,000). Ten herpes-zoster--like clinical events were recorded. Although the frequency of these events, approximately 1/100 patient-years, is within the expected range of such events for this age cohort, the number of lesions was small, there was very little pain, and there was no postherpetic neuralgia. These results support the development of a vaccine to prevent or attenuate herpes zoster. PMID: 9852987 [PubMed - indexed for MEDLINE] 2509. J Infect Dis. 1998 Nov;178 Suppl 1:S104-8. Cellular immunity to varicella-zoster virus in patients with major depression. Irwin M, Costlow C, Williams H, Artin KH, Chan CY, Stinson DL, Levin MJ, Hayward AR, Oxman MN. VA Medical Center, University of California, San Diego, USA. mirwin@ucsd.edu Erratum in: J Infect Dis 1999 Mar;179(3):753. The incidence of herpes zoster increases markedly with advancing age, and this appears to be causally related to an age-dependent decline in varicella-zoster virus (VZV)-specific cellular immunity. Psychologic stress has also been linked to the occurrence of herpes zoster, but the mechanism involved has not been investigated. This study examined the relationship between major depression and VZV-specific cellular immunity by comparing VZV-specific responder cell frequency (RCF) in adults with major depression (n = 11) to that in age- and sex-matched nondepressed controls (n = 11) and in a larger group of nondepressed adults who were > or = 60 years old. VZV-specific RCF in depressed patients was markedly reduced compared with the RCF in matched controls (t = 2.7, P < .02). In fact, the levels of VZV-specific RCF in the depressed patients were comparable in magnitude to the low levels found in adults > or = 60 years of age. These data indicate that major depression is associated with a marked decline in VZV-specific cellular immunity. PMID: 9852986 [PubMed - indexed for MEDLINE] 2510. J Infect Dis. 1998 Nov;178 Suppl 1:S91-4. Postherpetic neuralgia: the importance of preventing this intractable end-stage disorder. Watson CP. An argument is presented here for postherpetic neuralgia as an intractable end-stage disorder for many patients. The exciting possibility of prevention of this disorder by early, aggressive treatment exists; however, the extent to which therapy can be effective is unknown. Early, aggressive treatment of the pain of herpes zoster is, nevertheless, urged, and the options for treatment are discussed. These options include antiviral therapy within the first 72 h, if possible, from the onset of rash or radicular pain and the use of analgesics, including opioids (if necessary), nerve blocks, and early antidepressant therapy. In addition, the extent to which vaccination of older adults will prevent postherpetic neuralgia is unknown but appears to hold promise. PMID: 9852983 [PubMed - indexed for MEDLINE] 2511. J Infect Dis. 1998 Nov;178 Suppl 1:S85-90. Cost effectiveness of newer antiviral agents for herpes zoster: is the evidence spotty? Smith KJ, Roberts MS. Department of Medicine, Mercy Hospital of Pittsburgh, PA 15219, USA. ksmith@mercy.pmhs.org Famciclovir and valaciclovir were approved for use in the treatment of herpes zoster despite controversy over antiviral therapy in zoster due to high costs and uncertain benefits. To explore these issues, a Markov decision model was developed, and the incremental cost effectiveness of antiviral treatment for herpes zoster was estimated using these agents compared with no antiviral therapy. A third-party payer perspective was taken. Sensitivity analyses were performed, modeling differences in antiviral efficacy, postherpetic neuralgia (PHN) risk, and other illness parameters. Treatment of severely symptomatic acute zoster was found reasonable from a cost-effectiveness standpoint in base-case and worst-case scenarios. Treatment of mildly symptomatic acute zoster was more expensive but would likely be considered cost effective in scenarios where PHN risk was higher, PHN duration longer, or antiviral shortening of PHN greater. Further research comparing antiviral efficacy in herpes zoster is needed. PMID: 9852982 [PubMed - indexed for MEDLINE] 2512. J Infect Dis. 1998 Nov;178 Suppl 1:S81-4. Treatment of acute herpes zoster: effect of early (< 48 h) versus late (48-72 h) therapy with acyclovir and valaciclovir on prolonged pain. Wood MJ, Shukla S, Fiddian AP, Crooks RJ. Department of Infection, Heartlands Hospital, Birmingham, United Kingdom. m.j.wood@hbham.ac.uk The efficacy of early versus late treatment with acyclovir and valaciclovir on zoster-associated pain was assessed from two databases (1076 patients) that were compiled from randomized trials. Early treatment was started < 48 h and late treatment was started 48-72 h after the onset of cutaneous herpes zoster. Median times to complete resolution of zoster-associated pain were 28 and 62 days, respectively, for patients (> or = 18 years of age) treated with acyclovir and placebo within 48 h (hazard ratio [HR], 1.68; 95% confidence limit [95% CL], 1.19, 2.38) and 28 and 58 days, respectively, for those treated later (HR, 2.20; 95% CL, 1.03, 4.71). In the valaciclovir versus acyclovir study (in patients > or = 50 years of age), the corresponding figures were 44 and 51 days for patients treated early (HR, 1.28; 95% CL, 1.03, 1.60) and 36 and 48 days for those treated later (HR, 1.40; 95% CL, 1.04, 1.87). Acyclovir significantly shortened the time to complete resolution of zoster-associated pain compared with placebo (and valaciclovir was superior to acyclovir in this regard) even when therapy was delayed up to 72 h after rash onset. PMID: 9852981 [PubMed - indexed for MEDLINE] 2513. J Infect Dis. 1998 Nov;178 Suppl 1:S76-80. Postherpetic neuralgia: impact of famciclovir, age, rash severity, and acute pain in herpes zoster patients. Dworkin RH, Boon RJ, Griffin DR, Phung D. Department of Anesthesiology, University of Rochester School of Medicine and Dentistry, New York 14642, USA. dwrkn@troi.cc.rochester.edu New and previously reported analyses of the data from a placebo-controlled trial of famciclovir are reviewed in light of recently proposed recommendations for the analysis of pain in herpes zoster trials. The analyses examined the effect of famciclovir treatment on the duration of postherpetic neuralgia (PHN), which was defined as pain persisting after rash healing, pain persisting > 30 days after study enrollment, or pain persisting > 3 months after study enrollment; the baseline characteristics of patients in the famciclovir and placebo groups who developed PHN; the impact of famciclovir treatment on the duration of PHN, while controlling for significant covariates; and the prevalence of PHN at monthly intervals from 30 to 180 days after enrollment. The results of these analyses indicated that greater age, rash severity, and acute pain severity are risk factors for prolonged PHN. In addition, they demonstrated that treatment of acute herpes zoster patients with famciclovir significantly reduces both the duration and prevalence of PHN. PMID: 9852980 [PubMed - indexed for MEDLINE] 2514. J Infect Dis. 1998 Nov;178 Suppl 1:S71-5. The identification of risk factors associated with persistent pain following herpes zoster. Whitley RJ, Shukla S, Crooks RJ. Department of Pediatrics, Microbiology, and Medicine, University of Alabama at Birmingham 35233, USA. RWhitley@peds.uab.edu Demographic and clinical characteristics of patients with herpes zoster at the time of presentation predict the duration and severity of pain on long-term follow-up. Analyses by Cox's proportional hazard models of six databases from controlled trials of antiviral drugs (total subjects = 2367) identified covariates for zoster-associated pain; all tests for significance were two-sided. Age strongly influenced pain outcome: patients > or = 50 years old were significantly more likely to have prolonged zoster-associated pain compared with those < 30 years old. Patients with prodromal symptoms or moderate or severe pain at presentation were also more likely to experience prolonged zoster-associated pain. Neither time to initiating treatment after rash onset nor sex of patient influenced pain outcome. Advancing age, prodromal symptoms, and acute pain severity at presentation predicted those individuals most at risk of prolonged pain and postherpetic neuralgia. When two or more of these factors were present, the risk of persistent pain was increased. PMID: 9852979 [PubMed - indexed for MEDLINE] 2515. J Infect Dis. 1998 Nov;178 Suppl 1:S67-70. Racial and psychosocial risk factors for herpes zoster in the elderly. Schmader K, George LK, Burchett BM, Pieper CF. Department of Psychiatry and Sociology, Duke University Medical Center, Durham, NC 27710, USA. The effects of black race and psychologic stress on the risk of acquiring herpes zoster in late life were examined. Subjects were participants of a stratified probability sample of community-dwelling persons > or = 65 years old. A comprehensive health survey was administered in 1986-1987 (P1), 1989-1990 (P2), and 1992-1994 (P3). Incident cases of zoster between P1 and P2 and P2 and P3 served as the dependent variables. Hypothesis-testing variables included race, negative life events, and measures of social support. Control variables included age, sex, education, cancer, other chronic diseases, hospitalization, activities of daily living, self-rated health, depression, and cigarette smoking. From P1 to P2, 1.4% of black and 3.4% of white subjects developed zoster (P < .001). From P2 to P3, 2.9% of black and 7.5% of white subjects developed zoster (P < .001). After controlling for variables, black subjects were significantly less likely to develop zoster than were white subjects (adjusted odds ratio, 0.37; 95% confidence interval, 0.26, 0.53; P = .0001). Most measures of stress were not significantly related to zoster; however, study limitations preclude definitive conclusions. PMID: 9852978 [PubMed - indexed for MEDLINE] 2516. J Infect Dis. 1998 Nov;178 Suppl 1:S64-6. Polymerase chain reaction and restriction fragment length polymorphism analysis of varicella-zoster virus isolates from the United States and other parts of the world. LaRussa P, Steinberg S, Arvin A, Dwyer D, Burgess M, Menegus M, Rekrut K, Yamanishi K, Gershon A. Columbia University, New York City, New York, USA. psL1@columbia.edu A polymerase chain reaction (PCR) assay that identifies and differentiates wild-type (wt) and vaccine strains of varicella-zoster virus (VZV) was used to determine if VZV strains with restriction fragment length polymorphisms resembling those of the Japanese Oka vaccine strain were present in the wt pool outside of Japan. Virus samples (n = 114) from patients with chickenpox and zoster from various parts of the United States and Australia were analyzed. The assay correctly identified 113 samples as wt strain. The 1 sample identified as Oka vaccine strain came from a child with leukemia who developed a vaccine-associated rash after receiving the live attenuated varicella vaccine. At this point, there is no evidence that wt strains resembling the vaccine are circulating outside of Japan. This indicates that this PCR assay can be utilized to distinguish rashes due to vaccine and wt VZV. PMID: 9852977 [PubMed - indexed for MEDLINE] 2517. J Infect Dis. 1998 Nov;178 Suppl 1:S55-7. Single amino acid change in DNA polymerase is associated with foscarnet resistance in a varicella-zoster virus strain recovered from a patient with AIDS. Visse B, Dumont B, Huraux JM, Fillet AM. Laboratoire de Virologie, CERVI, Hôpital Pitié-Salpêtrière, Paris, France. The genetic characterization of a foscarnet-resistant strain of varicella-zoster virus (VZV) that was isolated from a patient with AIDS is reported. Compared with the sequence of the Dumas reference strain, this strain, which was isolated from a patient in whom foscarnet treatment failed, had two point mutations. The emergence of one of the mutations, which includes a change from a glutamic acid to a lysine at position 512 in the DNA polymerase, suggests that this mutation is implicated in the VZV foscarnet resistance. The other mutation, which replaces serine 863 by a glycine, is also present in 2 susceptible strains--Oka and a wild-type isolate. PMID: 9852975 [PubMed - indexed for MEDLINE] 2518. J Infect Dis. 1998 Nov;178 Suppl 1:S48-51. Evidence of latent varicella-zoster virus in rat dorsal root ganglia. Annunziato P, LaRussa P, Lee P, Steinberg S, Lungu O, Gershon AA, Silverstein S. Department of Pediatrics, Columbia University, College of Physicians and Surgeons, New York, New York 10032, USA. paa5@columbia.edu Latent varicella-zoster virus (VZV) was studied in ganglia of rats that had been inoculated subcutaneously with either a high-passaged wild-type, a low-passaged wild-type, or the vaccine strain of virus using in situ hybridization. Nine of 11 rats injected with virus and no control rats developed serum VZV antibodies as demonstrated by fluorescent antibody membrane antigen. Polymerase chain reaction 2 weeks following inoculation did not detect viremia in the rats. VZV was detected by in situ hybridization in ganglia of 10 of the 11 infected rats but not in ganglia of the control rats. The distribution of VZV DNA is identical to that seen in humans; satellite cells and neurons contain VZV DNA. Although all animals received unilateral injections of virus, VZV DNA was in ipsilateral and contralateral ganglia in 6 animals, suggesting that virus replication and viremia had occurred. PMID: 9852973 [PubMed - indexed for MEDLINE] 2519. J Infect Dis. 1998 Nov;178 Suppl 1:S43-7. Varicella-zoster virus IE63, a virion component expressed during latency and acute infection, elicits humoral and cellular immunity. Sadzot-Delvaux C, Arvin AM, Rentier B. Department of Pediatrics, Stanford University School of Medicine, California, USA. csadzot@ulg.ac.be Varicella-zoster virus (VZV) latency in human dorsal root ganglia is characterized by the transcription of large regions of its genome and by the expression of large amounts of some polypeptides, which are also expressed during lytic cycles. The immediate early 63 protein (IE63) is a virion component expressed very early in cutaneous lesions and the first viral protein detected during latency. Immune response against IE63 has been evaluated among naturally immune adults with a history of chickenpox: Specific antibodies were detected in serum, and most subjects who had a T cell proliferation with unfractionated VZV antigens had T cell recognition of purified IE63. The cytotoxic T cell (CTL) response to IE63 was equivalent to CTL recognition of IE62, the major tegument component of VZV, whose immunogenicity has been previously described. T cell recognition of IE63 and other VZV proteins is one of the likely mechanisms involved in controlling VZV reactivation from latency. PMID: 9852972 [PubMed - indexed for MEDLINE] 2520. Hosp Med. 1998 Oct;59(10):770-6. Shingles: a review of diagnosis and management. Morgan R, King D. Department of Medicine for the Elderly, Wirral NHS Trust Hospital, Merseyside. Herpes zoster or shingles results from reactivation of varicella zoster virus previously dormant in cells of the dorsal root ganglion. The incidence of shingles increases with age and immunosuppression. Guidelines for managing shingles are now available and implementation, with the emphasis on early treatment, may reduce the severity of a shingles attack and reduce the incidence of complications. PMID: 9850292 [PubMed - indexed for MEDLINE] 2521. Neurobiol Dis. 1998 Oct;5(4):209-27. Postherpetic neuralgia: irritable nociceptors and deafferentation. Fields HL, Rowbotham M, Baron R. Department of Neurology, University of California at San Francisco 94143, USA. Postherpetic neuralgia (PHN) is a common and often devastatingly painful condition. It is also one of the most extensively investigated of the neuropathic pains. Patients with PHN have been studied using quantitative testing of primary afferent function, skin biopsies, and controlled treatment trials. Together with insights drawn from an extensive and growing literature on experimental models of neuropathic pain these patient studies have provided a preliminary glimpse of the pain-generating mechanisms in PHN. It is clear that both peripheral and central pathophysiological mechanisms contribute to PHN pain. Some PHN patients have abnormal sensitization of unmyelinated cutaneous nociceptors (irritable nociceptors). Such patients characteristically have minimal sensory loss. Other patients have pain associated with small fiber deafferentation. In such patients pain and temperature sensation are profoundly impaired but light moving mechanical stimuli can often produce severe pain (allodynia). In these patients, allodynia may be due to the formation of new connections between nonnociceptive large diameter primary afferents and central pain transmission neurons. Other deafferentation patients have severe spontaneous pain without hyperalgesia or allodynia and presumably have lost both large and small diameter fibers. In this group the pain is likely due to increased spontaneous activity in deafferented central neurons and/or reorganization of central connections. These three types of mechanism may coexist in individual patients and each offers the possibility for developing new therapeutic interventions. PMID: 9848092 [PubMed - indexed for MEDLINE] 2522. J Neuroimmunol. 1998 Nov 2;91(1-2):19-27. Myelin basic protein reactive Th2 T cells are found in acute disseminated encephalomyelitis. Pohl-Koppe A, Burchett SK, Thiele EA, Hafler DA. Center for Neurologic Diseases, Department of Neurology, Brigham and Womens's Hospital, Harvard Medical School, Boston, MA 02115-5817, USA. Acute disseminated encephalomyelitis (ADEM), a postinfectious illness of the central nervous system (CNS), is thought to be an autoimmune disease. Here, we characterized the cytokines secreted by myelin-reactive T cells generated from patients with ADEM. The frequency of MBP-reactive T cell lines was ten-fold higher in patients with ADEM compared to patients with encephalitis and normal subjects. Whereas there was no significant IFN-gamma secretion, the predominant cytokine secreted by MBP-reactive T cell lines was IL-4 in patients with ADEM. In contrast, IL-4 secretion was only rarely detected in the controls. The presence of high frequencies of MBP-reactive IL-4 secreting T cells in subjects with ADEM during their recovery phase may be similar to myelin reactive IL-4 secreting T cells observed during the spontaneous recovery of animals with EAE. PMID: 9846815 [PubMed - indexed for MEDLINE] 2523. JAMA. 1998 Dec 2;280(21):1863-4. Symptomatic treatment of painful neuropathy. Low PA, Dotson RM. Comment on: JAMA. 1998 Dec 2;280(21):1837-42. JAMA. 1998 Dec 2;280(21):1831-6. PMID: 9846782 [PubMed - indexed for MEDLINE] 2524. JAMA. 1998 Dec 2;280(21):1837-42. Gabapentin for the treatment of postherpetic neuralgia: a randomized controlled trial. Rowbotham M, Harden N, Stacey B, Bernstein P, Magnus-Miller L. UCSF Pain Clinical Research Center, University of California, San Francisco 94115, USA. Comment in: JAMA. 1999 Jul 14;282(2):134-5. JAMA. 1998 Dec 2;280(21):1863-4. CONTEXT: Postherpetic neuralgia (PHN) is a syndrome of often intractable neuropathic pain following herpes zoster (shingles) that eludes effective treatment in many patients. OBJECTIVE: To determine the efficacy and safety of the anticonvulsant drug gabapentin in reducing PHN pain. DESIGN: Multicenter, randomized, double-blind, placebo-controlled, parallel design, 8-week trial conducted from August 1996 through July 1997. SETTING: Sixteen US outpatient clinical centers. PARTICIPANTS: A total of 229 subjects were randomized. INTERVENTION: A 4-week titration period to a maximum dosage of 3600 mg/d of gabapentin or matching placebo. Treatment was maintained for another 4 weeks at the maximum tolerated dose. Concomitant tricyclic antidepressants and/or narcotics were continued if therapy was stabilized prior to study entry and remained constant throughout the study. MAIN OUTCOME MEASURES: The primary efficacy measure was change in the average daily pain score based on an 11-point Likert scale (0, no pain; 10, worst possible pain) from baseline week to the final week of therapy. Secondary measures included average daily sleep scores, Short-Form McGill Pain Questionnaire (SF-MPQ), Subject Global Impression of Change and investigator-rated Clinical Global Impression of Change, Short Form-36 (SF-36) Quality of Life Questionnaire, and Profile of Mood States (POMS). Safety measures included the frequency and severity of adverse events. RESULTS: One hundred thirteen patients received gabapentin, and 89 (78.8%) completed the study; 116 received placebo, and 95 (81.9%) completed the study. By intent-to-treat analysis, subjects receiving gabapentin had a statistically significant reduction in average daily pain score from 6.3 to 4.2 points compared with a change from 6.5 to 6.0 points in subjects randomized to receive placebo (P<.001). Secondary measures of pain as well as changes in pain and sleep interference showed improvement with gabapentin (P<.001). Many measures within the SF-36 and POMS also significantly favored gabapentin (P< or =.01). Somnolence, dizziness, ataxia, peripheral edema, and infection were all more frequent in the gabapentin group, but withdrawals were comparable in the 2 groups (15 [13.3%] in the gabapentin group vs 11 [9.5%] in the placebo group). CONCLUSIONS: Gabapentin is effective in the treatment of pain and sleep interference associated with PHN. Mood and quality of life also improve with gabapentin therapy. PMID: 9846778 [PubMed - indexed for MEDLINE] 2525. Ugeskr Laeger. 1998 Nov 23;160(48):6993-6. [Antiviral treatment of Varicella zoster virus infection] [Article in Danish] Petersen CS. Dermato-venerologisk afdeling, H:S Bispebjerg Hospital. PMID: 9846101 [PubMed - indexed for MEDLINE] 2526. Ugeskr Laeger. 1998 Nov 23;160(48):6943. [Treatment of chickenpox and shingles] [Article in Danish] Gerstoft J. PMID: 9846086 [PubMed - indexed for MEDLINE] 2527. Zh Nevrol Psikhiatr Im S S Korsakova. 1998;98(11):4-8. [Clinical course and treatment of herpetic trigeminal ganglionic neuropathy] [Article in Russian] Grachev IuV, Kukushkin ML, Sudarikov AP, Zhuravlev VF, Gerasimenko MIu. 45 patients were observed in the periods of both acute herpes zoster and postherpetic neuralgia (PHN). In most of the patients herpetic eruptions were located in the areas of innervation of the first branch of the trigeminal nerve. In acute period of the disease there were used aciclovir, helepin or alpisarinum, antiherpetic immunoglobulin, deoxyribonuclease, non-narcotic analgetics were used. Of 28 patients residual PHN was observed in 6 cases, delayed PHN (during 3 months)--in 2 patients. The PHN development was characteristic for elderly patients, delayed request for medical care, concomitant diseases, eruptions with hemorrhagic component and secondary pyodermia and considerable residual sensory deficit. In therapy of PHN the most effective drugs were amitriptylin, non-narcotic analgetics, anticonvulsants as well as acupuncture and electroacupuncture. Relief of a typical deafferentation of pain syndrome was achieved by means of ultrasonic destruction of the trigeminal nucleus (one case). Early therapy of acute herpes zoster does not prevent completely PHN development, but it decreased considerably probability of its forming as well as the severity of its course. PMID: 9845932 [PubMed - indexed for MEDLINE] 2528. J Infect Dis. 1999 Jan;179(1):9-15. Herpes zoster: risk categories for persistent pain. Whitley RJ, Weiss HL, Soong SJ, Gnann JW. Department of Pediatrics, University of Alabama at Birmingham, USA. RWhitley@PEDS.UAB.EDU Acute neuritis and persistent pain are the most significant clinical manifestations of herpes zoster and are end points for clinical trials therapy. In an acyclovir and prednisone study, patients were categorized according to pain severity and number of lesions at presentation. Risk categories were defined according to the magnitude of risk ratios (RRs) and a comparison of Kaplan-Meier survival estimates. For acute neuritis and zoster-associated pain, RRs defined rate of resolution. Patients who presented with severe or incapacitating pain and a large number of lesions were less likely to achieve resolution of both acute neuritis and zoster-associated pain (RR, 18.0; 95% confidence interval [CI], 6. 6-48.6, and RR, 5.3; 95% CI, 4.2-17.2, respectively). These analyses identify the subgroups of patients for whom aggressive interventions are most strongly indicated. PMID: 9841816 [PubMed - indexed for MEDLINE] 2529. Aust N Z J Ophthalmol. 1998 Nov;26(4):327-8. Failure of sorivudine therapy in progressive outer retinal necrosis caused by varicella zoster virus. Rosenthal G, Bartz-Schmidt KU, Walter P, Kirchhof B, Heimann K. Department of Vitreoretinal Surgery, University of Cologne, Germany. gidir@ramat-negev.org.il BACKGROUND: We report on the case of a 23-year-old female who presented with ocular signs of progressive outer retinal necrosis (PORN) syndrome and who failed to respond to acyclovir, ganciclovir, foscarnet and oral sorivudine. METHODS: The patient was treated with the antiviral drugs acyclovir, ganciclovir, foscarnet and oral sorivudine. RESULTS: The patient failed to respond to a combination of antiviral drugs. Unfortunately, progression of the retintis occurred, which led to blindness. CONCLUSION: Despite new drugs, the prognosis of PORN is poor and recurrence is common. PMID: 9843261 [PubMed - indexed for MEDLINE] 2530. Rev Stomatol Chir Maxillofac. 1998 Oct;99(3):155-64. [Zona of the cranial nerves. Current aspects] [Article in French] Carreau JP, Gola R, Cheynet F, Guyot L. Service de Stomatologie, Chirurgie Maxillo-Faciale et Plastique de la face, CHU Nord, Marseille. Recurrence of the chickenpox virus, herpes zoster localizes in cranial nerves in 30% of cases, with a predilection for the ophthalmic nerve. In young patients, clinicians must search for a herpes zoster-HIV association as well as oculomotor proprioception impairment in herpes zoster ophthalmicus. Enhanced MRI allows good objective view of the facial nerve lesions in herpes zoster facial paralysis. Finally, the gravity and aftereffects of cephalic herpes zoster can be decreased by an appropriate therapeutic approach. PMID: 9842661 [PubMed - indexed for MEDLINE] 2531. Int J Immunopharmacol. 1998 Oct;20(10):521-35. Comparative study of transfer factor and acyclovir in the treatment of herpes zoster. Estrada-Parra S, Nagaya A, Serrano E, Rodriguez O, Santamaria V, Ondarza R, Chavez R, Correa B, Monges A, Cabezas R, Calva C, Estrada-Garcia I. Department of Immunology, National School of Biological Sciences, National Polytechnic Institute, Prol. Carpio Y Plan de Ayala, Mexico, D.F. i-estrad@bios.encb.ipn.mx Reactivation of varicella herpes virus (VHV), latent in individuals who have previously suffered varicella, gives rise to herpes zoster and in some cases leads to a sequela of post herpetic neuritis with severe pain which is refractory to analgesics. Many different antiviral agents have been tried without achieving satisfactory results. Of all the antiviral agents employed, acyclovir has been the most successful in reducing post herpetic pain. However acyclovir has not been as reliable as interferon alpha (IFN-alpha). We have previously looked into the use of transfer factor (TF) as a modulator of the immune system, specifically with respect to its effectiveness in the treatment of herpes zoster. In this work findings from a comparative clinical evaluation are presented. A double blind clinical trial of TF vs acyclovir was carried out in which 28 patients, presenting acute stage herpes zoster, were randomly assigned to either treatment group. Treatment was administered for seven days and the patients were subsequently submitted to daily clinical observation for an additional 14 days. An analogue visual scale was implemented in order to record pain and thereby served as the clinical parameter for scoring results. The group treated with TF was found to have a more favorable clinical course, P < or = 0.015. Laboratory tests to assess the immune profile of the patients were performed two days prior and 14 days after initial treatment. The results of these tests showed an increase in IFN-gamma levels, augmentation in the CD4+ cell population but not the percentage of T rosettes in the TF treated group. These parameters were however insignificantly modified in patients receiving acyclovir. Although TF treated patients showed an increase in CD4+ counts these cells remained below the levels for healthy individuals. The fact that IFN-gamma levels as well as the counts for CD4+ cells rose in the TF treated group and not in the acyclovir one is very significant and confirms the immunomodulating properties of TF. PMID: 9839657 [PubMed - indexed for MEDLINE] 2532. Eur J Pediatr. 1998 Nov;157(11):953-4. False-positive serological tests for Lyme disease in facial palsy and varicella zoster meningo-encephalitis. Woelfle J, Wilske B, Haverkamp F, Bialek R. PMID: 9835449 [PubMed - indexed for MEDLINE] 2533. J Med Virol. 1998 Dec;56(4):359-63. Detection of varicella-zoster virus DNA in peripheral mononuclear cells from patients with Ramsay Hunt syndrome or zoster sine herpete. Terada K, Niizuma T, Kawano S, Kataoka N, Akisada T, Orita Y. Department of Pediatrics, Kawasaki Medical School, Kurashiki, Okayama, Japan. kihei@med.kawasaki-m.ac.jp On the basis of alterations in varicella-zoster virus (VZV) antibody titers, it appears that Bell's palsy in some patients could be associated with VZV reactivation, that is, zoster sine herpete. To obtain stronger evidence of this association, polymerase chain reaction (PCR) was used to detect VZV DNA in auricular lesions or peripheral blood mononuclear cells (PBMCs) from Bell's palsy or Ramsay Hunt syndrome patients. VZV DNA was detected in the auricular lesions of Ramsay Hunt syndrome, in PBMCs from 2 Ramsay Hunt syndrome patients, and in 4 of 17 samples from 16 Bell's palsy patients. Three of these four positive patients were thought to have zoster sine herpete because of hearing difficulty, vertigo, and pain. VZV IgM antibodies were positive in 1 of the 2 patients with Ramsay Hunt syndrome, and in 2 of the 17 samples from the Bell's palsy patients. VZV IgG antibody titers during the acute phase were significantly higher in the patients positive for the PCR or VZV IgM antibody than in those negative for them. These findings provide evidence that Bell's palsy in some patients could be associated with VZV reactivation. PMID: 9829642 [PubMed - indexed for MEDLINE] 2534. Neurourol Urodyn. 1998;17(6):613-9. Urinary retention due to herpes virus infections. Yamanishi T, Yasuda K, Sakakibara R, Hattori T, Uchiyama T, Minamide M, Ito H. Department of Urology, Chiba University, School of Medicine, Chiba City, Japan. Urinary retention is uncommon in patients with herpes zoster and anogenital herpes simplex. Seven patients (four men, three women) with a mean age of 68.1 years (range, 35-84) with urinary retention due to herpes zoster (n = 6) or anogenital herpes simplex (n = 1) were studied. Six patients had unilateral skin eruption in the saddle area (S2-4 dermatome) and one patient with herpes zoster had a skin lesion in the L4-5 dermatome. All patients had detrusor areflexia without bladder sensation, and two of them had inactive external sphincter on electromyography at presentation. Clean intermittent catheterization was performed, and voiding function was recovered in 4-6 weeks (average, 5.4) in all patients. Urodynamic study was repeated after recovery of micturition in three patients, and they returned to normal on cystometrography and external sphincter electromyography. Acute urinary retention associated with anogenital herpes infection has been thought to occur when the meninges or sacral spinal ganglia were involved, and, in conclusion, this condition may be considered to be reversible. PMID: 9829425 [PubMed - indexed for MEDLINE] 2535. South Med J. 1998 Nov;91(11):1064-6. In utero varicella-zoster infections. Derrick CW Jr, Lord L. Department of Pediatrics, University of South Carolina School of Medicine, Columbia 29203, USA. In utero varicella-zoster infections, though infrequent, may have significant consequences for the affected infant depending on the gestational timing of the infection. We present a case of infantile zoster in a 5-month-old boy after maternal varicella infection. Also, we review the three major disorders resulting from in utero infection with respect to severity and management. PMID: 9824193 [PubMed - indexed for MEDLINE] 2536. Am J Ophthalmol. 1998 Nov;126(5):732-3. Triple viral retinitis diagnosed by polymerase chain reaction of the vitreous biopsy in a patient with Richter syndrome. Levinson RD, Hooks JJ, Wang Y, Chiu MT, Kellaway J, Chan CC. Eye Associates of New Mexico and Southwest Colorado, Albuquerque 87102, USA. PURPOSE: To report the evaluation and identification of herpes viruses associated with retinitis in a patient with Richter syndrome. METHODS: Diagnostic vitrectomy was performed on a patient with systemic leukemia and retinitis. The vitreous sample was evaluated by cytology, analysis of cytokines by ELISA, and detection of virus by polymerase chain reaction. RESULTS: The vitreous biopsy specimen showed no malignant cells but predominant CD8+ lymphocyte infiltration with elevated interferon gamma and interleukin-6. DNA amplification and Southern blot analysis demonstrated DNA of herpes simplex, varicella-zoster, and cytomegalovirus. CONCLUSION: Retinitis associated with multiple viruses in the vitreous biopsy may mimic leukemic infiltration in the eye. PMID: 9822244 [PubMed - indexed for MEDLINE] 2537. Anesthesiology. 1998 Nov;89(5):1254-6. The source of epidural infection following epidural analgesia identified by pulsed-field gel electrophoresis. Sakuragi T, Yasunaka K, Hirata K, Hori K, Dan K. Department of Anesthesiology, School of Medicine, Fukuoka University, Japan. hh034563@msat.fukuoka-u.ac.jp PMID: 9822017 [PubMed - indexed for MEDLINE] 2538. Lancet. 1998 Nov 7;352(9139):1526. Evaluation of cyberdocs. Eysenbach G, Diepgen TL. PMID: 9820312 [PubMed - indexed for MEDLINE] 2539. Radiol Med. 1998 Jul-Aug;96(1-2):107-8. [Magnetic resonance findings in a case of herpes zoster myelitis] [Article in Italian] Pierallini A, Piattella MC, Ferone E. Dipartimento di Scienze Neurologiche, Università degli Studi La Sapienza, Roma. PMID: 9819630 [PubMed - indexed for MEDLINE] 2540. J Infect. 1998 Mar;36(2):209-14. Acute Herpes zoster in Tayside: demographic and treatment details in immunocompetent patients 1989-1992. Torrens J, Nathwani D, MacDonald T, Davey PG. Infection and Immunodeficiency Unit, Kings Cross Hospital, Dundee Teaching Hospitals NHS Trust, Dundee, UK. Medical records of 105 patients admitted to Tayside hospitals with acute Herpes zoster without underlying immunosuppression were examined retrospectively for the period 1984-1992. In this elderly population (median age: 79 years) there was a female preponderance (70.5%), most admissions were for trigeminal zoster (49.5%) and length of stay ranged from 1-70 days (median: 11 days), indicating significant morbidity. There was a wide variation in both pre-admission and inpatient treatment; 53.3% of patients did not receive any anti-viral therapy prior to admission, and prescribing patterns for in-patients revealed marked differences, according to the dermatome affected. Idoxuridine 5% solution was prescribed by 15.24% of General Practitioners. Given the significant morbidity and associated costs of Herpes zoster, and that existing anti-viral agents exert maximal benefit when administered early in the course of the disease, recommendations are made with respect to appropriate therapy, and auditing current management of this serious illness, which is expected to increase in prevalence as the population ages. PMID: 9570656 [PubMed - indexed for MEDLINE] 2541. J Infect. 1998 Jan;36(1):53-6. Prevalence of antibodies against varicella zoster, herpes simplex (types 1 and 2), hepatitis B and hepatitis A viruses among Spanish adolescents. Gil A, González A, Dal-Ré R, Ortega P, Dominguez V. Preventive Medicine and Public Health Department, School of Medicine, Complutense University, Madrid, Spain. The aim of this cross-sectional study was to assess the seroprevalence of antibodies against varicella zoster (VZV), herpes simplex type 1 (HSV-1) and type 2 (HSV-2), hepatitis B (HBV) and hepatitis A (HAV) viruses in adolescents (14-17 years of age) in Madrid, Spain. At the study visit, demographic data and blood samples were obtained. The enzyme linked immunosorbent assay (ELISA) method was used to assess the presence of anti-VZV, anti-HSV-1, anti-HSV-2, anti-HBc and anti-HAV antibodies. A total of 1191 serum samples were collected. Mean age (SD) and male/female ratio of the study population were 15.3 (1.1) years and 0.9, respectively. Seroprevalences obtained were as follows: anti-VZV (94%), anti-HSV-1 (46%), anti-HSV-2 (5%), anti-HBc (3%) and anti-HAV (5%). These data show that Spanish adolescents should be considered a target group for prevention programmes against HSV-2, HBV and HAV infections. PMID: 9515669 [PubMed - indexed for MEDLINE] 2542. J Infect. 1998 Jan;36 Suppl 1:1-10. Molecular biology of varicella-zoster virus. A review prepared for the UK Advisory Group on Chickenpox. Harper DR, Gilbert RL, Jeffries DJ. Department of Virology, St Bartholomew's and the Royal London Hospital School of Medicine and Dentistry, London, UK. Varicella-zoster virus (human herpesvirus 3; VZV) is one of eight herpes viruses that routinely infect humans. It is classified as a member of the genus Varicellovirus, subfamily Alphaherpesvirinae, family Herpesviridae. Of the other human herpes viruses it is most closely related to the herpes simplex viruses (also members of the Alphalerpesvirinae). Like all herpes viruses, the virus has a large double-stranded DNA genome within an icosahedral nucleocapsid. This is surrounded by a proteinaceous tegument and a trilaminar membrane derived from host-cell membranes into which the viral glycoproteins are inserted. The structure of the virion is summarized in Fig. 1. PMID: 9514102 [PubMed - indexed for MEDLINE] 2543. Ann Neurol. 1998 Nov;44(5):789-95. Unilateral postherpetic neuralgia is associated with bilateral sensory neuron damage. Oaklander AL, Romans K, Horasek S, Stocks A, Hauer P, Meyer RA. Department of Neurosurgery, the Johns Hopkins Medical Institutions, Baltimore, MD, USA. Shingles can cause chronic neuropathic pain (postherpetic neuralgia) long after skin lesions heal. To investigate its causes, we quantitated immunolabeled sensory neurites in skin biopsies from 18 subjects with and 16 subjects without postherpetic neuralgia after unilateral shingles. Subjects rated the intensity of their pain. Punch skin biopsies were evaluated from the site of maximum pain or shingles involvement, the homologous contralateral location, and a site on the back, distant from shingles involvement. Sections were immunostained with anti-PGP9.5 antibody, a pan-axonal marker, and the density of epidermal and dermal neurites determined. The group with postherpetic neuralgia had a mean density of 339 +/- 97 neurites/mm2 in shingles-affected epidermis compared with a density of 1,661 +/- 262 neurites/mm2 for subjects without pain. Neurite loss was more severe in epidermis than dermis. Unexpectedly, the group with pain had also lost half of the neurites in contralateral epidermis. Contralateral damage occurred despite the lack of contralateral shingles eruptions or pain, correlated with the presence and severity of ongoing pain at the shingles site, and did not extend to the distant site. Thus, the pathophysiology of postherpetic neuralgia pain may involve a new bilateral mechanism. PMID: 9818935 [PubMed - indexed for MEDLINE] 2544. Neurology. 1998 Nov;51(5):1405-11. CSF and MRI findings in patients with acute herpes zoster. Haanpää M, Dastidar P, Weinberg A, Levin M, Miettinen A, Lapinlampi A, Laippala P, Nurmikko T. Department of Neurology, Tampere University Hospital, Finland. OBJECTIVE: To explore MRI and CSF findings in patients with herpes zoster (HZ) and to correlate the findings with clinical manifestations of the disease. METHODS: Fifty immunocompetent patients (mean age, 59 years; range, 17 to 84 years) with HZ of fewer than 18 days duration participated. None had clinical signs of meningeal irritation, encephalitis, or myelitis. In 42 patients (84%), the symptoms constituted pain and rash only. Six patients (12%) had motor paresis, and three patients (6%) had ocular complications. One to three CSF samples were obtained from 46 patients (the first sampling taken 1 to 18 days from onset of rash), and 16 patients (all with either trigeminal or cervical HZ) underwent MRI of the brain. The clinical follow-up continued at least 3 months. RESULTS: CSF was abnormal in 28/46 patients (61%): pleocytosis (range, 5 to 1,440 microL) was detected in 21, elevated protein concentration in 12, varicella zoster virus (VZV) DNA in 10, and immunoglobulin G antibody to VZV in 10. These changes were more common in patients with acute complications, although they did not predict development of postherpetic neuralgia (PHN). In 9/16 patients (56%), MRI lesions attributable to HZ were seen in the brainstem and cervical cord. At 3 months, 5/9 patients (56%) with abnormal MRI had PHN, whereas none of the 7 patients with no HZ-related lesions on MRI had any remaining pain. CONCLUSIONS: Subclinical extension of viral inflammation into the CNS occurs commonly in HZ. This finding may have implications for treatment of HZ and prevention of various associated complications. PMID: 9818869 [PubMed - indexed for MEDLINE] 2545. J Am Dent Assoc. 1998 Nov;129(11):1608-11. Diseases and disorders that open a seam between the face and the self. Slavkin HC. National Institute of Dental and Craniofacial Research, Bethesda, Md. 20892-2290, USA. Comment in: J Am Dent Assoc. 1999 Feb;130(2):158, 160. PMID: 9818581 [PubMed - indexed for MEDLINE] 2546. Lupus. 1998;7 Suppl 2:S63-6. Antibody-mediated thrombosis: relation to the antiphospholipid syndrome. Vermylen J, Van Geet C, Arnout J. Center for Molecular and Vascular Biology, University of Leuven, Belgium. Various forms of antibody-mediated thrombosis are presented and the mechanisms involved in their pathogenesis are discussed. Antibody-mediated thrombosis includes heparin-induced thrombocytopenia and thrombosis, autoantibodies to von Willebrand factor mimicking an antiphospholipid syndrome, thrombosis following injection of the murine monoclonal antibody OKT3, hyperacute and acute xenograft rejection, and varicella-associated antibody against protein S. In several of these entities the pathogenesis of thrombosis is closely related to development of cellular procoagulant activity through tight occupancy of Fc receptors, or through complement activation, or through cell-cell interactions. Integrating the antiphospholipid syndrome into the more general category of antibody-mediated thrombosis may provide some hints as to how we could approach the study of those intriguing patients who have the clinical features of the antiphospholipid syndrome but lack those antibodies that currently characterize it. PMID: 9814676 [PubMed - indexed for MEDLINE] 2547. New Microbiol. 1998 Oct;21(4):397-401. In vitro activity of acetylsalicylic acid on replication of varicella-zoster virus. Primache V, Binda S, De Benedittis G, Barbi M. Institute of Virology, University of Milan, Italy. Topical application of a mixture of acetylsalicylic acid (ASA) and diethyl ether is effective in the treatment of acute herpes zoster and postherpetic neuralgia. To study whether the other-than-analgesic effects of that treatment could be due to an antiviral activity of ASA the effects of the drug on the replication of varicella zoster virus (VZV) were assessed by the fluorescent focus assay on MRC5 and Vero cells. ASA caused a marked reduction in the spread of infection in MRC5 monolayers while in growing Vero cells the effective dose proved toxic. ASA concentrations (5-10 mM) which were effective in vitro against VZV are higher than the plasma concentrations attained in the standard treatment of chronic inflammatory states, but are consistent with the skin concentration attained by topical application of ASA/diethyl ether mixture. These data support similar findings relating the antiviral activity of acetylsalicylic acid to influenza virus, CMV, and HIV. PMID: 9812322 [PubMed - indexed for MEDLINE] 2548. J Pharmacol Exp Ther. 1998 Nov;287(2):791-9. A possible mechanism of eighteen patient deaths caused by interactions of sorivudine, a new antiviral drug, with oral 5-fluorouracil prodrugs. Okuda H, Ogura K, Kato A, Takubo H, Watabe T. Department of Drug Metabolism and Molecular Toxicology, School of Pharmacy, Tokyo University of Pharmacy and Life Science, 1432-1 Horinouchi, Hachioji-shi, Tokyo 192-03, Japan. A toxicokinetic study was performed using rats to investigate the possible mechanism of 18 acute deaths in Japanese patients with cancer and herpes zoster by interactions of the new oral antiviral drug, sorivudine (SRV), with one of the oral 5-fluorouracil (5-FU) prodrugs within 40 days after approval of the use of SRV. Tegafur, an anticancer 5-FU prodrug suggested to be used by most of the patients who died, and SRV were orally administered to rats simultaneously once daily. All of these rats died within 10 days, whereas rats given SRV or tegafur alone under the same dosage conditions showed no appreciable change over 20 days compared with controls. In the rats given both drugs, bone marrow and intestinal membrane mucosa were greatly damaged at an early stage of the coadministration, and before death, the animals showed marked decreases in white blood cell and platelet counts, diarrhea with bloody flux, and severe anorexia, as was also manifested by the patients who subsequently died. In the rats given both drugs for 6 days, extremely enhanced 5-FU levels were observed from the first day of administration in plasma and in all tissues examined, including bone marrow and intestines. The extreme enhancement of the tissue 5-FU levels was attributable to the facile inactivation by (E)-5-(2-bromovinyl)uracil (BVU) of hepatic dihydropyrimidine dehydrogenase (DPD), a key enzyme regulating the systemic 5-FU level in the rat and human. BVU, a major metabolite formed from SRV by gut flora, was found at considerable levels in the liver of rats orally administered SRV alone or SRV and tegafur, and there was a marked decrease in hepatic DPD activity. In the presence of NADPH, DPD purified from rat liver cytosol was rapidly and irreversibly inactivated by [14C]BVU as a suicide inhibitor with concomitant incorporation of the radioactivity into the enzyme protein, although SRV showed no inhibitory effect on DPD under the same conditions. Human liver DPD was recently demonstrated by us to be inactivated with BVU in a manner very similar to rat DPD. PMID: 9808711 [PubMed - indexed for MEDLINE] 2549. East Afr Med J. 1998 Jul;75(7):379-81. Significance of herpes zoster in HIV/AIDS in Kweneng district, Botswana. Edhonu-Elyetu Y. Comment in: East Afr Med J. 1998 Jul;75(7):377-8. OBJECTIVE: To determine the relevance of herpes zoster eruption or scar relative to other symptoms and signs of HIV/AIDS and to look for a syndromic model that could be used in the diagnosis of HIV infection. DESIGN: Retrospective case-control study on data from the results of HIV request forms in the district from 1st January 1993 to 31st March 1996. HIV request forms bearing ELISA positive results represented the cases. SETTING: All the 55 health facilities and one district hospital in Kweneng district, Botswana. SUBJECTS: Six hundred and forty one valid request forms across all age groups and both sexes were analysed. MAIN OUTCOME MEASURES: Proportion of herpes zoster among cases and controls. Sensitivity and specificity test values for herpes zoster as a screening test. Logistic regression on 11 symptoms and signs found to have a significant relationship to ELISA either on the chi 2 test or on tests for the attributes of an ideal screening test. RESULTS: Herpes zoster ranked sixth as the most common sign associated with a positive ELISA result. The difference in the proportion of herpes zoster among cases and controls was highly significant, (chi 2 = 13.1, OR 3.75, CI =1.7-9.3. p = 0.0003). The following also had a significant relationship; chronic diarrhoea, persistent generalised lymphadenopathy (PGL) and non-healing genital ulcers. In addition, herpes zoster and chronic diarrhoea were highly specific and had high positive predictive values for a positive HIV ELISA positive result in 95.5% cases; chronic diarrhoea, weight loss, herpes zoster, persistent generalised lymphadenopathy and non-healing genital ulcers. CONCLUSION: Herpes zoster is an important predictor of HIV/AIDS in Kweng district (PPV = 90%). Used in the above model, prediction rises up to 95.5%. In the absence of an HIV ELISA test, this model alone could be sufficient for a clinical diagnosis of HIV infection, at least in Kweneng. It is also suggested that the presence or a history of herpes zoster scar or eruption be elevated to the status of a major sign in the World Health Organization (WHO) clinical definition for AIDS surveillance. PMID: 9803626 [PubMed - indexed for MEDLINE] 2550. East Afr Med J. 1998 Jul;75(7):377-8. Herpes zoster in HIV/AIDS--a little recognised opportunistic infection with important clinical and cost implications. McLigeyo SO. Comment on: East Afr Med J. 1998 Jul;75(7):379-81. PMID: 9803625 [PubMed - indexed for MEDLINE] 2551. Pediatr Infect Dis J. 1998 Oct;17(10):931-3. Varicella and zoster in children with human immunodeficiency virus infection. Derryck A, LaRussa P, Steinberg S, Capasso M, Pitt J, Gershon AA. Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, NY, USA. PMID: 9802645 [PubMed - indexed for MEDLINE] 2552. Pediatr Infect Dis J. 1998 Oct;17(10):905-8. Herpes zoster in children and adolescents. Petursson G, Helgason S, Gudmundsson S, Sigurdsson JA. Department of Family Medicine, University of Iceland, Reykjavik. OBJECTIVES: To follow the clinical course of herpes zoster and to determine the incidence, frequency of complications and association with malignancy in children and adolescents. DESIGN: Prospective cohort study in a primary health care setting in Iceland. The main outcome measures were age and sex distribution of patients and discomfort or pain 1, 3 and 12 months after the rash and general health before and 3 to 6 years after the zoster episode. RESULTS: During observation of the target population for a period of 75750 person years, 121 episodes of acute zoster developed (incidence 1.6/1000/year) in 118 patients. End points were gained for all 118 patients after 554 person years of follow-up. Systemic acyclovir was never used. No patient developed postherpetic neuralgia, moderate or severe pain or any pain lasting longer than 1 month from start of the rash (95% confidence interval, 0 to 0.03). Potential immunomodulating conditions were diagnosed in 3 patients (2.5%) within 3 months of contracting zoster. Only 5 (4%) had a history of severe diseases. CONCLUSIONS: The probability of postherpetic neuralgia in children and adolescents is extremely low. Zoster is seldom associated with undiagnosed malignancy in the primary care setting. PMID: 9802633 [PubMed - indexed for MEDLINE] 2553. Arch Dermatol. 1998 Oct;134(10):1280-1, 1283-4. An atypical presentation of a common disease. Herpes zoster without vesicles. Unger S, Lynfield Y, Alapati U. Department of Veterans Affairs Medical Center, Brooklyn, NY, USA. PMID: 9801687 [PubMed - indexed for MEDLINE] 2554. Postgrad Med J. 1998 Jul;74(873):423-5. Neurological manifestations in a patient with visceral leishmaniasis. Karak B, Garg RK, Misra S, Sharma AM. Department of Neurology, Banaras Hindu University, Varanasi, India. PMCID: PMC2360987 PMID: 9799919 [PubMed - indexed for MEDLINE] 2555. Ann Pharmacother. 1998 Oct;32(10):1099-103. Oral corticosteroids for pain associated with herpes zoster. Ernst ME, Santee JA, Klepser TB. Division of Clinical and Administrative Pharmacy, College of Pharmacy, University of Iowa, Iowa City, IA 52242, USA. michael-ernst@uiowa.edu It is apparent from published studies that corticosteroids do not prevent the development of postherpetic neuralgia. Earlier trials that indicated some benefit in both acute neuralgia and the prevention of postherpetic neuralgia are of limited use to clinicians due to problems with uncontrolled study designs, small sample sizes, and the absence of statistical analysis of the results. The lack of a consensus definition of postherpetic neuralgia, the variable agents and dosages used, and the different pain scales reported are of concern when trying to interpret the results of these studies for their clinical significance. In more recent larger and well-designed studies, similar rates of postherpetic neuralgia were observed in the corticosteroid and control groups. As a result of these findings, corticosteroids should not be recommended for the prevention of postherpetic neuralgia. Despite lack of efficacy in preventing postherpetic neuralgia, limited studies suggest corticosteroids such as prednisone (40-60 mg/d tapered over 3 wk) are well tolerated and may confer slightly significant benefits in reducing the duration of acute neuralgia and improving quality-of-life measures. However, the clinical significance and application of these findings remain to be addressed. If corticosteroids are used for acute neuralgia, clinicians are advised to select their patients carefully. The patients treated in these studies were generally healthy and free of comorbid diseases, such as hypertension, diabetes mellitus, and psychiatric disorders, which can be exacerbated in the presence of corticosteroids. Although dissemination of herpes zoster has been reported infrequently, it remains a potential risk with use of corticosteroids. Until the results of these studies are repeated in more diverse patient populations, corticosteroids appear to have a limited role in the management of acute neuralgia associated with herpes zoster. PMID: 9793604 [PubMed - indexed for MEDLINE] 2556. Med Clin (Barc). 1998 Sep 5;111(6):238-9. [Meningitis caused by varicella-zoster virus and ophthalmic trigeminal neuralgia without skin lesions in an immunocompetent woman] [Article in Spanish] Maigues Llácer JM, Pujol Farriols R, Pérez Sáenz JL, Fernández Viladrich P. PMID: 9789235 [PubMed - indexed for MEDLINE] 2557. J Am Osteopath Assoc. 1998 Sep;98(9):508-9. Rare presentation of acute urinary retention secondary to herpes zoster. Ginsberg PC, Harkaway RC, Elisco AJ 3rd, Rosenthal BD. Department of Surgery, Albert Einstein Medical Center, Philadelphia, Pa. 19141-3030, USA. There are many causes of acute urinary retention. Reported here is a case of one of the more rare causes: herpes zoster. Fewer than 70 cases have been reported in the literature since 1890. In the present clinical environment where many patients are immunocompromised, reports of herpes zoster and its sequelae are no longer thought of as anecdotal. The virus may interrupt the detrusor reflex due to involvement of the sacral dorsal root ganglia. Urinary retention with sensory loss of both bladder and rectum as well as flaccid paralysis of the detrusor can develop in patients with herpes zoster. Fortunately, the outcome of this process is benign and full recovery of the detrusor is likely. PMID: 9785747 [PubMed - indexed for MEDLINE] 2558. Ryumachi. 1998 Aug;38(4):589-94. [Influence on patients with Sjögren's syndrome after the Great Hanshin-Awaji Earthquake] [Article in Japanese] Kohriyama K, Kohno A. Department of Internal Medicine, Kobe West City Hospital. We investigated the influence of clinical findings on patients with Sjögren's syndrome after the Great Hanshin-Awaji Earthquake. Fifty eight (90%) of 64 patients were struck severely by the earthquake and 26 patients (42%) were forced to take refuge in emergency shelters. There was no aggravation of clinical findings or complications in eight patients inhabiting the area where the damage was mild. Dry eyes were deteriorated in 14 patients (22%). Dry mouth was aggravated in 6 patients (9%). However, the mean values of Schirmer's test and gum test were not different between pre-earthquake and postearthquake in these patients. Malaise was worsen in 8 patients (13%). The cause was cease of taking prednisolone for autoimmune hepatitis in 2 patients or was impossibility of taking T4 drug for hypothyroidism in 2 patients. Other 4 patients had not taken any medication. Arthralgia was deteriorated in 4 patients (5%). These findings indicated that deterioration of sicca symptoms, arthralgia and malaise was caused predominantly by the worsen living condition including shortage of water and polluted atmosphere in the affected regions. PMID: 9785986 [PubMed - indexed for MEDLINE] 2559. Ocul Immunol Inflamm. 1998 Sep;6(3):185-8. Recurrent varicella-zoster virus retinitis in a patient treated with systemic corticosteroids. Satoh N, Abe T, Nakajima A, Sakuragi S. Department of Ophthalmology, Akita University School of Medicine, Japan. A case of recurrent unilateral varicella-zoster virus (VZV) retinitis is reported. The retinitis was characterized by arteriolitis and retinal necrosis with secondary chorioretinal atrophy localized in the periphery of the supratemporal quadrant of the retina. Polymerase chain reaction analysis of aqueous humor demonstrated VZV DNA in both the initial and recurrent episode. The Goldmann-Witmer coefficient for VZV IgG was elevated. The initial VZV retinitis was successfully treated with acyclovir and corticosteroids. Three years later, high-dose corticosteroids alone were used to treat idiopathic facial nerve palsy. One month after concluding corticosteroids therapy, the VZV retinitis recurred in the same eye, suggesting that administration of the high-dose corticosteroids caused VZV reactivation and induced recurrence of VZV retinitis. PMID: 9785609 [PubMed - indexed for MEDLINE] 2560. J Eur Acad Dermatol Venereol. 1998 Sep;11(2):194-5. Unusual isotopic responses on healed herpes zoster lesions--report on two cases. Khanna N, D'Souz P, Singh M. PMID: 9784058 [PubMed - indexed for MEDLINE] 2561. J Eur Acad Dermatol Venereol. 1998 Sep;11(2):147-50. Bullous erythema multiforme following herpes zoster and varicella-zoster virus infection. Weisman K, Petersen CS, Blichmann CW, Nielsen NH, Hultberg BM. Department of Dermato-Venereology, Bispebjerg Hospital, Copenhagen NV, Denmark. Four cases of herpes zoster-induced bullous erythema multiforme (EM) are reported. Three patients presented with widespread skin lesions 10 to 14 days after an episode of thoracic herpes zoster. In these patients a high increase in varicella-zoster virus (VZV) antibody titer was detected, indicating secondary VZV infection. Histologic examinations of skin biopsy from a patient with widespread lesions (case 4) revealed a mixture of EM, toxic epidermal necrolysis and herpetic virus infection. VZV should be included in the list of infectious agents able to trigger EM and Stevens-Johnson syndrome. PMID: 9784041 [PubMed - indexed for MEDLINE] 2562. Neurology. 1998 Oct;51(4):1202-5. Rapid diagnosis of varicella zoster virus infection in acute facial palsy. Murakami S, Honda N, Mizobuchi M, Nakashiro Y, Hato N, Gyo K. Department of Otolaryngology, Ehime University School of Medicine, Japan. Comment in: Neurology. 2000 Sep 12;55(5):738. Patients with zoster sine herpete and Ramsay Hunt syndrome without pathognomonic vesicles at the initial visit are often misdiagnosed with Bell's palsy and treated without antiviral agents. With PCR, we found that varicella zoster virus genomes were frequently detectable in auricular skin exudate from patients with zoster sine herpete or Ramsay Hunt syndrome before the appearance of vesicles. PMID: 9781562 [PubMed - indexed for MEDLINE] 2563. Neurology. 1998 Oct;51(4):1166-71. Nortriptyline versus amitriptyline in postherpetic neuralgia: a randomized trial. Watson CP, Vernich L, Chipman M, Reed K. Etobicoke General Hospital, Canada. OBJECTIVE (BACKGROUND): Amitriptyline (AT) is a standard therapy for postherpetic neuralgia (PHN). Our hypothesis was that nortriptyline (NT), a noradrenergic metabolite of AT, may be more effective. METHODS: A randomized, double-blind, crossover trial of AT versus NT was conducted in 33 patients. RESULTS: Thirty-one patients completed the trial. Twenty-one of 31 (67.7%) had at least a good response to AT or NT, or both. We found no difference with regard to relief of steady, brief, or skin pain by visual analog scales for pain and pain relief; mood; disability; satisfaction; or preference between the two drugs. Intolerable side effects were more common with AT. Most patients (26/33) were not depressed, and most responding showed no change in rating scales for depression despite the occurrence of pain relief. CONCLUSIONS: We concluded that this study provides a scientific basis for an analgesic action of NT in PHN because pain relief occurred without an antidepressant effect, and that although there were fewer side effects with NT, AT and NT appear to have a similar analgesic action for most individuals. PMID: 9781549 [PubMed - indexed for MEDLINE] 2564. Am J Ophthalmol. 1998 Oct;126(4):594-7. Recurrent nodular scleritis associated with varicella zoster virus. Livir-Rallatos C, El-Shabrawi Y, Zatirakis P, Pellett PE, Stamey FR, Foster CS. Uveitis and Immunology Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston 02114, USA. PURPOSE: To describe a case of recurrent nodular scleritis that was apparently caused by reactivation of a varicella zoster virus infection. METHODS: Case report. Immunohistochemistry and polymerase chain reaction were used to detect viral antigen and DNA in the biopsy specimen of inflamed sclera of a patient with a history of recurrent nodular scleritis. PMID: 9780109 [PubMed - indexed for MEDLINE] 2565. Vaccine. 1998 Nov;16(18):1768-70. Postherpetic neuralgia in immunocompetent elderly people. Schmader K. Department of Medicine, Duke University Medical Center, Durham, NC, USA. The most menacing complication of herpes zoster in immunocompetent elderly people is chronic pain or postherpetic neuralgia (PHN). The cardinal epidemiological feature of PHN is its striking relationship to aging. Among zoster patients over 60 years old, estimates of the occurrence of PHN, defined as pain 1 month after rash onset, vary from 27 to 68%. The pathogenesis of PHN is incompletely understood but seems to involve varicella-zoster virus (VZV)-induced damage of peripheral afferent neurons and resultant changes in central afferent neurons and efferent pain-modulating neurons. PHN improves over time in many elderly patients, but an unfortunate subset experience of debilitating pain lasts for years. They experience constant and/or intermittent spontaneous pain and stimulus-evoked pain such as allodynia or hyperpathia. The outcomes of this pain include fatigue, sleep disturbance, anorexia, depression, social withdrawal, impaired activities of daily living and profound lowering of quality of life. The management of PHN is hampered by two problems: (1) a uniformly effective treatment for PHN is not available (although tricyclic antidepressants, local or regional anaesthetics, capsaicin, opiates, anticonvulsants and physical therapies are sometimes useful); and (2) early antiviral therapy of zoster may be ineffective in preventing PHN, partly related to the fact that days of VZV replication and neuronal destruction have occurred by the time the patient reaches the doctor. A potential solution to the problem of PHN is the vaccination of elderly persons with the varicella vaccine to prevent or attenuate zoster or PHN. PMID: 9778754 [PubMed - indexed for MEDLINE] 2566. Clin Infect Dis. 1998 Sep;27(3):509-12. Herpes zoster and lymphopenia associated with sodium stibogluconate therapy for cutaneous leishmaniasis. Wortmann GW, Aronson NE, Byrd JC, Grever MR, Oster CN. Infectious Disease Service, Walter Reed Army Medical Center, Washington, D.C. 20307-5001, USA. A review of 84 patients with cutaneous leishmaniasis treated with sodium stibogluconate (Pentostam) at our institution revealed that three had developed herpes zoster during or shortly after receiving therapy. Because zoster has been associated with depressed cellular immunity, we prospectively followed serial lymphocyte subpopulations in eight patients with cutaneous leishmaniasis who received Pentostam. By day 7 of therapy, the white blood cell count had fallen by a median of 1.15/mm3, the total lymphocyte count by a median of 804/mm3, and the CD4+ lymphocyte count by a median of 306/mm3 (67% of baseline; confidence interval, 52%-78%). An in vitro cell-viability assay demonstrated that Pentostam is not toxic to human mononuclear cells. The administration of Pentostam for the treatment of cutaneous leishmaniasis results in lymphopenia that may be related to the subsequent occurrence of herpes zoster. PMID: 9770149 [PubMed - indexed for MEDLINE] 2567. Cutis. 1998 Sep;62(3):143-6. Recurrent malignant melanoma presenting with zosteriform metastases. North S, Mackey JR, Jensen J. Department of Medicine, University of Alberta, Edmonton, Canada. A 63-year-old man with recurrent metastatic malignant melanoma presented with a painful right twelfth thoracic dermatomal eruption initially thought to be herpes zoster. However, 3 weeks later, the patient clearly had melanoma skin metastases confined exclusively to this dermatome. Radiotherapy and opiate analgesics provided effective pain relief. We propose that in this patient, no herpes zoster infection occurred, but rather that skin metastases presented in a zosteriform pattern due to lymphatic spread from a previously excised paravertebral skin metastasis. This is the second reported case of malignant melanoma presenting as zosteriform metastases, and we suggest physicians consider this possibility in patients with melanoma presenting with dermatomal skin changes. PMID: 9770130 [PubMed - indexed for MEDLINE] 2568. Anesth Analg. 1998 Oct;87(4):911-4. Percutaneous electrical nerve stimulation: an alternative to antiviral drugs for acute herpes zoster. Ahmed HE, Craig WF, White PF, Ghoname ES, Hamza MA, Gajraj NM, Taylor SM. Department of Anesthesiology, Eugene McDermott Center for Pain Management, University of Texas Southwestern Medical Center at Dallas, 75235-9068, USA. Comment in: Anesth Analg. 1999 Dec;89(6):1585-6. PMID: 9768793 [PubMed - indexed for MEDLINE] 2569. Presse Med. 1998 Jul 4-11;27(24):1237. [Management of varicella-zoster virus infections. No systematic vaccination against varicella in France] [Article in French] Lorette G. PMID: 9767786 [PubMed - indexed for MEDLINE] 2570. Presse Med. 1998 Jul 4-11;27(24):1231-6. [Management of VZV infections. Short text of the 11th consensus conference on anti-infectious therapies] [Article in French] [No authors listed] PMID: 9767785 [PubMed - indexed for MEDLINE] 2571. Neurol Clin. 1998 Nov;16(4):813-32. Pain caused by herpes zoster infection. Cluff RS, Rowbotham MC. Department of Neurology, Pain Clinical Research Center, University of California, San Francisco 94115, USA. Postherpetic neuralgia (PHN) is a neuropathic pain disorder that occurs most often in the elderly. This painful condition is uniquely suited for clinical research, resulting in an emerging understanding of the pathophysiology of the persistent pain. Until recently, only the tricyclic antidepressants proved effective for PHN. Controlled trials of a wide variety of therapeutic strategies are in progress or have been recently completed. PMID: 9767064 [PubMed - indexed for MEDLINE] 2572. Br J Dermatol. 1998 Aug;139(2):357-8. Elevated soluble Fas levels in herpes zoster patients. Kato M, Tamada Y, Kageyama M, Yamashita T, Nitta Y, Ikeya T, Nakashima I. PMID: 9767625 [PubMed - indexed for MEDLINE] 2573. Br J Dermatol. 1998 Aug;139(2):295-8. Acute infiltration by non-Hodgkin's B-cell lymphoma of lesions of disseminated herpes zoster. Turner RJ, Sviland L, Lawrence CM. Department of Dermatology, Royal Victoria Infirmary, Newcastle-upon-Tyne NE1 4LP, U.K. Turnerrich@aol.com A man with a 15-year history of non-Hodgkin's lymphoma presented with disseminated herpes zoster which initially responded to aciclovir. This was shortly followed by an acute exacerbation in the sites previously affected which was apparently resistant to antiviral therapy. Biopsy revealed a dense monomorphic lymphocytic infiltrate below active herpes zoster which had the same morphology and immunoreactivity as the underlying lymphoma. His clinical condition resolved with further chemotherapy for his lymphoma and continued treatment with aciclovir. PMID: 9767247 [PubMed - indexed for MEDLINE] 2574. Ann Otolaryngol Chir Cervicofac. 1998 May;115(2):59-72. [Gadolinium and contrast medium MRI of the acoustic nerve in patients with meningeal neuritis and acoustico-facial syndrome] [Article in French] Dumas G, Charachon R, Perret J, Vasdev A, Boulat E, Boubagra K. Clinique ORL, CHU, Hôpital A. Michallon, Grenoble. Twelve cases of vestibular neuritis were investigated in gradient echo MRI with gadolinium. Only 3 severe cases associated with an acoustico facial syndrome (2 cases of herpes zoster oticus and one case after influenzae) demonstrated focal enhancement within the internal auditory canal on post contrast T1 weighted images. This enhancement involved at least 2 differents nerves. These 3 severe cases associating sensory neural hearing loss and facial palsy revealed a meningeal reaction after cerebrospinal fluid examination. The enhancement lasted a long time (up to 10 months) in one case of RAMSAY HUNT syndrome associated with a chronic lymphocytic leukemia. The MRI was able to confirm the anatomical reality of the vestibular neuritis and more precisely of the meningoneuritis and gave arguments for the theory of the polyneuropathy of Adour. Enhancement at MRI seems correlated with the severity of the affection (permanent vestibular areflexia in 3 cases and permanent hearing loss in 1 case). PMID: 9765700 [PubMed - indexed for MEDLINE] 2575. Dtsch Med Wochenschr. 1998 Sep 4;123(36):1035-8. [Meningeal irritation--a complication of herpes zoster] [Article in German] Bredlich RO, Alfke K, Brickenstein H, Pillekamp H, Peter RU. Abteilung Dermatologie, Klinikums der Universität Ulm. HISTORY AND CLINICAL FINDINGS: A previously healthy 26-year-old man complained of gradually increasing headache after an attack of flu. After 4 days an erythema with papules but no blisters was noted in the area of distribution of the left 10th thoracic nerve. As a child he had varicella (chickenpox) without complications. INVESTIGATIONS: Lymphocytic pleocytosis and evidence of an abnormal blood-brain barrier were noted in cerebrospinal fluid (CSF). Serology for varicella zoster virus revealed an IgG titre of > 7400 IU/l in serum and 21 IU/l in CSF. The corresponding IgM titres were negative. TREATMENT AND COURSE: The headaches and cutaneous changes regressed under i.v. treatment with acyclovir, 10 mg/kg body weight, 3 x daily for 10 days. Repeat CSF examination after 10 days showed merely minimal residual changes of inflammation. CONCLUSION: This case illustrates the risk of severe neurological complications of herpes zoster infection. A seemingly minor rash with headache must be correctly diagnosed and immediate high-dosage acyclovir treatment instituted to prevent life-threatening and severe complications of herpes zoster meningitis or encephalitis. PMID: 9765607 [PubMed - indexed for MEDLINE] 2576. AIDS. 1998 Sep 10;12(13):1719-20. Herpes zoster infection in HIV-seropositive patients associated with highly active antiretroviral therapy. Aldeen T, Hay P, Davidson F, Lau R. PMID: 9764795 [PubMed - indexed for MEDLINE] 2577. Br J Dermatol. 1998 Jul;139(1):66-72. The management of established postherpetic neuralgia: a comparison of the quality and content of traditional vs. systematic reviews. Ladhani S, Williams HC. Department of Biochemistry and Molecular Biology, United Medical and Dental Schools, Guy's Hospital, London, U.K. In the face of an exponential increase in published biomedical studies, dermatologists frequently turn to review articles in order to keep abreast of important developments in the treatment of skin diseases. Traditional review articles have recently been criticized on the basis of their incompleteness and susceptibility to bias. Such biases can be minimized by employing a systematic approach to gathering, combining and interpreting the evidence of treatment efficacy. Using eight predetermined quality criteria, we compared the quality of 10 traditional review with one systematic review of treatments for postherpetic neuralgia, which were identified from the Medline database for 1992-96. None of the 10 traditional review articles satisfied all eight criteria: one satisfied five, two satisfied four and the rest satisfied two or fewer criteria. There was a wide variation in the recommendations of the authors for the treatment of postherpetic neuralgia, often based on anecdotal evidence and clinical experience. On the other hand, the systematic review fulfilled seven of the eight quality criteria, failing only to discuss future directives. Furthermore, treatment recommendations were made solely on the basis of randomized controlled trials, which are considered to be the gold standard for measuring the benefits of any intervention. The variation in quality and treatment recommendations of traditional reviews is worrying. Systematic reviews should be encouraged in dermatology because they provide a summary of evidence of the effects of dermatological treatments, which has been derived using explicit methods widely accepted within science. PMID: 9764150 [PubMed - indexed for MEDLINE] 2578. Arch Dermatol. 1998 Sep;134(9):1168-9. Unilateral abdominal distention following herpes zoster outbreak. Vincent KD, Davis LS. PMID: 9762046 [PubMed - indexed for MEDLINE] 2579. Pharm Biotechnol. 1998;11:313-43. Famciclovir. Discovery and development of a novel antiherpesvirus agent. Jarvest RL, Sutton D, Vere Hodge RA. SmithKline Beecham Pharmaceuticals, Harlow, Essex CM19 5AW, England. PMID: 9760686 [PubMed - indexed for MEDLINE] 2580. J Fr Ophtalmol. 1998 May;21(5):381-6. [Optic neuromyelitis and bilateral acute retinal necrosis due to varicella zoster in a patient with AIDS] [Article in French] Merle H, Smadja D, Cordoba A. Service d'Ophtalmologie, CHU de Fort de France, Hôpital Pierre Zobda-Quitman, Fort-de-France, Martinique. We report a case of bilateral acute retinal necrosis (ARN) following an acute optic neuromyelitis (AONM) in an immunodepressed patient (T CD4 lymphocyte count under 50/mm3) suffering from acquired immunodeficiency syndrome (AIDS). Despite the medical treatment the evolution led to blindness by bilateral total retinal detachment. The neuro-ophthalmological features occurred prior to the retinal manifestation, and the acute optic neuromyelitis occurred after a spreading zoster. The varicella-zoster virus (VZV) seemed to be involved because of recurring cutaneous zoster, spreading of this zoster just before the AONM, previous reports showing a link between VZV and AONM, and VZV and ARN. However, our patient had first an AONM responding well to corticosteroid therapy following one month later by an ARN leading to blindness despite the antiviral treatments received as soon as possible. There is a chronical viremia+ in immunodepressed patients with recurring and spreading zoster. The rupture of the hemato-encephalic barrier observed in AONM could facilitate the invasion of the eye by the virus, leading to an ARN. This hypothesis could explain the two complications due to the VZV, the AONM and the ARN, the first one is of dysimmunitary origin and the second one could probably result of a direct viral attack of the retina. This should incite to treat as soon as possible each retrobulbar optic neuritis in patients with AIDS, especially if past history of zoster. PMID: 9759432 [PubMed - indexed for MEDLINE] 2581. Ann Biol Clin (Paris). 1998 Mar-Apr;56(2):211-2. [Varicella-zoster virus meningo-encephalomyelitis without skin eruption] [Article in French] Sissoko D, Bellagra N, Dewilde A, Rogelet P, Hober D, Wattré P. Laboratoire de virologie, Institut Gernez-Rieux, CHU de Lille. PMID: 9754250 [PubMed - indexed for MEDLINE] 2582. Nihon Kokyuki Gakkai Zasshi. 1998 Jun;36(6):531-4. [Ramsay Hunt syndrome associated with eosinophilic pneumonia] [Article in Japanese] Kodama K. Department of Internal Medicine, Minamitane Town Hospital, Kagoshima, Japan. A 66-year-old woman was admitted to the hospital because of dry coughing. Ten days before admission, the patient had suffered from facial palsy accompanying otic zoster infection (Ramsay Hunt syndrome). Acyclovir was given, and during the two weeks after admission, the facial palsy resolved completely. The dry coughing worsened, and marked eosinophilia developed (1.930/mm3). A chest roentgenogram and a computed tomogram revealed wandering non-segmental infiltration in the left lung field. Examination of a specimen obtained by transbronchial lung biopsy revealed moderate eosinophilic infiltration into thickened alveolar septa and alveolar spaces. An elevated CD 4/CD 8 ratio (4.12) and a high level of eosinophilic cationic protein (8.730 micrograms/l) were found in bronchoalveolar lavage fluid. Eosinophilic pneumonia was diagnosed. The patients condition improved without medication within one month after the onset of the dry coughing. Laboratory results revealed no parasitic or mycotic infection, and both an acyclovir skin test and a lymphocyte stimulation test were negative, which suggested that the pneumonia had been induced by an allergic reaction to unknown antigens resulting from Th 1/Th 2 imbalance after reactivation of varicella-zoster virus latent in sensory ganglia. PMID: 9754004 [PubMed - indexed for MEDLINE] 2583. Nurs Times. 1998 Aug 5-11;94(31):52-3. Postherpetic neuralgia: a care study. Clarke K. Acute Pain Services, Wrexham Maelor Hospital. PMID: 9752207 [PubMed - indexed for MEDLINE] 2584. Neurology. 1998 Sep;51(3):914-5. Varicella zoster virus-associated focal vasculitis without herpes zoster: recovery after treatment with acyclovir. Nau R, Lantsch M, Stiefel M, Polak T, Reiber H. Department of Neurology, University of Göttingen, Germany. Comment in: Neurology. 1999 Jul 13;53(1):242. PMID: 9748063 [PubMed - indexed for MEDLINE] 2585. Arch Ophthalmol. 1998 Sep;116(9):1249. Progressive outer retinal necrosis in a patient with rheumatoid arthritis. Bryan RG, Myers FL. PMID: 9747694 [PubMed - indexed for MEDLINE] 2586. Br J Dermatol. 1998 Jun;138(6):1091. Elevated soluble Fas levels in herpes zoster patients. Kato M, Tamada Y, Kageyama M, Yamashita T, Nitta Y, Ikeya T, Nakashima I. PMID: 9747383 [PubMed - indexed for MEDLINE] 2587. Ann Dermatol Venereol. 1998 Feb;125(2):127-8. [Acyclovir-resistance zona in a immunocompromised HIV seronegative patient] [Article in French] Lesueur A, Fillet AM, Bouscary D, Ginsburg C, Palmer P, Chaine B, Salmon-Ceron D, Dreyfus F, Huraux JM, Sicard D. Service de médecine interne 2, Hôpital Cochin, Paris. INTRODUCTION: Resistance to antiviral therapy is getting actually more frequent. Immunocompromised host are more concerned with this problem. OBSERVATION: We present a case of disseminated zoster resisting to acyclovir (ACV) therapy, but healing with foscarnet in a man treated with chemotherapy for lymphoma and seronegative for HIV. CI50 of VZV strain was 48 microM for ACV, which was 2.8 times higher than value of the reference OKA strain tested simultaneously, which confirmed the resistance for ACV. DISCUSSION: Immunocompromised patients often present varicella zoster virus (VZV) infection. They usually heal in response to ACV therapy, but some HIV infected patients have already presented with resistant strains of VZV. This case is the first described in a non-HIV infected patient. Foscarnet therapy resulted twice in complete healing because of its direct activity on viral DNA polymerase, so it is efficaceous therapy for patients with thymidine-kinase-deficient ACV-resistant VZV infection. PMID: 9747231 [PubMed - indexed for MEDLINE] 2588. Kansenshogaku Zasshi. 1998 Jul;72(7):714-9. [Possibility of prevention of herpes zoster by use of varicella vaccine] [Article in Japanese] Kawano S, Terada K, Yagi Y, Kataoka N. Department of Pediatrics, Kawasaki Medical School. It has been considered that a decline in specific cell-mediated immunity (CMI) for the varicella-zoster virus (VZV) could be responsible for a high incidence of herpes zoster in the elderly. If the strength of CMI for VZV could be increased by immunization of the elderly with a varicella vaccine, herpes zoster might be preventable. We compared the CMI for VZV (using a lymphoproliferative assay and a varicella skin test) and VZV-IgG antibodies in serum before and after 2-3 months of vaccination in 15 subjects more than 40 years old. When the CMI for VZV was measured by the lymphoproliferative assay, a stimulation index (SI) of more than 2.0 was estimated to be positive in this study. The SIs (mean +/- SD) before and after the vaccination were 2.7 +/- 1.8 and 2.7 +/- 1.9, respectively, and no significant difference was noted. On the other hand, the diameter of erythema in the varicella skin test after the vaccination became larger than that before the vaccination in the 10 of 13 subjects. In addition, serum VZV-IgG antibodies increased after vaccination in 6 of 14 subjects. There were no obvious reasons for the discrepancy in the results of the lymphoproliferative assay and the varicella skin test. However, because of the poor response indicated by the assay, only one vaccination for the elderly might not be enough to increase the CMI for VZV. The appropriate age for vaccination should also be considered. Lastly, further investigation of the CMI for VZV before and after vaccination on larger scale is required. PMID: 9745221 [PubMed - indexed for MEDLINE] 2589. J Clin Epidemiol. 1998 Aug;51(8):667-76. Valuing outcomes in health care: a comparison of willingness to pay and quality-adjusted life-years. Bala MV, Wood LL, Zarkin GA, Norton EC, Gafni A, O'Brien B. Research Triangle Institute, Research Triangle Park, North Carolina 27709, USA. Quality-adjusted life-years (QALYs) and willingness to pay (WTP) are two preference-based measures of health-related outcomes. In this article, we compare these two measures in eliciting individuals' preferences for health outcomes associated with shingles. To collect the necessary preference data, we administered computer-interactive interviews to a sample of 65- to 70-year-olds. We found no significant correlation between QALYs and WTP across individuals. We discuss our findings and argue that our results raise questions about whether QALYs and WTP are equivalent preference-based measures of health outcomes. PMID: 9743315 [PubMed - indexed for MEDLINE] 2590. Clin Ther. 1998 Jul-Aug;20(4):661-70. Advances in the treatment of herpesvirus infection: the role of famciclovir. Tyring SK. Department of Microbiology/Immunology, University of Texas Medical Branch, Galveston 77555, USA. Shingles (herpes zoster) is the result of reactivation of varicella-zoster virus after years of latency. The acute phase is self-limiting but is often associated with moderate-to-severe pain; postherpetic neuralgia is the most frequent and debilitating complication of shingles, occurring in 3.4 per 1000 individuals per year. In the case of genital herpes, herpes simplex virus can reactivate to cause recurrent episodes as often as several times a year, sometimes for the remainder of a person's life. Antiviral agents such as famciclovir, valacyclovir, and acyclovir can be used to shorten the course and decrease the severity of these diseases and may suppress the virus itself, thereby preventing future outbreaks of genital herpes. This article presents a brief synopsis of the etiology of herpes zoster and genital herpes and reviews 12 key studies that demonstrate the efficacy of famciclovir in the management of these two conditions. PMID: 9737826 [PubMed - indexed for MEDLINE] 2591. Neurologia. 1998 Jun-Jul;13(6):311-2. [Unilateral lumbosacral plexus neuritis after herpes zoster infection. Favorable response to prednisone] [Article in Spanish] Modrego Pardo PJ, Pueyo MJ, Gracia B, Pina MA. Comment in: Neurologia. 2000 Feb;15(2):85-6. PMID: 9734207 [PubMed - indexed for MEDLINE] 2592. Neurologia. 1998 Jun-Jul;13(6):313-4. [Abdominal tumor presenting as segmental weakness caused by zoster] [Article in Spanish] Boto de los Bueis A, López Domínguez JM, Menéndez de León C, Pujol de la Llave E. PMID: 9734209 [PubMed - indexed for MEDLINE] 2593. Eur Neurol. 1998 Jul;40(1):57-8. Herpes zoster ophthalmicus and delayed contralateral hemiparesis: a case of ipsilateral midbrain involvement. Fukutake T, Hatakeyama H, Shinotoh H, Hattori T. Department of Neurology, Chiba University School of Medicine, Chiba, Japan. PMID: 9729115 [PubMed - indexed for MEDLINE] 2594. Eur J Dermatol. 1998 Sep;8(6):397-402. Management of infections due to the varicella-zoster virus. 11th consensus conference on anti-infectious therapy of the French-speaking Society of Infectious Diseases (SPILF). Peyramond D, Chidiac C, Lucht F, Perronne C, Saimot AG, Soussy JC, Stahl JP. Hôpital de la Croix-Rousse, Service des Maladies infectieuses et tropicales, 93, grande rue de la Croix-Rousse, 69317 Lyon Cedex 04. PMID: 9729449 [PubMed - indexed for MEDLINE] 2595. Vestn Oftalmol. 1998 May-Jun;114(3):38-42. [Features of the course and treatment of several eye diseases in Eastern Africa] [Article in Russian] Korneev IuM, Beliaev VS, Shinaev NN. Ophthalmologist with a 4-year history (1993-1997) of practice at the Russian Red Cross Hospital in Addis Ababa (Ethiopia) shares his experience. More than 30,000 patients were examined and treated. Interesting cases are described: cytomegalovirus retinitis in the presence of AIDS, AIDS-associated involvement of the eyes (uveitis, keratitis, Kaposi's sarcoma), herpes zoster involvement of the eyes, phlyctenar keratoconjunctivitis, vernal conjunctivitis, trachoma, diseases of the eyes concomitant with syphilis, a case with Vogt-Koyanagi-Harada. Clinical course and therapy of these diseases under local conditions are described. PMID: 9720400 [PubMed - indexed for MEDLINE] 2596. Masui. 1998 Jul;47(7):882-4. [Lidocaine tape (Penles--a dressing tape based on 60% lidocaine--) reduces the pain of postherpetic neuralgia] [Article in Japanese] Tamakawa S, Ogawa H. Department of Anesthesia, Rumoi Municipal Hospital. The treatment of postherpetic neuralgia (PHN) by topical administration of local anesthetics has a number of drawbacks. Lidocaine tape (Penles) is a 15 cm2 dressing tape based on 60% lidocaine used to anesthetize skin when an intravenous catheter is inserted. This study aims to evaluate the analgesic efficacy of lidocaine tape in patients with PHN by comparing the results with those of surgical drape (Tegaderm). In a single-blind, two session study, lidocaine tape or surgical drape was applied to the affected skin of 10 patients. In one session, lidocaine tape was applied to the painful skin area, and in another, surgical drape was applied to the same area. Pain score and side effects were measured over 12 hours. Pain score was reduced at measurements taken starting from 1 hour after lidocaine tape application (P < 0.05). Lidocaine tape induced minor side-effects, erythema in a patient and increase in pain in another patient. In conclusion, lidocaine tape is effective for relief of PHN. PMID: 9720343 [PubMed - indexed for MEDLINE] 2597. Nephrol Dial Transplant. 1998 Aug;13(8):2074-6. Cyclosporin for the prevention of disease reactivation in relapsing ANCA-associated vasculitis. Haubitz M, Koch KM, Brunkhorst R. Department of Nephrology, Medical School, Hannover, Germany. BACKGROUND: In patients with ANCA-associated vasculitis the frequent development of relapses after successful initial treatment remains a major therapeutic problem. Thus a long-term prophylactic therapy with low side-effect potential is needed. As recent data suggest an involvement of T cells in the pathogenesis of ANCA-associated vasculitis, the prophylactic value of therapy with low-dose cyclosporin was investigated in seven patients (three with Wegener's granulomatosis, four with microscopic polyangiitis, all with renal involvement) who had developed at least one relapse during cyclophosphamide (CP) treatment or in the first 4 months after the end of CP therapy. METHODS: After remission had been achieved for 6 months using CP and prednisolone, the CP dose was reduced (3 months 75%, 3 months 50%) and cyclosporin was added concomitantly (dose adjusted to whole blood levels 60-90 ng/ml). Cyclosporin therapy was continued for 1 year after the end of CP treatment. RESULTS: During a mean follow-up of 24 months no patient developed a relapse. Two patients developed a herpes zoster infection. No severe bacterial infection occurred. CONCLUSIONS: These preliminary results indicate that cyclosporin can be successfully used to sustain remission in patients with a relapsing course of ANCA-associated vasculitis and renal involvement. PMID: 9719168 [PubMed - indexed for MEDLINE] 2598. Dermatology. 1998;197(1):87-8. Zosteriform lichen planus after herpes zoster. Braun RP, Barua D, Masouyé I. PMID: 9711434 [PubMed - indexed for MEDLINE] 2599. Ann Plast Surg. 1998 Aug;41(2):191-3. Cutaneous reinnervation of the rectus abdominis musculocutaneous flap after chest wall reconstruction: development of herpes zoster in the transplanted musculocutaneous flap. Tomita K, Inoue K. Department of Plastic and Reconstructive Surgery, Haibara General Hospital, Shizuoka, Japan. We report a patient in whom herpes zoster developed in the transplanted rectus abdominis musculocutaneous flap 14 months after a chest wall reconstruction for recurrent breast cancer. Based on the distribution of the varicella zoster virus spreading along the sensory nerve fibers, we concluded that the virus spread along the reinnervated sensory nerves from the dorsal ganglia, through the intercostal nerves, and into the flap skin. It is suggested that this finding demonstrates the pathway of reinnervation into the transferred musculocutaneous flap on the chest wall. PMID: 9718154 [PubMed - indexed for MEDLINE] 2600. J Neurovirol. 1998 Aug;4(4):457-60. VZV fulminant necrotizing encephalitis with concomitant EBV-related lymphoma and CMV ventriculitis: report of an AIDS case. Nebuloni M, Vago L, Boldorini R, Bonetto S, Costanzi G. Pathology Unit, L. Sacco Institute of Medical Science, University of Milan, Italy. A case of AIDS with varicella zoster virus fulminant necrotizing encephalitis associated with cytomegalovirus ependymitis-subependymitis and a periventricular Epstein-Barr virus-related lymphoma is described. The patient had no herpes zoster cutaneous eruptions and died three days after the onset of symptoms. Varicella zoster virus and cytomegalovirus antigens were found by immunohistochemistry in the same area around a necrotic periventricular lesion; a periventricular lymphoma, large B cell type, was also observed. In situ hybridization with Epstein-Barr virus-encoded- RNAs probe was positive in about 40% of the neoplastic cells. The association of herpes-related lesions in the same cerebral region should be consistent in AIDS cases with acute neurological symptoms. PMID: 9718139 [PubMed - indexed for MEDLINE] 2601. J Neurovirol. 1998 Aug;4(4):438-44. Infectious simian varicella virus expressing the green fluorescent protein. Mahalingam R, Wellish M, White T, Soike K, Cohrs R, Kleinschmidt-DeMasters BK, Gilden DH. Department of Neurology, University of Colorado Health Sciences Center, Denver 80262, USA. Clinical, pathologic, immunologic and virologic features of simian varicella virus (SVV) infection in primates closely resemble varicella-zoster virus (VZV) infection in humans. Such similarities provide a rationale to analyze SVV infection in primates as a model of varicella pathogenesis and latency. Thus, we constructed an SVV-expressing green fluorescent protein (SVV-GFP) by inserting the GFP gene into the unique short segment of the virus genome by homologous recombination. Analysis of recombinant viral DNA and the expressed proteins of plaque-purified SVV-GFP confirmed the location of the GFP insert and that the recombinant SVV expressed the 27 kDa GFP. Infection of monkey kidney cells in tissue culture with SVV-GFP revealed bright green fluorescence associated with the characteristic focal cytopathic effect produced by SVV infection. Microscopic examination of lung from a 3-month-old African green monkey 10 days after infection with SVV-GFP revealed bright green fluorescence in areas of acute necrotizing pneumonitis. SVV-GFP allows ready identification of cells infected with SVV both in vitro and in vivo, and will be useful for further analysis of varicella pathogenesis and latency in experimentally infected animals--studies not possible in humans. PMID: 9718136 [PubMed - indexed for MEDLINE] 2602. Lancet. 1998 Aug 15;352(9127):540. A nurse with a rash on her neck. Aarset H, Fagerli UM, Opsjøn SL, Skarsvåg S. Department of Pathology, University Hospital of Trondheim, Norway. PMID: 9716059 [PubMed - indexed for MEDLINE] 2603. Arch Ophthalmol. 1998 Aug;116(8):1011-7. Chronic varicella-zoster virus epithelial keratitis in patients with acquired immunodeficiency syndrome. Chern KC, Conrad D, Holland GN, Holsclaw DS, Schwartz LK, Margolis TP. Francis I. Proctor Foundation, University of California San Francisco Medical Center, USA. OBJECTIVE: To characterize further a chronic epithelial keratitis caused by varicella-zoster virus infection in patients with acquired immunodeficiency syndrome (AIDS). METHODS: Patients with AIDS and chronic epithelial keratitis associated with varicella-zoster virus from 3 institutions were identified. Patient records were reviewed retrospectively for the following data: medical and demographic characteristics, techniques of diagnosis, physical findings, course, response to treatment, and outcome. RESULTS: Sixteen patients were studied. CD4+ T-lymphocyte cell counts were available in 11 patients, with a median of 0.034 x 10(9)/L (range, 0-0.094 x 10(9)/L). Two patients had no history of a zosteriform rash. In the remaining patients, the interval between rash and keratitis ranged from 0 days to 6 years. In all cases, the keratitis was chronic and characterized by gray, elevated, dendriform epithelial lesions that stained variably with fluorescein and rose bengal. The peripheral and midperipheral cornea was most commonly affected, and, in 13 of the 16 patients, the lesions crossed the limbus. Pain was a prominent feature, occurring in 12 of 16 patients. In 9 of 12 patients tested, varicella-zoster virus was identified by culture, direct fluorescent antibody testing, polymerase chain reaction testing, or a combination of these studies, with direct fluorescent antibody testing (6 of 8 positive results) and polymerase chain reaction testing (3 of 3 positive results) appearing to be the most sensitive. Response to antiviral medication was variable. CONCLUSIONS: In patients with AIDS, varicella-zoster virus may cause a chronic infection of the corneal epithelium. The keratitis is characterized by dendriform lesions, prolonged course, and frequently by extreme pain. It can occur without an associated dermatitis. PMID: 9715680 [PubMed - indexed for MEDLINE] 2604. South Med J. 1998 Aug;91(8):739-44. Gabapentin for treatment of pain and tremor: a large case series. Merren MD. Neurology Clinic of San Antonio, TX 78229, USA. BACKGROUND: Several anticonvulsant agents, including carbamazepine, phenytoin, and valproate, are effective in some patients for the treatment of pain and tremor. This study reports on a trial of the newly introduced anticonvulsant, gabapentin, for pain and tremor control. METHODS: A large case series of patients with centrally mediated pain, peripherally mediated pain, migraine, and tremor were treated in an open-label study with gabapentin (maximum of 2,700 mg/day). RESULTS: Thirty-nine patients (65%) had moderate-to-excellent improvement in symptoms, with the best responses occurring in patients with peripherally mediated neuropathic pain. The other conditions treated that showed some improvement were benign essential/familial tremor, restless legs syndrome, centrally mediated pain, and periodic nighttime leg movements. CONCLUSIONS: Gabapentin offers an effective, safe alternative therapy or co-therapy for the listed painful conditions and tremor; it does not affect the metabolism of other medications and is well tolerated. PMID: 9715219 [PubMed - indexed for MEDLINE] 2605. Lakartidningen. 1998 Jul 22;95(30-31):3284. [Are valacyclovir and famcyclovir good enough against PHN?] [Article in Swedish] Liedholm H, Linné AB. PMID: 9715062 [PubMed - indexed for MEDLINE] 2606. Eur J Clin Microbiol Infect Dis. 1998 Apr;17(4):286-9. Response to acyclovir in two cases of herpes zoster leukoencephalitis and review of the literature. Otero J, Ribera E, Gavaldà J, Rovira A, Ocaña I, Pahissa A. Servei de Malatties Infeccioses, Hospital General Vall d'Hebron, Barcelona, Spain. Herpes zoster leukoencephalitis is a rare complication of varicella-zoster virus infection. Associated with high mortality, the majority of cases have been discovered postmortem; today, however, magnetic resonance imaging is being used successfully as an aid in the diagnosis of this disease. The first two reported cases of HIV-infected patients with herpes zoster leukoencephalitis who recovered clinically and showed complete resolution of the magnetic resonance demyelination images after acyclovir treatment are described. In addition, the cases of herpes zoster leukoencephalitis reported in the literature to date are reviewed. PMID: 9707315 [PubMed - indexed for MEDLINE] 2607. J Am Geriatr Soc. 1998 Aug;46(8):973-7. Race and stress in the incidence of herpes zoster in older adults. Schmader K, George LK, Burchett BM, Hamilton JD, Pieper CF. Department of Medicine, Duke University Medical Center, and Durham Veterans Affairs Medical Center, North Carolina 27710, USA. OBJECTIVES: To examine the effect of black race and acute (negative life events) and chronic (lack of social support) psychological stress on the risk of herpes zoster in late life. DESIGN: A population-based, prospective cohort study. SETTING: Central North Carolina. PARTICIPANTS: Duke Established Populations for Epidemiological Studies of the Elderly, a stratified probability sample of community-dwelling persons more than 65 years of age. MEASUREMENTS: Interviewers administered a comprehensive health survey to the participants in 1986-1987 (P1, n = 4162), 1989-1990 (P2, n = 3336), and 1992-1994 (P3, n = 2568). Incident cases of zoster between P1 and P2 and P2 and P3 served as the dependent variable. Hypothesis-testing variables included race, negative life events, and five measures of social support. Control variables included age, sex, education, cancer, chronic diseases, basic ADLs, instrumental ADLs, depression, self-rated health, hospitalization, and cigarette smoking. Statistical analyses employed chi-square tests and proportional hazards model. RESULTS: At baseline, the sample had a mean age of 73.6 years and was 55% black, 45% white, and 65% female. There were 65 cases of zoster between P1 and P2 and 102 cases of zoster between P2 and P3. From P1 to P2, 1.4% of blacks and 3.4% of whites developed zoster (P < .001). From P2 to P3, 2.9% of blacks and 7.5% of whites developed zoster (P < .001). After controlling for the above variables, blacks were significantly less likely to develop zoster (adjusted risk ratio = 0.35; 95% confidence interval (CI), 0.24-0.51; P < .001). Negative life events increased the risk of zoster, but the result was borderline for statistical significance (adjusted RR = 1.38, 95% CI 0.96-1.97; P = .078). No measures of social support were significantly associated with zoster. CONCLUSION: Black race decreased the risk of zoster in late life significantly. Measures of stress were not significantly related to zoster, but study limitations preclude definitive conclusions. Future research should focus on these factors in larger samples and different populations. PMID: 9706885 [PubMed - indexed for MEDLINE] 2608. J Am Acad Dermatol. 1998 Aug;39(2 Pt 1):207-10. Herpes zoster in children. Kakourou T, Theodoridou M, Mostrou G, Syriopoulou V, Papadogeorgaki H, Constantopoulos A. First Department of Pediatrics, Athens University, Greece. BACKGROUND: The clinical studies of series of children with herpes zoster (HZ) are rather limited. OBJECTIVE: The purpose of this study was to evaluate the epidemiologic conditions, clinical manifestations, therapy, and outcome of HZ in children. METHODS: Twenty-one patients with HZ have been studied. Five patients who had herpes simplex virus infection were excluded. The laboratory diagnosis was made by fluorescent techniques. Acyclovir was administered systematically for 2 more days after no new lesions had developed. RESULTS: Thirteen patients (group A) were immunocompromised; eight patients (group B) were otherwise healthy. Two patients from group B had intrauterine varicella; the other six patients had had varicella under the age of 4 years. Three patients were recently exposed to varicella. The duration of HZ was significantly longer in group A than in group B, but the outcome was good in all patients. CONCLUSION: Herpes simplex virus infection may simulate the pattern of HZ; varicella in early childhood is a risk factor for HZ in otherwise healthy children; exposure of a child to varicella may cause reactivation of latent HZ virus; and acyclovir therapy within 3 days of exanthem onset prevents significant morbidity and death in immunocompromised children with HZ. PMID: 9704830 [PubMed - indexed for MEDLINE] 2609. J Neurol Neurosurg Psychiatry. 1998 Aug;65(2):208. Pontine inflammatory lesion due to shingles. Kidd D, Duncan JS, Thompson EJ. Department of Clinical Neurology, The National Hospital for Neurology and Neurosurgery, London, UK. PMCID: PMC2170210 PMID: 9703172 [PubMed - indexed for MEDLINE] 2610. Int J STD AIDS. 1998 Aug;9(8):476-9. Herpes zoster ophthalmicus and HIV infection in Nigeria. Umeh RE. Department of Ophthalmology, College of Medicine, University of Nigeria, Enugu, Africa. Eight patients, 3 men and 5 women, aged between 24 and 40 years who had herpes zoster ophthalmicus (HZO) were seen in the Eye Department of the University of Nigeria Teaching Hospital, Enugu between 1994 and 1997. One of the patients was already on treatment for active pulmonary tuberculosis at the time he was first seen. All had skin eruptions at different stages of development in the area of distribution of the first trigeminal nerve on the affected side of the face and head. Ocular examination revealed impaired vision in the affected eye (between 6/12 and hand movement) in all the patients. All had lid oedema while 5 had ptosis (3 partial and 2 complete). Various degrees of conjunctival injection were observed in all patients while 6 of them had corneal anaesthesia and keratitis. Uveal inflammation, present in all the patients varied from mild iritis in 4 individuals to severe iridocyclitis in the remaining 4. Pupils reacted to light sluggishly in 2 patients while they were dilated and fixed in 3 others. None had any associated abnormalities in the posterior segment. Six of the patients consented and were screened for human immunodeficiency virus (HIV) infection. Of these, 4, including the patient with pulmonary tuberculosis, tested seropositive while 2 were seronegative. All 8 were treated with topical acyclovir. This was combined with oral acyclovir in one of the patients. Follow-up period was between 2 and 52 weeks. During this period skin eruptions and anterior segment signs improved in 5 patients while remaining stable in 3 others; post-herpetic neuralgia persisted on the affected side in 4 patients. Patients who were HIV seropositive did not recover as quickly or to the same extent as the seronegative ones. It is concluded that HZO infection may indicate underlying HIV infection in young Africans as has been found in whites. PIP: Manifestations of herpes zoster ophthalmicus (HZO) infection are well known in HIV-seropositive White patients in developed countries, but this association has not been previously noted in African AIDS patients. This paper analyzes 8 cases (3 men and 5 women) 24-40 years of age who were treated at the Eye Department of the University of Nigeria Teaching Hospital, Enugu, for HZO in 1994-97. Of the 6 patients who consented to HIV screening, 4 were HIV-seropositive. One of the HIV-infected patients had been treated for pulmonary tuberculosis a year prior to the present illness, but the remaining 7 were in apparent good health. The patients presented with skin eruptions in the area of distribution of the trigeminal nerve on the affected side of the face and head. Visual acuity was impaired in all 8 cases. The most common ocular findings were lid edema, ptosis, conjunctival infection, corneal anesthesia, keratitis, uveal inflammation, and abnormal pupillary reaction. The severity of presentation was similar in HIV-positive and HIV-negative patients and all improved during follow-up; however, clinical improvement was less rapid or pronounced among the HIV-positive patients. These findings suggest that HZO infection in young Africans should be regarded as a possible indicator of HIV infection. PMID: 9702597 [PubMed - indexed for MEDLINE] 2611. J Med Virol. 1998 Sep;56(1):91-8. Characterization of viremia at different stages of varicella-zoster virus infection. Mainka C, Fuss B, Geiger H, Höfelmayr H, Wolff MH. Institute of Microbiology and Virology, University of Witten/Herdecke, Germany. Varicella-zoster virus (VZV) viremia at different stages of infection was characterized. Different approaches were used, polymerase chain reaction (PCR), isothermal transcription based nucleic acid amplification (NASBA), and immunofluorescence to describe and quantitate viral infection of peripheral blood mononuclear cells (PBMC). In patients with acute varicella 200 to 5,000 copies of the viral genome in every 150,000 PBMC were found with quantitative competitive PCR (QCPCR). With NASBA, viral transcriptional activity was detected in these cells. RNA transcribed from the immediate early gene IE 63 as well as from the late gene 68 were found, indicating a productive infection. Glycoprotein gE specific immunofluorescence visualized by confocal laser scanning microscopy revealed that only 1 in 10,000 to 100,000 PBMC was infected. T and B lymphocytes as well as monocytes expressed viral protein on their surface. Similar results were obtained with PBMC from immunocompetent zoster patients. In some cases a transient viremia was found shortly after the onset of rash, although the viral load seemed to be lower than in patients with varicella. Examination of blood samples from 16 persons with postherpetic neuralgia (PHN) signs of viral replication in PBMC were not detected. In conclusion, the data suggest that VZV viremia is a frequent event in patients with varicella and zoster, but not in those with postherpetic neuralgia. Moreover, the results indicated that subclinical reactivations occur both in immunocompromised and immunocompetent individuals. PMID: 9700639 [PubMed - indexed for MEDLINE] 2612. J Infect Dis. 1998 Aug;178(2):539-43. Congenital varicella-zoster virus infection and Barrett's esophagus. Ussery XT, Annunziato P, Gershon AA, Reid BS, Lungu O, Langston C, Silverstein S, Lee KK, Baker CJ. Department of Pediatrics, Baylor College of Medicine, Houston, Texas 77030, USA. Congenital varicella syndrome is a rare complication of varicella-zoster virus (VZV) infection during pregnancy. An infant was exposed to VZV at 18.5 weeks of gestation and had eye and skin abnormalities at birth and persistent feeding difficulties, prompting esophageal biopsies at 12 days and 20 and 20.5 months of age. Esophageal tissues demonstrated specialized intestinal metaplasia (Barrett's esophagus). VZV DNA (in situ hybridization) and proteins (immunohistochemistry and polymerase chain reaction) were found in esophageal epithelial cells adjacent to the Barrett's lesion. Immediate-early 63 protein (IE63) of VZV was demonstrated in the day 12 specimen, and IE62 and the late VZV glycoprotein E (gE) were found in the 20-month specimen. Clinical and endoscopic improvement followed fundoplication and acyclovir therapy, but VZV DNA and IE62 persisted in esophageal tissue. These findings associate VZV with specialized intestinal metaplasia within the esophagus and suggest a novel site for either latent or active VZV infection. PMID: 9697739 [PubMed - indexed for MEDLINE] 2613. J Infect Dis. 1998 Aug;178(2):310-7. Recombinant varicella-zoster virus glycoproteins E and I: immunologic responses and clearance of virus in a guinea pig model of chronic uveitis. Kimura H, Wang Y, Pesnicak L, Cohen JI, Hooks JJ, Straus SE, Williams RK. National Institutes of Health, Medical Virology Section, Laboratory of Clinical Investigation, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, USA. Guinea pigs immunized with recombinant varicella-zoster virus (VZV) glycoproteins E (gE) and I (gI) developed antigen-specific antibodies in the sera, vitreous, and conjunctival washes. Sera from immunized animals neutralized both cell-free and cell-associated VZV, and peripheral blood lymphocytes proliferated in vitro in response to recombinant gE and gI and to antigens from VZV-infected cells. Immunized guinea pigs were inoculated intravitreally with VZV, which induces chronic uveitis. VZV DNA was more rapidly cleared and infectious VZV was isolated less frequently from the retinas of animals immunized with gE and gI compared with that in controls receiving adjuvant alone. Nonetheless, cellular infiltrates in the vitreous, retina, and choroid were prevalent 21 days after VZV inoculation in both the adjuvant-alone- and gE-gI-immunized animals. Immunization with VZV gE and gI induced potent humoral and cellular responses that accelerated the clearance of VZV DNA and may neutralize virus within the eye. PMID: 9697709 [PubMed - indexed for MEDLINE] 2614. Clin Exp Dermatol. 1998 Mar;23(2):87-8. Necrotizing fasciitis complicating disseminated cutaneous herpes zoster. Jarrett P, Ha T, Oliver F. Department of Dermatology, Auckland Hospital, New Zealand. The association of necrotizing fasciitis, often due to group A streptococcus and primary varicella (chicken pox), is unusual but recognized in children. The association in adults is rare but one report in the literature describes a previously healthy man with the two disorders. We now describe a case of disseminated cutaneous herpes zoster complicated by subacute necrotizing fasciitis in an elderly woman taking low dose methotrexate and prednisone for rheumatoid arthritis. Staphylococcus aureus was isolated. Localized debridement and split skin grafting were required. PMID: 9692314 [PubMed - indexed for MEDLINE] 2615. Ugeskr Laeger. 1998 Jul 20;160(30):4429-30. [Granuloma annulare after herpes zoster: isotopic response] [Article in Danish] Bygum A. Dermatovenerologisk afdeling I, Odense Universitetshospital. A 33 year-old woman was seen with a localized zosteriform papular eruption in a Th7 dermatomal distribution. The patient experienced neuralgic pain. A skin biopsy demonstrated palisading granulomatous dermatitis and a diagnosis of granuloma annulare after a subclinical herpes zoster infection was made. "Isotopic response" describes the occurrence of a new disorder at the site of another, unrelated, and already healed skin disease. PMID: 9691836 [PubMed - indexed for MEDLINE] 2616. Jpn J Ophthalmol. 1998 May-Jun;42(3):208-12. Detection of varicella-zoster virus genome in the vitreous humor from two patients with acute retinal necrosis; lacking or having a PstI cleavage site. Mochizuki K, Matsushita H, Hiramatsu Y, Yanagida K. Yanagida Eye Clinic, Shizuoka, Japan. Using polymerase chain reaction, we detected the varicella-zoster virus genome in the vitreous humor of two patients with clinically diagnosed acute retinal necrosis. One of the two cases was thought to be caused by infection with a varicella-zoster virus lacking a PstI cleavage site. We could not find any clinical differences between the two substrains. The presence of a PstI cleavage site on the varicella-zoster virus genome might not be associated with the occurrence of acute retinal necrosis. PMID: 9690900 [PubMed - indexed for MEDLINE] 2617. Acta Derm Venereol. 1998 Jul;78(4):300. "Zosteriform" lichen planus: the bizarre consequences of a misnomer. Happle R. Comment on: Acta Derm Venereol. 1997 Nov;77(6):491-2. PMID: 9689303 [PubMed - indexed for MEDLINE] 2618. Acta Paediatr. 1998 Jun;87(6):692-4. Specific cellular immunity in immunocompetent children with herpes zoster. Terada K, Tanaka H, Kawano S, Kataoka N. Department of Paediatrics, Kawasaki Medical School, Okayama, Japan. We investigated whether specific immunity is low in immunocompetent children with zoster. Specific cellular immunity was found to be significantly lower in 13 otherwise normal children with zoster than it was in 8 matched controls by a lymphoproliferative assay. However, there was no significant difference between them with regard to the antibody response. Therefore, even in the immunocompetent children, decreased specific cellular immunity may play an important role in the mechanism of virus reactivation. PMID: 9686665 [PubMed - indexed for MEDLINE] 2619. Eur J Clin Pharmacol. 1998 May;54(3):231-5. Skin and plasma levels of acetylsalicylic acid: a comparison between topical aspirin/diethyl ether mixture and oral aspirin in acute herpes zoster and postherpetic neuralgia. Bareggi SR, Pirola R, De Benedittis G. Department of Pharmacology, University of Milan, Italy. OBJECTIVE: The aim of this investigation was to elucidate whether the analgesic effect was due to the local aspirin or to the systemic drug. This was done by comparing skin and plasma levels of acetylsalicylic acid (ASA) and salicylic acid (SA) after topically administered ASA/diethyl ether (ADE) mixture in acute herpetic neuralgia (AHN) and postherpetic neuralgia (PHN). The analgesia and the plasma and skin levels of ASA were also determined after oral administration of aspirin. METHODS: Nineteen patients, 11 (57.9%) with AHN and 8 (42.1 %) with PHN were given, on different days, a single 500-mg oral dose of ASA or a topical dose (750 mg) of (ADE) daubed onto the painful skin. The analgesic effect was assessed by means of a visual analogue scale (VAS). Overall pain relief was graded as: excellent, good, fair, or poor. AHN as well as PHN patients had severe pain at baseline (6.83 and 5.93). Levels of ASA and SA in plasma and in the stratum corneum after adhesive tape stripping of the treated area were determined by HPLC. RESULTS: After ADE application, the analgesic effect was very rapid and VAS scores were lower than at baseline. Pain significantly decreased by 82.6% after topical and 15.4% after oral ASA. After ADE, 95% of the patients had excellent or good pain relief, but after oral administration 79% of the patients had a poor response. Pain relief was similar in the two subgroups after ADE. Skin concentrations of ASA, but not of SA, after ADE were about 80- to 100-fold those after oral administration. Levels of ASA and SA in plasma after oral administration were similar to those previously found, but after ADE were undetectable or very low. Patients with excellent pain relief showed a trend towards higher ASA skin concentrations. CONCLUSIONS: The analgesic effect can be obtained only after topical administration, because by this route the skin levels of ASA are much higher than after oral administration. The mechanism is exclusively local; there are no active drugs in plasma after topical administration. PMID: 9681665 [PubMed - indexed for MEDLINE] 2620. Int J Dermatol. 1998 Jul;37(7):544-6. A retrospective study on the clinical outcome of herpes zoster in patients treated with acyclovir or valaciclovir vs. patients not treated with antiviral. Goh CL, Khoo L. Institute of Dermatology, Singapore, National Skin Centre, Singapore. PMID: 9679698 [PubMed - indexed for MEDLINE] 2621. Turk J Pediatr. 1998 Apr-Jun;40(2):231-5. Blockade of acute grade IV skin and eye graft-versus-host disease by anti-interleukin-2 receptor monoclonal antibody in genoidentical bone marrow transplantation setting. Ozşahin H, Tuchschmid P, Lauener R, Waldvogel K, Nadal D, Seger RA. Division of Immunology/Hematology, University Children's Hospital, Zürich, Switzerland. A six-year-old boy with homozygous beta-thalassemia in the favorable class 1 risk group received a bone marrow transplant, from his histocompatible sister. He developed grade IV skin and eye graft-versus-host disease (GVHD) following varicella zoster reactivation. Despite the appropriate prophylactic use of cyclosporin A (CsA), methotrexate (MTX), and prompt treatment with high-dose steroids, GVHD progressed resulting in total body epidermal necrolysis. Anti-IL-2 receptor monoclonal antibodies (anti-IL-2R moAb) in combination with steroids were administered to selectively block the activated T cells. After 27 days of daily administration, followed by 17 doses of alternate-day therapy with anti-IL-2R moAb, the severe skin and eye GVHD resolved. The patient, at two years posttransplant, has full engraftment and immune reconstitution without chronic GVHD (cGVHD). In conclusion, we suggest that in the HLA-genoidentical bone marrow transplantation setting, very severe and steroid-resistant GVHD can be controlled through the use of anti-IL-2 receptor antibodies which specifically block the activated IL-2 receptor expressing T cells. PMID: 9677728 [PubMed - indexed for MEDLINE] 2622. Klin Monbl Augenheilkd. 1998 May;212(5):353-5. [Varicella zoster virus and atypical necrotizing retinopathies in HIV and AIDS patients] [Article in German] Pedroli GL, Garweg JG, Imesch P, Böhnke M. Universitäts-Augenklinik, Inselspital, Bern. BACKGROUND: Necrotizing retinopathies of suspected viral origin, but which do not meet the criteria for either CMV-retinitis or acute retinal necrosis syndrome, have been grouped together under the term atypical necrotizing retinopathies. Nothing is known about their etiology. PATIENTS AND METHODS: Aqueous humor samples were drawn from two HIV-positive and eight patients with AIDS presenting with an atypical necrotizing retinopathy, additionally from six patients with acute retinal necrosis syndrome and 28 patients with active CMV-retinitis at the time of diagnosis as well as from thirty healthy controls at surgery. All samples underwent DNA extraction and amplification for viral DNA of HSV-1, VZV and CMV. RESULTS: VZV-DNA was detected in seven of nine aqueous humor samples derived from patients with atypical necrotizing retinopathies and in four of six samples from patients with acute retinal necrosis syndrome, but not in any one from the 28 patients with CMV retinitis. In the latter group, CMV DNA was detectable in 23 samples, in two of these additionally HSV-1 DNA. No viral DNA was amplified from any of the samples from healthy controls. CONCLUSIONS: Varicella zoster virus ist the leading cause of atypical necrotizing retinopathies. This should be considered in the antiviral chemotherapy. Moreover, we were able to establish the diagnosis using DNA amplification for the viruses of the herpes family irrespective of the etiology in 80% of necrotizing retinopathies. PMID: 9677577 [PubMed - indexed for MEDLINE] 2623. J Clin Epidemiol. 1998 Jul;51(7):533-5. The varicella-zoster virus and multiple sclerosis. Ross RT. Department of Medicine, University of Manitoba, and The Health Sciences Centre, Winnipeg, Canada. This article is a review of the evidence suggesting a unique relationship between the varicella-zoster virus (as a possible antigen or antigen mimic) and multiple sclerosis (MS). Both MS and varicella have increased prevalences in temperate zones and both are rare in countries closer to the equator. Migration studies suggest an infectious agent acquired prior to age 14 plays a role in the risk of subsequent MS. Hutterites, who educate their children at home, have less varicella, MS, and herpes zoster than their neighbors and have the appropriate reduced varicella-zoster seropositivity matching these clinical observations. Paradoxically, patients with MS report more herpes zoster, and at an earlier age and more often, than a group of non-MS patients. PMID: 9674659 [PubMed - indexed for MEDLINE] 2624. Dtsch Med Wochenschr. 1998 Jun 19;123(25-26):803-6. [Periorbital pain syndrome. I. Differential diagnosis] [Article in German] Förderreuther S, Straube A. Neurologische Klinik und Poliklinik, Ludwig-Maximilians-Universität München. sfoe@nefo.med.uni-muenchen.de PMID: 9672488 [PubMed - indexed for MEDLINE] 2625. J R Coll Physicians Lond. 1998 May-Jun;32(3):199-202. Update on herpesvirus infections. Griffiths P. Royal Free Hospital School of Medicine, London. PMID: 9670143 [PubMed - indexed for MEDLINE] 2626. Br J Dermatol. 1998 May;138(5):921-2. Lichen simplex chronicus as a complication of herpes zoster. Gerritsen MJ, Gruintjes FW, Andreissen MA, van der Valk PG, van de Kerkhof PC. PMID: 9666859 [PubMed - indexed for MEDLINE] 2627. Med Clin (Barc). 1998 Jun 13;111(1):19-22. [Abdominal pain as the initial symptom of visceral varicella zoster infection in hematopoietic stem cell transplant recipients] [Article in Spanish] Muñoz L, Balmaña J, Martino R, Sureda A, Rabella N, Brunet S. Unidad de Hematología Clínica, Hospital de la Santa Creu i Sant Pau, Barcelona. Varicella zoster virus (VZV) infections are an important cause of morbidity after stem cell transplantation (SCT), with no differences in their overall incidence between allogeneic and autologous transplants. We report four patients who developed a disseminated VZV infection with visceral involvement after an allogeneic (n = 3) or autologous (n = 1) SCT. In all 4 cases, the initial symptom was severe abdominal pain which preceded the appearance of the classical herpetic vesicular skin lesions from two to four days in three cases, while one never developed skin lesions. The interval from the transplant to the infection ranged from 5 to 13 months, and all three allogeneic SCT received a T-cell depleted graft, although two suffered from chronic GVHD. All patients had clinical, radiologic and/or biochemical findings indicative of gastrointestinal or visceral involvement. An extensive bibliography review of this specific form of presentation of disseminated VZV infection is presented. The interval from the abdominal pain to the development of the skin lesions has ranged from one to 10 days, and this has led to a delay in the initiation of specific antiviral therapy in many cases, including our only fatal case. We conclude that an abdominal pain of unknown origin in this particular clinical setting should always be regarded as a possible prodromal phase of a disseminated VZV infection. PMID: 9666431 [PubMed - indexed for MEDLINE] 2628. Ophthalmology. 1998 Jul;105(7):1323-30. Detection of varicella zoster virus DNA and viral antigen in human eyes after herpes zoster ophthalmicus. Wenkel H, Rummelt V, Fleckenstein B, Naumann GO. Department of Ophthalmology, University of Erlangen-Nürnberg, Germany. OBJECTIVE: The purpose of the study was to identify varicella zoster virus (VZV) DNA and viral antigen in human eyes at various intervals after clinical onset of herpes zoster ophthalmicus (HZO). DESIGN: A retrospective case series. PARTICIPANTS: There were 9 eyes and 4 corneal buttons surgically obtained from 13 patients with HZO at the University Eye Hospital of Erlangen-Nürnberg between 1984 and 1994. Specimens were examined at different timepoints after clinical onset of HZO (range, 1 day-19 years; median, 36 months). METHODS: Histopathologic evaluation was performed on formalin-fixed and paraffin-embedded tissue by routine histology, immunohistochemistry (5-B-7 murine monoclonal antibody to VZV; peroxidase-antiperoxidase method), and DNA-in situ hybridization (35S deoxyadenosine triphosphate-labeled HindIII fragments [A and C] of VZV). RESULTS: Typical histopathologic changes associated with HZO were identified: vascularization of the corneal stroma (11 of 13), granulomatous reaction to Descemet's membrane (8 of 13), fusiform-shaped ciliary scarring (5 of 9), optic neuritis (4 of 9), and perineuritis (8 of 9) and perivasculitis (8 of 9) of the long posterior ciliary nerves and arteries. VZV antigen was detected in two patients with acute infection 1 and 7 days after onset of HZO, respectively. VZV-DNA was identified in seven patients up to 10 years after onset of HZO in corneal epithelial cells (2 of 13), corneal stroma (5 of 13), inflammatory infiltrate of the anterior chamber (1 of 9), episclera (2 of 9), posterior ciliary nerves (1 of 9) and arteries (5 of 9), optic nerve (5 of 9), and adjacent leptomeninges (2 of 9). CONCLUSION: Persistence of viral genomes, most likely accompanied by gene expression or slow viral replication, appears to be responsible for the often smoldering panophthalmitis and the chronic recurrent keratouveitis in patients with HZO. Localization of viral DNA in vascular structures suggests a role for vasculitis in the pathogenesis of some ocular findings associated with HZO. PMID: 9663241 [PubMed - indexed for MEDLINE] 2629. Anesth Analg. 1998 Jul;87(1):116-8. Methicillin-resistant Staphylococcus aureus sepsis resulting from infection in paravertebral muscle after continuous epidural infusion for pain control in a patient with herpes zoster. Iseki M, Okuno S, Tanabe Y, Mitsuhata H, Miyazaki T. Department of Anesthesiology, Juntendo University School of Medicine, Tokyo, Japan. PMID: 9661558 [PubMed - indexed for MEDLINE] 2630. J Infect Dis. 1998 Jul;178(1):35-8. Identification of the Oka strain of the live attenuated varicella vaccine from other clinical isolates by molecular epidemiologic analysis. Mori C, Takahara R, Toriyama T, Nagai T, Takahashi M, Yamanishi K. Research Foundation for Microbial Diseases, Osaka University, Kannonji, Japan. A method was developed to distinguish the Oka vaccine strain of varicella-zoster virus (VZV) from other clinical isolates. The molecular characteristics of 52 clinical isolates from varicella or zoster patients with no history of VZV vaccination and the Oka strain, including vaccine and parental viruses, were analyzed by PstI cleavage of the PstI site-less (PSL) region. This was followed by single-strand conformational polymorphism (SSCP) after polymerase chain reaction amplification of repeating region 2 (R2). Most of the clinical isolates tested, especially recent isolates, had a PstI site in the PSL region, but the Oka strain did not. The SSCP patterns of R2 in Oka strain virus differed from those of other viruses. These results suggest that analysis of the PstI site followed by SSCP of R2 will be useful for identifying the Oka vaccine virus in isolates. PMID: 9652420 [PubMed - indexed for MEDLINE] 2631. J Infect Dis. 1998 Jul;178(1):27-34. T cells specific for the triggering virus infiltrate the eye in patients with herpes simplex virus-mediated acute retinal necrosis. Verjans GM, Feron EJ, Dings ME, Cornelissen JG, Van der Lelij A, Baarsma GS, Osterhaus AD. Rotterdam Eye Hospital, and Institute of Virology, Erasmus University Rotterdam, The Netherlands. Verjans@viro.fgg.eur.nl Acute retinal necrosis (ARN) is a rare, potentially blinding retinal disease resulting from ocular infections with herpes simplex virus (HSV) or varicella-zoster virus (VZV). To determine the antigen specificity and functional characteristics of ocular infiltrating T cells in ARN, T cells were isolated and expanded nonspecifically from intraocular fluid (IOF) samples from 2 patients with HSV-1- and 3 with VZV-mediated ARN. HSV-specific T cell reactivity could be detected only in the IOF-derived T cell lines (TCLs) of the 2 patients with HSV-mediated ARN. These TCLs consisted of both HSV type-common and type-specific CD4+ and CD8+ T cell clones (TCCs) with differential T cell receptor usage. Irrespective of their phenotype, the TCCs were cytolytic and secreted interferon-gamma, tumor necrosis factor-alpha, interleukin-4, and interleukin-5. In both patients, the antigen specificity of a substantial number of HSV-1-specific TCCs could be mapped to approximately 0.67-0.73 HSV-1 map units. The data presented suggest the contribution of T cells, specific for the triggering virus, to the pathogenesis of ARN. PMID: 9652419 [PubMed - indexed for MEDLINE] 2632. Johns Hopkins Med Lett Health After 50. 1998 Jul;10(5):3. Taking the sting out of shingles. [No authors listed] PMID: 9650524 [PubMed - indexed for MEDLINE] 2633. Int J Dermatol. 1998 Jun;37(6):476-7. Zosteriform skin metastases from breast carcinoma in association with herpes zoster. Cecchi R, Brunetti L, Bartoli L, Pavesi M, Giomi A. PMID: 9646143 [PubMed - indexed for MEDLINE] 2634. Int J Dermatol. 1998 Jun;37(6):465-8. Jaipur block in postherpetic neuralgia. Bhargava R, Bhargava S, Haldia KN, Bhargava P. Department of Dermatology, SMS Medical College, Jaipur, India. BACKGROUND: Postherpetic neuralgia, a common sequele to herpes zoster infection, is a chronic debilitating problem. The available therapeutic modalities are usually ineffective. METHODS: A total of 3960 patients (1326 women and 2634 men; age group, 21-84 years), with postherpetic neuralgia as the presenting complaint and with pain lasting from 2 months to 5 years, were treated with Jaipur block, consisting of local subcutaneous infiltration of 2% xylocaine, 0.5% bupivacaine, and 4 mg/mL dexamethasone solution. Patients were followed up at six-weekly intervals with subsequent injections given in non-responders. RESULTS: Twenty-eight per cent of patients obtained complete relief from pain after a single injection, another 57% after a second injection, and 11% after a third injection; 4% of patients did not respond to treatment. The non-responders were either old (over 60 years) or had pain lasting for more than 2 years. The response to therapy was similar in both sexes. There were 31 left-handed patients in this study. Pain was less severe in left-handed patients and they obtained complete relief after a single injection. Side-effects including giddiness and sweating were seen, occasionally, in a few patients. CONCLUSIONS: Ninety six per cent of patients obtained complete relief after the block with a follow-up of up to 19 years. PMID: 9646140 [PubMed - indexed for MEDLINE] 2635. J Endod. 1998 Feb;24(2):143-4. Herpes zoster infection as a differential diagnosis of acute pulpitis. Lopes MA, de Souza Filho FJ, Jorge Júnior J, de Almeida OP. Faculty of Odontology, University of Campinas, São Paulo, Brazil. Many diseases can cause orofacial pain, and the diagnosis must be established before final treatment. This case report presents a patient with orofacial pain that was diagnosed as an acute pulpitis. However, there was no evidence of this problem on examination. After 4 days, the patient showed multiples vesicles on the face, and a herpes zoster viral infection was diagnosed. The patient was treated with acyclovir and, after 2 yr, she still complains of facial sensitivity. PMID: 9641149 [PubMed - indexed for MEDLINE] 2636. J Dermatol. 1998 May;25(5):347-8. Recurrent herpes zoster. Horiuchi Y. Division of Dermatology, Tsukuba Memorial Hospital, Ibaraki, Japan. PMID: 9640892 [PubMed - indexed for MEDLINE] 2637. Br J Dermatol. 1998 Apr;138(4):714-5. Hyperkeratotic varicella zoster virus infection in an HIV-infected patient. Successful treatment of persistent lesions with cryosurgery. Schöfer H, Baur SI, Gregel C, Wolter M, Milbradt R. PMID: 9640393 [PubMed - indexed for MEDLINE] 2638. Am J Infect Control. 1998 Jun;26(3):369-81; quiz 382-4. Varicella-zoster virus: infection, control, and prevention. Stover BH, Bratcher DF. Kosair Children's Hospital, Clinical Information Management Department, Alliant Health System, Louisville, Ky., USA. Varicella-zoster virus is a herpes virus that produces a primary infection, chickenpox, manifested by a vesicular eruption and is considered one of the common childhood infectious diseases. After the initial infection the virus becomes latent, then when activated it is manifested as herpes zoster, commonly known as shingles. This highly communicable human disease is associated with serious morbidity and significant mortality, particularly among the immunocompromised. When introduced in the hospital, significant disruptions occur and serious sequelae may results. Recently, a live virus varicella vaccine was approved by the Food and Drug Administration in the United States. Studies have shown the vaccine to be safe and effective. Widespread use of this vaccine may be beneficial in reducing the opportunities for varicella-zoster virus introductions in health care settings. PMID: 9638300 [PubMed - indexed for MEDLINE] 2639. Ir J Med Sci. 1998 Apr-Jun;167(2):74-8. Post herpetic neuralgia: a review. Griffin MJ, Chambers FA, MacSullivan R. Department of Pain Management and Anaesthesia, Mater Misericordiae Hospital, Dublin. PMID: 9638018 [PubMed - indexed for MEDLINE] 2640. Neurology. 1998 Jun;50(6):1922-3. Possible postherpetic neuralgia first occurring seven years after herpes zoster. Lampl C, Neuner L, Klingler D. Department of Neurology, General Hospital Linz, Austria. PMID: 9633769 [PubMed - indexed for MEDLINE] 2641. Neurology. 1998 Jun;50(6):1837-41. Efficacy of oxycodone in neuropathic pain: a randomized trial in postherpetic neuralgia. Watson CP, Babul N. Department of Medicine, University of Toronto, Ontario, Canada. OBJECTIVE: Although opioid analgesics are used in the management of neuropathic pain syndromes, evidence of their efficacy remains to be established. We evaluated the clinical efficacy and safety of oxycodone in neuropathic pain using postherpetic neuralgia as a model. METHODS: Patients with postherpetic neuralgia of at least moderate intensity were randomized to controlled-release oxycodone 10 mg or placebo every 12 hours, each for 4 weeks, using a double-blind, crossover design. The dose was increased weekly up to a possible maximum of 30 mg every 12 hours. Pain intensity and pain relief were assessed daily, and steady (ongoing) pain, brief (paroxysmal) pain, skin pain (allodynia), and pain relief were recorded at weekly visits. Clinical effectiveness, disability, and treatment preference were also assessed. RESULTS: Fifty patients were enrolled and 38 completed the study (16 men, 22 women, age 70+/-11 years, onset of postherpetic neuralgia 31+/-29 months, duration of pain 18+/-5 hours per day). The oxycodone dose during the final week was 45+/-17 mg per day. Compared with placebo, oxycodone resulted in pain relief (2.9+/-1.2 versus 1.8+/-1.1, p=0.0001) and reductions in steady pain (34+/-26 versus 55+/-27 mm, p=0.0001), allodynia (32+/-26 versus 50+/-30 mm, p=0.0004), and paroxysmal spontaneous pain (22+/-24 versus 42+/-32 mm, p=0.0001). Global effectiveness, disability, and masked patient preference all showed superior scores with oxycodone relative to placebo (1.8+/-1.1 versus 0.7+/-1.0, p=0.0001; 0.3+/-0.8 versus 0.7+/-1.0, p=0.041; 67% versus 11%, p=0.001, respectively). CONCLUSIONS: Controlled-release oxycodone is an effective analgesic for the management of steady pain, paroxysmal spontaneous pain, and allodynia, which frequently characterize postherpetic neuralgia. PMID: 9633737 [PubMed - indexed for MEDLINE] 2642. J Antimicrob Chemother. 1998 May;41(5):549-56. A randomized controlled trial of acyclovir versus netivudine for treatment of herpes zoster. International Zoster Study Group. Söltz-Szöts J, Tyring S, Andersen PL, Lucht RF, McKendrick MW, Diaz Perez JL, Shukla S, Fiddian AP. Department of Dermatology, Hospital Rudolfstiftung and Ludwig Boltzmann Institute of Research on Infectious Dermato- and Venerological Diseases, Vienna, Austria. Oral acyclovir has become the standard of care for treatment of acute herpes zoster. Netivudine is a novel antiviral with greater in-vitro activity against varicella zoster virus. It was compared with acyclovir in a randomized, double-blind, controlled trial in immunocompetent adults with herpes zoster. Patients with rash for less than 72 h were assigned to receive either acyclovir or netivudine, then assessed regularly for 6 months. No evidence for a dose response with netivudine was found, so intent-to-treat analyses of all 511 enrolled patients compared acyclovir with netivudine. The time to complete cessation of pain (P = 0.007) and to cessation of moderate to excruciating pain (P = 0.005) was accelerated in acyclovir recipients. Rash outcomes and adverse event profiles were similar for both treatments. This study has confirmed the efficacy of acyclovir in decreasing the duration and severity of pain following herpes zoster. Greater in-vitro activity of newer agents may not necessarily provide greater benefit in humans. PMID: 9630408 [PubMed - indexed for MEDLINE] 2643. Eur J Clin Microbiol Infect Dis. 1998 Feb;17(2):120-3. Diagnosis of herpetic keratoconjunctivitis by nested polymerase chain reaction in human tear film. Hidalgo F, Melón S, de Oña M, Do Santos V, Martínez A, Cimadevilla R, Rodríguez M. Servicio de Microbiología 1, Hospital Central de Asturias, Sección de Virología, Oviedo, Asturias, Spain. A study was performed to evaluate nested PCR (nPCR) versus viral cultures as method and tear film versus corneal scrapings as specimen in the diagnosis of viral keratoconjunctivitis. Tear film specimens were taken from both eyes and corneal scrapings from the affected eye only in 17 patients with suspected viral keratoconjunctivitis. In 15 of the 17 patients the viral agent of the infection could be detected: 11 patients had herpes simplex virus type 1, two varicella-zoster virus, one both herpes simplex virus type 1 and varicella-zoster virus, and one adenovirus. Overall there was no significant difference between the detection rate for corneal scrapings (85%) and tear film (75%). In both types of specimens nPCR showed a higher detection rate than viral cultures (corneal scrapings: 87.5% vs 31.25%; tear film: 75% vs 12.5%; P 0.05). For the diagnosis of keratoconjunctivitis nPCR is superior to viral culture and tear film is an adequate sample that is easier to collect, causing the patient less discomfort. PMID: 9629979 [PubMed - indexed for MEDLINE] 2644. An Esp Pediatr. 1998 Apr;48(4):425-6. [Ramsay-Hunt syndrome in infancy. Apropos of a case] [Article in Spanish] Fleta Zaragozano J, Royo López J, Ruíz Pastora R, Baselga Asensio C, Bueno Sánchez M. Departamento de Pediatría, Hospital Clínico Universitario Lozano Blesa, Universidad de Zaragoza. PMID: 9629806 [PubMed - indexed for MEDLINE] 2645. RN. 1998 May;61(5):80. Managing the aftermath of shingles. Scholz MJ. Northwest Neuroscience Institute, USA. PMID: 9626020 [PubMed - indexed for MEDLINE] 2646. J Med Virol. 1998 Jul;55(3):250-4. Acyclovir-resistant varicella-zoster virus: phenotypic and genetic characterization. Fillet AM, Dumont B, Caumes E, Visse B, Agut H, Bricaire F, Huraux JM. Virology Department, Pitié-Salpêtrière Hospital, Paris, France. A man with acquired immunodeficiency syndrome (AIDS) developed zoster of the right arm which was resistant clinically to acyclovir. Varicella-zoster virus (VZV) was cultured from a skin biopsy performed at the beginning of acyclovir therapy (isolate 1) and after its failure (isolate 2). The emergence of acyclovir resistance during treatment was investigated by developing a simple and rapid drug sensitivity assay based on the plaque reduction reference method. This late-antigen synthesis reduction assay involved serial dilutions of cell-associated virus. The 50% inhibitory concentration (IC50) of acyclovir was 16 +/- 7.5 microM for the susceptible reference strain OKA, in agreement with published data. The acyclovir IC50 increased from 6.5 microM for isolate 1 to 100 microM for isolate 2. In comparison with the sequence of isolate 1, isolate 2 had a single mutation consisting of a C to T change at position 907 of the thymidine kinase gene, which changed a glutamine codon into a stop codon at position 303 of the thymidine kinase protein. These results show the emergence of acyclovir resistance through a single previously undescribed mutation in the thymidine kinase gene, and confirm the heterogeneity of mutations inducing acyclovir resistance. PMID: 9624615 [PubMed - indexed for MEDLINE] 2647. J Am Board Fam Pract. 1998 May-Jun;11(3):224-8. The use of corticosteroids in the management of herpes zoster. MacFarlane LL, Simmons MM, Hunter MH. Department of Family Medicine, Medical University of South Carolina, Charleston 29425, USA. PMID: 9625514 [PubMed - indexed for MEDLINE] 2648. Clin Infect Dis. 1998 Apr;26(4):839, 981. Photo quiz I. Varicella zoster virus-associated leukocytoclastic vasculitis. Singh N, Deng JS. Department of Medicine, Veterans Affairs Medical Center, Pittsburgh, Pennsylvania, USA. PMID: 9564458 [PubMed - indexed for MEDLINE] 2649. Clin Infect Dis. 1998 Apr;26(4):806-10. Effect of prophylaxis on the clinical manifestations of AIDS-related opportunistic infections. Sepkowitz KA. Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA. Administration of targeted prophylaxis for AIDS-related opportunistic infections has contributed significantly to the recent decrease in mortality among patients with AIDS in the United States. Most reported prophylaxis trials have focused on determining (a) the percentage of cases prevented and (b) the effect of widespread antibiotic use on drug susceptibility. A third phenomenon that is seldom reported on is the attenuating effect of failed prophylaxis on the clinical presentation of opportunistic infections (OIs). With the increasingly widespread use of prophylaxis for OIs, more atypical "breakthrough" cases of opportunistic infections will be seen. Reports of clinical changes are reviewed below. Investigators should routinely report the clinical manifestations of breakthrough cases in all articles pertaining to prophylaxis for opportunistic infections in patients with AIDS. PMID: 9564456 [PubMed - indexed for MEDLINE] 2650. Ned Tijdschr Geneeskd. 1998 Mar 21;142(12):654-7. [Fatal varicella-zoster encephalitis; a rare complication of herpes zoster] [Article in Dutch] Westenend PJ, Hoppenbrouwers WJ. Pathologisch Laboratorium voor Dordrecht en Omstreken. In a 82-year-old woman varicella zoster encephalitis was diagnosed, a rare complication of shingles. The case was remarkable for its rapid and fatal course in a patient without an underlying disease. At autopsy, the histological picture of an acute haemorrhagic encephalitis was seen, also a rare finding. PMID: 9623132 [PubMed - indexed for MEDLINE] 2651. Postgrad Med J. 1998 Feb;74(868):101-3. Characteristics of patients with shingles admitted to a district general hospital. Morgan R, King D. Department of Geriatric Medicine, Arrowe Park Hospital, Wirral, Merseyside, UK. Little is known about why some patients with shingles are admitted to hospital. We reviewed 72 case notes from a list of 80 patients admitted to hospital with shingles over a six-year period. Pain was the main complaint of the patients admitted, most of whom were elderly and lived alone. The commonest site of involvement in hospital admissions was the eye (herpes zoster ophthalmicus). Diagnosis of shingles was made after admission in 12 patients, eight of whom had originally been diagnosed as having an acute medical or surgical condition. We conclude that the prodromal phase of shingles may lead to misdiagnosis. PMCID: PMC2360807 PMID: 9616491 [PubMed - indexed for MEDLINE] 2652. Reg Anesth Pain Med. 1998 May-Jun;23(3):328. A herpes zoster outbreak temporarily associated with an epidural steroid injection. Szokol JW, Gilbert HC. PMID: 9613553 [PubMed - indexed for MEDLINE] 2653. Clin Exp Dermatol. 1997 Nov;22(6):274-6. Cutaneous granulomatous vasculitis after herpes zoster infection showing polyarteritis nodosa-like features. Rodríguez-Pereira C, Suárez-Peñaranda JM, del Río E, Forteza-Vila J. Department of Pathology, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain. Various cutaneous lesions have been described after herpes zoster infection, such as lymphomas, pseudolymphoma and granulomatous conditions (granuloma annulare, tuberculoid granuloma, sarcoidosis). However, granulomatous vasculitis is an extremely rare sequel. We now describe a case of superficial granulomatous vasculitis with deep 'polyarteritis nodosa (PAN)-like' arteritis that developed after herpes zoster infection. Polymerase chain reaction did not detect genome of the herpes virus. We suggest that this condition could be an immune response to viral proteins. PMID: 9604453 [PubMed - indexed for MEDLINE] 2654. Acta Derm Venereol. 1998 May;78(3):236-7. Verrucous-crusted herpes zoster in an immunocompetent patient. Veraldi S, Gnecchi L, Zorzi F. PMID: 9602245 [PubMed - indexed for MEDLINE] 2655. Acta Derm Venereol. 1998 May;78(3):234-5. Herpes zoster. Nikkels AF, Piérard GE. Comment on: Acta Derm Venereol. 1997 May;77(3):194-7. PMID: 9602243 [PubMed - indexed for MEDLINE] 2656. Rinsho Ketsueki. 1998 Apr;39(4):290-6. [Acquired pure red cell aplasia associated with relapsed non-Hodgkin's lymphoma: a case report-improvement of PRCA after acute hepatitis] [Article in Japanese] Kuramoto K, Oda K, Katsutani S, Fujii T, Abe K, Imamura N, Kimura A. Department of Hematology and Oncology, Hiroshima University. A 47-year-old male patient was admitted because of anemia. He had been diagnosed as non-Hodgkin's lymphoma (Follicular mixed, B cell type, stage ISA) by splenectomy two years before. Bone marrow examination on admission revealed lymphoma cell infiltration and marked decrease in erythroid cells. These findings confirmed relapsed lymphoma with acquired pure red cell aplasia. After several courses of combination chemotherapy, lymphoma cells disappeared from bone marrow, but PRCA was not improved. In this case there were two times remission of PRCA. At first time, acute B type hepatitis occurred during the chemotherapy, anemia improved transiently. At the second time, mild acute hepatitis associated with herpes zoster occurred. Twenty days after hepatic injury, PRCA was improved, and continued in remission state till present day. To disclose the mechanism of PRCA in this case, erythroid colony assay of marrow cells was performed. This showed the presence of inhibitory factor in patient's serum at PRCA state, that was considered to be related to the occurrence of PRCA. These findings suggest that the improvement of PRCA was associated with the changes on immunological condition after acute hepatitis in this case. PMID: 9597896 [PubMed - indexed for MEDLINE] 2657. Antimicrob Agents Chemother. 1998 May;42(5):1139-45. Sorivudine versus acyclovir for treatment of dermatomal herpes zoster in human immunodeficiency virus-infected patients: results from a randomized, controlled clinical trial. Collaborative Antiviral Study Group/AIDS Clinical Trials Group, Herpes Zoster Study Group. Gnann JW Jr, Crumpacker CS, Lalezari JP, Smith JA, Tyring SK, Baum KF, Borucki MJ, Joseph WP, Mertz GJ, Steigbigel RT, Cloud GA, Soong SJ, Sherrill LC, DeHertogh DA, Whitley RJ. Division of Infectious Diseases, University of Alabama at Birmingham, 35294-2170, USA. jgnann@uabid.dom.uab.edu The present randomized, double-blind, placebo-controlled, multicenter clinical trial was designed to compare the efficacy and tolerability of sorivudine [1-beta-D-arabinofuranosyl-E-(2-bromovinyl)uracil] and acyclovir for the treatment of dermatomal herpes zoster in human immunodeficiency virus (HIV)-seropositive patients. A total of 170 HIV-seropositive adults presenting with herpes zoster (confirmed by direct fluorescent-antigen testing and/or viral culture) were enrolled and randomized to receive a 10-day course of orally administered sorivudine (40 mg once daily plus acyclovir placebos) or acyclovir (800 mg five times daily plus sorivudine placebo). Patients were monitored daily to document the events of cutaneous healing, pain, zoster-related complications, and drug-related adverse events. Patients were reassessed on days 21 and 28 and then once monthly for 1 year. The primary efficacy endpoint was time to the cessation of new vesicle formation. Secondary efficacy endpoints included times to other events of cutaneous healing, resolution of pain, and frequency of dissemination and zoster recurrence. In a multivariate analysis, sorivudine was superior to acyclovir for reducing the times to the cessation of new vesicle formation (relative risk [RR] = 1.54, 95% confidence interval [CI] = 1.00 to 2.36; P = 0.049) and total lesion crusting (RR = 1.48, 95% CI = 1.07 to 2.04; P = 0.017). In a univariate analysis, there was a trend favoring sorivudine for the cessation of new vesicle formation (median of 3 versus 4 days; P = 0.07) and a significant advantage for time to total lesion crusting (median of 7 versus 8 days; P = 0.02). The time to the resolution of zoster-associated pain, the frequency of dissemination, and the frequency of zoster recurrence were not different between the two treatment groups. Both drugs were well tolerated. Sorivudine is an effective drug for the treatment of herpes zoster in HIV-infected patients and results in accelerated cutaneous healing when compared with acyclovir therapy. PMCID: PMC105759 PMID: 9593141 [PubMed - indexed for MEDLINE] 2658. J Acquir Immune Defic Syndr Hum Retrovirol. 1998 May 1;18(1):46-50. Foscarnet decreases HIV-1 plasma load. Devianne-Garrigue I, Pellegrin I, Denisi R, Dupon M, Ragnaud JM, Barbeau P, Breilh D, Leng B, Fleury HJ, Pellegrin JL. Laboratoire de Virologie, CHU de Bordeaux, France. OBJECTIVE: To evaluate the effect of foscarnet on HIV-1 replication in vivo. PATIENTS AND METHODS: Seventeen AIDS patients with cytomegalovirus (CMV), herpes simplex virus (HSV), varicella-zoster virus (VZV) infection, Kaposi's sarcoma (KS), or a combination of these were treated with foscarnet. HIV RNA quantification (bDNA 2.0, Chiron, Emeryville, CA, U.S.A.), CMV pp65 antigenemia (Argene Biosoft, Varilhes, France), and CMV viremia were determined before and during therapy. RESULTS: Four patients had CMV retinitis (1 with KS), 2 patients had CMV pneumonia (1 with KS), 1 patient had CMV cholecystitis, 2 patients had VZV infection (1 with KS), 1 patient had HSV-2 infection, and 7 patients had KS alone. The decrease in HIV-1 load was -0.73 +/- 0.39 log copies/ml (p = 2.10(-6)) after 3 days of treatment and -1.15 +/- 0.49 log copies/ml (p < 10(-7)) after 10 days of treatment, compared with day 0. Furthermore, reduction of HIV-1 plasma load during foscarnet therapy did not depend on the presence or absence of CMV disease or on a positive pp65 antigenemia at day 0. CONCLUSION: We observed decreased HIV-1 plasma load in all patients treated with foscarnet, regardless of presence or absence of clinical or biologic CMV infection. This decrease supports the proposition that foscarnet anti-HIV-1 activity may be of clinical importance. PMID: 9593457 [PubMed - indexed for MEDLINE] 2659. J Am Acad Dermatol. 1998 May;38(5 Pt 1):761-3. Herpes zoster after varicella immunization. Liang MG, Heidelberg KA, Jacobson RM, McEvoy MT. Mayo Clinic and Foundation, Department of Dermatology, Rochester, Minnesota 55905, USA. PMID: 9591823 [PubMed - indexed for MEDLINE] 2660. Acta Otolaryngol. 1998 Mar;118(2):145-9. Varicella-zoster virus distribution in Ramsay Hunt syndrome revealed by polymerase chain reaction. Murakami S, Nakashiro Y, Mizobuchi M, Hato N, Honda N, Gyo K. Department of Otolaryngology, Ehime University School of Medicine, Japan. murakami@m.ehime-u.ac.jp The pathogenesis of facial nerve paralysis and vestibulo-cochlear dysfunction of Ramsay Hunt syndrome remains unclear as varicella-zoster virus (VZV) has not been demonstrated in the lesions. Using the polymerase chain reaction, we detected VZV genomes not only in the vesicles on the auricles or oral cavity but also in the facial nerve sheath, middle ear mucosa and cerebrospinal fluid from patients with Ramsay Hunt syndrome. The VZV genome was undetectable in the same kinds of clinical samples obtained from control patients with facial nerve paralysis of other etiologies. The results indicated that VZV spreads widely in the neural components, mucocutaneous tissue and cerebrospinal fluid. The present study will facilitate better understanding of the pathogenesis of facial nerve paralysis, vertigo, hearing impairment and other cranial nerve dysfunction of Ramsay Hunt syndrome. PMID: 9583779 [PubMed - indexed for MEDLINE] 2661. Genitourin Med. 1997 Dec;73(6):467-70. Herpes zoster and the stage and prognosis of HIV-1 infection. McNulty A, Li Y, Radtke U, Kaldor J, Rohrsheim R, Cooper DA, Donovan B. Taylor Square Private Clinic, Australia. OBJECTIVES: To examine the incidence of herpes zoster in HIV-1 infection. To assess the prognostic significance of the occurrence of herpes zoster and progression to AIDS or death DESIGN AND METHODS: 146 homosexually active men with known times of HIV-1 seroconversion were identified through the Sydney AIDS Prospective Study and the clinic records of a private medical practice with large caseload of HIV infected homosexual men. Medical records were reviewed for a history of herpes zoster, CD4+ lymphocyte counts, and HIV-1 disease status. Cox's proportional hazards model was used to determine whether herpes zoster predicted progression to AIDS or death. RESULTS: After a mean follow up of 54 months, 30 men (20%) had an episode of herpes zoster and three of these men had one recurrence. The overall incidence of herpes zoster was 44.4 episodes per 1000 person years (95% CI 30.0-63.5). Herpes zoster was not found to be a marker of deteriorating immune functions as measured by CD4+ lymphocyte counts. CD4+ counts did not differ significantly between those with and without zoster at 1 year (551 v 572.10(6)/1, p = 0.79), 2 years (451 v 557, p = 0.11), and 3 years (424 v 481, p = 0.50) following HIV-1 seroconversion. There was no statistically significant difference in progression to AIDS (RR = 1.89, 95% CI 0.80-4.46, p = 0.15) or death (RR = 0.90, 95% CI 0.31-2.65, p = 0.85) from HIV-1 sero-conversion in those who did and those who did not develop herpes zoster. CONCLUSION: The incidence of herpes zoster was consistent with the findings of other studies. There was no association between the occurrence of herpes zoster and progression of HIV-1 disease. PMCID: PMC1195926 PMID: 9582462 [PubMed - indexed for MEDLINE] 2662. Genitourin Med. 1997 Dec;73(6):462-6. Necrotising herpetic retinopathy in patients with advance HIV disease. Miller RF, Brink NS, Cartledge J, Sharvell Y, Frith P. Department of Sexually Transmitted Diseases, UCL Medical School, London. OBJECTIVES: To describe the presenting features, clinical and laboratory diagnosis, response to treatment, and outcome of necrotising herpetic retinopathy (NHR) in HIV infected patients. METHODS: Retrospective case records/laboratory data review of five HIV infected patients presenting to the specialist HIV/AIDS unit at UCL Hospitals, London from April 1994 to August 1996 with a clinical diagnosis of NHR. RESULTS: All patients had advanced HIV disease with a median CD4 count of 20.10(6)/1. Three patients had cutaneous varicella zoster virus (VZV) infection within the preceding 8 weeks. All had uniocular loss of visual acuity; one also had headache and another ocular pain. All had typical retinal appearances. VZV DNA was detected in cerebrospinal fluid of four patients (and in vitreous fluid of one of the four) and in vitreous fluid of one other. One patient refused therapy and rapidly became blind. Four patients received intravenous foscarnet with intravenous aciclovir for 6 weeks: three subsequently received oral famciclovir and one oral valaciclovir; two patients also had intravitreal injections of foscarnet. In none of the four did treatment bring about improvement in visual acuity, but in all four visual loss from retinitis was halted. CONCLUSIONS: NHR occurs in HIV infected patients with advanced HIV disease and is strongly associated with evidence of VZV infection. With aggressive use of antiviral drugs the outcome is not uniformly poor. PMCID: PMC1195925 PMID: 9582461 [PubMed - indexed for MEDLINE] 2663. An Esp Pediatr. 1998 Jan;48(1):63-4. [Herpes zoster during chickenpox] [Article in Spanish] Gener Turon C, Luelmo Aguilar J, Jorge Bravo J, Reverte Meca L, Ramírez Rodríguez J. Unidad de Dermatología, Consorci Hospitalari del Parc Taulí, Sabadell, Barcelona. PMID: 9542228 [PubMed - indexed for MEDLINE] 2664. Rev Neurol. 1997 Dec;25(148):2073-4. [Meningitis and focal encephalopathy due to varicella zoster virus] [Article in Spanish] Núñez MJ, Amigo MC, Amador L, Rodríguez JR, Cebrián E, García JC, Allegue MJ. PMID: 9580298 [PubMed - indexed for MEDLINE] 2665. Neurologia. 1998 Feb;13(2):94-7. [Uncommon neurologic complications related to varicella-zoster virus] [Article in Spanish] Martín del Pozo M, Benito-León J, Rodríguez J, Molina JA, Díaz-Guzmán J, Bermejo FP. Servicio de Neurología, Hospital Universitario 12 de Octubre, Madrid. Neurological complications caused by varicella-zoster virus, excluding post-herpetic neuralgia and aseptic meningitis, are infrequent and varied. Other complications, which have been described are peripheral motor neuropathy, cranial nerve palsies, meningoencephalitis, Guillain-Barré syndrome, myelitis, herpes zoster ophthalmicus with delayed contralateral hemiparesis and Reye syndrome. We present 4 patients with infrequent neurological complications associated with varicella-zoster virus: 3 cases of meningoencephalitis and one case of myelitis. PMID: 9578678 [PubMed - indexed for MEDLINE] 2666. Lakartidningen. 1998 Mar 25;95(13):1384-5. [Are famciclovir and valaciclovir truly effective in the treatment of shingles?] [Article in Swedish] Liedholm H, Linné AB. PMID: 9560964 [PubMed - indexed for MEDLINE] 2667. Masui. 1998 Mar;47(3):346-9. [Two elderly patients with thoracic herpetic pain and post herpetic neuralgia treated with continuous thoracic sympathetic ganglion block through a placed catheter] [Article in Japanese] Takeda T, Iida H, Ohta S, Oda A, Abe K, Oohata H, Akamatsu S, Dohi S. Department of Anesthesiology and Critical Care Medicine, Gifu University School of Medicine. Epidural block is very useful in the treatment of herpetic pain and post herpetic neuralgia. However, in the elderly patients with cardiac disease or diabetes mellitus, severe cardiovascular changes may occur by epidural block. Epidural block caused severe hypotension in two elderly patients with herpetic pain and post herpetic neuralgia who had diabetes mellitus or hypertension. Continuous thoracic sympathetic ganglion block with local anesthetics through a placed catheter reduced their pain and caused almost no changes in cardiovascular system. PMID: 9560549 [PubMed - indexed for MEDLINE] 2668. Geriatrics. 1998 Apr;53(4):93-4, 101-2. Ramsay Hunt syndrome: a challenging herpes zoster virus infection. Rahimi AR. Department of Internal Medicine Education, Medical College of Georgia, Savannah, USA. PMID: 9559030 [PubMed - indexed for MEDLINE] 2669. Reg Anesth Pain Med. 1998 Jan-Feb;23(1):25-9. High thoracic epidural block relieves acute herpetic pain involving the trigeminal and cervical regions: comparison with effects of stellate ganglion block. Higa K, Hori K, Harasawa I, Hirata K, Dan K. Department of Anesthesiology, School of Medicine, Fukuoka University, Japan. BACKGROUND AND OBJECTIVES: Stellate ganglion block can promptly relieve acute herpetic pain (AHP) involving the trigeminal and cervical regions. However, repeated blocks are needed to maintain pain relief in most patients with severe AHP. Because continuous epidural block is easily performed using an indwelling catheter, we compared the effect of high thoracic epidural block with that of stellate ganglion block to relieve moderate-to-severe AHP involving these regions. METHODS: Six patients received stellate ganglion blocks and seven patients received high thoracic epidural blocks. Six milliliters 1% of mepivacaine was given to each patient. Acute herpetic pain was evaluated before and up to 60 minutes after the blocks, using a visual analog scale (VAS) of pain. RESULTS: There was no significant difference in VAS pain scores before the blocks between the groups, but there were significant (P < .05) decreases in VAS pain scores for both groups between 10 and 60 minutes after the blocks. There were no significant differences in VAS pain scores between the groups after the blocks. CONCLUSIONS: High thoracic epidural block was as effective as stellate ganglion block in relieving moderate-to-severe AHP involving the trigeminal and cervical regions. PMID: 9552775 [PubMed - indexed for MEDLINE] 2670. Hautarzt. 1998 Feb;49(2):135-8. [Zosteriform lichen aureus] [Article in German] Dippel E, Schröder K, Goerdt S. Hautklinik und Poliklinik, Universitätsklinikum Benjamin Franklin, Freie Universität Berlin. Lichen aureus is a special localized variant of purpura pigmentosa chronica. A patient presented with an unusual striate and segmental or zosteriform distribution of lichen aureus involving the left leg and lower abdominal area. Histology showed the characteristic dense band-like infiltrate consisting mainly of small lymphocytes and numerous hemosiderin-containing macrophages. No underlying infection or medication could be identified as a trigger. The lesions did not respond well to topical corticosteroid therapy. PMID: 9551337 [PubMed - indexed for MEDLINE] 2671. Curr Opin Obstet Gynecol. 1998 Apr;10(2):123-8. Vertical transmission of viral infections. Mandelbrot L. Hôpital Cochin, Service de Gynécologie Obstetrique I, Paris, France. laurent.mandelbrot@cch.ap.hop.paris.fr A variety of congenital viral infections are responsible for a large proportion of the mortality and morbidity in infancy and childhood. Vertical transmission may occur during primary maternal infection or during chronic or recurrent infection, with different implications for counselling and testing in pregnancy. Strategies for the diagnosis and prevention of mother-to-child transmission differ according to the timing and mechanisms involved. As demonstrated by hepatitis B research in the past and human immunodeficiency virus today, multicenter cohort studies and clinical trials are a key to developing effective interventions. PMID: 9551307 [PubMed - indexed for MEDLINE] 2672. Singapore Med J. 1997 Nov;38(11):471-4. Clinical presentation of herpes zoster in a Singapore hospital. Oh HM, Ho AY, Chew SK, Monteiro EH. Communicable Disease Centre, Singapore. BACKGROUND: There is a direct correlation between increasing age and incidence of herpes zoster. There is an increased risk of complications in the elderly and the immunocompromised. OBJECTIVE: To study the clinical epidemiology of hospitalised patients with herpes zoster. METHODS: Medical records of all patients hospitalised with zoster were respectively analysed. RESULTS: Sixty-seven patients (3% of total admissions) were studied. There were 35 males and 32 females with a mean age of 50.35 +/- 21.71. There was an increased proportion of older patients in the study cohort. Nineteen patients (28.4%) were immunocompromised with malignancy occurring in 9 patients. Thirteen had been on cytotoxic and/or steroid therapy. The commonest symptoms were rash, pain and fever. Eighty-five percent of the patients had complications (bacterial super-infection in (61%), dissemination (31%), ocular involvement (5%) and post-herpetic neuralgia (13.4%). There was an increasing frequency of duration of pain with increasing age in the patients with post-herpetic neuralgia. Forty-three patients were treated with acyclovir. The median time to healing of lesions was 11 days. The 41 patients with bacterial super-infection received antibiotics with median time to healing of 12 days. CONCLUSION: Increasing age and immunocompromised state appear to be risk factors for developing herpes zoster in hospitalised patients. PMID: 9550907 [PubMed - indexed for MEDLINE] 2673. Ophthalmic Surg Lasers. 1998 Mar;29(3):198-206. The progressive outer retinal necrosis syndrome: successful treatment with combination antiviral therapy. Ciulla TA, Rutledge BK, Morley MG, Duker JS. Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, USA. BACKGROUND AND OBJECTIVE: To assess a two-drug combination of antiviral therapy for the progressive outer retinal necrosis syndrome (PORN), given the current poor outcome with acyclovir alone. PATIENTS AND METHODS: A retrospective review was performed on six consecutive patients who were diagnosed with PORN and were treated with various combinations of intravenous or oral plus intravenous antiviral therapy. The relative efficacies of these modalities were compared. RESULTS: Six eyes of six patients showed active retinitis at the time of presentation. Three patients had unilateral retinitis, and the remaining patients had necrotic, end-stage disease in their fellow eye. All the patients were treated with combination therapy, consisting of either ganciclovir and acyclovir (three patients), foscarnet and ganciclovir (two patients), or foscarnet and acyclovir (one patient). Standard induction doses were employed. During the combination therapy, all six eyes showed resolution of the retinitis, manifested by complete fading of the original retinal lesions and an absence of new lesion formation. At the final follow-up, the areas of prior active retinitis had resolved and remained quiescent. A mild recurrence developed in one eye when ganciclovir and foscarnet were both tapered to a single daily dose. This recurrence promptly resolved with reinduction (twice daily) dosing. Two patients maintained a visual acuity of 20/50 or better in their involved eye for the duration of follow-up (38 and 27 weeks, respectively). One patient maintained a visual acuity of 20/40 for 14 weeks. The remaining three patients had macula-off retinal detachments despite resolution of active retinitis. In addition, for the duration of follow-up, one of the three patients with unilateral disease had retinitis in the uninvolved eye; all three uninvolved fellow eyes maintained a visual acuity of 20/20. One patient had progressive optic atrophy. CONCLUSIONS: Prolonged combination antiviral therapy for PORN may successfully arrest the progression of retinitis, maintain remission, and prevent involvement of the fellow eye. Furthermore, if aggressive therapy is begun early, good vision may be preserved. PMID: 9547773 [PubMed - indexed for MEDLINE] 2674. Ann Neurol. 1998 Apr;43(4):534-6. Optic neuritis heralding varicella zoster virus retinitis in a patient with acquired immunodeficiency syndrome. Meenken C, van den Horn GJ, de Smet MD, van der Meer JT. Department of Ophthalmology, Academic Medical Center, University of Amsterdam, The Netherlands. We report on a 29-year-old severely compromised acquired immunodeficiency syndrome patient who developed retrobulbar optic neuritis 5 weeks after an episode of cutaneous herpes zoster infection. During the optic neuritis, varicella zoster virus could be demonstrated in the cerebrospinal fluid. The neuritis responded well to treatment with foscarnet, but, 3 weeks into therapy, varicella zoster retinitis developed. Additional treatment with intravenous acyclovir stopped progression of the retinitis and resulted in healing of the retinal lesions. This case suggests that retrobulbar optic neuritis can be regarded as a prodrome of imminent acute retinal necrosis. Early recognition and prompt therapy with combined antivirals may prevent the development of this devastating ocular complication of varicella zoster infection. PMID: 9546338 [PubMed - indexed for MEDLINE] 2675. Prof Nurse. 1998 Feb;13(5):310-3. Post-herpetic neuralgia. Millerchip S. Walsgrave NHS Trust, Coventry. PMID: 9544083 [PubMed - indexed for MEDLINE] 2676. Arch Dis Child Fetal Neonatal Ed. 1998 Jan;78(1):F57-61. Antibodies to varicella zoster virus in the cerebrospinal fluid of neonates with seizures. Mustonen K, Mustakangas P, Smeds M, Mannonen L, Uotila L, Vaheri A, Koskiniemi M. Department of Neuropediatrics, North Karelia Central Hospital, Ioensu, Finland. Four neonates with convulsions had IgG antibodies in their cerebrospinal fluid (CSF) to varicella zoster virus (VZV). These antibodies were found in the sera of two of these patients after the age of 6 months. Antibodies to 16 different microbes were studied from the serum and CSF of 201 neonates with neurological problems. The presence of DNA specific to HSV-1, HSV-2, and VZV in the CSF was also investigated using the polymerase chain reaction (PCR). Antibodies to VZV were detected in the CSF of four neonates. Antibody indices suggested production of VZV specific antibodies in the central nervous system. These findings suggest that intrathecal production of antibodies to VZV can appear in neonates with neurological problems, which suggests that intrauterine VZV infection can be acquired without cutaneous symptoms in the mother. PMCID: PMC1720737 PMID: 9536843 [PubMed - indexed for MEDLINE] 2677. Br J Dermatol. 1998 Jan;138(1):161-8. Cutaneous reactions at sites of herpes zoster scars: an expanded spectrum. Requena L, Kutzner H, Escalonilla P, Ortiz S, Schaller J, Rohwedder A. Department of Dermatology, Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain. Several types of cutaneous lesions have previously been described at the sites of herpes zoster scars. We describe 16 patients with cutaneous lesions which had developed on herpes zoster scars. Biopsies were taken from these lesions, and a polymerase chain reaction assay was used to detect the viral genome in paraffin-embedded specimens. Histopathological findings enabled diagnosis of nonspecific granulomatous dermatitis in five patients, granulomatous vasculitis in two patients, lichen sclerosus in two patients, and pseudolymphoma, keloid, sarcoidal granuloma, granuloma annulare, granulomatous folliculitis, lichen planus and cutaneous Rosai-Dorfman disease, each in one patient. Varicella-zoster virus DNA was not identified in any of the patients. Granulomatous folliculitis, lichen sclerosus and cutaneous Rosai-Dorfman disease have not previously been described in herpes zoster scars, but they are three new cutaneous reaction patterns that may have developed within these scars. Our investigations indicate that the cutaneous reactions appearing in herpes zoster scars are not due to the persistence of varicella-zoster virus DNA within the lesions. PMID: 9536241 [PubMed - indexed for MEDLINE] 2678. Mult Scler. 1998 Feb;4(1):22-6. Intrathecal synthesis of virus-specific oligoclonal IgG, and of free kappa and free lambda oligoclonal bands in acute monosymptomatic optic neuritis. Comparison with brain MRI. Frederiksen JL, Sindic CJ. Department of Neurology, Glostrup University Hospital, Denmark. Twenty-seven patients with acute monosymptomatic optic neuritis were randomly selected from a population-based cohort of patients extensively screened for known etiologies of ON. Paired serum and CSF obtained median 20 days from onset were examined for oligoclonal IgG, free kappa and free lambda chains, and virus-specific oligoclonal IgG antibodies by an affinity-mediated capillary blot technique. CSF-restricted oligoclonal IgG bands, free kappa and free lambda chain bands were observed in 17, 15 and nine patients, respectively. In addition, 16 patients showed a polyspecific intrathecal synthesis of oligoclonal IgG antibodies against one or more viruses (12 measles, nine varicella zoster, six rubella, six mumps) compared to all the 18 examined patients with definite multiple sclerosis (P = 0.0014). The presence of virus-specific oligoclonal IgG was significantly related to the results of oligoclonal IgG (P = 0.0034), free kappa chain bands (P = 0.0020), and brain MRI abnormalities (P = 0.0402). At 1 year follow-up five patients had developed clinically definite multiple sclerosis; all had virus-specific oligoclonal IgG antibodies, oligoclonal IgG and abnormal MRI at onset. PMID: 9532588 [PubMed - indexed for MEDLINE] 2679. Rev Neurol. 1997 Dec;25(148):1922-4. [Horner's syndrome secondary to ophthalmic herpes zoster] [Article in Spanish] Tola-Arribas MA, Zarco-Tejada JM, Marco-Llorente J. Servicio de Neurología, Hospital Universitario, Valladolid, España. INTRODUCTION: Ophthalmoparesias is a frequent complication of ophthalmic herpes zoster. It occurs in 31% of all cases. However, the presence of Horner's syndrome during viral reactivation is a rarity which has only been previously described on two occasions, and never associated with cranial nerve involvement. CLINICAL CASE: We describe a patient with the first case of Horner's syndrome secondary to ophthalmic herpes zoster, with simultaneous, homolateral lesions of the third and sixth cranial nerves. Clinical evaluation, the course of the disorder, negative magnetic resonance studies and tests with cocaine and foledrin eye drops confirmed the presence of a post-ganglionar sympathetic lesion, probably situated in the ipsilateral cavernous sinus. CONCLUSIONS: Ophthalmoparesias as a complication of ophthalmic herpes zoster may have various origins. Diffusion of viral particles from the Gasserian ganglion and branches of the trigeminal nerve to adjacent structures, muscles, nerves and vessels, is the mechanism often mentioned. Presence of a simultaneous sympathetic lesion is very rare and of unknown pathology. However, it is probable that the origin of the lesion of the vegetative fibres is the same as that of the sensory or motor fibres, and adjacent inflammatory process caused by the virus extending. We analyze the factors involved in the low incidence of this association. PMID: 9528032 [PubMed - indexed for MEDLINE] 2680. Arch Phys Med Rehabil. 1998 Mar;79(3):336-8. Myofascial trigger points in intercostal muscles secondary to herpes zoster infection of the intercostal nerve. Chen SM, Chen JT, Kuan TS, Hong CZ. Department of Physical Medicine and Rehabilitation, National Cheng-Kung University Hospital, Tainan, Taiwan. Chronic pain in the chest wall is a major complication after herpes zoster infection of intercostal nerves. It is usually difficult to control pain of such origin. Two cases are reported of postherpetic neuralgia after herpes zoster infection involving the intercostal nerves. Both patients had shooting, burning, aching, and localized pain in the muscle supplied by the involved intercostal nerves 1 to 3 months after onset. Compression palpation of a tender spot in one of these muscles induced a referred pain that followed the corresponding interspace, usually in the distal anterior direction. Local twitch responses could be elicited during injection of 0.5% or 1% lidocaine into one of these tender spots; the pain in the interspace was consistently eliminated immediately after injection. One patient had complete pain relief after three series of injections. The effect of pain relief for the other patient lasted for 1 to 2 weeks after the initial injection and lasted progressively longer (up to 2 months) after repeated injections. It appears that many of the tender spots formed in intercostal muscles after herpes zoster are myofascial trigger points that respond to injection with referred pain, local twitch responses, and immediate pain relief. PMID: 9523788 [PubMed - indexed for MEDLINE] 2681. Arch Dermatol. 1998 Mar;134(3):279-81. Tumescent infiltration of corticosteroids, lidocaine, and epinephrine into dermatomes of acute herpetic pain or postherpetic neuralgia. Chiarello SE. Dermatology and Skin Cancer Center of Southwest Florida, Port Charlotte, USA. PMID: 9521026 [PubMed - indexed for MEDLINE] 2682. J Med Virol. 1998 Mar;54(3):158-61. Herpes simplex virus-1 and varicella virus infections in familial dysautonomia patients. Maayan C, Nimrod A, Morag A, Becker Y. Department of Pediatrics, Hadassah University Hospital, Mt. Scopus, Israel. Familial dystautonomia (FD) patients are deficient in type C fibers, suggesting that there may be a different pattern of infection and clinical presentation when infected by Herpes simplex virus type 1 (HSV-1) or Varicella-Zoster virus (VZV). These viruses infect and are reactivated in the periphery of the body through type C sensory nerve fibers. HSV-1 infects epithelial cells, penetrates into type C fibers, and migrates to the ganglia to generate latent infection. In reactivation, the viral DNA migrates through type C fibers, infecting the epidermis at the entry site. VZV infects through the respiratory tract, causing systemic viral infection and latency in the ganglia, from which it is reactivated and reaches the skin. The study was carried by clinical questionnaire and by HSV and VZV IgG antibodies on fifty-one FD patients and eighty matched controls. The questionnaire revealed that no FD patient had a history of clinical HSV-1 infection, compared to 15% in the control group (P < 0.05), while 50% FD patients had been infected by varicella, compared to 66% in the VZV control group. However in FD, VZV clinical manifestations were mild in comparison to controls. There was no difference in infection rates for some other viral diseases. HSV-1 antibodies were detected in 24% of the FD patients, compared to 38% in the control group (P < 0.1). VZV antibodies were similar in FD and controls (66%, 63%). We concluded that the rate of HSV infection in FD is low and clinical reactivation is rare. The rate of varicella infection appears to be the same for patients and controls, but in FD the clinical presentation is mild. We suggest that these differences are due to the lack of type C fibers in FD patients. PMID: 9515762 [PubMed - indexed for MEDLINE] 2683. J Med Virol. 1998 Mar;54(3):155-7. Investigation of vesicular rashes for HSV and VZV by PCR. Beards G, Graham C, Pillay D. Public Health Laboratory, Birmingham Heartlands Hospital, United Kingdom. 106573.3726@compuserve.com Vesicular fluid from rashes of 132 patients was tested by a multiplex PCR shown to be specific for herpes simplex virus (HSV) type 1 and 2, and varicella zoster virus (VZV) genomic DNA. The results were compared with those obtained by examination by electron microscopy and virus isolation by cell culture. The PCR did not differentiate between HSV 1 and 2. By PCR, 64 HSV infections and 53 VZV infections were identified, with presumed 100% sensitivity and specificity. Fifteen specimens tested negative by PCR, electron microscopy, and virus isolation for herpes viruses. The sensitivities of virus isolation and electron microscopy for detection of herpes simplex virus were 56% and 80%. For varicella zoster virus, the sensitivities of virus isolation and electron microscopy were 47% and 60%. These data illustrate the advantage of rapid PCR diagnosis of herpes simplex virus and varicella zoster virus in vesicle fluids. PMID: 9515761 [PubMed - indexed for MEDLINE] 2684. Am J Ophthalmol. 1998 Mar;125(3):285-91. Herpes zoster ophthalmicus in patients with human immunodeficiency virus infection. Margolis TP, Milner MS, Shama A, Hodge W, Seiff S. Francis I. Proctor Foundation, University of California, San Francisco, Medical Center 94122-0944, USA. tpms@itsa.ucsf.edu PURPOSE: To investigate the ocular complications of herpes zoster ophthalmicus in patients with human immunodeficiency virus (HIV) infection. METHODS: This was a retrospective cohort study of 48 HIV-infected patients (48 eyes) treated at San Francisco General Hospital for herpes zoster ophthalmicus from December 1985 through March 1994. RESULTS: All patients were initially treated with either intravenous or oral acyclovir. The median CD4 lymphocyte count at diagnosis was 48 per mm3 (range, 2 to 490 per mm3). Fifteen patients (31%) had mild or no ocular involvement. Seventeen patients (35%) had stromal keratitis, mostly mild, and two (4)% developed chronic infectious pseudodendritic keratitis. Twenty-four study patients (50%) had iritis, but only three (6%) had elevations in intraocular pressure. Two patients (4%) developed postherpetic neuralgia, and two others (4%) had zoster-associated central nervous system disease. Only two patients (4%) developed necrotizing retinitis, both in the form of the progressive outer retinal necrosis syndrome. CONCLUSIONS: Excluding the patients with retinitis and central nervous system disease, the rate of sight-threatening complications in our series was lower than expected. Almost one third of study patients had no ocular complications or only mild surface epithelial disease. Although the relatively low incidence of sight-threatening disease in our study population may have been a consequence of aggressive management with acyclovir, chronic infectious pseudodendritic keratitis, retinitis, and central nervous system disease, complications of ophthalmic zoster whose pathogenesis is largely a consequence of active viral replication, were particularly devastating and difficult to manage. PMID: 9512144 [PubMed - indexed for MEDLINE] 2685. Ophthalmology. 1998 Mar;105(3):467-71. Varicella zoster virus retrobulbar optic neuritis preceding retinitis in patients with acquired immune deficiency syndrome. Lee MS, Cooney EL, Stoessel KM, Gariano RF. Department of Ophthalmology, Yale University School of Medicine, New Haven, Connecticut, USA. OBJECTIVE: This study aimed to describe a recently recognized and rare presentation of varicella zoster virus (VZV) retrobulbar optic neuritis preceding retinitis in patients with acquired immune deficiency syndrome and to identify factors that may relate to improved visual outcome. METHODS: Diagnosis, treatment, and clinical course are described for three eyes of two patients with this viral infection. RESULTS: Patients had decreased vision, headache, and recent zoster dermatitis. Varicella zoster virus retrobulbar optic neuritis was diagnosed on the bases of clinical, laboratory, and electrophysiologic examination results. Profound vision loss and peripheral retinitis ensued despite intravenous antiviral treatment. Combination intravenous and intravitreous antiviral injections were administered with dramatic visual recovery. CONCLUSIONS: Varicella zoster virus retrobulbar optic neuritis should be considered in immunocompromised patients with visual loss. Early diagnosis and aggressive combination therapy via systemic and intravitreous routes may enable return of useful vision. PMID: 9499777 [PubMed - indexed for MEDLINE] 2686. Ophthalmology. 1998 Mar;105(3):390-1. Repair of retinal detachments due to herpes varicella-zoster virus retinitis. Ciulla TA, Danis RP. Comment on: Ophthalmology. 1997 Feb;104(2):279-82. PMID: 9499760 [PubMed - indexed for MEDLINE] 2687. Acta Derm Venereol. 1998 Jan;78(1):74-5. Centroblastic-centrocytic lymphoma arising at the site of previous herpes zoster eruption. Drago F, Rampini P, Lugani C, Rebora A. PMID: 9498039 [PubMed - indexed for MEDLINE] 2688. Postgrad Med J. 1997 Oct;73(864):623-9. The management of postherpetic neuralgia. Bowsher D. Pain Research Institute, Walton Hospital, Liverpool, UK. Postherpetic neuralgia is defined as pain persisting, or recurring, at the site of shingles at least three months after the onset of the acute rash. Thus defined, at least half of shingles sufferers over the age of 65 years develop postherpetic neuralgia. In addition to increasing age, less important risk factors for postherpetic neuralgia are pain severity of acute shingles and trigeminal distribution. Postherpetic neuralgia accounts for 11-15% of all referrals to pain clinics and would, in fact, be far more effectively dealt with in primary care. Effective treatment of acute shingles by systemic antivirals at the appropriate time may have some effect in reducing the incidence of postherpetic neuralgia, making it easier to treat with tricyclics and greatly reducing scarring (25% of all cases affect the face). Pre-emptive treatment with low-dose tricyclics (ami- or nor-triptyline 10-25 mg nocte) from the time of diagnosis of acute shingles reduces the incidence of postherpetic neuralgia by about 50%. Established postherpetic neuralgia should be vigorously treated with adrenergically active tricyclics in a dose rising over two or three weeks from 10-25 mg to 50-75 mg. Positive relaxation should also be used. Carbamazepine, like conventional analgesics, is of little or no value. Failure of tricyclics to effect relief within eight weeks calls for specialist treatment. North American practitioners in particular believe that some opioids (e.g., oxycodone) may be helpful in otherwise intractable cases. PMCID: PMC2431485 PMID: 9497970 [PubMed - indexed for MEDLINE] 2689. Nephron. 1998;78(2):228-9. More about acyclovir neurotoxicity in patients on haemodialysis. Gómez Campderá FJ, Verde E, Vozmediano MC, Valderrábano F. PMID: 9496746 [PubMed - indexed for MEDLINE] 2690. J R Soc Med. 1997 Dec;90(12):670-4. Herpes zoster ophthalmicus. Marsh RJ. Moorfields Eye Hospital, London, UK. PMCID: PMC1296736 PMID: 9496292 [PubMed - indexed for MEDLINE] 2691. Rinsho Ketsueki. 1998 Jan;39(1):53-8. [Acute abdomina pain as a presenting symptom of varicella-zoster virus infection in an allogeneic bone marrow transplant] [Article in Japanese] Hamanishi T, Nishikawa H, Kobayashi M, Nakao T, Ohagi S, Sasaki H, Matsumoto G, Sanke T, Nanjo K. First Department of Medicine, Wakayama University of Medical Science. A 26-year old man was admitted because of acute abdominal pain. He had received an allogeneic bone marrow transplant (BMT) for aplastic anemia 6 months before. All physical, laboratory, roentgenographic, and ultrasonographic studies were performed but nondiagnostic. On the fourth hospital day the patient developed visual disturbance and on the following day skin eruption appeared. Laboratory findings revealed severe liver dysfunction. We diagnosed this case as varicella-zoster virus (VZV) infection with visceral dissemination. Antiviral therapy with acyclovir was initiated and abdominal pain markedly reduced and visual acuity was recovered after 4 days. In case of VZV infection, acute abdominal pain prior to skin eruptions is rare. However in such cases the patients are highly fatal due to visceral dissemination. Antiviral therapy begun before visceral dissemination of VZV is highly effective in preventing serious disease, whereas it is less effective after dissemination. We consider that early diagnosis and treatment of VZV infection is necessary for BMT recipients who are undergoing immunosuppressive therapy. PMID: 9492554 [PubMed - indexed for MEDLINE] 2692. J Dermatol. 1997 Dec;24(12):751-7. Evaluation of acceleration plethysmograms in dermatology--efficacy of lipo PGE1 preparations against herpes zoster and neuralgia following herpes. Okuda T, Oh-i T, Koga M. Department of Dermatology, Tokyo Medical College, Japan. Reports published in recent years indicate that administration of lipo PGE1 is effective against herpes zoster and neuralgia following herpes. However, there are presently no standards to objectively assess efficacy. We therefore looked into the possibility of achieving this goal by using an acceleration plethysmograph. The results showed a significant difference in the rate of change of pulse waves after initiation of drip infusion as compared to before drip infusion among the effective group, the control group, and the non-effective group. This method appears to be useful to objectively assess both the analgesic effects of lipo PGE1 and the efficacy of drugs in general, based on data analysis. Our results suggest that investigations using this method may be able to predict the therapeutic effects of vasodilators and analyze hemodynamic disorders of the skin. PMID: 9492437 [PubMed - indexed for MEDLINE] 2693. J Am Acad Dermatol. 1998 Feb;38(2 Pt 1):279-80. Gastrointestinal complications of dermatomal herpes zoster successfully treated with famciclovir and lactulose. Hong JJ, Elgart ML. Department of Dermatology, George Washington University Medical Center, Washington, DC 20037, USA. PMID: 9486692 [PubMed - indexed for MEDLINE] 2694. Lancet. 1998 Feb 7;351(9100):419-20. Triggering of delayed-onset postherpetic neuralgia. Schott GD. PMID: 9482304 [PubMed - indexed for MEDLINE] 2695. Ophthalmology. 1998 Feb;105(2):347-52. Characteristics of uveitis presenting for the first time in the elderly. Chatzistefanou K, Markomichelakis NN, Christen W, Soheilian M, Foster CS. Ophthalmology Department, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston 02114-3069, USA. OBJECTIVE: This study aimed to describe the clinical characteristics of uveitis presenting de novo in the elderly. DESIGN: The study design was a description of a retrospectively identified case series. PARTICIPANTS: A population of 138 patients (209 eyes) with uveitis beginning after age 60 was analyzed. RESULTS: Uveitis in the elderly accounted for 10.4% of the authors' uveitis population. The localization of uveitis was anterior in 56.5% of patients, intermediate uveitis was diagnosed in two patients (1.4%), posterior uveitis was found in 25.4%, while 16.7% of patients presented with panuveitis. Idiopathic uveitis accounted for the majority of cases (31.2%), whereas herpes zoster ophthalmicus (11.6%), herpes simplex virus (6.5%), presumed sarcoidosis (5.8%), syphilis (4.3%) ankylosing spondylitis (4.3%), and birdshot chorioretinopathy (3.6%) were the most frequent specific diagnostic entities. Secondary elevation of intraocular pressure was common (67 eyes, or 32%). The development of macular edema complicated 28.7% of cases (60 eyes). Two cases of intraocular lymphoma were identified in 19 diagnostic vitreous biopsy specimens. Fifty-two percent of eyes retained visual acuity of 20/40 or more; 32.6% had final visual acuity worse than 20/100. CONCLUSIONS: Uveitis presenting for the first time in the elderly is not uncommon. Idiopathic uveitis accounts for the majority of cases, and herpes zoster ophthalmicus and herpes simplex virus are particularly prevalent. Intraocular lymphoma does not predominate in this age group. With adequate control of intraocular inflammation and its sequelae, the visual prognosis in patients in this age group with uveitis is relatively good. PMID: 9479298 [PubMed - indexed for MEDLINE] 2696. Eur Neurol. 1998;39(1):26-31. Herpes zoster oticus: correlations between clinical and MRI findings. Berrettini S, Bianchi MC, Segnini G, Sellari-Franceschini S, Bruschini P, Montanaro D. Department of Neurosciences, Ear, Nose and Throat Unit, University of Pisa, Italy. Many gadolinium-enhanced magnetic resonance imaging (MRI) studies focusing on the anatomy and pathology of the 7th cranial nerve have already been published. However, only scattered cases of herpes zoster oticus (HZO) have been described and only the MRI appearance of the soft temporal bone structures has been reported. Enhanced MRI was performed in 4 patients with HZO observed at the Department of Otorhinolaryngology of the University of Pisa. A good correlation was found between the clinical data and MRI findings in both the acute and chronic stages of the disease. The 2 cases with complete facial palsy presented prominent and diffuse enhancement of the 7th and 8th cranial nerves on postcontrast MRI, while the patient with grade III facial palsy showed more limited nerve enhancement. The patient with grade II facial palsy presented no MRI abnormalities. In our series, enhancement limited to the geniculate ganglion and to the labyrinthine segment of the facial nerve indicates a good prognosis while a widespread enhancement correlates with a poor prognosis. In conclusion, MRI with contrast may be useful during the acute stage of HZO because it can confirm the diagnosis and can provide prognostic information on the facial function. PMID: 9476720 [PubMed - indexed for MEDLINE] 2697. Ann Pharmacother. 1998 Jan;32(1):111-3. Acyclovir- and ganciclovir-induced neurotoxicity. Ernst ME, Franey RJ. College of Pharmacy, University of Iowa, Iowa City, USA. michael-ernst@uiowa.edu With increasing use of acyclovir and ganciclovir, primarily due to the increased number of AIDS and transplant patients, further cases of neurologic toxicity will undoubtedly be encountered. Discontinuation or dosage reduction of acyclovir and ganciclovir is necessary to manage neurologic toxicity that is directly attributed to either agent. Renal dysfunction is a known risk factor for acyclovir neurotoxicity, and case reports indicate that renal dysfunction may also be a risk factor for ganciclovir neurotoxicity. Since ganciclovir is structurally related to acyclovir, clinicians should monitor for signs and symptoms of neurotoxicity as they would with acyclovir until the risk factors are more clearly defined. Dosage reduction for both agents and increased monitoring should occur when renal dysfunction is present, to minimize the risk of neurotoxicity and other serious adverse effects. Tables 1 and 2 summarize the recommended dosages of acyclovir and ganciclovir, respectively, in the presence of renal dysfunction. However, as a few case reports describe, neurotoxicity from these agents has also occurred in patients with normal renal function. Therefore, clinicians should always remain vigilant in monitoring for signs of neurotoxicity when acyclovir or ganciclovir is administered, and have a high index of suspicion for these agents if neurotoxicity is encountered during therapy. PMID: 9475829 [PubMed - indexed for MEDLINE] 2698. Am J Nurs. 1998 Feb;98(2):46-7. Clinical snapshot: herpes zoster. Bjorgen S. PMID: 9473984 [PubMed - indexed for MEDLINE] 2699. Am J Nurs. 1998 Feb;98(2):18-20. Pain from herpes zoster and postherpetic neuralgia. Pasero CL, Davies PS. Veterans Administration Medical Center, Seattle, WA, USA. PMID: 9473979 [PubMed - indexed for MEDLINE] 2700. Pediatr Rev. 1998 Feb;19(2):62-6; quiz 67. Varicella-zoster. Fisher RG, Edwards KM. Duke University School of Medicine, Durham, NC, USA. PMID: 9473945 [PubMed - indexed for MEDLINE] 2701. S Afr Med J. 1997 Nov;87(11):1558. HIV and the doctor's responsibility. Schramm R. PMID: 9472290 [PubMed - indexed for MEDLINE] 2702. BMJ. 1998 Jan 17;316(7126):234. Steroids in facial palsy due to herpes zoster. Corticosteroids are accepted treatment. Homer JJ, England RJ, Ell SR. Comment on: BMJ. 1997 Nov 1;315(7116):1163. PMCID: PMC2665432 PMID: 9468720 [PubMed - indexed for MEDLINE] 2703. BMJ. 1998 Jan 17;316(7126):233-4. Steroids in facial palsy due to herpes zoster. Steroids are indicated if paralysis is complete and no contraindications exist. Fielder CP, Raza SA. Comment on: BMJ. 1997 Nov 1;315(7116):1163. PMCID: PMC2665422 PMID: 9468719 [PubMed - indexed for MEDLINE] 2704. J Infect Dis. 1998 Feb;177(2):293-300. Chronic uveitis in guinea pigs infected with varicella-zoster virus expressing Escherichia coli beta-galactosidase. Cohen JI, Wang Y, Nussenblatt R, Straus SE, Hooks JJ. Medical Virology Section, Laboratory of Clinical Investigation, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland 20892, USA. There is no small animal model that replicates chickenpox and herpes zoster, which are caused by varicella-zoster virus (VZV). Therefore, to detect VZV in tissues of infected animals, the Escherichia coli beta-galactosidase gene was inserted into the viral genome. Intravitreal inoculation of guinea pigs with virus-infected cells resulted in a chronic uveitis, with mononuclear cells in the vitreous cavity of the eye of nearly all animals. Staining with X-gal demonstrated the presence of VZV in the ciliary body or iris of approximately 40% of the animals and in retinal pigmented epithelial cells in 4 animals. X-gal staining showed VZV in the eye of 1 animal 140 days after inoculation. These experiments indicate that VZV expressing beta-galactosidase is useful for detecting virus in tissues and that VZV can cause a chronic uveitis in which virus can be detected in some animals for up to 4 months. PMID: 9466514 [PubMed - indexed for MEDLINE] 2705. Support Care Cancer. 1998 Jan;6(1):57-62. Ambulatory management of varicella-zoster virus infection in immunocompromised cancer patients. Rolston KV, Manzullo E, Elting L, Frisbee-Hume S, Rodriguez S, Rubenstein EB. Ambulatory and Supporting Care Oncology Research Program (ASCORP), University of Texas, M.D. Anderson Cancer, Houston 77030, USA. Immunocompromised patients with varicella-zoster virus (VZV) infection are at greater risk for dissemination and the development of complications than immunocompetent individuals. Consequently, they are generally hospitalized in strict isolation rooms and treated with parenterally administered acyclovir. Although effective, this approach is expensive and creates logistic difficulties in the hospital. We treated 38 immunosuppressed cancer patients presenting to our ambulatory treatment center with VZV infections with intravenous acyclovir (500 mg/m2 8-hourly) in an ambulatory/home setting. Patients were monitored for success or failure of therapy, progression of infection, development of complications or drug toxicity, and satisfaction/compliance with therapy. Most patients (33, or 87%) responded to therapy. Among the failures, 2 patients had progressive VZV infection, 2 were hospitalized due to renal toxicity, and 1 developed a superinfection. All patients eventually responded and there were no deaths on this study. Two patients relapsed within 1 month of initial response. Both responded to retreatment with acyclovir, without hospitalization. The median duration of parenteral therapy with acyclovir was 7.5 days. Seven patients (18%) had to be switched to oral acyclovir (800 mg, 5 times a day) before complete response, owing to problems with venous access. All 7 completed therapy successfully. Overall, patients expressed a high level of satisfaction with outpatient therapy, and there were no instances of noncompliance or patient requests for withdrawal from study. The results of this study indicate that VZV infections in clinically stable immunosuppressed cancer patients are relatively benign and do not require hospitalization. Parenterally administered acyclovir in an ambulatory setting is effective therapy for such infections. PMID: 9458538 [PubMed - indexed for MEDLINE] 2706. Support Care Cancer. 1998 Jan;6(1):39-45. Current concepts and challenges in the prevention and treatment of viral infections in immunocompromised cancer patients. Reusser P. Department of Medicine, University Hospital, Basel, Switzerland. Patients with acute leukemia treated with intensive chemotherapy and recipients of bone marrow or peripheral blood stem cell transplants are at high risk of serious viral disease. Recent progress in diagnostic methods and in antiviral drug treatment has permitted the development of efficient management strategies particularly for infections due to herpes simplex virus, varicella-zoster virus, and cytomegalovirus in these patients. By contrast, specific treatment of other virus infections in immunocompromised cancer patients remains an unresolved issue. The emergence of herpesvirus resistance to antiviral drugs is a matter of concern, and its clinical importance among patients with malignancy needs to be elucidated. Future investigations may furthermore help to clarify the role of novel antiviral agents, such as cidofovir, lobucavir, and compound 1263W94, and of the adoptive immunotherapy with virus-specific CTL clones in severely immunodeficient cancer patients. PMID: 9458535 [PubMed - indexed for MEDLINE] 2707. Clin Infect Dis. 1998 Jan;26(1):241-2. Morbidity among adults with varicella-zoster virus infection. Amstey MS. Comment on: Clin Infect Dis. 1997 May;24(5):753-61; quiz 762-3. PMID: 9455574 [PubMed - indexed for MEDLINE] 2708. Clin Infect Dis. 1998 Jan;26(1):85-90. Acyclovir use and survival among human immunodeficiency virus-infected patients with CD4 cell counts of < 500/mm3. The Terry Beirn Community Programs for Clinical Research on AIDS (CPCRA). Torres RA, Neaton JD, Wentworth DN, Barr MR, Abrams D, Sherer R, Ward T, Sampson J. AIDS Center, St. Vincent's Hospital and Medical Center of New York, New York 10011, USA. To examine the relationship between acyclovir use and survival in AIDS, we performed a retrospective analysis of data collected through an observational cohort of the 17-site Community Program for Clinical Research on AIDS (CPCRA), under the sponsorship of the National Institute of Allergy and Infectious Diseases. Data were analyzed regarding 2,368 patients with CD4+ lymphocyte counts of < 500/mm3, and 7,836 follow-up visits were conducted from September 1990 to July 1994. Factors associated with use of acyclovir were studied by stratified analysis of variance and Mantel-Haenzel chi 2 tests. The association between acyclovir and survival was studied with use of the proportional hazards regression model. Individuals reporting acyclovir use were more likely to be white, male, and homosexual; to have a history of herpes simplex and zoster; and to have lower CD4+ T cell counts than those who did not. After adjustments for differences in baseline factors, acyclovir use was not associated with prolonged survival. PMID: 9455514 [PubMed - indexed for MEDLINE] 2709. Clin Infect Dis. 1998 Jan;26(1):34-45; discussion 46-7. Rapidly progressive herpetic retinal necrosis: a blinding disease characteristic of advanced AIDS. Ormerod LD, Larkin JA, Margo CA, Pavan PR, Menosky MM, Haight DO, Nadler JP, Yangco BG, Friedman SM, Schwartz R, Sinnott JT. Department of Ophthalmology, University of South Florida College of Medicine, Tampa, USA. Eleven patients with rapidly progressive herpetic retinal necrosis (RPHRN) complicating AIDS were investigated retrospectively to study the disease spectrum, systemic involvement, and therapy. The mean CD4 cell count was 24/microL. There was a characteristic disease pattern with rapid progression, 82% bilaterality, relative resistance to intravenous antiviral therapy, and 70% retinal detachment. Varicella-zoster virus was the probable cause in 10 patients (detected by polymerase chain reaction in two eyes investigated), and herpes simplex virus was the probable cause in one. Cutaneous zoster occurred previously in 73% but was not concurrent. Seventy-three percent had central nervous system disease, possibly virus-related. RPHRN may be a local herpetic recrudescence in an immune-privileged site with transneural spread. Only four of 20 affected eyes retained useful vision. Poor ocular bioavailability, retinal ischemia, acquired drug resistance, and strain pathogenicity may underlie treatment failure. Acyclovir therapy appears relatively ineffective. Combined intravenous and intravitreal therapy with foscarnet and ganciclovir may be the best current management. Research advances are needed urgently. PMID: 9455507 [PubMed - indexed for MEDLINE] 2710. Lakartidningen. 1997 Dec 17;94(51-52):4881-4. [Antiviral therapy in herpes zoster. Famciclovir and valaciclovir are two good agents against shingles] [Article in Swedish] Sköldenberg B. Infektionskliniken, Danderyds sjukhus. PMID: 9454005 [PubMed - indexed for MEDLINE] 2711. J Rheumatol. 1997 Dec;24(12):2487-8. Herpes zoster encephalomyelitis in a patient with rheumatoid arthritis treated with low dose methotrexate. Golden HE. Comment on: J Rheumatol. 1997 Mar;24(3):589-91. PMID: 9415667 [PubMed - indexed for MEDLINE] 2712. Pain. 1997 Nov;73(2):231-8. Afferent large fiber polyneuropathy predicts the development of postherpetic neuralgia. Baron R, Haendler G, Schulte H. Klinik für Neurologie, Christian-Albrechts-Universität zu Kiel, Germany. r.baron@neurologie.uni-kiel.de Acute zoster infection may be followed by a chronic pain syndrome, i.e., postherpetic neuralgia (PHN). Besides older age, the intensity of pain and neuronal damage within the acutely affected body region are regarded as predictors or risk factors for PHN. As an alternative approach an underlying peripheral polyneuropathy may be considered as potential co-factor. Is a preexisting generalized impairment of certain fiber classes important in initiating chronic pain states after subsequent localized nerve lesion due to zoster infection? Neurophysiological tests of different efferent and afferent small and large fiber systems were performed prospectively at unaffected body regions in patients with acute herpes zoster. Patients that were still in pain 6 months later (PHN, n = 17) and pain free patients (non-PHN, n = 17) were compared regarding the results obtained during the acute phase. Both groups were age matched. Nociceptive C-fiber function was assessed at the forearm by quantitative measurement of the axon reflex vasodilatation and flare induced by histamine iontophoresis. Mechanosensitive A beta-fibers were tested at all extremities by quantitative vibrametry. Parasympathetic small fiber function was studied by heart rate variability tests. No clinically manifest polyneuropathy was present. However, in PHN risk patients considerably higher vibration detection thresholds in hands and feet were detected compared with non-PHN patients. Pathologic test results of vibration sense at the lower extremity predicted PHN with a sensitivity of 70%. Nociceptive C-fiber and parasympathetic fiber function demonstrated no significant differences in both groups. Acute zoster pain was slightly more intense in the PHN group. We concluded that (i) a mild generalized impairment of afferent A beta-fiber function (A beta-polyneuropathy) seems to be an important co-factor in the development of PHN and (ii) impairment of vibration sense, i.e., impairment of afferent A beta-fiber function, may be used as a predictor of PHN. PMID: 9415510 [PubMed - indexed for MEDLINE] 2713. Arch Ophthalmol. 1998 Jan;116(1):104-5. Varicella-zoster virus retinitis presenting as an acute vitreous hemorrhage. Lewis JM, Puklin JE. PMID: 9445218 [PubMed - indexed for MEDLINE] 2714. J Virol. 1998 Feb;72(2):965-74. Attenuation of the vaccine Oka strain of varicella-zoster virus and role of glycoprotein C in alphaherpesvirus virulence demonstrated in the SCID-hu mouse. Moffat JF, Zerboni L, Kinchington PR, Grose C, Kaneshima H, Arvin AM. Department of Pediatrics, Stanford University School of Medicine, California 94305-5208, USA. The SCID-hu mouse implanted with human fetal tissue is a novel model for investigating human viral pathogenesis. Infection of human skin implants was used to investigate the basis for the clinical attenuation of the varicella-zoster virus (VZV) strain, V-Oka, from which the newly licensed vaccine is made. The pathogenicity of V-Oka was compared with that of its parent, P-Oka, another low-passage clinical isolate, strain Schenke (VZV-S), and VZV-Ellen, a standard laboratory strain. The role of glycoprotein C (gC) in infectivity for human skin was assessed by using gC-negative mutants of V-Oka and VZV-Ellen. Whereas all of these VZV strains replicated well in tissue culture, only low-passage clinical isolates were fully virulent in skin, as shown by infectious virus yields and analysis of implant tissues for VZV DNA and viral protein synthesis. The infectivity of V-Oka in skin was impaired compared to that of P-Oka, providing the first evidence of a virologic basis for the clinical attenuation of V-Oka. The infectivity of V-Oka was further diminished in the absence of gC expression. All strains except gC-Ellen retained some capacity to replicate in human skin, but cell-free virus was recovered only from implants infected with P-Oka or VZV-S. Although VZV is closely related to herpes simplex virus type 1 (HSV-1) genetically, experiments in the SCID-hu model revealed differences in tropism for human cells that correlated with differences in VZV and HSV-1 disease. VZV caused extensive infection of epidermal and dermal skin cells, while HSV-1 produced small, superficial lesions restricted to the epidermis. As in VZV, gC expression was a determinant for viral replication in skin. VZV infects human CD4+ and CD8+ T cells in thymus/liver implants, but HSV-1 was detected only in epithelial cells, with no evidence of lymphotropism. These SCID-hu mouse experiments show that the clinical attenuation of the varicella vaccine can be attributed to decreased replication of V-Oka in skin and that tissue culture passage alone reduces the ability of VZV to infect human skin in vivo. Furthermore, gC, which is dispensable for replication in tissue culture, plays a critical role in the virulence of the human alphaherpesviruses VZV and HSV-1 for human skin. PMCID: PMC124567 PMID: 9444989 [PubMed - indexed for MEDLINE] 2715. Ophthalmology. 1998 Jan;105(1):37-44; discussion 44-5. Polymerase chain reaction-based assays of vitreous samples for the diagnosis of viral retinitis. Use in diagnostic dilemmas. Knox CM, Chandler D, Short GA, Margolis TP. Francis I. Proctor Foundation, University of California, San Francisco 94122-0944, USA. OBJECTIVE: This study aimed to review the authors' results using polymerase chain reaction (PCR)-based assays for the diagnosis of viral retinitis. DESIGN: The study design was a retrospective case series. PARTICIPANTS: Thirty-seven patients (38 eyes) with active retinitis from whom vitreous biopsy specimens were received in the authors' laboratory for diagnostic evaluation. INTERVENTION: Vitreous biopsy specimens were evaluated with previously described PCR-based assays for cytomegalovirus (CMV), varicella zoster virus (VZV), and herpes simplex virus (HSV) DNA; clinical histories were reviewed. MAIN OUTCOME MEASURES: Laboratory findings and clinical course were measured. RESULTS: The results of the authors' assays were consistent with the long-term clinical course of each patient. Cytomegalovirus, VZV, or HSV DNA was detected in the vitreous from 24 patients. Cytomegalovirus DNA was detected in vitreous biopsy specimens from 10 patients (11 eyes). Nine patients (ten eyes) with acquired immune deficiency syndrome ultimately were diagnosed with CMV retinitis as they were followed clinically over time. Varicella zoster virus DNA was detected in vitreous biopsy specimens from eight patients; seven adult patients were ultimately diagnosed with acute retinal necrosis or progressive outer retinal necrosis. Herpes simplex virus DNA was detected in vitreous biopsy specimens from six patients; five patients had previous or subsequent herpes encephalitis. No viral DNA was detected in the vitreous from 13 patients; all were ultimately diagnosed with toxoplasmosis, syphilis, Behcet disease, fungal endophthalmitis, or idiopathic inflammation. CONCLUSIONS: These data further support the use of PCR-based assays of vitreous specimens in the diagnostic evaluation of patients with infectious retinitis. PMID: 9442777 [PubMed - indexed for MEDLINE] 2716. Z Arztl Fortbild Qualitatssich. 1997 Sep;91(6):533-6. [Sudden hyponatremia with unconsciousness. Case report and brief overview of the syndrome of inadequate antidiuresis (SIAD or Schwartz-Bartter syndrome] [Article in German] Reimann D, Gross P. Klinik für Innere Medizin, Universitätsklinikum C. G. Carus, Dresden. A sixty-six year old female was admitted to the hospital with an incomplete hemiparesis on the left side combined with a short episode of unconsciousness. According to her husband's account she had a seizure. Relevant laboratory measurements: plasma sodium concentration 113.9 mmol/l, plasma concentration of ADH 10.3 pg/ml, urine sodium concentration 44.4 mmol/l. The plasma concentrations of creatinine and urea were within normal limits. The working hypothesis was SIAD (syndrome of inappropriate antidiuresis) or Schwartz-Bartter-syndrome. The patient was treated immediately with water restriction (500-1000 ml/day), furosemide and i.v. replacement of urinary sodium losses by 3% NaCl. The analysis of cerebrospinal fluid showed pleocytosis and increased concentrations of immunoglobulins G and M. Serological diagnosis was positive for antigen of varicella-zoster virus. These observations were thought to be compatible with a diagnosis of SIAD in the setting of encephalitis. Under water restriction, infusion of 3% saline, treatment with loop diuretics and aciclovir (3 x 750 mg daily) the neurological function returned to normal within 2 days. A standard oral water load on the 14th hospital days showed a return to a normal water metabolism. PMID: 9441028 [PubMed - indexed for MEDLINE] 2717. Am J Ophthalmol. 1997 Sep;124(3):418-21. Intravitreal ganciclovir treatment in progressive outer retinal necrosis. Pérez-Blázquez E, Traspas R, Méndez Marín I, Montero M. Department of Ophthalmology, 12 de Octubre University Hospital, Madrid, Spain. epblazquez@mx2.Redestb.es PURPOSE: To report two patients with progressive outer retinal necrosis, which is presumed to be caused by the varicella-zoster virus in patients with acquired immunodeficiency syndrome (AIDS). METHOD: Case report. RESULTS: The patients were treated with intravenous foscarnet, 60 mg per kg of body weight three times per week, without response. Remission of retinal necrosis occurred with the commencement of intravitreal ganciclovir treatment, 400 mg two times per week. Laser photocoagulation was performed in both cases. Neither patient developed retinal detachment. CONCLUSIONS: Intravitreal ganciclovir treatment combined with systemic antiviral agent therapy in patients with progressive outer retinal necrosis may delay progress of the disease. Early photocoagulation may prevent the development of retinal detachment if retinal necrosis is controlled. PMID: 9439379 [PubMed - indexed for MEDLINE] 2718. Headache. 1997 Nov-Dec;37(10):663-4. Herpes zoster ophthalmicus mimicking carotid artery dissection: a case report. Verghese J, Kachroo A, Sparr SA. Department of Neurology, Albert Einstein College of Medicine, Bronx, NY 10461, USA. Herpes zoster is a common viral illness presenting with vesicular eruptions which are usually preceded by pain, erythema, and tenderness in a dermatomal distribution. The ophthalmic division of the trigeminal nerve is commonly involved (herpes zoster ophthalmicus). Early diagnosis before eruption of vesicles can be difficult and symptoms may be confused with other neurologic disorders. We present a patient with herpes zoster ophthalmicus who presented with face and neck pain associated with visual symptoms mimicking carotid artery dissection. Atypical presentation and benefits of early antiviral treatment are discussed. PMID: 9439089 [PubMed - indexed for MEDLINE] 2719. J Neuroophthalmol. 1997 Dec;17(4):262-5. Complete ophthalmoplegia after zoster ophthalmicus. Chang-Godinich A, Lee AG, Brazis PW, Liesegang TJ, Jones DB. Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA. Complete ophthalmoplegia following herpes zoster ophthalmicus (HZO) is rare. We report three cases of HZO-associated complete ophthalmoplegia and review thirteen additional cases reported in the English language medical literature over the past 30 years. HZO-associated complete ophthalmoplegia occurs mostly in individuals over the age of 50 years and usually occurs within one to two weeks of the development of cutaneous HZO. The prognosis for recovery is good, with-significant improvement typically seen within 2 months and complete or near resolution within 18 months time. PMID: 9427180 [PubMed - indexed for MEDLINE] 2720. Can Fam Physician. 1997 Dec;43:2123. Dilemmas in care of the elderly. Pereles L, Triscott J, Meiring P. Division of Geriatric Medicine, University of Alberta. PMCID: PMC2255083 PMID: 9426930 [PubMed - indexed for MEDLINE] 2721. Reg Anesth. 1997 Nov-Dec;22(6):575-8. The "three-in-one block" for treatment of pain in a patient with acute herpes zoster infection. Hadzić A, Vloka JD, Saff GN, Hertz R, Thys DM. Department of Anesthesiology, St. Luke's-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, New York 10025, USA. BACKGROUND AND OBJECTIVES: Herpes zoster infection in elderly patients frequently results in disabling pain, carries a high risk of postherpetic neuralgia (PHN), and can pose a significant therapeutic challenge. METHODS: We describe a successful use of the perivascular technique of lumbar plexus blockade ("three-in-one block") for treatment of pain during acute herpes zoster infection in an 82-year-old severely ill patient in whom other modalities were contraindicated. RESULTS: Three-in-one block using 40 mL of 0.25% bupivacaine with 1:300,000 epinephrine resulted in excellent pain relief that lasted for 2 weeks. CONCLUSIONS: The perivascular technique of lumbar plexus blockade may be a useful alternative to epidural and paravertebral techniques of lumbar blockade in the occasional patient for whom these other approaches are contraindicated. PMID: 9425976 [PubMed - indexed for MEDLINE] 2722. J Am Acad Dermatol. 1997 Dec;37(6):1022. Cutaneous localization of B-cell chronic lymphocytic leukemia at the site of varicella/herpesvirus eruptions. Cerroni L, Kerl H. Comment on: J Am Acad Dermatol. 1997 Jan;36(1):98-9. PMID: 9418787 [PubMed - indexed for MEDLINE] 2723. Pain. 1997 Oct;73(1):97-9. Mexiletine-induced severe skin eruption, fever, eosinophilia, atypical lymphocytosis, and liver dysfunction. Higa K, Hirata K, Dan K. Department of Anesthesiology, School of Medicine, Fukuoka University, Japan. higak@msat.fukuoka-u.ac.jp A 64-year-old man developed a severe generalized pruritic morbilliform skin eruption, fever, eosinophilia, atypical lymphocytosis, and liver dysfunction 30 days after ingestion of mexiletine, a sodium channel blocker, prescribed to treat postherpetic neuralgia. Following intravenous dexamethasone, body temperature normalized the next day. However, the skin eruption did not disappear completely for 4 weeks. The patch test was positive for mexiletine. Clinical features and the result of patch test indicated that the patient developed hypersensitivity syndrome, a severe adverse cutaneous drug reaction, caused by mexiletine. We propose that mexiletine be added to the list of drugs that can cause severe adverse cutaneous drug reactions and that patients receiving mexiletine be warned to stop taking the drug immediately if a skin eruption occurs. PMID: 9414061 [PubMed - indexed for MEDLINE] 2724. New Microbiol. 1997 Oct;20(4):351-4. Detection of varicella zoster virus DNA in single trigeminal ganglia by polymerase chain reaction. Mainka C, Wolff MH. Institute of Microbiology and Virology, University Witten/Herdecke, Germany. Single human trigeminal ganglia were studied for DNA sequences of varicella zoster virus immediate early gene 63 by PCR. Out of 24 trigeminal ganglia five were tested positive for VZV DNA by standard PCR (21%), in six more VZV DNA was detectable using nested PCR (46%). PMID: 9385606 [PubMed - indexed for MEDLINE] 2725. BMJ. 1997 Nov 1;315(7116):1163. Steroids should never be given until possible herpes zoster infection has been excluded. Devine JC. Comment in: BMJ. 1998 Jan 17;316(7126):233-4. BMJ. 1998 Jan 17;316(7126):234. PMCID: PMC2127728 PMID: 9374910 [PubMed - indexed for MEDLINE] 2726. Urol Nurs. 1997 Sep;17(3):119-21. Herpes zoster as a reversible cause of neurogenic bladder. Wozniak-Petrofsky J. PMID: 9349049 [PubMed - indexed for MEDLINE] 2727. J Infect Dis. 1997 Dec;176(6):1496-500. Varicella-zoster virus infection in children with underlying human immunodeficiency virus infection. Gershon AA, Mervish N, LaRussa P, Steinberg S, Lo SH, Hodes D, Fikrig S, Bonagura V, Bakshi S. Department of Pediatrics, Columbia University College of Physicians & Surgeons, and Mt. Sinai Medical Center, New York, New York 10032, USA. This article describes a prospective longitudinal study of varicella-zoster virus (VZV) infections in human immunodeficiency virus (HIV)-infected children, designed to determine their natural history of VZV infection and possible effects of VZV on the progression of HIV infection. Varicella was usually not a serious acute problem, and it did not seem to precede clinical deterioration. The rate of zoster was high: 70% in children with low levels of CD4+ lymphocytes at the time of development of varicella. It is predicted that immunization with live attenuated varicella vaccine is unlikely to be deleterious to HIV-infected children. Moreover, if they are immunized when they still have relatively normal levels of CD4+ lymphocytes, they may have a lower rate of reactivation of VZV than if they were allowed to develop natural varicella when their CD4+ cell counts have fallen to low levels as a result of progressive HIV infection. PMID: 9395360 [PubMed - indexed for MEDLINE] 2728. Acta Derm Venereol. 1997 Nov;77(6):491-2. Zosteriform lichen planus without evidence of herpes simplex virus or varicella-zoster virus by polymerase chain reaction. Report of two cases. Lutz ME, Perniciaro C, Lim KK. Comment in: Acta Derm Venereol. 1998 Jul;78(4):300. PMID: 9394999 [PubMed - indexed for MEDLINE] 2729. J Child Neurol. 1997 Oct;12(7):464-6. Childhood AIDS, varicella zoster, and cerebral vasculopathy. Frank Y, Lu D, Pavlakis S, Black K, LaRussa P, Hyman RA. North Shore University Hospital, New York, USA. PMID: 9373805 [PubMed - indexed for MEDLINE] 2730. Arch Fam Med. 1997 Nov-Dec;6(6):537-41. Concerns regarding universal varicella immunization. Time will tell. MacFarlane LL, Sanders ML, Carek PJ. Department of Family Medicine, Medical University of South Carolina, Charleston, USA. macfarll@musc.edu The American Academy of Pediatrics, the Advisory Committee on Immunization Practices, and the American Academy of Family Physicians now recommend universal immunization for varicella for all susceptible children and adolescents. Although the varicella vaccine appears safe and efficacious, it is unknown how universal immunization will influence the epidemiology of varicella infections. The duration of immunity, both conferred and passive reinoculation, remains a concern and must continue to be evaluated in the population of vaccinees. As universal immunization is implemented, the cost-effectiveness of such a program will need to be evaluated. Physicians and parents must be educated about the risks and benefits of vaccination vs natural infection. PMID: 9371046 [PubMed - indexed for MEDLINE] 2731. Am J Obstet Gynecol. 1997 Oct;177(4):894-8. Prenatal diagnosis of fetal varicella-zoster virus infection with polymerase chain reaction of amniotic fluid in 107 cases. Mouly F, Mirlesse V, Méritet JF, Rozenberg F, Poissonier MH, Lebon P, Daffos F. Laboratoire de Recherche sur les Infections Virales, Hôpital Saint Vincent de Paul, Université René Descartes, Paris, France. OBJECTIVE: Varicella, resulting from primary infection by varicella zoster virus, carries a risk of severe congenital varicella. Prenatal diagnosis is rarely applied because methods remain to be validated. STUDY DESIGN: From 1989 to 1994, 107 women contracted clinical varicella before 24 weeks of pregnancy. Amniocentesis was performed in all cases, with simultaneous fetal blood sampling in 82 cases. Virus was detected in amniotic fluid by cell culture inoculation and polymerase chain reaction. Fetal blood was tested for anti-varicella zoster virus immunoglobulin M. RESULTS: Of the 107 amniotic fluid samples tested, nine of 107 (8.4%) were positive by polymerase chain reaction, but only two of these (1.8%) were positive in cell culture; none of the blood samples from infected fetuses were positive for specific anti-varicella zoster virus immunoglobulin M. The outcome of 99 pregnancies was fully documented. CONCLUSION: The risk of transplacental passage before 24 weeks of pregnancy was 8.4% in our series. The risk of congenital varicella is 3 in 107 (2.8%) and that of isolated postnatal varicella zoster infection is 3 in 78 (3.8%). Polymerase chain reaction is more sensitive than cell culture for the detection of varicella zoster virus in amniotic fluid. PMID: 9369842 [PubMed - indexed for MEDLINE] 2732. Indian J Gastroenterol. 1997 Oct;16(4):153-4. Intestinal lymphangiectasia: presentation in pregnancy and association with herpes zoster and alopecia. Ghoshal UC, Gupta R, Aggarwal R, Puri AS, Naik SR. Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow. We report a woman with intestinal lymphangiectasia whose symptoms were wrongly attributed to pregnancy; the diagnosis was made in the postpartum period. She also developed alopecia and herpes zoster. PMID: 9357190 [PubMed - indexed for MEDLINE] 2733. J Infect. 1997 Sep;35(2):183-5. Disseminated cutaneous zoster and aseptic meningitis in a previously healthy patient. Moriuchi H, Moriuchi M, Sun CC, Trucksis M. Department of Internal Medicine, University of Maryland School of Medicine, Baltimore, U.S.A. A previously healthy, 37-year-old immunocompetent man presented with disseminated cutaneous zoster and aseptic meningitis. Varicella zoster virus DNA was recovered from the cerebrospinal fluid (CSF) by the polymerase chain reaction. Cytological evaluation of the CSF revealed 'reactive, highly atypical lymphocytosis'. The patient fully recovered after treatment with aciclovir. PMID: 9354356 [PubMed - indexed for MEDLINE] 2734. Int J Dermatol. 1997 Sep;36(9):717-8. Herpes zoster-like Sweet's syndrome in acute myelogenous leukemia. Chiang CT, Chan HL, Kuo TT, Wang PN. PMID: 9352420 [PubMed - indexed for MEDLINE] 2735. Int J Dermatol. 1997 Sep;36(9):667-72. A retrospective study of the clinical presentation and outcome of herpes zoster in a tertiary dermatology outpatient referral clinic. Goh CL, Khoo L. Institute of Dermatology, National Skin Center, Singapore. BACKGROUND: This is a retrospective study of the epidemiology and morbidity of herpes zoster and the risk factors for herpes zoster morbidity in Singapore. RESULTS: The mean age of 164 patients with herpes zoster seen at our dermatology clinic between January 1994 and December 1995 was 48.8 years, with a sex ratio of 1:1. The common presenting symptoms were pain (90%), feelings of helplessness and depression (20%), and flu-like symptoms (12%). The commonest prodromes were pain (41%), itching (27%), and paresthesia (12%). Prodromal pain was more frequently experienced by patients aged more than 50 years (42%) than by patients aged less than 30 years (25%). The thoracic (45%) and cervical (23%) dermatomes were the most commonly affected in all age groups. There was no statistically significant difference in the frequency of dermatomal distribution among the different age groups and between the sexes. Pain was experienced by almost all (95%) patients during the course of their disease. It tended to be more severe in older patients. Burning (26%), stabbing (15%), and shooting (15%) pain were the most common types experienced. Post-herpetic neuralgia was significantly more common in older patients. The prevalence of post-herpetic neuralgia decreased over time in all age groups. A higher proportion of older patients (more than 50 years of age) (20%) suffered from post-herpetic neuralgia compared with younger patients (less than 30 years of age) (7%) (not significant). Patients in all age groups considered acute pain (46%) and persistent pain (25%) to be their most unbearable symptoms during the course of herpes zoster. The most significant problems caused by herpes zoster pain were insomnia (25%), misery (feeling helpless and depressed) (20%), limitation of movement (9%), and inability to continue work (8%). Insomnia was significantly more commonly experienced by patients more than 50 years of age (36%) than those less than 30 years of age (P = 0.026). Few patients (9%) consulted their general practitioner (GP) during the prodrome or on the day of appearance of skin eruptions. Most patients (45%) consulted their GP within the first 3 days of the onset of skin eruptions; 33% sought treatment more than 3 days after the appearance of zoster symptoms. Only 30% of patients were willing to pay more than S$200 for antiviral therapy. Most (43%) were only prepared to pay for antiviral treatment if it cost less than S$200. The most important features the patients wished to derive from antiviral therapy were a shortening of the duration of skin lesions (55%) and a reduction in the severity of pain (acute and chronic) (30%). CONCLUSIONS: Our study indicated that older patients (aged more than 50 years) were at a higher risk of developing post-herpetic neuralgia. They were also more likely to suffer morbidity, e.g. insomnia. There is a need to educate patients at risk to identify the prodrome and skin eruptions of herpes zoster so that early antiviral therapy can be considered. PMID: 9352407 [PubMed - indexed for MEDLINE] 2736. J Clin Microbiol. 1997 Nov;35(11):2807-9. Molecular epidemiology of varicella-zoster virus in East London, England, between 1971 and 1995. Hawrami K, Hart IJ, Pereira F, Argent S, Bannister B, Bovill B, Carrington D, Ogilvie M, Rawstorne S, Tryhorn Y, Breuer J. Department of Medical Microbiology and Virology, St. Bartholomew's and Royal Hospital School of Medicine and Dentistry, Queen Mary Westfield College, London, United Kingdom. The molecular epidemiology of varicella-zoster virus in London, England, between 1971 and 1995 was examined by using two informative polymorphic markers, variable repeat region R5 and a BglI restriction site in gene 54. Viruses from 105 cases of chickenpox and 144 of zoster were typed. Two alleles of R5, A and B, were found at prevalences of 89 and 6%, respectively. No difference in allele frequency between the zoster and chickenpox cases was found, and no change in the frequencies of these alleles was observed to occur over time. By contrast, a BglI restriction site (BglI+) was found with increasing frequency over time among cases of varicella (P < 0.005) and, to a lesser extent, cases of zoster. The BglI+ polymorphism was strongly associated (P < 0.0005) with zoster in subjects who had immigrated to the United Kingdom from countries with low adult immunity to varicella (LAIV). Sixty-three percent of the subjects with zoster who had emigrated from countries with LAIV carried the BglI+ virus, in contrast to 10% of adults who had grown up in countries with high adult immunity to varicella. The significance of these data, in view of the changing epidemiology of chickenpox, is discussed. PMCID: PMC230066 PMID: 9350738 [PubMed - indexed for MEDLINE] 2737. J Okla State Med Assoc. 1997 Sep-Oct;90(7):376-82. AMA Council on Scientific Affairs. Immunization of health care workers with varicella vaccine. [No authors listed] Varicella-zoster virus (VZV) is the etiologic agent of two common diseases: varicella (chickenpox) and herpes zoster (shingles). Groups such as infants under one year of age, the immunocompromised, and adults are at increased risk of developing complications from VZV infection. The transmission of VZV within health care facilities from contact with infected patients, staff, and visitors is a potentially serious problem. Nosocomial outbreaks of varicella can result in significant morbidity and mortality in high-risk patients, particularly in pediatric wards. VZV transmission to susceptible individuals is difficult to prevent because exposures may occur before appropriate infection control procedures can be implemented. In 1995, a varicella vaccine was approved for use in the United States. The vaccine has been shown to be fairly effective in preventing varicella in adults and very effective in preventing severe disease. While current data indicate that the vaccine is safe and poses minimal risks, more research is needed to address concerns about the long-term safety, efficacy, and epidemiological impact of more widespread use of the vaccine. It is important for health care workers, especially those working with high-risk groups, to know their VZV immune status. Unless contraindicated, health care workers who have no history of VZV infection and are serologically negative should be considered a priority for immunization with the varicella vaccine. Administration of the vaccine to health care workers could reduce nosocomial transmission of VZV. Furthermore, significant cost and labor savings could be realized by avoiding expensive and potentially disruptive infection control measures. PMID: 9379251 [PubMed - indexed for MEDLINE] 2738. J Gen Intern Med. 1997 Oct;12(10):626-8. Translating statistics for use in the clinic. Atkins CD. PMCID: PMC1497176 PMID: 9346459 [PubMed - indexed for MEDLINE] 2739. Plast Reconstr Surg. 1997 Oct;100(5):1357-9. Herpes zoster after breast augmentation. Tantille MB, Adams WP, Duffy FJ. PMID: 9326805 [PubMed - indexed for MEDLINE] 2740. Dent Clin North Am. 1997 Oct;41(4):877-90. Diagnosis and treatment of common oral lesions found in the elderly. Fantasia JE. Department of Dental Medicine, Long Island Jewish Medical Center, New Hyde Park, New York 11040, USA. A wide variety of oral lesions are recognized in the geriatric patient. The most common lesions include neoplasia, immunologic based mucosal disease, hematological disorders, oral manifestation of systemic disease, and conditions characterized by oral or facial pain. Diagnostic and treatment considerations for leukoplakia, carcinoma, metastatic disease, candidiasis, herpes zoster, plasmacytoma, myeloma, lymphoma, several of the more common vesiculoulcerative mucosal diseases and idiopathic burning mouth syndrome are presented. PMID: 9344282 [PubMed - indexed for MEDLINE] 2741. Muscle Nerve. 1997 Nov;20(11):1433-8. Motor involvement in acute herpes zoster. Haanpää M, Häkkinen V, Nurmikko T. Department of Neurology, Tampere University Hospital, Finland. Motor involvement in acute herpes zoster is considered rare, but its incidence is unknown. In a sample of 40 patients with acute herpes zoster of varying severity, an abnormal electromyogram (EMG) (fibrillation, positive waves, high-frequency discharges) was found in 21 (53%), suggesting extension of inflammation to the anterior horn and/or anterior motor roots. In the majority of patients these changes were not confined to the segment invaded by the rash but were widespread, extending several segments cranially and caudally, and both ipsi- and contralaterally. In 5 (13%) patients these changes became more extensive on repeat EMG over a period of months. There was no association between severity of rash, pain, postherpetic neuralgia, and EMG changes. We conclude that widespread subclinical motor involvement is relatively common in herpes zoster, may last for months, and is easily detectable by EMG. PMID: 9342160 [PubMed - indexed for MEDLINE] 2742. Bone Marrow Transplant. 1997 Sep;20(5):381-3. Varicella vaccination in children after bone marrow transplantation. Sauerbrei A, Prager J, Hengst U, Zintl F, Wutzler P. Institute for Antiviral Chemotherapy of the Friedrich Schiller University, Jena, Germany. Herpes zoster (HZ) is one of the most common complications after bone marrow transplantation (BMT) in children. Apart from treatment with antiviral drugs, effective prevention by active immunization with varicella-zoster virus (VZV) appears to be possible. In this study 15 patients were vaccinated with a live attenuated VZV vaccine (Varilrix) 12-23 months after BMT. The vaccine was well tolerated without adverse reactions. Chickenpox or HZ were not observed for up to 2 years after immunization. Eight out of nine seronegative patients seroconverted and in six virus-specific IgG could still be demonstrated 2 years later. The incidence of VZV diseases in 133 non-immunized children after BMT was 26.3%. Infections usually occurred within 18 months after BMT. PMID: 9339753 [PubMed - indexed for MEDLINE] 2743. Bone Marrow Transplant. 1997 Sep;20(5):369-74. Allogeneic bone marrow transplantation for relapsed and refractory Hodgkin's disease and non-Hodgkin's lymphoma. Dann EJ, Daugherty CK, Larson RA. Department of Medicine, The University of Chicago, IL 60637-1470, USA. The relative benefit of allogeneic bone marrow transplantation (alloBMT) vs autologous BMT (autoBMT) for patients with relapsed or refractory Hodgkin's disease (HD) or non-Hodgkin's lymphoma (NHL) remains uncertain. Toxicity from graft-versus-host disease (GVHD) may diminish the potential benefits both of graft-versus-tumor activity and of receiving uncontaminated donor marrow stem cells. From 1987 to 1995, 27 adults (ages 18-60 years; median 36) underwent alloBMT for lymphoma after failure of standard chemotherapy. Twenty-one had NHL and six had HD (nodular sclerosis). Thirteen patients had primary refractory disease or chemotherapy-resistant relapses; two of these had relapsed after autoBMT. Three patients had untested relapses (one of them had relapsed after autoBMT), and 11 had chemotherapy-sensitive relapses. Twenty-four received HLA-matched bone marrow from a sibling (one twin); three received haploidentical marrow cells. Nine (33%) died from lymphoma. Eleven (41%) died of treatment-related causes. Opportunistic infections were a substantial problem leading to eight of these deaths (30%). Six patients (22%) survive free of lymphoma 17-70 months post-BMT (median, 56 months); four had had sensitive relapses, one had had a resistant relapse, and one had had nontested relapse. Three have chronic GVHD (limited in one; extensive in two). One HD patient who had relapsed after autoBMT remains in remission 19 months after alloBMT. No therapy-related myelodysplasia has been observed. We conclude that alloBMT has substantial morbidity in heavily pretreated lymphoma patients due to acute toxicity, infections and GVHD. However, 22% of our HD/NHL patients have had long-term disease-free survival. PMID: 9339751 [PubMed - indexed for MEDLINE] 2744. JAMA. 1997 Oct 8;278(14):1148; author reply 1149. Contempo 1997: dermatology. Marks L, Saltzman R. Comment on: JAMA. 1997 Jun 18;277(23):1848-50. PMID: 9326466 [PubMed - indexed for MEDLINE] 2745. Arch Dermatol. 1997 Oct;133(10):1316-7. Comedones appearing after herpes zoster infection: a report of 7 cases. del Río E, Nova A, Allegue F, Fachal C, Veiga HA, Peñaranda JM. PMID: 9382580 [PubMed - indexed for MEDLINE] 2746. J Infect Dis. 1997 Oct;176(4):1080-4. Polymerase chain reaction detection and clinical significance of varicella-zoster virus in cerebrospinal fluid from human immunodeficiency virus-infected patients. Burke DG, Kalayjian RC, Vann VR, Madreperla SA, Shick HE, Leonard DG. Department of Medicine, University Hospitals of Cleveland, Ohio, USA. Varicella-zoster virus (VZV) causes ocular and other central nervous system (CNS) disease in human immunodeficiency virus (HIV)-infected persons. To study the prevalence of CNS disease due to VZV, cerebrospinal fluid (CSF) specimens from 84 consecutive HIV-infected patients with new neurologic symptoms were tested for VZV DNA by a polymerase chain reaction (PCR) assay. Six patients were PCR-positive for VZV in CSF; 3 additional patients were subsequently identified who were not part of the serial population sample. Among these 9 patients, all had clinical presentations consistent with ocular and other CNS disease due to VZV; 4 were without zoster on presentation. Sustained improvement in association with antiviral therapy was observed in 3. Therefore, VZV DNA was detected in the CSF of 7% of HIV-infected patients presenting with neurologic symptoms; the diagnosis of VZV-related CNS disease was facilitated by this assay; improvement in association with antiviral therapy was observed in some patients. PMID: 9333172 [PubMed - indexed for MEDLINE] 2747. Anesth Analg. 1997 Oct;85(4):870-1. Stellate ganglion block improved loss of visual acuity caused by retrobulbar optic neuritis after herpes zoster. Mori T, Terai T, Hatano M, Oda Y, Asada A, Moriwaki M. Department of Anesthesiology and Intensive Care Medicine, Osaka City University Medical School, Japan. PMID: 9322472 [PubMed - indexed for MEDLINE] 2748. Clin Infect Dis. 1997 Sep;25(3):634-9. Varicella-zoster virus (VZV) DNA in cerebrospinal fluid of patients infected with human immunodeficiency virus: VZV disease of the central nervous system or subclinical reactivation of VZV infection? Cinque P, Bossolasco S, Vago L, Fornara C, Lipari S, Racca S, Lazzarin A, Linde A. Department of Infectious Diseases, San Raffaele Scientific Institute, Luigi Sacco Hospital, Milan, Italy. To identify varicella-zoster virus (VZV) infections of the nervous system in patients infected with human immunodeficiency virus (HIV), polymerase chain reaction (PCR) analysis of cerebrospinal fluid (CSF) samples from 514 consecutive HIV-infected patients with neurological disease was performed to detect VZV DNA. VZV DNA was detected in CSF of 13 (2.5%) of 514 patients. Four of 13 patients had VZV encephalitis or meningoencephalomyelitis. These four patients received intravenous acyclovir therapy; CSF became negative for VZV DNA and clinical conditions improved for two, whereas CSF remained positive for VZV DNA and clinical conditions worsened until death for two. In nine of 13 patients, the neurological symptoms were likely caused by other simultaneous HIV-related complications in the central nervous system. After intravenous therapy with high doses of acyclovir or foscarnet, VZV was cleared from CSF in eight of nine patients. VZV DNA can be detected in CSF of HIV-infected patients in association with either manifestations of neurological VZV disease or subclinical reactivation of VZV infection. Antiviral treatment may be effective in suppressing VZV replication in the nervous system. PMID: 9314452 [PubMed - indexed for MEDLINE] 2749. J Fam Pract. 1997 Sep;45(3):203-4. Treatments for postherpetic neuralgia. Chasuk R. Baton Rouge General Medical Center, Louisiana, USA. rob_chasuk @generalhealth.org PMID: 9312562 [PubMed - indexed for MEDLINE] 2750. Ophthalmology. 1997 Sep;104(9):1421-5. Herpes zoster sine herpete. A potential cause of iridoplegic granulomatous iridocyclitis. Schwab IR. Department of Ophthalmology, University of California, Davis, Medical Center, Sacramento, USA. OBJECTIVE: Herpes zoster ophthalmicus (HZO) is a recurrence of varicella zoster virus involving cranial nerve V-1, but does not always have skin manifestations. The objective of this work is to study iridoplegic granulomatous iridocyclitis as an acute, fulminant iridocyclitis that probably is caused by the recurrence of varicella zoster virus without skin eruptions. PARTICIPANTS: The author reports 15 cases of iridoplegia granulomatous iridocyclitis with involvement of the anterior uveal tract without known skin eruptions. RESULTS: All patients have had a clinical course of iridocyclitis closely resembling those cases of herpes zoster with skin eruptions. Nine of the 15 are documented to have had a recurrence of varicella zoster virus with an appropriate rise and fall of systemic titers. The remaining six patients had clinical findings, including loss of accommodation, iridoplegia, and sectoral iris atrophy that were more typical for HZO than other infectious agents. CONCLUSIONS: Iridoplegic granulomatous iridocyclitis is a newly described, acute, fulminant uveitis probably caused by a herpes virus and most probably by varicella zoster virus. Herpes zoster sine herpete (erupticum) should be suspected as a potential diagnosis in patients with appropriate anterior segment manifestations. Further study is necessary to discern if any of such cases could be caused by herpes simplex. PMID: 9307636 [PubMed - indexed for MEDLINE] 2751. J Neuroophthalmol. 1997 Sep;17(3):199-201. Ocular findings in Ramsay Hunt syndrome. Mansour AM, Bailey BJ. Department of Ophthalmology, University of Texas Medical Branch, Galveston, USA. PMID: 9304535 [PubMed - indexed for MEDLINE] 2752. J Immunol. 1997 Sep 15;159(6):2802-6. Recognition of the latency-associated immediate early protein IE63 of varicella-zoster virus by human memory T lymphocytes. Sadzot-Delvaux C, Kinchington PR, Debrus S, Rentier B, Arvin AM. Department of Pediatrics, Stanford University School of Medicine, CA 94305, USA. Varicella-zoster virus (VZV) is a human alpha herpesvirus that establishes latency in sensory ganglia. Latency is characterized by the abundant expression of the immediate early protein 63 (IE63), whereas other viral proteins have not yet been detected during the quiescent phase of VZV infection. The IE63 protein is a component of the virion and is expressed very early in the infectious cycle. The IE63 protein is also expressed in skin during episodes of varicella and herpes zoster. We have evaluated the cell-mediated immune response against IE63 in naturally immune adults with a history of chickenpox, by T lymphoproliferation and cytotoxicity assays. Among donors who had T cell proliferation to unfractionated VZV Ags from infected cell extract, 59% had T cell recognition of purified IE63. The CTL response to IE63 was equivalent to CTL recognition of IE62, the major tegument component of VZV whose immunogenicity has been previously described. IgG Abs against IE63 were detected in serum from healthy immune adults. These results indicate that IE63 is an important target of immunity to VZV. T cell recognition of IE63 is likely to be involved in controlling VZV reactivation from latency. PMID: 9300702 [PubMed - indexed for MEDLINE] 2753. J Med Virol. 1997 Sep;53(1):63-8. Neutralizing antibody responses induced by varicella-zoster virus gE and gB glycoproteins following infection, reactivation or immunization. Haumont M, Jurdan M, Kangro H, Jacquet A, Massaer M, Deleersnyder V, Garcia L, Bosseloir A, Bruck C, Bollen A, Jacobs P. Applied Genetics, University of Brussels, Nivelles, Belgium. The purpose of this study was to compare the antibody responses to varicella-zoster virus (VZV) gE and gB after natural VZV infection and after vaccination with live attenuated OKA vaccine in order to determine the relative importance of these proteins as components of a subunit vaccine. Anti-VZV antibody titers determined by IFA were of the same order of magnitude in sera from individuals with a history of varicella and in vaccinated children but higher in individuals given booster vaccination. The titers of anti-gE and anti-gB antibodies were measured by ELISA using recombinant gE or gB as capture antigen. From these experiments, it appears that the ratio of anti-gE to anti-gB antibody is highly variable from one individual to another but relatively stable over a long period of time for a particular individual, even after a zoster episode. Neutralizing antibodies directed against gE or gB were also measured by subtracting the neutralization titers obtained before and after depletion of the specific antibodies on immobilized recombinant gE, gB, or both. This showed that, with respect to neutralization, anti-gE and anti-gB are equally prevalent in vaccinated children and that anti-gE is generally, but not always, predominant over anti-gB in VZV-infected individuals. Finally, antibodies to these two glycoproteins appear to be predominant among the neutralizing antibodies directed to other VZV antigens. PMID: 9298734 [PubMed - indexed for MEDLINE] 2754. J Med Virol. 1997 Sep;53(1):60-2. Analysis of United Kingdom wild-type strains of varicella-zoster virus: differentiation from the Oka vaccine strain. Hawrami K, Breuer J. Department of Medical Microbiology, St. Bartholomew's, Royal London School of Medicine and Dentistry, England. In Japan and the United States, where vaccination against varicella-zoster virus (VZV) infection with the live attenuated Oka strain of varicella is routine, cases of chickenpox or shingles occurring in vaccinees can be caused by either wild-type or vaccine virus. Differentiating such cases is important epidemiologically and can be achieved only using molecular typing methods. In the United Kingdom, the Oka vaccine is being considered for use in groups at risk of severe primary varicella, such as seronegative immunocompromised patients and women who may be considering pregnancy. In addition, seronegative health workers who may be occupationally exposed to VZV infection might also be offered vaccination. We analysed 249 U.K. wild-type VZV strains, 105 from cases of chickenpox and 144 from shingles cases, to determine whether they could be distinguished from Oka by the genotyping systems used in Japan and the United States. Four polymorphic loci were examined, a Pst 1 restriction site in gene 38, a Bgl 1 restriction site in gene 54, the R5 repeat region, and the R2 repeat region. The results suggest that U.K. strains of VZV are more similar to U.S. strains than to Japanese strains. All the U.K. wild-type viruses were positive for the Pst 1-1 restriction site, unlike Oka, which is negative. However, one of thirty strains was indistinguishable from Oka at all other loci. PMID: 9298733 [PubMed - indexed for MEDLINE] 2755. Laryngoscope. 1997 Sep;107(9):1165-75. Molecular temporal bone pathology: II. Ramsay Hunt syndrome (herpes zoster oticus). Wackym PA. Department of Otolaryngology, Mount Sinai School of Medicine, New York, New York 10029-6574, U.S.A. In 1907 J. Ramsay Hunt suggested that herpes zoster oticus resulted from a geniculate ganglionitis; however, many contemporary authors believe that this disorder represents a neuritis or polycranial neuropathy. Herpes varicella-zoster viral (VZV) DNA was identified, using the polymerase chain reaction, in archival celloidin-embedded temporal bone sections from two patients who clinically had Ramsay Hunt syndrome (herpes zoster oticus). The presence of VZV was confirmed by sequencing the PCR products. These experiments demonstrated that VZV genomic DNA was present in the geniculate ganglion of the side with facial paralysis and cutaneous recrudescence in both patients and in the clinically unaffected side in patient 1. In addition, patient 2 had a sudden hearing loss and was found to have VZV genomic DNA in sections from the affected side containing the spiral ganglion, Scarpa's ganglion, organ of Corti, and macula of the saccule. No VZV genomic DNA was identified in temporal bone sections from five patients with Bell's palsy and ten patients without evidence of otologic disease. In this study, the histopathology of these two cases yielded complementary information regarding the role of VZV in herpes zoster oticus. These data suggest that in patients with Ramsay Hunt syndrome, latent VZV is located in the geniculate ganglia and may be present in the auditory and vestibular primary afferent ganglia in some patients. PMID: 9292598 [PubMed - indexed for MEDLINE] 2756. J Pain Symptom Manage. 1997 Sep;14(3):134-5. Abrupt spontaneous remission of postherpetic neuralgia after coma. Ng KF, Chan WS, Yang JC. PMID: 9291699 [PubMed - indexed for MEDLINE] 2757. J Infect Dis. 1997 Sep;176(3):578-85. Early reconstitution of immunity and decreased severity of herpes zoster in bone marrow transplant recipients immunized with inactivated varicella vaccine. Redman RL, Nader S, Zerboni L, Liu C, Wong RM, Brown BW, Arvin AM. Department of Pediatrics, Stanford University School of Medicine, California 94305, USA. Varicella-zoster virus (VZV) causes herpes zoster after bone marrow transplantation (BMT). The immunogenicity of heat-inactivated varicella vaccine and effects on VZV pathogenesis were evaluated in 75 BMT patients randomized to receive vaccine or no intervention. Among 14 patients given a single dose at 1 month after transplantation, the mean (+/-SE) stimulation index (SI) was 12.20 +/- 3.13 compared with 4.83 +/- 2.74 (P = .036) in 14 unvaccinated patients, but clinical disease was not altered. Among 24 patients vaccinated at 1, 2, and 3 months, mean SI was 8.43 +/- 3.89 versus 2.00 +/- 0.33 (P = .014) in 23 unvaccinated patients at 4 months and 8.56 +/- 2.81 versus 5.30 +/- 2.47 (P = .043) at 5 months. Disease severity associated with VZV reactivation was decreased dramatically in vaccinees given three doses; severity scores were 6.4 +/- 1.0 versus 11.8 +/- 1.1 (P = .007). This experience with varicella vaccine in BMT patients is the first evidence that active immunization can reduce morbidity due to herpesvirus reactivation in high-risk populations. PMID: 9291302 [PubMed - indexed for MEDLINE] 2758. N Engl J Med. 1997 Aug 21;337(8):535. Images in clinical medicine. Positive Tzanck smear. Cohen LM. Harvard Medical School, Cambridge, MA 02139, USA. PMID: 9262497 [PubMed - indexed for MEDLINE] 2759. Rev Med Liege. 1997 Aug;52(8):553-5. [Drug of the month. Valaciclovir (Zelitrex)] [Article in French] Piérard GE, Nikkels AF. Service de Dermatopathologie, Université de Liège. PMID: 9381007 [PubMed - indexed for MEDLINE] 2760. Neuroimaging Clin N Am. 1997 Aug;7(3):513-25. Central nervous system opportunistic infections. Wright D, Schneider A, Berger JR. Department of Neurology, University of Kentucky College of Medicine, Lexington, USA. The spectrum of opportunistic infections occurring in association with human-immunodeficiency virus, type 1, is very broad. These infections develop most frequently in the setting of advanced immunosuppression. There is no part of the neuraxis that is immune to these complications and the concurrence of more than one infectious illness may always be considered. The neuroimaging features, when coupled with the clinical and laboratory findings, often suggest the correct diagnosis and enable the physician to initiate therapy. PMID: 9376966 [PubMed - indexed for MEDLINE] 2761. Arch Phys Med Rehabil. 1997 Aug;78(8):880-2. Herpes zoster polyradiculopathy. Braverman DL, Ku A, Nagler W. Department of Rehabilitation Medicine, The New York Hospital-Cornell Medical Center, New York, USA. Herpes zoster infection, resulting from reactivation of the dormant varicella zoster virus in the dorsal root ganglia, usually causes a painful dermatomal vesicular rash. Rarely, associated peripheral motor weakness is present, the mechanism of which is unclear. Three patients are reported who had focal limb muscle weakness associated with zoster infection. Physical and occupational therapy played a key role in motor function recovery of the patients, yet emphasis on the rehabilitation of postherpetic motor weakness is lacking in the literature. Physiatrists evaluating patients with limb muscle weakness following herpes zoster infection should be alert to this condition. The clinical syndrome of herpes zoster radiculopathy and the rehabilitation of these patients are discussed. PMID: 9344310 [PubMed - indexed for MEDLINE] 2762. Br J Dermatol. 1997 Aug;137(2):259-61. Routine detection of herpes simplex virus and varicella zoster virus by polymerase chain reaction reveals that initial herpes zoster is frequently misdiagnosed as herpes simplex. Rübben A, Baron JM, Grussendorf-Conen EI. Department of Dermatology at the RWTH Aachen, Germany. The differential diagnosis of herpes simplex and zoster may require virological confirmation, yet virus typing is not regarded as necessary in routine dermatological assessment. In an attempt to evaluate the clinical benefits of the routine detection of herpes simplex virus (HSV) and varicella zoster virus (VZV), we analysed skin swabs from 110 patients who were diagnosed at the first clinical visit as having herpes simplex (n = 45) or zoster (n = 65). Viruses were typed using the polymerase chain reaction (PCR) with the general primer pair GPHV-RU. PCR analysis showed that at the initial clinical presentation, herpes simplex in these patients was not mistaken for zoster but that zoster was incorrectly diagnosed as herpes simplex in nine cases. Thus these results suggest that initial zoster often mimics herpes simplex, hence routine PCR diagnosis of HSV and VZV or alternative rapid diagnostic approaches may be beneficial in these cases. PMID: 9292077 [PubMed - indexed for MEDLINE] 2763. Br J Dermatol. 1997 Aug;137(2):255-8. Herpes zoster in three healthy children immunized with varicella vaccine (Oka/Biken); the causative virus differed from vaccine strain on PCR analysis of the IV variable region (R5) and of a PstI-site region. Na GY. Department of Dermatology, Fatima Hospital, Sin-Am Dong, Dong Gu, Taegu, South Korea. This study was undertaken to determine whether the causative virus was a vaccine-derived or wild-type virus when zoster occurred in healthy children immunized with varicella vaccine (Oka/Biken). The DNAs of clinical isolated strains and vaccine strain (Oka/Biken) were analyzed by the polymerase chain reaction with two sets of primers for the variable region IV (R5 tandem direct reiterations, TDR) and for the region with a PstI site in a middle portion of the long unique segment of the varicella zoster virus genome. Of six zoster patients after vaccination with Biken, three clinical isolates were examined and had two copies in R5 TDR and were PstI-site positive. Therefore, these strains were different from the vaccine-type strain (Oka/Biken), which had two copies in R5 TDR and was PstI-site-negative. The mean age of onset of zoster was 4 years. The mean age of vaccination was 25 months. The mean interval between vaccination and onset of zoster was 22 months. Hence the results indicate that the causative virus of zoster in healthy children immunized with varicella vaccine (Oka/Biken) was wild type and differed from the vaccine strain. Some vaccinees probably do not have protective immunity for a long time after immunization because the mean interval between vaccination and onset of zoster was 22 months. PMID: 9292076 [PubMed - indexed for MEDLINE] 2764. J Korean Med Sci. 1997 Aug;12(4):360-3. Recurrent herpes zoster myelitis. Baik JS, Kim WC, Heo JH, Zheng HY. Department of Neurology, Yonsei University College of Medicine. Recurrent zoster myelitis is quite rare. We present a previously healthy 27-year-old woman who developed recurrent attacks of myelopathy shortly after the characteristic skin rashes of herpes zoster. Magnetic resonance imaging studies demonstrated each lesion in the spinal cord at the same segments as the skin lesions. She had two attacks at opposite sites at the same spinal cord level and complete recovery after being treated with intravenous acyclovir. We suspect that direct invasion of varicella zoster virus was the cause of recurrent myelopathy in our patient. PMID: 9288637 [PubMed - indexed for MEDLINE] 2765. J Am Optom Assoc. 1997 Aug;68(8):527-38. Herpes zoster ophthalmicus and the immunocompromised host: a case report and review. McPherson RE. Moore Eye Institute, Brandywine Hospital, Exton, Pennsylvania, USA. BACKGROUND: Herpes zoster is the secondary form of varicella zoster virus disease, caused by the reactivation of the dormant virus in the sensory ganglia. It manifests as a unilateral cutaneous dermatitis with a prodromal fever and malaise. Herpes zoster ophthalmicus occurs when the ophthalmic division of the trigeminal nerve becomes afflicted. CASE REPORTS: This case represents a middle-aged female with breast carcinoma. Cancer radiotherapy and chemotherapy created an immunosuppressed state, which allowed the development of herpes zoster ophthalmicus. Most patients who manifest zoster are immunocompetent. However, with the increased incidence of immunodeficient states (e.g., chemotherapy, organ transplantation and acquired immunodeficiency syndrome), clinicians are faced with a greater number of cases of zoster. In the immunodeficient population, especially, dissemination of the zoster and potentially damaging complications can occur. CONCLUSIONS: In the light of these facts, clinicians must be well versed in all aspects of herpes zoster disease, including the clinical and laboratory diagnosis, as well as the incidence and presentation of herpes zoster. Current treatments, such as the use of famciclovir, acyclovir, valcyclovir, and prednisone, must also be understood. PMID: 9279053 [PubMed - indexed for MEDLINE] 2766. J Allergy Clin Immunol. 1997 Aug;100(2):274-82. Conversion of the CD4+ T cell profile from T(H2)-dominant type to T(H1)-dominant type after varicella-zoster virus infection in atopic dermatitis. Fujimura T, Yamanashi R, Masuzawa M, Fujita Y, Katsuoka K, Nishiyama S, Mitsuyama M, Nomoto K. Department of Dermatology, Kitasato University School of Medicine, Kanagawa, Japan. Skin lesions of atopic dermatitis were examined for cytokine expression by reverse transcription-polymerase chain reaction. The profile of mRNA for various cytokines revealed that both T(H1) and T(H2) types of CD4+ T cells, probably including T(H0) type, infiltrate into the skin lesion. We observed that atopic skin lesions improved after varicella infection. In such lesions, expression of T(H1) type cytokines predominated. The peripheral blood T cells from atopic patients exhibited a differentiation into T(H2) type cells upon in vitro stimulation with mite antigen. In contrast they differentiated into T(H1) type cells upon stimulation by varicella antigen. Since IL-12 has been reported to switch the in vitro recall response of allergen-specific T cells of atopic donors from a T(H2)- to a T(H1)-like phenotype, we examined its local production in varicella lesions. IL-12 p35 and p40 mRNA were expressed in fresh lesions. Peripheral blood mononuclear cells from atopic patients expressed p40 mRNA upon in vitro stimulation with live varicella zoster virus, but they did not show p40 mRNA without stimulation. This finding suggested that in atopic skin lesions containing the virus, IL-12 was produced and the cell type was changed to T(H1) type-predominance. These results suggested that patients with atopic dermatitis always have highly reactive CD4+ T cells infiltrating into their skin, and that the switch to T(H1) or T(H2) dominance is related to whether the lesion is improved or exacerbated. PMID: 9275152 [PubMed - indexed for MEDLINE] 2767. J Cutan Pathol. 1997 Aug;24(7):425-8. Herpetic syringitis associated with eccrine squamous syringometaplasia in HIV-positive patients. Muñoz E, Valks R, Fernández-Herrera J, Fraga J. Department of Pathology, Hospital Universitario de la Princesa, Madrid, Spain. Herpetic syringitis has been described as a rare manifestation of herpes virus infection in patients with an immunodeficiency, usually secondary to human immunodeficiency virus (HIV) infection. Eccrine squamous syringometaplasia (ESS) is an infrequent alteration of the eccrine duct epithelium reported in association with several conditions, including chronic ulcers, inflammatory processes, and patients receiving chemotherapy. The association of herpetic syringitis with ESS has not been reported before. We identified 3 cases of herpetic syringitis associated with ESS in patients with the acquired immunodeficiency syndrome. In 2 of 3 cases the signs of herpetic syringitis were limited to the metaplastic duct epithelium, but in 1 case there were also herpetic alterations without ESS. The histological features of herpetic infection in HIV-positive patients may be atypical and lack the typical epidermal alterations, observing only an extensive epidermal necrosis. In those cases, the alterations of the eccrine ducts may be a diagnostic clue in the diagnosis of herpetic infection. ESS of the ductal epithelium is probably secondary to the herpetic infection, although it might also stimulate the extension of the herpetic infection. Further studies are needed to elucidate the association of ESS and herpes virus infection. PMID: 9274960 [PubMed - indexed for MEDLINE] 2768. Neurology. 1997 Aug;49(2):631-2. Magnetic resonance imaging in a patient with segmental zoster paresis. Hanakawa T, Hashimoto S, Kawamura J, Nakamura M, Suenaga T, Matsuo M. Department of Brain Pathophysiology, Kyoto University Faculty of Medicine, Japan. PMID: 9270616 [PubMed - indexed for MEDLINE] 2769. Arch Dermatol. 1997 Aug;133(8):983-6. Viral folliculitis. Atypical presentations of herpes simplex, herpes zoster, and molluscum contagiosum. Weinberg JM, Mysliwiec A, Turiansky GW, Redfield R, James WD. Department of Dermatology, University of Pennsylvania School of Medicine, Philadelphia, USA. Comment in: Arch Dermatol. 1997 Aug;133(8):1039-41. BACKGROUND: Viral folliculitis is an infrequently reported entity. The patients described herein were seen over a 12-year period of practice in a referral dermatologic setting. The cases involve a variety of viral infections limited to the hair follicle. OBSERVATIONS: We describe 5 patients with a variety of viral folliculitides: 2 with herpetic sycosis caused by herpes simplex; 1 with herpex simplex folliculitis (this patient also had human immunodeficiency virus); 1 with herpes zoster without blisters; and 1 with molluscum contagiosum. CONCLUSIONS: These 5 cases demonstrate that viral folliculitis has varied causes and presentations. Clinicians should consider viral agents in the differential diagnosis of superficial infectious folliculitis, especially in cases that are refractory to antibacterial or antifungal therapy. PMID: 9267244 [PubMed - indexed for MEDLINE] 2770. Chest. 1997 Aug;112(2):538-40. Progressive somnolence leading to coma in a 68-year-old man. Bradley J, Forero N, Pho H, Escobar B, Kasinath BS, Anzueto A. Brooke Army Medical Center, San Antonio, Tex., USA. PMID: 9266897 [PubMed - indexed for MEDLINE] 2771. Med Pregl. 1997 Jul-Aug;50(7-8):305-8. [Herpes zoster--treatment with acyclovir] [Article in Croatian] Jovanović J, Cvjetković D, Pobor M, Brkić S. Klinika za infektivne i kozno-venericne bolesti, Medicinski fakultet, Novi Sad. We investigated the effect of acyclovir to the evolution of cutaneous changes and acute herpetic neuralgia at the time of herpes zoster infection. The examined group of 47 patients predominantly consisted of women in older ages, with anamnestic data usually referring to the chronic disease or stress as a provoking factor. In case of 19 patients the therapy was initiated in the phase of maculopapular changes, in 24 patients it was in the phase of vesicular changes and in 4 patients in the phase of encrustation. The evolution of cutaneous changes was accelerated under the acyclovir therapy regardless of the phase in which it was initiated. The intensity and duration of acute herpetic neuralgia directly depended on the time of therapy initiation. The patients who were given the therapy in time (not later than 6 days after the disease onset) reported the pain of lower intensity which completely ceased at the time of hospital discharge. PMID: 9441217 [PubMed - indexed for MEDLINE] 2772. An Med Interna. 1997 Jul;14(7):379. [Herpetic meningitis and cutaneous herpes zoster] [Article in Spanish] Martí J, Martínez C, Antón E. PMID: 9410135 [PubMed - indexed for MEDLINE] 2773. Postgrad Med J. 1997 Jul;73(861):437-8. A treatable cause of lymphocytic meningo-encephalitis. Fox K, Wright EP, Ramage JK. Department of Medicine, Conquest Hospital, St Leonards-on-Sea, East Sussex, UK. PMCID: PMC2431399 PMID: 9338036 [PubMed - indexed for MEDLINE] 2774. Hautarzt. 1997 Jul;48(7):492-5. [Atypical zosteriform segmental embolia cutis medicamentosa] [Article in German] Köhler LD, Worret WI, Hofmann H. Dermatologische Klinik und Poliklinik, TU München. A 35-year-old male suffered from an extremely painful embolia cutis medicamentosa. The atypical segmental localization first led to the diagnosis of herpes zoster and an antiviral therapy. Regarding the unusual course of the complication following an intramuscular injection in this case, the question for the real pathomechanisms still remains. PMID: 9333630 [PubMed - indexed for MEDLINE] 2775. J R Soc Med. 1997 Jul;90(7):395-6. Horner's syndrome due to herpes zoster in the T3-T4 dermatome. Poole TR, Acheson JF, Smith SE, Steiger MJ. Western Eye Hospital, London, England. PMCID: PMC1296385 PMID: 9290422 [PubMed - indexed for MEDLINE] 2776. Rev Infirm. 1997 Jul;(29):67-8. [Zona and herpes: current viral diseases] [Article in French] de Villermay D. PMID: 9283499 [PubMed - indexed for MEDLINE] 2777. J Neurol. 1997 Jul;244(7):470-2. Delayed-onset hemidystonia secondary to herpes zoster ophthalmicus-related intracerebral arteritis in an adolescent. Burbaud P, Berge J, Lagueny A, Mensire A, Melon M, Caillé JM, Bioulac B. PMID: 9266471 [PubMed - indexed for MEDLINE] 2778. Pediatr Dermatol. 1997 Jul-Aug;14(4):333. Herpes zoster in a 3-month-old infant. Handa S. PMID: 9263323 [PubMed - indexed for MEDLINE] 2779. Ir J Med Sci. 1997 Jul-Sep;166(3):141-2. Disseminated herpes zoster in the elderly. O'Toole EA, Mooney EE, Walsh JB, Sweeney EC, Barnes L. Department of Dermatology, St. James's Hospital, Dublin. We describe three cases of disseminated herpes zoster occurring in the elderly, and discuss the investigation and diagnosis of this condition. The presentation may be atypical with excoriated papular lesions. We suggest that disseminated herpes zoster does occur in the non-immunocompromised elderly patient, and is sometimes overlooked. PMID: 9256548 [PubMed - indexed for MEDLINE] 2780. ORL J Otorhinolaryngol Relat Spec. 1997 Jul-Aug;59(4):235-7. Laryngeal zoster with unilateral laryngeal paralysis. Nishizaki K, Onoda K, Akagi H, Yuen K, Ogawa T, Masuda Y. Department of Otolaryngology, Okayama University Medical School, Japan. nishizak@c.okayama-u.ac.jp The case of a 60-year-old man with a unilateral laryngeal mucosal lesion and complete left vocal cord paralysis is reported. The lesion localized to the left side of the larynx covered the laryngeal vestibule, arytenoid, false vocal cord and true vocal cord, but did not extend to the hypopharynx or oropharynx. Enzyme immunoassay for varicella-zoster virus (VZV) led to a diagnosis of VZV infection. PMID: 9253027 [PubMed - indexed for MEDLINE] 2781. Cutis. 1997 Jul;60(1):51-2. Dermatophytosis in healing herpes zoster lesions. Ferahbas A, Alpay K, Agaoglu C. Department of Dermatology, Farabi Hospital, Karadeniz Technical University, Trabzon, Turkey. Fungal infection of the face is frequently misdiagnosed, since the typical ringworm, erythematous, slightly scaling, indistinct borders are only uncommonly seen on the face. Herpes zoster is a common infection caused by the varicella-zoster virus that transmits varicella (chickenpox). Granulomatous reactions such as granuloma annulare, pseudolymphoma, sarcoidal reaction, and eruptive keratoacanthoma have been described in herpes zoster scars. We describe here the first reported case of dermatophytosis occurring in healing herpes zoster lesions. This condition has not been previously reported. PMID: 9252737 [PubMed - indexed for MEDLINE] 2782. Am J Otol. 1997 Jul;18(4):512-7. Surgical management of geniculate neuralgia. Lovely TJ, Jannetta PJ. Department of Neurological Surgery, University of Pittsburgh, School of Medicine, Pennsylvania, USA. BACKGROUND: Geniculate ganglion or nervus intermedius neuraigia is an unusual condition resulting in deep ear pain with or without signs of atypical trigeminal neuralgia, deep face, or throat pain. This article describes an experience with 14 patients who came to the neurosurgical service at the University of Pittsburgh Medical Center with a diagnosis of geniculate neuralgia. METHODS: After failing conservative treatment and after undergoing neurologic, otologic, and dental evaluations, these 14 patients underwent 20 intracranial procedures consisting of retromastoid craniectomies with microvascular decompression of cranial nerves V, IX, and X with section of the nervus intermedius in most cases. RESULTS: At operation, vascular compression of the nerves and nervus intermedius was found, which implicated vascular compression as an etiology of this disorder. Initially, 10 of 14 patients had an excellent outcome (71.5%), 3 experienced partial relief (21.5%), and there was 1 failure (7%). Ten patients were available for long-term (> 12 months) follow-up. Of these 10, 3 retained the excellent result (30%), 6 experienced partial relief (60%), and there was 1 failure (10%). Complications included one transient facial paresis, one facial numbness, one paresis of cranial nerves IX and X, one chemical meningitis, two cerebrospinal fluid leaks, and one superficial wound infection. Of those that fell from the excellent to partial category, this usually involved a return of atypical facial pain, but otalgia remained resolved. CONCLUSIONS: Overall, good results (with excellent or partial relief) were found long term for 90% of patients in this series. The authors recommend microvascular decompression of cranial nerves V, IX, and X with nervus intermedius section for the treatment of geniculate neuralgia. PMID: 9233495 [PubMed - indexed for MEDLINE] 2783. Postgrad Med. 1997 Jul;102(1):187-90, 192-4. Varicella-zoster virus infection. The complex prevention-treatment picture. Brody MB, Moyer D. Department of Medicine, Temple University School of Medicine, Philadelphia, PA 19140, USA. The highly prevalent and contagious varicella-zoster virus is usually benign in healthy persons but may cause substantial morbidity in immunocompromised patients and some adults. New developments in prevention and treatment, as discussed in this article, offer attractive options but also present difficult management decisions for primary care physicians. PMID: 9224486 [PubMed - indexed for MEDLINE] 2784. J Med Virol. 1997 Jul;52(3):316-9. Detection of varicella-zoster virus DNA in patients with acute peripheral facial palsy by the polymerase chain reaction, and its use for early diagnosis of zoster sine herpete. Furuta Y, Fukuda S, Suzuki S, Takasu T, Inuyama Y, Nagashima K. Department of Otolaryngology, Hokkaido University School of Medicine, Sapporo, Japan. Varicella-zoster virus (VZV) reactivation without cutaneous vesicles (zoster sine herpete) has been demonstrated in 8 to 25% of patients with acute peripheral facial palsy (APFP) by serological methods. To make an early diagnosis of zoster sine herpete, VZV DNA in oropharyngeal swabs from patients with APFP was examined by the polymerase chain reaction (PCR). VZV DNA was detected in oropharyngeal swabs from 6 of 36 (17%) patients with APFP by PCR. VZV DNA was detected in the oropharyngeal swabs from the six patients at their initial visit (2 to 4 days after the onset of APFP), while the anti-VZV IgM and IgG antibody titers were not increased significantly. In contrast, VZV DNA was undetectable in the oropharyngeal swabs at the time when the VZV specific antibody response appeared. These results indicate that detection of VZV DNA in oropharyngeal swabs by PCR is more useful than currently available serological assays for the early diagnosis of zoster sine herpete in patients with APFP. PMID: 9210042 [PubMed - indexed for MEDLINE] 2785. J Infect Dis. 1997 Jul;176(1):261-4. Chronic varicella-zoster virus skin lesions in patients with human immunodeficiency virus are related to decreased expression of gE and gB. Nikkels AF, Rentier B, Piérard GE. Department of Dermatopathology, Institute of Pathology, University of Liège, Belgium. The pathogenesis of chronic, verrucous varicella-zoster virus (VZV) cutaneous lesions in human immunodeficiency virus (HIV)-infected persons is unknown. It has been hypothesized that these lesions are due to an altered pattern of virus gene expression. Immediate early and late (L) gene expression in five chronic verrucous VZV lesions, four full-blown herpes zoster vesicular lesions in HIV-infected persons, and eight vesicular herpes zoster lesions in immunocompetent individuals was semiquantitatively assessed immunohistochemically using specific antibodies to the IE63, gE (L), and gB (L) proteins. All patients had evidence of IE63 expression in keratinocytes; however, gE expression was either weak or absent in keratinocytes of three verrucous lesions, and gB was either weak or absent in two. These results suggest that chronic VZV skin lesions are associated with diminished gE and gB expression. It is inferred that the VZV behavior in keratinocytes may vary from a latency-like state to a fully developed, productive infection. PMID: 9207378 [PubMed - indexed for MEDLINE] 2786. J Infect Dis. 1997 Jul;176(1):103-11. Evaluation of sorivudine (BV-araU) versus acyclovir in the treatment of acute localized herpes zoster in human immunodeficiency virus-infected adults. The Multinational Sorivudine Study Group. Bodsworth NJ, Boag F, Burdge D, Généreux M, Borleffs JC, Evans BA, Modai J, Colebunders R, Thomas M, DeHertogh D, Pacelli L, Thomis J. Sydney Hospital and Taylor Square Private Clinic, Australia. The clinical efficacy and safety of sorivudine as treatment for acute cutaneous zoster in human immunodeficiency virus-infected adults was compared with that of acyclovir in a double-blinded randomized study. A total of 125 patients with laboratory-confirmed zoster rash present for < or =72 h were assigned treatment with either 40 mg of sorivudine once daily or 800 mg of acyclovir five times daily, both taken orally for 7 days. Patients were assessed daily until all lesions crusted and then monthly for 6 months for postherpetic neuralgia (PHN) and for 12 months for recurrent or new episodes of zoster. Sorivudine significantly shortened the median period of new vesicle formation from 3.0 to 4.0 days (log rank P = .0001). Sorivudine was effective regardless of duration of rash before treatment. Zoster recurrences and new episodes were experienced by fewer patients assigned sorivudine (11%) than acyclovir (26%, P = .037). No differences were seen in incidence, severity, or duration of either acute neuritis or PHN. Both treatments were well tolerated. PMID: 9207355 [PubMed - indexed for MEDLINE] 2787. JAMA. 1997 Jun 18;277(23):1848-50. Dermatology. Dover JS, Arndt KA. Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Mass, USA. Comment in: JAMA. 1997 Oct 8;278(14):1148; author reply 1149. JAMA. 1997 Oct 8;278(14):1148; author reply 1149. PMID: 9185795 [PubMed - indexed for MEDLINE] 2788. Med Clin (Barc). 1997 Jun 14;109(3):95-7. [Aphthae] [Article in Spanish] Coll J. PMID: 9289522 [PubMed - indexed for MEDLINE] 2789. Arch Intern Med. 1997 Jun 9;157(11):1217-24. Risk factors for postherpetic neuralgia. Choo PW, Galil K, Donahue JG, Walker AM, Spiegelman D, Platt R. Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Boston, Mass, USA. Comment in: Arch Intern Med. 1997 Jun 9;157(11):1166-7. BACKGROUND: The risk factors for postherpetic neuralgia (PHN), the most common complication of herpes zoster, have not been well established. OBJECTIVE: To elucidate the risk factors for PHN. METHODS: Automated medical, claims, and pharmacy records of a health maintenance organization were used to identify cases of PHN and obtain data on risk factors. A case-base design was used to assess the impact of various patient, disease, and treatment factors on the prevalence of PHN 1 and 2 months after developing zoster. RESULTS: There were 821 cases of herpes zoster that met all eligibility criteria. The prevalence of PHN more than 30 days after onset of zoster was 8.0% (95% confidence interval [CI], 6.3%-10.1%) and 4.5% (95% CI, 3.2%-6.2%) after 60 days. Compared with patients younger than 50 years, individuals aged 50 years or older had a 14.7-fold higher prevalence (95% CI, 6.8-32.0) 30 days and a 27.4-fold higher prevalence (95% CI, 8.8-85.4) 60 days after developing zoster. Prodromal sensory symptoms and certain conditions associated with compromised immunity were also associated with PHN. Systemic corticosteroids before zoster and treatment of zoster with acyclovir or corticosteroids did not significantly affect the prevalence of PHN. CONCLUSIONS: Increased age and prodromal symptoms are associated with higher prevalence of PHN 1 and 2 months after onset of zoster. Overall, systemic acyclovir appears not to confer any protection against PHN, although benefit among elderly patients cannot be excluded. PMID: 9183233 [PubMed - indexed for MEDLINE] 2790. Arch Intern Med. 1997 Jun 9;157(11):1209-13. The sequelae of herpes zoster. Galil K, Choo PW, Donahue JG, Platt R. Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Boston, Mass, USA. Comment in: Arch Intern Med. 1997 Jun 9;157(11):1166-7. BACKGROUND: The last 40 years was a period during which the incidence of herpes zoster appears to have increased substantially. OBJECTIVE: To determine whether the risk of complications of herpes zoster has changed during the last 40 years. METHODS: The automated medical records of a health maintenance organization were screened for diagnosis codes suggesting herpes zoster and potentially complicated cases of zoster. The predictive value of a herpes zoster diagnosis was calculated from sampling full-text records. Records of all patients with codes suggesting complications were reviewed in full. RESULTS: Of 859 individuals with herpes zoster who met the eligibility criteria, 101 were identified who experienced at least 1 complication, corresponding to a 60-day risk of 12%. Corrected for the sensitivity of the complication-finding strategy, the risk estimate was 14%. Risk increased markedly with age, with those older than 64 years having more than 6 times the risk of complications of those younger than 25 years (odds ratio, 8.3; 95% confidence interval, 2.5-29.3). Trigeminal distribution of rash and the presence of certain conditions associated with immune compromise appeared to increase risk. CONCLUSIONS: The apparent increase in the incidence of herpes zoster was not accompanied by a change in the risk of specific or overall complications in a population-based sample. Advanced age and other conditions associated with waning cellular immunity may confer an increased risk of experiencing a complicated course of herpes zoster. PMID: 9183232 [PubMed - indexed for MEDLINE] 2791. Arch Intern Med. 1997 Jun 9;157(11):1166-7. Postherpetic neuralgia. Predicting and preventing risk. Kost RG, Straus SE. Comment on: Arch Intern Med. 1997 Jun 9;157(11):1217-24. Arch Intern Med. 1997 Jun 9;157(11):1209-13. PMID: 9183226 [PubMed - indexed for MEDLINE] 2792. AIDS Patient Care STDS. 1997 Jun;11(3):198. Famciclovir safe and effective for management of shingles. [No authors listed] PMID: 11361804 [PubMed - indexed for MEDLINE] 2793. J Tradit Chin Med. 1997 Jun;17(2):124-6. Clinical application of contralateral acupuncture technique. Lu F. Overseas Education College of Xiamen University. PMID: 10437182 [PubMed - indexed for MEDLINE] 2794. J Indian Med Assoc. 1997 Jun;95(6):197, 200. Ramsay Hunt syndrome in a patient of malignant granulosa cell tumour of ovary. Shivaprakash P, Deo RP, Raghavan A, Radheshyam D. Department of Oncology, Manipal Hospital, Bangalore. PMID: 9420406 [PubMed - indexed for MEDLINE] 2795. Acta Med Port. 1997 Jun-Jul;10(6-7):497-501. [Verrucous herpes zoster in AIDS patients] [Article in Portuguese] Agusto V, Franca I, Mansinho K, Araújo C, Borges F, Champalimaud JL, Poiares-Baptista A, Martins C, Ricardo JL. Unidade de Doenças Infecciosas e Parasitárias, Hospital Egaz Moniz. The authors describe a case of disseminated Herpes-Zoster (VZV) in an HIV 1 positive patient with AIDS. Hyperkeratotic characteristics, acyclovir resistance and sensitivity to foscarnet of cutaneous lesions are the most important features of this example. From the casuistics of the department, the authors describe two similar cases and review the medical literature with emphasis on etiopathogenic, diagnostic and therapeutic factors of lesions caused by DNA Virus in immunocompromised hosts. PMID: 9341044 [PubMed - indexed for MEDLINE] 2796. Acta Ophthalmol Scand. 1997 Jun;75(3):311-3. The use of capsaicin in herpes zoster ophthalmicus neuralgia. Frucht-Pery J, Feldman ST, Brown SI. Department of Ophthalmology, Hadassah University Hospital, Jerusalem, Israel. The treatment of neuralgia which occurs during and following herpes zoster ophthalmicus is often unsatisfactory. Capsaicin (trans-8-methyl-N-vanillyl-6-nonenamide) is a drug which depletes substance P and may be effective in inhibiting pain. We utilized topical capsaicin to the affected dermatome five times daily for 4 weeks in 6 patients with acute and post herpetic neuralgia. In four cases pain was markedly relieved and narcotic medications were either discontinued or significantly reduced. In two cases, pain was not reduced. Four patients had side effects including burning sensation at the site of the drug administration (4 cases), dermatitis as a result of overuse of the drug (2 cases) and hyperesthesia (1 case). Our results suggest that capsaicin may be a useful therapy for the alleviation of pain in some individuals with herpes zoster ophthalmicus. However, controlled studies are needed to establish these results. PMID: 9253983 [PubMed - indexed for MEDLINE] 2797. Int J Dermatol. 1997 Jun;36(6):457-9. Cost-benefit of oral acyclovir in the treatment of herpes zoster. Kubeyinje EP. Skin Clinic, Arar Central Hospital, Saudi Arabia. BACKGROUND: Oral acyclovir is a costly antiviral agent shown to be effective in the treatment of herpes zoster. Herpes zoster runs a relatively benign course in young, healthy individuals, as compared with elderly and immunologically compromised patients, in whom complications are common. This study attempts to assess the cost-benefit of treatment with oral acyclovir in young healthy adults with herpes zoster. PATIENTS AND METHODS: The records of 42 healthy young adults suffering from herpes zoster and treated with oral acyclovir (800 mg five times daily for 7 days) were compared with those of 40 healthy young adults with herpes zoster seen during the same period but treated without oral acyclovir. The duration of zoster-associated pain and the presence of complications were noted. RESULTS: There was no statistically significant difference in the duration of zoster-associated pain between the two groups of patients (P = 0.11). Other complications of herpes zoster were few and similar in the two groups. CONCLUSIONS: At a cost of $250 to $300 for a 7-day course of oral acyclovir, the use of this antiviral agent in healthy young individuals with herpes zoster is not justified, especially in developing countries with limited resources. PMID: 9248895 [PubMed - indexed for MEDLINE] 2798. Biologicals. 1997 Jun;25(2):227-30. Live attenuated varicella vaccine for prevention of herpes zoster. Gershon A, Silverstein S. Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, NY, USA. PMID: 9236057 [PubMed - indexed for MEDLINE] 2799. Virchows Arch. 1997 Jun;430(6):510-1. Hair follicle involvement in herpes zoster. Nikkels AF, Pierard GE. Comment on: Virchows Arch. 1996 Jul;428(4-5):275-80. PMID: 9230918 [PubMed - indexed for MEDLINE] 2800. J Hosp Infect. 1997 Jun;36(2):133-40. Control of varicella-zoster infection on renal and other specialist units. Jones EM, Barnett J, Perry C, Roome AP, Caul EO, Tomson CR, MacGowan AP, Reeves DS. Department of Medical Microbiology, Southmead Health Services NHS Trust, Westbury-on-Trym, Bristol, UK. The introduction of chickenpox onto our renal unit recently raised several issues surrounding the management of patient and staff contracts. This paper describes the action taken and makes various recommendations for future management of similar cases. Guidelines are proposed for the management of patients and staff as well as the role of the infection control team in handling a chickenpox problem. Future developments, including the use of VZ vaccine for patient and staff, are also discussed. PMID: 9211160 [PubMed - indexed for MEDLINE] 2801. J Pain Symptom Manage. 1997 Jun;13(6):327-31. The effects of pre-emptive treatment of postherpetic neuralgia with amitriptyline: a randomized, double-blind, placebo-controlled trial. Bowsher D. Pain Research Institute, Walton Hospital, Liverpool, United Kingdom. Seventy-two patients older than 60 years of age who received a diagnosis of herpes zoster (HZ) were entered into a randomized, double-blind, placebo-controlled trial of daily amitriptyline 25 mg. Treatment with either amitriptyline or placebo continued for 90 days after diagnosis. Pain prevalence at 6 months was the primary outcome. Results showed that early treatment with low-dose amitriptyline reduced pain prevalence by more than one-half (p < 0.05; odds ratio, 2.9:1) This finding makes a strong case for the pre-emptive administration of amitriptyline, in combination with an antiviral drug, to elderly patients with acute herpes zoster. PMID: 9204652 [PubMed - indexed for MEDLINE] 2802. Clin Infect Dis. 1997 Jun;24(6):1256-60. Clinical profile of herpes zoster ophthalmicus in Ethiopians. Bayu S, Alemayehu W. Department of Ophthalmology, Faculty of Medicine, Addis Ababa University, Ethiopia, East Africa. We conducted a prospective study of 100 consecutive Ethiopian patients with herpes zoster ophthalmicus (HZO); this study revealed a high incidence of HZO among the young (mean age, 35 years). Eighty-one (95%) of 85 patients who underwent serological testing were seropositive for antibodies to human immunodeficiency virus (HIV). Unlike previous investigators, we found a marked increase in the incidence and severity of eyelid (25%) and ocular (78%) complications as well as postherpetic neuralgia (55%). Visual loss occurred in 56% of the cases. Lack of medication, delay in presentation, severity of HIV-related HZO, and application of herbal medications adversely affected the outcomes for these patients. We conclude that all patients with HZO, especially those younger than 45 years of age, should be screened for HIV infection. Because HZO is a vision-threatening problem, all health care workers should become aware of its management. PMID: 9195095 [PubMed - indexed for MEDLINE] 2803. Clin Infect Dis. 1997 Jun;24(6):1100-6. Use of polymerase chain reaction assays of aqueous humor in the differential diagnosis of retinitis in patients infected with human immunodeficiency virus. Danise A, Cinque P, Vergani S, Candino M, Racca S, De Bona A, Novati R, Castagna A, Lazzarin A. Department of Infectious Diseases, San Raffaele Scientific Institute, Milan, Italy. We performed polymerase chain reaction (PCR) for detection of cytomegalovirus (CMV), varicella-zoster virus (VZV), herpes simplex virus (HSV), and Toxoplasma gondii DNA in aqueous humor from 15 patients who were infected with human immunodeficiency virus (HIV) and who had retinitis of unclear origin; these patients were selected from among 820 patients evaluated by ophthalmoscopic examination. On the basis of the final response to treatment, CMV, VZV, and T. gondii retinitis was diagnosed in 5, 2, and 4 of the 15 patients, respectively. No final etiologic diagnosis was reached for four patients. All 5 patients with CMV retinitis were CMV DNA-positive. 1 of 2 patients with VZV retinopathy were VZV DNA-positive, and 3 of 4 patients with T. gondii retinitis were T. gondii DNA-positive. All PCR assays of aqueous humor from the four patients without infectious retinitis were negative. PCR assay of aqueous humor is helpful in the etiologic diagnosis of retinitis of unclear origin in HIV-infected patients. PMID: 9195064 [PubMed - indexed for MEDLINE] 2804. Infect Control Hosp Epidemiol. 1997 Jun;18(6):405-11. Varicella vaccination for healthcare workers at a university hospital: an analysis of costs and benefits. Tennenberg AM, Brassard JE, Van Lieu J, Drusin LM. Department of Epidemiology, New York Hospital, New York, USA. OBJECTIVE: To demonstrate the costs and benefits of vaccinating varicella-susceptible healthcare workers at a university hospital with live, attenuated varicella-zoster virus vaccine. DESIGN: Retrospective review of employee medical records and data on the cost of special paid absence for susceptible healthcare workers after exposure to varicella or herpes zoster. SETTING: A 988-bed tertiary-care university hospital. RESULTS: In 1994, 224 hospital employees (3.4%) were susceptible to the varicella-zoster virus. There were 40 exposures to varicella and herpes zoster in that year, involving 29 of the susceptible employees. Nine (31%) of the exposed susceptibles became varicella immune by indirect fluorescent antibody testing subsequent to exposure. Seventeen (59%) have had multiple varicella exposures and special paid absences while employed by the hospital. In 1994, wages paid to healthcare workers while furloughed for the communicable period following varicella exposure totaled $38,463.93. An additional $24,748.74 was paid to replacement workers during that same time. Varicella vaccine to immunize all 224 susceptibles in 1994 would have cost $17,920. Absences due to varicella and herpes zoster exposure also result in disruptions to patient care. CONCLUSIONS: Varicella vaccination for varicella-susceptible healthcare workers at a university hospital would result in financial savings and improved patient care. We recommend that other institutions consider the costs and benefits of adopting a varicella immunization program for their susceptible employees. PMID: 9181396 [PubMed - indexed for MEDLINE] 2805. Am J Health Syst Pharm. 1997 May 15;54(10):1180-4. Economic evaluation of famciclovir in reducing the duration of postherpetic neuralgia. Huse DM, Schainbaum S, Kirsch AJ, Tyring S. Medical Research International, Burlington, MA 01803, USA. The economic impact of famciclovir therapy for postherpetic neuralgia (PHN) in patients with acute herpes zoster was studied. A decision-analytic model of the treatment of herpes zoster and PHN was used to compare the cost of PHN between patients treated with oral famciclovir 500 mg three times daily for seven days and patients not receiving any antiviral therapy. The effects of famciclovir on PHN in the model were based on the results of a randomized, double-blind trial in 419 adult outpatients. The cost of the course of famciclovir therapy (21 tablets) was estimated as the sum of the drug's wholesale acquisition cost and the pharmacy dispensing cost. The cost of treating PHN (physician visits, medications, and miscellaneous nondrug therapy) was estimated by consulting a panel of physicians. According to the model, the cost of treating PHN was $85 lower per famciclovir recipient ($294 for famciclovir versus $379 for no antiviral therapy). The net cost of famciclovir therapy was $23 per patient ($108 for acquisition and dispensing minus the $85 savings). Among patients 50 years of age or older, famciclovir reduced the average cost of PHN by $155 ($414 for famciclovir versus $569 for no antiviral therapy) and yielded a net savings of $7 per patient. A model for the use of famciclovir to treat acute herpes zoster showed that the cost of such therapy was largely offset by savings in the cost of treating this complication. PMID: 9161626 [PubMed - indexed for MEDLINE] 2806. Ann Intern Med. 1997 May 15;126(10):831-2. Acyclovir plus steroids for herpes zoster. Carson MP. Comment on: Ann Intern Med. 1996 Sep 1;125(5):376-83. PMID: 9148669 [PubMed - indexed for MEDLINE] 2807. Ann Intern Med. 1997 May 15;126(10):831; author reply 832. Acyclovir plus steroids for herpes zoster. Herbert DA. Comment on: Ann Intern Med. 1996 Sep 1;125(5):376-83. PMID: 9148668 [PubMed - indexed for MEDLINE] 2808. Ann Intern Med. 1997 May 15;126(10):831; author reply 832. Acyclovir plus steroids for herpes zoster. Atkins CD. Comment on: Ann Intern Med. 1996 Sep 1;125(5):376-83. PMID: 9148667 [PubMed - indexed for MEDLINE] 2809. N Z Med J. 1997 May 9;110(1043):167-9. Neurotoxicity associated with acyclovir in end stage renal failure. Kitching AR, Fagg D, Hay NM, Hatfield PJ, Macdonald A. Department of Medicine, Wellington School of Medicine. AIMS: To alert practitioners to the danger of acyclovir neurotoxicity occurring in the presence of renal failure. METHODS: Two case reports of acyclovir neurotoxicity in the patients on continuous ambulatory peritoneal dialysis. RESULTS: In one case neurotoxicity resulted from the use of a dosage regimen that would be appropriate in patients with normal renal function. In the other case, neurotoxicity occurred even though a reduced dose of acyclovir was given. Supportive management resulted in a complete recovery. CONCLUSIONS: In patients with end stage renal failure with varicella zoster infections, when acyclovir is prescribed the loading dose should be 400 mg and the maintenance dose should be 200 mg twice daily. PMID: 9196501 [PubMed - indexed for MEDLINE] 2810. Clin Exp Dermatol. 1997 May;22(3):148-51. Transient leukaemia cutis in chronic lymphocytic leukaemia. Wakelin SH, Young E, Kelly S, Turner M. Department of Dermatology, Amersham Hospital, Bucks. Leukaemia cutis arises from cutaneous infiltration by neoplastic leukocytes or their precursors. Recent evidence suggests that this sign does not necessarily herald a poor prognosis. We describe a 72-year-old woman with B-cell chronic lymphatic leukaemia who developed a papular eruption of her breast at the site of a recent herpetic eruption. Histology and immunostaining showed a dense dermal B-cell infiltrate in keeping with leukaemia cutis. The papules cleared in 6 months without treatment, leaving atrophic scars. The histological features and possible aetiological mechanisms of post-herpetic papular eruptions in chronic lymphatic leukaemia are reviewed. PMID: 9425697 [PubMed - indexed for MEDLINE] 2811. Aust N Z J Ophthalmol. 1997 May;25(2):173. A dental prosthesis to close the palpebral fissure. Meades K. Sydney Eye Hospital, NSW, Australia. PMID: 9267607 [PubMed - indexed for MEDLINE] 2812. HNO. 1997 May;45(5):353-5. [Guidelines/algorithms of the German Society of Otorhinolaryngology, Head and Neck Surgery. German Society of Otorhinolaryngology, Head and Neck Surgery] [Article in German] Ganzer U. PMID: 9265016 [PubMed - indexed for MEDLINE] 2813. Br J Gen Pract. 1997 May;47(418):330-1. Corneal exposure in herpes zoster ophthalmicus. Potamitis T, O'Sullivan JN, Mohan-Roberts I. PMCID: PMC1313019 PMID: 9219421 [PubMed - indexed for MEDLINE] 2814. J Infect. 1997 May;34(3):261-2. Bilateral facial palsy secondary to herpes zoster meningoencephalitis in a HIV-positive woman. Mahadeen ZI, Brennan RW, Kothari MJ. Division of Neurology, Pennsylvania State University, College of Medicine, Hershey 17033, USA. Bilateral facial paralysis of diverse infectious aetiologies has been reported in HIV infected patients. We present a patient with bilateral facial palsy most likely due to herpes zoster meningoencephalitis in a patient with neutropenia and who subsequently tested HIV-positive. PMID: 9200035 [PubMed - indexed for MEDLINE] 2815. Acta Derm Venereol. 1997 May;77(3):245. Higher herpes zoster infection frequency in right-handed patients and more frequent appearance in the left body side of females. Ertunç V, Dane S, Karakuzu A, Deniz O. PMID: 9188890 [PubMed - indexed for MEDLINE] 2816. Acta Derm Venereol. 1997 May;77(3):194-7. Histopathological findings, viral DNA distribution and lymphocytic immunophenotypes in vesicular and papular types of herpes zoster. Yi JY, Kim TY, Shim JH, Cho BK, Kim CW. Department of Dermatology, Catholic University Medical College, Seoul, Korea. Comment in: Acta Derm Venereol. 1998 May;78(3):234-5. The characteristics rash of herpes zoster begins as erythematous macules and papules, progressing to vesicles within 12-24 h. Patients with persistent papules without vesicular change are occasionally found. Our aim was to elucidate differences in vesicular and papular types of herpes zoster. Biopsy specimens from 21 patients were examined by an in situ hybridization method to observe viral distribution, and lymphocytic immunophenotypes were evaluated immunohistochemically. There was no differences in cell-mediated immunity or immunophenotypes in lymphocytic infiltrates between vesicular and papular types of herpes zoster. DNA of varicella-zoster virus was detected in the epidermis and hair follicles in the vesicular type but was found in the pilosebaceous unit in the papular type. This indicates that the appearance of clinical types of herpes zoster depends on the infected site of varicella-zoster virus in the tissue. PMID: 9188869 [PubMed - indexed for MEDLINE] 2817. Can J Neurol Sci. 1997 May;24(2):137-9. Varicella zoster antibodies after herpes zoster, varicella and multiple sclerosis. Ross RT, Nicolle LE, Dawood MR, Cheang M, Feschuk C. Section of Neurology, University of Manitoba, Winnipeg. BACKGROUND: We previously showed that Manitoba Hutterites seek physician care for varicella zoster virus infection significantly less than non-Hutterites. The current study was undertaken to measure varicella zoster virus seroprevalence for Hutterite and non-Hutterite controls. METHODS: Blood was obtained from 315 Hutterites and 259 similar age and sex controls at the time of blood donations to The Canadian Red Cross Society. The controls were from the same or a contiguous postal code area and were collected at the same time as the Hutterite samples. The immune status of the specimens was determined by the ELISA method (enzyme linked immunosorbent assay). RESULTS: Twenty-eight per cent of 315 Hutterites had no immunity and an additional 25% had only marginal immunity. Among the 259 controls, 10% had no immunity and an additional 10% had only marginal immunity (p < .0001). CONCLUSIONS: Manitoba Hutterites have significantly decreased seroprevalence to varicella zoster virus infection. This study of serum varicella zoster virus antibodies verifies a previous population based study that demonstrated the relative rarity of varicella and herpes zoster among a particular population group. PMID: 9164691 [PubMed - indexed for MEDLINE] 2818. Clin Pharmacol Ther. 1997 May;61(5):563-73. The effect of sorivudine on dihydropyrimidine dehydrogenase activity in patients with acute herpes zoster. Yan J, Tyring SK, McCrary MM, Lee PC, Haworth S, Raymond R, Olsen SJ, Diasio RB. Department of Pharmacology and Toxicology, University of Alabama at Birmingham 35294, USA. OBJECTIVE: Bromovinyl-uracil (BVU) is the principal metabolite of sorivudine, a potent anti-zoster nucleoside. BVU binds to, and irreversibly inhibits, the enzyme dihydropyrimidine dehydrogenase (DPD). The objective of this study was to assess the time course of recovery of DPD activity after oral administration of sorivudine in patients with herpes zoster and to correlate restoration of DPD activity and levels of uracil with the elimination of sorivudine and its metabolite BVU from the circulation. METHODS: Sorivudine was given orally as 40 mg once-daily doses for 10 consecutive days to a total of 19 patients with herpes zoster. Serum sorivudine, BVU, and circulating uracil and DPD activity in peripheral blood mononuclear cells (PBMCs) were determined before, during, and after administration of sorivudine. RESULTS: BVU was eliminated from the circulation within 7 days after the last sorivudine dose. DPD activity in PBMCs, which was completely suppressed in 18 of the 19 subjects and markedly suppressed in the remaining subject during administration of sorivudine, recovered to baseline levels within 19 days after the last dose of sorivudine in all subjects and within 14 days in all but one of the subjects. The restoration of DPD activity was temporally associated with elimination of BVU from the circulation. The elevated uracil concentrations produced by inhibition of DPD activity fell rapidly after cessation of sorivudine administration and also were temporally associated with elimination of BVU from the circulation. The time course of recovery of DPD activity in three patients with renal impairment was similar to that of the other subjects. CONCLUSIONS: This study indicates that sorivudine therapy is associated with a profound depression of DPD activity. Recovery of DPD activity occurred within 4 weeks of the completion of sorivudine therapy, which indicates that fluorinated pyrimidines may be safely administered 4 weeks after completion of sorivudine therapy. PMID: 9164418 [PubMed - indexed for MEDLINE] 2819. Arch Ophthalmol. 1997 May;115(5):664-5. The use of polymerase chain reaction techniques to detect varicella-zoster virus in corneal transplant tissue. Liesegang TJ. Comment on: Arch Ophthalmol. 1997 May;115(5):590-4. PMID: 9152136 [PubMed - indexed for MEDLINE] 2820. Arch Ophthalmol. 1997 May;115(5):590-4. Detection of varicella-zoster virus DNA in keratectomy specimens by use of the polymerase chain reaction. Mietz H, Eis-Hübinger AM, Sundmacher R, Font RL. Department of Ophthalmology, Baylor College of Medicine, Houston, Tex, USA. h.mietz@uni-koeln.de Comment in: Arch Ophthalmol. 1997 May;115(5):664-5. OBJECTIVE: To study the correlation of clinical findings, histopathologic features, and detection of varicella-zoster virus (VZV) DNA in keratectomy specimens. MATERIALS AND METHODS: Fourteen corneal buttons from patients with a confirmed history of herpes zoster ophthalmicus were examined by use of light microscopy and the polymerase chain reaction. The polymerase chain reaction techniques included gel electrophoresis and hybridization for the detection of VZV DNA. RESULTS: Seven (50%) of the 14 specimens were positive for VZV DNA. The positive findings in the specimens correlated with the clinical findings of uveitis (3/3) and the histopathologic features of chronic stromal keratitis (4/4). Patients with stromal scarring, granulomatous keratitis, and neurotrophic ulcers had negative findings. The largest interval between the initial appearance and detection of viral DNA was 51 years. CONCLUSIONS: The results suggest that VZV DNA is not detectable in the cornea in every patient and at every stage of zoster keratitis. This may be due to the low number of VZV particles present in the cornea or the lack of viral DNA in the keratocytes. It remains unclear whether the VZV-related keratopathy is caused by an immunologic response to a viral antigen, the viable virus itself, or both. PMID: 9152125 [PubMed - indexed for MEDLINE] 2821. J Am Acad Dermatol. 1997 May;36(5 Pt 2):831-3. Chronic varicella zoster infection mimicking a basal cell carcinoma in an AIDS patient. Tsao H, Tahan SR, Johnson RA. Department of Dermatology, Harvard Medical School, Boston, MA, USA. Chronic herpesvirus infections are common in patients infected with HIV. Atypical skin lesions secondary to long-standing varicella-zoster virus (VZV) infection have been reported. We present a case of an AIDS patient with a chronic VZV infection that simulated a basal cell carcinoma. Histologic examination and immunohistochemistry confirmed the presence of the virus in the follicular epithelium. In the immunocompromised patient, biopsies should be performed on all suspicious lesions because medically-treatable infections may take on the appearance of malignancy. PMID: 9146560 [PubMed - indexed for MEDLINE] 2822. J Am Acad Dermatol. 1997 May;36(5 Pt 1):778-9. Acquired reactive perforating collagenosis: unilateral umbilicated papules along the lesions of herpes zoster. Bang SW, Kim YK, Whang KU. Department of Dermatology, College of Medicine, Soon-chunhyang University, Seoul, South Korea. PMID: 9146541 [PubMed - indexed for MEDLINE] 2823. Clin Infect Dis. 1997 May;24(5):753-61; quiz 762-3. Varicella-zoster virus vaccine. White CJ. North American Vaccine, Inc., Beltsville, Maryland 20705, USA. Comment in: Clin Infect Dis. 1998 Jan;26(1):241-2. PMID: 9142766 [PubMed - indexed for MEDLINE] 2824. Arch Intern Med. 1997 Apr 28;157(8):909-12. The effect of treating herpes zoster with oral acyclovir in preventing postherpetic neuralgia. A meta-analysis. Jackson JL, Gibbons R, Meyer G, Inouye L. Department of Medicine, Madigan Army Medical Center, Tacoma, Wash, USA. BACKGROUND: Herpes zoster is a common affliction in older patients, with up to 15% experiencing some residual pain in the distribution of the rash several months after healing. Despite numerous randomized clinical trials, the effect of treating herpes zoster with oral acyclovir in preventing postherpetic neuralgia remains uncertain because of conflicting results. METHODS: Meta-analysis of published randomized clinical trials on the use of acyclovir to prevent postherpetic neuralgia using the fixed-effects model of Peto. RESULTS: Thirty clinical trials of treatment with oral acyclovir in immunocompetent adults were identified. After excluding studies with duplicate data, suboptimal and topical dosing, non-placebo-controlled or nonrandomized designs, and those using intravenous acyclovir, 5 trials were found to be homogeneous and were combined for analysis. From these trials, the summary odds ratio for the incidence of "any pain" in the distribution of rash at 6 months in adults treated with acyclovir was 0.54 (95% confidence interval, 0.36-0.81). CONCLUSION: Treatment of herpes zoster with 800 mg/d of oral acyclovir within 72 hours of rash onset may reduce the incidence of residual pain at 6 months by 46% in immunocompetent adults. PMID: 9129551 [PubMed - indexed for MEDLINE] 2825. Dent Update. 1997 Apr;24(3):126-8. HIV-associated fulminating herpes zoster infection with alveolar necrosis and tooth exfoliation: a case report. Chindia ML. Department of Oral and Maxillofacial Surgery/Oral Pathology and Oral Medicine, Faculty of Dental Sciences, University of Nairobi, Kenya. This paper presents a case of HIV-associated fulminating herpes zoster infection (HZI) that culminated in right mandibular necrosis and tooth exfoliation. The occurrence of such infection in immunosuppression and the impending clinical features are briefly reviewed and discussed. PMID: 9515379 [PubMed - indexed for MEDLINE] 2826. Rev Clin Esp. 1997 Apr;197(4):297. [Neurotoxicity of acyclovir] [Article in Spanish] Calvo Romero JM, Barquilla Esteban JF, Arrobas Vacas M. PMID: 9197149 [PubMed - indexed for MEDLINE] 2827. Pain. 1997 Apr;70(2-3):287-9. Comments on De Benedittis and Lorenzetti: on topical aspirin/diethyl ether for postherpetic neuralgia, PAIN, 65 (1996) 45-51. Bonicalzi V, Canavero S. Comment on: Pain. 1996 Apr;65(1):45-51. PMID: 9150304 [PubMed - indexed for MEDLINE] 2828. Aliment Pharmacol Ther. 1997 Apr;11(2):415-7. Acyclovir-induced colitis. Wardle TD, Finnerty JP, Swale V, Beer T. Department of Medicine, Countess of Chester Hospital, Liverpool, UK. Three patients developed acute colitis, either de novo, or as an exacerbation of pre-existing colitis, following the use of oral acyclovir, prescribed for Herpes zoster or Herpes simplex infection. Rechallenge with oral acyclovir was performed in one patient, and resulted in a recurrence of colitic symptoms. It is speculated that acyclovir can have a direct irritant effect on large bowel mucosa. PMID: 9146784 [PubMed - indexed for MEDLINE] 2829. Clin Infect Dis. 1997 Apr;24(4):603-8. Varicella-zoster virus is strongly associated with atypical necrotizing herpetic retinopathies. Garweg J, Böhnke M. Department of Ophthalmology, University of Bern, Inselspital, Switzerland. Aqueous humor samples from nine patients with atypical necrotizing retinopathies of suspected viral origin, six with acute retinal necrosis syndrome (ARN), and 17 with active cytomegalovirus (CMV) retinitis underwent amplification for viral DNA of herpes simplex virus type 1 (HSV-1), varicella-zoster virus (VZV), and human CMV. VZV DNA was detected in seven of the nine aqueous humor samples from patients with atypical necrotizing retinopathies of suspected viral origin and in four of the six samples from individuals with ARN; of the two other samples from patients with ARNS, no viral DNA was found in one, and both CMV DNA and HSV-1 DNA, but not VZV DNA, were detected in one (this patient presented with bilateral ARNS 2 months after being successfully treated for CMV retinitis). Thus, VZV is likely to be the main pathogen of atypical necrotizing herpetic retinopathies. DNA amplification may be used to establish an early, sensitive, and reliable diagnosis of any form of necrotizing retinopathy in 80% of cases, irrespective of viral etiology. PMID: 9145733 [PubMed - indexed for MEDLINE] 2830. Am J Dermatopathol. 1997 Apr;19(2):133-7. Histopathology of peripheral nerves in cutaneous herpesvirus infection. Worrell JT, Cockerell CJ. Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, USA. Cutaneous herpesvirus infection is a common viral disorder manifest by epidermal and/or mucosal vesicle formation. Though it is believed that the virus most likely resides in regional sensory ganglia following primary infection and that cutaneous involvement represents reactivation of a latent infection, the histopathology of cutaneous nerves in sites of disease has not been well characterized. In order to assess and characterize the pathologic changes of these nerves, we retrospectively examined 54 cases of cutaneous and mucosal herpesvirus infection as defined by the presence of diagnostic multinucleate epithelial giant cells that demonstrated viral cytopathic effect. Dermal nerves were evaluable in 48 of 54 cases. All cases showed perineural inflammation that consisted of a dense mixed lymphocyte-polymorphonuclear cell infiltrate. Twenty-six cases exhibited intraneural infiltrations accompanied by Schwann cell hypertrophy with nuclear eosinophilia and pyknosis. Frank neuronal necrosis was present in 21 cases, with viral cytopathic effect evident within neurons of four cases. The degree of peri- and intraneural inflammation correlated with the severity of the inflammatory response within the dermis in most cases; however, in eight cases there was inflammatory involvement of neurovascular structures distant from and out of proportion to dermal and epidermal changes. Immunoperoxidase staining using a polyvalent antibody to human herpesvirus was performed in two cases and demonstrated viral antigen within nerve twigs. This pattern of peripheral nerve twig inflammation, along with the occurrence of more distant neural involvement, may prove to have diagnostic implications and serve as a clue in the recognition of cutaneous herpesvirus infection, particularly in cases with subtle or absent epidermal alteration. Furthermore, the presence of inflammation within and around nerves as well as degenerative changes suggest that nerve twigs are not passive conduits for viral spread but may be directly involved in infection. PMID: 9129697 [PubMed - indexed for MEDLINE] 2831. J Neurol. 1997 Apr;244(4):239-45. Subcortical type cognitive impairment in herpes zoster encephalitis. Hokkanen L, Launes J, Poutiainen E, Valanne L, Salonen O, Sirén J, Iivanainen M. Department of Neurology, University of Helsinki, Finland. Nine immunocompetent patients with acute herpes zoster encephalitis (HZE) were studied with the help of neurological investigations. All patients were treated with acyclovir. Neuropsychological performance was compared with that of a group of 16 healthy controls. Computed tomography of the head showed infarct-like hypodense lesions in two patients, involving the internal capsule in one case and the temporoparietal cortex and white matter in another. Hypoperfusion shown by single photon emission computed tomography, mostly involving the frontal areas bilaterally, was seen in six of the seven patients examined. Hyperperfusion as seen in herpes simplex encephalitis was not encountered. One patient remained mildly demented, but all the other patients recovered relatively well. Neuropsychological examination after acyclovir treatment showed a decline in memory and speed of cognitive processes, without circumscribed neuropsychological deficits. Six of the nine patients showed behavioural disinhibition, and mood changes were also observed. Memory impairment in HZE was not as global or as severe as is described after encephalitis due to herpes simplex virus. In HZE both the brain perfusion pattern and the neuropsychological test profile showed features compatible with subcortical dysfunction. PMID: 9112592 [PubMed - indexed for MEDLINE] 2832. Am J Epidemiol. 1997 Apr 1;145(7):594-7. Does prior infection with varicella-zoster virus influence risk of adult glioma? Wrensch M, Weinberg A, Wiencke J, Masters H, Miike R, Barger G, Lee M. Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco 94143-0560, USA. To evaluate a possible association between varicella-zoster virus infection and glioma, the authors asked adults with glioma (n = 462) whose tumors were diagnosed between August 1, 1991, and March 31, 1994, and age-, sex-, and ethnicity-matched controls (n = 443) about their histories of chickenpox or shingles. Cases were significantly less likely than controls to report a history of either chickenpox (odds ratio = 0.4, 95% confidence interval (CI) 0.3-0.6) or shingles (odds ratio = 0.5, 95% CI 0.3-0.8). To obtain serologic support for these findings, the authors conducted double-blind enzyme-linked immunosorbent assays for immunoglobulin G antibodies to varicella-zoster virus among 167 self-reporting subjects for whom blood samples were available. Cases and controls reporting no history of chickenpox were equally likely to test positive (73% vs. 75%), but among those reporting a positive history, cases were less likely than were controls to test positive (71% vs. 85%). Despite the misclassification, an odds ratio of 0.6 was obtained using either serologic data (95% CI 0.3-1.3) or reported history of chickenpox (95% CI 0.3-1.1) in this subgroup of subjects. This suggests that adults with glioma were less likely than controls either to have had prior varicella-zoster virus infection or to have an immunoglobulin G antibody response adequate to indicate positivity. Since either explanation suggests novel mechanisms for brain tumor pathogenesis, these findings require corroboration and elaboration. PMID: 9098175 [PubMed - indexed for MEDLINE] 2833. Pediatrics. 1997 Apr;99(4):608-10. Perianal herpes zoster presenting as suspected child abuse. Christian CW, Singer ML, Crawford JE, Durbin D. University of Pennsylvania School of Medicine, Division of General Pediatrics, Children's Hospital of Philadelphia 19104, USA. PMID: 9093310 [PubMed - indexed for MEDLINE] 2834. J Commun Dis. 1997 Mar;29(1):57-61. Optic neuroretinitis, a rare manifestation of herpes zoster ophthalmicus: a case report. Dhar MY, Goel JL, Sota LD. Guru Nanak Eye Centre, New Delhi. PMID: 9282530 [PubMed - indexed for MEDLINE] 2835. Br J Biomed Sci. 1997 Mar;54(1):72-3. Diagnosing varicella zoster virus infection. Bryden AS. PMID: 9167311 [PubMed - indexed for MEDLINE] 2836. Ceylon Med J. 1997 Mar;42(1):36-7. Acute colonic pseudo-obstruction associated with varicella zoster infection and acyclovir therapy. Herath P, Gunawardana SA. Sri Jayawardenepura General Hospital, Nugegoda, Sri Lanka. PMID: 9164030 [PubMed - indexed for MEDLINE] 2837. West J Med. 1997 Mar;166(3):211-5. Management of herpes simplex and varicella-zoster virus infections. Erlich KS. Department of Medicine, University of California, San Francisco, School of Medicine, USA. Herpes simplex virus and varicella-zoster virus are common infections and are seen frequently in clinical practice. Infection with these viruses results in cutaneous lesions that may be diagnosed clinically, but widely available laboratory testing is useful for confirmation. Asymptomatic herpes simplex virus shedding, or "subclinical reactivation," likely occurs in all persons infected with herpes simplex virus and results in the transmission of virus despite the absence of signs or symptoms that suggest active infection. Oral and intravenous acyclovir are effective in treating initial and recurrent herpes simplex and varicella-zoster virus infections. The daily administration of oral acyclovir as suppressive therapy is effective in patients with frequently recurring genital infection with herpes simplex virus by reducing the number of symptomatic recurrences and the frequency of asymptomatic virus shedding. Two new antiviral agents, famciclovir and valacyclovir hydrochloride, have been approved for the short-term treatment of recurrent genital herpes simplex virus and recurrent zoster in nonimmunocompromised hosts. Famciclovir and valacyclovir demonstrate superior pharmacokinetics compared with acyclovir and allow for less frequent daily dosing with higher achievable serum drug concentrations. The attenuated live varicella virus vaccine is now available in the United States and prevents primary varicella-zoster virus infection in susceptible children and adults. PMCID: PMC1304126 PMID: 9143202 [PubMed - indexed for MEDLINE] 2838. J Med Virol. 1997 Mar;51(3):214-6. Detection of latent varicella-zoster virus infection in human vestibular and spiral ganglia. Furuta Y, Takasu T, Suzuki S, Fukuda S, Inuyama Y, Nagashima K. Department of Otolaryngology, Hokkaido University School of Medicine, Sapporo, Japan. Varicella-zoster virus (VZV) becomes latent in the sensory ganglia after primary infection and VZV DNA has been found in human trigeminal, thoracic, and geniculate ganglia. In this study, human vestibular and spiral ganglia, which do not received innervation from the skin, were examined for VZV DNA using the polymerase chain reaction. VZV DNA was detected in 2 of 10 (20%) vestibular ganglia and in 2 of 10 (20%) spiral ganglia from five adults. VZV DNA was undetectable in either type of ganglion from a newborn and from two of the five adults. These two adults were VZV seronegative. The results indicate that VZV becomes latent in several types of sensory ganglion after primary infection and suggest the possibility that reactivation of the virus from the vestibular and spiral ganglia may cause disorders in the labyrinth. PMID: 9139086 [PubMed - indexed for MEDLINE] 2839. Br J Ophthalmol. 1997 Mar;81(3):189-94. Management of varicella zoster virus retinitis in AIDS. Moorthy RS, Weinberg DV, Teich SA, Berger BB, Minturn JT, Kumar S, Rao NA, Fowell SM, Loose IA, Jampol LM. Department of Ophthalomology, Northwestern University Medical School, Chicago, IL 60611, USA. AIMS/BACKGROUND: Varicella zoster virus retinitis (VZVR) in patients with AIDS, also called progressive outer retinal necrosis (PORN), is a necrotising viral retinitis which has resulted in blindness in most patients. The purposes of this study were to investigate the clinical course and visual outcome, and to determine if the choice of a systemic antiviral therapy affected the final visual outcome in patients with VZVR and AIDS. METHODS: A review of the clinical records of 20 patients with VZVR from six centres was performed. Analysis of the clinical characteristics at presentation was performed. Kruskall-Wallis non-parametric one way analysis of variance (KWAOV) of the final visual acuities of patients treated with acyclovir, ganciclovir, foscarnet, or a combination of foscarnet and ganciclovir was carried out. RESULTS: Median follow up was 6 months (range 1.3-26 months). On presentation, 14 of 20 patients (70%) had bilateral disease, and 75% (15 of 20 patients) had previous or concurrent extraocular manifestations of VZV infection. Median initial and final visual acuities were 20/40 and hand movements, respectively. Of 39 eyes involved, 19 eyes (49%) were no light perception at last follow up; 27 eyes (69%) developed rhegmatogenous retinal detachments. Patients treated with combination ganciclovir and foscarnet therapy or ganciclovir alone had significantly better final visual acuity than those treated with either acyclovir or foscarnet (KWAOV: p = 0.0051). CONCLUSIONS: This study represents the second largest series, the longest follow up, and the first analysis of visual outcomes based on medical therapy for AIDS patients with VZVR. Aggressive medical treatment with appropriate systemic antivirals may improve long term visual outcome in patients with VZVR. Acyclovir appears to be relatively ineffective in treating this disease. PMCID: PMC1722141 PMID: 9135381 [PubMed - indexed for MEDLINE] 2840. J Clin Epidemiol. 1997 Mar;50(3):337-9. Common infectious diseases in a population with low multiple sclerosis and varicella occurrence. Ross RT, Cheang M. Section of Neurology, University of Manitoba, Winnipeg, Canada. A previous study revealed the rarity of varicella zoster virus (VZV) diseases among 5601 Hutterite Brethren living in a high-risk area for these diseases. The current study was established to determine the frequency of other common infectious diseases. The information was gathered from a population-based study of a unique group of Manitoba citizens and compared with an equal number of their age and sex-matched neighbors. The data were contained in the records of the Manitoba Health Services Commission (MHSC). The MHSC, the sole paying agency for medical diseases in Manitoba, contained 94,383,972 records for all of Manitoba for the years 1985 to 1991 inclusive. From these, the records of a cohort of 5601 Hutterites and an equal number of non-Hutterite age- and sex-matched controls were examined for the frequency of 14 diseases of interest. To be eligible a Hutterite subject must have one of the 22 unique family names and live on a Colony with the precise address. A control must be age (within 10 years) and sex-matched, live in the same or a contiguous postal code, and use the same medical practitioners. There were no interventions or identification of any member of the study. Mumps, acute coryza, and rubella are of the same frequency among the two groups. Only herpes simplex and cellulitis are more common among the Hutterites. All of the other nine common infectious diseases are significantly more common among the controls. The VZV diseases are not exclusively less common among the Hutterite Brethren. Nine other common infectious diseases are also less common but the degree of significant difference does not reach the level of the VZV diseases. The reduction in numbers of these diseases among the Hutterites is not related to the vaccination habits of the group and is not due to physical isolation. The Hutterites appear to have a more effective immune system relative to their neighbors. PMID: 9120534 [PubMed - indexed for MEDLINE] 2841. Br J Dermatol. 1997 Mar;136(3):466-7. Isotopic response. Wolf R, Ruocco V, Filioli FG. Comment on: Br J Dermatol. 1996 Mar;134(3):504-9. Br J Dermatol. 1996 Mar;134(3):606. PMID: 9115937 [PubMed - indexed for MEDLINE] 2842. Br J Dermatol. 1997 Mar;136(3):465. Leukaemia cutis at the site of prior herpes zoster. Bahadoran P, Lacour JP, Ortonne JP. Comment on: Br J Dermatol. 1996 Mar;134(3):504-9. PMID: 9115935 [PubMed - indexed for MEDLINE] 2843. J Dermatol. 1997 Mar;24(3):205-7. Mo2+ HLA-DR- monocytosis in varicella zoster virus infection. Horiuchi Y. Division of Dermatology, Higashi-Matsuyama Medical Association Hospital, Saitama, Japan. Two-color analysis using Mo2+ (CD14) monocytes and HLA-DR class II monoclonal antibodies confirmed monocytosis in varicella zoster virus (VZV) infection in eight cases of herpes zoster and two cases of varicella. Only three cases, one being varicella, showed extensive Mo2+ HLA-DR- monocytosis of more than 12%. Accordingly, monocytosis in VZV infection may not be specific to the VZV antigen. PMID: 9114622 [PubMed - indexed for MEDLINE] 2844. Acta Anaesthesiol Scand. 1997 Mar;41(3):422-6. Four years' treatment with ketamine and a trial of dextromethorphan in a patient with severe post-herpetic neuralgia. Klepstad P, Borchgrevink PC. Department of Anesthesiology, Regional Hospital, University of Trondheim, Norway. Comment in: Acta Anaesthesiol Scand. 1997 Mar;41(3):329-31. N-methyl-D-aspartate (NMDA) receptors are involved in the development of neuropathic pain. Ketamine, a non-competitive NMDA receptor antagonist, has in several case reports given pain relief but efficacy in dosages tolerated in long-term ketamine treatment is unknown. Another substance with an antagonist action at NMDA receptors and which is approved for peroral administration is dextromethorphan. In a randomized study dextromethorphan was no better than placebo for neuropathic pain but this does not exclude efficacy in selected patients. We report a patient with severe post-herpetic pain resistant to conventional pain treatment which was treated with ketamine for 4 years with good pain relief. The practical application of long-term treatment in different administration forms of ketamine is described. The patient also responded with pain relief in a double-blind trial with oral dextromethorphan. PMID: 9113190 [PubMed - indexed for MEDLINE] 2845. Clin Neuropathol. 1997 Mar-Apr;16(2):61-4. Herpes zoster brachial plexus neuritis. Fabian VA, Wood B, Crowley P, Kakulas BA. Department of Neuropathology, Royal Perth Hospital, Western Australia. This is the first report of brachial plexus inflammation associated with clinical herpes zoster paresis. A 78-year-old female with a 3-week history of herpes zoster of the C4, C5, and C6 dermatomes developed left upper arm monoplegia. She died from an acute myocardial infarction. Post-mortem provided a rare opportunity to study the neuropathology of herpes zoster motor involvement. Histology of the brachial plexus showed extensive lymphocytic infiltration, myelin breakdown, and preservation of axons without vasculitis. The cervical spinal cord showed perivascular lymphocytic cuffing and no anterior horn necrosis. We suggest, the brachial plexus inflammation was a distal extension of a dorsal ganglionitis. Brachial plexus neuritis may be a direct cause of reversible upper limb paresis in herpes zoster. We demonstrate the motor neuropathy is an inflammatory demyelinative process consistent with the recovery observed in a number of patients. We postulate post-herpetic neuralgia may be related to an ongoing inflammatory process. PMID: 9101105 [PubMed - indexed for MEDLINE] 2846. Pharmacotherapy. 1997 Mar-Apr;17(2):333-41. Comparison of valaciclovir and acyclovir for the treatment of herpes zoster in immunocompetent patients over 50 years of age: a cost-consequence model. Grant DM, Mauskopf JA, Bell L, Austin R. GlaxoWellcome Research and Development, Greenford, United Kingdom. A method was developed for modeling the costs and consequences of treating varicella zoster viral infections to clinical data generated in a pivotal phase III clinical trial of valaciclovir versus acyclovir for the treatment of acute herpes zoster in immunocompetent patients over 50 years of age. Direct medical costs and indirect costs (productivity losses) were modeled using unit costs applicable in the United States. Compared with acyclovir, valaciclovir reduced average direct medical costs per patient by 17% ($60.01) and indirect costs by an average of 25% ($46.54). Median duration of pain was reduced by 13 days for valaciclovir compared with acyclovir in the intent-to-treat population or by 19 days in patients with pain after rash healing. The cost variables described in the model (drug costs, cost of treating long-term pain, physician visits, hospitalization, treatment of severe ocular involvement, productivity losses) were tested by sensitivity analysis. Total costs associated with valaciclovir treatment remained lower than those with acyclovir over the range of the analysis. PMID: 9085325 [PubMed - indexed for MEDLINE] 2847. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1997 Mar;83(3):354-7. Cranial polyneuropathy--Ramsay Hunt's syndrome: case report and discussion. Turner JE, Geunes PM, Schuman NJ. Department of Biologic and Diagnostic Sciences, University of Tennessee College of Dentistry, Memphis, USA. Ramsay Hunt's syndrome is an infectious cranial polyneuropathy caused by varicella zoster, the herpetic virus that also causes chickenpox and shingles. Its symptoms include facial paralysis, ear pain, and an auricular rash. Oral lesions are also present in most cases. This syndrome can affect any cranial nerve and usually affects multiple nerves, causing central, cervical, and peripheral effects. This article reports the case of a 35-year-old white female who was treated by the oral surgery service of a large urban hospital, after first reporting to the emergency clinic. Her reported symptoms of unilateral left-side facial paralysis, auricular pain, and trigeminal hyperesthesia were confirmed by clinical examination. An initial short low-dose steroid regimen was unsuccessful. A second daily dosage of 50 mg of prednisone was successful in 21 days. No permanent sequelae were evident or reported after treatment. PMID: 9084199 [PubMed - indexed for MEDLINE] 2848. J Rheumatol. 1997 Mar;24(3):589-91. Herpes zoster encephalomyelitis associated with low dose methotrexate for rheumatoid arthritis. Lyon CC, Thompson D. Wharfedale General Hospital, Otley, UK. Comment in: J Rheumatol. 1997 Dec;24(12):2487-8. We describe herpes zoster encephalomyelitis occurring 9 days after the onset of cutaneous zoster in an elderly patient taking low dose weekly methotrexate without concomitant prednisolone. PMID: 9058671 [PubMed - indexed for MEDLINE] 2849. Pharmacoeconomics. 1997 Mar;11(3):262-73. Economic evaluation of antiviral therapy for the treatment of herpes zoster in immunocompetent adults. Grüger J, Backhouse ME. SmithKline Beecham Pharmaceuticals, Munich, Germany. Jens.GRUEGER@sb.com Shingles (herpes zoster) affects 20% of the population at some stage during their lives. The economic consequences can be significant. For example, in the UK, the costs of post-herpetic neuralgia, a complication that affects between 10 and 14% of patients with shingles, have been estimated between 4.8 million and 17.9 million pounds sterling (Pounds). This study is the first formal assessment of the cost-effectiveness of the 2 most commonly used oral antiviral treatments that have proven efficacy in patients with shingles: famciclovir and aciclovir (acyclovir). It shows that the clinical advantages of famciclovir over aciclovir are accompanied by potential economic advantages in the form of savings in direct costs to the UK National Health Service of between 2.04 pounds and 16.85 pounds per patient treated. Future economic research to validate the benefits of antiviral treatment should focus on prospective assessments alongside controlled trials incorporating resource use analysis, quality-of-life appraisal, assessments of pain severity, and long term follow-up with continuation protocols. PMID: 10165315 [PubMed - indexed for MEDLINE] 2850. Am J Ophthalmol. 1997 Feb;123(2):255-7. Famciclovir for the treatment of acute retinal necrosis (ARN) syndrome. Figueroa MS, Garabito I, Gutierrez C, Fortun J. Department of Ophthalmology, Ramon y Cajal University Hospital, Madrid, Spain. PURPOSE: To document a case of acute retinal necrosis syndrome in an immunocompetent patient who was successfully treated with famciclovir after unsuccessful treatment with acyclovir. METHODS: After diagnosing acute retinal necrosis syndrome in the patient's left eye, we treated him with 13 mg/kg/24 hours of intravenous acyclovir in three daily doses for 14 days, followed by 800 mg of acyclovir five times per day orally. New areas of retinitis developed within the posterior pole despite treatment with the maximum dosage of acyclovir; thus, we used a new antiviral agent, famciclovir. RESULTS: When we administered 500 mg of famciclovir orally every 8 hours for 3 months, the retinitis regressed within 1 month, leaving atrophic granular pigmented scars. CONCLUSION: Famciclovir can effectively treat acute retinal necrosis syndrome in immunocompetent patients. PMID: 9186134 [PubMed - indexed for MEDLINE] 2851. Am J Ophthalmol. 1997 Feb;123(2):254-5. Disciform keratitis: a case of herpes zoster sine herpete. Silverstein BE, Chandler D, Neger R, Margolis TP. Francis I. Proctor Foundation, University of California, San Francisco Medical Center 94143-0944, USA. PURPOSE: To describe a case of disciform keratitis in a patient with acquired immunodeficiency syndrome (AIDS) in which varicella-zoster virus was the causative agent. METHOD: Case report, Polymerase chain reaction-based assays for varicella-zoster virus, cytomegalovirus, and herpes simplex virus were used to analyze an aqueous aspirate. RESULTS: We examined a 41-year-old man with AIDS but without a history of varicella-zoster virus dermatitis who had disciform corneal edema in his left eye. Varicella-zoster virus was detected by a polymerase chain reaction-based assay in the aqueous of the left eye; however, neither cytomegalovirus nor herpes simplex virus DNA were detected by polymerase chain reaction-based assays. The corneal edema slowly resolved while the patient was treated with famciclovir. CONCLUSION: Varicella-zoster virus may cause disciform keratitis without a preceding skin eruption. PMID: 9186133 [PubMed - indexed for MEDLINE] 2852. Am J Ophthalmol. 1997 Feb;123(2):252-4. Primary varicella-zoster keratitis: diagnosis by polymerase chain reaction. Power WJ, Hogan RN, Hu S, Foster CS. Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston 02114, USA. PURPOSE: To report the value of polymerase chain reaction in the diagnosis of a worsening corneal ulcer. METHODS: A 6-year-old boy underwent an emergent penetrating keratoplasty for a corneal ulcer that continued to worsen despite intensive antibiotic therapy. RESULTS: Examination of the corneal specimen by polymerase chain reaction was positive for varicella-zoster virus but negative for herpes simplex. Based on polymerase chain reaction studies, we diagnosed primary varicella-zoster keratitis with corneal perforation. Electron microscopy showed herpetic virus particles in the cornea. CONCLUSIONS: Polymerase chain reaction analysis of corneal buttons at the time of penetrating keratoplasty may benefit patients with undiagnosed recalcitrant corneal ulcers. PMID: 9186132 [PubMed - indexed for MEDLINE] 2853. Am J Ophthalmol. 1997 Feb;123(2):243-51. The potential impact of the varicella vaccine and new antivirals on ocular disease related to varicella-zoster virus. Pepose JS. Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St Louis, Missouri 63110, USA. pepose@am.seer.wustl.edu PMID: 9186131 [PubMed - indexed for MEDLINE] 2854. Am J Ophthalmol. 1997 Feb;123(2):157-64. A polymerase chain reaction-based assay for diagnosing varicella-zoster virus retinitis in patients with acquired immunodeficiency syndrome. Short GA, Margolis TP, Kuppermann BD, Irvine AR, Martin DF, Chandler D. Francis I. Proctor Foundation, University of California, San Francisco Medical Center 94143-0944, USA. PURPOSE: To develop a rapid, sensitive, and specific laboratory assay based on the polymerase chain reaction for the diagnosis of varicella-zoster virus retinitis in patients with acquired immunodeficiency syndrome (AIDS). METHODS: We developed and tested a polymerase chain reaction-based assay for the detection of varicella-zoster virus DNA in vitreous samples. We attempted to detect varicella-zoster virus DNA in 14 vitreous samples from patients with AIDS and a clinical diagnosis of progressive outer retinal necrosis syndrome. For controls, we also attempted to detect varicella-zoster virus DNA in vitreous samples from 75 immunocompetent patients with vitreoretinal disease and 88 patients with AIDS and vitreoretinal inflammatory disease not related to progressive outer retinal necrosis syndrome. RESULTS: Varicella-zoster virus DNA was detected in 11 of 14 vitreous samples from AIDS patients with progressive outer retinal necrosis syndrome. All three samples that scored negative for varicella-zoster virus DNA came from eyes that had been treated aggressively with antiviral drugs and had clinically inactive disease at the time of vitreous biopsy. Varicella-zoster virus DNA was detected in only two of 75 control vitreous samples from immunocompetent patients with vitreoretinal disease and two of 88 control vitreous samples from patients with AIDS and vitreoretinal inflammatory disease not related to progressive outer retinal necrosis syndrome. CONCLUSION: We have developed a rapid, sensitive, and specific polymerase chain reaction-based diagnostic assay for varicella-zoster virus DNA that will assist in the diagnosis of varicella-zoster virus retinitis in patients with AIDS. PMID: 9186120 [PubMed - indexed for MEDLINE] 2855. Ther Umsch. 1997 Feb;54(2):79-82. [The dangerous headache] [Article in German] Mumenthaler M. Some particularities are frequent in headache types due to a potentially dangerous disease, namely sudden onset, rapid increase of pain intensity, very localized headache, increasing frequency and intensity of pain, and the insurgence of neurological or psychopathological signs. The headache types showing one of these characteristics are discussed in detail. PMID: 9139409 [PubMed - indexed for MEDLINE] 2856. Pain. 1997 Feb;69(3):245-53. Severity of skin lesions of herpes zoster at the worst phase rather than age and involved region most influences the duration of acute herpetic pain. Higa K, Mori M, Hirata K, Hori K, Manabe H, Dan K. Department of Anesthesiology, School of Medicine, Fukuoka University, Japan. Duration of acute herpetic pain (AHP) in 1431 patients for whom treatment was begun within 14 days after the onset of herpes zoster (HZ) was analyzed with respect to age, involved region, and severity of skin lesions. All patients were treated with repeated sympathetic nerve blocks until their pain was almost nil. Severity of the skin lesions at the worst phase was defined as mild when they covered less than one-quarter of the primary dermatome, as severe when they covered more than three-quarters of the primary dermatome, and moderate if they were between mild and severe. Without taking into account the severity of skin lesions, the duration of AHP for those aged 60 years or over and for those with trigeminal involvement was significantly longer than for patients aged under 40 years (P < 0.01 and P < 0.001) and for patients with thoracic (P < 0.001) and lumbosacral (P < 0.01) involvement, respectively. However, duration of AHP was significantly longer with increase in the severity of skin lesions in all age groups (the mild group versus the moderate group, P < 0.01 and P < 0.001; the moderate group versus the severe group, P < 0.01 and P < 0.001). The mean duration of AHP for patients aged 60 years or over with mild skin lesions ranged from 17.4 to 22.9 days, while that for patients aged 30-59 years with severe skin lesions ranged from 37.2 to 50.1 days. In addition, duration of AHP was significantly longer with increase in the severity of skin lesions in all regions (the mild group versus the moderate group, P < 0.01 and P < 0.001; the moderate group versus the severe group, P < 0.05 and P < 0.001). The mean duration of AHP for those with trigeminal involvement with mild skin lesions was 19.5 days, while the range was from 51.3 to 55.0 days for patients with severe skin lesions involving regions other than the trigeminal area. The frequency of severe skin lesions was significantly higher (P < 0.001) in patients aged 60 years or over and in those with trigeminal involvement. Multiple stepwise regression analysis revealed that the most important factors influencing the duration of AHP were the severity of skin lesions of HZ at the worst phase (r = 0.412), age (r = 0.277) and the involved region (r = -0.101). Thus, AHP in the elderly and in cases of trigeminal involvement is longer because of higher frequencies of severe HZ in the elderly and in trigeminal involvement rather than "being aged' and "trigeminal involvement' itself. We propose that one needs to analyze the results of treatment of AHP with respect to the severity of skin lesions at the worst phase. PMID: 9085298 [PubMed - indexed for MEDLINE] 2857. Drugs Aging. 1997 Feb;10(2):80-94. Herpes zoster and postherpetic neuralgia. Optimal treatment. Johnson RW. Pain Management Clinic, Bristol Royal Infirmary, University of Bristol, England. Herpes zoster is a common disease primarily affecting the elderly. Although some individuals experience no symptoms beyond the duration of the acute infection, many develop chronic pain [postherpetic neuralgia (PHN)], which is the commonest complication of herpes zoster infection and remains notoriously difficult to treat once established. It may persist until death and has major implications for quality of life and use of healthcare resources. Predictors for the development of PHN are present during the acute disease and should indicate the need for the use of preventive therapy. At the present time, use of antiviral and certain tricyclic antidepressant drugs, combined with psychosocial support, seem most effective, but are far from perfect. Sympathetic nerve blocks reduce acute herpetic pain but it is uncertain whether they prevent PHN. In the future, vaccines may have an important place in reducing the incidence of chickenpox in the population or, through the vaccination of middle-aged individuals, in boosting immunity to varicella zoster virus, thus preventing or modifying the replication of the virus from its latent phase that results in herpes zoster. Developments in the understanding of the pathophysiology of PHN indicate possible directions for improved drug management of established PHN, although no evidence yet exists for efficacy of the drugs concerned. Such agents include new generation anticonvulsants and N-methyl-D-aspartate antagonists. PMID: 9061266 [PubMed - indexed for MEDLINE] 2858. Ophthalmology. 1997 Feb;104(2):279-82. Repair of retinal detachments due to herpes varicella-zoster virus retinitis in patients with acquired immune deficiency syndrome. Weinberg DV, Lyon AT. Department of Ophthalmology, Northwestern University Medical School, Chicago, Illinois, USA. Comment in: Ophthalmology. 1998 Mar;105(3):390-1. PURPOSE: The authors characterize surgical techniques and report results for repair of retinal detachments due to varicella-zoster retinitis in patients with acquired immune deficiency syndrome (AIDS). BACKGROUND: Varicella-zoster virus (VZV) retinitis is a distinctly aggressive infection in patients with AIDS. Retinal detachments occur in the majority of such patients, and contribute to their poor visual prognosis. METHODS: A case series of five eyes in four patients with AIDS and retinal detachments due to VZV retinitis is presented, highlighting surgical technique and results. Pars plana vitrectomy, silicone oil tamponade, and endolaser photocoagulation were used in all cases. RESULTS: Apparent contraction of the necrotic retina was observed, requiring large relaxing retinectomies to achieve retinal attachment in three of the five eyes. Follow up after surgery was 4, 6, 15, 29, and 30 months. Four eyes maintained ambulatory vision and the retinas remained attached. CONCLUSION: Vitrectomy with silicone oil tamponade may be used to preserve ambulatory vision in carefully selected patients with AIDS and retinal detachments due to VZV retinitis. Relaxing retinectomy is a useful technique to achieve and maintain retinal attachment. PMID: 9052632 [PubMed - indexed for MEDLINE] 2859. Neurology. 1997 Feb;48(2):407-12. The neurologic complications of B-cell chronic lymphocytic leukemia. Bower JH, Hammack JE, McDonnell SK, Tefferi A. Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA. We performed a retrospective study to characterize the type, frequency, and timing of neurologic complications in patients with B-cell chronic lymphocytic leukemia (B-CLL). We reviewed 962 total charts with a median follow-up time of 57.5 months. There were 109 cases (11.3%) of neurologic complications, including 69 cases (7.2%) of herpes zoster infection, 17 cases (1.8%) of other opportunistic infection, 14 cases (1.5%) of treatment-related conditions, eight cases (0.8%) of direct leukemic involvement of neural tissue, and 1 case (0.1%) of intracranial hemorrhage. No cases of a non-zoster opportunistic infection presented in early-stage (Rai stage 0-2) B-CLL, and only one case of direct leukemic involvement of neural structures presented in early-stage B-CLL. Of the 25 cases of non-zoster or treatment-related complications, only 5 presented before 6 years from the initial B-CLL diagnosis. Three of these were in advanced-stage B-CLL, staging could not be determined in one, and one presented in early-stage B-CLL. We conclude that the overall neurologic complication rate of B-CLL is low, and that the Rai stage of the disease correlates best with the risk of developing neurologic complications. The occurrence of a related non-zoster neurologic complication in a patient with B-CLL stage 0-2 approaches 1:1,000. PMID: 9040730 [PubMed - indexed for MEDLINE] 2860. Muscle Nerve. 1997 Feb;20(2):229-31. Painful neuropathy after diffuse herpes zoster. Mondelli M, Scarpini C, Malandrini A, Romano C. EMG Service, USL 7, Siena, Italy. PMID: 9040664 [PubMed - indexed for MEDLINE] 2861. J Am Acad Dermatol. 1997 Feb;36(2 Pt 1):183-5. PUVA-induced phototoxicity: incidence and causes. Morison WL, Marwaha S, Beck L. Department of Dermatology, Johns Hopkins Medical School, Baltimore, MD, USA. BACKGROUND: Phototoxicity is the most significant short-term adverse effect of PUVA therapy. OBJECTIVE: We attempted to determine the incidence and possible causes of phototoxicity of sufficient degree to cause interruption of treatment. METHODS: A retrospective study was conducted of 16,506 PUVA treatments given to 414 patients in two treatment centers. RESULTS: Phototoxicity occurred in 10.9% of patients and was an adverse effect in 0.3% of treatments. Problems with the treatment protocol were the main cause. CONCLUSION: Phototoxicity is a common adverse effect, and patients should be warned of this potential occurrence. Awareness of the causes may help to reduce the incidence of this problem. PMID: 9039165 [PubMed - indexed for MEDLINE] 2862. J Neurosurg. 1997 Feb;86(2):197-202. Chronic electrical stimulation of the gasserian ganglion for the relief of pain in a series of 34 patients. Taub E, Munz M, Tasker RR. Division of Neurosurgery, University of Toronto, Ontario, Canada. The use of an implanted system for chronic electrical stimulation of the gasserian ganglion for relief of facial pain was described in 1980 by Meyerson and Håkansson. Between 1982 and 1995, the senior author (R.R.T.) performed gasserian ganglion stimulation in 34 patients for the relief of chronic medically intractable facial pain. The etiology of pain was peripheral damage to the trigeminal nerve in 22 patients (65%), central (stroke) damage in seven (21%), postherpetic neuralgia in four (12%), and unclassifiable cause in one (3%). All patients received a trial of transcutaneous stimulation (Stage 1). Successful trials in 19 patients (56%) were followed by implantation of a permanent system (Stage II). Trial and postimplantation stimulation were deemed successful when there was a reduction of pain by at least 50% whenever the stimulator was on. Success rates varied from five (71%) of seven patients for central pain to five (23%) of 22 for peripheral pain and none (0%) of four for postherpetic neuralgia. The median follow-up duration in successful cases was 22.5 months. Infections occurred in seven patients, all of whom had undergone Stage II treatment. Infections were more frequent when the stimulating electrode from Stage I was left in place for Stage II (six [43%] of 14) than when completely new hardware was used and prophylactic antibiotic drugs were administered (one [20%] of five). Other complications included iatrogenic injury to the trigeminal nerve or ganglion in three cases (9%), transient diplopia in two (6%), increased pain in two (6%), and various technical problems in 10 (29%). It is concluded that pain of central origin (stroke) is the type most likely to be relieved by this procedure. This finding is new, as the few other clinical series reported to date contain no patients with this type of pain. The risk of infection seems to be lower when completely new hardware is used for Stage II and prophylactic antibiotic drugs are administered. PMID: 9010419 [PubMed - indexed for MEDLINE] 2863. J Clin Microbiol. 1997 Feb;35(2):347-9. Antigen detection: the method of choice in comparison with virus isolation and serology for laboratory diagnosis of herpes zoster in human immunodeficiency virus-infected patients. Dahl H, Marcoccia J, Linde A. Department of Virology, Swedish Institute for Infectious Disease Control, Stockholm, Sweden. Ninety-two adult human immunodeficiency virus (HIV)-infected patients with suspected herpes zoster were included in a study. The clinical diagnosis of herpes zoster was verified by examination of blister cell and fluid material or serum samples. Antigen detection by a direct immunofluorescence assay with a fluorescein isothiocyanate-labelled monoclonal antibody, virus isolation, and serologic methods (in-house varicella-zoster virus [VZV] immunoglobulin G [IgG] and IgM enzyme-linked immunosorbent assays and the commercial Enzygnost assay) were compared. The direct immunofluorescence assay was found to be the most sensitive method, diagnosing 85 of 92 infections (92%), while the sensitivity of virus isolation was 65% (60 of 92 patients). Despite the use of two different serological methods, only 60 of 92 patients (65%) had significant VZV IgG titer rises, and only 26 of 92 patients (28%) had detectable VZV IgM. The lack of a VZV IgG antibody titer rise was found to correlate with low CD4 counts in peripheral blood and high VZV IgG titers in the acute-phase serum sample. The frequency of IgM-positive sera was lower than that expected from reports of studies with patients without AIDS. This may be related to early antiviral treatment or deficient antibody production due to the HIV-related immunosuppression. There was no significant difference in CD4 counts between VZV IgM-positive and -negative patients. PMCID: PMC229577 PMID: 9003593 [PubMed - indexed for MEDLINE] 2864. Dtsch Med Wochenschr. 1997 Jan 31;122(5):132-9. [Zoster. The manifestation forms in the skin, complications and therapy] [Article in German] Gross G. Klinik für Dermatologie und Venerologie, Universität Rostock. PMID: 9072484 [PubMed - indexed for MEDLINE] 2865. Biomed Pharmacother. 1997;51(10):449-54. Cerebral infarction associated with vasculitis due to varicella zoster virus in patients infected with the human immunodeficiency virus. Picard O, Brunereau L, Pelosse B, Kerob D, Cabane J, Imbert JC. Service de Médecine Interne, Hôpital Saint-Antoine, Paris, France. Cases of herpes zoster ophtalmicus (HZO) with delayed contralateral hemiparesis caused by hemispheric stroke secondary to granulomatous angiitis have been reported and are a well-recognized complication of herpes zoster. Similar cases have been reported more recently during infection with human immunodeficiency virus (HIV). We describe two HIV+ patients without any clinical history of zoster dermatitis who developed a sudden hemiparesis followed 2 weeks later for one by an acute retinal necrosis. Computerized tomography (CT) scan, magnetic resonance imaging (MRI), magnetic resonance angiography (MRA), and digital subtraction angiography (DSA) were performed and showed a hemispheric stroke with evidence of a segmental arteritis of the carotid syphon. Varicella zoster virus (VZV) was found in the cerebro spinal fluid (CSF) in the two patients and after puncture of the vitreous fluid of the patient with the acute retinal necrosis. These two cases exemplify the difficulty of diagnosis of stroke in HIV+ patients, which seems to be more frequent than in similarly aged non-infected patients and demonstrates that VZV needs to be taken in consideration and identified even without any past history of zoster dermatitis. PMID: 9863504 [PubMed - indexed for MEDLINE] 2866. Ann Dermatol Venereol. 1997;124(2):144-50. [Skin diseases disclosing human immunodeficiency virus infection in Mali] [Article in French] Mahé A, Bobin P, Coulibaly S, Tounkara A. Institut Marchoux, BP 251, Bamako, République du Mali. INTRODUCTION: Several skin diseases are associated with human immunodeficiency virus (HIV) infection. In Africa, due to the difficult access to medical care and complementary examinations, certain diseases are of particular importance. In the present work, we report the skin manifestations observed in a dermatology unit of a large city in Africa over a 3 year period and which were the revealing signs of HIV infection. PATIENTS AND METHODS: All adult subjects (>15 years) with a positive HIV serology (confirmed by Western blot) that had been revealed by a skin disease seen at the Marchoux Institute at Bamako between June 1991 and September 1994 were included in the study. RESULTS: Two hundred sixty-three skin diseases revealed 233 cases of HIV infection. Diseases observed were: zoster (n = 71), seborrheic dermatitis (n = 43), Kaposi's sarcoma (n = 34), prurigo (n = 31), sexually transmitted diseases (n = 27), extensive dermatophytosis (n = 12), psoriasis (n = 12), molluscum contagiosum (n = 8), acquired ichthyosis (n = 3), cutaneous leishmaniasis (n = 2) and other skin diseases (n = 10). More than one disease were associated in 28 patients. Certain particular features were noted (superinfection of zoster, papular margin in dermatophytosis). DISCUSSION: In Africa, certain skin diseases often reveal HIV infection and some diseases have a high positive predictive value for HIV infection (zoster, seborrheic dermatitis, prurigo, Kaposi's sarcoma, extensive dermatophytotis). For prognosis, frequently associated diseases are signs of AIDS (Kaposi's disease, prurigo, molluscum contagiosum). PMID: 9740824 [PubMed - indexed for MEDLINE] 2867. Ann Dermatol Venereol. 1997;124(4):366-9. [Question of the month: should herpes zoster in an immunocompetent subject (except ocular herpes zoster) be treated by antiviral agents?] [Article in French] [No authors listed] PMID: 9739950 [PubMed - indexed for MEDLINE] 2868. Ann Dermatol Venereol. 1997;124(5):401-3. [Oculomotor nerve paralysis with complete ptosis in herpes zoster ophthalmicus: 2 cases] [Article in French] Schoenlaub P, Grange F, Nasica X, Guillaume JC. Service de dermatologie, Hôpital Pasteur, Colmar. INTRODUCTION: Only few studies focus on ocular motor paralyses in herpes zoster ophtalmicus. We report 2 cases of complete ptosis resulting from paralysis of the superior lid levator, appearing at day 6 and 7 of an ophtalmic herpes zoster under treatment with acyclovir. CASE REPORTS: Case 1: A 68 year old woman presented an history of ophtalmic herpes zoster with kerato-conjunctivitis and uveitis treated with acyclovir. At the third day of the treatment and 7th day of the ophtalmic zoster, an incomplete paralysis of the oculomotor nerve appeared resulting in a complete ptosis. The treatment was carried on until the 21st day without improvement. Four months later, all symptoms had completely cleared. CASE 2: A 66 year old woman was treated with acyclovir for an ophtalmic herpes zoster without ocular involvement. At the 4th day of the treatment and 6th day of the onset of the ophtalmic zoster, a paralytic ptosis and a acute epithelial keratitis appeared. Acyclovir treatment was continued for 10 days. The ptosis resolved gradually during 2 months. DISCUSSION: The manifestation of a complete ptosis with paralysis of the oculomotor nerve or of one of its branch is rarely seen in ophtalmic herpes zoster. However minor symptoms are often detected when patients were carefully examined with regard to external ocular movements. The physiopathological mechanism are discussed about. The possible action of an early antiviral treatment on the prevention of these complications is not known. In our two cases, a paralytic ptosis broke out suddenly, even under treatment with acyclovir for respectively 3 and 4 days. For future prospective studies about antiviral drugs for ophtalmic herpes zoster, a systematic evaluation of these neurological symptoms would be interesting. PMID: 9739899 [PubMed - indexed for MEDLINE] 2869. Intervirology. 1997;40(5-6):343-56. Antiviral therapy of herpes simplex and varicella-zoster virus infections. Wutzler P. Institute for Antiviral Chemotherapy, Clinicum of the University of Jena, Erfurt, Germany. Antiviral treatment of herpesvirus infections is rapidly changing since the advent of new drugs with improved oral availability. The efficacy of valaciclovir, the prodrug of aciclovir, and famciclovir, the prodrug of penciclovir, in the treatment of herpes genitalis and acute herpes zoster has been well documented in large clinical trials. Both drugs are effective on zoster-associated pain. Brivudin and sorivudine which are the most active compounds against varicella-zoster virus (VZV) in cell culture have also been successful in the treatment of herpes zoster. Aciclovir is still the standard therapy of severe herpes simplex virus (HSV) and varicella virus infections. In patients treated with aciclovir, the mortality of herpes encephalitis has been reduced to about 25%. The development of resistance against aciclovir and the other nucleoside analogues has not been a problem to date in the treatment of immunocompetent individuals. However, in immunocompromised patients, aciclovir-resistant HSV strains often emerge. In such cases, intravenous foscarnet is the current treatment of choice. PMID: 9675639 [PubMed - indexed for MEDLINE] 2870. Can Fam Physician. 1997 Jan;43:35, 43. Dermacase. Herpes zoster. Adams SP. Dermatology Department, University of Calgary, Alta. PMCID: PMC2255151 PMID: 9626420 [PubMed - indexed for MEDLINE] 2871. Dermatology. 1997;195(4):311-6. Intracutaneous histamine injection can detect damage of cutaneous afferent fibres in postherpetic neuralgia. Stücker M, Hügler P, von Kobyletzki G, Reuther T, Hoffmann K, Laubenthal H, Altmeyer P. Department of Dermatology, Ruhr University, Bochum, Germany. BACKGROUND: The axon reflex response in diseased skin of patients with postherpetic neuralgia may be significantly impaired. OBJECTIVE: In the present study we introduced a simple test for quantifying the decreased axon reflex flare response in the clinical routine. METHODS: Histamine was intradermally applied to the diseased dermatome as well as to the corresponding dermatome of the contralateral side of the body. Ten minutes after application, skin blood flow and the extension of the hyperaemic response were assessed by means of laser Doppler scanning. RESULTS: In the skin region affected by the postherpetic neuralgia, the hyperaemic area was significantly smaller than in the healthy skin. The mean flux values did not differ significantly between the two sites. There was no correlation between the hyperaemic response and the intensity of pain sensation assessed by a clinical visual analogue score. CONCLUSION: The smaller hyperaemic area in the dermatome with postherpetic neuralgia strongly indicates a C fibre or C nociceptor damage. We consider histamine injections as a useful tool in the differential diagnosis of postherpetic neuralgia. PMID: 9529547 [PubMed - indexed for MEDLINE] 2872. Rev Med Interne. 1997;18(12):991. [Paralytic sciatica of zoster origin] [Article in French] Trivalle C, Benharrats I, Wetterwald E, Beaufils M. PMID: 9500006 [PubMed - indexed for MEDLINE] 2873. Intervirology. 1997;40(2-3):72-84. Infections of the nervous system caused by varicella-zoster virus: a review. Echevarría JM, Casas I, Martínez-Martín P. National Center for Microbiology, Instituto de Salud Carlos III, Majadahonda, Spain. Varicella-zoster virus (VZV) is a cause of neurologic disease among humans. Both primary infection and recurrence may lead to neurologic infection and disease. Neurologic syndromes associated with acute VZV infection are caused by abnormal immune responses, the most frequent manifestation being cerebellar ataxia. Those associated with recurrences are often due to the direct effect of viral replication in the nervous tissue. VZV reaches the nervous system either through the bloodstream or by direct spread from sensory ganglia where it remains latent. Postherpetic neuralgia, acute encephalitis, aseptic meningitis and myelitis are the most frequent diseases and have been recorded both in association with herpes zoster and in the absence of a cutaneous rash. Early diagnosis may be established by detecting virus-specific DNA sequences in the cerebrospinal fluid (CSF) after amplification by the polymerase chain reaction and then confirmed by detection of intrathecally produced, specific IgG antibody. Virus isolation from CSF and antibody testing in serum are unsuitable for diagnosis. Early acyclovir therapy is recommended in immuno-compromised patients and those with serious disease. PMID: 9450225 [PubMed - indexed for MEDLINE] 2874. Retina. 1997;17(6):560-2. Successful treatment of progressive outer retinal necrosis using high-dose intravitreal ganciclovir. Meffert SA, Kertes PJ, Lim PL, Conway MD, Peyman GA. LSU Eye Center, Louisiana State University Medical Center School of Medicine, New Orleans 70112-2234, USA. PMID: 9428025 [PubMed - indexed for MEDLINE] 2875. Arch Anat Cytol Pathol. 1997;45(2-3):142-52. [Central nervous system infection due to varicella and zoster virus in AIDS] [Article in French] Chrétien F, Bélec L, Lescs MC, Authier FJ, De Truchis P, Scaravilli F, Gray F. Département de Pathologie (Neuropathologie), Faculté de Médecine de Créteil, Université Paris-Val-de-Marne, Hôpital Henri Mondor, France. We have reviewed 23 cases of varicella-zoster virus infection of the central nervous system in patients with the acquired immunodeficiency syndrome, previously reported in the literature, including 11 from our own series. This allowed us to identify 5 clinico-pathological patterns which could occur simultaneously. In most cases, viral proteins or viral genome were identified using immunocytochemistry or in situ hybridization. Multifocal encephalitis involves predominantly the white matter and is likely to be due to haematogenous spread of the infection. Ventriculitis may have variable appearance according to the course of the disease. In one incipient case, the ependymal lining appeared irregular with foci of infected ependymal cells some of which protruded into the ventricular lumen; in other instances, there was acute or chronic necrosis of the ventricular wall with marked vasculitis. Acute haemorrhagic meningo-myelo-radiculitis with necrotising vasculitis may be associated with ventriculitis and results from shedding of infected ependymal cells into the ventricular lumen and secondary seeding of the cerebrospinal fluid. Focal necrotising encephalitis or myelitis usually follows cutaneous herpes zoster in the corresponding dermatoma and is considered to result from neural spread from the diseased trigeminal or dorsal root ganglion. Vasculopathy involving leptomeningeal arteries and causing cerebral infarcts is associated with meningitis in most cases. These findings are in keeping with the observation in other immunocompromised patients, that varicella-zoster virus spread to the central nervous system may follow different routes. Our study tends to show that varicella-zoster virus infection of the central nervous system is more frequent in the acquired immunodeficiency syndrome than previously suspected and suggests this diagnosis must be considered systematically in cases of encephalitis, ventriculitis, focal myelitis, acute myeloradiculitis and cerebral infarcts in these patients, since an efficient treatment is available. PMID: 9382606 [PubMed - indexed for MEDLINE] 2876. Pharmacol Ther. 1997;75(1):1-19. Chronic neuropathic pain and its control by drugs. MacFarlane BV, Wright A, O'Callaghan J, Benson HA. School of Pharmacy, University of Queensland, Brisbane, Australia. The medical treatment and some currently known aspects of the aetiology of five neurogenic pain states are discussed. Neurogenic pain can be described as pain resulting from noninflammatory dysfunction of the peripheral or central nervous system without nociceptor stimulation or trauma. The enormity of the field has limited this review to post-herpetic neuralgia, complex regional pain syndromes, phantom pain, trigeminal neuralgia and diabetic neuralgia. Evidence suggests that many neurogenic pain states are not effectively controlled. This may be due in part to a lack of understanding of the aetiology of these conditions and to the lack of high quality studies evaluating existing treatments. A compact review of the literature is presented with some treatment options and possible future directions. Where appropriate surgical management and physical therapy have been discussed; however, a thorough appraisal of nondrug treatments was not the main priority of this review. PMID: 9364578 [PubMed - indexed for MEDLINE] 2877. Clin Exp Dermatol. 1997 Jan;22(1):37-40. Transient leukaemia cutis in chronic lymphocytic leukaemia. Wakelin SH, Young E, Kelly S, Turner M. Department of Dermatology, Amersham Hospital, Bucks, UK. Leukaemia cutis arises due to cutaneous infiltration of neoplastic leukocytes or their precursors. Recent evidence suggests that this sign does not necessarily herald a poor prognosis. We describe a 72-year-old woman with B-cell chronic lymphatic leukaemia (CLL) who developed a papular eruption on her breast at the site of a recent herpetic eruption. Histology and immunostaining showed a dense dermal B-cell infiltrate in keeping with leukaemia cutis. The papules cleared in 6 months without treatment, leaving atrophic scars. The histological features and possible aetiological mechanisms of post-herpetic papular eruptions in CLL are reviewed. PMID: 9330053 [PubMed - indexed for MEDLINE] 2878. Med Trop (Mars). 1997;57(2):207-8. [Antecubital herpes zoster in AIDS] [Article in French] Loembe PM, Assengone-Zeh Y, Okome-Kouakou M, Mbiguino Ndjoyi A, Kouna P, Moubeka Mounguengui M, Mwanyombet-Ompounga L. PMID: 9304020 [PubMed - indexed for MEDLINE] 2879. Med Trop (Mars). 1997;57(1):65-7. [Recurrent varicella and HIV infection. Apropos of 10 cases seen in Lomé] [Article in French] Pitche P, Gbadoe AE, Tidjani O, Tchangai-Walla K. Service de Dermatologie et Vénéréologie, Centre Hospitalier et Universitaire Tokoin, Lomé, Togo. Herpes-zoster is commonly observed in immunodepressed patients with HIV infection in Africa. It is due to reactivation of the varicella-zoster virus. Varicella which is usually considered as the acute invasive phase of infection can recur in the same subject during immunodepression, thus constituting recurrent varicella. Little information is available concerning recurrent varicella in Africa. The purpose of the present report is to describe 10 cases observed in 9 adults and 1 child in Lomé, Togo. In 6 cases recurrence of varicella allowed diagnosis of HIV infection. Clinical symptoms were severe with widespread lesions and fever-related changes in general status. Nine of the 10 patients required hospitalization. In all cases the illness lasted more than 3 weeks. This series demonstrates that varicella in adults can be the first clinical manifestation of HIV infection in tropical areas and that this possibility should be investigated especially if varicella is recurrent. PMID: 9289614 [PubMed - indexed for MEDLINE] 2880. Acta Otolaryngol Suppl. 1997;528:77-9. 3D analysis of nystagmus during peripheral vertiginous attacks. Ohyama Y, Yagi T, Ushio K, Suzuki K. Department of Otolaryngology, Nippon Medical School, Tokyo, Japan. In order to localize the site of lesion of peripheral vertigo, 3D analysis of nystagmus during peripheral vertiginous attacks was carried out. In comparison between the three components, the horizontal component had the largest ratio in each disease. Spontaneous nystagmus was directed toward the affected side in 3 cases and to the opposite side in 15. In patients with Menière's disease (MD), all subjects had horizontal and torsional components and had almost the same slow phase velocity in these two components. In patients with vestibular neuritis (VN) and Hunt's syndrome (HS), nystagmus was directed toward the opposite side. Furthermore, in VN, all subjects had an upward component, in addition to horizontal and torsional components. Inferring the focus from the character of nystagmus, it is speculated that the pathological changes are located in the entire inner ear in MD, whereas in VN the lesion is located in the horizontal and anterior semicircular canal or the superior vestibular nerve. PMID: 9288245 [PubMed - indexed for MEDLINE] 2881. Intervirology. 1997;40(1):15-21. Antiviral efficacies of famciclovir, valaciclovir, and brivudin in disseminated herpes simplex virus type 1 infection in mice. Wutzler P, Ulbricht A, Färber I. Institute for Antiviral Chemotherapy, Friedrich Schiller University of Jena, Erfurt, Germany. The animal model of necrotic hepatitis caused by HSV-1 infection in juvenile mice was used to compare the efficacies of the oral antiherpes agents famciclovir (FCV), valaciclovir (VACV) and brivudin (BVDU). The experimental infection allows the measurement of viral replication in the liver by macroscopic lesions and the evaluation of mortality from encephalitis. Mice intravenously inoculated with a highly virulent clinical HSV-1 isolate were orally treated by gavage over a period of 3 days starting on day 2 post infection. The reference drug acyclovir (ACV) was administered subcutaneously. Necrotic hepatitis was significantly (p < 0.01) reduced by treatment with FCV, VACV and ACV at a dose of 50 mg/kg per day divided into 3 doses. No significant effect was achieved with BVDU at 200 mg/kg per day. Treatment with FCV at 50 mg/kg per day, ACV at 100 mg/kg per day, and VACV at 200 mg/kg per day significantly (p < 0.001) decreased mortality in mice. BVDU treatment at 200 mg/kg per day did not reduce mortality but significantly prolonged (p < 0.05) the survival time. PMID: 9268766 [PubMed - indexed for MEDLINE] 2882. Ann Med Interne (Paris). 1997;148(3):255-7. [Prevention of herpes simplex and varicella zoster infections in patients of HIV infections] [Article in French] Caumes E, Bricaire F. Service de Maladies Infectieuses et Tropicales, GH Pitié-Salpêtrière, Paris. Reactivation of Herpes simplex virus and varicella zoster virus infections occurs frequently in patients infected with human immunodeficiency virus (HIV). Prevention of Herpes simplex recurrences with oral acyclovir (400 mg x 2/day) should be recommended for patients with more than 6 relapses per year. Varicella-zoster immunoglobulin is recommended for prophylaxis of varicella in exposed HIV-infected adults and children who are susceptible. Prevention of varicella-zoster recurrences with oral acyclovir (800 mg x 5/day) should be considered for patients with retinopathy. PMID: 9255335 [PubMed - indexed for MEDLINE] 2883. Eye (Lond). 1997;11 ( Pt 1):33-6. Management of viral retinitis-associated retinal detachment in AIDS. Hannouche D, Korobelnik JF, Cochereau I, Hoang-Xuan T. Department of Opthalmology, Bichat-Claude Bernard Hospital, Paris, France. We retrospectively reviewed the results of surgery in 27 cases of retinal detachment related to viral necrotising retinitis in acquired immune deficiency syndrome (AIDS). Vitrectomy and silicone oil tamponade were performed in all cases. Scleral buckling was applied to 9 eyes. Silicone oil was left in the eye in all cases. Mean follow-up period was 13 weeks. Post-operative flattening of the retina at the posterior pole was achieved in 89% of the eyes. Anatomical results were not related to the intraoperative use of an encircling procedure. Visual acuity improved by 2 Snellen lines or more in 40% of cases and 67% of the eyes retained a post-operative ambulatory vision. Phacosclerosis and optic atrophy developed in 29% and 22% of cases, respectively. Vitrectomy and silicone oil tamponade without scleral buckling are effective in the management of retinitis-associated retinal detachments. This procedure is short and can be performed under local anaesthesia. PMID: 9246273 [PubMed - indexed for MEDLINE] 2884. Drugs. 1997;53 Suppl 2:34-9. [Treatment of post-herpes zoster pain with tramadol. Results of an open pilot study versus clomipramine with or without levomepromazine] [Article in French] Göbel H, Stadler T. Service de Neurologie, Hôpital Universitaire, Kiel, Allemagne. To date, no universally applicable recommendations are available for the treatment of patients with postherpetic neuralgia. A mixture of clinical anecdotes, experimental findings and observations from clinical trials form the basis of the medical arsenal for this condition. Tricyclic antidepressants are commonly used, and clinical experience and several investigations have documented their effectiveness. Today, single entity antidepressants, which can be combined with neuroleptics to increase analgesia, are generally recommended for the treatment of postherpetic neuralgia. Some authors also recommend the additional administration of an opioid if analgesia is inadequate. Just over a decade ago, opioids were considered ineffective for the treatment of neuropathic pain; however, more recent investigations relating to the use of opioids, primarily in the treatment of nontumour-related chronic pain, have led to a revision of their use in neuropathic pain. Nevertheless, the use of opioid therapy for neurogenic pain remains controversial. Tramadol is a synthetic, centrally acting analgesic with both opioid and nonopioid analgesic activity. The nonopioid component is related to the inhibition of noradrenaline (norepinephrine) reuptake and stimulation of serotonin (5-hydroxytryptamine; 5-HT) release at the spinal level. In this regard, there are parallels with antidepressants, which are believed to potentiate the effect of biogenic amines in endogenous pain-relieving systems. There is evidence that, in tramadol, both mechanisms act synergistically with respect to analgesia. The aim of this pilot study was to investigate, for the first time, the analgesic efficacy and tolerability of tramadol, compared with the antidepressant clomipramine, in the treatment of postherpetic neuralgia. If necessary, clomipramine was used in combination with the neuroleptic levomepromazine. The study allowed individualised dosages at predetermined intervals up to a maximum daily dose of tramadol 600mg and clomipramine 100mg, or clomipramine 100mg with or without levomepromazine 100mg. 21 (60%) of 35 randomised patients (> or = 65 years) received the study medication over the 6-week period [tramadol n = 10; clomipramine with or without levomepromazine) n = 11]. After 3 weeks' treatment the dosage in both groups remained almost constant for the rest of the 6-week treatment phase (mean daily dose: tramadol 250 to 290mg; clomipramine 59.1 to 63.6mg). Only 3 patients required the combination of clomipramine and levomepromazine. At the outset, both groups recorded an average pain level of 'moderate' to 'very severe'. In correlation with increasing the study medication, this had decreased to 'slight' by the end of the treatment, when 9 of 10 patients in the tramadol group and of 6 of 11 patients in the clomipramine group retrospectively rated their analgesia as excellent, good or satisfactory. The psychological/physical condition of the patients did not change significantly during tramadol treatment. Sensitivity and depression parameters decreased in the clomipramine group. The incidence of adverse events for all patients was similar in both groups (tramadol 76.5%; clomipramine with or without levomepromazine 83.3%). In conclusion, tramadol would appear to be an interesting therapeutic alternative for pain relief in postherpetic neuralgia, particularly in patients who are not depressed. In clinical practice, tramadol and clomipramine can best be used differentially. For example, tramadol could be the drug of first choice in patients with obvious cardiovascular disease (not an uncommon problem in the > or = 65 year age group) in whom antidepressants are contraindicated, and similarly in patients in whom an antidepressant effect is not required. (ABSTRACT TRUNCATED) PMID: 9190323 [PubMed - indexed for MEDLINE] 2885. Dermatology. 1997;194(3):306. Interferon alpha gel for herpes zoster. Miyoshi H, Hirotsuji N, Kino T, Katsu K. PMID: 9187858 [PubMed - indexed for MEDLINE] 2886. Dermatology. 1997;194(3):276-7. Congenitally acquired herpes zoster infection in a newborn. Mogami S, Muto M, Mogami K, Asagami C. Department of Dermatology, Yamaguchi University, Japan. mogami-ygc@umin.u-tokyo.ac.jp. We report a case of congenitally acquired herpes zoster infection in a newborn whose mother suffered from varicella in her eighth month of pregnancy. The newborn had vesicles with limited distribution on the left C7 region. Herpes zoster infection was clinically suspected and confirmed by the Tzanck test and a high titer of anti-varicella-zoster-virus immunoglobulin M (x1,280). PMID: 9187848 [PubMed - indexed for MEDLINE] 2887. Kurume Med J. 1997;44(1):61-6. A case of zoster in the 2nd and 3rd branches of the trigeminal nerve associated with simultaneous herpes labialis infection--a case report. Terasaki S, Kameyama T, Yamamoto S. Department of Oral Surgery, Kurume University School of Medicine, Japan. A patient with herpes zoster infection affecting the second and third branches of the trigeminal nerve is reported. This case demonstrates the occurrence of a simultaneous VZV and HSV infection. Isolation of these viruses from exudates of the blisters was required to prove coexistence of the two viruses within the same blister. Relevant literature is discussed. PMID: 9154763 [PubMed - indexed for MEDLINE] 2888. Acta Otorhinolaryngol Belg. 1997;51(1):49-50. A nasal septum perforation caused by a Varicella zoster infection in an AIDS patient. Colebunders R, De Roo A, Benimadho S, Mestdagh F, Van Damme P. Institute of Tropical Medicine, University Hospital, University of Antwerp, Wilrijk, Belgium. A nasal septum perforation caused by a Varicella Zoster Infection in an AIDS patient. A patient with an acquired immune deficiency syndrome is described who developed a nasal septum perforation. This perforation was probably caused by frequently scratching chronic zoster lesions inside the nose. PMID: 9105484 [PubMed - indexed for MEDLINE] 2889. Cancer Invest. 1997;15(2):165-76. Postherpetic neuralgia: a review. Hanania MM, Brietstein D. Department of Anesthesiology, Long Island Jewish Medical Center, Albert Einstein College of Medicine, New Hyde Park, New York, USA. Comment in: Cancer Invest. 1997;15(2):163-4. PMID: 9095213 [PubMed - indexed for MEDLINE] 2890. Cancer Invest. 1997;15(2):163-4. Introduction--postherpetic neuralgia: a treatment dilemma. Elliott KJ. Department of Neurology, Memorial Sloan-Kettering Cancer Center, New York, New York, USA. Comment on: Cancer Invest. 1997;15(2):165-76. PMID: 9095212 [PubMed - indexed for MEDLINE] 2891. Presse Med. 1997 Jan;26 Suppl 1:10-2. [Herpes simplex virus and varicella-zoster virus infections in HIV-infected patients] [Article in French] Leport C, Brun-Vézinet F. Service des-Maladies infectieuses et tropieales Centre Hospitalier Bichat-Claude Bernard, Paris. PMID: 9082434 [PubMed - indexed for MEDLINE] 2892. Pain. 1997 Jan;69(1-2):55-63. Effect of adrenergic receptor activation on post-herpetic neuralgia pain and sensory disturbances. Choi B, Rowbotham MC. Department of Neurology, UCSF Pain Clinical Research Center 94115, USA. Patients with acute herpes zoster, and to a lesser extent post-herpetic neuralgia (PHN), have been reported to respond to local anesthetic blockade of the sympathetic nervous system. In animal models of nerve injury, local injection of adrenergic agonists after nerve injury, but not before, excites nociceptors. In some patients with chronic neuropathic pain, local application of norepinephrine evokes pain. In 15 subjects with PHN, the role of adrenergic receptors in PHN pain was assessed in a two-session double blind study comparing the response to cutaneous infiltration of epinephrine or phenylephrine (30 micrograms in 3 ml) with the response to normal saline in both the painfully affected skin and mirror-image normal skin. Two adjacent sites were studied on each side of the body, one site for injection and the other for measuring sensory effects of the injection. In the morning part of each session, mirror-image normal skin was injected. In the afternoon portion of each session, skin in the most painful area affected by PHN was injected. Injection of saline or the adrenergic agonist in normal skin produced mild and transient pain without development of allodynia and without affecting overall PHN pain intensity. In PHN skin, injection of saline and the adrenergic agonist produced an equivalent degree of transient pain that was slightly greater than injection into mirror-image normal skin. After injection of the adrenergic agonist into PHN skin, both overall PHN pain and allodynia severity were significantly greater than after saline injection, peaking at 10-15 min post-injection. Even when PHN has been present for years, adrenergic receptor stimulation in PHN skin increases pain, most likely through direct activation of C-nociceptors in the painful skin. Increased allodynia is most likely mediated centrally and driven by the increase in C-nociceptor input. PMID: 9060013 [PubMed - indexed for MEDLINE] 2893. Clin Dermatol. 1997 Jan-Feb;15(1):93-111. Human immunodeficiency virus in women: mucocutaneous manifestations. Wright SW, Johnson RA. Division of Dermatology, Harvard Medical School, Deaconess Hospital, Boston, MA 02215, USA. PMID: 9034659 [PubMed - indexed for MEDLINE] 2894. Antiviral Res. 1997 Jan;33(2):73-85. Assessment of pain in herpes zoster: lessons learned from antiviral trials. Dworkin RH, Carrington D, Cunningham A, Kost RG, Levin MJ, McKendrick MW, Oxman MN, Rentier B, Schmader KE, Tappeiner G, Wassilew SW, Whitley RJ. Columbia-Presbyterian Medical Center, New York, NY, USA. Pain typically accompanies acute herpes zoster and, in a proportion of patients, it persists well beyond rash healing. Pain must therefore be analyzed in trials of antiviral agents in herpes zoster, but different methods have been used to analyze pain in recent published trials. These reports are reviewed and their methodological strengths and weaknesses examined. Based on this review, recommendations for the design and analysis of future trials of antiviral agents in herpes zoster are proposed. The principal recommendation is that antiviral efficacy should be evaluated both by distinguishing post-herpetic neuralgia from acute pain and by considering pain as a continuum. The primary endpoint should address both the prevalence and duration of post-herpetic neuralgia and should be examined in those patients who have post-herpetic neuralgia. Adopting the proposed recommendations in design and analysis of future trials should facilitate comparison across trials of the efficacy of antiviral agents in the treatment of herpes zoster. PMID: 9021049 [PubMed - indexed for MEDLINE] 2895. Clin Neuropathol. 1997 Jan-Feb;16(1):1-12. Neocortical temporal lobe sclerosis masquerading as Alzheimer dementia: does herpes virus encephalopathy protect against Alzheimer's disease? Ball MJ, Kaye JA, Steiner I. Department of Pathology, Oregon Health Sciences University, Portland 97201-3098, USA. Semi-quantitative neuropathological analysis and morphometric evaluations of the brains of 5 elderly people (63-85 years old) dying following a 5-27-year history of dementia reveal that, despite exhaustive survey of all major brain regions, 4 of these cases show virtually no histopathological lesions of Alzheimer's disease. Instead their CNS manifests a severe, bilateral, neuronal depletion, and astrogliosis afflicting the lateral temporal neocortex, highly compatible with a previous herpetic viral encephalitis. In the fifth case unilateral neocortical temporal lobe sclerosis is accompanied by Alzheimer's disease, but with much more dense Alzheimer lesions throughout the contralateral cerebral hemisphere. Three of these 5 individuals had a history either of herpes zoster of the skin or of a single episode of viral meningoencephalitis, roughly concomitant with the onset of memory loss. This clinical and pathological evidence that a remote herpes virus encephalopathy (when bilateral) "protects" that brain against Alzheimer's disease strengthens our growing suspicion that incomplete replication cycles of herpes simplex or zoster virus, following repeated reactivation within neurons of the trigeminal ganglia, may link these viruses to the pathogenetic cascade underlying dementia of the Alzheimer type. PMID: 9020387 [PubMed - indexed for MEDLINE] 2896. J Virol Methods. 1997 Jan;63(1-2):71-9. Luminometric microplate hybridization for detection of varicella-zoster virus PCR product from cerebrospinal fluid. Koskiniemi M, Mannonen L, Kallio A, Vaheri A. Haartman Institute, Department of Virology, University of Helsinki, Finland. marjaleena.Koskiniemi@helsinki.fi We modified and optimized a new microplate hybridization assay to detect the varciella-zoster virus (VZV) PCR product, and studied cerebrospinal fluid (CSF) samples of 287 patients with meningitis, encephalitis or other neurological diseases or symptoms. Specific antibodies to VZV and reference antigens were determined by enzyme immunoassay from serum and CSF, they were then compared with clinical findings and with the results obtained by VZV-PCR using different detection methods for VZV-specific amplified DNA. VZV DNA was found in the CSF of 25 patients using the microplate hybridization assay and chemiluminescence detection for amplified DNA. All 25 CSF samples were also positive in Southern blotting. Among the patients, 10 had chickenpox, 4 had shingles, and 11 had no rash at all. The detection rate of VZV-specific DNA by microplate hybridization was 30% higher than that obtained by conventional agarose gel electrophoresis. In most patients the diagnosis was confirmed by demonstrating specific intrathecal antibody production to VZV but not to other viruses. These results indicate the presence of VZV in the central nervous system (CNS) in many patients with chickenpox or shingles, and even in patients without a rash. The microplate hybridization assay based on chemiluminescence detection improves considerably the detection rate of the VZV-PCR product compared to agarose gel electrophoresis and will add to the list of recognized VZV infections in the CNS. It is especially useful in cases where there is no cutaneous manifestation. PMID: 9015277 [PubMed - indexed for MEDLINE] 2897. Pediatrics. 1997 Jan;99(1):35-9. Varicella and zoster in children after kidney transplantation: long-term results of vaccination. Broyer M, Tete MJ, Guest G, Gagnadoux MF, Rouzioux C. Department of Pediatric Nephrology, Hôpital Necker-Enfants Malades, Paris, France. OBJECTIVE: To determine the long-term prevalence of varicella infection and herpes zoster after kidney transplantation and to assess the effectiveness of varicella immunization with the Oka attenuated strain. METHODS: This study involved 704 children and adolescents who received a kidney graft in our institution from 1973 to 1994 and had routinely been given varicella vaccine beginning in 1980 in preparation for transplantation. RESULTS: After vaccination 62% of these patients still had varicella/zoster (VZ) antibodies at 1 year and 42% after 10 years. After transplantation the incidence of varicella was significantly lower, 26/212 (12%), in patients who received immunization than in those who did not and had no history of varicella, 22/49 (45%). The disease was also significantly less severe in the vaccinated patients (three deaths among naive patients vs none among vacciness). In the vaccinees, varicella infection was observed only in those who did not develop or lost VZ antibodies; in addition, 21 patients of this subgroup had an asymptomatic seroconversion. Four of the 415 patients with a history of varicella had another episode of benign varicella after grafting. Herpes zoster was observed in 76 of the 704 patients included in the study. The prevalence differed according to VZ status at the time of grafting: 13% in patients with a history of varicella, 7% in the vacciness, and 38% in the naive patients at grafting who developed varicella. Three rejection episodes occurred in association with a varicella episode and four with a zoster episode, but graft function was only transiently impaired, and as a whole varicella or zoster did not significantly affect graft function or survival. CONCLUSION: Naive VZ patients with a kidney graft are at risk to develop severe varicella and this may be effectively prevented by available immunization. PMID: 8989334 [PubMed - indexed for MEDLINE] 2898. Commun Dis Rep CDR Wkly. 1996 Dec 13;6(50):433. Shortage of varicella zoster immunoglobulin prompts restriction on use. [No authors listed] PMID: 8996931 [PubMed - indexed for MEDLINE] 2899. N Engl J Med. 1996 Dec 5;335(23):1769; author reply 1769. Treatment of postherpetic neuralgia. Rösler A, Schnorpfeil F, Fritz C. Comment on: N Engl J Med. 1996 Jul 4;335(1):32-42. PMID: 8965886 [PubMed - indexed for MEDLINE] 2900. N Engl J Med. 1996 Dec 5;335(23):1768-9; author reply 1769. Treatment of postherpetic neuralgia. Zenz T, Zenz M, Tryba M. Comment on: N Engl J Med. 1996 Jul 4;335(1):32-42. PMID: 8965885 [PubMed - indexed for MEDLINE] 2901. Asian Pac J Allergy Immunol. 1996 Dec;14(2):129-31. Prevalence of anti-varicella zoster IgG antibody in undergraduate students. Bhattarakosol P, Chantarabul S, Pittayathikhun K, Mung-mee V, Punnarugsa V. Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. Sera from 74 healthy Thai undergraduate students, mean age 21 + 1.7 years, were tested for the presence of IgG antibody against varicella zoster virus (anti-VZV IgG) by ELISA. Fifty-five of 74 (74.3%) individuals possessed anti-VZV IgG antibody. The presence of anti-VZV IgG was associated with a past history of varicella (p < 0.005, X2 = 33.4989). No sexual preponderance was observed. We therefore found that 1 of 4 Thai young adults was susceptible to VZV infection. PMID: 9177828 [PubMed - indexed for MEDLINE] 2902. Soins Gerontol. 1996 Dec;(5):38-9. [Herpes in the elderly] [Article in French] Portet L. Service de Gériatrie, hôpital Emile Roux, Eaubonne. PMID: 9077297 [PubMed - indexed for MEDLINE] 2903. Anaesthesia. 1996 Dec;51(12):1190. Epidural morphine and postherpetic neuralgia. Mayne CC, Hudspith MJ, Munglani R. Comment on: Anaesthesia. 1996 Jul;51(7):647-51. PMID: 9038480 [PubMed - indexed for MEDLINE] 2904. J Toxicol Sci. 1996 Dec;21(5):299-300. Strategic proposals for predicting drug-drug interactions during new drug development: based on sixteen deaths caused by interactions of the new antiviral sorivudine with 5-fluorouracil prodrugs. Watabe T. Department of Drug Metabolism and Molecular Toxicology, School of Pharmacy, Tokyo University of Pharmacy and Life Science, Japan. PMID: 9035040 [PubMed - indexed for MEDLINE] 2905. West Indian Med J. 1996 Dec;45(4):127-8. Ramsay Hunt syndrome complicated by contralateral cerebral infarction. Barrow KO, Richards JS. Department of Medicine, University of the West Indies, Jamaica. Varicella-zoster virus has been associated with a variety of neurological manifestations. We describe a patient with the Ramsay Hunt Syndrome who developed a contralateral cerebral infarction. PMID: 9033235 [PubMed - indexed for MEDLINE] 2906. J Pathol. 1996 Dec;180(4):434-40. Alterations in mast cell proteinases and protease inhibitors in the progress of cutaneous herpes zoster infection. Kaminska R, Harvima IT, Naukkarinen A, Nilsson G, Horsmanheimo M. Department of Dermatology, Kuopio University Hospital, Finland. The possible involvement of mast cell proteases in the cutaneous inflammation of herpes zoster was studied histochemically in ten patients. Mast cell tryptase and chymase bioactivities were demonstrated enzyme-histochemically. The localization of protease inhibitors as well as tryptase and chymase proteins in mast cells was established using a sequential double-staining method which first demonstrated bioactive tryptase or chymase, followed by immunohistochemical identification of these antigens. Biopsies were taken from involved vesicular and erythematous skin, as well as from normal healthy-looking skin. Tryptase-bioactive mast cells were significantly lower in number in the upper, but not in the deeper dermis of vesicular skin (68 +/- 37 cells/mm2, mean +/- SD) when compared with either healthy-looking (97 +/- 38) or erythematous skin (105 +/- 36) (t-test, P < 0.005). In contrast, chymase-bioactive mast cells were significantly reduced in number both in erythematous skin (44 +/- 20, P < 0.02) and even more so in vesicular skin (26 +/- 20, P < 0.0005) when compared with healthy-looking skin (64 +/- 27). The percentage of alpha 1-antitrypsin -immunoreactive and alpha 1-antichymotrypsin-immunoreactive mast cells in the upper dermis increased steadily from the values in healthy-looking skin (37.9 +/- 18.8 and 82.5 +/- 21.6 per cent) to those in erythematous (64.4 +/- 16.4 and 93.5 +/- 7.9 per cent) and vesicular skin (75.2 +/- 10.2 and 96.4 +/- 4 per cent). A novel finding was that cells showing tryptase immunoreactivity but no enzyme activity were found in two out of nine erythematous skin specimens and in four out of seven vesicular specimens. In healthy-looking skin, all cells with chymase immunoreactivity also displayed chymase bioactivity, but only 53.2 +/- 24.25 per cent of these mast cells in erythematous lesions and 44.4 +/- 15.9 per cent in vesicular lesions showed chymase bioactivity, suggesting inactivation of chymase by protease inhibitors. These results show prominent alterations in mast cell proteinases and protease inhibitors, indicating that these enzymes participate in the cutaneous inflammation due to herpes zoster. PMID: 9014866 [PubMed - indexed for MEDLINE] 2907. Aust Fam Physician. 1996 Dec;25(12):1878. Infectious diseases case study. Could this be viral? Golledge CL. Clinical Microbiology and Infectious Diseases, Western Australian Centre for Pathology and Medical Research. PMID: 9009009 [PubMed - indexed for MEDLINE] 2908. J Cutan Pathol. 1996 Dec;23(6):576-81. Dermatomal lichenoid chronic graft-vs-host disease following varicella-zoster infection despite absence of viral genome. Baselga E, Drolet BA, Segura AD, Leonardi CL, Esterly NB. Department of Dermatology, Medical College of Wisconsin, Milwaukee, USA. Localized cutaneous graft-versus-host disease (GVHD) following a dermatomal distribution or in a pattern of Blaschko's lines. Some authors have postulated that dermatomal GVHD is triggered by a varicella-zoster virus infection, although in reported cases, there was no history of a preceding herpes zoster. We describe a case of GVHD localized to the exact dermatome of a culture-proven varicella-zoster virus infection. PCR analysis failed to detect persistence of viral genome in the affected skin. PMID: 9001991 [PubMed - indexed for MEDLINE] 2909. S Afr Med J. 1996 Dec;86(12):1562-3. Herpes zoster--results from a questionnaire-based surveillance of patients and their general practitioners. Schoub BD, Sacho H. PMID: 8998234 [PubMed - indexed for MEDLINE] 2910. Nippon Jibiinkoka Gakkai Kaiho. 1996 Dec;99(12):1772-9. [Clinical features and prognosis of facial palsy and hearing loss in patients with Ramsay Hunt syndrome] [Article in Japanese] Murakami S, Hato N, Horiuchi J, Miyamoto Y, Aono H, Honda N, Yanagihara N. Department of Otolaryngology, Ehime University School of Medicine. Clinical studies were performed on 325 patients with Ramsay Hunt syndrome who were treated in the Facial Nerve Clinic at Ehime University Hospital between 1976 and 1995. The clinical manifestations of Ramsay Hunt syndrome were various. Three major symptoms, auricular vesicles, facial paralysis and vestibulo-cochlear dysfunction, were found in 57.6% of the patients although these symptoms did not always appear simultaneously. Auricular vesicles appeared before (19.3%), during (46.5%), or after (34.2%) the onset of facial paralysis. Hearing loss was observed subjectively in only 20% but objectively in 48.2% of the patients. Hearing loss appeared before (34.3%), during (34.3%), or after (31.3%) the onset of facial paralysis. Complete recovery from facial paralysis was achieved in 52.4% of the patients. Good recovery of the facial nerve function was achieved in patients who had zoster vesicles or vestibulo-cochlear dysfunction preceding the development of facial paralysis. Complete recovery of hearing was also achieved in 45.4% of the patients, and the recovery was better in patients having light hearing loss, less than 35dB. The patients younger than 16 years old showed better recovery from both facial paralysis and hearing loss than the patients older than 60 years. Glossopharyngeal nerve or vagal nerve paralysis concomitant with facial paralysis was found in 8 (2.5%) patients. The outcome of glossopharyngeal nerve paralysis was good but that of the vagal nerve was poor. PMID: 8997096 [PubMed - indexed for MEDLINE] 2911. Br J Cancer. 1996 Dec;74(12):2013-7. High-dose chemotherapy supported by peripheral blood progenitor cells in poor prognosis metastatic breast cancer--phase I/II study. Edinburgh Breast Group. Cameron DA, Craig J, Gabra H, Lee L, MacKay J, Parker AC, Leonard RC, Anderson E, Anderson T, Chetty U, Dixon M, Hawkins A, Jack W, Kunkler I, Leonard R, Matheson L, Miller W. Western General Hospital, Edinburgh, UK. Current treatments for metastatic breast cancer are not associated with significant survival benefits despite response rates of over 50%. High-dose therapy with autologous bone marrow transplantation (ABMT) has been investigated, particularly in North America, and prolonged survival in up to 25% of women has been reported, but with a significant treatment-related mortality. However, in patients with haematological malignancies undergoing autologous transplantation, haematopoietic reconstruction is significantly quicker and mortality lower than with ABMT, when peripheral blood progenitor cells (PBPCs) are used. In 32 women with metastatic breast cancer, we investigated the feasibility of PBPC mobilisation with high-dose cyclophosphamide and granulocyte colony-stimulating factor (G-CSF) after 12 weeks' infusional induction chemotherapy and the subsequent efficacy of the haematopoietic reconstitution after conditioning with melphalan and either etoposide or thiotepa. PBPC mobilisation was successful in 28/32 (88%) patients, and there was a rapid post-transplantation haematopoietic recovery: median time to neutrophils > 0.5 x 10(9) l-1 was 14 days and to platelets > 20 x 10(9) l-1 was 10 days. There was no procedure-related mortality, and the major morbidity was mucositis (WHO grade 3-4) in 18/32 patients (56%). In a patient group of which the majority had very poor prognostic features, the median survival from start of induction chemotherapy was 15 months. Thus, PBPC mobilisation and support of high-dose chemotherapy is feasible after infusional induction chemotherapy for patients with metastatic breast cancer, although the optimum drug combination has not yet been determined. PMCID: PMC2074804 PMID: 8980406 [PubMed - indexed for MEDLINE] 2912. Br J Dermatol. 1996 Dec;135(6):1005-6. Leishmania infection occurring in herpes zoster lesions in an HIV positive patient. Del Giudice P. Comment on: Br J Dermatol. 1996 Jan;134(1):164-6. PMID: 8977732 [PubMed - indexed for MEDLINE] 2913. J Fam Pract. 1996 Dec;43(6):539-40. Acyclovir or prednisone for treating herpes zoster. Becker LA, Horst PS. SUNY Health Science Center at Syracuse, New York, USA. PMID: 8969699 [PubMed - indexed for MEDLINE] 2914. South Med J. 1996 Dec;89(12):1224. Is the syndrome of inappropriate secretion of antidiuretic hormone responsible for hyponatremia in a patient with herpes varicella zoster virus? Calenda E, Muraine M, Dessole E. PMID: 8969365 [PubMed - indexed for MEDLINE] 2915. Transplant Proc. 1996 Dec;28(6):3296-7. Varicella zoster in a transplant program: experience with 15 cases and 70 contacts. Zayas E, González Caraballo Z, Morales Otero L, Santiago Delpín EA. Department of Surgery, University of Puerto Rico Medical School, San Juan, Puerto Rico 00936-5067. PMID: 8962279 [PubMed - indexed for MEDLINE] 2916. Acad Emerg Med. 1996 Dec;3(12):1144-5, 1153-5. Facial weakness and rash. Ramsay Hunt syndrome (herpes zoster cephalicus, herpes zoster oticus, herpes zoster auricularis). Birinyi F. Department of Emergency Medicine, Ohio State University, Columbus, USA. esi@netset.com PMID: 8959171 [PubMed - indexed for MEDLINE] 2917. Ophthalmic Epidemiol. 1996 Dec;3(3):151-8. A uveitis register at the Leicester Royal Infirmary. Thean LH, Thompson J, Rosenthal AR. Department of Ophthalmology, Leicester Royal Infirmary, U.K. In the study of uveitis, epidemiology is frequently neglected. Our uveitis register consisted of data collected on all uveitis patients except minor, easily resolved, anterior uveitis cases at the Leicester Royal Infirmary. The diagnoses of these patients were classified by the aetiological method. A total of 712 patients was entered into the register over a period of 10 years starting from January 1985. In the study, 73.0% of the cases fit into named clinical syndromes while 27.0% of the cases were diagnosed as idiopathic but uncategorised. The commonest definable cause of anterior uveitis was HLA-B27-related acute anterior uveitis, comprising 15.2% of all uveitis cases. Intermediate uveitis accounted for 7.9% of all cases while the commonest definable cause of posterior uveitis was toxoplasmosis, forming 4.6% of all uveitis cases. The aim of the study was to present data relating to diagnostic categories from a primary and secondary uveitis clinic, and to explore the usefulness of such a uveitis register within an ophthalmic department. PMID: 8956319 [PubMed - indexed for MEDLINE] 2918. Arch Ophthalmol. 1996 Dec;114(12):1481-5. Optic neuropathy preceding acute retinal necrosis in acquired immunodeficiency syndrome. Friedlander SM, Rahhal FM, Ericson L, Arevalo JF, Hughes JD, Levi L, Wiley CA, Graham EM, Freeman WR. Department of Pathology, University of California, San Diego, La Jolla, USA. Erratum in: Arch Ophthalmol 2000 Apr;118(4):543. Arrevalo JF [corrected to Arevalo JF]. OBJECTIVE: To describe the clinical course of varicella-zoster optic neuropathy preceding acute retinal necrosis in patients with acquired immunodeficiency syndrome. DESIGN: Case series. SETTING: Two tertiary care centers in San Diego, Calif, and London, England. PATIENTS: Three human immunodeficiency virus-positive men with previous cutaneous zoster infection, optic neuropathy, and necrotizing retinitis. RESULTS: All patients had an episode of zoster dermatitis treated with acyclovir. Visual loss consistent with an optic neuropathy ensued, followed by typical herpetic retinitis. The cause of visual loss was not suspected to be varicella-zoster until after the retinitis occurred. Despite aggressive medical treatment, 4 of 6 eyes progressed to retinal detachment. CONCLUSIONS: Varicella-zoster may cause an optic neuropathy in patients with acquired immunodeficiency syndrome, especially in those with previous shingles. A high index of suspicion is necessary to establish the diagnosis and begin early antizoster treatment. PMID: 8953979 [PubMed - indexed for MEDLINE] 2919. J Clin Microbiol. 1996 Dec;34(12):2869-74. Application of long PCR method of identification of variations in nucleotide sequences among varicella-zoster virus isolates. Takayama M, Takayama N, Inoue N, Kameoka Y. Department of Virology I, National Institute of Health, Tokyo, Japan. Restriction fragment length polymorphism (RFLP) analysis of whole viral DNA of varicella-zoster virus (VZV) requires the time-consuming and laborious preparation of a large amount of purified viral DNA. RFLP analysis of small DNA fragments amplified by PCR was developed as an alternative method. However, its use has been limited because of the small number of variations in VZV. To overcome these drawbacks and to identify variations in VZV, we developed an RFLP analysis method combined with the long PCR method which has recently been developed for the amplification of DNA fragments between 5 and 35 kb in length. We amplified three DNA regions ranging from 6.8 to 11.4 kb and demonstrated that RFLP analyses of these regions allowed for the classification of 40 VZV isolates in Japan into 17 groups. One-fourth of the isolates contained a nucleotide difference of C versus T, which abolished the StyI site at position 76530; this alteration was linked to the reported PstI site polymorphism at position 69349 (nucleotide positions are based on those of strain Dumas). Nucleotide sequence variation in the examined regions among VZV isolates in Japan was estimated at roughly less than 0.05%, confirming the previously proposed idea that VZV is genetically stable and not highly diversified. Our method will be useful for studies of the molecular epidemiology of VZV. PMCID: PMC229425 PMID: 8940414 [PubMed - indexed for MEDLINE] 2920. N Engl J Med. 1996 Nov 21;335(21):1587-95. Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 36-1996. A 37-year-old man with AIDS, neurologic deterioration, and multiple hemorrhagic cerebral lesions. [No authors listed] PMID: 8900094 [PubMed - indexed for MEDLINE] 2921. N Engl J Med. 1996 Nov 14;335(20):1514-21. Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 35-1996. A 57-year-old woman with fever, sweats, neuropathy, and multiple pulmonary nodules. [No authors listed] PMID: 8890104 [PubMed - indexed for MEDLINE] 2922. Clin Diagn Virol. 1996 Nov;7(2):69-76. In situ hybridization detection of varicella zoster virus in paraffin-embedded skin biopsy samples. Annunziato P, Lungu O, Gershon A, Silvers DN, LaRussa P, Silverstein SJ. Department of Pediatrics, Columbia University, College of Physicians and Surgeons, New York, NY 10032, USA. BACKGROUND: When virologic and molecular diagnostic techniques are unavailable, the diagnosis of varicella zoster virus (VZV) infection depends on clinical criteria and histologic evaluation of skin biopsy specimens or Tzank preparations. These methods can misdiagnose chickenpox and zoster, particularly when the clinical manifestations are atypical. OBJECTIVE: To improve diagnosis in these settings, we developed an in situ hybridization technique for the detection of VZV utilizing a fluorescein-labeled oligonucleotide probe visualized with anti-fluorescein alkaline phosphatase-conjugated antibody. STUDY DESIGN: We retrospectively examined 26 paraffin-embedded skin biopsy specimens with histologic features consistent with VZV or herpes simplex virus (HSV) infection and 11 control cases by in situ hybridization. In situ hybridization for VZV and HSV-1 was compared with polymerase chain reaction (PCR) for VZV and HSV-1 and clinical and histologic examination. RESULTS: Thirteen of the 26 study cases and two of the 11 control cases were positive for VZV by in situ hybridization. When compared with PCR, in situ hybridization was 92% sensitive and 88% specific. When compared with clinical diagnosis, in situ hybridization was 86% sensitive and 87% specific. All cases of chickenpox had VZV-positive inflammatory cells in the dermis but this finding was less frequent among the cases of zoster. CONCLUSIONS: This in situ hybridization technique is a sensitive and specific method for the diagnosis of VZV in skin lesions that is applicable to most histopathology laboratory settings. In addition, in situ hybridization reveals individual infected cells and may provide insight into the pathogenesis of VZV skin infection. PMID: 9137862 [PubMed - indexed for MEDLINE] 2923. Drugs. 1996 Nov;52(5):754-72. Valaciclovir. A review of its antiviral activity, pharmacokinetic properties and therapeutic efficacy in herpesvirus infections. Perry CM, Faulds D. Adis International Limited, Auckland, New Zealand. Valaciclovir, the L-valyl ester of aciclovir (acyclovir), is an oral prodrug that undergoes rapid and extensive first-pass metabolism to yield aciclovir and the essential amino acid L-valine. Aciclovir, the active antiviral component of valaciclovir, shows good in vitro activity against the herpesviruses herpes simplex virus (HSV)-1, HSV-2 and varicella zoster virus. The bioavailability of aciclovir from oral valaciclovir is considerably greater than that achieved after oral aciclovir administration. Thus, valaciclovir delivers therapeutic aciclovir concentrations when administered in a less frequent oral dosage regimen than is required for aciclovir. Valaciclovir is an effective treatment for herpes zoster in immunocompetent adults. In a large comparative study that included patients > or = 50 years of age, valaciclovir (1000mg 3 times daily for 7 or 14 days) and oral aciclovir (800mg 5 times daily) were equally effective in achieving resolution of cutaneous zoster lesions. Importantly, valaciclovir was significantly more effective than aciclovir in reducing the duration of zoster-associated pain. Preliminary results of several studies indicate that valaciclovir (500 to 1000mg twice daily for 5 to 10 days) is as effective as aciclovir (200mg 5 times a day for 5 to 10 days) in the treatment of genital herpes. In patients with first or recurrent episodes of genital herpes, valaciclovir reduced the duration of viral shedding, hastened lesion healing and decreased lesion-associated pain. Valaciclovir was also effective in suppressing recurrent episodes of genital herpes and significantly prolonged the time to a recurrent episode of infection compared with placebo. Valaciclovir is a well tolerated drug; in herpes zoster and HSV studies its tolerability profile was similar to that of aciclovir or placebo. Valaciclovir represents and advance in antiherpes drug therapy and is a useful treatment option for patients with herpes zoster or genital herpes. It is at least as effective as aciclovir and is administered in a more convenient oral dosage regimen. Thus, valaciclovir may ultimately succeed aciclovir as a first-line treatment for genital herpes or herpes zoster. PMID: 9118821 [PubMed - indexed for MEDLINE] 2924. Rev Alerg Mex. 1996 Nov-Dec;43(6):148-51. [Interferon alpha 2b in pain caused by herpes zoster. Preliminary report] [Article in Spanish] Montero Mora P, Colín D, González Espinosa A, Almeida Arvizu V. Departamento de alergia e inmunología clínica, Hospital de Especialidades del Centro Médico Nacional Siglo XXI, México D.F. We studied forty patients with Zoster Herpes, twenty two of them, with this acute disease, eighteen with postherpetic neuralgia, to those that were considered chronic. The evaluation of the effect of INF alpha 2b, in the secondary pain of Zoster Herpes acute disease, in the patients with chronic severe secondary neuralgia they shared; the evolution with the treatment for half for visual pain analog scale in both groups the patients with acute pain, entered for visual pain analog scale between 10 and two points, with medium of 8.2 SD 2.1. They did not find any significance difference with this values p < 0.6. Most of the patients with acute pain was of 6 a 0 points with the medium a 0.27 y SD: 1,2 in the chronics went from. 6 to 0 points with a medium of 1.27 (SD:2.4), with a significative difference for t Student for comparation the initial scale in final in both groups of (p < 0.0001). The comparation of the best days, the disease bettered in acute quicker than the chronics with significance difference: (p < 0.001). PMID: 9053126 [PubMed - indexed for MEDLINE] 2925. Radiologe. 1996 Nov;36(11):890-6. [Inflammatory facial paralysis in MRI. An overview] [Article in German] Sartoretti-Schefer S, Wichmann W, Valavanis A. Institut für Neuroradiologie, Universitätsspital Zürich. In inflammatory peripheral facial nerve palsy pathologically intense, linear and smooth enhancement of the distal intrameatal nerve segment can always be observed on T1-w- SE- MR sequences. The other nerve segments often present with a pathological enhancement as well. On T2-w- SE sequences, a thickening of the distal intrameatal nerve segment can be observed. The pathological enhancement persists over weeks and months; even in patients with complete clinical recovery, a persistent enhancement of the distal intrameatal nerve segment can be demonstrated. No correlation can be established between the intensity of the enhancement, the clinical condition and the electrophysiological data on electroneurography. The persistent enhancement of the different nerve segments is due to a long-lasting breakdown of the blood-peripheral nerve-barrier related to the process of degeneration and regeneration of the facial nerve in inflammatory palsy. PMID: 9036431 [PubMed - indexed for MEDLINE] 2926. Internist (Berl). 1996 Nov;37(11):1168-9. [Possible involvement of the autonomic nervous system in herpes zoster] [Article in German] Prange H. Neurologische Universitätsklinik, Göttingen. PMID: 9036114 [PubMed - indexed for MEDLINE] 2927. Vet Microbiol. 1996 Nov;53(1-2):55-66. Lessons to be learned from varicella-zoster virus. Rentier B, Piette J, Baudoux L, Debrus S, Defechereux P, Merville MP, Sadzot-Delvaux C, Schoonbroodt S. Department of Microbiology, University of Liège, Belgium. brentier@ulg.ac.be Varicella-zoster virus (VZV) is an alphaherpesvirus responsible for two human diseases: chicken pox and shingles. The virus has a respiratory port of entry. After two successive viremias, it reaches the skin where it causes typical lesions. There, it penetrates the peripheral nervous system and it remains latent in dorsal root ganglia. It is still debatable whether VZV persists in neurons or in satellite cells. During latency, VZV expresses a limited set of transcripts of its immediate early (IE) and early (E) genes but no protein has been detected. Mechanisms of reactivation from ganglia have not been identified. However, dysfunction of the cellular immune system appears to be involved in this process. The cell-associated nature of VZV has made it difficult to identify a temporal order of gene expression, but there appears to be a cascade mechanism as for HSV-1. The lack of high titre cell-free virions or recombination mutants has hindered so far the understanding of VZV gene functions. Five genes, ORFs 4, 10, 61, 62, and 63 that encode regulatory proteins could be involved in VZV latency. ORF4p activates gene promoters with basal activities. ORF10p seems to activate the ORF 62 promoter. ORF61p has trans-activating and trans-repressing activities. The major IE protein ORF62p, a virion component, has DNA-binding and regulatory functions, transactivates many VZV promoters and even regulates its own expression. ORF63p is a nuclear IE protein of yet unclear regulatory functions, abundantly expressed very early in infection. We have established an animal model of VZV latency in the rat nervous system, enabling us to study the expression of viral mRNA and protein expression during latency, and yielding results similar to those found in humans. This model is beginning to shed light on the molecular events in VZV persistent infection and on the regulatory mechanisms that maintain the virus in a latent stage in nerve cells. PMID: 9010998 [PubMed - indexed for MEDLINE] 2928. Br J Ophthalmol. 1996 Nov;80(11):982-5. Association of progressive outer retinal necrosis and varicella zoster encephalitis in a patient with AIDS. van den Horn GJ, Meenken C, Troost D. Department of Ophthalmology, Academic Medical Center, University of Amsterdam, The Netherlands. BACKGROUND: A patient with AIDS who developed the clinical picture of bilateral progressive outer retinal necrosis (PORN) in combination with varicella zoster encephalitis is described. The picture developed more than 2 years after an episode of ophthalmic zoster infection, and following intermittent exposure to oral acyclovir because of recurrent episodes of cutaneous herpes simplex infection. METHODS: Aqueous humour, obtained by paracentesis of the anterior chamber, was analysed using immunofluorescence and polymerase chain reaction (PCR). Postmortem analysis of eye and brain tissue was performed by using conventional techniques and in situ hybridisation. RESULTS: While conventional techniques all failed to detect a causative agent, analysis of the aqueous humour using PCR, and histological examination of necropsy specimens from eyes and brain using in situ hybridisation were conclusive for the diagnosis varicella zoster virus (VZV) infection. CONCLUSION: This case documents the presumed association of PORN and VZV encephalitis in a severely immunocompromised AIDS patient. PMCID: PMC505676 PMID: 8976726 [PubMed - indexed for MEDLINE] 2929. Br J Ophthalmol. 1996 Nov;80(11):956-61. Aetiology of uveitis in Sierra Leone, west Africa. Ronday MJ, Stilma JS, Barbe RF, McElroy WJ, Luyendijk L, Kolk AH, Bakker M, Kijlstra A, Rothova A. Netherlands Opthalmic Research Institute, Amsterdam, The Netherlands. BACKGROUND: In 1992, non-onchocercal uveitis caused 9% of blindness, 8% of visual impairment, and 11% of uniocular blindness among patients visiting an eye hospital in Sierra Leone, west Africa. The aim of this study was to determine the aetiology of uveitis in this population. METHODS: General and ophthalmic examination complemented by serum and aqueous humour analyses for various infectious agents was performed for 93 uveitis patients and compared with serum (n = 100) and aqueous humour (n = 9) analysis of endemic controls. RESULTS: At the initial examination, 45 patients (48%) proved to be severely visually handicapped. After clinical and laboratory analyses, an aetiological diagnosis was established for 49 patients (52%). Toxoplasma gondii was the most important cause of uveitis (40/93; 43%). Anti-toxoplasma IgM antibodies were detected in serum samples of seven of 93 patients (8%) compared with one of 100 controls (1%, p < 0.05). At least six patients (15%) with ocular toxoplasmosis had acquired the disease postnatally. Antibodies against Treponema pallidum were detected in 18 of 92 patients (20%) and in 21 controls (21%). Other causes of uveitis were varicella zoster virus (one patient), herpes simplex virus (two patients), and HLA-B27 positive acute anterior uveitis with ankylosing spondylitis (one patient), while one patient had presumed HTLV-I uveitis. CONCLUSIONS: In a hospital population in Sierra Leone, west Africa, uveitis was associated with severe visual handicap and infectious diseases. Toxoplasmosis proved to be the most important cause of the uveitis. Although the distribution of congenital versus acquired toxoplasmosis in this population could not be determined, the results indicate an important role of postnatally acquired disease. The results further suggested minor roles for HIV, tuberculosis, toxocariasis, and sarcoidosis as causes of uveitis in this population. PMCID: PMC505671 PMID: 8976721 [PubMed - indexed for MEDLINE] 2930. J Pain Symptom Manage. 1996 Nov;12(5):290-9. Postherpetic neuralgia and its treatment: a retrospective survey of 191 patients. Bowsher D. Pain Research Institute, Walton Hospital, Liverpool, United Kingdom. One hundred and ninety-one patients with postherpetic neuralgia (PHN) in whom treatment was begun 3 or more months after acute herpes zoster (HZ) were retrospectively considered. Relieved (> or = 75% fall in visual analogue score for worst pain within last 24 hr) and unrelieved groups were subdivided into those who had and those who had not received antiviral treatment for their acute shingles. More than 90% of all patients experienced allodynia with a clinically evident sensory deficit for temperature and/or pinprick sensation. The probability of relief is worst in patients with PHN of the isolated ophthalmic nerve and of the brachial plexus, and best when involving the jaw, neck, and trunk. The presence (90%) or absence of allodynia has no predictive significance; but the small number of patients without allodynia or sensory deficit (all of whom had had antiviral treatment for their acute shingles) all improved. The probability of pain relief was found to correlate very strongly with the brevity of the interval between rash onset and commencement of treatment with an adrenergically active antidepressant. Further, time to relief in patients treated with an antidepressant starting at the same interval after HZ is significantly shorter in patients who received acyclovir for their original HZ. With the possible exception of dextroamphetamine added to the antidepressant, other treatments (particularly analgesics, anticonvulsants, and sympathetic blockade) were found to be without value in most cases. Thirty percent of patients who recover from PHN and have had their original shingles treated with acyclovir subsequently suffer from severe itching. It is recommended that elderly patients be given low-dose antidepressant on diagnosis of shingles, and asked to report back in 6 weeks. If they are pain-free at this interval, low-dose antidepressant should be continued for another month or so and then stopped. If, however, pain is present at 6 weeks, the dose of antidepressant should be increased and the patient reviewed every 2 months. PMID: 8942124 [PubMed - indexed for MEDLINE] 2931. Orthopedics. 1996 Nov;19(11):976-7. Herpes zoster related lumbar radiculopathy. Shapiro M. Tahoe Spine Center, Incline Village, Nev, USA. PMID: 8936535 [PubMed - indexed for MEDLINE] 2932. AIDS. 1996 Nov;10(13):1604-6. AIDS-related varicella zoster meningoencephalitis and radicular pain without cutaneous eruption. Débat Zoguéreh D, Saadoun R, Zandotti C, Cawston P, Moreau J. PMID: 8931804 [PubMed - indexed for MEDLINE] 2933. J Med Virol. 1996 Nov;50(3):244-8. Effect of acyclovir and prednisolone on the serological response in herpes zoster. Bates CJ, Kudesia G, McKendrick MW. Sheffield Public Health Laboratory, England. The serological response of patients with acute herpes zoster was studied to determine whether a diagnosis could be made on a single serum sample, and whether this response was modified by treatment with antiviral and/or steroid therapy. The patients received one of four regimes of acyclovir and prednisolone, Varicella zoster virus (VZV) IgG, IgM, and IgA responses were measured by commercial and in-house enzyme immunoassays (EIA) using serum samples taken at days 0, 7, and 21 after entry into the study. Samples were also tested for IgM to Epstein-Barr virus (EBV) viral capsid antigen (VCA), and cytomegalovirus (CMV) IgM and for herpes simplex virus (HSV) antibodies by the complement fixation test (CFT). Analysis was carried out on data from 71 patients. VZV IgM was detected in 72%, VZV IgA in 78%, and either VZV IgM or IgA in 88% of patients tested, at some time during the 3-week study period. The optimal time to detect either class of antibody was approximately 1 week after the onset of the vesicular rash, when 85% of patients had one or both classes of acute phase antibody in their serum. There was no evidence of cross reaction with EBV, CMV, or HSV antibodies. Neither treatment with prednisolone nor the length of therapy with acyclovir affected significantly the VZV IgM or IgA responses. Therefore it is possible to make a serological diagnosis of herpes zoster on a single sample, optimally 1 week after the onset of the rash, in patients treated with acyclovir alone or with acyclovir and steroids. PMID: 8923289 [PubMed - indexed for MEDLINE] 2934. Clin Infect Dis. 1996 Nov;23(5):990-5. Herpes zoster and progression to AIDS in a cohort of individuals who seroconverted to human immunodeficiency virus. Italian HIV Seroconversion Study. Alliegro MB, Dorrucci M, Pezzotti P, Rezza G, Sinicco A, Barbanera M, Castelli F, Tarantini G, Petrucci A. Centro Operativo AIDS, Istituto Superiore di Sanità, Rome, Italy. A prospective study of 1,198 individuals who seroconverted to human immunodeficiency virus (HIV) was conducted to estimate the incidence and determinants of herpes zoster and to determine whether herpes zoster can accelerate the progression to AIDS. Herpes zoster was diagnosed for 48 individuals (4%). After adjusting for the CD4 cell count, individuals acquiring HIV infection through sexual contact were more likely to have herpes zoster than were injection drug users (relative hazard, 1.50). The crude relative hazard of AIDS for individuals who had herpes zoster compared with those without herpes zoster was 2.44; the adjusted relative hazard was 1.08. After adjusting for the CD4 cell count, fever was the only specific characteristic of herpes zoster that was significantly associated with a more rapid progression to AIDS (relative hazard, 6.52). Data suggest that herpes zoster occurs more frequently in individuals acquiring HIV infection through sexual transmission. There was no evidence that herpes zoster per se is an independent cofactor of progression of HIV disease, although febrile episodes of herpes zoster may predict a faster progression to AIDS. PMID: 8922791 [PubMed - indexed for MEDLINE] 2935. Cornea. 1996 Nov;15(6):633-4. Presumed bilateral herpes zoster ophthalmicus in an AIDS patient: a case report. Yau TH, Butrus SI. Department of Ophthalmology, Washington Hospital Center, DC, USA. A 31-year-old man with the acquired immunodeficiency syndrome presented with herpes zoster ophthalmicus on the right. Five days after he began treatment for the zoster pseudodendrites and skin lesions, he developed superficial punctate keratitis, uveitis, and crusting skin lesions in the left eye. After treatment, the ocular lesions resolved in both eyes without incident. The bilateral manifestation of herpes zoster ophthalmicus is a result of the increased severity associated with immunosuppression caused by the human immunodeficiency virus. PMID: 8899277 [PubMed - indexed for MEDLINE] 2936. Ugeskr Laeger. 1996 Oct 28;158(44):6282-4. [Painful skin eruptions precedes prolonged pain in herpes zoster. Four cases from general practice and a review] [Article in Danish] Kardel T. Four cases of herpes zoster with prolonged severe pain illustrate the dilemma that specific antiviral therapy cannot be instituted at onset of symptoms in the cases that would most benefit from such therapy: In all four cases the characteristic skin eruption was preceded by severe, but unspecific, pain for several days. PMID: 8966814 [PubMed - indexed for MEDLINE] 2937. Rev Prat. 1996 Oct 15;46(16):2009-14. [Varicella and herpes zoster. Epidemiology, physiopathology, diagnosis, development, treatment] [Article in French] Perronne C. Service des maladies infectieuses et tropicales, hôpital Raymond-Poincaré, Garches. PMID: 8978209 [PubMed - indexed for MEDLINE] 2938. Hosp Pract (Minneap). 1996 Oct 15;31(10):42. Expanding zoster's differential diagnosis. Kahn CB. Comment on: Hosp Pract (Minneap). 1996 Jul 15;31(7):137-44. PMID: 8859205 [PubMed - indexed for MEDLINE] 2939. J Laryngol Otol. 1996 Oct;110(10):918-21. Impaired specific cellular immunity to the varicella-zoster virus in patients with herpes zoster oticus. Ikeda M, Hiroshige K, Abiko Y, Onoda K. Department of Otolaryngology, Nihon University School of Medicine, Tokyo, Japan. The possible involvement of depression on cellular immunity in reactivation of varicella-zoster virus (VZV) in herpes zoster oticus was investigated. The subjects comprised 59 cases of herpes zoster oticus, 33 cases of herpes zoster sine herpete (ZSH) with facial paralysis, and 205 cases of Bell's palsy. The transformation rate of lymphocytes to phytohaemagglutinin in herpes zoster oticus tended to be lower than that in Bell's palsy. In skin tests with purified protein derivatives of tuberculin, the positivity rate in herpes zoster oticus was significantly lower than that in Bell's palsy (p < 0.015). In skin tests using VZV antigen the positivity rate in herpes zoster oticus and ZSH were significantly lower than that of Bell's palsy (p < 0.001 and p < 0.015, respectively). Thus, it was noted that cellular immunity, especially specific cellular immunity against VZV, was significantly depressed in herpes zoster oticus and ZSH. We consider that depression of specific cellular immunity plays an important role in triggering reactivation of VZV and onset of these diseases. PMID: 8977852 [PubMed - indexed for MEDLINE] 2940. Emerg Infect Dis. 1996 Oct-Dec;2(4):361-2. Epidemic zoster and AIDS. Morens DM, Agarwal AK, Sarkar S, Panda S, Detels R. PMCID: PMC2639927 PMID: 8969257 [PubMed - indexed for MEDLINE] 2941. Pain. 1996 Oct;67(2-3):241-51. Pain and its persistence in herpes zoster. Dworkin RH, Portenoy RK. Department of Anesthesiology, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA. The nature and duration of pain associated with herpes zoster is highly variable. This review of research on pain in acute herpes zoster and postherpetic neuralgia (PHN) explores those observations relevant to the definition and pathogenesis of PHN and the design of treatment trials. A model for the pathogenesis of PHN is presented, which gains support from studies of risk factors. Several directions for future research are identified. PMID: 8951917 [PubMed - indexed for MEDLINE] 2942. Acta Ophthalmol Scand. 1996 Oct;74(5):506-8. Progressive outer retinal necrosis in an immunocompetent patient. Carrillo-Pacheco S, Vazquez-Marouschek MC, Lopez-Checa F, Sanchez-Roman J. Department of Ophthalmology, Hospital Universitario Virgen del Rocio, Seville, Spain. Progressive outer retinal necrosis syndrome is a variant of necrotizing herpetic retinopathy, a group of retinal infections caused by the herpes viruses. It has been described only in immunosuppressed patients. We present a healthy immunocompetent 16-year-old male who suffered a bilateral progressive outer retinal necrosis. Varicella-zoster virus infection was confirmed on the basis of serologic study. Treatment with intravenous acyclovir and oral prednisone was successful. PMID: 8950404 [PubMed - indexed for MEDLINE] 2943. Infect Control Hosp Epidemiol. 1996 Oct;17(10):694-705. Prevention and control of varicella-zoster infections in healthcare facilities. Weber DJ, Rutala WA, Hamilton H. Division of Infectious Disease, University of North Carolina School of Medicine, USA. Varicella-zoster virus (VZV) is the causative agent of two diseases: varicella (chickenpox) and zoster (shingles). Although varicella generally is a mild disease in children, serious morbidity and mortality are common if infection occurs in neonates, pregnant women, adults, or immunocompromised patients. For this reason, the Centers for Disease Control and Prevention recommends that all the hospitals institute control measures. Healthcare workers should be screened for VZV immunity and, if susceptible, should receive the recently licensed Oka/Merck vaccine (unless contraindicated). This article reviews nosocomial outbreaks associated with VZV and provides detailed algorithms for preexposure immunization and postexposure management of healthcare workers exposed to VZV. PMID: 8899447 [PubMed - indexed for MEDLINE] 2944. Clin Microbiol Rev. 1996 Oct;9(4):448-68. Pediatric human immunodeficiency virus infection. Domachowske JB. Pediatric Infectious Disease, State University of New York Health Science Center, Syracuse 13210, USA. jdomach@helix.nih.gov In the past decade, an increase in pediatric human immunodeficiency virus (HIV) infection has had a substantial impact on childhood morbidity and mortality worldwide. The vertical transmission of HIV from mother to infant accounts for the vast majority of these cases. Identification of HIV-infected pregnant women needs to be impoved so that appropriate therapy can be initiated for both mothers and infants. While recent data demonstrate a dramatic decrease in HIV transmission from a subset of women treated with zidovudine during pregnancy, further efforts at reducing transmission are desperately needed. This review focuses on vertically transmitted HIV infection in children, its epidemiology, diagnostic criteria, natural history, and clinical manifestations including infectious and noninfectious complications. An overview of the complex medical management of these children ensues, including the use of antiretroviral therapy. Opportunistic infection prophylaxis is reviewed, along with the important role of other supportive therapies. PMCID: PMC172904 PMID: 8894346 [PubMed - indexed for MEDLINE] 2945. Int J Dermatol. 1996 Oct;35(10):749-50. Treatment of herpes zoster with interferon alpha-2A. Naoum C, Perissios A, Varnavas V, Lagos D. Department of Dermatology, General Hospital of Athens, "Evagelismos," Greece. PMID: 8891834 [PubMed - indexed for MEDLINE] 2946. Am J Ophthalmol. 1996 Oct;122(4):586-8. Varicella-zoster virus retrobulbar optic neuritis in a patient with human immunodeficiency virus. Shayegani A, Odel JG, Kazim M, Hall LS, Bamford N, Schubert H. Department of Ophthalmology, Edward S. Harkness Eye Institute, USA. PURPOSE: To determine the cause of bilateral retrobulbar optic neuritis followed by progressive outer retinal necrosis in a patient with human immunodeficiency virus (HIV). METHODS: Extensive ophthalmologic, neurologic, infectious disease, rheumatologic, and radiologic examinations were performed. RESULTS: Cerebrospinal fluid samples taken after the onset of bilateral retrobulbar optic neuritis and before the development of clinical progressive outer retinal necrosis disclosed varicella-zoster virus from polymerase chain reaction and viral culture. CONCLUSION: Ophthalmologists and neurologists should consider varicella-zoster virus optic neuritis as a potential precursor of progressive outer retinal necrosis and as a cause of retrobulbar optic neuritis in patients infected with HIV. PMID: 8862063 [PubMed - indexed for MEDLINE] 2947. Am J Emerg Med. 1996 Oct;14(6):588-601. Dermatologic problems encountered in the emergency department. Ferrera PC, Dupree ML, Verdile VP. Department of Emergency Medicine, Albany Medical College, USA. PMID: 8857814 [PubMed - indexed for MEDLINE] 2948. Neurology. 1996 Oct;47(4):929-31. Zoster myelitis: improvement with antiviral therapy in two cases. de Silva SM, Mark AS, Gilden DH, Mahalingam R, Balish M, Sandbrink F, Houff S. Department of Neurology, Veterans Affairs Medical Center, Washington, DC 20422, USA. This report describes two patients with acquired immunodeficiency syndrome (AIDS) and herpes zoster myelopathy. Patient one had a T-8 myelitis that preceded the onset of T-8-distribution zoster and was followed by cervical myelopathy. Antibody to varicella zoster virus (VZV) was present in the CSF. He never received steroids or other immunosuppressive drugs, and his condition improved dramatically after treatment with intravenous acyclovir. The second patient had a rapidly progressive myelitis with paralysis of both legs. Detection of VZV DNA and antibody to VZV in his CSF led to successful treatment with famciclovir despite discontinuation of dexamethasone and earlier treatment failure with acyclovir. These cases support the idea that VZV myelopathy in the immunosuppressed host is caused by virus invasion. CSF analysis for antiviral antibody and for VZV DNA by polymerase chain reaction are helpful in establishing the diagnosis. Aggressive antiviral therapy is advised. PMID: 8857721 [PubMed - indexed for MEDLINE] 2949. J Tradit Chin Med. 1996 Sep;16(3):214-7. Acupuncture treatment of dermopathies and pediatric diseases. Sun Y, Wang D. Beijing College of Acupuncture and Traumatology. PMID: 9389123 [PubMed - indexed for MEDLINE] 2950. Acta Anaesthesiol Sin. 1996 Sep;34(3):151-5. Epidural coadministration of ketamine, morphine and bupivacaine attenuates post-herpetic neuralgia--a case report. Wong CS, Shen TT, Liaw WJ, Cherng CH, Ho ST. Department of Anesthesiology, National Defense Medical Center, Taipei, Taiwan, R.O.C. Erratum in: Acta Anaesthesiol Sin 1996 Dec;34(4):252. The N-methyl-D-aspartate (NMDA) receptor system plays an important role in nociceptive signal modulation in the central nerve system. There is considerable evidence that NMDA receptor antagonists can abolish hypersensitivity of nociceptors in animal models. In this case report, we described a patient who suffered post-herpetic neuralgia with severe pain, allodynia, and hyperesthesia over right side T2 to T8 dermatomes. Treatment with conventional doses of non-steroid anti-inflammatory drug (NSAID), antidepressant, anticonvulsant and benzodiazepine failed to provide satisfactory pain relief. With the patient's consent, we administered subanalgesic doses of ketamine (10 mg), morphine (1 mg), and 6 ml bupivacaine (0.1%) through the thoracic epidural route. After the treatment, hyperalgesia and allodynia improved dramatically, and the receptive field also reduced. After four weeks' treatment, satisfactory pain relief was achieved with conventional analgesics treatment. The combination of relatively low doses of morphine, ketamine and bupivacaine epidurally provides effective pain relief in this case. The result strongly suggests a synergy from this combination that warrants a formal study of the dose-response relationship involved in this treatment and the mechanism by which this effect is achieved. This regimen provides a promising treatment for the neuropathic pain with limited side effects. PMID: 9084539 [PubMed - indexed for MEDLINE] 2951. Aviat Space Environ Med. 1996 Sep;67(9):899-900. You're the flight surgeon: severe headache. Geyer DE. PMID: 9045600 [PubMed - indexed for MEDLINE] 2952. Practitioner. 1996 Sep;240(1566):552. Shingles. Wyndham M. British Society for the Study of Infection. PMID: 8984465 [PubMed - indexed for MEDLINE] 2953. Br J Dermatol. 1996 Sep;135(3):502-3. Cytological diagnosis of zosteriform skin metastases in undiagnosed breast carcinoma. Heckmann M, Volkenandt M, Lengyel ER, Schirren CG, Gizycki-Nienhaus BV. PMID: 8949466 [PubMed - indexed for MEDLINE] 2954. J Dermatol. 1996 Sep;23(9):631-4. A case of herpes zoster associated with colitis. Okimura H, Muto M, Ichimiya M, Mogami S, Takahata H, Asagami C. Department of Dermatology, Yamaguchi University School of Medicine, Ube, Japan. A 58-year-old Japanese woman who had herpes zoster in association with colitis was successfully treated with intravenously administrated acyclovir. Vesicular lesions with red haloes ranged from the left side of her buttock to the left extremity, corresponding to the L4 to S2 dermatomes. Her colitis was considered to have been induced by varicella-zoster virus, based on the facts that the clinical courses were correlated and that the innervation of the affected site of the colon corresponded to an infected dermatome (S2). PMID: 8916665 [PubMed - indexed for MEDLINE] 2955. Electromyogr Clin Neurophysiol. 1996 Sep;36(6):369-75. Segmental zoster paresis of limbs. Merchut MP, Gruener G. Department of Neurology, Loyola University Medical Center, Maywood, IL 60153 USA. Segmental zoster paresis (SZP) is the focal, asymmetrical neurogenic weakness which may occur in a limb affected by cutaneous zoster. We have summarized the features of this syndrome, based on a retrospective review of 8 personal and 96 published cases. Limb SZP becomes apparent in at least 3-5% of patients with cutaneous zoster, who are usually over the age of sixty and weak proximally (C5,6,7 or L2,3,4 innervated muscles). Functional motor recovery occurs in about 75% of cases, generally by 1-2 years. Limb weakness is probably due to a lesion of the ventral nerve root, in close proximity to the initiating dorsal ganglionitis. The electrodiagnostic findings, scarce in the literature, typically consist of absent compound sensory nerve action potentials in the involved limb, with less frequent reduction or loss of compound muscle action potentials. Fibrillations and positive sharp waves become detectable within 1-4 months in limb and related paraspinal muscles, decreasing or disappearing later. In addition to this radiculopathy, peripheral nerves may also occasionally become involved, manifest as mononeuropathies of the median, ulnar, long thoracic, recurrent laryngeal, and phrenic nerves. The zoster infection or consequent inflammatory response appears able to affect motor axons distally as well as proximally. PMID: 8891477 [PubMed - indexed for MEDLINE] 2956. J Med Virol. 1996 Sep;50(1):82-92. Detection of both herpes simplex and varicella-zoster viruses in cerebrospinal fluid from patients with encephalitis. Casas I, Tenorio A, de Ory F, Lozano A, Echevarría JM. Department of Diagnosis, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain. Cerebrospinal fluid (CSF) samples from 46 patients with encephalitis were studied for the presence of herpes simplex virus (HSV) types 1 and 2 and/or varicella zoster virus (VZV)-specific DNA sequences by the polymerase chain reaction (PCR) assay. Patients were studied because of detection of intrathecal production of IgG antibody to HSV alone (10 patients, Group A) or to both HSV and VZV (11 patients, Group B) or because of the presence of specific anti-HSV IgG in CSF without evidence of intrathecal antibody production (25 patients, Group C). CSF samples taken between days 1 and 10 from onset of encephalitis were available from all patients, and follow-up samples (taken after 10 days from onset) were obtained from some of them. Positive PCR results were obtained in a total of 13 patients. Four patients (three from Group A and one from Group B) gave amplification of HSV type 1 DNA alone, two patients (both from Group B) showed amplification of VZV DNA alone, and seven patients (all from Group B) gave dual amplification of both HSV type 1 and VZV DNA sequences in CSF. All CSF samples from patients in Group C were negative by PCR. Ten patients with CSF samples positive by PCR lacked a prior history of herpetic cutaneous lesions. In seven patients, serum antibody tests (specific IgM detection and specific IgG avidity assays) identified both primary and recurrent infections. The results suggest that the dual presence of IgG antibody to both HSV and VZV in CSF from patients with encephalitis may reflect in some cases a dual infection of the central nervous system caused by both agents. PMID: 8890045 [PubMed - indexed for MEDLINE] 2957. Cutis. 1996 Sep;58(3):231-4. Connatal herpes zoster. Querol I, Bueno M, Cebrian A, Gonzalez-Echeverria FJ. Department of Dermatology, Hospital Reina Sofia de Tudela, Spain. We describe a case of connatal herpes zoster present in a newborn girl whose mother had been exposed to varicella infection during the seventh month of pregnancy. A few minutes after delivery, the newborn was examined for an erythematous maculopapular rash with clear grouped vesicles involving the right L2-L4 dermatome. She was given varicella zoster immunoglobulin and oral and topical acyclovir, and all the skin lesions were completely healed eight days later. This report emphasizes one aspect of the relationship between maternal exposure to varicella zoster virus infection and the occurrence of connatal shingles, the benign course of the disease in this case, and the favorable response to acyclovir therapy in neonates. PMID: 8886539 [PubMed - indexed for MEDLINE] 2958. AIDS. 1996 Sep;10(11):1300-1. Famciclovir in AIDS-related acute retinal necrosis. Klein JL, Sandy C, Migdal CS, Main J. Comment on: AIDS. 1996 Jan;10(1):55-60. PMID: 8883599 [PubMed - indexed for MEDLINE] 2959. Int J Dermatol. 1996 Sep;35(9):665-6. Herpes zoster: treatment with Clinacanthus nutans cream. Charuwichitratana S, Wongrattanapasson N, Timpatanapong P, Bunjob M. Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. PMID: 8876301 [PubMed - indexed for MEDLINE] 2960. AIDS. 1996 Sep;10(10):1174-5. Ocular and neurological complications of varicella zoster virus infection in a patient with AIDS. Meenken C, van den Horn GJ, Danner SA. PMID: 8874639 [PubMed - indexed for MEDLINE] 2961. Cornea. 1996 Sep;15(5):446-50. Herpes zoster peripheral ulcerative keratitis in patients with the acquired immunodeficiency syndrome. Neves RA, Rodriguez A, Power WJ, Muccioli C, Lane L, Belfort R Jr, Foster CS. Department of Ophthalmology, Massachusetts Eye & Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA. The purpose of this study was to describe the clinical characteristics and course of peripheral ulcerative keratitis (PUK) secondary to herpes varicella-zoster virus in patients with the acquired immunodeficiency syndrome (AIDS). Three AIDS patients with ocular herpes zoster infection (mean age at onset, 33.0 years; range, 30-42) developed PUK. The three patients had skin involvement, and two of them had bilateral keratouveitis. All were treated with high-dose oral acyclovir (4 g/day) with or without topical antiviral therapy. Two of the patients responded well to oral acyclovir, but one of them stopped the treatment, and bilateral progressive outer retinal necrosis and lethal encephalitis developed. The third patient had a recurrent episode of inflammation with PUK, extensive stromal scarring, and deep neovascularization. AIDS patients with herpes varicella-zoster virus infection may have severe and protracted corneal manifestations, including PUK. The correct diagnosis and aggressive early long-term systemic antiviral treatment must be instituted to control inflammation, ulcer progression, and complications. PMID: 8862919 [PubMed - indexed for MEDLINE] 2962. Infect Dis Clin North Am. 1996 Sep;10(3):677-88. New varicella vaccines. Ellis RW. Merck Research Laboratories, West Point, Pennsylvania, USA. The live attenuated varicella vaccine, which is available for the prevention of chickenpox, was produced by a classic technology that also has been used for polio, measles, mumps, and rubella vaccines. There are many newer technologies that have been applied to the research and development of other vaccines. Each of these other approaches offers potential advantages and disadvantages relative to the current varicella vaccine. PMID: 8856359 [PubMed - indexed for MEDLINE] 2963. Infect Dis Clin North Am. 1996 Sep;10(3):657-75. The varicella vaccine. Prevention of herpes zoster. Levin MJ, Hayward AR. Department of Pediatrics, Children's Hospital, Denver, Colorado, USA. The live attenuated varicella vaccine offers some hope that the frequency or severity of herpes zoster might be reduced. Universal immunization with this vaccine should result in less latent varicella-zoster virus in dorsal root and cranial nerve ganglia than that which occurs following varicella. Moreover, the vaccine virus is not well adapted for growth in human cells at normal body temperature. Thus, reduced virus for reactivation, and less robust replication, may lessen the problem of herpes zoster in vaccinees. For those individuals who have already had varicella, the risk of herpes zoster is closely related to the loss of varicella-zoster virus cell-mediated immune responses, which decline with aging (or immune suppression). In aging individuals these immune responses can be enhanced by booster immunization with the varicella vaccine, suggesting that a vaccine to prevent herpes zoster is feasible. PMID: 8856358 [PubMed - indexed for MEDLINE] 2964. Infect Dis Clin North Am. 1996 Sep;10(3):631-55. Epidemiologic effects of varicella vaccination. Halloran ME. Department of Biostatistics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA. For a plausible range of values for the different efficacy characteristics of the live varicella (Oka) vaccine at different levels of coverage, modeling results suggest that routine immunization of preschool children would greatly reduce the number of primary varicella cases, whereas the shift in age distribution of cases would not result in increased overall morbidity as measured by number of hospitalizations. Although information about some of the vaccine assumptions is scanty, the combinations of assumptions leading to an increase in morbidity seem unlikely. A catch-up program in older children who have not yet had chickenpox will be important. The number and age distribution of the cases in vaccinees are sensitive to assumptions about the vaccine, especially the degree and distribution of partial protection against infection, relative residual infectiousness, and waning of immunity. Responsiveness to boosting by wild-type VZV infection was especially important in reducing the number of older cases. The advantage conferred by responsiveness to boosting depends on the level of transmission. The direct and indirect effects of vaccines and vaccination programs interact. Understanding how a vaccine works at the individual level is important for the vaccinated individual, but it also influences the overall public health benefits of an immunization programs. Lieu et al based a cost-effectiveness analysis of varicella vaccines on this model of varicella dynamics and assumptions about how the vaccines work. Models cannot replace biologic understanding. The purpose of such models is not to predict the number of cases of varicella, but to examine some possible consequences of introducing a vaccine into the routine immunization schedule of preschool children in the United States, effects of different vaccination strategies, and the benefits of a temporary catch-up program for older children. Modeling exercises of this sort force us to formalize our thinking, for instance about the vaccine mechanisms, and to admit our uncertainties, such as about the vaccine efficacy assumptions. Such models also show where more data need to be collected, for example, on boosting and waning of immunity and relative residual infectiousness. Improvements in the design of vaccine efficacy studies are necessary to provide the input to these models for looking at the long-term effects of vaccination programs. Frailty models can be used to analyze the data in the presence of heterogeneities in susceptibility. Waning can also be estimated using appropriate methods. Relative infectiousness of vaccinees with breakthrough cases can be measured by comparing the relative secondary attack rates when the index infected person is vaccinated and when the index infected person is unvaccinated. More studies are needed to understand how to evaluate responsiveness to boosting. Vaccine efficacy studies in the field should be designed to obtain better estimates of residual susceptibility, residual infectiousness, duration of protection, and the effects of boosting by reinfection with wild-type VZV. PMID: 8856357 [PubMed - indexed for MEDLINE] 2965. Infect Dis Clin North Am. 1996 Sep;10(3):617-29. Modified varicella-like syndrome. Clements DA. Division of General Pediatrics, Duke University Medical Center, Durham, North Carolina, USA. After incidental exposure to natural varicella, up to 18% of vaccinees reported a breakthrough infection known as modified varicella-like syndrome (MVLS) over up to 10 years of postvaccination follow-up, compared with natural varicella occurring in similarly aged unvaccinated children at the rate of 9% per year. Children with MVLS are frequently asymptomatic, and their disease is characterized by having fewer lesions, less fever, and lasting fewer days than natural varicella. When a case of MVLS occurs there are few secondary cases, suggesting that it is infrequently transmitted. Sequelae such as secondary bacterial infection, cerebellar ataxia, encephalitis, and pneumonia occur infrequently. PMID: 8856356 [PubMed - indexed for MEDLINE] 2966. Infect Dis Clin North Am. 1996 Sep;10(3):609-15. Clinical trials of varicella vaccine in healthy adolescents and adults. Arbeter AM. Department of Pediatric and Adolescent Medicine, Albert Einstein Medical Center, Philadelphia, Pennsylvania, USA. Adolescents and adults have an increased risk of severe and, rarely, fatal varicella. Increased risk of exposure of susceptible teens and adults occurs because of the more common use of day care and nursery programs, and more common exposure of health care workers to herpes zoster. The exposure of susceptible parents to their own children represents an important hazard. Live attenuated varicella vaccine requires two doses to be adequately immunogenic in adults. Safety and clinical tolerability have been well documented, and persistent antibody protection from infection and virtual absence of early herpes zoster infections are inferred from encouraging preliminary data. PMID: 8856355 [PubMed - indexed for MEDLINE] 2967. Infect Dis Clin North Am. 1996 Sep;10(3):595-608. Clinical trials of varicella vaccine in healthy children. White CJ. The Oka varicella vaccine has been tested in clinical trials worldwide in thousands of children. Following licensure in Japan, Korea, Germany, and the United States, the vaccine has been used in several millions of children. The vaccine has been generally well-tolerated with the most common complaints being pain and redness at the injection site and a mild rash following vaccination. The incidence of herpes zoster has not increased in vaccinees and may have decreased. Efficacy rates vary between 65% and 100% depending on the intensity of exposure to natural varicella and the potency of the vaccine. In those few vaccinees who develop MVLS, the rash is generally milder than seen following natural infection (median < 50 versus 300 lesions, respectively, as well as a lower incidence of fever). There has been no evidence to date to indicate waning immunity postvaccination. Studies are in progress in the United States to evaluate whether this will occur and the effect of booster doses of vaccine. It is expected that in countries where there is widespread use of the vaccine in healthy children, disease rates will fall dramatically as will the morbidity and mortality associated with natural varicella in this population. PMID: 8856354 [PubMed - indexed for MEDLINE] 2968. Infect Dis Clin North Am. 1996 Sep;10(3):583-94. The varicella vaccine. Clinical trials in immunocompromised individuals. Gershon AA, LaRussa P, Steinberg S. Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, New York, USA. A review of the use of live attenuated varicella vaccine in immunocompromised children, particularly those with underlying leukemia in remission, is presented. Data concerning safety, immunogenicity, and efficacy of this vaccine in high-risk children are reviewed. The unique contributions toward our understanding of varicella vaccine, including spread of vaccine-type virus, incidence of zoster, and immune correlates provided by studies of immunocompromised patients are discussed. The importance of protecting high-risk children against severe varicella by the use of varicella vaccine is apparent. PMID: 8856353 [PubMed - indexed for MEDLINE] 2969. Infect Dis Clin North Am. 1996 Sep;10(3):571-81. The epidemiology of varicella-zoster virus infections. Wharton M. Child Vaccine Preventable Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA. Historically, varicella has been a disease predominantly affecting preschool and school-aged children in the United States. The live attenuated varicella vaccine was licensed in this country in 1995 and has been recommended for routine use in immunization of children 12 to 18 months of age. As an increasing proportion of the children in the United States are protected from varicella by vaccination, changes in the current epidemiology of the disease are anticipated. This article reviews the current epidemiology of VZV infection and outlines issues related to possible changes in varicella epidemiology that may follow widespread use of the live varicella (Oka) vaccine. PMID: 8856352 [PubMed - indexed for MEDLINE] 2970. Infect Dis Clin North Am. 1996 Sep;10(3):469-88. The varicella vaccine. Vaccine development. Takahashi M. Research Institute for Microbial Diseases, Osaka University, Japan. In this article, rationales and method of development of attenuated live varicella (Oka) vaccine are described, with biologic and biophysical characteristics of the vaccine virus. The results of early clinical trials in Japan are also described, along with the results of detection of viremia in vaccinees and a follow-up of incidence of zoster in acute leukemic children, which indicate possible immunopathogenesis of varicella and zoster. PMID: 8856348 [PubMed - indexed for MEDLINE] 2971. Hum Pathol. 1996 Sep;27(9):927-38. The patterns of varicella zoster virus encephalitis. Kleinschmidt-DeMasters BK, Amlie-Lefond C, Gilden DH. Department of Pathology, University of Colorado Health Sciences Center, Denver 80262, USA. Varicella zoster virus (VZV) encephalitis has become increasingly prevalent in the era of acquired immunodeficiency syndrome (AIDS), and a widening spectrum of pathological lesions has defined the disease in these and other severely immunosuppressed patients. VZV produces three distinct morphological patterns of brain damage. VZV can cause bland or hemorrhagic infarctions secondary to a large or medium vessel vasculopathy. Deep white matter, ovoid mixed necrotic, and demyelinative lesions occur as a consequence of small vessel vasculopathy, with demyelination dependent on the degree of additional oligodendrocyte infection. Distinctive Cowdry A intra-nuclear viral inclusions are rare in either large or small blood vessels or near infarctions, but are commonly found in glial cells at the edge of the smaller ovoid, demyelinative lesions. Ependymal and periventricular necrosis occurs as a result of vasculopathy of subependymal vessels and secondary infection of ependymal and other glial cells in the periventricular region. To clarify these patterns of VZV encephalitis and shed light on their pathogenesis, the authors have examined all cases of VZV encephalitis seen at our institution since 1984. Additionally, the authors review the extensive literature in an attempt to classify the patterns of VZV encephalitis into (1) large/ medium vessel vasculopathy with bland or hemorrhagic infarctions, (2) small vessel vasculopathy with mixed ischemic/demyelinative lesions, and (3) ventriculitis/periventriculitis. Although one of these three patterns often predominates clinically and radiographically, careful histological examination at autopsy shows mixed features in many cases. PMID: 8816888 [PubMed - indexed for MEDLINE] 2972. J Pain Symptom Manage. 1996 Sep;12(3):149. Postherpetic neuralgia: treatment reminder. Hargus EP, Clark J, Gadbaw J, Paige D. PMID: 8803377 [PubMed - indexed for MEDLINE] 2973. Ann Intern Med. 1996 Sep 1;125(5):376-83. Acyclovir with and without prednisone for the treatment of herpes zoster. A randomized, placebo-controlled trial. The National Institute of Allergy and Infectious Diseases Collaborative Antiviral Study Group. Whitley RJ, Weiss H, Gnann JW Jr, Tyring S, Mertz GJ, Pappas PG, Schleupner CJ, Hayden F, Wolf J, Soong SJ. Department of Pediatrics, University of Alabama at Birmingham, Children's Hospital 35233, USA. Comment in: Ann Intern Med. 1997 May 15;126(10):831; author reply 832. Ann Intern Med. 1997 May 15;126(10):831-2. Ann Intern Med. 1997 May 15;126(10):831; author reply 832. OBJECTIVE: To determine the effect of acyclovir and prednisone treatment of herpes zoster on chronic pain and quality-of-life outcomes. DESIGN: Randomized, double-blind, placebo-controlled study with a 2 x 2 factorial design. SETTING: 15 university hospitals or affilliated clinics. PATIENTS: 208 immunocompetent patients older than 50 years of age who had localized herpes zoster that developed less than 72 hours before study enrollment. INTERVENTION: Acyclovir or a matched placebo was administered orally, 800 mg five times daily, for 21 days. Prednisone or a matched placebo was administered orally at 60 mg/d for the first 7 days, 30 mg/d for days 8 to 14, and 15 mg/d for days 15 to 21. The four treatments regimens given were acyclovir plus prednisone; acyclovir plus prednisone placebo; prednisone plus acyclovir placebo; and placebos for both acyclovir and prednisone. MEASUREMENTS: Patients were monitored daily for the first 28 days for lesion healing, resolution of pain, return to usual activity, and return to uninterrupted sleep. Monitoring was then done monthly for 6 months. Patients documented analgesic requirements each day, and adverse events and laboratory abnormalities were recorded at each clinical visit. An intention-to-treat analysis was used. RESULTS: Patients were randomly allocated to receive one of the four regimens. Demographic characteristics were similar for each group. Time to total crusting and healing was accelerated for patients receiving acyclovir plus prednisone compared with patients receiving two placebos; the risk ratios were 2.27 (95% Cl, 1.46 to 3.55) for total crusting and 2.07 (Cl, 1.26 to 3.38) for healing. Similarly, compared with the placebo group, patients receiving acyclovir plus prednisone had accelerated time to cessation of acute neuritis (risk ratio, 3.02 [Cl, 1.42 to 6.41]), time to return to uninterrupted sleep (risk ratio, 2.12 [Cl, 1.25 to 3.58]); time to return to usual daily activity (risk ratio, 3.22 [Cl, 1.92 to 5.40]); and time to cessation of analgesic therapy (risk ratio, 3.15 [Cl, 1.69 to 5.89]). In the acyclovir plus prednisone group, resolution of pain during the 6 months after disease onset did not statistically differ from that in the other groups. No important clinical or laboratory adverse events occurred in any group. CONCLUSIONS: In relatively healthy persons older than 50 years of age who have localized herpes zoster, combined acyclovir and prednisone therapy can improve quality of life. PMID: 8702088 [PubMed - indexed for MEDLINE] 2974. Hautarzt. 1996 Aug;47(8):604-9. [Epidemiology of varicella zoster infection. Results of a prospective study in the Ansbach area] [Article in German] Paul E, Thiel T. Hautklinik, Klinikum Nürnberg Nord, Universität Erlangen-Nürnberg. In the country city of Ansbach, Germany all cases of varicellazoster virus infection seen by dermatologists, pediatricians and general practitioners were registered over a period of 16 months, from February 1992 until May 1993. 152 patients were clinically diagnosed with herpes zoster and 437 patients with chickenpox. The population-based incidence of zoster infections was 22.6 per 10,000 inhabitants per year, while the incidence of chickenpox was 42.4. There was a slight predominance of male patients with zoster. There was also a marked influence of age and sex, on the localization of the involved nerve segments. Zoster was seen in patients of all ages but there was a clear predominance in older patients. The peak of the disease occurred in the eighth decade. In patients with chickenpox, the sex ratio was equal. The disease typically occurs in children and we observed a predominance of the cases in the first decade. Spread over the year, zoster was seen equally during all seasons. Chickenpox, however, showed epidemiological peaks of frequency. It is possible that the epidemic spread of the disease and the end of the peak are influenced by special metereological conditions. PMID: 8964702 [PubMed - indexed for MEDLINE] 2975. Immunol Rev. 1996 Aug;152:157-73. Human herpes viruses latent infection in the nervous system. Steiner I. Department of Neurology, Hadassah University Hospital, Jerusalem, Israel. The neurotropic herpes viruses, HSV-1, HSV-2 and VZV, colonize and establish latent infection in human peripheral sensory ganglia. Recurrent diseases due to reactivation of these viral pathogens can take place despite an effective immune response. Molecular, cellular, physiological and immune mechanisms work in concert to enable the establishment of latency, the maintenance of the latent state for the entire life of the host, and the reactivation infection. Although all three viruses belong to the same family and establish latent infection in the same tissue, the clinical pattern of their reactivation is quite different. This review covers current knowledge of the basis of these infections, and offers a theory explaining the basis of HSV-1 latent infection and the differences of the disorders caused by HSV-1 and VZV reactivation in humans. PMID: 8930672 [PubMed - indexed for MEDLINE] 2976. Aust N Z J Ophthalmol. 1996 Aug;24(3):287-8. CT appearance of a functioning Jones tube after dacryocystorhinostomy and bypass tube surgery. Francis IC, Egan CA, Wilcsek GA. Dalcross Hospital, Killara, New South Wales. PMID: 8913135 [PubMed - indexed for MEDLINE] 2977. J Med Virol. 1996 Aug;49(4):279-82. Evaluation of a new general primer pair for rapid detection and differentiation of HSV-1, HSV-2, and VZV by polymerase chain reaction. Baron JM, Rübben A, Grussendorf-Conen EI. Department of Dermatology, RWTH-Aachen, Germany. Erratum in: J Med Virol 1997 Feb;51(2):137. The polymerase chain reaction (PCR) enables rapid and sensitive detection of VZV and HSV DNA and its efficiency depends mainly on the choice of the primers. Primers should hybridize to conserved DNA sequences within the viral genomes in order to avoid unreliable amplification due to DNA sequence variation between different strains. The aim of the study was to design and to evaluate a general primer pair which permits fast and reliable detection of HSV and VZV. The genes UL 15 of HSV and UL 42 of VZV share the highest degree of homology within the two genomes. We designed a primer pair (GPHV-RU) which hybridizes to these genes. The genetic variability of amplified sequences from clinical specimens was analyzed by restriction enzyme cleavage analysis and by temperature gradient SSCP analysis (TG-SSCP). PCR with GPHV-RU amplified viral sequences from all analyzed specimens (25 x VZV, 10 x HSV-1, 5 x HSV-2) obtained from patients with clinical evidence of HSV or VZV infection. Restriction enzyme cleavage analysis with Hpa II further permitted reliable distinction between VZV, HSV-1, and HSV-2. Analysis of the heterogeneity of the amplified sequences by restriction enzyme cleavage and by TG-SSCP demonstrated no variability between the analyzed clinical specimens of VZ and of HSV-2 and only one differing TG-SSCP-pattern within the HSV-1 isolates. The results suggest that detection of HSV and VZV using the new primer pair GPHV-RU should give reliable results as the amplified sequences show little genetic variability within clinical isolates of HSV-1/2 and VZV. PMID: 8877759 [PubMed - indexed for MEDLINE] 2978. J Neurol. 1996 Aug;243(8):618-9. Dual detection of antibody to both herpes simplex and varicella-zoster viruses in cerebrospinal fluid: cross reactivity or dual infection? Echevarría JM, Casas I, Tenorio A, Martínez-Martín P. PMID: 8865033 [PubMed - indexed for MEDLINE] 2979. J Dermatol. 1996 Aug;23(8):556-8. Milia arising in herpes zoster scars. Lee WS, Kim SJ, Ahn SK, Lee SH. Department of Dermatology, Yonsei University Wonju, College of Medicine, Korea. Milia caused by proliferative tendencies of the epithelium after injury may occur in areas of bullous eruption (10). Even though the possibility of milia arising in herpes zoster scar is real, it has not been reported previously. We describe a case of milia arising in herpes zoster scars as an another example of milia occurring in traumatized skin. PMID: 8854589 [PubMed - indexed for MEDLINE] 2980. Int J Dermatol. 1996 Aug;35(8):603-4. Guillain-Barré syndrome associated with varicella-zoster infection. da Rosa-Santos OL, Moreira AM, Golfetto CA, Maceira JP, Ramos-e-Silva M. PMID: 8854170 [PubMed - indexed for MEDLINE] 2981. Nervenarzt. 1996 Aug;67(8):623-9. [Herpes zoster: follow-up, complications and therapy] [Article in German] Straube A, Padovan CS. Neurologische Klinik, Klinikum Grosshadern, Ludwig-Maximilians-Universität, München. In clinical practice herpes zoster infections are common. The cause is the reactivation of the herpes varicella virus that persists in the sensory ganglia after an earlier primary infection with shingles. There are several neurological complications such as meningitis, ventriculitis, encephalitis, myelitis, cerebral angiitis, myositis, paresis of motor nerves, acute polyneuritis, and most commonly post-zoster neuralgia. A proposed reason for these complications is the direct infiltration of the virus or a hematogenous infection. Some of the complications can be treated symptomatically such as post-zoster neuralgia and the occurrence of certain complications that can be prevented by the right choice of acute therapy. PMID: 8805107 [PubMed - indexed for MEDLINE] 2982. Epidemiol Infect. 1996 Aug;117(1):165-71. An analysis of infection control of varicella-zoster virus infections in Addenbrooke's Hospital Cambridge over a 5-year period, 1987-92. Wreghitt TG, Whipp J, Redpath C, Hollingworth W. Clinical Microbiology & Public Health Laboratory, Addenbrooke's Hospital, Cambridge, UK. This prospective study analyses infections with varicella-zoster virus (VZV) in Addenbrooke's Hospital, Cambridge during 1987-92 and examines the spread of infection. In total, 93 patients and staff experienced VZV infection. Twenty-one patients had varicella and 49 experienced zoster. None of 101 patients and 1 of 625 staff members in contact with varicella cases acquired infection. By contrast, 2 of 227 patients, and 5 of 1039 staff in contact with zoster cases acquired varicella. One out of 28 (3.6%) VZV antibody-negative patients and staff in contact with varicella acquired infection, compared with 5 out of 29 (17.2%) VZV antibody-negative patients and staff in contact with zoster. Thus, zoster was found to be a more frequent cause of nosocomial infection than varicella. Fourteen members of staff had VZV infection during the study period. One of 99 patients and none of 389 staff members in contact with these cases developed varicella. The cost of dealing with infection control for VZV infections in our hospital is estimated to be Pounds 714 per patient case and a total of Pounds 13,204 per year. PMCID: PMC2271659 PMID: 8760965 [PubMed - indexed for MEDLINE] 2983. Arch Dermatol. 1996 Aug;132(8):963, 966. Vesicular eruption on the scalp. Varicella-zoster virus with Torulopsis glabrata colonization. Meffert JJ, Rush WL, Kennard CD. Wilford Hall Air Force Medical Center, Lackland Air Force Base, Tex, USA. PMID: 8712849 [PubMed - indexed for MEDLINE] 2984. Surg Endosc. 1996 Aug;10(8):848-9. Herpes zoster mistaken for biliary colic and treated by laparoscopic cholecystectomy: a cautionary case report. Hassan I, Donohue JH. Department of Surgery, Mayo Clinic and Mayo Foundation, 200 First Street, SW, Rochester, MN 55905, USA. Herpes zoster must be included in the differential diagnosis of acute right upper quadrant pain. The presence of a dermatomal vesicular rash should be considered a contraindication to surgical intervention. PMID: 8694952 [PubMed - indexed for MEDLINE] 2985. Hosp Pract (Minneap). 1996 Jul 15;31(7):137-44. Early treatment of herpes zoster. Tyring SK. Department of Dermatology, University of Texas Medical Branch at Galveston, USA. Comment in: Hosp Pract (Minneap). 1996 Oct 15;31(10):42. Although varicella virus vaccine may eventually decrease the incidence of herpes zoster, the disease will continue to plague patients and physicians for at least the next several decades. Recognition of shingles early in its vesicular stage is important, since that is when antiviral treatment is effective. Moreover, a variety of agents are now available for symptomatic relief of postherpetic neuralgia. PMID: 8682880 [PubMed - indexed for MEDLINE] 2986. MMWR Recomm Rep. 1996 Jul 12;45(RR-11):1-36. Prevention of varicella: Recommendations of the Advisory Committee on Immunization Practices (ACIP). Centers for Disease Control and Prevention. [No authors listed] These recommendations represent the first statement by the Advisory Committee on Immunization Practices (ACIP) on the use of live, attenuated varicella virus vaccine--VARIVAX--manufactured by Merck and Company, Inc. and licensed in March 1995 for use in healthy persons > or = 12 months of age. In addition to presenting information regarding vaccine, this statement updates previous recommendations concerning the use of varicella zoster immune globulin (VZIG) as prophylaxis against varicella (MMWR 1984; 33:84-90, 95-100). PMID: 8668119 [PubMed - indexed for MEDLINE] 2987. Proc Natl Acad Sci U S A. 1996 Jul 9;93(14):7231-5. Mass vaccination to control chickenpox: the influence of zoster. Ferguson NM, Anderson RM, Garnett GP. Wellcome Centre for the Epidemiology of Infectious Disease, Department of Zoology, Oxford University, United Kingdom. The impact of transmission events from patients with shingles (zoster) on the epidemiology of varicella is examined before and after the introduction of mass immunization by using a stochastic mathematical model of transmission dynamics. Reactivation of the virus is shown to damp stochastic fluctuations and move the dynamics toward simple annual oscillations. The force of infection due to zoster cases is estimated by comparison of simulated and observed incidence time series. The presence of infectious zoster cases reduces the tendency for mass immunization to increase varicella incidence at older ages when disease severity is typically greater. PMCID: PMC38965 PMID: 8692974 [PubMed - indexed for MEDLINE] 2988. N Engl J Med. 1996 Jul 4;335(1):32-42. Postherpetic neuralgia--pathogenesis, treatment, and prevention. Kost RG, Straus SE. Medical Virology Section, National Institute of Allergy and Infectious Diseases, Bethesda, MD 20892, USA. Comment in: N Engl J Med. 1996 Dec 5;335(23):1769; author reply 1769. N Engl J Med. 1996 Dec 5;335(23):1768-9; author reply 1769. PMID: 8637540 [PubMed - indexed for MEDLINE] 2989. Am J Otol. 1996 Jul;17(4):625-9. Delayed facial palsy after acoustic neuroma resection: the role of viral reactivation. Gianoli GJ, Kartush JM. Department of Otolaryngology-Head and Neck Surgery, Tulane University Medical Center, New Orleans, Louisiana 70112, USA. Delayed facial palsy after acoustic neuroma resection may occur in up to 15% of cases. Prognosis is generally good if the palsy does not progress to total paralysis. However, a delayed palsy with subsequent total paralysis has a more variable final outcome, which ranges from normal function to permanent total paralysis. This delayed paralysis has been attributed to edema from surgical manipulation of the facial nerve. Steroids and intraoperative decompression of the meatal foramen have been used with some success, but some cases remain refractory to these measures. Herpes simplex virus and varicella-zoster virus are ubiquitous in the population and remain in a latent state in neural ganglia. These viruses are reactivated during times of stress. Trigeminal nerve surgery (partial sensory rhizotomy and microvascular decompression) stimulates reactivation of herpes simplex with manifestations in the sensory distribution of the trigeminal nerve in 38-94% of procedures. Prevention of this reactivation has been demonstrated in placebo-controlled trials by using prophylactic acyclovir. We present a patient who underwent translabyrinthine resection of an intracanalicular acoustic neuroma and in whom developed otalgia, vesicles on the ear canal and the ipsilateral buccal mucosa, and progressive facial palsy the week after surgery. Serologic evaluation confirmed the diagnosis of herpes zoster oticus. Reactivation of latent virus apparently occurred as a result of surgical manipulation of the facial nerve. This parallels viral reactivation seen in trigeminal nerve surgery. We propose a new theory for an additional cause of delayed facial palsy after acoustic neuroma resection-reactivation of latent herpesvirus resulting from surgical trauma. Acyclovir should be evaluated in clinical trials for a prophylactic role in patients undergoing acoustic neuroma resection or a therapeutic role in patients in whom a delayed postoperative facial palsy develops. PMID: 8841711 [PubMed - indexed for MEDLINE] 2990. Clin Pharmacokinet. 1996 Jul;31(1):1-8. The clinical pharmacokinetics of famciclovir. Gill KS, Wood MJ. Department of Infection and Tropical Medicine, Birmingham Heartlands Hospital, Bordesley Green East, England. Famciclovir is an oral prodrug of the antiherpesvirus nucleoside analogue, penciclovir. Following oral administration famciclovir undergoes extensive first pass metabolism to penciclovir and essentially no parent compound is recovered from plasma or urine. Penciclovir plasma concentrations reach a maximum less than 1 hour after famciclovir administration in fasting individuals, but are delayed if famciclovir is taken within 2 hours of a meal. The bioavailability of penciclovir, measured by urinary recovery, is approximately 60% and is not affected by food. Over the likely therapeutic dose range of famciclovir 125 mg to 750 mg, the pharmacokinetics of penciclovir are linear. The volume of distribution of penciclovir after intravenous administration is more than 1 L/kg, indicating extensive distribution into the tissue. Penciclovir is predominantly eliminated unchanged by the kidney, partly by active tubular excretion and has a terminal phase elimination half-life (t1/2 beta) of between 2 and 2.5 hours and a renal clearance (CLR) of between 25 and 30 L/h in individuals with normal renal function. In those with severe renal impairment the CLR falls markedly and the t1/2 beta increases to over 18 hours. Haemodialysis appears to be effective in clearing penciclovir from plasma. Elderly individuals tolerate famciclovir well, despite slower elimination secondary to age-related lower renal clearance. Uncomplicated herpes zoster does not affect the pharmacokinetic profile of penciclovir. In the limited studies undertaken so far, no significant drug interactions have been demonstrated. PMID: 8827396 [PubMed - indexed for MEDLINE] 2991. Ir Med J. 1996 Jul-Aug;89(4):132-4. Treatment of herpes simplex & varicella zoster infection. Barrg C, Sheehan G. PMID: 8824033 [PubMed - indexed for MEDLINE] 2992. Pediatr Infect Dis J. 1996 Jul;15(7):643-4. Acute glomerulonephritis with zoster. Rossetti A, Tönz M, Bianchetti MG. PMID: 8823871 [PubMed - indexed for MEDLINE] 2993. Graefes Arch Clin Exp Ophthalmol. 1996 Jul;234(7):419-24. A comparative study of the polymerase chain reaction and local antibody production in acute retinal necrosis syndrome and cytomegalovirus retinitis. Abe T, Tsuchida K, Tamai M. Department of Ophthalmology, Tohoku University School of Medicine, Miyagi, Japan. BACKGROUND: It has been thought that herpes viruses may play an important role in acute retinal necrosis syndrome (herpes simplex and varicella-zoster viruses) as well as in cytomegalovirus retinitis and it would be useful to know the specificity of the methods for detecting the viruses. METHODS: Amplification of the herpetic viral genome DNA by polymerase chain reaction (PCR) in aqueous and vitreous humor was compared with Goldmann-Witmer coefficients against herpetic antigens in five patients with acute retinal necrosis syndrome and in two patients with cytomegalovirus retinitis, using vitreous samples to determine the specificity of these diagnostic methods. RESULTS: The varicella-zoster virus genome DNA was amplified by PCR in four of the five patients with acute retinal necrosis syndrome, and cytomegalovirus genome DNA was enhanced in both patients with cytomegalovirus retinitis. Four patients who exhibited the varicella-zoster viral genome showed marked increase of the Goldmann-Witmer coefficient against varicella-zoster virus. Conversely, the two patients with cytomegalovirus retinitis showed no remarkable changes among the antigens. CONCLUSION: Our results showed that the amplification of the viral genome DNA in the samples by PCR is specific in both diseases, and that the increased level of local antibody production also is specific in varicella-zoster retinitis. In cytomegalovirus retinitis, however, antibody production against cytomegalovirus does not show increase of the Goldmann-Witmer coefficient. PMID: 8817284 [PubMed - indexed for MEDLINE] 2994. Clin Infect Dis. 1996 Jul;23(1):201-2. Prednisone therapy is not associated with increased risk of herpetic infections in patients infected with human immunodeficiency virus. Keiser P, Jockus J, Horton H, Smith JW. University of Texas Southwestern Medical Center, Dallas, USA. PMID: 8816167 [PubMed - indexed for MEDLINE] 2995. Clin Microbiol Rev. 1996 Jul;9(3):361-81. Varicella-zoster virus. Arvin AM. Department of Pediatrics, Stanford University School of Medicine, California 94305-5119, USA. MN.AMA@FORSYTHE.STANFORD.EDU Varicella-zoster virus (VZV) is a ubiquitous human alphaherpesvirus that causes varicella (chicken pox) and herpes zoster (shingles). Varicella is a common childhood illness, characterized by fever, viremia, and scattered vesicular lesions of the skin. As is characteristic of the alphaherpesviruses, VZV establishes latency in cells of the dorsal root ganglia. Herpes zoster, caused by VZV reactivation, is a localized, painful, vesicular rash involving one or adjacent dermatomes. The incidence of herpes zoster increases with age or immunosuppression. The VZV virion consists of a nucleocapsid surrounding a core that contains the linear, double-stranded DNA genome; a protein tegument separates the capsid from the lipid envelope, which incorporates the major viral glycoproteins. VZV is found in a worldwide geographic distribution but is more prevalent in temperate climates. Primary VZV infection elicits immunoglobulin G (IgG), IgM, and IgA antibodies, which bind to many classes of viral proteins. Virus-specific cellular immunity is critical for controlling viral replication in healthy and immunocompromised patients with primary or recurrent VZV infections. Rapid laboratory confirmation of the diagnosis of varicella or herpes zoster, which can be accomplished by detecting viral proteins or DNA, is important to determine the need for antiviral therapy. Acyclovir is licensed for treatment of varicella and herpes zoster, and acyclovir, valacyclovir, and famciclovir are approved for herpes zoster. Passive antibody prophylaxis with varicella-zoster immune globulin is indicated for susceptible high-risk patients exposed to varicella. A live attenuated varicella vaccine (Oka/Merck strain) is now recommended for routine childhood immunization. PMCID: PMC172899 PMID: 8809466 [PubMed - indexed for MEDLINE] 2996. Hawaii Med J. 1996 Jul;55(7):118-21. Herpes zoster at school-age: a case presentation and discussion of the unique aspects within the pediatric population. Piette ML. John A. Burns School of Medicine, University of Hawaii, Honolulu, USA. This paper is a case presentation and discussion of a 12-year-old boy previously in excellent health who presents with dematomal herpes zoster. Although not unheard of, the occurrence of herpes zoster in the pediatric population is infrequent. This case provides the opportunity to address many of the aspects of herpes zoster that are unique to the pediatric population including epidemiology, pathophysiology, management and course, and the potential impact of the live attenuated varicella vaccine, recently approved for the prevention of the primary varicella infection, chickenpox. PMID: 8771986 [PubMed - indexed for MEDLINE] 2997. Virchows Arch. 1996 Jul;428(4-5):275-80. Hair follicle involvement in herpes zoster: pathway of viral spread from ganglia to skin. Muraki R, Iwasaki T, Sata T, Sato Y, Kurata T. Department of Dermatology, Kasumigaura National Hospital, Ibaraki, Japan. Comment in: Virchows Arch. 1997 Jun;430(6):510-1. Herpes zoster is caused by reactivation of varicella-zoster virus (VZV) persisting in dorsal root or trigeminal ganglia. To clarify the pathway of viral spread from the ganglia to skin, 16 biopsy specimens of early skin lesions of herpes zoster obtained from the face and trunk of 13 patients were studied histologically and immunohistochemically using monoclonal antibodies to the structural proteins of VZV. VZV-infected cells were detected in the hair follicles in 10 of the 16 specimens and in the epidermis in 2 specimens. Infected cells were localized in the isthmus of every involved follicle (12/12), frequently in the stem (8/10) and infundibulum (6/10), and never in the bulb. The high frequency of follicular involvement in herpes zoster suggests that VZV spreads to the area of skin innervated by myelinated nerves, which end around the isthmus of hair follicles and sebaceous glands. PMID: 8764937 [PubMed - indexed for MEDLINE] 2998. Anaesthesia. 1996 Jul;51(7):647-51. Epidural morphine for postherpetic neuralgia. Watt JW, Wiles JR, Bowsher DR. Pain Relief Foundation, Liverpool. Comment in: Anaesthesia. 1996 Dec;51(12):1190. Eleven patients with established postherpetic neuralgia, unresponsive to antidepressant therapy, entered this single-blind, placebo-controlled study to assess the effectiveness of epidural morphine in the control of the pain of postherpetic neuralgia. Two patients obtained a reduction in pain of greater than 50% following morphine 0.5 mg. The duration of this pain relief was 36 h in one patient and 72 h in the other. Repeated doses, however, were ineffective in one patient and resulted in intolerable side effects in the other. The other six patients who received morphine developed opioid-related side effects without pain relief. Three patients did not receive morphine as they gained significant, long-lasting pain relief from placebo. Two retained that benefit for more than 6 months. Epidural morphine is more likely to produce side effects than pain relief when administered to patients with postherpetic neuralgia. PMID: 8758156 [PubMed - indexed for MEDLINE] 2999. J Infect Dis. 1996 Jul;174(1):239-41. Racial differences in herpes zoster and age at onset of varicella. Dworkin RH. Comment on: J Infect Dis. 1995 Mar;171(3):701-4. PMID: 8656005 [PubMed - indexed for MEDLINE] 3000. Am J Health Syst Pharm. 1996 Jun 15;53(12):1454, 1456. Confusion and bradykinesia associated with famciclovir therapy for herpes zoster. Gales BJ, Gales MA. PMID: 8781691 [PubMed - indexed for MEDLINE] 3001. Blood. 1996 Jun 15;87(12):5341-54. Human herpesvirus 6: infection and disease following autologous and allogeneic bone marrow transplantation. Kadakia MP, Rybka WB, Stewart JA, Patton JL, Stamey FR, Elsawy M, Pellett PE, Armstrong JA. Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, PA 15261, USA. Human herpesvirus 6 activity (HHV-6) was studied in 15 allogeneic and 11 autologous marrow transplantation patients. After transplantation, HHV-6 was isolated from the peripheral blood mononuclear cells of 12 of 26 patients (6 allogeneic and 6 autologous). All isolates were variant B. Eleven of 26 and 12 of 19 patients showed salivary shedding of HHV-6 DNA before and after transplantation, respectively. The antibody titer increased in 7 of 26 patients. Thus, 23 of 26 patients showed evidence of active HHV-6 infection either by virus isolation, salivary shedding, or increases in antibody titers. The fraction of saliva specimens positive in 19 patients was negatively associated with their antibody titers (P= .005). The proportion of cultures positive increased after transplantation (P = .007). Sinusitis was associated with HHV-6 isolation in autologous recipients (P= .002). In allogeneic patients, active human cytomegalovirus infection was associated with HHV-6 isolation (P = .04). No association was observed between HHV-6 infection and GVHD, pneumonia, delay in engraftment, or marrow suppression. Of the 120 clinical events analyzed in 26 patients, HHV-6 was defined as a probable cause of 16 events in 9 patients based on the propinquity of HHV-6 activity and the clinical event plus the absence of other identified causes of the event. PMID: 8652850 [PubMed - indexed for MEDLINE] 3002. J Assoc Physicians India. 1996 Jun;44(6):427-8. Myocarditis in herpes zoster. Chauhan R, Singh RP, Hooda AK, Vadhera V, Singh VP, Mabena DM. Botswana Defence Force. PMID: 9282569 [PubMed - indexed for MEDLINE] 3003. Pol Tyg Lek. 1996 Jun;51(23-26):338-9. [Efficacy of cimetidine in treatment of Herpes zoster in the first 5 days from the moment of disease manifestation] [Article in Polish] Kapińska-Mrowiecka M, Turowski G. 221 patients with Herpes zoster have undergone the treatment. They were given cimetidine in the daily dose 3 x 200 mg and 1 x 400 mg to night. It was proved that the efficacy of the Herpes zoster treatment by cimetidine is inversely proportional to the time of the disease duration. The authors suggest to use cimetidine in the treatment of Herpes zoster virus infections even during the prodromal period. PMID: 9273526 [PubMed - indexed for MEDLINE] 3004. Pol Tyg Lek. 1996 Jun;51(23-26):321-3. [Herpes zoster--clinical aspects] [Article in Polish] Wnuk A, Pynka M, Boroń-Kaczmarska A. Katedry i Kliniki Chorób Zakaźnych Pomorskiej AM w Szczecinie. Clinical course of herpes zoster was assessed in 119 immuno-competent and in 28 immuno-compromised hosts. Complications of herpes zoster were observed in one third cases. However, the frequency of post-herpetic neuralgia was lower than that seen by other authors. Despite severe underlying diseases in compromised hosts, good outcome of herpes zoster was obtained. It may be related to the use of aciclovir in all these cases. Early and rational treatment with aciclovir is important for decreasing of the frequency of severe complications of herpes zoster. PMID: 9273519 [PubMed - indexed for MEDLINE] 3005. Neurobiol Dis. 1996;3(3):205-14. Cutaneous innervation density in the allodynic form of postherpetic neuralgia. Rowbotham MC, Yosipovitch G, Connolly MK, Finlay D, Forde G, Fields HL. Department of Neurology, University of California, School of Medicine, San Francisco 94143-1635, USA. The relationship between deafferentation, sensory function, and pain was explored in 18 subjects with chronic postherpetic neuralgia (PHN). Subjective thresholds for warmth, cooling, and heat pain were measured quantitatively in painful skin areas and compared with normal contralateral skin. The severity of allodynia was graded in the affected area. Two 3-mm punch biopsies were taken from the most painful skin area and one from unaffected contralateral mirror-image skin. Immunofluorescence with the axonal marker PGP 9.5 revealed a reduction in density of innervation of the epidermis, the dermal-epidermal junction, and the eccrine sweat glands in PHN skin. In painful PHN skin, the reduction in innervation density was positively correlated with the magnitude of the thermal sensory deficits. However, loss of cutaneous innervation was inversely correlated with allodynia, indicating that surviving cutaneous primary afferent nociceptors that are spontaneously active and/or sensitized contribute to PHN pain and allodynia. PMID: 8980021 [PubMed - indexed for MEDLINE] 3006. Semin Dermatol. 1996 Jun;15(2 Suppl 1):27-31. Efficacy of famciclovir in the treatment of herpes zoster. Tyring SK. University of Texas Medical Branch, Galveston 77555, USA. Although vidarabine was the first systemic antiviral drug for the treatment of acute herpes zoster, the agent now used most frequently is acyclovir, a far safer drug that became available a decade ago. However, even with widespread use of acyclovir, postherpetic neuralgia (PHN) remains a principal cause of postinfectious morbidity. Newer antiviral agents, such as famciclovir and valacyclovir, have recently been introduced for the treatment of uncomplicated herpes zoster. In a double-blind, randomized study, 500 mg of famciclovir three times daily for 7 days was compared with placebo; in a second study, 500 mg of famciclovir three times daily for 7 days was compared with 800 mg of acyclovir five times daily for 7 days. Famciclovir significantly reduced duration of viral shedding (P = 0.0001) and accelerated lesion resolution compared with placebo. Famciclovir was comparable to acyclovir for these acute parameters. Most importantly, famciclovir recipients lost PHN two times faster than those receiving placebo (P = 0.02 all patients; P = 0.004 patients > or = 50 years) resulting in a reduction in the median duration of PHN (56 days all patients; 100 days patients > or = 50 years). This reduction translated to a 3.5-month reduction in the median duration of PHN for patients 50 years or older, those at greatest risk for developing the most common complication of herpes zoster. Famciclovir 500 mg administered three times a day for 7 days is an effective and well-tolerated treatment for acute herpes zoster, and is the only oral antiviral agent proven to reduce the duration of PHN when administered during acute zoster infection. PMID: 8840413 [PubMed - indexed for MEDLINE] 3007. Semin Dermatol. 1996 Jun;15(2 Suppl 1):14-26. The pharmacological profile of famciclovir. Crumpacker C. Division of Infectious Diseases, Beth Israel Hospital, Boston, MA 02215, USA. Famciclovir is the well-absorbed oral form of penciclovir, a potent and selective antiviral agent, with activity against members of the herpesvirus family, including varicella-zoster virus (VZV), and herpes simplex virus-1 (HSV-1) and HSV-2. Famciclovir is rapidly absorbed and converted to penciclovir. Penciclovir has excellent bioavailability (77%) after oral administration of 500 mg of famciclovir. Similar to acyclovir, famciclovir is converted by phosphorylation to its active metabolite, penciclovir-triphosphate. Penciclovir-triphosphate has a prolonged in vitro intracellular half-life of 10 to 20 hours in HSV-1-and HSV-2-infected cells, respectively, and 9 to 14 hours in VZV-infected cells. In contrast, the in vitro intracellular half-life of acyclovir is substantially shorter at 0.7 and 1 hours in HSV-1- and HSV-2-infected cells, respectively, and 0.8 hours in VZV-infected cells. Famciclovir is eliminated primarily via the kidneys. Dosage adjustment is not required for famciclovir in elderly patients with normal or mildly impaired renal function, and the extent of penciclovir availability is not affected by food. The excellent bioavailability ensures that adequate drug reaches virus-infected cells, and the prolonged intracellular half-life of the active form of famciclovir results in persistent antiviral activity. PMID: 8840412 [PubMed - indexed for MEDLINE] 3008. Semin Dermatol. 1996 Jun;15(2 Suppl 1):8-13. Epidemiology and management of postherpetic neuralgia. Gershon AA. Columbia University, College of Physicians and Surgeons, New York, NY 10032, USA. Herpes zoster occurs rarely in immunocompetent children and infrequently in immunocompetent young adults. However, its incidence increases with age, particularly after age 50. Reactivation of varicella-zoster virus (VZV) is characterized by a rash and is generally accompanied by considerable pain, dysesthesias, and skin hypersensitivity. Chronic pain that is sometimes experienced after the rash has healed is referred to as postherpetic neuralgia (PHN), the most common complication of herpes zoster. Postherpetic neuralgia is often severe and, unfortunately, refractory to most forms of treatment. The incidence of PHN also increases dramatically with increased age. More than 50% of zoster patients over 60 years old will develop PHN, which may persist for months and even years. Thus, established PHN is difficult to manage, often causing serious morbidity, depression, and high costs in terms of consumption of healthcare resources. Currently, early antiviral treatment with famciclovir has shown promise of reducing the duration of PHN. PMID: 8840411 [PubMed - indexed for MEDLINE] 3009. Semin Dermatol. 1996 Jun;15(2 Suppl 1):4-7. Varicella-zoster virus: overview and clinical manifestations. Arvin AM. Stanford University School of Medicine, CA 94305, USA. Varicella-zoster virus (VZV) is a human pathogen that has probably infected humans since prehistoric times. Varicella-zoster virus causes chickenpox in childhood (varicella), and establishes latency in sensory ganglia after the primary infection. Varicella-zoster virus may reemerge later in life, taking advantage of the decline in immune function that occurs with aging. Varicella-zoster virus reactivation causes herpes zoster, commonly known as shingles. The incidence of herpes zoster increases with advancing age. Severe pain is the major cause of acute and chronic morbidity in patients with herpes zoster. Fortunately, the acute phase is self-limiting and transient. However, chronic and often debilitating pain may persist after the lesions have healed and is referred to as postherpetic neuralgia (PHN), the most common complication of herpes zoster. Similar to acute herpes zoster, the incidence of PHN increases dramatically with age. PMID: 8840410 [PubMed - indexed for MEDLINE] 3010. Semin Dermatol. 1996 Jun;15(2 Suppl 1):1-3. Advances in the management of herpesvirus infections. Introduction. Whitley RJ. University of Alabama at Birmingham, USA. PMID: 8840409 [PubMed - indexed for MEDLINE] 3011. Intern Med. 1996 Jun;35(6):478-81. Syndrome of inappropriate secretion of antidiuretic hormone in elderly patients with rheumatoid arthritis associated with infections: report of two cases. Furuta E, Yasuda M, Yoshioka K, Isayama T, Nobunaga M. Department of Physical Therapy and Rheumatology, Beppu National Hospital. Two rheumatoid arthritis (RA) patients with the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) during the course of infection are herein reported. One patient developed SIADH during the course of a localized cutaneous herpes zoster infection while the other developed SIADH in conjunction with Staphylococcus simulans septicemia. We consider that the development of SIADH was strongly associated with superimposed infections in the underlying RA. This is the first report discussing the association of SIADH and infections in RA patients in which SIADH is diagnosed by measurement of plasma ADH. PMID: 8835600 [PubMed - indexed for MEDLINE] 3012. Am J Infect Control. 1996 Jun;24(3):201-2. The 1996 CDC and HICPAC isolation guideline: a pediatric perspective. Stover BH. Kosair Children's Hospital, Louisville, KY 40204, USA. Comment in: Am J Infect Control. 1997 Jun;25(3):287-8. PMID: 8806998 [PubMed - indexed for MEDLINE] 3013. Cutis. 1996 Jun;57(6):421-4. Ramsay Hunt syndrome presenting as a cranial polyneuropathy. Asnis DS, Micic L, Giaccio D. Department of Internal Medicine, Flushing Hospital Medical Center, New York 11355, USA. Ramsay Hunt syndrome is herpes zoster of the facial nerve, frequently associated with VIII cranial nerve involvement, but on rare occasions V, VI, IX, and X cranial nerves are affected as well. We present a case of a Ramsay Hunt syndrome with involvement of V, VII, and VIII cranial nerves. PMID: 8804844 [PubMed - indexed for MEDLINE] 3014. Clin Infect Dis. 1996 Jun;22(6):1128-9. Ramsay Hunt syndrome in a patient infected with human immunodeficiency virus. Johnson KB, Blazes DL, Keith M, Decker CF, Ohl CA. Comment on: Clin Infect Dis. 1995 Aug;21(2):370-5. PMID: 8783739 [PubMed - indexed for MEDLINE] 3015. Enferm Infecc Microbiol Clin. 1996 Jun-Jul;14(6):396-7. [Meningoencephalitis and pancreatitis caused by the varicella virus, herpes zoster] [Article in Spanish] Pascual-Velasco F. Comment on: Enferm Infecc Microbiol Clin. 1995 Jan;13(1):6-11. PMID: 8756222 [PubMed - indexed for MEDLINE] 3016. Drugs Aging. 1996 Jun;8(6):459-76. Amitriptyline. A review of its pharmacological properties and therapeutic use in chronic pain states. Bryson HM, Wilde MI. Adis International Ltd, Auckland, New Zealand. Amitriptyline is a tricyclic antidepressant agent which also has analgesic properties. Whether its analgesic effects are linked to its mood-altering activity or attributable to a discrete pharmacological action (or a combination of both) is unknown. Clinical trials demonstrate that oral amitriptyline achieves at least a good or moderate response in up to two-thirds of patients with post-herpetic neuralgia and three-quarters of patients with painful diabetic neuropathy, neurogenic pain syndromes that are often unresponsive to narcotic analgesics. Amitriptyline has also demonstrated efficacy in heterogeneous groups of patients with chronic non-malignant pain. Other possible areas of use for amitriptyline are in patients with fibromyalgia or as an adjuvant for uncontrolled cancer pain, although evidence for the latter application is limited. Adverse events resulting from the antimuscarinic activity of amitriptyline (primarily dry mouth and sedation) are commonly reported, even at the low dosages used for the control of pain. Low starting doses and careful dosage titration may help to minimise these effects. Orthostatic hypotension and tachycardia, sometimes associated with tricyclic antidepressant agents, may also pose a problem in the elderly. In summary, amitriptyline has a valuable place in the treatment of chronic pain conditions that affect the elderly provided that the drug is used judiciously to minimise adverse effects. Importantly, amitriptyline remains the best studied of the antidepressant agents in post-herpetic neuralgia and diabetic neuropathy and is an important and effective treatment option in these syndromes. PMID: 8736630 [PubMed - indexed for MEDLINE] 3017. Transplant Proc. 1996 Jun;28(3):1511-2. Varicella-zoster infection in cyclosporine A-treated renal transplant patients. Lo CY, Cheng IK. Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong. PMID: 8658764 [PubMed - indexed for MEDLINE] 3018. J Am Acad Dermatol. 1996 Jun;34(6):1084-6. Predictive value of seborrheic dermatitis and other common dermatoses for HIV infection in Bamako, Mali. Mahé A, Simon F, Coulibaly S, Tounkara A, Bobin P. Institut Marchoux, Bamako, Mali. PMID: 8647980 [PubMed - indexed for MEDLINE] 3019. Electroencephalogr Clin Neurophysiol. 1996 Jun;101(3):185-91. Electrophysiological findings in peripheral fibres of subjects with and without post-herpetic neuralgia. Mondelli M, Romano C, Della Porta P, Rossi A. Institute of Neurological Sciences, University of Siena, Italy. The peripheral nervous system was studied using classical electrophysiological methods in 23 subjects with post-herpetic neuralgia (PHN), and compared with the same parameters in 64 herpes zoster (HZ) patients without PHN. The findings indicated sensory axonopathy, the severity of which varied in different patients. Ten percent of all cases showed segmental paresis corresponding to dermatomes affected by HZ. In another 17% of patients axonal motor damage was only detectable by EMG as denervation. No statistically significant difference was found between the two groups in the mean percentage differences of the electrophysiological data for peripheral sensory fibres with respect to mean control values, or between sides affected by HZ and healthy sides. Hence HZ is associated with sensory axonopathy, the severity of which is similar, on the whole, in the groups with and without PHN and stable in time. This suggests that damage to peripheral large-diameter sensory fibres is not the cause of PHN. PMID: 8647028 [PubMed - indexed for MEDLINE] 3020. Muscle Nerve. 1996 Jun;19(6):784-6. Segmental zoster paresis: an electrophysiological study. Sachs GM. Department of Clinical Neurosciences, Brown University School of Medicine, Providence, Rhode Island 02903, USA. PMID: 8609933 [PubMed - indexed for MEDLINE] 3021. Muscle Nerve. 1996 Jun;19(6):696-700. Neuromuscular complications associated with liver transplantation. Wijdicks EF, Litchy WJ, Wiesner RH, Krom RA. Department of Neurology, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA. We studied neuromuscular complications in a cohort of 520 patients with liver transplantation. Perioperative mononeuropathy developed in 9 patients. The peroneal nerve, radial nerve, and cutaneous branch of the femoral nerve were affected in 2 patients each. Two patients had herpes zoster-associated radiculopathy, and 1 patient had Horner's syndrome. Recovery was good in most patients. In 7 patients, severe quadriplegia complicated the perioperative course. In 5 patients, electrophysiologic studies suggested acute necrotic myopathy, and muscle biopsy specimens showed evidence of rhabdomyolysis in 1 patient. Outcome in survivors was good, all recovering completely. We conclude that neuromuscular complications in liver transplantation are uncommon (less than 1%) and do not significantly contribute to morbidity. Mononeuropathies may have iatrogenic perioperative causes, and rhabdomyolysis may be an important cause of generalized muscle weakness after liver transplantation. PMID: 8609918 [PubMed - indexed for MEDLINE] 3022. N Z Med J. 1996 May 24;109(1022):196. Immunocompromised patients, herpes zoster and acyclovir. Elder M, Thomas MG, Ellis-Pegler RB. PMID: 8657394 [PubMed - indexed for MEDLINE] 3023. Dtsch Med Wochenschr. 1996 May 10;121(19):635-8. [Zoster and the nervous system] [Article in German] Malin JP. Neurologische Klinik, Ruhr-Universität Bochum. PMID: 8631229 [PubMed - indexed for MEDLINE] 3024. Lik Sprava. 1996 May-Jun;(5-6):134-6. [Amizon in the treatment of nervous system involvement in herpes zoster] [Article in Russian] Rudenko AE, Trinus FP, Korzhenevskiĭ LV, Bukhtiarova TA, Koval' AZ, Malyĭ VD, Novikova OV, Tkachenko EV. The authors submit results of treatment of patients having suffered from postherpetic pain syndrome (herpetic ganglionitis of the cervical, thoracic, lumbosacral localization, postherpetic intercostal neuralgia, ganglionitis of the trigeminal nerve). In viral diseases, amizone has marked analgetic, antiinflammatory, and immunomodulating effects. The drug is well tolerated by patients, is not associated with side effects under prescribed doses (0.25-0.75 as one dose on a three- or four-times daily schedule during the course of treatment lasting three or four weeks). The drug preparation in question is less effective in the treatment of chronic recurring post-therapeutic intercostal neuralgias, radiculalgia. PMID: 9377379 [PubMed - indexed for MEDLINE] 3025. Aust Fam Physician. 1996 May;25(5):798. Spinal nerves are most commonly involved in herpes zoster. Monz W. PMID: 8935557 [PubMed - indexed for MEDLINE] 3026. Masui. 1996 May;45(5):629-33. [Analgesic effect of dextromethorphan for postherpetic neuralgia] [Article in Japanese] Suzuki T, Kato J, Saeki S, Ogawa S, Suzuki H. Department of Anesthesiology, Surugadai Nihon University Hospital, Tokyo. We investigated the analgesic effect of dextromethorphan (DM), a non-selective NMDA receptor antagonist, in 25 patients with postherpetic neuralgia (PHN). We administered DM 45mg.day-1 orally for 14 days and then 90mg.day-1 for next 14 days. Decrease in pain intensity and alleviation of allodynia were observed in 9 patients (36%). Side effects with no severe cases occurred in 8 patients (32%) and these were mainly digestive symptoms. We concluded that DM might be useful to treat PHN with allodynia probably due to central sensitization. PMID: 8847791 [PubMed - indexed for MEDLINE] 3027. Pediatr Dermatol. 1996 May-Jun;13(3):226-9. Herpes zoster in childhood: case report and review of the literature. Smith CG, Glaser DA. Division of Dermatology, Saint Louis University School of Medicine, Missouri 63104, USA. Herpes zoster in childhood is uncommon even in the setting of known risk factors such as primary varicella zoster infection before 12 months of age and immunocompromised states. We report a 7-year-old, otherwise healthy girl with shingles, and review the risk factors, prognosis, and treatment of pediatric zoster. PMID: 8806124 [PubMed - indexed for MEDLINE] 3028. An Med Interna. 1996 May;13(5):243-4. [The clinico-microbiological diagnosis of encephalitis due to herpes zoster in an elderly patient: apropos a case] [Article in Spanish] Muñoz García MD, Guerrero Díaz MT, Díaz Guzmán J, Torres González M. Servicio de Geriatría, Hospital Universitario de Getafe, Madrid. Varicella-zoster infection consists of well-recognized cutaneous manifestations. However, in several cases it is complicated with central nervous system disorders. We present a 79-year-old diabetic woman with zoster ophthalmicus, who developed an acute confusional syndrome. EEG, cranial computed tomographic, biochemical and haematologic and liquoral studies were performed. An increased in the CSF-IgG index was founded, and it was related with Varicella-Zoster Herpes antibodies. She was treated with intravenous acyclovir, and her encephalopathy was resolved. PMID: 8767873 [PubMed - indexed for MEDLINE] 3029. J Radiol. 1996 May;77(5):367-71. [Cerebral arteritis in AIDS. Demonstration with MRA in 2 patients] [Article in French] Brunereau L, Picard O, Lévy C, Marsot-Dupuch K, Tubiana JM. Service de Radiologie, Hôpital Saint-Antoine, Paris. Two cases of cerebral arteritis related to varicella-zoster virus in seropositive patients are presented. Diagnosis of arteritis was made by conventional angiography. However, 3D Time of Flight MR Angiography demonstrated an excellent sensitivity in detection of cerebral arterial stenosis located at the skull base. PMID: 8762936 [PubMed - indexed for MEDLINE] 3030. Nihon Kyobu Shikkan Gakkai Zasshi. 1996 May;34(5):610-5. [Pneumonia caused by varicella-zoster virus in a patient with rheumatoid arthritis] [Article in Japanese] Nakamura M, Kanazawa M, Yamaguchi K, Akizuki M, Satoh S, Inada S. Department of Medicine, School of Medicine, Keio University, Tokyo, Japan. A 56-year-old woman suffering from rheumatoid arthritis, was admitted to our hospital for evaluation of fever and dyspnea. A month before admission, she had been given a diagnosis of herpes zoster and was treated with an antiviral agent. However, a perineal eruption persisted. A chest X-ray film and a chest CT scan showed many diffuse nodular shadows in both lung fields. With conservative treatment, the shadows regressed along with the skin eruption and other symptoms. Pneumonia caused by varicella-zoster virus was diagnosed from the clinical course, chest roentgenographic and CT scan findings, and serological data. The risk of mortality in varicella-zoster pneumonia is high in adults, especially in immunosuppressed patients. Early diagnosis and effective treatment are, therefore, essential in the management of this disease. Though varicella-zoster pneumonia is rare, chest roentgenographic and CT scan findings are characteristic and suggestive. This case may serve as a reminder of the features of varicella-zoster pneumonia: many nodular shadows on the chest X-ray film and CT scan. PMID: 8753124 [PubMed - indexed for MEDLINE] 3031. Pediatr Hematol Oncol. 1996 May-Jun;13(3):231-8. Varicella zoster infections in children with acute lymphoblastic leukemia. Poulsen A, Schmiegelow K, Yssing M. Section of Pediatric Hematology and Oncology, Juliane Marie Centre, University Hospital, Copenhagen, Denmark. During the period July 1986 through December 1991, 67 children were treated for non-B-cell acute lymphoblastic leukemia at The Juliane Marie Centre, GGK, The University Hospital Rigshospitalet, Copenhagen. Twenty-five children were susceptible to varicella zoster (VZ) virus at diagnosis. For these patients the cumulated risk of VZ exposure was 90% after 32 months. Five patients developed varicella (two of whom had pneumonitis) during the period of antileukemic treatment. Two of these had received prophylactic treatment with acyclovir. The 2 year cumulated risk of having chickenpox or herpes zoster in children with previous VZ infection was 24% and 34%, respectively. VZ vaccination ought to be considered for this group of children in order to diminish transmission and morbidity. PMID: 8735338 [PubMed - indexed for MEDLINE] 3032. Pharmacotherapy. 1996 May-Jun;16(3):466-8. Does acyclovir increase serum lithium levels? Sylvester RK, Leitch J, Granum C. MeritCare Hospital, North Dakota State University, Fargo 58105, USA. A 42-year-old woman was admitted to the hospital to receive intravenous acyclovir for a herpes zoster infection. At the time she was taking lithium carbonate 450 mg twice/day. Six days after starting acyclovir she exhibited signs of lithium toxicity. When measured, the serum lithium level had increased 4-fold during acyclovir therapy. Both agents are excreted by the kidneys, raising the possibility that acyclovir at high serum concentrations may interfere with the renal excretion of lithium. A MEDLINE search did not identify any citation describing the possibility of an interaction between the drugs. This case suggests that acyclovir when given intravenously in doses of 10 mg/kg may result in increased serum lithium concentrations. Until additional data are available, if intravenous acyclovir is administered concurrently with lithium, we recommend closely monitoring patients for signs of lithium toxicity and measuring serum lithium levels every second or third day. PMID: 8726608 [PubMed - indexed for MEDLINE] 3033. Pediatr Infect Dis J. 1996 May;15(5):471-2. Herpes zoster ophthalmicus with delayed contralateral hemiplegia. François P, Bost C, Pavese P, Bost M. Department of Pediatrics, Centre Hospitalier Universitaire de Grenoble, Grenoble, France. PMID: 8724079 [PubMed - indexed for MEDLINE] 3034. Pediatr Infect Dis J. 1996 May;15(5):461-2. Varicella disease and transmission in pediatric house officers. Oshiro AC, Begue RE, Steele RW. Department of Pediatrics, Louisiana State University School of Medicine and Children's Hospital, New Orleans 70118, USA. PMID: 8724072 [PubMed - indexed for MEDLINE] 3035. Clin Infect Dis. 1996 May;22(5):886. Use of famciclovir and valaciclovir in the treatment of viral keratitis. Gatchel S. Comment on: Clin Infect Dis. 1995 Sep;21(3):479-86; quiz 487-8. PMID: 8722973 [PubMed - indexed for MEDLINE] 3036. Psychiatr Prax. 1996 May;23(3):146. [Sexual side-effects of clomipramine--a psychopharmacologic personal experience] [Article in German] Haberfellner EM. Facharzt für Psychiatre und Neurologie, Linz. PMID: 8711010 [PubMed - indexed for MEDLINE] 3037. Isr J Med Sci. 1996 May;32(5):331-4. Cases 1A and 1B. 1995 intravenous lidocaine infusion for chronic pain therapy. Avidan A, Devor M. Department of Anesthesiology and CCM, Hadassah University Hospital, Ein Kerem, Jerusalem. PMID: 8641876 [PubMed - indexed for MEDLINE] 3038. Am J Hematol. 1996 May;52(1):58-9. Paraneoplastic pemphigus in a patient with non-Hodgkin's lymphoma. Plumb R, Doolittle GC. Division of Clinical Oncology, University of Kansas Medical Center, Kansas City 66160-7353, USA. Paraneoplastic pemphigus (PNP) is an autoimmune disorder occurring in the setting of an underlying neoplasm in which patients have polymorphous skin and mucous membrane lesions. We describe a patient with non-Hodgkin's lymphoma who developed bullous, ulcerating lesions in an area being treated with radiation therapy. The diagnosis of PNP was confirmed by indirect immunofluorescence of the patient's serum on rat bladder. The disorder was refractory to therapy, and ultimately the patient expired. PMID: 8638613 [PubMed - indexed for MEDLINE] 3039. Lancet. 1996 Apr 27;347(9009):1195. Garlic burns mimicking herpes zoster. Farrell AM, Staughton RC. PMID: 8609803 [PubMed - indexed for MEDLINE] 3040. Cas Lek Cesk. 1996 Apr 17;135(8):244-8. [Changes in the incidence and clinical manifestations of herpes zoster] [Article in Czech] Cerný Z. Infekcní klinika LF MU, Brno. BACKGROUND: Shingles is the manifestation of activated latent disease caused by the varicella-herpes zoster virus. The prerequisite of its activation is a reduction of the immunity of the organism: the incidence (with some reservations) of herpes zoster in the population can be therefore considered an indicator of the general immune state. The objective of the submitted paper was to assess whether and to what extent the frequency of herpes zoster increased (whether the number of patients hospitalized at the Clinic for Infectious Diseases increased in 1974-1994, and if so, by how much). METHODS AND RESULTS: By comparing clinical manifestations of herpes zoster in a group of 348 patients hospitalized in 1992-1994 with results of a similar investigation made in the same department in a group of 308 patients hospitalized in 1979-1983 the following was revealed: the annual numbers of treated patients with herpes zoster doubled during the last 15 years. Almost 70% of the affected patients were then and now above 60 years of age, among the patients women predominated markedly (chi 2 = 69.540), the number of malignancies increased greatly (chi 2 = 4.435), there was also a significant increase of ischaemic heart disease, hypertension (chi 2 = 39.741) etc. As to the ratio of different sites of the shingles, no significant changes were observed, while there was a significant increase of manifestations of dermal generalization (chi 2 = 36.377) and a significant increase of peripheral pareses (chi 2 = 5.615). The author explains the fact that the period of hospitalization was not longer and that there was even a significant decrease in the number of postherpetic neuralgias persisting for more than a month, by the early onset of treatment with acyclovir administered by the i.v. route. CONCLUSIONS: The annual numbers of patients hospitalized on account of herpes zoster doubled during the past 15 years, the number of malignancies increased as well as the number of cardiovascular diseases, and the frequency of skin generalizations and peripheral pareses increased. Treatment with acyclovir had a favourable effect on the period of hospitalization. PMID: 8689663 [PubMed - indexed for MEDLINE] 3041. Ann Intern Med. 1996 Apr 15;124(8):775. Effects of famiciclovir in acute herpes zoster. Tirelli U. PMID: 8633841 [PubMed - indexed for MEDLINE] 3042. J Virol Methods. 1996 Apr 5;57(2):169-74. Typing of varicella zoster virus by amplification of DNA polymorphisms. Hawrami K, Harper D, Breuer J. Department of Medical Microbiology, London Hospital Medical College, UK. The polymerase chain reaction was used to amplify five variable regions of varicella zoster virus DNA from 20 samples of vesicle fluid. Two of the regions, R1 and R5, were found to be polymorphic, with the former having three alleles (A, B and C) and the latter, two (A and B). The R1 and R5 polymorphisms were stable up to passage five in tissue culture. The sensitivity of the PCR (down to six copies) enabled detection of virus from vesicle fluid dried on glass slides and overall the method was five times more sensitive than conventional tissue culture. The method described is simple, sensitive and informative and provides a means by which questions about the epidemiology and clinical biology of VZV infection may begin to be addressed. PMID: 8801228 [PubMed - indexed for MEDLINE] 3043. Enferm Infecc Microbiol Clin. 1996 Apr;14(4):277-8. [Diagnosis of infections caused by varicella zoster virus] [Article in Spanish] Barraquer P, Rabella N, Labeaga R, Mercader M, Prats G. PMID: 9044653 [PubMed - indexed for MEDLINE] 3044. Pain. 1996 Apr;65(1):45-51. Topical aspirin/diethyl ether mixture versus indomethacin and diclofenac/diethyl ether mixtures for acute herpetic neuralgia and postherpetic neuralgia: a double-blind crossover placebo-controlled study. De Benedittis G, Lorenzetti A. Pain Research and Treatment Unit, University of Milan, Italy. Comment in: Pain. 1997 Apr;70(2-3):287-9. The efficacy of topical aspirin/diethyl ether (ADE) mixture in the treatment of acute herpetic neuralgia and postherpetic neuralgia, suggested in a previous open-label study (De Benedittis et al. 1992), has been evaluated in a double-blind crossover placebo-controlled study as compared with two other NSAID (indomethacin and diclofenac) drug/ether mixtures. The study included 37 patients (15 with acute herpetic neuralgia (AHN) and 22 with postherpetic neuralgia (PHN)). Comparative treatment results showed that only aspirin (but not indomethacin and diclofenac) was significantly superior to placebo, as compared with baseline and duration of pain relief (P < 0.05 and P < 0.01, respectively), in both AHN and PHN groups. Good-to-excellent results were achieved by 87% of AHN patients and by 82% of PHN patients treated with the ADE mixture, with no significant differences between the two groups. On the whole, patients with trigeminal involvement, less severe pain and with dysaesthetic quality of pain yielded best results. PMID: 8826489 [PubMed - indexed for MEDLINE] 3045. Pain. 1996 Apr;65(1):39-44. Lidocaine patch: double-blind controlled study of a new treatment method for post-herpetic neuralgia. Rowbotham MC, Davies PS, Verkempinck C, Galer BS. Department of Neurology, UCSF Pain Clinical Research Center, University of California 94115, USA. Post-herpetic neuralgia (PHN) is a common and often intractable neuropathic pain syndrome predominantly affecting the elderly. Topical local anesthetics have shown promise in both uncontrolled and controlled studies. Thirty-five subjects with established PHN affecting the torso or extremities completed a four-session, random order, double-blind, vehicle-controlled study of the analgesic effects of topically applied 5% lidocaine in the form of a non-woven polyethylene adhesive patch. All subjects had allodynia on examination. Up to 3 patches, covering a maximum of 420 cm2, were applied to cover the area of greatest pain as fully as possible. Lidocaine containing patches were applied in two of the four 12-h-long sessions, in one session vehicle patches were applied, and one session was a no-treatment observation session. Lidocaine containing patches significantly reduced pain intensity at all time points 30 min to 12 h compared to no-treatment observation, and at all time points 4--12 h compared to vehicle patches. Lidocaine patches were superior to both no-treatment observation and vehicle patches in averaged category pain relief scores. The highest blood lidocaine level measured was 0.1 micrograms/ml, indicating minimal systemic absorption of lidocaine. Patch application was without systemic side effect and well tolerated when applied on allodynic skin for 12 h. This study demonstrates that topical 5% lidocaine in patch form is easy to use and relieves post-herpetic neuralgia. PMID: 8826488 [PubMed - indexed for MEDLINE] 3046. Rinsho Shinkeigaku. 1996 Apr;36(4):590-3. [A patient with thyroid carcinoma who developed consciousness disturbance during acyclovir administration for herpes zoster] [Article in Japanese] Matsumoto R, Yoshida T, Tabata K, Nakagawa S, Yanagisawa N. Department of Neurology, Saku Central Hospital. A 69-year-old man developed confusion and disorientation, following intravenous administration of acyclovir for herpes zoster at the right C5 area. His consciousness was disturbed four days after the beginning of acyclovir therapy (daily dose: 500 mg, every 12 h), and the symptoms resolved two days after cessation of acyclovir. Neuroradiological examination revealed no intracranial abnormality, and the routine CSF examination was within the normal range of values except for a mild elevation of IgG (7.4 mg/dl). An electroencephalogram showed diffuse slow activities without paroxysmal waves on admission, but the findings of electroencephalograms were gradually normalized in parallel with the recovery of consciousness. Fever, signs of meningeal irritation, involuntary movement or renal dysfunction were not observed during the course of illness. Although the serum concentration of acyclovir was not elevated, we considered the adverse effects of acyclovir had resulted in his consciousness disturbance. Acyclovir is greatly useful for herpes simplex and varicella-zoster virus infections, and its complications are extremely rare. However, several reports described various neuropsychiatric side effects in patients receiving acyclovir. Most of such cases had an association with severe renal failure or malignant tumor; actually, an intense malignancy surveillance over our case revealed thyrogenic papillary adenocarcinoma without metastasis. The excretion of acyclovir is mainly through the kidney, so that the neurotoxicity of acyclovir in cases with renal insufficiency stems from its excessive accumulation in the body. In malignancy complicated patients, on the other hand, some authors surmised about the influences from the co-use of other neurotoxic drugs or radiation therapy, but reasons for such conditions remain obscure. The neuropsychiatric manifestation caused by acyclovir is an entity distinguishable from viral encephalitis, and a careful surveillance for malignancy is required in such cases. PMID: 8810856 [PubMed - indexed for MEDLINE] 3047. J Neurovirol. 1996 Apr;2(2):136-8. Another case of virologically confirmed zoster sine herpete, with electrophysiologic correlation. Amlie-Lefond C, Mackin GA, Ferguson M, Wright RR, Mahalingam R, Gilden DH. Department of Neurology, University of Colorado Health Sciences Center, Denver 80662, USA. A third virologically-confirmed case of thoracic-distribution zoster sine herpete is reported. Electromyography (EMG) of paraspinal muscles demonstrated frequent fibrillation potentials restricted to chronically painful thoracic root segments. Treatment with intravenous acyclovir and oral famciclovir were ineffective. These findings suggest the usefulness of EMG of muscles corresponding to painful dermatomes, combined with virologic studies, to support the diagnosis of zoster sine herpete. PMID: 8799205 [PubMed - indexed for MEDLINE] 3048. Eur J Clin Microbiol Infect Dis. 1996 Apr;15(4):273-5. Advances and controversies in the antiviral therapy of herpes zoster. Cunningham AL, Dwyer DE. PMID: 8781875 [PubMed - indexed for MEDLINE] 3049. Neurology. 1996 Apr;46(4):1175-6. Gabapentin as a novel treatment for postherpetic neuralgia. Segal AZ, Rordorf G. Department of Neurology, Massachusetts General Hospital, Boston 02114, USA. PMID: 8780121 [PubMed - indexed for MEDLINE] 3050. Acta Ophthalmol Scand. 1996 Apr;74(2):194-6. Retrobulbar neuritis in a patient with acquired immune deficiency syndrome. Cacciatori M, Ling CS, Dhillon B. Department of Ophthalmology, Princess Alexandra Eye Pavilion, Edinburgh, Scotland. PMID: 8739690 [PubMed - indexed for MEDLINE] 3051. Br J Dermatol. 1996 Apr;134(4):788-90. Colonic pseudo-obstruction: a complication of herpes zoster. Jucgla A, Badell A, Ballesta C, Arbizu T. Department of Dermatology, Cuitat Sanitària i Universitària de Bellvitge, Spain. Herpes zoster has been associated rarely with somatic and visceral motor complications, including segmental motor paralysis, neurogenic bladder dysfunction and, unusually, colonic pseudo-obstruction. We report a patient who developed acute pseudo-obstruction of the colon which followed the appearance of dermatomal herpes zoster. PMID: 8733394 [PubMed - indexed for MEDLINE] 3052. J Rheumatol. 1996 Apr;23(4):763-5. Resolution of the neutropenia of Felty's syndrome by longterm administration of recombinant granulocyte colony stimulating factor. Krishnaswamy G, Odem C, Chi DS, Kalbfleisch J, Baker N, Smith JK. Department of Medicine, East Tennessee State University, James H. Quillen College of Medicine, Johnson City 37614-0622, USA. Felty's syndrome is characterized by neutropenia, splenomegaly, and recurrent infection in patients with rheumatoid arthritis. We used recombinant granulocyte colony stimulating factor (rGCSF) in a patient with Felty's syndrome and recurrent sepsis. rGCSF induced a statistically significant increase in the patient's absolute neutrophil and total white blood cell counts. During 14 months of followup taking rGCSF, disseminated varicella zoster was the only infectious complication. Except mild thrombocytopenia and a transient flare of arthritis, no serious adverse effects occurred. rGCSF may be a safe and effective therapy for Felty's syndrome in selected patients. PMID: 8730142 [PubMed - indexed for MEDLINE] 3053. AIDS. 1996 Apr;10(4):393-9. Complications of varicella zoster virus reactivation in HIV-infected homosexual men. Veenstra J, van Praag RM, Krol A, Wertheim van Dillen PM, Weigel HM, Schellekens PT, Lange JM, Coutinho RA, van der Meer JT. Department of Public Health and Environment, University of Amsterdam, The Netherlands. OBJECT: To study the complication rate of varicella zoster virus (VZV) reactivation and the relationship between complications, presentation and localization of zoster and immune function in HIV disease. DESIGN AND METHODS: A total of 142 episodes of VZV reactivation in 113 out of 544 HIV-1-infected participants in the Amsterdam Cohort Study of homosexual men were studied. Persistent hyperkeratotic or necrotic skin lesions, post-herpetic neuralgia, other neurological events, ocular events and pneumonitis occurring within 6 months of the onset of the last episode of VZV reactivation were defined as complications, provided that other possible diagnoses were excluded and the event had been previously described in the literature as related to VZV reactivation. RESULTS: Twenty-four complications occurred in 15 (11%) of these 142 episodes. Complications occurred exclusively in the 40 episodes with either multidermatomal or disseminated presentation, or a trigeminal localization, or both. In the group of episodes of unidermatomal zoster at a non-trigeminal localization no complications occurred. Twenty-one episodes of herpes zoster were localized in the trigeminal area. Localization was not significantly associated with the level of immune function. Compared to unidermatomal presentation (n = 120), multidermatomal (n = 15) and disseminated presentation (n = 7) occurred at lower median CD4+ cell counts (330, 240 and 50 x 10(6)/l, respectively; P = 0.003) and significantly lower levels of CD3 monoclonal antibodies or phytohaemagglutinin-induced T-cell reactivity in vitro. Complications were related to CD4+ cell counts, but in the cases of disseminated, multidermatomal or trigeminal zoster a CD4+ cell measurement provided no additional information on the risk of complications. CONCLUSION: In HIV-infected individuals the extent of the clinical presentation and the occurrence of complications of VZV reactivation are related to the degree of immunodeficiency. In episodes of VZV reactivation with either multidermatomal or disseminated presentation or a trigeminal localization, or both the complication rate was high. CD4+ cell counts provided no additional information on the complication risk. Oral acyclovir appears to be sufficient as therapy for unidermatomal zoster at a non-trigeminal localization. PMID: 8728043 [PubMed - indexed for MEDLINE] 3054. Nephrol Dial Transplant. 1996 Apr;11(4):752. Acyclovir-associated encephalopathy in haemodialysis. Peces R, de la Torre M, Alcázar R. PMID: 8671884 [PubMed - indexed for MEDLINE] 3055. Dent Clin North Am. 1996 Apr;40(2):359-68. Herpesvirus infections. Greenberg MS. Department of Oral Medicine, University of Pennsylvania School of Dental Medicine, Philadelphia, USA. There are presently seven known herpes viruses that infect humans. Those viruses are important in the fields of oral medicine and dentistry because they cause oral lesions, infect saliva, and cause serious and potentially life-threatening infections in patients whose immune systems are compromised by cancer chemotherapy, immunosuppressive drugs, or HIV infection. This article reviews the basic virology and clinical manifestations of the herpes viruses while highlighting the clinical aspects of herpes-related diseases important to dentistry. PMID: 8641526 [PubMed - indexed for MEDLINE] 3056. J Fam Pract. 1996 Apr;42(4):350. Famciclovir for the treatment of herpes zoster. Gordon A. PMID: 8627199 [PubMed - indexed for MEDLINE] 3057. Laryngoscope. 1996 Apr;106(4):438-42. Quantitative assessment of the variation within grades of facial paralysis. Neely JG, Joaquin AH, Kohn LA, Cheung JY. Department of Otolaryngology-Head and Neck Surgery. Washington University School of Medicine, St. Louis, MO 63110, USA. A completely objective, unambiguous outcome measure of facial function is now available. A new automated computer-assisted clinimetric system combines the crucial detection capabilities of the human observer and the unique capacity of the computer to quantify the image light reflectance difference observed during facial expression. The new system was applied to 27 patients with a variety of diseases affecting the facial nerve. All subjects could be individually and objectively ranked, and disease-specific profiles could be constructed. These tasks are not possible with the House-Brackmann scale, because of the wide variation within grades and the ambiguity between grades. With the automated objective, unambiguous outcome measure, it may be possible to define individual case progression, recovery, and outcome over the course of disease. PMID: 8614218 [PubMed - indexed for MEDLINE] 3058. Dtsch Med Wochenschr. 1996 Mar 15;121(11):331-5. [Varicella-zoster-virus myelitis without herpes. An important differential diagnosis of the radicular syndrome] [Article in German] Jacobs A, Bamborschke S, Szelies B, Lanfermann H, Schröder R, Heiss WD. Klinik und Poliklinik für Neurologie und Psychiatrie der Universität, Köln. HISTORY AND CLINICAL FINDINGS: A 43-year-old woman was admitted with a 14-day history of general malaise, subfebrile temperature, radicular dysaesthesias in the "riding breeches" area, severe pain in the lumbar region and progressive disorders of bladder and rectal emptying. Physical examination showed a conus-cauda syndrome. Differential diagnosis was between myelitis (inflammatory or infectious), space-occupying intraspinal mass or vascular lesion. INVESTIGATIONS: Cerebrospinal fluid contained 1700/3 cells and there was intrathecal antibody synthesis against varicella zoster virus (VZV) and positive VZV-DNA analysis in the polymerase chain reaction. Magnetic resonance imaging of the lumbar spine revealed an inflamed enlarged conal and epiconal area with small haemorrhagic spots. There was no evidence of an underlying immune-modulated disease. TREATMENT AND COURSE: With the diagnosis of varicella zoster myelitis with cutaneous changes having been established the clinical signs and symptoms regressed almost completely with aciclovir administration (10mg/kg intravenously for 14 days). CONCLUSION: VZV without cutaneous involvement should be considered in the differential diagnosis of the radicular pain syndrome. When clinical signs of beginning myelitis or encephalitis are present, immediate investigations and therapy are necessary. PMID: 8681722 [PubMed - indexed for MEDLINE] 3059. J Assoc Physicians India. 1996 Mar;44(3):220-1. Zoster myelitis and its response to Acyclovir. Sharma R, Vijayvergiya R, Baid CS, Maheshwari VD, Sunderam SM. Department of Medicine, SMS Hospital, Jaipur. PMID: 9251328 [PubMed - indexed for MEDLINE] 3060. J Antimicrob Chemother. 1996 Mar;37(3):583-97. Multiple dose netivudine, a potent anti-varicella zoster virus agent, in healthy elderly volunteers and patients with shingles. Peck RW, Crome P, Wood MJ, McKendrick MW, Bannister B, Mandal BK, Crooks RJ. Wellcome Research Laboratories, Beckenham, Kent, UK. Netivudine is a nucleoside analogue with potent anti-varicella zoster virus activity. We now report two open studies of the pharmacokinetics and tolerability of netivudine in doses of 50, 100 and 200 mg twice daily. In one study, healthy volunteers received an initial, single dose followed, a week later, by repeat dosing for 9 1/2 days; in the other, patients with shingles were treated for 8 days and data were also recorded for rash resolution and pain duration and intensity. Netivudine was well tolerated in both studies. Plasma concentrations were similar in patients and healthy volunteers and increased in proportion to dose. Steady state concentrations were 15-25% lower than expected from single dose data, probably because of slightly decreased netivudine absorption after food. Elimination half-life was l4-20 h. Plasma concentrations of 5-propynyluracil (5-PU), the main metabolite of netivudine, did not increase in proportion to the netivudine dose and tended to be higher in patients than volunteers. 5-PU concentrations remained elevated for up to 72 h after the last netivudine dose, suggesting continued but slow release from unabsorbed netivudine in the gut lumen. New lesion formation ceased and vesicles crusted most quickly in the 200 mg group; zoster-associated pain intensity, was reduced in a dose-related manner. PMID: 9182115 [PubMed - indexed for MEDLINE] 3061. Cornea. 1996 Mar;15(2):135-8. Aqueous tear production in patients with neurotrophic keratitis. Heigle TJ, Pflugfelder SC. Department of Ophthalmology, University of Miami School of Medicine, Florida, USA. The purpose of this study was to determine whether corneal epithelial defects and epitheliopathy in patients with unilateral dysfunction of the ophthalmic division of the trigeminal nerve (neurotrophic keratitis) is associated with reduced aqueous tear production. Sensation of the skin, cornea, and nasal mucosa, aqueous tear production by Schirmer 1 testing, nasal-lacrimal reflex, and exposure zone rose bengal staining were evaluated in the affected and fellow eyes of subjects with neurotrophic keratitis (n = 5), eyes of subjects who had recent herpes zoster ophthalmicus (HZO) and who did not develop neurotrophic keratitis (n = 4), and normal controls (n = 10). Sensation in the brow and upper lid skin and nasal mucosa was absent on the affected side of patients with neurotrophic keratitis, but was intact in all other groups. Corneal sensation and Schirmer 1 test values were significantly reduced (p < or = 0.05) in eyes with neurotrophic keratitis compared with the other groups. The nasal-lacrimal reflex was absent on the involved side of subjects with neurotrophic keratitis but was intact in subjects with HZO without keratopathy, and in normal controls (p < 0.008). Rose bengal keratitis staining scores were significantly increased in eyes with neurotrophic keratitis compared with the other groups (p < 0.05). We conclude that neurotrophic keratitis is associated with reduced cutaneous, nasal mucosal, and corneal sensation on the affected side, as well as marked reduction in aqueous tear production with loss of the nasal-lacrimal reflex. It is possible that the corneal epithelial pathology in neurotrophic keratitis is due in part to aqueous tear deficiency. PMID: 8925660 [PubMed - indexed for MEDLINE] 3062. Aust Fam Physician. 1996 Mar;25(3):299-307. Management issues in herpes zoster. Dwyer DE. Centre for Infectious Diseases and Microbiology, Westmead Hospital, New South Wales. Herpes zoster is a common clinical illness, with acute and chronic pain a major feature. Antiviral agents started within 72 hours of the onset of the rash are effective in the acute illness and in post herpetic neuralgia or zoster associated pain. Newer agents offer advantages in efficacy and dosage convenience. PMID: 8867180 [PubMed - indexed for MEDLINE] 3063. J Rheumatol. 1996 Mar;23(3):548-50. Herpes zoster myelitis occurring during treatment for systemic lupus erythematosus. Ebo DG, DeClerck LS, Stevens WJ, Ieven M, Ursi D, Van Goethem JW, Couttenye MM. Department of Immunology, Allergology, and Rheumatology, University of Antwerp, Belgium. A woman with systemic lupus erythematosus (SLE) presented with a zoster eruption. Transverse myelitis developed at the site of the dermatomal distribution of the rash. SLE and varicella zoster virus (VZV) can both cause myelitis, and are difficult to differentiate. The topographic association between the cutaneous and the neurological involvement suggesting VZV myelitis was confirmed by polymerase chain reaction (PCR) for VZV in the cerebrospinal fluid. This case illustrates the potential role of the selective amplification of VZV DNA in cerebrospinal fluid to diagnose central neurological complications associated with VZV. The value of magnetic resonance imaging of the spinal cord in the evaluation of patients with myelitis is emphasized. PMID: 8833001 [PubMed - indexed for MEDLINE] 3064. Indian J Ophthalmol. 1996 Mar;44(1):40-2. Bilateral and multifocal generalized eruptions in herpes zoster ophthalmicus: case report. Nath R. Department of Ophthalmology, King George's Medical College, Lucknow. PMID: 8828306 [PubMed - indexed for MEDLINE] 3065. J Pediatr. 1996 Mar;128(3):353-6. Herpes zoster infection after bone marrow transplantation in children. Kawasaki H, Takayama J, Ohira M. Department of Pediatrics, Kansai Medical University, Osaka, Japan. OBJECTIVE: To determine the frequency of, risk factors for, and clinical course of herpes zoster (HZ) after bone marrow transplantation (BMT) in children. STUDY DESIGN: A total of 107 children with hematologic malignancy or solid tumor who underwent allogeneic or autologous BMT were studied retrospectively. RESULTS: Of the 107 patients, HZ developed in 35 (33%) after BMT; 31 (89%) of these 35 patients had localized HZ. The median onset of infection was day 96 after BMT, and 89% of cases of HZ occurred before day 365 after BMT. HZ developed in 26 (58%) of 45 patients (13/21 (62%) allogeneic and 13/24 (54%) autologous patients) with hematologic malignancy; most of these patients had undergone total body irradiation. Of 33 patients with solid tumor, HZ developed in 9 (27%). All patients with HZ were treated with acyclovir, and no patients died of complications directly resulting from HZ. CONCLUSION: Herpes zoster occurred earlier after BMT than in adults, and it occurred frequently in children who had hematologic malignancy and/or had undergone total body irradiation. Prompt antiviral therapy reduced the mortality rate and significant morbidity associated with HZ. PMID: 8774503 [PubMed - indexed for MEDLINE] 3066. Clin Exp Dermatol. 1996 Mar;21(2):174-5. Varicella zoster virus infection complicating bullous pemphigoid. Cliff S, Ostlere LS, Harland CC. PMID: 8759218 [PubMed - indexed for MEDLINE] 3067. Acta Derm Venereol. 1996 Mar;76(2):159-60. Herpes zoster-associated trigeminal neurotrophic ulcer. Nielsen NH, Petersen CS. PMID: 8740279 [PubMed - indexed for MEDLINE] 3068. Antiviral Res. 1996 Mar;29(2-3):141-51. Famciclovir: review of clinical efficacy and safety. Cirelli R, Herne K, McCrary M, Lee P, Tyring SK. Department of Microbiology/Immunology, University of Texas Medical Branch, Galveston 77555, USA. Famciclovir is the well-absorbed oral form of penciclovir, an antiviral agent with potent activity against varicella-zoster virus (VZV) and herpes simplex virus (HSV-1) and 2 (HSV-2). After oral administration, famciclovir is rapidly converted to penciclovir with a bioavailability of 77%. penciclovir is efficiently phosphorylated to the active metabolite, penciclovir-triphosphate, and has a prolonged intracellular half-life of approximately 9-10 h in VZV-infected cells, and 10 and 20 h in cells infected with HSV-1 and HSV-2, respectively. Two multicenter clinical trials have shown that famciclovir given during the acute zoster phase accelerated healing of cutaneous lesions. More importantly, in a placebo-controlled study, famciclovir reduced the duration of postherpetic neuralgia (PHN), particularly in elderly patients. Famciclovir has also been proven effective in treating recurrent genital herpes, as demonstrated by a reduction in times to cessation of viral shedding, complete healing, and loss of all symptoms. One study showed that suppressive therapy with famciclovir was effective in reducing genital herpes episodes in patients with frequent recurrences. A promising new area of investigation for famciclovir is controlling virus replication in patients with chronic hepatitis B virus (HBV) or HBV reinfections after liver transplant. Results from a double-blind, placebo-controlled, pilot study and several case reports have shown that famciclovir, alone or in combination with other agents, decreased HBV-DNA levels and was tolerated with long-term treatment. Available clinical data indicate that famciclovir is an effective agent for treating herpes and holds significant promise for the treatment of chronic HBV infection HBV reinfection after liver transplantation. PMID: 8739594 [PubMed - indexed for MEDLINE] 3069. Br J Dermatol. 1996 Mar;134(3):606. Nodular solar degeneration following herpes zoster. Yamamoto T, Yokoyama A. Comment in: Br J Dermatol. 1997 Mar;136(3):466-7. PMID: 8731699 [PubMed - indexed for MEDLINE] 3070. Br J Dermatol. 1996 Mar;134(3):504-9. Cutaneous reactions following herpes zoster infections: report of three cases and a review of the literature. Gibney MD, Nahass GT, Leonardi CL. Division of Dermatology, St Louis University Health Sciences Center, Missouri 63104, USA. Comment in: Br J Dermatol. 1997 Mar;136(3):465-6. Br J Dermatol. 1997 Mar;136(3):465. Br J Dermatol. 1997 Mar;136(3):466-7. Three patients, one healthy and two immunocompromised, developed cutaneous reactions that histologically mimicked granuloma annulare at sites of resolved varicella-zoster virus (VZV) reactivation infections. Variable latency periods between the infection and the granulomatous reaction were noted. As in other case reports, the presence of VZV DNA in these lesions was inconsistently demonstrated by the polymerase chain reaction (PCR) and appears more common in early, as opposed to late, post-zoster granulomas. In addition to various granulomatous reactions, vasculitic and neoplastic eruptions following resolved VZV infections have been described and are reviewed here. Therapeutically, topical, intralesional and systemic corticosteroids, as well as acyclovir, have been tried with inconsistent results. Although the pathogenesis remains unclear, the presence of VZV DNA in early lesions that histologically do not display viral cytopathic changes, suggests the virus induces an atypical delayed hypersensitivity reaction not affected by antiviral therapy. PMID: 8731677 [PubMed - indexed for MEDLINE] 3071. Compr Ther. 1996 Mar;22(3):183-6. Clinical management of herpes zoster in the elderly patient. Beutner KR. Department of Dermatology, University of California, San Francisco 94589-2500, USA. PMID: 8706390 [PubMed - indexed for MEDLINE] 3072. J Clin Pathol. 1996 Mar;49(3):243-8. Distribution of varicella zoster virus and herpes simplex virus in disseminated fatal infections. Nikkels AF, Delvenne P, Sadzot-Delvaux C, Debrus S, Piette J, Rentier B, Lipcsei G, Quatresooz P, Piérard GE. Department of Dermatopathology, CHU Sart Tilman, Belgium. AIMS: To study the cutaneous and visceral distribution of herpes simplex virus (HSV) and varicella zoster virus (VZV) in fatal infections. METHODS: Standard histology, immunohistochemistry (monoclonal antibodies VL8 and VL2 and polyclonal antibody IE63 directed against VZV; monoclonal antibodies IBD4 and HH2 and polyclonal antibodies directed against HSVI and HSVII) and in situ hybridisation (anti-HSV and anti-VZV probes) were applied to formalin fixed, paraffin wax sections. RESULTS: On histological examination, Herpesviridae infection was evident in various organs including the lungs, liver and skin. In addition, immunohistochemistry and in situ hybridisation revealed the presence of HSV and VZV antigens and nucleic acids in several cell types and tissues showing no cytopathological alterations suggestive of Herpesviridae infection. The organs with histological evidence of infection also contained VZV or HSV antigens and their genes. CONCLUSIONS: These findings suggest that organ failure in disseminated VZV and HSV infections is primarily caused by HSV or VZV induced cell damage and lysis. They also indicate that immunohistochemistry and in situ hybridisation can provide an accurate, type-specific diagnosis on formalin fixed, paraffin wax embedded tissue even when classic histological and cytological characteristics are lacking. PMCID: PMC500407 PMID: 8675738 [PubMed - indexed for MEDLINE] 3073. Schweiz Med Wochenschr. 1996 Feb 17;126(7):264-76. [Prenatal and perinatal infections--problems for the practicing pediatrician: group B streptococci, varicella, toxoplasmosis] [Article in German] Kind C, Duc G. Neonatologic Frauenklinik, Kantonsspital St. Gallen. A practical approach is reported for the care of the neonate born to a mother infected/colonized during pregnancy by group B streptococcus, varicella-zoster virus or Toxoplasma gondii. Starting from clinical situations, an attempt is made to work out evidence based recommendations using an overview of the current literature. GROUP B STREPTOCOCCI: Relevant factors for the treatment of infants born to colonized mothers are clinical symptoms, gestational age, additional risk factors (such as premature rupture of membranes or maternal fever) and intrapartum antibiotics. Postnatal antibiotic prophylaxis and laboratory screens failed the test of controlled trials. Transfer to a neonatology unit is recommended for symptomatic term and all preterm infants. Asymptomatic term infants should be carefully monitored during the first 48 hours for signs of respiratory, circulatory or thermoregulatory compromise. VARICELLA: In the case of maternal varicella near term, delaying delivery for one week will lower the risk of severe neonatal varicella. The postnatal administration of varicella-zoster-immunoglobulin to the neonate is supported by some (if limited) evidence from the literature in the case of maternal eruption between 7 days before and 2 days after delivery. In newborns of mothers with eruption appearing later immunoglobulin is often recommended, though no supporting clinical evidence is available. There are no data to justify the use of immunoglobulin after exposure during pregnancy in order to prevent pneumonia in the pregnant patient, but there are preliminary indications that its application could lower the risk of congenital varicella syndrome (2% between 13 and 20 weeks). The use of immunoglobulin in very low birth weight infants after nosocomial exposure is generally recommended but efficacy data are lacking. TOXOPLASMOSIS: The practical approach depends on clinical findings in the newborn and laboratory results during pregnancy and after birth. Examination of the newborn should include fundoscopy, cranial sonography and, in cases of documented infection, lumbar puncture. Serology from cord blood comprises assays for IgG, IgM and if possible IgA/IgE. If available, demonstration of the parasite by culture or PCR can be helpful. All infants with documented congenital toxoplasmosis should be treated for a minimum of 12 months. In the case of suspected toxoplasmosis the child should be treated as long as the suspicion persists. The prognosis after consequential therapy is less bleak than previously reported for untreated children even in seriously symptomatic patients. PMID: 8720324 [PubMed - indexed for MEDLINE] 3074. Drugs Aging. 1996 Feb;8(2):97-112. Antiviral therapy of acute herpes zoster in older patients. Herne K, Cirelli R, Lee P, Tyring SK. Department of Microbiology/Immunology, University of Texas Medical Branch, Galveston 77555, USA. Although herpes zoster (shingles) can occur in anyone with a history of chickenpox, it is more prevalent and usually more severe in older patients (i.e. persons over 50 years of age). While the cutaneous manifestations of shingles usually resolve in approximately 4 weeks, the pain can persist for several months, or even years in the untreated patient. This pain following healing of the skin, termed post-herpetic neuralgia (PHN), can be very severe. Three well tolerated and effective antiviral drugs are available for the therapy of acute herpes zoster. The nucleoside analogues, aciclovir, famciclovir and valaciclovir, appear to shorten the duration of PHN to a similar degree, but none affects the incidence of PHN. Aciclovir is taken 5 times daily for 7 days, while famciclovir is taken 3 times daily for 7 days. Valaciclovir, the L-valyl ester of aciclovir, when taken orally, produces plasma levels of aciclovir equivalent to those seen following intravenous administration of aciclovir. Valaciclovir has not only been proved to be more efficient than aciclovir (i.e. 3 times daily administration) but also more effective than aciclovir in shortening the duration of PHN. Current studies are determining the relative efficacy of valaciclovir versus famciclovir. Presently, a fourth drug, sorivudine, is being compared with aciclovir for the therapy of acute herpes zoster in older patients, but data from these trials are not yet available. Corticosteroids have been used to treat herpes zoster for much longer than the antiviral drugs, but the effect of corticosteroids on PHN does not appear to be consistent. Corticosteroids plus aciclovir did not provide an added benefit over aciclovir alone in one study but this combination did appear to improve the quality of life of older patients in another investigation. The recent availability of the varicella zoster vaccine may cause shingles to be an uncommon and/or mild disease by the mid twenty-first century. Meanwhile, the search continues for more effective and efficient therapies for acute herpes zoster with the primary goal in older patients to affect the most important sequela of zoster in this population, PHN. PMID: 8845591 [PubMed - indexed for MEDLINE] 3075. Clin Infect Dis. 1996 Feb;22(2):341-7. Oral acyclovir therapy accelerates pain resolution in patients with herpes zoster: a meta-analysis of placebo-controlled trials. Wood MJ, Kay R, Dworkin RH, Soong SJ, Whitley RJ. Department of Infection & Tropical Medicine, Birmingham Heartlands Hospital, United Kingdom. Meta-analysis of four double-blind, randomized, placebo-controlled trials of oral acyclovir (800 mg five times daily) for the treatment of herpes zoster was conducted to provide definitive assessments of the effect of acyclovir on the resolution of zoster-associated pain. The studies involved a total of 691 patients, and the analysis was performed on an intent-to-treat basis. A range of milestones of pain cessation were evaluated by means of Cox regression models with adjustment for relevant prognostic factors. The proportion of patients with postherpetic neuralgia at 3 and 6 months was also determined. Advancing age and more severe pain at presentation were associated with more prolonged pain. Acyclovir was clearly shown to accelerate pain resolution by all of the measures employed. Benefit was especially evident in patients 50 years of age or older. Fewer acyclovir recipients had postherpetic neuralgia at 3 or 6 months. Overall, the reductions of pain duration and prevalence were approximately twofold. PMID: 8838194 [PubMed - indexed for MEDLINE] 3076. Rinsho Shinkeigaku. 1996 Feb;36(2):345-7. [A case of diaphragmatic paralysis following herpes zoster] [Article in Japanese] Fujimoto S, Matsuno O, Matsumoto T, Kumamoto T, Tsuda T. Third Department of Internal Medicine, Oita Medical University. We report a case of diaphragmatic paralysis after herpes zoster. A 82-year-old woman developed shortness of breath on effort after about two months of a typical herpes zoster eruptions affecting the C4 and C5 dermatomic areas on the right side. A chest x-ray showed an elevated right diaphragm. The diaphragmatic evoked potential by stimulation of the right phrenic nerve at the posterior border of the sternocleidomastoid muscle was not elicited. Chest CT and cervical MRI were normal. The viral antibody titers of herpes zoster were elevated in the serum. Cervical herpes zoster should be considered as a possible cause of hemidiaphragmatic paralysis. PMID: 8752692 [PubMed - indexed for MEDLINE] 3077. Fam Pract. 1996 Feb;13(1):84-91. Treatments for postherpetic neuralgia--a systematic review of randomized controlled trials. Volmink J, Lancaster T, Gray S, Silagy C. Department of Public Health and Primary Care, University of Oxford, Radcliffe Infirmary, UK. BACKGROUND. A number of different therapies have been used for postherpetic neuralgia. We decided to conduct a systematic review of existing randomized controlled trials. OBJECTIVE. To determine the efficacy of available therapies for relieving the pain of established postherpetic neuralgia. METHODS. We performed a systematic review, including meta-analysis, of existing randomized controlled trials. Eleven published trials and one unpublished trial were identified which met the inclusion criteria and were included in the current review. RESULTS. Pooled analysis of the effect of tricyclic antidepressants demonstrate statistically significant pain relief (OR 0.15, CI 0.08-0.27). Pooling of the results of the three trials comparing the effects of capsaicin and placebo could not be done due to heterogeneity. This heterogeneity was mainly attributable to an unpublished trial which differed in terms of the dose and duration of treatment. When this study was omitted, no heterogeneity was found and the pooled analysis revealed a statistically significant benefit (OR 0.29, 95% CI 0.16-0.54). However, problems with blinding in patients using capsaicin may have accounted for the positive effect. One small study of vincristine iontophoresis compared to placebo also yielded a favourable result (OR 0.05, 95% CI 0.01-0.26). Other treatment evaluated include lorazepam, acyclovir, topical benzydamine, and acupuncture. We found no evidence that these are effective in relieving pain associated with postherpetic neuralgia. CONCLUSION. Based on evidence from randomized trials, tricyclic anti-depressants appear to be the only agents of proven benefit for established postherpetic neuralgia. PMID: 8671108 [PubMed - indexed for MEDLINE] 3078. J Tenn Med Assoc. 1996 Feb;89(2):47-8. The great imposter. Hanumanthu S. Vanderbilt University Medical Center, Nashville, USA. PMID: 8649028 [PubMed - indexed for MEDLINE] 3079. Geriatrics. 1996 Feb;51(2):56. Painful rash on the right cheek. Levine N. University of Arizona Health Sciences Center, Tucson, USA. PMID: 8631532 [PubMed - indexed for MEDLINE] 3080. Arch Otolaryngol Head Neck Surg. 1996 Feb;122(2):195, 197-8. Pathologic quiz case 2. Bilateral herpes zoster oticus. Lee D, Belmont M, Lucente FE. PMID: 8630216 [PubMed - indexed for MEDLINE] 3081. J Infect Dis. 1996 Feb;173(2):450-3. The protective effect of immunologic boosting against zoster: an analysis in leukemic children who were vaccinated against chickenpox. Gershon AA, LaRussa P, Steinberg S, Mervish N, Lo SH, Meier P. Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, New York 10032, USA. Whether reexposure of varicella-immune persons to varicella-zoster virus would protect against or predispose to development of zoster was analyzed. The rate of zoster in 511 leukemic recipients of varicella vaccine who had 1 or > 1 dose of varicella vaccine and in those who did or did not have a household exposure to varicella was determined. A Kaplan-Meier life-table analysis revealed that the incidence of zoster was lower in those given > 1 dose of vaccine (P < .05). A Cox proportional hazards analysis showed that both household exposure to varicella and receipt of > 1 dose of vaccine were highly protective (P < .01) against zoster. Thus, the risk of zoster is decreased by reexposure to varicella-zoster virus, either by vaccination or by close exposure to varicella. PMID: 8568309 [PubMed - indexed for MEDLINE] 3082. Med Lett Drugs Ther. 1996 Jan 5;38(965):3-4. Valacyclovir. [No authors listed] PMID: 8551979 [PubMed - indexed for MEDLINE] 3083. Arch Virol. 1996;141(12):2465-9. B-cell epitopes of varicella-zoster virus glycoprotein II. Kjartansdóttir A, Lycke E, Norrby SR. Department of Infectious Diseases, Lund University, Sweden. B-cell epitopes of varicella-zoster virus glycoprotein II were mapped by means of solid phase ELISA, synthetic oligopeptides (constructed according to the Davison-Scott sequencing of the varicella-zoster virus genome) and sera from varicellae and herpes zoster patients. The individual pattern of antibody peptide binding varied considerably but at least 9 more reactive sites seemed discernible. A 31-mer-peptide corresponding to a hydrophilic segment of the glycoprotein (aa 417-447) was constructed. This peptide reacted with 2 out of 4 varicellae and 5 out of 9 zoster sera, respectively. PMID: 9526550 [PubMed - indexed for MEDLINE] 3084. Rom J Virol. 1996 Jan-Dec;47(1-4):75-80. Immunomodulating and antiviral therapy in herpes zoster. Topciu V, Mihăilescu R. University of Medicine and Pharmacy, Timişoara. Two groups of patients with herpes zoster were followed up. The first group was subjected, beside a symptomatic therapy, to an immunological and antiviral treatment. The control group was treated only symptomatically. The immunological preparations used were: the immunostimulant SRE (Corynebacterium parvum), which stimulated the lymphocytes and macrophages, Moroxidin (Virustat-Paris) and Antiherpin (interferon inductor), which acted by blocking the virus replication. The preparations were indigenous and atoxic. A significant difference between the courses of disease in the two groups was observed, namely, the severity and duration of subjective and objective symptoms were more than double and followed by persistent neurological sequelae in the control group in comparison with the patients of the experimental group. PMID: 9495784 [PubMed - indexed for MEDLINE] 3085. Bull Soc Belge Ophtalmol. 1996;262:107-13. Bromovinyldeoxyurdine treatment of outer retinal necrosis due to varicella-zoster virus: a case-report. Dullaert H, Maudgal PC, Leys A, Dralands L, Clercq E. Department of Ophthalmology, U.Z. Leuven. In December 1995, a 70-years old male was referred to us because of rapid visual loss in the right eye, one month after a central retinal artery occlusion in the left eye. This renal transplant patient, with limited renal function, was on immunosuppressive therapy. The diagnosis of bilateral progressive outer retinal necrosis (PORN) due to varicella-zoster virus (VZV) was confirmed by polymerase chain reaction (PCR) detection of VZV DNA in the aqueous fluid. As retinitis progressed despite of intravenous acyclovir administration, the antiviral therapy was switched to oral bromovinyldeoxyuridine (BVDU). This case-report demonstrates that oral BVDU can be a good alternative to acyclovir for the treatment of VZV retinal infections. PMID: 9339038 [PubMed - indexed for MEDLINE] 3086. Scand J Infect Dis Suppl. 1996;100:51-4. Antiviral drugs in development for herpes zoster. Fiddian AP. International Medical Affairs Division, Glaxo Wellcome plc, Stockley Park, Middlesex, UK. Until recently aciclovir has been the only licensed drug for the treatment of herpes zoster. A number of new drugs have emerged over the past few years which offered the potential for improved efficacy or ease of administration. With the completion of the first efficacy trials for each of these agents it has become apparent that, whilst less frequent dosing can he accomplished, it is not easy to significantly improve on the efficacy of aciclovir. Increasing age, the presence of prodromal pain and more severe pain at presentation have, however, been found to predispose to a longer duration of pain. Taking cessation of pain as the single most important parameter, at least for the older immunocompetent population as a whole, only valaciclovir has, to date, been shown to be superior to standard therapy with aciclovir. This review utilises primarily intent-to-treat data to illustrate the relative efficacy of the different therapies. PMID: 9163026 [PubMed - indexed for MEDLINE] 3087. Scand J Infect Dis Suppl. 1996;100:46-50. Latency and reactivation of varicella zoster virus infections. Dueland AN. Department of Neurology, Ulleval Hospital, Oslo, Norway. Varicella zoster virus (VZV) is the causative agent of chickenpox (varicella) and shingles (zoster). The study of latency and reactivation has been hampered by the fact that the virus is strictly human and grows to low titres in tissue culture. Molecular biology techniques have opened a new era of VZV research. The site of VZV latency was determined to be sensory ganglia by Southern blotting and later by PCR technology. It was also demonstrated that the entire virus genome is present in the latently infected ganglia and that VZV is latent in multiple ganglia along the entire human neuraxis. Since the amount of latent VZV per cell is very low, the question of which cell type is involved in VZV latency could not be conclusively settled by the use of traditional in situ hybridization studies. However, we have now demonstrated the presence of latent VZV DNA in neurons only, by using a more sensitive method which employs a combination of in situ PCR and in situ hybridization. The transcriptional activity of VZV during latency is still not completely clear. Ganglia are small and the total amount of latent VZV is low, therefore conventional methods to detect latent VZV have proved limited. Nevertheless, the detection of a latent transcript from the SalI C region of the virus was demonstrated by Southern hybridization of cDNA synthesized from RNA isolated from latently-infected ganglia. Further studies have localized this transcript to the open reading frame of VZV gene 21. The study of VZV latency and reactivation has, until now, been dependent on the investigation of post mortem human tissue. However, simian varicella virus seems to be the simian counterpart to human VZV. The 2 viruses exhibit DNA homology as well as similarities in clinical, virological, and immunological features. Further studies of VZV infections may open new and possibly unpredictable opportunities in varicella virus research. PMID: 9163025 [PubMed - indexed for MEDLINE] 3088. Scand J Infect Dis Suppl. 1996;100:41-5. Polymerase chain reaction for diagnosis of varicella zoster virus central nervous system infections without skin manifestations. Bergström T. Department of Clinical Virology, Göteborg University, Göteborg, Sweden. Varicella zoster virus (VZV) can cause disease in the central nervous system (CNS) during both primary infection and reactivation. Rapid and adequate diagnosis of VZV have previously been hampered by the shortcomings of standard virological methods, such as isolation and serology. Earlier reported cases of CNS manifestations of VZV infection have, therefore, mostly been noted in connection with, or shortly after, onset of vesicular rash. Several studies have recently been described of cases of VZV-induced CNS disease occurring as the only sign of viral reactivation, with the diagnosis aided by polymerase chain reaction (PCR) amplification and other methods of genome detection. A prospective study was performed using PCR on cerebrospinal fluid (CSF) and brain samples received for routine diagnosis of possible VZV infection during a 2-year period. Samples from 8 (7 from CSF, 1 from brain) of the 260 patients investigated (3.1%) were found to be positive for VZV-DNA. All 8 had a presumed reactivated VZV infection according to serological and clinical analysis. Their CNS manifestations ranged from meningitis to severe encephalitis, and only in 3 of these patients was a vesicular rash present. Thus, VZV-DNA detection in the CSF was an unexpected finding for the clinician and, in 2 cases, antiviral treatment with aciclovir was initiated only because of the PCR evidence of CNS infection. VZV should be considered as a possible causative agent of infection in patients with CNS disease of suspected viral origin, even in the absence of skin manifestations. Rapid diagnosis by PCR amplification of VZV-DNA from CSF might allow for early and adequate antiviral treatment. PMID: 9163024 [PubMed - indexed for MEDLINE] 3089. Scand J Infect Dis Suppl. 1996;100:35-40. Neurological complications in herpes zoster. Flamholc L. Department of Infectious Diseases, Malmö University Hospital, University of Lund, Malmö, Sweden. This paper discusses the complications associated with herpes zoster, with emphasis on its neurological manifestations. These complications, which are particularly prevalent in elderly and immunodeficient patients, include focal muscle paralysis, contralateral hemiplegia, myelitis, cranial nerve palsies and meningoencephalitis. A causative relationship with herpes zoster in many of these syndromes is probably more common than previously suspected due to difficulties in diagnosis and lack of awareness among clinicians. Zoster sine herpete-- reactivation of varicella zoster virus without rash--is associated with a spectrum of neurological disease and, for obvious reasons, is particularly difficult to diagnose. The polymerase chain reaction could be a valuable tool in overcoming these diagnostic problems, especially in patients without characteristic eruptions, allowing the early initiation of effective antiviral therapy. PMID: 9163023 [PubMed - indexed for MEDLINE] 3090. Scand J Infect Dis Suppl. 1996;100:33-4. The Swedish telephone herpes helpline. Hallén A, Strand A, Juserius H. Dept. of Dermatology & Venereology, Akademiska Sjukhuset, University Hospital, Uppsala, Sweden. To increase the accessibility of qualified and anonymous advice on herpes infections in Sweden, a telephone counselling service was initiated in November 1994. The nucleus of the service is an answering machine that works around the clock. A caller can choose one of 3 different messages dealing with labial or genital herpes infection or herpes zoster--each message is approximately 3 min long. Those wanting written information can register and have material sent to them. For 2 h daily, 4 days a week, calls pass directly to the staff of the sexually transmitted diseases clinic of the University Hospital in Uppsala, Sweden--the caller pays only a single telephone unit charge. The personal calls deal with all aspects of herpes infections. During the first 3 months of the counselling service more than 4,500 calls were received. PMID: 9163022 [PubMed - indexed for MEDLINE] 3091. J Fr Ophtalmol. 1996;19(11):712-5. [Multifocal choroiditis associated with herpes zoster ophthalmicus. Apropos of a case] [Article in French] Chiquet C, Germain P, Burillon C, Coudry-Vergne D, Perez M, Paupert-Ravault M, Denis P. Service d'Ophtalmologie, Lyon. We describe a patient with multifocal choroidal lesions affecting the midperipheral fundus, with an atrophic and scattered punched-out pale aspect. Lesions were discovered seven months after an ipsilateral herpes zoster ophthalmicus. Fluorescein angiography findings exhibited a delay of choroidal injection and late moderate staining during the venous phase. The etiological arguments refer to a previous herpes zoster infection. The pathogeny would involve an occlusion of posterior ciliary arteries, lesions of posterior ciliary nerves and/or direct cytopathogenic involvement of chorioretina by neurotropic virus from ciliary ganglion. PMID: 9033894 [PubMed - indexed for MEDLINE] 3092. Ann Dermatol Venereol. 1996;123(8):471-3. [Cutaneous localizations of chronic lymphoid leukemia in a zona area] [Article in French] Bahadoran P, Lacour JP, Del Giudice P, Perrin C, Dubois D, Samak R, Ortonne JP. Service de Dermatologie, Hôpital Archet, Nice. INTRODUCTION: Leukemia cutis is a rare event in B-cell chronic lymphocytic leukemia. CASE REPORT: A patient with B-cell chronic lymphocytic leukemia developed leukemia cutis at the site of prior cervical (C2-C3) herpes zoster. DISCUSSION: Leukemia cutis on prior site of herpes zoster is exceptional. It should be differentiated from non specific skin reactions secondary to herpes zoster. PMID: 9033718 [PubMed - indexed for MEDLINE] 3093. Retina. 1996;16(6):530-4. The Agar sandwich technique for retinal biopsy processing. Banker AS, González C, Wiley CA, Bergeron-Lynn G, Freeman WR. Department of Ophthalmology, Shiley Eye Center, University of California, San Diego, USA. BACKGROUND: The authors developed an agar sandwich technique for retinal biopsy processing. This tissue agar embedding technique allows for a rapid and reliable method to handle and transport retinal biopsies from the operative field to the histology laboratory. METHODS: Biopsies from rabbit retinas infected with herpes simplex virus, epiretinal membranes from patients with macular pucker, and retinas from patients with acute retinal necrosis were studied. Each retinal biopsy was fixed, mounted on an agar disc, and covered with liquid agar. Light microscopy, electron microscopy, immunocytochemistry, and polymerase chain reaction were employed on the agar-embedded tissue. RESULTS: The tissues remained mounted in the agar sandwich and maintained their orientation throughout the processing. The morphologic integrity, histologic characteristics, antigenic properties, and DNA quality all were preserved using the agar sandwich technique. CONCLUSION: The agar sandwich technique is an efficient and simple technique for handling small biopsy specimens that require various analyses. PMID: 9002138 [PubMed - indexed for MEDLINE] 3094. Retina. 1996;16(6):479-87. Successful treatment of progressive outer retinal necrosis syndrome. Spaide RF, Martin DF, Teich SA, Katz A, Toth I. Department of Ophthalmology, St. Vincent's Hospital and Medical Center of New York, New York, USA. PURPOSE: Progressive outer retinal necrosis is a destructive retinopathy found in patients with acquired immune deficiency syndrome. Treatment of this disorder has been unsuccessful in reported patient series, with the patients experiencing profound bilateral loss of vision. METHODS: We treated six patients with combination antiviral therapy, usually with intravenous foscarnet and either ganciclovir or acyclovir. RESULTS: These six patients retained a visual acuity of 20/100 or better in at least one eye for the remainder of their lives (a period > 4 months for each patient). Retinal detachments developed in four patients, for which vitrectomy and silicone oil tamponade were required. CONCLUSIONS: A combination of intravenous antiviral therapy and aggressive vitrectomy techniques to repair any associated detachments may allow the preservation of useful visual acuity in patients with progressive outer retinal necrosis. This is the first reported series of successful long-term treatment of patients with this disorder. PMID: 9002130 [PubMed - indexed for MEDLINE] 3095. Biotherapy. 1996;9(1-3):73-5. Effect of anti-herpes specific transfer factor. Byston J, Cech K, Pekarek J, Jilkova J. Dept. of Allergology and Clinical Immunology, Faculty Hospital, Olomouc, Czech Republic. Using a blood cell separator, lymphocytes were collected from otherwise healthy convalescents suffering from herpetic infections. A specific anti-herpes dialysate (AH-DLE) was prepared from the lymphocytes, using standard procedures. Patients with recurrent herpetic infections were treated with a single dose of the dialysate, at the initial signs of herpetic infection (group A), with two doses (group B) or with three doses (group C). A total number of 37 patients (29 women, 8 men, age range 15-73 years) were treated. No improvement was observed in 7 patients (18.9%), whilst 7 patients did not manifest any exacerbation of their herpetic infection in the course of the one-year follow-up. The remaining 62.2% of the patients showed a marked improvement: decrease of the frequency and/or duration or relapses. Before AH-DLE administration, the mean number of herpes relapses in this group of patients was 12 p.a.. After therapy, the number of relapses decreased to 3.5 p.a.. No statistically significant difference was observed between groups A and B. The least favourable results were registered in group C. However, this group included 6 female patients extremely resistant to the previously therapeutic attempts, including inosiplex, non-specific DLE or acyclovir. Thus, even in this group, the therapy was successful in 50% of the patients. PMID: 8993761 [PubMed - indexed for MEDLINE] 3096. Int Ophthalmol Clin. 1996 Summer;36(3):17-28. Herpesvirus infections of the anterior segment. Chang EJ, Dreyer EB. Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston 02114, USA. PMID: 8989597 [PubMed - indexed for MEDLINE] 3097. Rev Clin Esp. 1996 Jan;196(1):53-4. [Lymphocytic meningitis, vesicles in the auricular concha, and facial paresis] [Article in Spanish] Otero Antón E, González Quintela A, Alende Sixto MR, Torre Carballada JA, Martín Martín C, Barrio Gómez E. Servicio de Medicina Interna, Complejo Hospitalario Universitario de Santiago de Compostela. PMID: 8948845 [PubMed - indexed for MEDLINE] 3098. Respiration. 1996;63(6):403-6. Hemidiaphragmatic paralysis caused by cervical herpes zoster. Soler JJ, Perpiña M, Alfaro A. Hospital Universitario La Fe, Servicio de Neumología, Valencia, Spain. Although herpes zoster virus usually affects sensory nerves, it can also damage motoneurons. Injury to the phrenic nerve has been described previously, but only anecdotally. We report on a case of left hemidiaphragmatic paralysis with severe axonal degeneration secondary to cervical herpes zoster, and describe its clinical, radiological, pulmonary function and electromyographic evolution during an 18-month follow-up. PMID: 8933664 [PubMed - indexed for MEDLINE] 3099. AIDS. 1996 Jan;10(1):55-60. Acute retinal necrosis in the course of AIDS: study of 26 cases. Batisse D, Eliaszewicz M, Zazoun L, Baudrimont M, Pialoux G, Dupont B. Infectious Disease Department, Pasteur Institute Hospital, Paris, France. Comment in: AIDS. 1996 Sep;10(11):1300-1. OBJECTIVE: To report 26 cases of acute retinal necrosis (ARN) in HIV-infected patients, to compare these data with the literature and to discuss the clinical spectrum of ARN during HIV infection. DESIGN AND SETTING: Twenty-six HIV-infected patients with ARN, collected from five ophthalmology departments in Paris (France) between 1985 and 1993, were analysed retrospectively. PATIENTS: Twenty-eight patients were enrolled; two were lost of follow-up. Diagnosis of ARN was established on the following criteria: (1) inflammation of the anterior segment and the characteristic triad, and (2) peripheral circular necrosis with centripetal progression toward the posterior pole associated with occlusive periarteritis and inflammation of the vitreous. RESULTS: ARN is a late event in the course of immunosuppression (CD4+ lymphocyte count < 100 x 10(6)/l). The most frequent presenting syndrome is a decrease of visual acuity, but signs related to a retrobulbar optic neuritis may also be present. In 60-90% of cases, vesicular viral eruption, usually shingles, precedes the onset of ARN by several days. Occasionally, neurological impairment is also present. Progression to blindness occurs in 76-85% of cases, bilaterally in 59%, and is usually induced by retinal detachment. This study and literature data suggest that varicella zoster virus (VZV) is directly implicated in the onset of ARN. At present, the most efficient therapeutic schedule is unknown. CONCLUSION: ARN is a rare and serious disease in AIDS patients. It is often associated with VZV infection. There is no preventive or curative efficient treatment. ARN might be considered as another opportunistic infection because of its rapid clinical evolution and severe prognosis. PMID: 8924252 [PubMed - indexed for MEDLINE] 3100. Retina. 1996;16(5):399-404. Multiple recurrent branch retinal artery occlusions associated with varicella zoster virus. Zamora RL, del Priore LV, Storch GA, Gelb LD, Sharp J. Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, MO 63110, USA. PURPOSE: The authors describe an immunocompetent patient who developed multiple recurrent branch retinal artery occlusions (BRAOs) associated with the varicella zoster virus (VZV). METHODS: A 69-year-old woman with mild bilateral vitritis developed superior and inferior BRAOs in her right eye with decreased visual acuity to 20/40, and a peripheral BRAO inferotemporally in her left eye. One month later, the inferotemporal BRAO progressed proximally in her left eye with a decrease of visual acuity to 20/40. After an extensive negative systemic evaluation, she underwent a diagnostic pars plana vitrectomy of her right eye. RESULTS: Vitreous fluid was positive for VZV DNA by polymerase chain reaction (PCR). The patient was treated with intravenous acyclovir and systemic oral steroids. After remaining disease free for 3 months, the patient had two recurrences: 1) a mild vitritis and 2) development of a new superior temporal artery occlusion in the left eye. Both recurrences were treated with oral acyclovir and systemic steroids. The patient remained recurrence free for 12 months on a maintenance dose of oral acyclovir, and for 4 additional months without acyclovir. CONCLUSIONS: Varicella zoster virus can be associated with the syndrome of multiple recurrent BRAOs. The diagnosis of VZV-associated BRAO can be established by PCR of intraocular fluid. PMID: 8912966 [PubMed - indexed for MEDLINE] 3101. Retina. 1996;16(5):393-8. Fluorescein angiography in the progressive outer retinal necrosis syndrome. Walton RC, Byrnes GA, Chan CC, Nussenblatt RB. Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA. PURPOSE: Progressive outer retinal necrosis syndrome is a devastating retinopathy seen primarily in patients with acquired immune deficiency syndrome. To provide additional details of the pathogenesis of this disease, the authors describe the evolution of clinical and fluorescein angiographic changes during the course of progressive outer retinal necrosis syndrome. METHODS: The authors performed serial clinical examinations, fundus photography, and fluorescein angiography in a patient with acquired immune deficiency syndrome with progressive outer retinal necrosis syndrome. Clinical and fluorescein angiographic findings were correlated to provide detailed sequential analysis of the pathologic changes occurring during the course of this disorder. RESULTS: The angiographic changes seen during the various stages of the disease consisted of zonal microvascular alterations, retinal pigment epithelium (RPE) destruction, and choroidal leakage. Retinal damage was correlated closely with regions of choroidal leakage and was clinically evident as outer retinal whitening. Disease reactivation occurred as a prominent brush-fire border of intense leakage involving the retina, RPE, and choroid. Extensive damage to the retinal vasculature and RPE was noted in the wake of clinical infection. CONCLUSIONS: The angiographic findings in our patient demonstrate that the progressive outer retinal necrosis syndrome is a retinochoroiditis that involves the full thickness of retina as well as the RPE and choroid. The inflammatory changes seen throughout the course of this disease correlate with the histopathologic patterns reported to date. PMID: 8912965 [PubMed - indexed for MEDLINE] 3102. Annu Rev Microbiol. 1996;50:59-100. Live attenuated varicella vaccine. Arvin AM, Gershon AA. Department of Pediatrics and Microbiology/Immunology, Stanford University Medical Center, California 94305, USA. Varicella-zoster virus (VZV) is a ubiquitous human pathogen that causes varicella, commonly called chicken pox; establishes latency; and reactivates as herpes zoster, referred to as shingles. A live attenuated varicella vaccine, derived from the Oka strain of VZV has clinical efficacy for the prevention of varicella. The vaccine induces persistent immunity to VZV in healthy children and adults. Immunization against VZV also has the potential to lower the risk of reactivation of latent virus. The varicella vaccine may eventually reduce or eliminate herpes zoster, which is a serious problem for elderly and immunocompromised individuals. PMID: 8905076 [PubMed - indexed for MEDLINE] 3103. Proc West Pharmacol Soc. 1996;39:47-8. Postherpetic neuralgia: response to topical clonidine. Abadir AR, Kraynack BJ, Mayda J 2nd, Gintautas J. Brookdale University Hospital and Medical Center, Brooklyn, NY 11212, USA. PMID: 8895966 [PubMed - indexed for MEDLINE] 3104. Eur Neurol. 1996;36(5):288-92. Effects of acyclovir on sensory axonal neuropathy, segmental motor paresis and postherpetic neuralgia in herpes zoster patients. Mondelli M, Romano C, Passero S, Porta PD, Rossi A. Institute of Neurological Sciences, University of Siena, Italy. The effect of oral treatment with acyclovir (ACV) on sensory axonal neuropathy, segmental motor paresis and postherpetic neuralgia (PHN) was studied in 105 patients with herpes zoster. Forty-seven patients were treated with ACV at a dose of 4 g/day in 5 doses for at least a week; the others did not undergo any kind of treatment. Electrodiagnostic examination of the nerves and muscles corresponding to the dermatomeric lesions was performed, including sensory and motor nerve conduction studies, blink reflex and electromyography (EMG). The patients treated with ACV showed a significant reduction in the number of cases in which there was electrophysiological evidence of axonal damage in afferent fibres of nerves arising from roots corresponding to affected dermatomes. The treated group also showed a smaller incidence of segmental motor neuritis, clinically evident or only detectable by EMG as denervation. However, there was no significant difference between groups as far as the incidence of PHN was concerned. Oral treatment with ACV therefore reduces peripheral sensory axonopathy due to ganglion damage and prevents the possibility of spread to anterior roots and spinal motoneurones. In this way it reduces the incidence of segmental motor neuritis, but does not reduce the incidence of PHN. PMID: 8864710 [PubMed - indexed for MEDLINE] 3105. Scand J Infect Dis Suppl. 1996;100:55-8. How to measure and reduce the burden of zoster-associated pain. Wood MJ. Department of Infection & Tropical Medicine, Birmingham Heartlands Hospital, Birmingham, UK. Several parameters of shingles' pain can be measured and each provides meaningful information. Generally, the more comprehensive the assessment the better, but there are significant difficulties in measuring the duration of post-herpetic neuralgia (PHN). Patients with herpes zoster usually feel pain as a continuum and, although acute pain and PHN have different qualities and pathophysiologies, we lack the sophistication to determine when PHN commences. Use of an arbitrarily defined starting point is meaningless for the patient and may introduce statistical bias (particularly if acute pain and PHN are divided by the point of rash healing). Thus, measurement of the pain as a continuum ('zoster-associated pain') is advocated. We also need to decide what degree of pain intensity is meaningful and whether complete cessation of pain or loss of pain (or only 'moderate/severe' pain) for a finite period is a better assessment. This approach to pain measurement was recently adopted in a meta-analysis of the placebo-controlled trials of oral aciclovir in herpes zoster. When 'time to complete cessation of all pain' was assessed, the hazard ratio was 2.13 in favour of aciclovir, with a 95% confidence interval (CI) of 1.42 to 3.19. For 'time to complete cessation of moderate/severe pain' the hazard ratio was 1.46 (95% CI; 1.11, 1.93); for 'time to first pain-free period' it was 1.31 (95% CI; 1.08, 1.60). These results indicate that aciclovir significantly speeds pain resolution in shingles. PMID: 8860354 [PubMed - indexed for MEDLINE] 3106. Clin Infect Dis. 1996 Jan;22(1):187-8. Neuropsychiatric toxicity in a patient undergoing hemodialysis and receiving treatment with oral acyclovir. Collins A, Krieff D, Smith C, Singer C. Division of Infectious Diseases, Long Island Jewish Medical Center, New York, USA. PMID: 8825003 [PubMed - indexed for MEDLINE] 3107. Adv Virus Res. 1996;46:263-309. Varicella-zoster virus: aspects of pathogenesis and host response to natural infection and varicella vaccine. Arvin AM, Moffat JF, Redman R. Stanford University School of Medicine, California 94305, USA. Events in the pathogenesis of infection and the host response to VZV are very closely linked. Our experiments demonstrate that CD4- and CD8+ T-lymphocyte populations that are targets of cell-associated VZV viremia also mediate protection against severe infection. Diminished cell-mediated immunity predisposes the host to progressive primary or recurrent VZV disease because infected lymphocytes persist in the circulation and carry the virus to major organs, causing pneumonitis, hepatitis, or other life-threatening complications. The live attenuated varicella vaccine induces cell-mediated immunity and protects against or significantly reduces the morbidity associated with primary VZV infections. The universal administration of varicella vaccine is likely to generate new insights about host-virus interactions, particularly in relation to how VZV immunity is maintained, that will be relevant to the design of vaccines for other human herpesviruses. PMID: 8824702 [PubMed - indexed for MEDLINE] 3108. Prenat Diagn. 1996 Jan;16(1):71-4. Prenatal diagnosis of congenital varicella infection. Kustermann A, Zoppini C, Tassis B, Della Morte M, Colucci G, Nicolini U. First Department of Obstetrics and Gynaecology, University of Milano, Italy. Fourteen fetuses at risk of Varicella-Zoster virus (VZV) infection underwent prenatal diagnosis at 10-24 weeks' gestation by a combination of chorionic villus sampling, amniocentesis, and fetal blood sampling. Polymerase chain reaction (PCR) was done on fetal and placental tissues, using primers which define a 221 bp region of the gene coding for the 44 kD protein of VZV. Positive cases were further analysed by dot blot hybridization, using radiolabelled DNA probes corresponding to the Hind III fragment VZV genome. The rate of placental/fetal infection was 36 per cent (5/14 fetuses: 2/11 in the first and 3/3 in the second trimester). At post-mortem examination, two aborted fetuses had hydrocephaly and VZV DNA was found in most of the examined tissues. The nine women who tested negative at prenatal investigation delivered healthy neonates whose VZV-specific IgM antibody titres were negative and none of them developed herpes zoster infection. In view of the high frequency of fetal VZV infection and the reported low rate of malformations, the role of invasive prenatal diagnosis in women who acquire the infection in the first half of gestation is mainly that of reassurance when the test is negative. PMID: 8821856 [PubMed - indexed for MEDLINE] 3109. Adv Exp Med Biol. 1996;394:33-9. Valacyclovir HCl (Valtrex): an acyclovir prodrug with improved pharmacokinetics and better efficacy for treatment of zoster. Smiley ML, Murray A, de Miranda P. Glaxo Wellcome Inc., Research Triangle Park, North Carolina, USA. PMID: 8815698 [PubMed - indexed for MEDLINE] 3110. Adv Exp Med Biol. 1996;394:17-31. Famciclovir: efficacy in zoster and issues in the assessment of pain. Boon RJ, Griffin DR. SmithKline Beecham Pharmaceuticals, Reigate, Surrey, United Kingdom. PMID: 8815684 [PubMed - indexed for MEDLINE] 3111. Rev Med Interne. 1996;17(2):169-70. [Varicella zoster virus retinitis in AIDS] [Article in French] Herrmann B, Rabaud C, Maalouf T, Angioi-Duprez C, May T, Canton P. Service d'ophtalmologie, CHU de Nancy, hôpitaux de Brabois, Vandoeuvre-lès-Nancy, France. PMID: 8787091 [PubMed - indexed for MEDLINE] 3112. Zh Nevrol Psikhiatr Im S S Korsakova. 1996;96(2):26-9. [The Guillain-Barré syndrome in herpes zoster patients] [Article in Russian] Shishov AS, Virych IE, Bagrov FI, Latysheva IT. A rare case of Guillain-Barré syndrome associated with herpes zoster developed on the 7th day of eruption in the right dermatoma DII-III in a man of 51 years old. The peculiarities of the symptoms, current status, liquor changes have been analysed basing on the data from foreign literature on 24 cases of Guillain-Barré syndrome (polyradiculoneuritis) associated with herpes zoster. PMID: 8754335 [PubMed - indexed for MEDLINE] 3113. Br J Dermatol. 1996 Jan;134(1):164-6. Leishmania infection occurring in herpes zoster lesions in an HIV-positive patient. Barrio J, Lecona M, Cosin J, Olalquiaga FJ, Hernanz JM, Soto J. Dermatology and Pathology Services, Gregario Maranón General Hospital, Madrid, Spain. Comment in: Br J Dermatol. 1996 Dec;135(6):1005-6. We report the first case of co-infection with herpes zoster and leishmania in the same lesion, on the face of a 29-year-old female, who was an intravenous drug user and who was HIV positive. The infection was initially resistant to acyclovir and itraconazole, and the patient died due to severe internal complications, not attributed to visceral leishmaniasis. The prevalence of leishmania infection in the Mediterranean countries is increasing among the HIV-positive population because of the existence of human carriers. Paradoxically, most of these patients show mild forms of visceral leishmaniasis. PMID: 8745907 [PubMed - indexed for MEDLINE] 3114. Curr Probl Dermatol. 1996;24:209-18. Aciclovir and its l-valyl ester, valaciclovir. Smiley ML, Murray A. Department of Infectious Diseases, Burroughs Wellcome Co., Research Triangle Park, N.C., USA. PMID: 8743272 [PubMed - indexed for MEDLINE] 3115. Horm Res. 1996;45(1-2):46-9. Aging and immune function: a possible role for growth hormone. Gelato MC. Division of Endocrinology, State University of New York, Stony Brook, USA. Elderly individuals have four to five times the case rate of cancer, tuberculosis and herpes zoster and six to seven times the fatality rate from pneumonia compared to young adults. This may be causally related to two changes that occur with aging, i.e. decreased growth hormone (GH)/insulin-like growth factor-1 (IGF-1) production and decreased immune function. Data from our laboratory as well as others have shown that, based on either GH secretory dynamics or IGF-1 levels, approximately 40% of adults aged 60 and older are GH deficient. In the same population of subjects, immune function decreases such that there is a decline in cell-mediated and humoral immune responsiveness. Some of these immune deficits have been shown to be reversed in humans and primates by GH and/or IGF-1 treatment. This paper will review some of these data. PMID: 8742118 [PubMed - indexed for MEDLINE] 3116. Acta Neurochir (Wien). 1996;138(4):364-9. Results of DREZ coagulations for pain related to plexus lesions, spinal cord injuries and postherpetic neuralgia. Rath SA, Braun V, Soliman N, Antoniadis G, Richter HP. Department of Neurosurgery, University of Ulm, Günzburg, Federal Republic of Germany. The results of 58 dorsal root entry zone (DREZ) thermocoagulation procedures in 51 patients are reported. The postoperative analgesic effect was judged by the patients as being good (more than 75% pain reduction), fair (25-75% pain reduction) or poor (less than 25% pain reduction). Of the 14 patients who underwent surgery for pain due to cervical root avulsion, 10 (77%) had permanently good (8) or fair (2) pain relief after a mean follow up period of 76 months, another 2 (15%) experienced recurrence to the preoperative level (initially 1 good, 1 fair) after more than 2 and 4 years, respectively. Twenty two paraplegics were operated upon, 3 of whom twice, for intractable pain. After a mean observation time of 54 months, continuing pain relief was reported by 12 (55%) patients (11 good, 1 fair), and one (initially fair) had recurrent pain after 8 months. All 3 (early) re-operations remain successful for an average period of 75 months. Poor results were seen especially in cases of associated spinal cord cysts (5 out of 7), despite combined drainage, and in patients with diffuse pain distribution (5 out of 6). Continuous marked improvement for longer periods (mean follow up: 52 months) after DREZ lesions was reported only by 2 out of 10 patients with postherpetic neuralgia (12 procedures) and by 1 out of 5 with painful states due to radiation-induced brachial plexopathy (2), previous surgery (2) and malignant tumour infiltration of the brachial plexus (1). Three patients died postoperatively due to acute cardiac failure (2) and pulmonary embolism (1). Major complications, especially permanent gait disturbances were observed in 6 patients (12%) following primary procedures and in 2 out of 7 patients after re-operations, most of them suffering from postherpetic neuralgia. Minor neurological deficits were noted in 9 cases (18%). DREZ lesions revealed to be an effective procedure in patients with pain related to root avulsion and paraplegia. In contrast, it seems to be less successful for painful states due to other plexus lesions or postherpetic neuralgia. PMID: 8738385 [PubMed - indexed for MEDLINE] 3117. Antiviral Res. 1996 Jan;29(1):67-8. Unique clinical trial design: combination acyclovir plus prednisone therapy of localized zoster in the normal host. Whitley RJ, Gnann JW Jr, Weiss HL, Soong SJ. University of Alabama at Birmingham 35294-2710, USA. PMID: 8721549 [PubMed - indexed for MEDLINE] 3118. Acta Derm Venereol. 1996 Jan;76(1):45-7. Pruritus circumscriptus sine materia: a sequel of postzosteric neuralgia. Evaluation by quantitative psychophysical examination and laser-evoked potentials. Darsow U, Lorenz J, Bromm B, Ring J. Department of Dermatology, University Hospital Eppendorf, University of Hamburg, Germany. A case of circumscribed pruritus existing since 1 year on clinically uninvolved skin is reported, in which careful history revealed a 5-year previous episode of herpes zoster in the same dermatome. Impairment of cutaneous sensitivity was evaluated by use of a quantitative psychophysical examination and laser-evoked cortical potentials (LEP). PMID: 8721492 [PubMed - indexed for MEDLINE] 3119. J Dermatol. 1996 Jan;23(1):22-32. Immunohistochemical study of cellular events in lesional skin during common virus infections. Tsukahara T, Horiuchi Y. Department of Dermatology, Kitasato University School of Medicine, Sagamihara, Japan. Determination was made of epidermal Langerhans cell (LC) distribution and infiltrating cellular events in lesional skin during varicella zoster virus (VZV) infection, and the results were compared with those for herpes simplex (HS), measles, and rubella by immunohistochemical staining with cell surface markers. CD1a positive epidermal LCs increased in number, particularly in measles and rubella. The number of LCs was within the normal range or slightly increased in the epidermis of VZV infection. In herpes zoster (HZ) and varicella, HLA-DR positive epidermal cells were present in the basal part of the epidermis. In measles, HLA-DR positive cells aggregated in papular lesions. In measles and rubella, the number of HLA-DQ positive epidermal cells appeared to increase. In HS cases, CD11b (OKM1) positivity of the upper epidermal keratinocytes was quite pronounced, but not in the basal layer. CD8 positive suppressor/cytotoxic cells extensively infiltrated the dermis of HZ and varicella. Dermal infiltrates were identified as CD8 positive cell dominant in measles, HZ, and varicella. These results provide a partial explanation as to why cellular events in skin lesions act immunosuppressively. PMID: 8720254 [PubMed - indexed for MEDLINE] 3120. Am J Otol. 1996 Jan;17(1):154-61. Correlation of MRI, clinical, and electroneuronographic findings in acute facial nerve palsy. Brändle P, Satoretti-Schefer S, Böhmer A, Wichmann W, Fisch U. Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Zurich, Switzerland. Intratemporal enhancement of (Gd-DTPA) was investigated by an interleaved-overlapping magnetic resonance imaging (MRI) technique in 35 cases of acute facial palsy. In a reference group (normal facial function), enhancement was localized from the ganglion geniculi to the stylomastoid foramen. In cases of acute palsy, the facial nerve enhanced in the meatal fundus independent of etiology (idiopathic, herpetic, or traumatic). In 70% of those with Ramsay-Hunt syndrome, the vestibular and cochlear nerves, the labyrinth, and the sheets of the internal and external auditory canal additionally enhanced. No correlation was found between intensity, extension, and duration of the enhancement and the clinical, intraoperative, or electroneuronographic degree of the facial palsy. The pathogenesis of the Gd-DTPA enhancement of the facial nerve appears to be closely connected with the vascular supply of the fallopian canal and the permeability of the neural sheets. PMID: 8694122 [PubMed - indexed for MEDLINE] 3121. Med Pregl. 1996;49(1-2):57-8. [Case report of a female patient with post-infection depression] [Article in Croatian] Soldatović-Stajić B, Drezgić-Vukić S. Medicinski fakultet, Novi Sad. In this article the authors present a case of a secondary depression in woman, 75 years old, without previous psychiatric anamnesis or heredity. She had post-herpetic intercostal neuralgia and developed symptoms of depression. This case is an example which points to necessity of cooperation of other medical branches with psychiatry. PMID: 8643074 [PubMed - indexed for MEDLINE] 3122. Eur J Clin Microbiol Infect Dis. 1996 Jan;15(1):1-3. Can herpes zoster be prevented? Levin MJ. PMID: 8641298 [PubMed - indexed for MEDLINE] 3123. Arch Fam Med. 1996 Jan;5(1):42-6. Shingles in one family practice. Richards P. One hundred twenty-four patients presented with herpes zoster in a small-town, solo practice between 1983 and 1992. This article reviews the clinical features and natural history of herpes zoster, followed by a description of the cases seen in the study practice. This common disease, easily diagnosed and treated by the family physician, usually responds well to treatment with acyclovir. PMID: 8542053 [PubMed - indexed for MEDLINE] 3124. Ann Intern Med. 1996 Jan 1;124(1 Pt 1):27-30. Bell palsy and herpes simplex virus: identification of viral DNA in endoneurial fluid and muscle. Murakami S, Mizobuchi M, Nakashiro Y, Doi T, Hato N, Yanagihara N. Ehime University School of Medicine, Japan. Comment in: Ann Intern Med. 1996 Oct 15;125(8):698-9. Ann Intern Med. 1996 Jan 1;124(1 Pt 1):63-5. OBJECTIVE: To determine whether herpes simplex virus type 1 (HSV-1) causes Bell palsy. DESIGN: Prospective study. SETTING: University inpatient service. PATIENTS: 14 patients with Bell palsy, 9 patients with the Ramsay-Hunt syndrome, and 12 other controls. MEASUREMENTS: Viral genomes of HSV-1, varicella-zoster virus, and Epstein-Barr virus were analyzed in clinical samples of facial nerve endoneurial fluid and posterior auricular muscle using polymerase chain reaction (PCR) followed by hybridization with Southern blot analysis. RESULTS: Herpes simplex virus type 1 genomes were detected in 11 of 14 patients (79%) with Bell palsy but not in patients with the Ramsay-Hunt syndrome or in other controls. The nucleotide sequences of the PCR fragments were identical to those of the HSV-1 genome. CONCLUSIONS: Herpes simplex virus type 1 is the major etiologic agent in Bell palsy. PMID: 7503474 [PubMed - indexed for MEDLINE] 3125. Virology. 1995 Dec 20;214(2):531-40. Identification of immunodominant regions and linear B cell epitopes of the gE envelope protein of varicella-zoster virus. Fowler WJ, Garcia-Valcarcel M, Hill-Perkins MS, Murphy G, Harper DR, Jeffries DJ, Burns NR, Adams SE, Kingsman AJ, Layton GT. British Biotech Pharmaceuticals Ltd., Oxford, United Kingdom. The envelope proteins of varicella-zoster virus (VZV) are highly immunogenic and one of the most abundant is glycoprotein E (gE). However, its immunodominant regions and epitopes have not been identified. In this study, using human sera from individuals with recent varicella or zoster infections, we have localized antigenic sequences of gE using recombinant hybrid Ty-virus-like particles (VLPs) carrying overlapping fragments of the gE protein. gE(1-134)-VLPs (particles carrying amino acids 1-134 of gE) and, to a lesser extent, gE(101-161)-VLPs were found to be the most antigenic when tested by Western blotting and ELISA. Other fragments of gE (spanning residues 161-623) showed weak or no antigenicity. Pepscan analysis of human sera on overlapping synthetic peptides representing residues 1-135 of gE revealed that the most antigenic region was between residues 50 and 135. Three immunodominant sequences (residues 86-105, 116-135, and, to a lesser extent, 56-75) were detected using sera from both varicella and zoster patients. All sera from varicella, but not zoster, patients reacted strongly with an epitope in peptide 66-85. Other epitopes were recognized weakly by some varicella or zoster sera. More sera need to be tested to assess the potential disease specificity of these epitopes. The neutralizing monoclonal antibody (MAb) IF-B9 reacted with residues 71-90; however, another neutralizing MAb, SG1A, which bound to both gE(1-134)-VLPs and gE(101-161)-VLPs did not bind to any peptide. The identification of immunodominant sequences of gE will help toward the development of a subunit VZV vaccine. PMID: 8553555 [PubMed - indexed for MEDLINE] 3126. Southeast Asian J Trop Med Public Health. 1995 Dec;26(4):677-83. Genome differences among varicella-zoster viruses isolated in Thailand. Thawaranantha D, Balachandra K, Jongtrakulsiri S, Yamkunthong W, Chimabutra K, Bhumiswasdi J. Department of Medical Sciences, Ministry of Public Health, Nonthaburi, Thailand. The DNAs of 17 isolates of varicella-zoster virus (VZV) obtained from 17 Thai individuals with normal varicella or zoster infections (no underlying diseases) were compared by restriction endonuclease analysis using BglI, PstI, EcoRI, SmaI and BamHI. The DNA of the Japanese strain, Kawaguchi, was also conducted as a reference DNA. All of virus isolates were confirmed for existence of VZV and VZV-DNA by immunofluorescent test and DNA-hybridization, respectively. Almost all of the Thai epidemiologically unrelated isolates and the Kawaguchi strain could be individually differentiated using BglI, PstI, and EcoRI. The other two isolates were identical in restriction profiles even after five endonuclease digestions which SmaI and BamHI were the two more enzymes used, therefore, they could be discriminated totally into 16 strains from overall 17 isolates. These findings demonstrate the strain variation of wild-type varicella-zoster viruses isolated in Thailand. PMID: 9139375 [PubMed - indexed for MEDLINE] 3127. Neurology. 1995 Dec;45(12):2293. Polyneuritis cranialis due to varicella-zoster virus in the absence of rash. Osaki Y, Matsubayashi K, Okumiya K, Wada T, Doi Y. Department of Medicine and Geriatrics, Kochi Medical School, Nankoku, Japan. PMID: 8848213 [PubMed - indexed for MEDLINE] 3128. J Antimicrob Chemother. 1995 Dec;36(6):1089-1101. How should zoster trials be conducted? Wood MJ, Balfour H, Beutner K, Bruxelle J, Fiddian P, Johnson R, Kay R, Cubed S, Portnoy J, Rentier B, et al. Department of Infection and Tropical Medicine, Birmingham Heartlands Hospital, UK. In 1994, an international group of interested clinicians and biostatisticians met to discuss the design of clinical trials in herpes zoster. They agreed that trials in herpes zoster should have prospectively agreed definitions of all outcome measures and plans for data analysis. In immunocompetent individuals, in whom pain is the major outcome measure, trials should only include patients over the age of 50 years, and for those recruited within 72 h of rash onset, should be designed to demonstrate superiority of any new therapy over existing antivirals. The primary endpoint should be time to cessation of pain for at least 4 weeks and, for the purposes of statistical analysis of its duration, the pain associated with herpes zoster ought to be considered as a continuum. All other variables, including the incidence of post-herpetic neuralgia and effects upon quality of life should be considered as secondary end-points. Evaluation of treatment effects on primary endpoints should be based upon an intent-to-treat (ITT) analysis and subgroup analysis should be used only to support the findings of the ITT analysis. These elements of good study design should be borne in mind in the evaluation of current and future trails of antiviral drugs in herpes zoster. PMID: 8821612 [PubMed - indexed for MEDLINE] 3129. Acta Med Okayama. 1995 Dec;49(6):309-12. Effects of varicella zoster virus or herpes simplex virus type I infection in vitro on response of human peripheral blood mononuclear cells to phytohemagglutinin. Horiuchi Y, Okuno T, Yamanishi K. Department of Dermatology, Kitasato University School of Medicine, Japan. Examination was made of the in vitro response of human peripheral blood mononuclear cells (PBNMCs) to phytohemagglutinin (PHA) following treatment with varicella zoster virus (VZV) or herpes simplex virus type 1 (HSV 1). Cell proliferation was determined by colorimetric assay using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-tetrazolium bromide. The response to PHA was depressed in all cases by virus infection of PBMNCs prior to PHA treatment. When the infection with the viruses was after PHA treatment, PHA response differed. For VZV infection, the response increased in four out of six samples, but was reduced in the other two. The response to PHA was depressed in all six samples by HSV 1 infection. PMID: 8770240 [PubMed - indexed for MEDLINE] 3130. Antiviral Res. 1995 Dec;28(4):281-90. Valacyclovir: a review of its antiviral activity, pharmacokinetic properties, and clinical efficacy. Beutner KR. Department of Dermatology, University of California at San Francisco, USA. Oral administration of the prodrug valacyclovir results in enhanced bioavailability and significantly greater plasma concentrations of acyclovir than can be achieved with oral doses of acyclovir itself. The results of clinical trials with valacyclovir have demonstrated significant benefits in the resolution of pain associated with herpes zoster infection. Efficacy parameters were similar for valacyclovir and acyclovir in the treatment of herpes simplex; however the results were achieved with lower and less-frequent doses of valacyclovir. The cost of a course of therapy with valacyclovir is expected to be similar to that of other antivirals. The potential clinical benefits of valacyclovir will likely be apparent in the case of acyclovir-resistant herpesvirus infections, where high-dose intravenous treatment with acyclovir has been necessary. Most of these resistant viruses have been encountered in immunocompromised patients, and the resistance has been attributed to inadequate exposure to the drug. Because optimal levels of acyclovir are achieved with a simpler dosing regimen of valacyclovir, compliance may be improved in many patients, thus reducing the incidence of resistant virus. PMID: 8669888 [PubMed - indexed for MEDLINE] 3131. J Dermatol. 1995 Dec;22(12):939-42. Sebaceous adenomas, squamous cell carcinoma and skin infections in a patient with carcinoma of the colon, rectum and bladder. Abraham Z, Glück Z, Lahat N, Kinarty A. Department of Dermatology, Reish Policlinic, Haifa, Israel. Sebaceous adenomas and squamous cell carcinoma developed in a male patient in addition to viral, mycotic and bacterial infections, several years after the removal of three malignant tumors from his lower gastrointestinal and urinary tract. Skin tests with trichophytin, candidin, and mixed bacteria were negative. Various aspects regarding cutaneous changes associated with colorectal and bladder carcinomas are discussed. PMID: 8648002 [PubMed - indexed for MEDLINE] 3132. J Med Virol. 1995 Dec;47(4):342-7. Immunohistochemical identification of varicella-zoster virus gene 63-encoded protein (IE63) and late (gE) protein on smears and cutaneous biopsies: implications for diagnostic use. Nikkels AF, Debrus S, Sadzot-Delvaux C, Piette J, Rentier B, Piérard GE. Department of Dermatopathology, CHU Sart Tilman, Liège, Belgium. Early and specific recognition of varicella zoster virus (VZV) infection is of vital concern in immunocompromised patients. The aim of this study was to compare the diagnostic accuracy of histochemical and immunohistochemical identification of the VZV ORF63 encoded protein (IE63) and of the VZV late protein gE on smears and formalin-fixed paraffin-embedded skin sections taken from lesions clinically diagnosed as varicella (n = 15) and herpes zoster (n = 51). Microscopic examinations of Tzanck smears and skin sections yielded a diagnostic accuracy of Herpesviridae infections in 66.7% (10/15) and 92.3% (12/13) of varicella, and 74.4% (29/39) and 87.8% (43/49) of herpes zoster, respectively. Immunohistochemistry applied to varicella provided a type-specific virus diagnostic accuracy of 86.7% (13/15; IE63) and 100% (15/15; gE) on smears, and of 92.3% for both VZV proteins on skin sections. In herpes zoster, the diagnostic accuracy of immunohistochemistry reached 92.3% (36/39; IE63) and 94.9% (37/39; gE) on smears, and 91.7% (44/48; IE63) and 91.8% (45/49; gE) on skin sections. These findings indicate that the immunohistochemical detection of IE63 and gE on both smears and skin sections yields a higher specificity and sensitivity than standard microscopic assessments. PMID: 8636701 [PubMed - indexed for MEDLINE] 3133. Masui. 1995 Dec;44(12):1680-4. [A case of RSD with complete disappearance of symptoms following intravenous ketamine infusion combined with stellate ganglion block and continuous epidural block] [Article in Japanese] Kishimoto N, Kato J, Suzuki T, Arakawa H, Ogawa S, Suzuki H. Department of Anesthesiology and Resuscitology, Kochi Medical School, Nankoku. A 74 year-old woman with a 6-month history of RSD following herpes zoster on her right arm was treated with stellate ganglion blocks (SGB), continuous epidural block (CEB) and continuous intravenous infusion of ketamine known as one of the NMDA receptor blockers. Of the symptoms of RSD, burning pain and hyperperspiration but allodynia disappeared after the treatment with SGB 8 times and CEB for 4 days. Allodynia disappeared completely after ketamine treatment, where ketamine was infused once using a subanesthetic dose for 2 hours. It is considered that ketamine is one of the useful drugs for the treatment of neuropathic pain with allodynia. PMID: 8583666 [PubMed - indexed for MEDLINE] 3134. Br J Dermatol. 1995 Dec;133(6):978-82. Necrotizing herpes zoster mimicking relapse of vasculitis in angioimmunoblastic lymphadenopathy with dysproteinaemia. Böni R, Dummer R, Dommann-Scherrer C, Dommann S, Zimmermann DR, Joller-Jemelka H, Burg G. Department of Dermatology, University Hospital of Zurich, Switzerland. An 81-year-old man presented with a generalized maculopapular rash, lymphadenopathy, conjunctivitis and arthritis. Vasculitis was confirmed by skin biopsy and by direct immunofluorescence, which showed perivascular C3 and granular IgM accumulation. Histology of an inguinal lymph node was diagnostic for angioimmunoblastic lymphadenopathy with dysproteinaemia (AILD), and this was confirmed by the finding of hypergammaglobulinaemia and elevated IgE levels. Immunohistology on a lymph node biopsy showed a T-helper cell (CD4) infiltrate expressing the interleukin (IL)-2 receptor alpha and beta chains. While receiving prednisone 100 mg/day, the patient developed new lesions, mimicking a relapse of vasculitis, which were subsequently shown to be necrotizing herpes zoster. Serum IL-2 and IL-6 levels were elevated. To our knowledge, this is the first report of simultaneous elevation of IL-2 and IL-6 in AILD: IL-2 may be involved in proliferation of the malignant cell clone, and IL-6 in the pathogenesis of both the vasculitis (via endothelial cell activation) and the hypergammaglobulinaemia. PMID: 8547055 [PubMed - indexed for MEDLINE] 3135. Neurology. 1995 Dec;45(12 Suppl 8):S78-9. Prospective epidemiologic study of painful and neurologic sequelae induced by herpes zoster in patients treated early with oral acyclovir. Bruxelle J. Department of Anesthesiology, Hospital Cochin-Tarnier, Paris, France. Three hundred and one patients with acute herpes zoster treated early with oral acyclovir were enrolled in an open, prospective study designed to evaluate painful and neurologic disorders over a 6-month period. Age, initial pain severity, and occurrence of a neurologic deficit influenced the incidence of postherpetic neuralgia. No relationship was found between initial rash severity and either pain incidence or neurologic deficit. PMID: 8545032 [PubMed - indexed for MEDLINE] 3136. Neurology. 1995 Dec;45(12 Suppl 8):S76-7. Efficacy of famciclovir in the treatment of herpes zoster: reduction of pain associated with zoster. Boon RJ, Griffin DR. SmithKline Beecham Pharmaceuticals plc, Harlow, Essex, UK. PMID: 8545031 [PubMed - indexed for MEDLINE] 3137. Neurology. 1995 Dec;45(12 Suppl 8):S73-5. Sorivudine: a promising drug for the treatment of varicella-zoster virus infection. Whitley RJ. Department of Pediatrics, University of Alabama at Birmingham 35233, USA. Sorivudine provides a unique nucleoside analog with significantly enhanced both in vitro and in vitro activity and enhanced oral bioavailability. Early indications from controlled studies indicate that sorivudine therapy is superior to acyclovir for the treatment of localized zoster in individuals with HIV infection and adults with chicken pox. However, these studies await peer evaluation. Importantly, recent experience in Japan indicates administration of sorivudine with 5-fluorouracil (5-FU) is contraindicated. Sorivudine inhibits dihydropyrimidine dehydrogenase, which is required for the metabolism of 5-FU. As a consequence, toxic levels of 5-FU accumulate in the plasma and have led to the deaths of nearly 30 patients in Japan. One might question, as these data unfold, the relative value of drugs with such enhanced in vitro activity and oral bioavailability as compared with standard therapeutic agents. Should accelerated healing occur, but not as dramatically as would have been anticipated from the in vitro data, unique approaches to the management of herpes zoster will need to be developed if further improvement is desired. Regardless, sorivudine appears superior to acyclovir for acceleration of cutaneous healing and, importantly, can be administered once daily in significantly smaller concentrations. These findings in and of themselves should allow for licensure of the compound in other developed societies. PMID: 8545030 [PubMed - indexed for MEDLINE] 3138. Neurology. 1995 Dec;45(12 Suppl 8):S70-2. The future of predictors, prevention, and therapy in postherpetic neuralgia. Johnson RW. Pain Management Clinic, Bristol Royal Infirmary, England. Pain is the most common complication of herpes zoster, but much confusion and dissent exist regarding terminology. Established (chronic) herpetic pain is remarkably resistant to treatment, but its prevention is partly achievable. Prodromal and acute herpetic pain are predictors for chronic pain. If research programs and clinical management are to progress optimally, researchers and clinicians must agree on appropriate use of such terms as "zoster-associated pain" and "postherpetic neuralgia." PMID: 8545029 [PubMed - indexed for MEDLINE] 3139. Neurology. 1995 Dec;45(12 Suppl 8):S63-5. Mechanical allodynia in postherpetic neuralgia: evidence for central mechanisms depending on nociceptive C-fiber degeneration. Baron R, Saguer M. Klinik für Neurologie, Christian-Albrechts-Universität Kiel, Germany. In 12 zoster patients who had developed postherpetic neuralgia with dynamic mechanical allodynia and in six zoster patients who had recovered without pain, the functional role of nociceptive C-fibers in allodynia was assessed by quantifying axon reflex reactions induced by histamine iontophoresis within allodynic regions and in their contralateral sites. In patients with postherpetic neuralgia, histamine responses were reduced or abolished within allodynic areas, indicating degeneration of nociceptive C-fibers. In patients who recovered without pain, histamine responses were bilaterally identical, indicating complete regeneration of nociceptive C-fibers. These results demonstrate that sensitized nociceptive C-fibers are not involved in signaling and maintenance of allodynia. Alteration in CNS processing may reorganize synaptic ties between central pain-signaling pathways and mechanoreceptive A beta-fibers depending on afferent C-fiber degeneration rather than ongoing C-fiber input. PMID: 8545026 [PubMed - indexed for MEDLINE] 3140. Neurology. 1995 Dec;45(12 Suppl 8):S61-2. How should we measure pain in herpes zoster? Wood MJ. Department of Infection and Tropical Medicine, Birmingham Heartlands Hospital, UK. Pain occurs during the acute phase of herpes zoster and as postherpetic neuralgia (PHN) for months or years after the acute illness has healed. The acute pain results from viral replication leading to the death of neurons together with cutaneous inflammation. However, the exact mechanism of PHN is still conjectural. Historically, PHN has been defined as any pain that follows disappearance of the rash of herpes zoster, but a number of other definitions (eg, pain present for more than 1 or 2 months after rash onset) have also been used. Since pain is purely subjective and is usually felt as a continuum, any definition is entirely arbitrary and sheds no light upon the pathophysiology of the prolonged pain. An arbitrary division of pain poses problems for the measurement of the effect of acute therapy upon the duration of PHN. Use of a definition of PHN that involves the time of rash healing also leads to considerable difficulties in the assessment of therapies that affect the duration of the rash. The median times for resolution of both acute pain and PHN are likely to be biased in favor of therapy that heals the rash more rapidly, even if the continuum of pain is not affected. For these reasons, the term "zoster-associated pain," encompassing both the acute and chronic pain associated with herpes zoster, has evolved as a more meaningful way of measuring pain both for the individual patient and also for the comparison of two potential therapies. PMID: 8545025 [PubMed - indexed for MEDLINE] 3141. Neurology. 1995 Dec;45(12 Suppl 8):S58-60. The treatment of postherpetic neuralgia. Watson CP. Department of Medicine, University of Toronto, ON, Canada. Postherpetic neuralgia, when defined as neuropathic pain persisting 1 month or longer after herpes zoster infection, affects about 10% of all patients who have contracted the disease. The incidence of postherpetic neuralgia increases with age; at age 60, about 50% of herpes zoster patients will suffer significant pain, and this proportion grows with subsequent decades. If therapy is carefully chosen and monitored, it is possible to give satisfactory relief, taking pain from severe to mild, to between 60 and 70% of patients. This article will review current treatment and focus on antidepressant drugs, treatments that are contentious and of current interest such as topical agents, and the use of opioids for this type of chronic neuropathic pain. PMID: 8545024 [PubMed - indexed for MEDLINE] 3142. Neurology. 1995 Dec;45(12 Suppl 8):S56-7. Pathophysiology of postherpetic neuralgia: towards a rational treatment. Bowsher D. Pain Research Institute, Walton Hospital, Liverpool, UK. PMID: 8545023 [PubMed - indexed for MEDLINE] 3143. Neurology. 1995 Dec;45(12 Suppl 8):S54-5. Clinical features and pathophysiologic mechanisms of postherpetic neuralgia. Nurmikko T. Department of Neurology, Tampere University Hospital, Finland. Postherpetic neuralgia is an unfortunate aftermath of shingles, and is most likely to develop, and most persistent, in elderly patients. Pain, allodynia, and sensory loss in the affected dermatome are the cardinal manifestations of the disorder. The pathophysiology of postherpetic neuralgia is not well known, but recent observations suggest multiple changes in the afferent pathways at both peripheral and central nervous system levels. PMID: 8545022 [PubMed - indexed for MEDLINE] 3144. Neurology. 1995 Dec;45(12 Suppl 8):S52-3. Herpes zoster and quality of life: a self-limited disease with severe impact. Lydick E, Epstein RS, Himmelberger D, White CJ. Merck Research Laboratories, West Point, PA 19486-0004, USA. PMID: 8545021 [PubMed - indexed for MEDLINE] 3145. Neurology. 1995 Dec;45(12 Suppl 8):S50-1. Herpes zoster ophthalmicus. Pavan-Langston D. Harvard Medical School/Massachusetts Eye and Ear Infirmary, Cambridge 02114, USA. PMID: 8545020 [PubMed - indexed for MEDLINE] 3146. Neurology. 1995 Dec;45(12 Suppl 8):S47-9. Localization of varicella-zoster virus nucleic acids and proteins in human skin. Nikkels AF, Debrus S, Sadzot-Delvaux C, Piette J, Rentier B, Piérard GE. Department of Dermatopathology, University of Liége, Belgium. The pathogenic mechanisms involved in varicella-zoster virus (VZV) infections remain elusive. The pattern of cutaneous distribution of the IE63 protein and of the gpI (gE) and gpII glycoproteins with their corresponding genome sequences during VZV infections was studied by immunohistochemistry and in situ hybridization. Skin biopsy specimens were obtained from immunocompetent and immunocompromised patients with varicella, herpes zoster, or atypical VZV lesions. The first evidence for VZV infection consisted of the presence of IE63 in keratinocytes. In the vesicles and pustules, the viral transcripts gpI, gpII, and IE63 and the corresponding nucleic acids for gpI and gpII were identified in keratinocytes, sebocytes, Langerhans cells, dermal dendrocytes, monocytes/macrophages, and endothelial cells. The gpI and gpII glycorpoteins were essentially located on the cellular membranes while IE63 expression was generally restricted to the nuclei. In three biopsies of early herpes zoster, viral proteins were disclosed in dermal nerves and in perineurial type I dendrocytes. This was never encountered in varicella. Vasculitic changes and endothelial cell involvement were more prominent in varicella than in herpes zoster. It is concluded that the secondary viremia in varicella that affects the dermal endothelial cells is followed by a cell-to-cell spread to keratinocytes. In herpes zoster, the viral progression through cutaneous nerves primarily extends to the pilosebaceous units with a secondary involvement of epidermal keratinocytes, followed by a further spread to dermal cells. PMID: 8545019 [PubMed - indexed for MEDLINE] 3147. Neurology. 1995 Dec;45(12 Suppl 8):S41-6. Immunization to reduce the frequency and severity of herpes zoster and its complications. Oxman MN. Department of Medicine, University of California, San Diego, USA. Herpes zoster (HZ) is a localized disease that results from reactivation of an endogenous varicella-zoster virus (VZV) infection that has persisted in latent form within sensory ganglia following an earlier attack of varicella. The incidence and the severity of HZ and its complications increase with advancing age, and this is temporally associated with an age-related decline in cell-mediated immunity (CMI) to VZV. Information on the cellular site and mechanism of VZV latency and on the events that follow reactivation appears to explain many of the clinical features of HZ and to provide a pathophysiologic basis for the presumption that immunity to VZV plays a critical role in limiting the frequency and consequences of VZV reactivation. The close temporal correlation between the decline in VZV-specific CMI and the increased frequency and severity of HZ and its complications in older individuals suggests that HZ may actually develop because VZV-specific CMI falls below some critical threshold. The development of a live attenuated varicella vaccine provides a means of stimulating VZV-specific CMI and thus of determining its role in the pathogenesis of HZ. Levin and his colleagues have demonstrated that waning VZV-specific CMI in elderly persons can be stimulated by varicella vaccine to levels typical of those observed in younger persons, in whom the incidence and severity of HZ are much reduced. Thus the stage is set for a large placebo-controlled clinical trial that will test directly the hypothesis that restoration of waning CMI to VZV will reduce the frequency and severity of HZ and its complications in the elderly. PMID: 8545018 [PubMed - indexed for MEDLINE] 3148. Neurology. 1995 Dec;45(12 Suppl 8):S21-8. Varicella-zoster virus ocular infection in the rabbit: a model of human zoster ophthalmicus. Dunkel EC, Geary PA, Pavan-Langston D, Piatak M, Zhu Q. Schepens Eye Research Institute, Harvard Medical School, Boston, MA, USA. PMID: 8545011 [PubMed - indexed for MEDLINE] 3149. Neurology. 1995 Dec;45(12 Suppl 8):S18-20. Varicella-zoster virus latency in the adult rat is a useful model for human latent infection. Sadzot-Delvaux C, Debrus S, Nikkels A, Piette J, Rentier B. Department of Microbiology, University of Liège, Belgium. A model of latent infection by varicella-zoster virus (VZV) was obtained in the adult rat. Inoculation of VZV-infected cells in the skin led to infection of the peripheral nervous system. Latency was characterized by a long-lasting presence of the viral genome, of selected viral gene transcripts, and of at least one viral protein in the dorsal root ganglia. Reactivation has not been obtained in vivo, but has occurred ex vivo after repeated stresses. Many similarities with VZV latency in humans were found, making this model useful for vaccine and antiviral studies. PMID: 8545010 [PubMed - indexed for MEDLINE] 3150. Neurology. 1995 Dec;45(12 Suppl 8):S1-79. Updated proceedings of the 2nd International Conference on the Varicella-Zoster Virus. Paris, France, July 7-8, 1994. [No authors listed] PMID: 8545006 [PubMed - indexed for MEDLINE] 3151. Proc Natl Acad Sci U S A. 1995 Nov 21;92(24):10980-4. Reactivated and latent varicella-zoster virus in human dorsal root ganglia. Lungu O, Annunziato PW, Gershon A, Staugaitis SM, Josefson D, LaRussa P, Silverstein SJ. Department of Microbiology, Columbia University, College of Physicians and Surgeons, New York, NY 10032, USA. Ganglia obtained at autopsy were examined by in situ hybridization from one patient with zoster (also called herpes zoster or shingles), two varicella-zoster virus (VZV)-seropositive patients with clinical evidence of zoster, one VZV-seronegative child, and one fetus. Ganglia positive for VZV had a hybridization signal in both neuronal and nonneuronal satellite cells. Ganglia obtained from the fetus and from the seronegative infant were consistently negative for VZV. Two striking observations were evident regarding the presence of VZV DNA in ganglia obtained from the individual with zoster at the time of death. First, ganglia innervating the sites of reactivation and ganglia innervating adjacent sites yielded strongly positive signals in neurons and satellite cells, whereas ganglia from distant sites were rarely positive. Second, VZV DNA was found in both the nuclei and the cytoplasm of neurons innervating areas of zoster. However, in neurons innervating zoster-free areas, VZV DNA was found only in the nucleus of neurons and their supporting satellite cells. Immunohistochemistry with a fluorescent monoclonal antibody to the VZV glycoprotein gpI, a late virus protein, revealed a positive signal in the cytoplasm of ganglia with clinical evidence of reactivation. These results illustrate that both neuronal and satellite cells become latently infected following primary VZV infection. The presence of VZV DNA and gpI in the cytoplasm of neurons demonstrates productive infection following reactivation at the site of latency. PMCID: PMC40554 PMID: 7479921 [PubMed - indexed for MEDLINE] 3152. Aten Primaria. 1995 Nov 15;16(8):508-10. [Herpes zoster in primary care] [Article in Spanish] Sanz Gallego PJ, Pérez Sánchez FC, Salgado Palacio MD, López Vázquez A. PMID: 8527636 [PubMed - indexed for MEDLINE] 3153. Clin Infect Dis. 1995 Nov;21(5):1348-9. Foscarnet-resistant multidermatomal zoster in a patient with AIDS. Fillet AM, Visse B, Caumes E, Dumont B, Gentilini M, Huraux JM. Department of Infectious and Tropical Diseases, Pitié-Salpêtrière Hospital, Paris, France. PMID: 8589182 [PubMed - indexed for MEDLINE] 3154. J Neurol Sci. 1995 Nov;133(1-2):194-6. Myasthenia gravis, acute transverse myelitis, and HTLV-I. Ijichi T, Adachi Y, Nishio A, Kanaitsuka T, Ohtomo T, Nakamura M. Department of Internal Medicine, Shakaihoken Kobe Central Hospital, Japan. We present the unusual case of a 49-year-old female carrier of HTLV-I with myasthenia gravis who presented with acute transverse myelitis. Laboratory data suggested a recent infection with varicella zoster virus and demyelination by an autoimmune process in the central nervous system. Adult T-cell leukemia-like cells were observed in the cerebrospinal fluid. T-cell-mediated immune responses modulated by HTLV-I infection may be involved in the pathogenesis of myasthenia gravis and acute transverse myelitis in this case. PMID: 8583226 [PubMed - indexed for MEDLINE] 3155. J Med Assoc Thai. 1995 Nov;78(11):624-7. Treatment of herpes zoster with Clinacanthus nutans (bi phaya yaw) extract. Sangkitporn S, Chaiwat S, Balachandra K, Na-Ayudhaya TD, Bunjob M, Jayavasu C. Department of Medical Sciences, Ministry of Public Health, Nonthaburi, Thailand. A randomized, placebo-controlled trial of the efficacy of topical formulation of Clinacanthus nutans (Bi Phaya Yaw) extract was carried out in 51 patients with varicella-zoster virus infection. The study medication was applied five times daily for 7-14 days until the lesions were healed. The number of patients with lesion crusting within 3 days and with lesion healing within 7 days and 10 days were significantly greater in the C. nutans extract-treated group than the placebo group (p < 0.01). Pain scores were reduced more rapidly in the C. nutans extract-treated group than in the placebo group. There were no side effects of the study medication. PMID: 8576675 [PubMed - indexed for MEDLINE] 3156. J Am Acad Dermatol. 1995 Nov;33(5 Pt 1):724-8. Rapid detection and distinction of cutaneous herpesvirus infections by direct immunofluorescence. Zirn JR, Tompkins SD, Huie C, Shea CR. Department of Dermatology, New York Hospital-Cornell Medical Center, USA. BACKGROUND: Optimal management of cutaneous herpes simplex virus (HSV) and varicellazoster virus (VZV) infections requires rapid, accurate distinction between these pathogens. OBJECTIVE: In a mixed-case series of suspected cutaneous herpesvirus infections, we compared the diagnostic utility of viral culture and direct immunofluorescence (DIF) using a panel of fluoresceinated monoclonal antibodies against HSV and VZV. METHODS: Epifluorescence microscopy of smears and viral culture were performed in parallel on 58 lesions. RESULTS: DIF and culture were equally sensitive (88%) in HSV infections, whereas DIF was four times as sensitive as culture (100% vs 18%) in VZV. DIF either refuted an incorrect clinical diagnosis or permitted definitive laboratory diagnosis of a clinically indeterminate lesion in 7 (12%) of 58 lesions tested. CONCLUSION: DIF is a rapid, simple, sensitive, specific, cost-effective, and clinically useful technique for detecting and distinguishing cutaneous HSV and VZV infections. PMID: 7593769 [PubMed - indexed for MEDLINE] 3157. J Clin Epidemiol. 1995 Nov;48(11):1319-24. Varicella zoster virus and multiple sclerosis in a Hutterite population. Ross RT, Nicolle LE, Cheang M. Section of Neurology, University of Manitoba, Winnipeg, Canada. There are similarities between multiple sclerosis and varicella. They are common in the same parts of the world and both are scarce in other areas. Immigration studies suggest the environmental cause of multiple sclerosis (MS) must be contracted prior to age 15 years and will usually remain dormant for years. At age 10 years varicella has occurred in greater than 95% of children living in the high-risk areas for both of these diseases. The varicella zoster virus (VZV) could be etiologically important in multiple sclerosis. The known host containment of the virus for decades with recrudescence and the variable cell-mediated immunity of the host, which can wax and wane without clinical manifestations, all lend themselves to the natural history of multiple sclerosis. A population-based study of the medical records of 5601 Hutterite Brethren was performed to determine the occurrence of multiple sclerosis, varicella, and herpes zoster. Compared to their matched non-Hutterite neighbors who acted as controls, these events were significantly less common among the Hutterites. Included in the study was an assessment of other common neurological diseases and "autoimmune" diseases among the Hutterites and the controls. There is evidence of a relationship between MS and VZV that may not be coincidental. PMID: 7490594 [PubMed - indexed for MEDLINE] 3158. Arch Ophthalmol. 1995 Nov;113(11):1381-5. Delayed herpes zoster pseudodendrites. Polymerase chain reaction detection of viral DNA and a role for antiviral therapy. Pavan-Langston D, Yamamoto S, Dunkel EC. Department of Ophthalmology, Harvard Medical School, Boston, Mass, USA. BACKGROUND: The late-onset pseudodendrites, delayed corneal mucous plaques, of herpes zoster ophthalmicus are reported to be of mechanical or immune origin and to be worsened by antiviral therapy. OBJECTIVE: To study pseudodendrites to ascertain a viral presence in the lesions and their response to antiviral therapy. DESIGN: Prospective clinical study. SETTING: Outpatient and inpatient hospital-based corneal specialty referral practice; molecular virology laboratory. PATIENTS: Six patients, aged 33 to 89 years, four with delayed herpes zoster ophthalmicus pseudodendrites and two with herpes zoster ophthalmicus neurotrophic ulceration. One patient was immunosuppressed. MAIN OUTCOME MEASURES: Findings from clinical evaluation; polymerase chain reaction assays of lesions and tear film of six patients; polymerase chain reaction and light and electron microscopy of the corneal button from one patient; and the clinical response of four patients to various antiviral drugs. RESULTS: In contrast to reports in the current literature, delayed pseudodendrites may also be infectious, as they are positive for zoster DNA by polymerase chain reaction and appear responsive to certain antiviral therapy. The corneal button from an immunosuppressed patient had mature and immature viral particles in the basal cells within 2 weeks of transplantation. CONCLUSIONS: To our knowledge, this is the first report of viral DNA in delayed zoster pseudodendrites. Recurrent viral infection may play a role in this form of zoster keratopathy and warrant antiviral therapy. PMID: 7487598 [PubMed - indexed for MEDLINE] 3159. Arch Ophthalmol. 1995 Nov;113(11):1358-9. Detecting varicella-zoster virus DNA in iridocyclitis using polymerase chain reaction: a case of zoster sine herpete. Yamamoto S, Tada R, Shimomura Y, Pavan-Langston D, Dunkel EC, Tano Y. PMID: 7487588 [PubMed - indexed for MEDLINE] 3160. South Med J. 1995 Nov;88(11):1089-92. Herpes zoster and internal malignancy. Smith JB, Fenske NA. Division of Dermatology and Cutaneous Surgery, University of South Florida, Tampa 33612, USA. Herpes zoster (HZ) often occurs concomitantly with various internal malignancies, most commonly hematologic in origin. Authors in the past proposed that HZ was a marker for internal malignancy, since it is often found in association with a malignancy. A critical review of the literature revealed that when HZ and malignancy occur in the same individual, rarely does HZ precede the malignancy, but usually follows it. Many studies have evaluated HZ in cancer patients, but only three studies have evaluated the occurrence of malignancy after the diagnosis of HZ, and all found no increased incidence of internal malignancy in patients with HZ. Since HZ is a poor marker for internal malignancy, extensive workups to find occult malignancy are not indicated. In rare cases, however, HZ precedes a malignancy. We therefore recommend a baseline history and physical examination, with further directed workup only if there are abnormal findings. PMID: 7481976 [PubMed - indexed for MEDLINE] 3161. N Z Med J. 1995 Oct 27;108(1010):432-3. Herpes zoster during pregnancy: a case report. Janes R. PMID: 7478348 [PubMed - indexed for MEDLINE] 3162. Med Lett Drugs Ther. 1995 Oct 13;37(959):87-94. Drugs for AIDS and associated infections. [No authors listed] PMID: 7565297 [PubMed - indexed for MEDLINE] 3163. Clin Infect Dis. 1995 Oct;21(4):989-90. Herpes zoster in patients with human immunodeficiency virus infection--an ever-expanding spectrum of disease. Whitley RJ, Gnann JW Jr. PMID: 8645853 [PubMed - indexed for MEDLINE] 3164. Clin Infect Dis. 1995 Oct;21(4):986-8. Chronic varicella-zoster virus myelitis without cutaneous eruption in a patient with AIDS: report of a fatal case. Manian FA, Kindred M, Fulling KH. Division of Infectious Diseases, St. John's Mercy Medical Center, St. Louis, Missouri 63141, USA. We describe a fatal case of varicella-zoster virus myelitis that was preceded by neurological symptoms for 10 months in a patient with human immunodeficiency virus infection and an extremely low CD4 cell count (20/microL). The patient was also receiving chronic acylovir therapy for suppression of herpes complex. Despite chronic unilateral periauricular and facial pain, which was later accompanied by upper- and lower-extremity weakness, a cutaneous eruption never developed. It is hypothesized that a blunted inflammatory response in the spinal cord--possibly related to a very low CD4 cell count--and long-term acylovir administration might have contributed to the atypical manifestation might have contributed to the atypical manifestation of varicella-zoster virus-related neurological disease in this immunocompromised patient. PMID: 8645852 [PubMed - indexed for MEDLINE] 3165. Clin Infect Dis. 1995 Oct;21(4):1035-7. Herpes zoster as the initial presentation of human immunodeficiency virus type 1 infection in Kenya. Tyndall MW, Nasio J, Agoki E, Malisa W, Ronald AR, Ndinya-Achola JO, Plummer FA. World Health Organization Collaborating Centre for Research and Training in Sexually Transmitted Diseases, Nairobi, Kenya. We conducted a prospective observational study to determine the clinical features, the degree of immunosuppression, and the prevalence of human immunodeficiency virus type 1 (HIV-1) infection associated with herpes zoster in Kenya. The study included 196 HIV-1 positive individuals and 34 HIV-1 negative individuals between the ages of 16 and 50 years who presented to a referral clinic in Nairobi. Comparison of the clinical characteristics in the two groups found that the duration of illness in the HIV-1-positive group was longer (32 vs. 22 days; P < .001) and that the HIV-1-positive group was more likely to have generalized lymphadenopathy (74% vs. 3%; OR: 12.2; 95% CI: 1.6, 91.7), severe pain (69% vs. 39%; OR: 3.6; 95% CI; 1.7, 7.6), bacterial superinfection (15% vs. 6%; OR: 5.7; 95% CI: 1.3, 25.0), and more than one affected dermatome (38% vs. 18%; OR: 2.8; 95% CI: 1.1, 8.0). Dermatomal distribution of the lesions was similar in the two groups, except for cranial lesions, which occurred exclusively in the HIV-1-positive group. The mean CD4 T lymphocyte count at presentation was 333/mm(3) in the HIV-1-positive group and 777/mm(3) in the HIV-1-negative group (P < .001). Herpes zoster is often recognized as the initial HIV-1-related illness in Kenya despite the fact that patients have moderate to severe depression of CD4 cell counts at presentation. Although the clinical features of herpes zoster may be more severe in HIV-1-positive individuals, recovery is generally complete and uncomplicated. PMID: 8645797 [PubMed - indexed for MEDLINE] 3166. J Mol Med. 1995 Oct;73(10):525-8. Molecular evidence for the existence of disseminated zoster as a distinct entity in an immunosuppressed renal transplant patient. Schlüpen EM, Korting HC, Nachbar F, Volkenandt M. Department of Dermatology, Ludwig-Maximilina University, München, Germany. Immunosuppressed renal transplant recipient are at substantially increased risk for the development of varicella zoster virus infections. They are also more prone than immunocompetent patients to develop atypical zoster and to experience a protracted course, and among them there is a higher frequency of generalized infections with possible fatal outcome. While establishing the diagnosis is essential to provide adequate therapy, conventional laboratory methods frequently fail to confirm the suspected infection. We report on a 47-year-old renal transplant recipient who developed multiple necrotic cutaneous ulcers under immunosuppressive treatment. While electron-microscopic analysis (negative staining) revealed no viral structures, varicella zoster virus specific DNA was detected by polymerase chain reaction in material obtained by a swab from these ulcers. Atypical herpetic infection should also be considered as a cause of disseminated ulcerative or necrotic skin lesions in immunosuppressed patients. Assays based on polymerase chain reaction are useful for the rapid confirmation or rejection of the suspected diagnosis of atypical herpetic infection. PMID: 8581515 [PubMed - indexed for MEDLINE] 3167. Pain. 1995 Oct;63(1):93-101. Capsaicin-induced flare and vasodilatation in patients with post-herpetic neuralgia. Morris GC, Gibson SJ, Helme RD. Prince Philip Hospital, Llanelli, Wales, UK. The aim of the present study was to investigate the role of primary afferent fibres with polymodal nociceptors in the various pain symptoms and signs associated with post-herpetic neuralgia (PHN). Forty-four patients with PHN affecting thoracic dermatomes were examined clinically for evidence of sensory disturbance to touch and pinprick and compared to 14 normal subjects and 9 subjects with evidence of past herpes zoster infection but no pain. The patients were then divided into 3 groups on the basis of their clinical symptoms and signs-those with steady burning discomfort only (n = 12), those with burning discomfort, allodynia and hyperalgesia to pinprick (n = 17), and those with burning discomfort, allodynia and hypalgesia to pinprick (n = 15). Indirect measurement of primary afferent fibre function was performed by measuring the neurogenic axon reflex flare to topical capsaicin using Doppler flowmetry in the 5 clinical groups. The 2 groups with allodynia had significantly decreased neurogenic flare responses compared to PHN subjects without allodynia and the 2 control groups. These results suggest that allodynia in patients with post-herpetic neuralgia may be a consequence of disrupted function of primary afferent fibres. PMID: 8577495 [PubMed - indexed for MEDLINE] 3168. Med Hypotheses. 1995 Oct;45(4):389-91. Obtaining automated diagnostic information and pain relief. Collins HW. The silent confluent flow of a conglomerate of sensory related signals is automatically delegated to the total specific distribution of a single spinal nerve. This silent confluent flow may be accessed, evaluated, and modified by using intradermal saline infiltration to stimulate the sensory receptors located in the skin overlying its nerve root. An unmistakable augmented burst of infiltration pain immediately followed by profound long lasting pain relief identifies a spinal nerve monitoring peripheral pathology. The identification of a monitoring spinal nerve tentatively confirms the presence of pathology confined to the specific peripheral distribution of that specific spinal nerve. The practically unknown visceral distribution proves to be specific and visceral pathology echoes through its collated spinal nerve without patent variation. Practically cost free and without side effects or contraindications dermatomal infiltration opens a whole new chapter in the field of diagnosis as it may be used to determine the presence of pathology, to locate that pathology to the specific distribution of a specific spinal nerve or nerves, and to produce unequalled pain relief. PMID: 8577304 [PubMed - indexed for MEDLINE] 3169. J Paediatr Child Health. 1995 Oct;31(5):483. Intra-uterine varicella or herpes zoster and childhood deafness. Mutton PE. PMID: 8554875 [PubMed - indexed for MEDLINE] 3170. Drugs Aging. 1995 Oct;7(4):317-28. Topical capsaicin. A review of its pharmacological properties and therapeutic potential in post-herpetic neuralgia, diabetic neuropathy and osteoarthritis. Rains C, Bryson HM. Adis International Ltd. Auckland, New Zealand. Capsaicin, the active principle of hot chili pepper, is thought to selectively stimulate unmyelinated C fibre afferent neurons and cause the release of substance P. Prolonged application of capsaicin reversibly depletes stores of substance P, and possibly other neurotransmitters, from sensory nerve endings. This reduces or abolishes the transmission of painful stimuli from the peripheral nerve fibres to the higher centres. In clinical studies of patients with post-hepatic neuralgia, diabetic neuropathy or osteoarthritis, adjunctive therapy with topical capsaicin achieved better relief than its vehicle in most studies. In a single trial, topical capsaicin in demonstrated similar efficacy to oral amitriptyline in patients with diabetic neuropathy. Topical capsaicin is not associated with any severe systemic adverse effects. However, stinging and burning, particularly during the first week of therapy, is reported by many patients. Topical capsaicin merits consideration as adjuvant therapy in conditions such as post-herpetic neuralgia, diabetic neuropathy and osteoarthritis, where the pain can be chronic and difficult to treat. PMID: 8535059 [PubMed - indexed for MEDLINE] 3171. Acta Paediatr Jpn. 1995 Oct;37(5):648-50. Herpes zoster in a normal child after varicella vaccination. Matsubara K, Nigami H, Harigaya H, Baba K. Department of Pediatrics, Nishi-Kobe Medical Center, Japan. A healthy 5 year old girl developed herpes zoster in the dermatome supplied by the ophthalmic branch of the fifth cranial nerve 40 months after varicella vaccination. She was admitted to our hospital because of high fever and painful vesicular lesions over the left side of her forehead. She was treated successfully with systemic and topical acyclovir without developing herpetic keratoconjunctivitis. Our acute and convalescent phase evaluations showed that non-specific cellular and humoral immunity was normal. This is the fourth case of herpes zoster developing in an immunocompetent child following vaccination. Unlike the previously reported cases, our patient required hospitalization mainly to prevent ocular involvement. The issue concerning whether the universal introduction of varicella vaccination of normal children will reduce the incidence of the subsequent occurrence of herpes zoster must await further studies involving longer follow-up periods. PMID: 8533598 [PubMed - indexed for MEDLINE] 3172. Fortschr Neurol Psychiatr. 1995 Oct;63(10):383-7. [Granulomatous vasculitis of the CNS as a complication of herpes zoster ophthalmicus] [Article in German] Terborg C, Busse O. Neurologische Klinik des Klinikums Minden. A 61-year old man with a history of arterial hypertension suffered a left HZO, and was treated with acyclovir. Three weeks later he suddenly developed moderate left hemiparesis particularly of the leg, severe paresis of the right leg, aphasia and somnolence. Treated with IV acyclovir and high-dose corticosteroids deterioration of the right hemiparesis was apparent. Serological and CSF-studies showed acute varicella-zoster virus infection with intrathecal antibody synthesis (antibody specificity index 2.7). On the third day CT scan revealed infarctions in the territory of both anterior cerebral arteries, at the fifth day additionally left striatocapsular infarction. Selective carotid arteriogram showed bilateral occlusions of anterior cerebral arteries in their proximal segment. With a mean delay of seven weeks granulomatous vasculitis is a rare complication of HZO, leading commonly to ischemic infarctions in the region of the middle cerebral artery. Trigeminovascular connections are the probable pathway of virus-transmission from the trigeminal nerve to ipsilateral branches of the circle of Willis. Because of the presumed pathogenesis immediate therapy with high-dose corticosteroids and acyclovir is justified. PMID: 8529986 [PubMed - indexed for MEDLINE] 3173. An Med Interna. 1995 Oct;12(10):501-2. [Acyclovir nephrotoxicity] [Article in Spanish] Briso-Montiano JM, Hernández E, Escudero E, Mendiluce A, Sánchez L, Miyar V. Servicio de Nefrología, Hospital Clínico-Universitario, Valladolid. Comment in: An Med Interna. 1996 Sep;13(9):459-60. We are presenting the case of a seventy-six year old male infected with Herpes zoster of the trigeminal nerve. He had no previous nephropathology, but developed acute renal failure following the administration of an intravenous bolus of Acyclovir. The existing literature was reviewed. Possible pathogenic mechanisms are discussed, and precautions against nephrotoxicity are emphasized. PMID: 8519942 [PubMed - indexed for MEDLINE] 3174. AIDS. 1995 Oct;9(10):1153-8. Herpes zoster, immunological deterioration and disease progression in HIV-1 infection. Veenstra J, Krol A, van Praag RM, Frissen PH, Schellekens PT, Lange JM, Coutinho RA, van der Meer JT. Department of Public Health and Environment, University of Amsterdam, The Netherlands. OBJECTIVE: To study the incidence of herpes zoster, the relationship between herpes zoster and immunological markers, and the prognostic value of herpes zoster for progression of HIV disease. DESIGN AND METHODS: A total of 966 homosexual participants in The Amsterdam Cohort Study were studied. Herpes zoster was defined by its characteristic clinical presentation. Incidence was calculated using Poisson regression, cumulative incidence by the Kaplan-Meier product-limit method and the prognostic value was evaluated using Cox proportional hazards model. RESULTS: The incidence of first episodes of herpes zoster was 3.31 per 1000 person-years (PY) in HIV-seronegatives and 51.51 per 1000 PY in HIV-1-seropositive individuals. Recurrences only occurred in HIV-1-positive patients (25.6%). Cumulative incidences of first episodes increased linearly with the duration of follow-up. In HIV-1-seropositives the incidence was 31.2 per 1000 PY at CD4+ cells > or = 500 x 10(6)/l, 47.2 per 1000 PY [relative risk (RR), 1.51; 95% confidence interval (CI), 0.78-2.94] at CD4+ cells 200-499 x 10(6)/l and 97.5 per 1000 PY (RR, 3.13; 95% CI, 1.54-6.32) at CD4+ cells < 200 x 10(6)/l. Besides CD4+ cell counts, CD3 monoclonal antibodies and phytohaemagglutinin-induced T-cell reactivity were independent predictors for herpes zoster. The hazard ratio for AIDS after herpes zoster was 1.6 (95% CI, 1.1-2.4) and for death 1.7 (95% CI, 1.1-2.5), but these were not independent from CD4+ cell counts. CONCLUSION: In HIV-1 infection the incidence of herpes zoster increases with the decrease of CD4+ cell counts and T-cell reactivity, but herpes zoster is not an independent predictor for disease progression. PMID: 8519451 [PubMed - indexed for MEDLINE] 3175. J Laryngol Otol. 1995 Oct;109(10):1013-5. Ramsay Hunt syndrome mimicking acoustic neuroma on MRI. Goldsmith P, Zammit-Maempel I, Meikle D. Nuffield Department of Medicine, John Radcliffe Hospital, Oxford. PMID: 7499937 [PubMed - indexed for MEDLINE] 3176. Transplant Proc. 1995 Oct;27(5 Suppl 1):10-2. Antiviral antibodies in transplantation. Snydman DR. Department of Medicine, New England Medical Center, Boston, Massachusetts 02111, USA. Antiviral antibodies clearly play a role in organ transplantation. The only antibody with a licensed indication for this population is CMVIG; however, the use of HBIG has become the standard of care for those patients at risk for HBV recurrence, and the use of VZIG would appear to be indicated for exposures to varicella-zoster in patients lacking immunity. Future studies defining the role of antiviral antibodies for therapy are necessary, and the role of antibody to prevent the EBV PTLD remains to be explored. PMID: 7482809 [PubMed - indexed for MEDLINE] 3177. Lancet. 1995 Sep 30;346(8979):914-5. Are varicella zoster and herpes simplex sentinel lesions for cytomegalovirus in renal transplant recipients? Lippmann BJ, Brennan DC, Wong J, Lowell JA, Singer GG, Howard TK. PMID: 7564715 [PubMed - indexed for MEDLINE] 3178. Acta Otolaryngol. 1995 Sep;115(5):577-84. Gd-DPTA enhanced MRI in Bell's palsy and herpes zoster oticus: an overview and implications for future studies. Jonsson L, Tien R, Engström M, Thuomas KA. Department of Oto-Rhino-Laryngology, Uppsala University, Akademiska sjukhuset, Sweden. Magnetic resonance imaging (MRI) is a new and important tool for use in diagnosing and investigating diseases affecting the facial nerve. In recent gadolinium-DTPA enhanced MRI (Gd-MRI) studies it has unequivocally been demonstrated that ipsilateral facial nerve contrast enhancement, predominantly in the meatal portion, is present in both Bell's palsy and herpes zoster oticus. In this overview, the results of MRI studies performed on patients with acute peripheral facial palsy, especially Bell's palsy and herpes zoster oticus, are discussed. The Gd-MRI pattern in Bell's palsy is very similar to that seen in herpes zoster oticus, and the findings reported so far support the theory that an inflammation may be the cause of the nerve injury in both cases. So far, however, Gd-MRI has not been helpful in evaluating the severity and/or prognosis of the facial palsy. Further studies employing improved techniques, including three-dimensional fast (or turbo) spin echo (3DFSE) MRI with heavily T2-weighted sections and high resolution three-dimensional Fourier transform (3DFT) MRI, need to be conducted in order to determine whether it is possible to follow the course of the disease and whether MRI and/or Gd-MRI are useful prognostic tools in the early stages of palsy. PMID: 8928627 [PubMed - indexed for MEDLINE] 3179. Pharmacotherapy. 1995 Sep-Oct;15(5 Pt 2):49S-58S. Cost-consequence models for varicella-zoster virus infections. Paul JE, Mauskopf JA, Bell L. Care Management Division, Glaxo Wellcome USA Inc., Research Triangle Park, North Carolina 27709, USA. Three cost-consequence models were developed for treatment of infections due to varicella-zoster virus (VZV) with acyclovir in immunocompetent patients--adult- and childhood-onset chickenpox, and herpes zoster (shingles) in adults. For chickenpox, separate models allow examination of differences in severity and impact of the disease for children and adults, as well as in the management of civilians and adults in military service. Each model includes direct medical costs, indirect costs and health-related productivity loss, symptom and quality of life impact, and model assumptions and conclusions. Alternatives of treatment and no treatment are addressed. Quality of life impact is conceptualized in terms of a quality-adjusted life-days decrement due to VZV symptoms of importance to the patient, such as pain, rash, and itching. As experience and data become available, alternative agents such as valacyclovir and famciclovir for the treatment of patients with herpes zoster should be included in the modeling process. PMID: 8577631 [PubMed - indexed for MEDLINE] 3180. Pharmacotherapy. 1995 Sep-Oct;15(5 Pt 2):43S-48S. Management of herpesvirus infections in the healthy host. Dudley MN. Antiinfective Pharmacology Research Unit, University of Rhode Island College of Pharmacy, Roger Williams Medical Center, Providence 02908-4734, USA. Human herpesvirus infections continue to be a concern in immunocompetent as well as immunocompromised hosts. They are often life threatening in the immunocompromised patient. In the healthy immunocompetent person the infections tend to be self-limited, although they can directly or indirectly cause periods of severe discomfort and disability, and their treatment can affect productivity, as shown by cost-outcome models. Treatment of primary or secondary episodes in the immunocompetent host is therefore directed toward more rapid resolution of initial and recurrent episodes, thereby limiting the impact of the infections. PMID: 8577630 [PubMed - indexed for MEDLINE] 3181. Rhinology. 1995 Sep;33(3):180-2. Hutchinson's sign and its importance in rhinology. Tomkinson A, Roblin DG, Brown MJ. Department of Otolaryngology, Royal Gwent Hospital, Newport, United Kingdom. Herpes zoster ophthalmicus usually has a typical appearance. However, if the disease is limited to the nasociliary branch of the trigeminal nerve, the ocular appearance may be confusing. Hutchinson in 1865 first noted that involvement of the external nasal branch of the fifth cranial nerve was associated with an increased incidence of ocular zoster. A case of herpes zoster ophthalmicus is presented that clinically resembled an ocular complication of sinus disease. The presence of a localized vesicular rash at the nasal tip assisted in an early diagnosis. Although this sign is known amongst ophthalmologists, its importance in rhinology is stressed. An anatomical explanation of Hutchinson's sign is given and the treatment of herpes zoster ophthalmicus is briefly discussed. PMID: 8560175 [PubMed - indexed for MEDLINE] 3182. Rev Neurol. 1995 Sep-Oct;23(123):1063-6. [CNS vasculitis after ophthalmic herpes zoster infection] [Article in Spanish] Muñoz A, Viñuela F, Mesa A, Fernández JM, Garcia Moreno JM, Izquierdo G. Servicio de Medicina Interna, Hospital Universitario Virgen Macarena, Sevilla. We present a case of cerebral vasculitis secondary to infection with Varicella Zoster Virus which appeared in a 27 year old patient after a latency period of eight weeks. We emphasize the usefulness of angioresonance as a fitting means of evolutive follow up without the need to carry out control cerebral angiography. We likewise point out the usefulness of acyclovir as the sole treatment necessary in non-complicated cases. PMID: 8556594 [PubMed - indexed for MEDLINE] 3183. Burns. 1995 Sep;21(6):477. Ophthalmic zoster as a reason for admission into a regional burns unit. Greenwood JE, Davenport PJ. PMID: 8554696 [PubMed - indexed for MEDLINE] 3184. Clin J Pain. 1995 Sep;11(3):220-8. Continuous epidural infusion of local anesthetics and shorter duration of acute zoster-associated pain. Manabe H, Dan K, Higa K. Department of Anesthesiology, School of Medicine, Fukuoka University, Japan. OBJECTIVE: The purpose of this study was to investigate the effects of continuous epidural blockade on acute zoster-associated pain, compared with intermittent epidural blocks. DESIGN: The design was a retrospective, nonrandomized study. SETTING: The study was conducted at a university hospital in Japan from 1982 through 1992. PATIENTS: A total of 178 otherwise healthy patients hospitalized with moderate or severe herpes zoster lesions. INTERVENTIONS: Group A (n = 66) had intermittent epidural blocks using 1% mepivacaine, 4-6 ml, three to six time daily; group B (n = 43) were given intermittent epidural blocks and parenteral acyclovir (500 mg/day) or vidarabine (600 mg/day) for 5 days; group C (n = 69) were administered a continuous epidural 0.5% bupivacaine infusion (0.3-1.0 ml/h) for approximately 2 weeks and antiviral agents followed by intermittent blocks. MAIN OUTCOME MEASURES: The number of treatment days was used as the outcome measure. RESULTS: The length of treatment was significantly shorter in group C than in groups A or B. For moderate lesions the means (days) were 36.2 [95% confidence interval (CI), 31.4-41.7), 45.6 (95% CI, 34.0-61.4), and 26.8 (95% CI, 22.3-32.3) for groups A, B, and C, respectively (p < 0.01). For severe lesions they were 73.3 (95% CI, 55.1-97.7), 81.7 (95% CI, 59.1-113.0), and 44.9 (95% CI, 35.2-57.3) for groups A, B, and C, respectively (p < 0.01). CONCLUSIONS: Continuous epidural blockade for patients with acute zoster can shorten the duration of treatment and may reduce the incidence of postherpetic neuralgia. PMID: 8535042 [PubMed - indexed for MEDLINE] 3185. Anesth Analg. 1995 Sep;81(3):646-8. A case of herpes zoster myelitis occurring during epidural analgesia. Oda Y, Terai T, Yukioka H, Fujimori M. Department of Anesthesiology and Intensive Care Medicine, Osaka City University Medical School, Japan. PMID: 7653839 [PubMed - indexed for MEDLINE] 3186. Laryngorhinootologie. 1995 Sep;74(9):553-4. [Detection of serum IgA antibodies to varicella zoster virus (VZV)--differential etiology of peripheral facial paralysis. A case report] [Article in German] May G, May W. Institut für Virusdiagnostik am Hyg.-bakt. Landesuntersuchungsamt, Westfalen, Münster. During the early manifestation of peripheral facial paralysis, VZV specific IgA antibodies were detected in the serum in a single case. In similar cases, this serological parameter should be tested for causal diagnosis in connection with early Aciclovir therapy. PMID: 7495437 [PubMed - indexed for MEDLINE] 3187. Aust Fam Physician. 1995 Sep;24(9):1747; quiz 1747-8. Shingles in a 63 year old woman. [No authors listed] PMID: 7487662 [PubMed - indexed for MEDLINE] 3188. J Neuroradiol. 1995 Sep;22(3):184-92. [CMV and VZV encephalitis in AIDS] [Article in French] Hassine D, Gray F, Chekroun R, De Truchis P, Schouman-Claeys E, Vallée C. Service de Radiologie, Hôpital Raymond Poincaré, Garches. MATERIAL AND METHODS: Eighty patients were followed up prospectively. Histological correlation was obtained in 25 cases. All MRI examinations were performed on at 0.5 Tesla in T1-weighted sequences with and without gadolinium injection, and in axial or frontal T2-weighted spin echo sequences. Histological confirmation was obtained 30 days on average after the last MRI examination. Immunohistochemical stainings were performed in search of CMV, VZV, toxoplasma, HIV antigen and lymphoma. RESULTS: CMV meningoencephalitis was found in 6 cases. In 3 of these it was manifested by atrophy, either isolated or associated with high signal intensity punctiform areas. Histology detected cortical or subcortical microglial nodules. In 2 cases MRI displayed abnormalities of subependymal nodular signals without enhancement, associated with punctiform abnormalities of subcortical signals. Histology showed subependymal foci of necrosis and abnormalities of white matter. In one case, MRI showed a ventriculitis confirmed by histology. VZV meningoencephalitis was diagnosed in 2 cases. MRI displayed abnormal basal ganglia related to meningitis (n = 1). All abnormalities were confirmed at histology. CONCLUSION: Some images (ventriculitis, infarction in basal ganglia, abnormal subependymal signal) would suggest VZV and CMV encephalitis. Other images (abnormalities of punctiform signals or atrophy) are not specific. PMID: 7472535 [PubMed - indexed for MEDLINE] 3189. J Neuroradiol. 1995 Sep;22(3):180-3. [Pathologic anatomy of cytomegalovirus encephalomyelitis and varicella-zona virus encephalomyelitis] [Article in French] Henin D, Gervaz E, Seilhean D. Service d'Anatomie et de Cytologie Pathologiques, Hôpital Beaujon, Clichy. Cytomegalovirus (CMV) infection of the nervous system is frequent in acquired immunodeficiency syndrome (AIDS) and can be responsible for encephalitis, encephalomyelitis, meningoradiculitis or polyradiculo-neuropathy. Encephalitis is characterized at microscopy by its periventricular and cerebellar location, and by the presence of cytomegalic cells, containing intranuclear and/or intracytoplasmic inclusions, microglial nodules and necrotic foci. The virus can infect almost all types of cells. Coexistence of CMV and HIV has been observed in giant cells of macrophagic origin. It has been suggested that the two viruses could act in synergy. The nervous system is seldom infected by the varicella-zoster virus (VZV) in AIDS. The infection can be responsible for multifocal leukoencephalitis, ventriculitis, vascular lesions associated or not with cerebral infarction, or with meningomyeloradiculitis. In almost all cell types Cowdry's type A intranuclear inclusions have been found. The virus can be demonstrated by immunohistochemistry or in situ hybridization. VZV antigens have been reported in the walls of vessels damaged by a non inflammatory obliterating vasculopathy or by a granulomatous angiitis. Coexistence of VZV and HIV has been observed in giant cells of macrophagic origin, and synergy between those two viruses has been suspected. PMID: 7472534 [PubMed - indexed for MEDLINE] 3190. Dtsch Med Wochenschr. 1995 Aug 18;120(33):1133-8. [Herpes zoster: a herpes non-simplex disease] [Article in German] Wutzler P, Doerr HW. Institut für Antivirale Chemotherapie der Universität Jena. PMID: 7656839 [PubMed - indexed for MEDLINE] 3191. Ned Tijdschr Geneeskd. 1995 Aug 12;139(32):1657. [Acetylsalicylic acid in acute and postherpetic neuralgia should no be dissolved in chloroform] [Article in Dutch] van Horssen N. Laboratorium der Nederlandse Apothekers, Den Haag. PMID: 7566222 [PubMed - indexed for MEDLINE] 3192. Arch Intern Med. 1995 Aug 7-21;155(15):1605-9. The incidence of herpes zoster. Donahue JG, Choo PW, Manson JE, Platt R. Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Boston, Mass., USA. BACKGROUND: There are few population-based studies of the natural history and epidemiology of herpes zoster. Although a relatively common cause of morbidity, especially among the elderly, contemporary estimates of herpes zoster incidence are lacking. Herein we describe a population-based investigation of incident and recurrent herpes zoster from 1990 through 1992 in a health maintenance organization. METHODS: The health maintenance organization's automated medical records contain clinical and administrative information about care rendered to patients in ambulatory settings, emergency departments, and hospitals. Cases of herpes zoster were ascertained by screening the medical record for coded diagnoses. The predictive value of a herpes zoster diagnosis code was determined by review of a sample of patient records. Records from all patients with potential recurrences were also reviewed. RESULTS: The overall incidence, based on 1075 cases in 500,408 person-years, was 215 per 100,000 person-years (95% confidence interval, 192 to 240 per 100,000) and did not vary by gender. Although the rate increased sharply with age, approximately 5% of the cases occurred among children younger than 15 years. Infection with human immunodeficiency virus was documented in 5% of the persons with incident herpes zoster and cancer in 6%. Four persons had confirmed recurrences of herpes zoster (744 per 100,000 person-years; 95% confidence interval, 203 to 1907); three of these persons were infected with the human immunodeficiency virus. CONCLUSIONS: The recorded incidence of herpes zoster was 64% higher than that reported 30 years ago; the age-standardized rate was more than twofold higher. Immunosuppressive conditions had little impact on overall incidence, although they were strongly associated with early recurrences. PMID: 7618983 [PubMed - indexed for MEDLINE] 3193. Dtsch Med Wochenschr. 1995 Aug 4;120(31-32):1102. [Therapy of peripheral facial nerve paralysis and hearing loss] [Article in German] Hüttenbrink KB. Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde der Technischenn Universität, Dresden PMID: 7543839 [PubMed - indexed for MEDLINE] 3194. An Med Interna. 1995 Aug;12(8):410-1. [Polyradiculitis and cutaneous herpes zoster] [Article in Spanish] Sánchez Ayuso FJ, Sicilia Enríquez de Salamanca JJ. PMID: 8924538 [PubMed - indexed for MEDLINE] 3195. Clin Infect Dis. 1995 Aug;21(2):370-5. Clinical spectrum of herpes zoster in adults infected with human immunodeficiency virus. Glesby MJ, Moore RD, Chaisson RE. Department of Medicine, Johns Hopkins University, School of Medicine, Baltimore, Maryland 21205, USA. Comment in: Clin Infect Dis. 1996 Jun;22(6):1128-9. To determine the incidence and clinical manifestations of herpes zoster in a hospital-based clinic for adults infected with human immunodeficiency virus (HIV), we reviewed the records of all patients for whom zoster was diagnosed at or after their first clinic visit. Fifty-two episodes of zoster occurred in 45 patients during 1,614 person-years of follow-up (incidence, 3.2 episodes per 100 person-years). The following major complications of zoster occurred in 12 patients (27%): ocular complications (5), neurological complications (4), and chronic atypical skin lesions (5). Six patients each had postherpetic neuralgia and bacterial superinfection, which were the common minor complications of zoster. Multivariate analysis revealed that only a low CD4 cell count (< or = 200/mm3) was predictive of a major complication of zoster (OR, 13.2; 95% CI, 1.52-114; P = .019). Thus, complications of herpes zoster are common in patients with HIV infection, especially those with advanced immunosuppression. PMID: 8562746 [PubMed - indexed for MEDLINE] 3196. Drugs. 1995 Aug;50(2):396-415. Famciclovir. A review of its pharmacological properties and therapeutic efficacy in herpesvirus infections. Perry CM, Wagstaff AJ. Adis International Limited, Auckland, New Zealand. Famciclovir, a synthetic acyclic guanine derivative, is a prodrug which, after oral administration, is rapidly metabolised to the highly bioavailable antiviral compound penciclovir. Penciclovir is active in vitro against the herpesviruses herpes simplex virus (HSV)-1, HSV-2 and varicella zoster virus (VZV). Famciclovir is an effective treatment of immunocompetent patients with acute herpes zoster (shingles) caused by VZV. Comparative studies have demonstrated that famciclovir has therapeutic efficacy similar to that of oral aciclovir (acyclovir) in attenuating the acute signs and symptoms of infection (including pain during the acute phase of infection). In a placebo-controlled study, famciclovir significantly reduced the duration of postherpetic neuralgia; this effect was more pronounced (almost a 3-fold reduction) in patients aged > or = 50 years. In immunocompetent patients with recurrent genital herpes infection, suppressive treatment with oral famciclovir effectively prolonged the time to recurrence of symptomatic episodes of infection compared with placebo. In addition, famciclovir significantly reduced the duration of viral shedding, accelerated healing of genital herpes lesions and reduced the duration of symptoms. Famciclovir is reported to be the first antiviral agent to significantly reduce symptoms associated with multiple genital herpes lesions. Famciclovir is a well-tolerated drug with a tolerability profile similar to that of placebo and aciclovir. Thus, famciclovir is now established as an effective treatment of immunocompetent patients with herpes zoster or genital herpes infection, particularly as famciclovir is administered in a convenient dosage regimen that may improve compliance compared with aciclovir. PMID: 8521764 [PubMed - indexed for MEDLINE] 3197. Arch Ophthalmol. 1995 Aug;113(8):972-3. Bilateral optic neuritis following herpes zoster ophthalmicus. Deane JS, Bibby K. PMID: 7639667 [PubMed - indexed for MEDLINE] 3198. Am J Ophthalmol. 1995 Aug;120(2):252-3. Aqueous and vitreous humor samples for the diagnosis of cytomegalovirus retinitis. Mitchell SM, Fox JD. Moorfields Eye Hospital, London, United Kingdom. PURPOSE/METHODS: Techniques for detection of viral DNA based on the polymerase chain reaction are increasingly being applied to ocular fluids; however, the clinical significance of such findings can sometimes be unclear. Two patients had the acquired immunodeficiency syndrome (AIDS) in whom different herpesviruses were detected in aqueous and vitreous fluids from the involved eye. RESULTS/CONCLUSIONS: In both patients dual viral infections were present and the application of polymerase chain reaction-based methods to ocular fluids made a useful contribution to the treatment of the patients. PMID: 7639312 [PubMed - indexed for MEDLINE] 3199. J Neurol Neurosurg Psychiatry. 1995 Aug;59(2):198-9. Herpes zoster meningoencephalitis without rash: varicella zoster virus DNA in CSF. Powell KF, Wilson HG, Croxson MO, Marshall MR, Wong EH, Anderson NE, Thomas MG. PMCID: PMC486008 PMID: 7629547 [PubMed - indexed for MEDLINE] 3200. Kansenshogaku Zasshi. 1995 Aug;69(8):908-12. [Incidence of herpes zoster in pediatricians and history of reexposure to varicella-zoster virus in patients with herpes zoster] [Article in Japanese] Terada K, Hiraga Y, Kawano S, Kataoka N. Department of Pediatrics, Kawasaki Medical School. We found that pediatricians have enhanced specific cellular immunity to varicella-zoster virus (VZV) compared with the general population, which may be due to reexposure to VZV from children with chickenpox. There have been some reported that the varicella vaccine enhance the specific cellular immunity. To estimate the efficacy of varicella vaccine for protection against herpes zoster in the elderly, we investigated the incidence of herpes zoster in 500 pediatricians and family practitioners with their fifties and sixties, and history of reexposure to VZV in 61 patients with herpes zoster by questionnaires retrospectively. Thirty-four of 352 pediatricians had a past history of herpes zoster. The incidence per 100,000 person-years of herpes zoster was 65.2 in those in their fifties and 158.2 in those in their sixties, which are 1/2 to 1/8 of other reports regarding the general population. Among 61 immunocompetent patients with herpes zoster, only 4 patients (6.6%) had the chance for reexpose to VZV before their herpes zoster. Only 7 (17.5%) of the 40 patients older than 50 years of age lived with their children less than 14 years of age. Twenty-three (57.5%) of them lived without their children and grandchildren. They are thought to be less chance to reexpose to VZV through children. We may think that the booster effect by reexposure to VZV plays an important role to prevent herpes zoster. Therefore, we can speculate that the varicella vaccine may protect against herpes zoster in the elderly by the enhanced specific cellular immunity due to the booster effect. PMID: 7594784 [PubMed - indexed for MEDLINE] 3201. Arch Dis Child. 1995 Aug;73(2):162-3. Reactivation of chickenpox contracted in infancy. Terada K, Kawano S, Hiraga Y, Morita T. Department of Paediatrics, Kawasaki Medical School, Okayama, Japan. Varicella zoster virus DNA in mononuclear cells was studied by the polymerase chain reaction to obtain virological evidence of reactivation in the children who had contracted chickenpox in infancy. The results appear to explain why chickenpox in infancy is a risk factor for herpes zoster in immunocompetent children. PMCID: PMC1511193 PMID: 7574864 [PubMed - indexed for MEDLINE] 3202. Rev Clin Esp. 1995 Aug;195(8):530-3. [Herpes-zoster virus infection in patients with systemic lupus erythematosus] [Article in Spanish] Moga I, Formiga F, Canet R, Pac M, Mitjavila F, Pujol R. Servicio de Medicina Interna, Hospital de Bellvitge-Princeps d'Espanya, CSU de Bellvitge. The prevalence of infection with VZV in 145 patients with SLE was investigated, with a mean follow-up of 7.6 years; its relationship with different variables, particularly with therapy of the underlying disease, was analyzed. Twenty episodes of VZV infection in 19 patients were diagnosed (13.1%). In no case was the therapeutic regime changed nor was worsening of SLE observed. There was neither dissemination of herpes nor superinfection. An increase in the number of VZV infections was observed in patients with SLE under corticosteroid therapy (p = 0.04) and particularly when drug administration was on a daily basis (p = 0.00006). Cytotoxic agents also favored the infection (p = 0.0014). VZV infection is of a benign nature in SLE and its emergence is favored by immunosuppressive agents. The risk is lower if corticosteroid administration is on alternate days. There is no need to decrease therapy for SLE. PMID: 7569198 [PubMed - indexed for MEDLINE] 3203. J Laryngol Otol. 1995 Aug;109(8):777-80. Early diagnosis and treatment of Ramsay Hunt syndrome: the role of magnetic resonance imaging. Kuo MJ, Drago PC, Proops DW, Chavda SV. Department of Otolaryngology and Radiology, Queen Elizabeth Hospital, Birmingham, UK. We present the case of a 47-year-old woman with left otalgia, rotatory vertigo, sensorineural hearing loss and acute facial nerve palsy. An enhanced magnetic resonance imaging (MRI) scan showed discrete enhancement of the facial and vestibulocochlear nerves in the left internal auditory canal as well as of the labyrinth. This appearance was compatible with that in Ramsay Hunt syndrome and acyclovir was started prior to the appearance of any vesicular eruption. The diagnosis was subsequently confirmed serologically. She regained full facial function but the sensorineural hearing loss persisted. The literature pertaining to the role of the MRI in acute facial palsies is reviewed. PMID: 7561508 [PubMed - indexed for MEDLINE] 3204. J Dermatol. 1995 Aug;22(8):625-6. Mild reduction of generalized rash in guinea pigs experimentally infected with varicella zoster virus or herpes simplex virus type 1. Horiuchi Y, Okuno T, Yamanishi K. PMID: 7560465 [PubMed - indexed for MEDLINE] 3205. Ann Intern Med. 1995 Jul 15;123(2):89-96. Famciclovir for the treatment of acute herpes zoster: effects on acute disease and postherpetic neuralgia. A randomized, double-blind, placebo-controlled trial. Collaborative Famciclovir Herpes Zoster Study Group. Tyring S, Barbarash RA, Nahlik JE, Cunningham A, Marley J, Heng M, Jones T, Rea T, Boon R, Saltzman R. University of Texas Medical Branch, Galveston, USA. Comment in: ACP J Club. 1995 Nov-Dec;123(3):67. Ann Intern Med. 1999 Nov 2;131(9):712-3. OBJECTIVE: To document the effects of treatment with famciclovir on the acute signs and symptoms of herpes zoster and postherpetic neuralgia. DESIGN: A randomized, double-blind, placebo-controlled, multicenter trial. SETTING: 36 centers in the United States, Canada, and Australia. PATIENTS: 419 immunocompetent adults with uncomplicated herpes zoster. INTERVENTION: Patients were assigned within 72 hours of rash onset to famciclovir, 500 mg; famciclovir, 750 mg; or placebo, three times daily for 7 days. MEASUREMENTS: Lesions were assessed daily for as long as 14 days until full crusting occurred and then weekly until the lesions healed. Viral cultures were obtained daily while vesicles were present. Pain was assessed at each of the visits at which lesions were examined and then monthly for 5 months after the lesions healed. Safety was assessed throughout the study. RESULTS: Famciclovir was well tolerated, with a safety profile similar to that of placebo. Famciclovir accelerated lesion healing and reduced the duration of viral shedding. Most importantly, famciclovir recipients had faster resolution of postherpetic neuralgia (approximately twofold faster) than placebo recipients; differences between the placebo group and both the 500-mg famciclovir group (hazard ratio, 1.7 [95% CI, 1.1 to 2.7]) and the 750-mg famciclovir group (hazard ratio, 1.9 [CI, 1.2 to 2.9]) were statistically significant (P = 0.02 and 0.01, respectively). The median duration of postherpetic neuralgia was reduced by approximately 2 months. CONCLUSIONS: Oral famciclovir, 500 mg or 750 mg three times daily for 7 days, is an effective and well-tolerated therapy for herpes zoster that decreases the duration of the disease's most debilitating complication, postherpetic neuralgia. PMID: 7778840 [PubMed - indexed for MEDLINE] 3206. Zh Mikrobiol Epidemiol Immunobiol. 1995 Jul-Aug;(4):72-5. [The clinical efficacy in using leukinferon in adults with diseases caused by the varicella-zoster virus] [Article in Russian] Kuznetsov VP, Nikolaeva IN, Barer GM, Beliaev DL, Sundukov AV, Babaiants AA, Iushchuk ND. To achieve more effective treatment of varicella (chickenpox) and herpes zoster in adults, a wide-spectrum immunocorrective agent containing, together with alpha-interferon, a number of other cytokines of the first phase of immune response was used. In patients with the different severity of disease leukinferon induced a rapid decrease in the severity of the disease, arrested the development of new elements on the skin and the buccal mucosa, and reduced the duration of the fever period. When used in such forms as intramuscular injections in combination with the irrigation of the buccal mucosa and ointment, leukinferon proved to be a highly effective preparation for the treatment of diseases caused by varicella-zoster virus. PMID: 9381878 [PubMed - indexed for MEDLINE] 3207. Ann Acad Med Singapore. 1995 Jul;24(4):528-33. Prevalence of skin disease in patients infected with human immunodeficiency virus in Bangkok, Thailand. Sivayathorn A, Srihra B, Leesanguankul W. Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. A detailed study of the skin lesions of 248 patients infected with the human immunodeficiency virus (HIV) in Bangkok, Thailand, is reported. The study population consisted of 140 patients with asymptomatic disease (stage I), 27 patients with symptomatic disease (stage II), and 81 patients with advanced stage of the disease (stage III). Ninety-five percent of all patients were observed to have one or more skin disorders. Conditions with prevalence higher than 5% included oral candidiasis (34.3%), pruritic papular eruption (32.7%), seborrhoeic dermatitis (21.0%), herpes zoster (16.1%), oral hairy leucoplakia (14.9%), herpes simplex (10.9%), onychomycosis (9.3%), cutaneous ringworm (7.7%), psoriasis (6.5%), and folliculitis (5.6%). Patients in the stage II and III subgroups were found to have a significantly more number of skin disorders than patients in stage I. The prevalence pattern of skin disorders in this study are generally similar to previous studies in the literature. Three notable differences, however, emerge from this study: (1) the high prevalence of pruritic papular eruption in all subgroups, (2) the high prevalence of Penicillium maneffei infection in patients with advanced disease, and (3) the absence of Kaposi's sarcoma in the study population. Knowledge about the cutaneous disease pattern in the locals will be more clinically relevant for proper care of the patients. PIP: During July 1993-June 1994 in Bangkok, Thailand, dermatologists examined the skin of 248 HIV-infected patients attending the outpatient clinic or admitted to the medical wards of Siriraj Hospital and performed a CD4+ T-lymphocyte count to determine the prevalence of skin disorders in HIV-infected people and to categorize them into clinical stages. 86% of the patients were male. 140 people were in the asymptomatic group, 27 in the symptomatic group, and 81 in the advanced group (CD4+ 50 cells/sq m). 95% of all HIV-infected patients had at least 1 skin disorder, especially oral candidiasis (34.3%) and pruritic papular eruption (PPE) (32.7%). Other skin disorders included seborrhoeic dermatitis (21%), herpes zoster (16.1%), oral hairy leukoplakia (14.9%), herpes simplex (10.9%), onychomycosis (9.3%), cutaneous ringworm (7.7%), psoriasis (6.5%), and folliculitis (5.6%). No one had Kaposi's sarcoma. 3.2% of all HIV-infected patients had Penicillium maneffei infection, which was limited to only AIDS patients. 9.9% of AIDS patients had Penicilliosis maneffei. Prior to the AIDS epidemic, this infection was unknown to most physicians. AIDS patients were more likely to have at least 3 skin disorders. AIDS patients were more likely to have severe skin lesions than asymptomatic and symptomatic patients (14.8% vs. 9.4% and 7.5%, respectively). Asymptomatic patients had higher prevalence of the frequently seen skin disorders, except cutaneous ringworm, than general patients attending the outpatient clinics (e.g., 3-fold increase for psoriasis, about 25-increase for candidiasis). PPE and oral hairy leukoplakia were unique to HIV infection. This population tended to share a similar pattern of skin manifestations of HIV disease. It is unusual that this population has a high prevalence of PPE and P. maneffei infection and no Kaposi's sarcoma. PMID: 8849182 [PubMed - indexed for MEDLINE] 3208. Rinsho Shinkeigaku. 1995 Jul;35(7):814-6. [A case of multiple cranial neuropathy due to varicella-zoster virus infection: detection of involvement of cranial ganglia with MRI] [Article in Japanese] Kikuchi H, Yoshimura T, Hara H, Mihara F, Kobayashi T. Department of Neurology, Kyushu University, Fukuoka, Japan. We describe here a 50-year-old patient who had multiple cranial nerve palsies (lt.VIII,IX,X,XI and rt.VII, IX,X) with varicella-zoster virus (VZV). He developed hoarseness, dysphagia on 30th, November, 1994. On the 8th day after the onset, he suffered from left tinnitus and left facial nerve palsy. Neurological examination on the 10th day revealed left peripheral facial nerve palsy, lt. vocal cord palsy, mild dysphagia and loss of bilateral taste. He did not show signs of meningeal irritation. On the 11th day, he felt vertigo and had horizontal nystagmus on the right lateral gaze. The cerebrospinal fluid findings revealed increased protein content but not pleocytosis. The antibody titer for varicella zoster virus elevated both in cerebrospinal fluid and in serum. Cranial magnetic resonance imaging (MRI) revealed gadlinium enhancement on the left geniculate ganglion and left superior or inferior ganglion of IX and X nerves, indicating that multiple cranial nerve palsies associated with VZV infection originate in the cranial ganglia. Focal brainstem encephalitis does not seem to be the main cause of multiple cranial neuropathy in this case. PMID: 8777811 [PubMed - indexed for MEDLINE] 3209. Cancer. 1995 Jul 1;76(1):26-31. Specific cutaneous infiltrates of B-cell chronic lymphocytic leukemia arising at the site of herpes zoster and herpes simplex scars. Cerroni L, Zenahlik P, Kerl H. Department of Dermatology, University of Graz, Austria. BACKGROUND. Cutaneous lymphoid infiltrates at sites of herpes zoster scars in patients with B-cell chronic lymphocytic leukemia (B-CLL) often are diagnosed as benign lymphoid hyperplasia ("pseudolymphomas"). The histologic and immunophenotypic features of these lesions are not well characterized. Appearance of skin lesions in B-CLL patients is considered a poor prognostic sign. METHOD. Eight punch biopsies from five patients (three males, two females; mean age, 66.7 years) affected by B-CLL and presenting with lesions at sites of previous herpes simplex (upper lip, one patient) or herpes zoster (trunk, four patients; forehead, one patient) infections were included in the study. Histologic examination was performed on routine sections stained with hematoxylin and eosin and Giemsa. Immunohistologic stainings were performed with a standard three-step immunoperoxidase technique on formalin fixed, paraffin embedded tissue sections. RESULTS. Specific cutaneous infiltrates of B-CLL were diagnosed histopathologically and immunophenotypically in eight biopsies from all five patients. Clinically, patients presented with erythematous papules or plaques confined to the area of previous herpes virus eruptions. Histopathologic features in most cases were characterized by a variably dense perivascular and periadnexal infiltrate of small hyperchromatic lymphocytes throughout the entire dermis, reaching the subcutaneous fat. In one case, a dense, diffuse infiltrate involving the entire dermis was observed. A granulomatous reaction with presence of epithelioid and multinucleated giant cells was a prominent feature in four biopsies from three patients. Light areas containing large lymphoid cells with features of prolymphocytes and paraimmunoblasts (so-called "proliferation centers") could be observed only in the case characterized by a diffuse infiltrate. Immunohistology revealed an aberrant CD20+/CD43+ phenotype of neoplastic B cells, which is not found in normal B lymphocytes (CD20+/CD43-). Reactive T lymphocytes were present in all lesions and had a normal CD20-/CD43+/CD45Ro+ phenotype. At the time of this writing, four patients were alive without signs of skin disease after a mean follow-up of 58.5 months, and one patient died of B-CLL 24 months after the cutaneous eruption. CONCLUSIONS. Specific cutaneous infiltrates of B-CLL are not uncommon at sites of herpes virus scars. The diagnosis can be confirmed by histopathologic and immunophenotypic criteria. The prognosis is better than previously reported. PMID: 8630873 [PubMed - indexed for MEDLINE] 3210. Alaska Med. 1995 Jul-Sep;37(3):118-9. Painless herpes zoster. Rodriguez MA. PMID: 8546259 [PubMed - indexed for MEDLINE] 3211. J Antimicrob Chemother. 1995 Jul;36(1):271-3. A pharmacokinetic and safety evaluation of a 28 day course of oral acyclovir in elderly patients with herpes zoster. Moss PJ, Wood MJ, Crooks RJ, Gallagher J, McKendrick MW. PMID: 8537281 [PubMed - indexed for MEDLINE] 3212. J Infect. 1995 Jul;31(1):82. New nucleoside analogues--time for caution? Nathwani D. PMID: 8522846 [PubMed - indexed for MEDLINE] 3213. Hautarzt. 1995 Jul;46(7):508-10. [Meeting report of the 2nd International Conference on Varicella Zoster VIrus, 7-8 July 1994 in Paris] [Article in German] Lilie HM, Wassilew SW. Dermatologische Klinik (Direktor: Prof. Dr. S. W. Wassilew), Städtische Krankenanstalten, Krefeld. PMID: 7672996 [PubMed - indexed for MEDLINE] 3214. J Neuroimaging. 1995 Jul;5(3):192-3. Cervical (C2) herpes zoster infection followed by pontine infarction. Patrick JT, Russell E, Meyer J, Biller J, Saver JL. Division of Neuroimaging Research, Dent Neurologic Institute, Buffalo, NY 14209, USA. This article reports a man who had herpes varicella zoster cervicalis with delayed stroke in the posterior circulation. Empiric treatment was acyclovir, methylprednisolone, and aspirin. Pontine infarction involving migration of the virus via cervicovascular innervation from C2 dorsal root ganglia to the vertebrobasilar circulation with attendant angiitis/angiopathy and thrombosis is proposed. PMID: 7626829 [PubMed - indexed for MEDLINE] 3215. J Comput Assist Tomogr. 1995 Jul-Aug;19(4):624-7. Herpes zoster vasculitis: demonstration by MR angiography. Sarazin L, Duong H, Bourgouin PM, Melanson M, Chalk C, Richardson J, Vézina JL. Department of Radiology, Montreal General Hospital, McGill University, Quebec, Canada. A patient presented with multiple cerebral infarcts in various vascular territories after having been treated for herpes zoster ophthalmicus. Magnetic resonance angiography demonstrated multiple focal stenoses involving the proximal intracranial vessels which corresponded to endarteritis at autopsy. PMID: 7622697 [PubMed - indexed for MEDLINE] 3216. Neurology. 1995 Jul;45(7):1422-3. CNS vasculitis. Mackey A, Simard D. Comment on: Neurology. 1994 Jul;44(7):1221-6. PMID: 7617211 [PubMed - indexed for MEDLINE] 3217. J Am Acad Dermatol. 1995 Jul;33(1):126-9. Concurrent herpes simplex and varicella-zoster infection in an immunocompromised patient. Gibney MD, Leonardi CL, Glaser DA. Division of Dermatology, Saint Louis University Health Sciences Center, St. Louis, MO, USA. PMID: 7601930 [PubMed - indexed for MEDLINE] 3218. J Rheumatol. 1995 Jul;22(7):1254-8. Herpes zoster in systemic lupus erythematosus. Manzi S, Kuller LH, Kutzer J, Pazin GJ, Sinacore J, Medsger TA Jr, Ramsey-Goldman R. Department of Medicine, Graduate School of Public Health, Pittsburgh, PA, USA. OBJECTIVE. To define the clinical spectrum and disease sequelae of herpes zoster and to determine the risk factors associated with the development of herpes zoster in patients with systemic lupus erythematosus (SLE). METHODS. Retrospective matched case control study in a consecutive series of patients with SLE first evaluated between 1979 and 1989. Patients were classified as cases if their first episode of zoster occurred after lupus diagnosis. Lupus patients who never had zoster were eligible as controls and were matched 2:1 to cases for age, race, sex, and survival status. Clinical features of the cases from the time of lupus diagnosis to the time of zoster were compared to their respective controls over similar time periods. RESULTS. Forty eight (15%) of 321 patients were classified as cases. Cases were more likely to have received cyclophosphamide (p = 0.03), and azathioprine (p = 0.006). More cases had lupus nephritis (p = 0.02), and a concurrent or previous malignancy (p = 0.01) than their controls. Seven cases had cutaneous dissemination. Seven patients had postherpetic neuralgia > 2 months and in only 2 patients symptoms persisted for > 12 months' duration. Only 3 of 36 patients had immunosuppressive medication discontinued at the time of diagnosis of zoster, and 10 cases received acyclovir for the zoster infection. There were no permanent neurologic deficits or death. CONCLUSION. Immunosuppressive therapy, specifically cyclophosphamide and azathioprine, lupus nephritis, and a concurrent or previous malignancy may be risk factors for the development of herpes zoster infections in patients with SLE. Our study suggests that although herpes zoster occurs frequently in patients with SLE, it has a relatively benign course. Discontinuing needed immunosuppressive therapy in patients with SLE may be unnecessary in the setting of a zoster infection. With the current emphasis on reduction in medical costs, both by limiting inpatient admissions and eliminating unneeded medications, it is necessary to identify which patients require more intensive therapy with antiviral medications and/or hospitalization and which are likely to have a benign, self-limited course without intervention. PMID: 7562754 [PubMed - indexed for MEDLINE] 3219. J Med Virol. 1995 Jul;46(3):252-7. Oral brivudin vs. intravenous acyclovir in the treatment of herpes zoster in immunocompromised patients: a randomized double-blind trial. Wutzler P, De Clercq E, Wutke K, Färber I. Institute for Antiviral Chemotherapy, Friedrich-Schiller University of Jena, Germany. The efficacy of oral brivudin vs. intravenous acyclovir was compared in a randomized multicentered study under double-blind conditions using the double-dummy technique. Forty-eight patients with a herpes zoster rash less than 72 hours in duration were entered in the study. Brivudin was given as one 125-mg tablet every 6 hours. Acyclovir was infused over 1 hour at a dose of 10 mg/kg every 8 hours. Treatment was continued for 5 days. There was no significant difference between the treatment groups when analyzed in terms of new lesion formation, increase in the area of rash within the primary dermatome, cutaneous dissemination, and affection of mucous membranes or visceral organs. Both treatment regimes were also equally effective in the time to full crusting of lesions. Oral brivudin and intravenous acyclovir were well tolerated by most patients. There was no need to interrupt the treatment in any case. As effective as intravenous acyclovir in the treatment of herpes zoster, oral brivudin offers the potential for outpatient treatment of herpes zoster in immunocompromised patients. PMID: 7561799 [PubMed - indexed for MEDLINE] 3220. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1995 Jul;80(1):92-5. Herpes zoster infection presenting as an acute pulpitis. Sigurdsson A, Jacoway JR. Department of Endodontics, School of Dentistry, University of North Carolina at Chapel Hill, USA. A major reason for referral to an endodontic practice is management of pain. Most cases are diagnosed as being of pulpal or periapical origin. However, some turn out quite differently than their initial appearance. This case report presents a patient referred to the endodontic clinic because of symptoms mimicking an irreversible pulpitis. On examination no obvious cause of the symptoms could be found. The patient was treated conservatively after which a herpes zoster viral infection was diagnosed. This case stresses the importance of a thorough investigation of all signs and symptoms and the delay of definitive treatment until a diagnosis is made. PMID: 7552870 [PubMed - indexed for MEDLINE] 3221. Antimicrob Agents Chemother. 1995 Jul;39(7):1546-53. Valaciclovir compared with acyclovir for improved therapy for herpes zoster in immunocompetent adults. Beutner KR, Friedman DJ, Forszpaniak C, Andersen PL, Wood MJ. Department of Dermatology, University of California at San Francisco, Vallejo 94589, USA. Acyclovir treatment of acute herpes zoster speeds rash healing and decreases pain and ocular complications. The limited oral bioavailability of acyclovir necessitates frequent dosing. Valaciclovir, the l-valyl ester of acyclovir, is rapidly and almost completely converted to acyclovir in vivo and gives three- to fivefold increases in acyclovir bioavailability. In a randomized, double-blind, multicenter study, the safety and efficacy of oral valaciclovir given at a dosage of 1,000 mg three times daily for 7 or 14 days and oral acyclovir given at a dosage of 800 mg five times daily for 7 days were compared in immunocompetent adults aged > or = 50 years with herpes zoster. Patients were evaluated for 6 months. The intent-to-treat analysis (1,141 patients) showed that valaciclovir for 7 or 14 days significantly accelerated the resolution of herpes zoster-associated pain (P = 0.001 and P = 0.03, respectively) compared with acyclovir; median pain durations were 38 and 44 days, respectively, versus 51 days for acyclovir. Treatment with valaciclovir also significantly reduced the duration of postherpetic neuralgia and decreased the proportion of patients with pain persisting for 6 months (19.3 versus 25.7%). However, there were no differences between treatments in pain intensity or quality-of-life measures. Cutaneous manifestations resolved at similar rates in all groups. Adverse events were similar in nature and prevalence among groups, and no clinically important changes occurred in hematology or clinical chemistry parameters. Thus, in the management of immunocompetent patients > or = 50 years of age with localized herpes zoster, valaciclovir given at 1,000 mg three times daily for 7 days accelerates the resolution of pain and offers simpler dosing, while it maintains the favorable safety profile of acyclovir. PMCID: PMC162779 PMID: 7492102 [PubMed - indexed for MEDLINE] 3222. Med Lett Drugs Ther. 1995 Jun 23;37(951):55-7. Varicella vaccine. [No authors listed] PMID: 7783692 [PubMed - indexed for MEDLINE] 3223. N Engl J Med. 1995 Jun 22;332(25):1684. Images in clinical medicine. Herpes zoster. Kulkarni AG, Brid NS. Krishna Hospital and Medical Research Centre, Karad, Maharashtra, India. PMID: 7760869 [PubMed - indexed for MEDLINE] 3224. Br J Hosp Med. 1995 Jun 21-Jul 11;54(1):49-50. Herpes zoster ophthalmicus masquerading as giant cell arteritis. Chittenden HB, Clearkin LG, Sidky K. Department of Ophthalmology at Frimley Park Hospital, Surrey. PMID: 7551476 [PubMed - indexed for MEDLINE] 3225. Indian J Ophthalmol. 1995 Jun;43(2):78-9. Optic neuropathy secondary to herpes zoster ophthalmicus. Menon V, Kumar G, Tandon R. Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi. PMID: 8818317 [PubMed - indexed for MEDLINE] 3226. Ann Neurol. 1995 Jun;37(6):784-90. The vasculopathy of varicella-zoster virus encephalitis. Amlie-Lefond C, Kleinschmidt-DeMasters BK, Mahalingam R, Davis LE, Gilden DH. Department of Neurology, University of Colorado Health Sciences Center, Denver 80262, USA. Varicella-zoster virus (VZV) encephalitis has become more prevalent in the era of acquired immunodeficiency syndrome and other immunosuppressive diseases and poses diagnostic and therapeutic challenges for clinicians, radiologists, and pathologists. Six cases studied at our institutions shed light on the patterns and pathogenesis of the disease. VZV encephalitis is predominantly a vasculopathy, involving small and large vessels, that generates seizures, mental changes, and focal deficits. Brain imaging reveals large and small ischemic or hemorrhagic infarcts, often both, of cortex and subcortical gray and white matter. Deep-seated white matter lesions often predominate and are ischemic and/or demyelinative, depending on the size of blood vessels involved and the amount of additional demyelination caused by infection of oligodendrocytes. The demyelinative lesions are smaller and less coalescent than those seen in progressive multifocal leukoencephalopathy. PMID: 7778852 [PubMed - indexed for MEDLINE] 3227. Pediatr Dermatol. 1995 Jun;12(2):138-44. Localized linear bullous eruption of systemic lupus erythematosus in a child. Roholt NS, Lapiere JC, Wang JI, Bernstein LJ, Woodley DT, Eramo LR. Department of Dermatology, Northwestern University Medical School, Children's Memorial Hospital, Chicago, Illinois 60611, USA. A 9-year-old girl newly diagnosed with systemic lupus erythematosus (SLE) developed a localized linear papulovesicular eruption over the right dorsal hand and ulnar forearm. The skin findings were clinically suggestive of herpes zoster, lichen striatus, or lichen planus-lupus erythematosus overlap. However, histologic, immunofluorescent, immunoelectron microscopic, and immunoblot studies revealed findings compatible with bullous SLE. Our patient is noteworthy because she is the first one reported with bullous SLE presenting in a localized linear pattern. She is also the second-youngest reported patient with bullous SLE. PMID: 7659640 [PubMed - indexed for MEDLINE] 3228. Acta Paediatr Jpn. 1995 Jun;37(3):302-7. Herpes zoster in children with bone marrow transplantation: Report from a single institution. Nakayama H, Okamura J, Ohga S, Miyazaki C, Matsuzaki A, Ikuno Y, Ueda K, Tasaka H. Section of Pediatrics, National Kyushu Cancer Center, Fukuoka, Japan. Herpes zoster (HZ) has been often observed after bone marrow transplantation (BMT) in childhood. The occurrence of HZ was reviewed in children who received BMT. The clinical features of HZ were reviewed in 44 children who underwent BMT at Kyushu Cancer Center. Among the 35 recipients with a history of varicella before BMT, several factors associated with BMT and the lymphocyte subsets were compared between the patients who developed HZ (HZ+ group) and those who did not (HZ- group). Twenty-two recipients (50%) developed HZ; in two-thirds of these cases (15/22: 68%), HZ occurred between 80 and 120 days after BMT (median 101 days). The recipients treated with busulfan had a higher occurrence of HZ than those treated without it. The patients with Grade II-IV acute graft-versus-host disease (GVHD) developed HZ more frequently. In the HZ+ group, the absolute number of lymphocytes, CD3+, CD4+ or CD8+ cells at 3 months was significantly lower than that observed at 12 months after BMT and the CD4/CD8 ratio was significantly lower at 1 month than after 3 months of BMT. In conclusion, recipients were susceptible to HZ at around 100 days after BMT. The development of HZ may be associated with unbalanced T lymphocytes at that time. PMID: 7645377 [PubMed - indexed for MEDLINE] 3229. Masui. 1995 Jun;44(6):841-4. [A case of using continuous double-tapped epidural analgesia for herpes zoster duplex] [Article in Japanese] Wajima Z, Ishikawa G, Kaneko K, Inoue T, Ogawa R. Department of Anesthesia, Kitamurayama Kohritsu Hospital, Yamagata. A 66-year-old woman developed herpes zoster duplex, which is a rare disease. She had severe pain at the right upper back area and left lower abdominal area. The authors used double-tapped continuous epidural analgesia for this patient. The catheters for the epidural block were placed at the 8th thoracic vertebral level and 2nd lumbar vertebral level. After the start of continuous epidural block, she suffered from nausea, vomited, and felt dizzy. It was evident that these symptoms were caused by local anesthetic toxicity. We emphasize that we must pay attention to the patient who undergoes continuous double-tapped epidural analgesia for pain relief so as not to elicit local anesthetic toxicity. PMID: 7637162 [PubMed - indexed for MEDLINE] 3230. J Med Virol. 1995 Jun;46(2):91-6. Distribution of varicella-zoster virus gpI and gpII and corresponding genome sequences in the skin. Nikkels AF, Delvenne P, Debrus S, Sadzot-Delvaux C, Piette J, Rentier B, Piérard GE. Department of Dermatopathology, Chu du Sart Tilman, Liège, Belgium. In the course of varicella-zoster virus (VZV) infection, some viral capsid antigens are found in the epidermis and dermis. The aim of this study was to investigate the localisation of two major VZV glycoproteins (gpI and gpII) and of their respective genes in the skin. The distribution of VZV gpI and II in 27 formalin fixed paraffin embedded skin biopsies from herpes zoster eruptions were compared by immunohistochemistry. Double immunostaining was carried our to identify infected cells. The presence of viral nucleic acids coding for gpI and gpII was examined by in situ hybridisation. The distribution of gpI and gpII and their corresponding genome sequences was similar in the epidermis. gpI and gpII were also detected in dermal FXIIIa positive dendrocytes, in Mac 387 and CD68 positive macrophages, and in perineural and endothelial cells. However, the corresponding viral nucleic acids were rarely and barely detected in these cells of the dermis. It is concluded that VZV infection of epithelial cells follows a different course than in dermal cells. PMID: 7636508 [PubMed - indexed for MEDLINE] 3231. Br J Ophthalmol. 1995 Jun;79(6):575-80. Retinal detachment and herpesvirus retinitis in patients with AIDS. Dowler JG, Towler HM, Mitchell SM, Cooling RJ, Lightman SL. Moorfields Eye Hospital, London. BACKGROUND--The prolongation of survival of patients with herpesvirus retinitis and AIDS has been associated with a rise in the incidence of retinal detachment. In such cases, however, retinal reattachment may be difficult to achieve, and postoperative visual acuity may be poor despite anatomically successful surgery. METHODS--In order to examine factors affecting the visual outcome of surgery, a retrospective review of 29 patients with retinal detachment, herpesvirus retinitis, and AIDS was performed. Retinal reattachment surgery (32 procedures) or prophylactic laser demarcation (five procedures) was performed in 28 eyes of 23 patients. RESULTS--The macula was attached in 23/28 (82%) eyes at the last outpatient visit. Best postoperative visual acuity (median 6/18, range 6/6-hand movements) was significantly greater than final postoperative acuity (median counting fingers, range 6/6-no perception of light) (Wilcoxon sign rank test, p = 0.003), and was retained for a median of 3 months (1-91 weeks) after surgery. Poor visual outcome as evidenced by submedian final visual acuity was invariably associated with persistence of macular detachment, and significantly associated with the occurrence of optic atrophy (odds ratio = 5, p = 0.02). CONCLUSION--Retinal reattachment surgery appears justified in patients with herpesvirus retinitis and AIDS, but postoperative visual deterioration may occur in association with optic atrophy. PMCID: PMC505169 PMID: 7626574 [PubMed - indexed for MEDLINE] 3232. Aust Fam Physician. 1995 Jun;24(6):1167-8. Cold sores and shingles. Holley WC. PMID: 7625954 [PubMed - indexed for MEDLINE] 3233. Vet Hum Toxicol. 1995 Jun;37(3):233-4. Hemodialysis removal of acyclovir. Leikin JB, Shicker L, Orlowski J, Blair AT, McAllister K. Emergency Services, Rush Poison Control Center, Rush Presbyterian St Luke's Medical Center, Chicago, Illinois 60612, USA. A 59-y-old with a history of chronic renal failure on hemodialysis was diagnosed with herpes zoster and begun on 800 mg acyclovir 5 times daily. Two days later the patient developed visual hallucinations, ataxia, confusion and memory loss along with focal myoclonus, nausea and vomiting. No fever, elevated WBC count or significant electrolyte imbalance was found. CT scan of the brain was unremarkable. The patient was then dialyzed for presumed acyclovir toxicity. Her acyclovir level was later found to have been 3.4 micrograms/ml (normal peak range 0.4-2 micrograms/ml) prior to dialysis. After 3 h of hemodialysis, her post-dialysis acyclovir level was 1.9 micrograms/ml. After a second course of hemodialysis the next day the patient's mental status improved, and she was discharged 5 d later. Due to its low volume of distribution (0.6 L/kg), low protein binding (about 15%) and water solubility, acyclovir is an example of the ideal drug that can be removed by hemodialysis. About 45% of the total body amount can be extracted through a 3-h course of hemodialysis with resultant improvement in symptoms. PMID: 7571352 [PubMed - indexed for MEDLINE] 3234. J Neurol. 1995 Jun;242(6):390-7. Intrathecal production of specific IgA antibodies in CNS infections. Roberg M, Forsberg P, Tegnell A, Ekerfeldt K. Department of Infectious Diseases, Faculty of Health Sciences, University Hospital, Linköping University, Sweden. Cerebrospinal fluid (CSF) and serum from subjects with herpes simplex encephalitis, herpes zoster, mumps meningitis and neuroborreliosis were analysed for the presence of immunoglobulin A (IgA) and G (IgG) antibodies to the corresponding four antigens. Specific intrathecal IgA antibody synthesis as manifested by an elevated index was a frequent finding. Higher IgA index values than the corresponding IgG was seen in one third of the samples from subjects with herpes simplex encephalitis and herpes zoster. Correlation between specific IgG and IgA index was most pronounced for varicella-zoster virus (r = 0.66, P < 0.001). In subjects with mumps meningitis a strong intrathecal IgA and IgG antibody response to Borrelia burgdorferi was demonstrated. Specific herpes simplex and varicella-zoster virus IgA was not found to contain secretory component, thus contradicting an active secretion into the CNS compartment. In conclusion, our data indicate that specific IgA is intrathecally produced in herpes simplex encephalitis, herpes zoster and mumps meningitis but is a rare finding in neuroborreliosis. PMID: 7561968 [PubMed - indexed for MEDLINE] 3235. Cephalalgia. 1995 Jun;15(3):241-2. Syncope and seizure-like activity secondary to acute herpes zoster infection of the trigeminal nerve. Bonamico L, Celnik P. A Thomson Neurological Center, Hospital Francés, Buenos Aires, Argentina. Syncope may occur with glossopharyngeal neuralgia. We describe a patient with acute herpetic infection of the first branch of the trigeminal nerve associated with episodes of shooting pain, cardiac arrest and tonic-clonic movements. Resemblances with the so-called "cardiovascular" form of glossopharyngeal neuralgia, as well as putative mechanisms of the syncope, are discussed. PMID: 7553816 [PubMed - indexed for MEDLINE] 3236. Bratisl Lek Listy. 1995 Jun;96(6):338-9. [Grawitz tumor in a female patient with minor manifestations of herpes zoster detected by an active dermatologic examination] [Article in Slovak] Kolibásová K, Baumgartner J, Stojkovic J, Ondrias F. Kozná klinika Institútu pre dalsie vzdelávanie zdravotníckych pracovníkov v Bratislave, Slovakia. PMID: 7552413 [PubMed - indexed for MEDLINE] 3237. Curr Opin Neurol. 1995 Jun;8(3):170-4. Acute viral infections. Jackson AC. Department of Medicine, Queen's University, Kingston, Ontario, Canada. There have been important recent advances in the diagnosis of acute viral infections of the nervous system. Polymerase chain reaction amplification of nucleic acids in cerebrospinal fluid and tissues is a rapid and accurate tool in the diagnostic evaluation of patients with suspected infections. It has proved to be highly valuable in the noninvasive diagnosis of herpes simplex virus encephalitis and also in establishing the role of herpes simplex virus infection in Mollaret's meningitis. Improved diagnosis of herpesvirus infections should lead to more appropriate antiviral therapy and better outcomes. PMID: 7551114 [PubMed - indexed for MEDLINE] 3238. J Formos Med Assoc. 1995 Jun;94(6):313-7. Varicella zoster virus infection after allogeneic or autologous hemopoietic stem cell transplantation. Tzeng CH, Liu JH, Fan S, Wang SY, Wang SR, Chen KY, Hsieh RK, Yung CH, Chen PM. Department of Medicine, Veterans General Hospital-Taipei, Taiwan ROC. A retrospective study was carried out in 161 patients who underwent allogeneic or autologous hemopoietic stem cell transplants. The aim was to determine the frequency, outcome and risk-factors associated with varicella zoster virus (VZV) infection. Post-transplant VZV infection occurred in 29 patients. The median onset of infection was 6.5 months post-transplant, with 82% of cases occurring within the first year. Localized herpes zoster was seen in 27 patients, one patient had varicella, and one patient had simultaneous presentation of both herpes zoster and varicella. No cutaneous or visceral dissemination was noted in the series. Each patient was treated with intravenous acyclovir. Mild complications with postherpetic neuralgia were reported by three patients. There were no deaths from VZV infection. Two risk factors noted to be associated with VZV infection were the presence of graft-versus-host disease in allogeneic transplants and leukemia as the underlying disease in autologous transplants. The overall incidence of post-transplant VZV infection in the present series was relatively low compared with that of other reports involving either allogeneic or autologous bone marrow transplantation. PMID: 7549549 [PubMed - indexed for MEDLINE] 3239. Dtsch Med Wochenschr. 1995 May 12;120(19):700. [Zoster neuralgia] [Article in German] Terborg C, Busse O. Neurologische Klinik, Klinikum Minden. PMID: 7768166 [PubMed - indexed for MEDLINE] 3240. Nippon Sanka Fujinka Gakkai Zasshi. 1995 May;47(5):503-6. [A case of pregnancy complicated with virus-associated hemophagocytic syndrome] [Article in Japanese] Yamanaka S, Katsube Y, Honda H, Kasaoka N, Toyota N. Department of Obstetrics and Gynecology, Kure Kyosai Hospital, Hiroshima. PMID: 7775820 [PubMed - indexed for MEDLINE] 3241. J Am Acad Dermatol. 1995 May;32(5 Pt 2):908-11. Atypical varicella-zoster virus infection in an immunocompromised patient: result of a virus-induced vasculitis. Erhard H, Rünger TM, Kreienkamp M, Müller J, Müller-Hermelink HK, Bröcker EB. Department of Dermatology, University of Würzburg, Germany. We describe a patient with cutaneous T-cell lymphoma in whom persistent, painless, ecthymatous nodules developed as a result of a varicella-zoster virus infection. The localized infection occurred without a vesicular stage. Ultrastructural studies revealed a lack of epidermal involvement and massive varicella-zoster virus replication within endothelial cells, leading to an obliterative vasculitis. This suggests direct infection of dermal vessels from adjacent nerves, bypassing the epidermis, which is usually infected first in the classic infectious pathway during varicella-zoster virus reactivation from sensory nerves. PMID: 7722056 [PubMed - indexed for MEDLINE] 3242. J Am Acad Dermatol. 1995 May;32(5 Pt 2):854-7. Zosteriform metastases in melanoma. Itin PH, Lautenschlager S, Buechner SA. Department of Dermatology, University of Basel, Switzerland. Zosteriform metastasis is a rare form of tumor spread to the skin that most often arises from an internal carcinoma or a hematologic malignancy. We describe a 29-year-old woman with malignant melanoma of the back in whom zosteriform metastases developed along the fifth thoracic dermatome. PMID: 7722043 [PubMed - indexed for MEDLINE] 3243. J Am Acad Dermatol. 1995 May;32(5 Pt 1):730-3. Detection of herpes simplex and varicella-zoster infection from cutaneous lesions in different clinical stages with the polymerase chain reaction. Nahass GT, Mandel MJ, Cook S, Fan W, Leonardi CL. Department of Internal Medicine, Saint Louis University Health Sciences Center, MO 63104, USA. BACKGROUND: The polymerase chain reaction (PCR) can be used to diagnose a variety of infectious processes. OBJECTIVE: We sought to determine whether Tzanck smear debris, vesicle fluid swabs, crusts, or fixed tissue specimens are the best source for template herpes simplex virus (HSV) or varicella-zoster virus (VZV) DNA for the PCR. METHODS: Patients with both clinical and histologic evidence of HSV (n = 6) or VZV (n = 16) infection were examined. Stained Tzanck smears, vesicle fluid swabs, dried crusts, and skin biopsy specimens were obtained at the same time from each patient. DNA was extracted from the different clinical specimens and then examined for HSV or VZV DNA with PCR. Fifteen control subjects did not have clinical or histologic evidence of herpesvirus infection. RESULTS: In cases of suspected VZV infection, PCR detected VZV DNA sequences from all 15 Tzanck smears, all 15 vesicle swabs, one of one crust, and 14 of 16 fixed tissue specimens. HSV DNA sequences were detected from all six Tzanck smears, all four vesicle fluid swabs, two of two crusts, and five of six fixed tissue specimens. CONCLUSION: PCR can detect VZV and HSV DNA sequences from a variety of sources including formalin-fixed tissue specimens. Although viral DNA was detected slightly more frequently from Tzanck smear debris, crusts, and vesicle fluid swabs compared with fixed tissue specimens, each was an excellent source of target DNA for the PCR to confirm the diagnosis of herpesvirus infection. PMID: 7722016 [PubMed - indexed for MEDLINE] 3244. J Virol. 1995 May;69(5):3240-5. Varicella-zoster virus gene 63 encodes an immediate-early protein that is abundantly expressed during latency. Debrus S, Sadzot-Delvaux C, Nikkels AF, Piette J, Rentier B. Laboratory of Fundamental Virology, Institute of Pathology, University of Liège, Belgium. Varicella-zoster virus (VZV) gene 63 encodes a protein with a predicted molecular mass of 30.5 kDa which has amino acid similarities with the immediate-early (IE) protein 22 (ICP-22) of herpes simplex virus type 1. In order to study the expression of this protein during lytic and latent infection, gene 63 was cloned in frame and downstream from the glutathione-S-transferase gene, expressed as a fusion protein, and purified. In VZV-infected Vero cells, antibodies directed against this protein detect two polypeptides of 45 and 38 kDa which are localized both in the cytoplasm and in the nucleus. Using a sequential combination of transcription and protein synthesis inhibitors (actinomycin D and cycloheximide, respectively), we demonstrated the immediate-early nature of this protein, which can thus be named IE63. Using a rat model of VZV latency, we showed that IE63 is heavily expressed, essentially in neurons, during latency. IE63 can also be detected in the skin of patients showing early herpes zoster symptoms. PMCID: PMC189034 PMID: 7707559 [PubMed - indexed for MEDLINE] 3245. J Infect. 1995 May;30(3):193-200. Guidelines for the management of shingles. report of a working group of the British Society for the Study of Infection (BSSI). [No authors listed] PMID: 7673741 [PubMed - indexed for MEDLINE] 3246. Bone Marrow Transplant. 1995 May;15(5):805-7. Visceral varicella zoster infection after bone marrow transplantation without skin involvement and the use of PCR for diagnosis. Rogers SY, Irving W, Harris A, Russell NH. University Department of Haematology, City Hospital, Nottingham, UK. A 41-year-old patient with acute myeloid leukemia was transplanted from an HLA-identical but ABO-incompatible sibling. The post-transplant course was complicated by pure erythrocyte aplasia and mild chronic graft-versus-host disease. Eleven months after transplant while on steroid therapy she developed abdominal pain rapidly followed by fatal fulminant hepatic failure. Varicella zoster virus (VZV) was detected using the polymerase chain reaction from blood and liver obtained at necropsy even though no skin manifestations of VZV were present. This case confirms previous reports of visceral VZV infection in the absence of skin lesions thus emphasising the importance of suspecting the presence of VZV in this clinical setting and outlines the possible value of PCR in the rapid diagnosis of infection. PMID: 7670413 [PubMed - indexed for MEDLINE] 3247. Pediatr Infect Dis J. 1995 May;14(5):395-7. Two cases of disseminated cutaneous herpes zoster in infants after intrauterine exposure to varicella-zoster virus. Chiang CP, Chiu CH, Huang YC, Lin TY. Department of Pediatrics, Chang Gung Children's Hospital, Kweishan, Taoyuan, Taiwan. PMID: 7638019 [PubMed - indexed for MEDLINE] 3248. Clin Infect Dis. 1995 May;20(5):1378-80. Brain stem encephalitis due to varicella-zoster virus in a patient with AIDS. Moulignier A, Pialoux G, Dega H, Dupont B, Huerre M, Baudrimont M. Service de Neurologie, Hôpital Tenon, Paris, France. We describe a patient infected with human immunodeficiency virus (HIV) who had localized brain stem encephalitis due to varicella-zoster virus (VZV) and no cutaneous eruption. Diagnosis of the infection was based on the presence of Cowdry type A intranuclear inclusions in neurons, astrocytes, and oligodendrocytes positive for VZV (as shown by immunochemical staining). Although this infection is rare, we demonstrate the need for clinicians to include VZV infection in the differential diagnosis of rapidly progressive multiple cranial nerve palsies in HIV-infected patients, particularly because specific treatment for VZV infection is effective and relatively safe. PMID: 7620026 [PubMed - indexed for MEDLINE] 3249. Int J Dermatol. 1995 May;34(5):341-8. Isotopic response. Wolf R, Brenner S, Ruocco V, Filioli FG. Department of Dermatology, Tel-Aviv Sourasky Medical Center, Ichilov Hospital, Israel. Comment in: Int J Dermatol. 2003 Aug;42(8):664-6. Int J Dermatol. 2009 Jul;48(7):783-4. Clin Exp Dermatol. 2003 Sep;28(5):555-6. BACKGROUND--The occurrence of a new skin disorder exactly at the site of another one, already healed and unrelated, was first described in 1955. In 1985, Wolf et al. recognized that we are dealing with a dermatologic phenomenon and established a precise definition for this phenomenon. Fifty-eight cases corresponding to the definition of this phenomenon have been reported until now. METHODS--The new phenomenon, for which the term "isotopic response" has been suggested, has been defined. Cases corresponding to the definition have been analyzed with special emphasis on the diseases involved, the time intervals, and the locations of the diseases. Eight new cases are described. RESULTS--A total of 58 cases of isotopic response have been described. The first disease in most of the patients was herpes zoster; in three cases it was herpes simplex, in two varicella, and in one, thrombophlebitis. The second disease, which appeared exactly at the site of the first, already healed disease, was in most reported cases a carcinoma (26 cases, in particular 15 cases of breast carcinoma, 5 basal cell carcinomas (BCC), 4 squamous cell carcinomas (SCC), 2 basosquamous carcinomas), or granuloma annulare (16 cases). Additional diseases were Kaposi's sarcoma (2 cases), pseudolymphoma (2 cases), sarcoid (2 cases), tinea (2 cases), tuberculoid and vasculitis granuloma (1 case), angiosarcoma, metastasis, Bowen's disease, lymphoma, leukemia cutis, and acne (1 case each). The diseases did not show any predilection for a particular location. The interval between the first and second disease was extremely variable (ranging from days to years) and showed no particular features. In the eight additional cases described in the present report, the first disease was herpes simplex (6 cases) or herpes zoster (2 cases). The second disease was viral warts (3 cases) or squamous cell carcinoma (2 cases). Additional diseases were furunculosis, contact dermatitis, and molluscum contagiosum (1 case each). CONCLUSIONS--The new term, "isotopic response," describes the occurrence of a new skin disorder at the site of another, unrelated, and already healed skin disease. It is suggested that the term "isotopic response" be included in the lexicon (glossary) of dermatology. Introducing the new term and classifying all the cases under a single key word, will make it possible to locate and collect them easily and to search for the mechanism underlying this phenomenon. PMID: 7607796 [PubMed - indexed for MEDLINE] 3250. Reg Anesth. 1995 May-Jun;20(3):255-6. Interpleural block for acute combined cervical and thoracic herpes zoster. Thwaites BK, Powell DR. PMID: 7547670 [PubMed - indexed for MEDLINE] 3251. Reg Anesth. 1995 May-Jun;20(3):227-33. Does sympathetic ganglionic block prevent postherpetic neuralgia? Literature review. Ali NM. Department of Anesthesiology, University of New Mexico School of Medicine, Albuquerque 87131, USA. BACKGROUND AND OBJECTIVES. To examine specifically the role of sympathetic block in the prevention of postherpetic neuralgia by its application in the treatment of acute herpes zoster. METHODS. Data sources included a Medline search and cross-referencing of articles and text books. A total of 84 references were reviewed. Peer-reviewed articles were selected according to their relevance to the subject and originality. The data were critically analyzed by the author with the specific intention of avoiding bias. RESULTS. The opinion of the medical community is divided on the role of sympathetic block in preventing postherpetic neuralgia because of the lack of controlled trials and the conflicting retrospective reports as to its effectiveness. While many reports promote the early use of sympathetic blocks during acute herpes zoster to prevent postherpetic neuralgia, others deny their value. CONCLUSIONS. Considering the degree of uncertainty, and the seriousness of postherpetic neuralgia, sympathetic block in addition to treatment with acyclovir should be considered early during acute herpes zoster. Large controlled trials are needed to provide the necessary scientific evidence. PMID: 7547660 [PubMed - indexed for MEDLINE] 3252. BMJ. 1995 Apr 15;310(6985):1005. Acyclovir and post-herpetic neuralgia. Two other participating study centres report different results. McKendrick MW, Wood MJ. Comment on: BMJ. 1994 Oct 29;309(6962):1124. PMCID: PMC2549382 PMID: 7728001 [PubMed - indexed for MEDLINE] 3253. BMJ. 1995 Apr 15;310(6985):1005. Acyclovir and post-herpetic neuralgia. The balance of available evidence supports its use. Harding SP. Comment on: BMJ. 1994 Oct 29;309(6962):1124. PMCID: PMC2549383 PMID: 7728000 [PubMed - indexed for MEDLINE] 3254. Am J Dermatopathol. 1995 Apr;17(2):163-8. Subtle clues to the diagnosis of the herpesvirus by light microscopy. Herpetic syringitis. Sangueza OP, Gordon MD, White CR Jr. Department of Pathology, Oregon Health Sciences University, Portland 97201, U.S.A. Among the numerous infections to which AIDS patients are susceptible, those caused by herpesvirus (simplex and varicella/zoster) are among the most common. Because herpetic infections may be the first manifestations of AIDS and often are associated with poor prognosis, rapid and accurate diagnosis of them is imperative. Herpesvirus infection may be diagnosed histopathologically by the presence of ballooned, acantholytic, and multinucleated keratinocytes; intranuclear eosinophilic viral inclusions; steel gray color of affected keratinocytic cytoplasm and nuclei, chromatin margination, and necrotic acantholytic keratinocytes in older lesions. These changes are often limited to the epidermis, but there may frequently be involvement of epithelia of follicles (herpetic folliculitis) and sebaceous glands as well. Similar changes, although seldom noted, may be present in eccrine ducts and glands (herpetic syringitis). Recognition of subtle histologic clues concerning the secretory and ductal components of sweat glands in an unusual case of herpes infection facilitated rapid diagnosis in an AIDS patient, allowing appropriate treatment. PMID: 8600782 [PubMed - indexed for MEDLINE] 3255. Arch Esp Urol. 1995 Apr;48(3):302-4. [Herpes and acute urinary retention] [Article in Spanish] Portillo Martín JA, Martín García B, Rodríguez Hernández R, Correas Gómez M, Gutierrez Baños JL, Monje Mirallas JM, Roca Edreira YA. Servicio de Urología, Hospital Universitario de Valdecilla, Santander, España. OBJECTIVE: The possible relationship between herpes zoster and acute urinary retention was investigated. METHODS: Two cases of acute urinary retention secondary to herpes zoster are described. The pathophysiological mechanisms that influence this condition are analyzed. RESULTS: Herpes zoster appears to play an important role in the development of micturition disorders. CONCLUSIONS: Acute urinary retention can result from herpes zoster infection, although it usually resolves spontaneously. PMID: 7755437 [PubMed - indexed for MEDLINE] 3256. Rev Med Suisse Romande. 1995 Apr;115(4):303-5. [Clinical problem: painful abdomen] [Article in French] Loizeau E. Clinique de Genolier. PMID: 7740254 [PubMed - indexed for MEDLINE] 3257. Med Care. 1995 Apr;33(4 Suppl):AS195-202. Estimating the value of a generic quality-of-life measure. Mauskopf JA, Austin R, Dix LP, Berzon RA. Burroughs Wellcome Company, Research Triangle Park, NC 27709, USA. In this paper, data from a clinical trial of a new antiviral agent for treating patients with zoster are used to answer the following question: Does the Nottingham Health Profile (NHP) add to the information obtained from the clinical measures? Three ways in which the NHP could add information are measured. First, Cox's regression analysis is used to determine whether health-related quality-of-life scores obtained at diagnosis give information about disease prognosis. Second, changes in mean NHP scores in different dimensions are computed after pain resolution to determine whether NHP scores provide more sensitive indicators of disease resolution. Third, linear regression is used to determine whether the impacts of disease on quality of life are measured adequately by the clinical parameters. These analyses show that use of the physical mobility and energy dimensions of the NHP increases understanding of disease prognosis; demonstrates the continuing impact of zoster on patients' sleep patterns and energy levels, disease symptoms not included as clinical measures, that persist after the cessation of zoster-associated pain; and gives a measure of the impact of zoster on the patient, which includes unmeasured and measured levels of severity. PMID: 7723447 [PubMed - indexed for MEDLINE] 3258. BMJ. 1995 Apr 1;310(6983):873. Immunisation against chickenpox. Good argument exists for universal vaccination. Skinner GR, Davies J. Comment on: BMJ. 1995 Jan 7;310(6971):2-3. PMCID: PMC2549276 PMID: 7711648 [PubMed - indexed for MEDLINE] 3259. Am J Ophthalmol. 1995 Apr;119(4):516-7. Treatment of progressive outer retinal necrosis with sorivudine. Pinnolis MK, Foxworthy D, Kemp B. Visual Services Department, Massachusetts Eye and Ear Infirmary, Boston 02114, USA. PURPOSE/METHODS: We examined a patient with progressive outer retinal necrosis, which is presumably caused by the varicella-zoster virus in patients with the acquired immunodeficiency syndrome. RESULTS/CONCLUSIONS: The patient was successfully treated with a combination of intravitreal ganciclovir and oral sorivudine. Treatment for progressive outer retinal necrosis has been disappointing; both acyclovir and ganciclovir have had only limited success. Sorivudine, a new antiviral medication with activity against varicella-zoster virus, may represent an effective alternative treatment for retinal necrosis. PMID: 7709980 [PubMed - indexed for MEDLINE] 3260. Eur J Clin Microbiol Infect Dis. 1995 Apr;14(4):318-29. Comparative activity of selected antiviral compounds against clinical isolates of varicella-zoster virus. Andrei G, Snoeck R, Reymen D, Liesnard C, Goubau P, Desmyter J, De Clercq E. Rega Institute for Medical Research, Katholieke Universiteit Leuven, Belgium. Sixteen freshly isolated varicella-zoster virus (VZV) strains were evaluated in vitro, in parallel with two reference strains expressing a functional thymidine kinase (TK+) (Oka and YS) and two thymidine kinase-deficient mutants (TK-) (07-1 and YS-R), for their susceptibility to a broad range of antiviral compounds. The following compounds were included: acyclovir (ACV), brivudine (BVDU), sorivudine (BVaraU), other BVDU congeners such as BTDU, CTDU, CVDC and CVDU, ganciclovir (GCV), FIAC, araT, araA, araC, foscarnet (PFA), phosphonoacetic acid (PAA), the acyclic nucleoside phosphonates HPMPC, cHPMPC, HPMPA, cHPMPA, HPMPc3A, PMEA and PMEDAP, the N7-isomeric acyclic nucleoside analogue N7AP, penciclovir (PCV), compounds 882C87 and H2G and two oxetanocin derivatives OXT-A and OXT-G. Fourteen of the 16 clinical isolates displayed the following order of decreasing selectivity against VZV: BVaraU > BVDU > CVDU approximately CVDC > H2G > N7AP approximately CTDU approximately BTDU approximately OXT-G approximately 882C87 > ACV > FIAC approximately araT > HPMPC approximately cHPMPC approximately HPMPA approximately HPMPc3A approximately cHPMPA > PCV approximately GCV approximately OXT-A > PMEDAP approximately PMEA > PFA approximately PAA approximately araA > araC. Two VZV strains (isolated from the cerebrospinal fluid of an AIDS patient) that were shown to have a truncated TK were clearly resistant to all the compounds that need the viral TK for their phosphorylation, while sensitivity to the acyclic nucleoside phosphonates, PFA, PAA, OXT-A and araA, remained unchanged. A slight (5- and 10-fold) increase was noted in the 50% inhibitory concentration of N7AP and OXT-G, respectively, for the TK- VZV strains as compared to the TK+ VZV strains. Ganciclovir and FIAC also showed a marked decrease in their activity against these two strains, but this was not as pronounced as for the other viral TK-dependent drugs. From our results, it appears that although acyclic nucleoside phosphonates may not have as favourable a therapeutic index as drugs requiring the viral TK, they should be considered for the treatment of TK- VZV life-threatening infections that are resistant to the viral TK-dependent drugs. PMID: 7649195 [PubMed - indexed for MEDLINE] 3261. J Dermatol. 1995 Apr;22(4):262-6. Primary Sjögren's syndrome and psoriasis vulgaris in a case of OKT4 epitope deficiency. Tanaka H, Mizutani H, Okada H, Shimizu M. Department of Dermatology, Mie University Faculty of Medicine, Tsu, Japan. We report a 29-year-old female OKT4 epitope deficiency patient with primary Sjögren's syndrome and psoriasis vulgaris. Immunological investigations during the prolonged clinical course of her herpes zoster revealed that she has OKT4 epitope deficiency and primary Sjögren's syndrome. She had been treated for psoriasis vulgaris for 17 years without systemic immunosuppressive therapy. Flow cytometric study revealed that her OKT4 deficiency is heterogeneous and excluded interference with the OKT4 epitope by anti OKT4 autoantibodies. The rare coexistence of primary Sjögren's syndrome and psoriasis implicates an immune disturbance due to an unusual phenotype of CD4. PMID: 7541811 [PubMed - indexed for MEDLINE] 3262. Masui. 1995 Mar 3;44(3):428-33. [The effect of iontophoresis with several Ca channel blockers for PHN patients] [Article in Japanese] Ikebe H, Miyagawa A, Mizutani A, Miyamoto M, Taniguchi K, Honda N. Department of Anesthesiology, Oita Medical University. We performed iontophoresis with Ca channel blockers for healthy adult volunteers. In this clinical study, we used iontophoresis with Ca channel blockers. Ten out patients with PHN treated at our pain clinic were treated with iontophoresis. They were randomly assigned to one of the following four treatments: (1) 5 ml of 4% lidocaine HCl, (2) 2 mg of nicardipine HCl + 5 ml of distilled water, (3) 2 mg of verapamil HCl + 5 ml of distilled water, and (4) 2 mg of diltiazem HCl + 5 ml distilled water. Iontophoresis was performed using the above four drugs on the positive pole. Using a VAS, each patient was evaluated concerning the analgesic effect. The pain before treatment (10 points) was used as the base line. Compared with the scores before treatment, VAS scores decreased significantly after iontophoresis in all four groups. In the lidocaine group, a significant decrease in VAS scores occurred immediately after iontophoresis and lasted up to 24 hours, reaching the nadir at 2 hours. In the nicardipine group, the decrease occurred immediately after iontophoresis and lasted up to one day, reaching the nadir at four hours. In the verapamil group, the decrease started 1 hour after iontophoresis and lasted up to 48 hours, reaching the nadir at 8 hours. In diltiazem group, the decrease started 1 hour after iontophoresis and lasted up to 48 hours, reaching the nadir at 4 hours. Iontophoresis with Ca channel blockers produced a prolonged analgesic effect in PHN patients. Previously we had observed the same effect in adult volunteers. Therefore, we believe that this therapy will be clinically useful. PMID: 7745800 [PubMed - indexed for MEDLINE] 3263. Semin Ophthalmol. 1995 Mar;10(1):28-41. Diagnosis and management of viral retinitis in the acute retinal necrosis syndrome. Morse LS, Mizoguchi M. University of California, Davis Department of Ophthalmology, Sacramento 95816, USA. PMID: 10155697 [PubMed - indexed for MEDLINE] 3264. J Neurovirol. 1995 Mar;1(1):130-3. Persistence of varicella-zoster virus DNA in elderly patients with postherpetic neuralgia. Mahalingam R, Wellish M, Brucklier J, Gilden DH. Department of Neurology, University of Golorado Health Sciences Center, Denver 80262, USA. The most common complication of zoster in the elderly is postherpetic neuralgia, operationally defined as pain persisting longer than 1-2 months after rash. The cause of postherpetic neuralgia is unknown. Using polymerase chain reaction, we detected varicella zoster virus DNA in blood mononuclear cells from 11 of 51 postherpetic neuralgia patients, but not in any of 19 zoster patients without postherpetic neuralgia, or in any of 11 elderly individuals without a history of zoster. Blood mononuclear cells from nine of 27 serially-bled postherpetic neuralgia patients were positive for varicella zoster virus DNA; six were positive once, and three patients were positive more than once. Our results indicated that postherpetic neuralgia may be related to persistence of varicella zoster virus. PMID: 9222350 [PubMed - indexed for MEDLINE] 3265. J Infect Dis. 1995 Mar;171(3):701-4. Racial differences in the occurrence of herpes zoster. Schmader K, George LK, Burchett BM, Pieper CF, Hamilton JD. Department of Medicine, Duke University Medical Center, Durham, North Carolina 27710. Comment in: J Infect Dis. 1996 Jul;174(1):239-41. The purpose of this study was to determine if there are racial differences in the occurrence of herpes zoster (shingles). The study population was the Duke Established Populations for Epidemiologic Studies of the Elderly, a probability sample of community-dwelling persons > 64 years old in North Carolina. Interviewers administered a comprehensive health survey to the participants that included questions about lifetime occurrence of shingles. Of the 3206 subjects, 316 (9.9%) had had zoster: 81 (4.5%) of 1754 blacks and 235 (16.1%) of 1452 whites had had shingles (P < .0001). After controlling for age, cancer, and demographic factors, blacks remained one-fourth as likely as whites (adjusted odds ratio 0.25, 95% confidence interval 0.18-0.35; P = .0001) to have experienced zoster. In summary, blacks had a significantly lower risk of developing herpes zoster than whites, a new finding in herpes zoster epidemiology. PMID: 7876622 [PubMed - indexed for MEDLINE] 3266. J Clin Gastroenterol. 1995 Mar;20(2):157-9. Ogilvie's syndrome from disseminated varicella-zoster infection and infarcted celiac ganglia. Nomdedéu JF, Nomdedéu J, Martino R, Bordes R, Portorreal R, Sureda A, Domingo-Albós A, Rutllant M, Soler J. Department of Hematology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. We report a patient who had refractory Hodgkin's disease and who received an autologous bone marrow transplantation and 8 months later developed abdominal pain associated with acute colonic dilation. The course of the patient was rapidly fatal due to a lobar pneumonia. Autopsy revealed signs of disseminated herpesvirus infection with marked hemorrhagic infarction of celiac sympathetic ganglia. This finding supports the hypothesis that denervation caused by virus reactivation and secondary hemorrhage is a main mechanism of acute colonic pseudoobstruction. PMID: 7769201 [PubMed - indexed for MEDLINE] 3267. J Adv Nurs. 1995 Mar;21(3):427-33. Patients' experiences of herpes zoster and postherpetic neuralgia. Engberg IB, Gröndahl GB, Thibom K. Department of Research, Bords University College of Health and Caring Sciences, Sweden. The purpose of the study was to investigate retrospectively whether patients (n = 73) who had suffered another disease and/or experienced psychosocial stress at the time of the onset of herpes zoster had experienced a more severe clinical course of herpes zoster, and were more subject to the development of postherpetic neuralgia than other patients (n = 45) with herpes zoster. The interview questionnaire included questions about changes in the patients' daily lives due to neuralgia, and their current living circumstances. Significantly more of the patients who had had another disease and/or psychosocial stress at the time of the onset of herpes zoster reported severe pain during the acute phase of herpes zoster. They also reported pain to a greater extent at the time of the interview and mentioned that their lives had changed owing to postherpetic neuralgia. More of these patients reported that their habits and activities had been negatively affected and they also experienced their current situation as unsatisfactory. These results must, however, be interpreted with caution as the patients' recollection of other diseases and/or psychosocial stress and the patients' current mood due to postherpetic neuralgia at the time of the interview may have influenced the memory and the answers. PMID: 7745194 [PubMed - indexed for MEDLINE] 3268. Br J Radiol. 1995 Mar;68(807):334-5. Prolonged contrast enhancement of the inner ear on MRI in Ramsay Hunt syndrome. Zammit-Maempel I, Campbell RS. PMID: 7735780 [PubMed - indexed for MEDLINE] 3269. Enferm Infecc Microbiol Clin. 1995 Mar;13(3):193-4. [Varicella zoster pneumonia. Treatment with orally administered acyclovir] [Article in Spanish] Gil Sanz ME, Arribas Blanco JM, López Romero A, González-Baylin ML. PMID: 7734507 [PubMed - indexed for MEDLINE] 3270. Nippon Ganka Gakkai Zasshi. 1995 Mar;99(3):289-95. [A statistical study of ocular complications of herpes zoster ophthalmicus and its prolongation factors] [Article in Japanese] Amaki S, Suzuki S, Shinbo R, Ando R, Oguchi Y, Shimizu H, Nishikawa T. Department of Ophthalmology; School of Medicine, Keio University, Tokyo, Japan. A statistical study was carried out on 218 patients (107 male and 111 female) with herpes zoster ophthalmicus (HZO) who visited our clinic from April 1985 to March 1992. The incidence of ocular complications (OCs) and the rate of prolonged OCs (over 6 months) were also studied with the factors that were considered to have affected them. There were 114 patients who showed OCs out of 218 HZO patients (52.3%). The incidence of OCs was higher among the patients with nose eruption than among those without (p < 0.001), and lower among the patients with acyclovir treatment in advance than among those without (p < 0.001). The rate of prolonged OCs was higher among the patients over 50 years old than among those under 50 years old (p < 0.05), higher among the patients with nose eruption than among those without (p < 0.05), and lower among the patients with acyclovir treatment in advance than among those without (p < 0.01). Those with nose eruption had a high rate of prolonged iritis. Severe visual acuity loss remained in 3 cases (2.6%): 2 cases of corneal opacity in the center and 1 case of neurouveitis. Two patients suffered from high intraocular pressure complicated with prolonged iritis. PMID: 7732919 [PubMed - indexed for MEDLINE] 3271. Fortschr Med. 1995 Feb 10;113(4):43-8. [Enzyme therapy--an alternative in treatment of herpes zoster. A controlled study of 192 patients] [Article in German] Billigmann P. PROBLEM: Herpes Zoster requires an effective, inexpensive form of treatment not only because it impairs quality of life, but also on account of its relatively high incidence and the resulting costs incurred. Given the present situation in the health care sector, the high costs of treatment with the standard drug, acyclovir, often mean that herpes zoster patients do not receive medicinal therapy. AIM: The aim of the present study was to establish whether the positive results of a prior investigation involving treatment with an enzyme combination preparation could be confirmed. METHOD: Over a period of 14 days, two groups of 96 patients each were given acyclovir or an enzyme combination preparation. During the course of the study, the intensity (score) of segmental pain and various skin lesions were investigated. RESULTS: In terms of the first end point, "segmental pain", the test groups showed no significant difference either on day 7 or on day 14. Although the second end point "segmental reddening" did reveal a significant difference (p = 0.015) in favor of the acyclovir group on day 14, no significant difference was found for any of the other examination endpoints. Nor did any of the other skin lesions evaluated differ significantly by the end of the study. CONCLUSIONS: Overall, the enzyme combination preparation showed identical efficacy with acyclovir. The results of the prior study were thus confirmed. Further investigations on the immunomodulatory potency, dosage and effects on postherpetic herpes neuralgia are, however, still required. PMID: 7713467 [PubMed - indexed for MEDLINE] 3272. J Ky Med Assoc. 1995 Feb;93(2):56-8. An alternate method for intercostal blockade for the management of post herpetic neuralgia. Ackerman WE 3rd, Kennedy LD. PMID: 7884295 [PubMed - indexed for MEDLINE] 3273. No Shinkei Geka. 1995 Feb;23(2):125-30. [Treatment of intractable postherpetic neuralgia and blepharospasm: intraneural injection of adriamycin] [Article in Japanese] Saiki M, Kondo A, Kinuta Y, Iwasaki K, Kobata H, Hasegawa K, Chin M, Nakano I, Yamamoto T. Department of Neurosurgery, Kitano Medical Research Institute and Hospital. Adriamycin, an anthracycline antineoplastic agent, can swiftly be transported to the sensory or somatic motor neurons by way of axoplasmic transport when injected into the subepineurium of the trigeminal nerve or sciatic nerve in experimental animals, and is consequently able to induce degeneration of the neurons without any systemic side effects. Intraneural injection of this agent was carried out for the treatment of a total of 22 patients presenting with intractable neural dysfunction (12 with neuralgia, including 7 with post-herpetic neuralgia and 10 with facial dystonia). The nerve which innervated the affected site was exposed under local anesthesia and approximately 10-60 microliters of 1-20% adriamycin was injected into the subepineurium. Results of the treatment after average follow-up periods of 21.5 months were as follows: Out of 12 patients with neuralgia, good results were obtained in 2 cases (16.7%), fair results in 6 cases (50.0%) (overall effective rate 67.7%). There were no changes in symptoms in 4 cases (33.3%). Out of 10 patients with facial dystonia, good results were obtained in 2 cases (20.0%), fair in 2 cases (20.0%) (overall effective rate 40.0%), and no changes in symptoms in 6 cases (60.0%). No major complications were encountered during these procedures and, once symptoms had disappeared after the treatment, no recurrence of symptoms was experienced. This method clearly differs from other various kinds of simple peripheral neurotomy, since transection of the peripheral nerve does not cause any, destructive changes in the sensory ganglion or motor nucleus and, hence, symptoms may recur.(ABSTRACT TRUNCATED AT 250 WORDS) PMID: 7877732 [PubMed - indexed for MEDLINE] 3274. Ann Neurol. 1995 Feb;37(2):246-53. Topical lidocaine gel relieves postherpetic neuralgia. Rowbotham MC, Davies PS, Fields HL. Department of Neurology, University of California-San Francisco 94143. Postherpetic neuralgia (PHN) following herpes zoster is a common and disabling neuropathic pain syndrome. In a double-blind, three-session study, 5% lidocaine gel or vehicle was applied simultaneously to both the area of pain and to the contralateral mirror-image unaffected skin. In the local session, lidocaine gel was applied to the painful skin area. In the remote session, lidocaine gel was applied to mirror-image skin. In the placebo session, vehicle was applied bilaterally. For cranial PHN, gel was applied without occlusion for 8 hours. For limb or torso PHN, gel was applied under occlusion for 24 hours. The 16 subjects with cranial PHN reported pain relief significantly favoring local drug application at 30 minutes, 2, 4, and 8 hours. The 23 subjects with torso or limb PHN reported significantly lower pain intensity with local drug application at 8 hours and both pain relief and reduced pain intensity at 24 hours. Remote lidocaine application to mirror-image skin was no different from placebo. No systemic adverse effects were reported and blood levels did not exceed 0.6 microgram/ml. Topical application of 5% lidocaine gel relieves PHN pain by a direct drug action on painful skin. PMID: 7847866 [PubMed - indexed for MEDLINE] 3275. J Am Acad Dermatol. 1995 Feb;32(2 Pt 2):357-61. Zosteriform zygomycosis. Woods SG, Elewski BE. Department of Dermatology, University Hospitals of Cleveland, Case Western Reserve University, Ohio 44106. We describe a patient with zygomycosis that resembled herpes zoster infection. The diagnosis was readily made with a potassium hydroxide preparation that revealed sparsely to non-septate hyphae. The patient responded to combination antifungal therapy with amphotericin B and fluconazole. The clinical response correlated with antifungal susceptibility test results. PMID: 7829740 [PubMed - indexed for MEDLINE] 3276. Ear Nose Throat J. 1995 Feb;74(2):128. 75-year-old patient who has Ramsey Hunt syndrome. Fitzgerald DC. Comment on: Ear Nose Throat J. 1994 Nov;73(11):850-2. PMID: 7755786 [PubMed - indexed for MEDLINE] 3277. Ann Rheum Dis. 1995 Feb;54(2):155. Severe, disseminated, life threatening herpes zoster infection in a patient with rheumatoid arthritis treated with methotrexate. Ching DW. Department of Medicine, Timaru Hospital, New Zealand. Comment on: Ann Rheum Dis. 1994 Apr;53(4):224-8. PMCID: PMC1005543 PMID: 7755781 [PubMed - indexed for MEDLINE] 3278. Qual Life Res. 1995 Feb;4(1):41-5. Area under the curve: a metric for patient subjective responses in episodic diseases. Lydick E, Epstein RS, Himmelberger D, White CJ. Department of Epidemiology, Merck Research Laboratories, West Point, PA 19486, USA. Herpes zoster manifests as a characteristic painful rash that resolves within 2 months of initial presentation in 90% of patients. As pain is a hallmark of the disease, the severity of an episode can be described by the magnitude and duration of pain. The Brief Pain Inventory (BPI) was used to follow the daily and weekly amount of pain reported by 50 patients with herpes zoster. Results demonstrate that the BPI is a reproducible, responsive and valid measure of pain due to herpes zoster. From the individual responses on the BPI, the area under the curve (AUC) for each patient was derived from the pain reported on sequential administrations of the BPI. This metric was simple to calculate, easy to explain and captured two dimensions of this episodic disease (magnitude and duration of pain) in a single continuous measure. AUC could prove useful in the application of patient response data to intervention trials in diseases that are of an episodic nature. PMID: 7711690 [PubMed - indexed for MEDLINE] 3279. Enferm Infecc Microbiol Clin. 1995 Feb;13(2):130-1. [Acute retinal necrosis caused by varicella zoster virus] [Article in Spanish] Sotorra O, Villalonga P, Ribera E, Mateo C, Castro M, Juste C. PMID: 7711128 [PubMed - indexed for MEDLINE] 3280. Enferm Infecc Microbiol Clin. 1995 Feb;13(2):128-9. [Disseminated herpes zoster with pneumonitis in an HIV-positive patient] [Article in Spanish] Geijo P, Santiago M, Ruiz D, de Benito L. PMID: 7711126 [PubMed - indexed for MEDLINE] 3281. Acta Ophthalmol Scand. 1995 Feb;73(1):83-5. Presumed ophthalmic herpes zoster after contralateral cataract extraction. Walland MJ. Moorfields Eye Hospital, London, England. Herpes zoster ophthalmicus (HZO) may occur spontaneously, but can be precipitated by stress, trauma, debility or systemic illness. A case is here reported of Herpes zoster involving the contralateral eye, associated with a midline skin rash, following cataract extraction under local anaesthesia. PMID: 7627766 [PubMed - indexed for MEDLINE] 3282. Rev Med Chil. 1995 Feb;123(2):225-8. [Hepatitis C virus viremia and Herpes zoster virus infection in a patient in hemodialysis treated with erythropoietin] [Article in Spanish] Duclos J. Departamento de Nefrología, Hospital Naval, Viña del Mar, Chile. Hepatitis C virus infection in chronic hemodialysis patients is associated with several unresolved problems. We report a 85 years old female patient in chronic hemodialysis and treated with erythropoietin, that during the course of an Herpes zoster, presented severe malaise, weight loss and muscle weakness. Two weeks later, a slight rise in serum transaminases was detected. The patient had negative antibodies for HIV and hepatitis C virus and negative hepatitis B surface antigen. A PCR test was positive for serum hepatitis C virus RNA. The patient's condition deteriorated and she died 7 days after admission. Erythropoietin administration, whose immunosuppressive effect has been reported previously, could have influenced the dismal outcome of this patient. PMID: 7569463 [PubMed - indexed for MEDLINE] 3283. Wiad Lek. 1995 Jan-Jun;48(1-12):234-41. [Central nervous system infections in patients with AIDS] [Article in Polish] Niwicka-Michałowska A. Katedry i Kliniki Chorób Zakaźnych Ak. Med., Lodzi. Central Nervous System (CNS) is very common site of the opportunistic infections in patients with AIDS. Patients, who died because of AIDS have described pathology of CNS in 80% in autopsy series. Toxoplasmic encephalitis (TE) is the most common infection in the course of AIDS, and it touches 25-50% of the HIV-infected people. The treatment of TE is very difficult, but relapses are very often and primary and secondary prophylaxis of TE is necessary. Fungal infections (particularly cryptococcal meningitis) are very unpopular in immunocompetent patients; in HIV-infected people Cryptococcus neoformans is the cause of the 30% of encephalitis. Viral and bacterial encephalitis, they are not very common in AIDS patients. PMID: 9638248 [PubMed - indexed for MEDLINE] 3284. Cancer Treat Res. 1995;79:149-71. Herpesvirus infections in immunocompromised patients. Snoeck R, De Clercq E. Rega Institute for Medical Research, Leuven, Belgium. PMID: 8746653 [PubMed - indexed for MEDLINE] 3285. Scand J Infect Dis. 1995;27(6):623-5. Chronic ulcerating acyclovir-resistant varicella zoster lesions in an AIDS patient. Bernhard P, Obel N. Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark. We describe a 28-year-old HIV-infected woman with AIDS, defined by cerebral toxoplasmosis and a CD4-count of less than 10 x 10(6) cells/I, who, after several eruptions of genital herpes and typical dermatomal herpes zoster, all successfully treated with acyclovir, developed chronic cutaneous ulcerating lesions on a finger and on the tibia. The lesions were found to contain varicella zoster virus antigen but repeated treatment courses with acyclovir were unsuccessful. After a course of intravenous foscarnet the lesions resolved. They recurred after discontinuation of foscarnet but finally responded to a second course of treatment. PMID: 8685644 [PubMed - indexed for MEDLINE] 3286. Nephron. 1995;71(4):485-6. Tubulointerstitial nephritis with uveitis syndrome following varicella zoster reactivation. Ljutić D, Glavina M. PMID: 8587642 [PubMed - indexed for MEDLINE] 3287. Acta Haematol Pol. 1995;26(4):393-402. [Natural cytotoxicity of peripheral blood mononuclear cells in Herpes simplex and Varicella-zoster virus infections] [Article in Polish] Leszczyszyn-Pynka M. Katedra i Klinika Chorób Zakaźnych Pomorskiej Akademii Medycznej w Szczecinie. Natural cytotoxicity of peripheral blood was assessed in adults with recurrent Herpes labialis and in patients with Herpes zoster. CD16+ cells count, lymphocytes forming conjugates with K 562 cells count and NK activity in chromium-release assay were measured. Decreased CD16+ cells count and depressed NK activity were found during latency of HSV infection. During reactivation of the infection lymphocytes forming conjugates count was increased. Functional activation of natural killing was noted in patients with herpes zoster in the acute phase of the disease. However, no differences between results of all NK tests after herpes zoster versus control group were found. PMID: 8571741 [PubMed - indexed for MEDLINE] 3288. Ophthalmologica. 1995;209(5):267-9. Effects of calcium antagonists in the treatment of ophthalmic postherpetic neuralgia. Famà F, Santamaria S, Castagna I, Genovese FR, Ferreri G. Institute of Ophthalmology, University of Messina, Italy. Postherpetic neuralgia is one of the most common, but also one of the most difficult conditions to treat. This condition mainly involves trigeminal, intercostal and sciatic nerves and the brachial plexus area. It mostly appears in patients older than 60 years. Although pain is a transient condition, the pain of postherpeutic neuralgia may become intractable, disabling an may decrease the quality of the patient's life. We studied 30 patients affected by ophthalmic postherpetic neuralgia, appearing, some months after fronto-orbital cutaneous eruption. All patients received nicardipine retard, decreasing gradually, 40 mg/day for 2 weeks. The monitoring of pain was performed using the visual analogue score of Scott-Huskissonn. The results show an improvement in 'pain relief'. PMID: 8570150 [PubMed - indexed for MEDLINE] 3289. J Fr Ophtalmol. 1995;18(10):625-33. [Bilateral acute retinal necrosis in a patient with acquired immunodeficiency syndrome] [Article in French] Menerath JM, Gerard M, Laurichesse H, Goldschmidt P, Peigue-Lafeuille H, Rozenberg F, Beytout J. Service d'Ophtalmologie, Hôpital Gabriel Montpied, CHU, BP 69, Clermont-Ferrand. A case of bilateral progressive outer retinal necrosis occurred after herpes zoster ophthalmicus in a patient with acquired immunodeficiency syndrome. This case does not correspond to the classical picture of progressive outer retinal necrosis. The disease led to blindness despite intravenous therapy with acyclovir and foscarnet. PCR could not identify any virus in the aqueous humour, but VZV is evidenced in cerebrospinal fluid. Acute retinal necrosis is now clearly defined by the American Uveitis Society, which should allow to determine its incidence and risk factors. Herpes zoster usually precedes the acute outer retinal necrosis. The infectious theory (VZV, HSV, CMV) widely prevails over the immune theory. We prefer the virus genome identification in the aqueous humor or in the vitreous by PCR to confirm diagnosis rather than the specific antibody titration. Therapy consists in acyclovir, foscarnet and ganciclovir. But whatever the treatment, the visual prognosis is poor. PMID: 8568169 [PubMed - indexed for MEDLINE] 3290. Nephrol Dial Transplant. 1995;10(9):1775-7. Acyclovir-associated encephalopathy, lack of relationship between acyclovir levels and symptoms. de Knegt RJ, van der Pijl H, van Es LA. Department of Internal Medicine, University Hospital Leiden, The Netherlands. PMID: 8559507 [PubMed - indexed for MEDLINE] 3291. Ophthalmic Res. 1995;27(5):310-6. Detection of varicella-zoster virus genome having a PstI site in the ocular sample from a patient with acute retinal necrosis. Kumano Y, Manabe J, Hamamoto M, Kawano Y, Minagawa H, Fukumaki Y, Inomata H. Department of Ophthalmology, Faculty of Medicine, Kyushu University, Fukuoka, Japan. We detected the virus genome in ocular samples from a 65-year-old woman with clinically diagnosed acute retinal necrosis using DNA amplification. She exhibited occlusive retinal vasculitis, confluent necrotizing retinitis, mainly peripheral, and iridocyclitis. For DNA amplification, we used recently published primers specific for varicella-zoster virus (VZV) and herpes simplex virus. Using VZV primers, we detected the VZV genome in the aqueous humor, but not in the vitreous, by amplifying a DNA fragment 642 base pairs in length. HSV DNA was not detected. After detecting the VZV genome, PstI restriction endonuclease was used because an epidemiological study found that about 25% of the VZV strains in Japan carry a mutation lacking a PstI recognition site. The VZV genome from the patient had a PstI cleavage pattern, while the positive control had a VZV genome that carried a PstI-site-less mutation. We considered our patient with acute retinal necrosis to be infected with VZV having a PstI site. PMID: 8552371 [PubMed - indexed for MEDLINE] 3292. J Acquir Immune Defic Syndr Hum Retrovirol. 1995 Jan 1;8(1):23-9. Neurologic manifestations of AIDS: a comparative study of two populations from Mexico and the United States. Trujillo JR, Garcìa-Ramos G, Novak IS, Rivera VM, Huerta E, Essex M. Department of Cancer Biology, Harvard School of Public Health, Boston, Massachusetts 02115, USA. Neurologic complications associated with human immunodeficiency virus type 1 (HIV-1) infection vary geographically. To understand the pattern of HIV-associated neurologic complications in Mexico, 120 AIDS patients from Mexico City, Mexico, and 500 AIDS patients from Houston, Texas, were studied cross-sectionally and retrospectively. Neurologic, laboratory, imaging, and pathologic examinations identified 40 Mexican patients and 130 U.S. patients with neurologic complications. Whereas AIDS dementia complex was the most common neurologic manifestation in both groups, intracranial tuberculoma was present only in the Mexican population (10%). Primary brain lymphoma was more prevalent in the U.S. population (8.4%). The different findings in the Mexican population likely reflect afflictions common to developing countries--a high prevalence of tuberculosis and a high mortality rate. These conditions preclude complications such as lymphoma, which develop later in the natural course of HIV infection. PMID: 8548343 [PubMed - indexed for MEDLINE] 3293. Eye (Lond). 1995;9 ( Pt 5):594-8. Herpes zoster chorioretinopathy. Roberts TV, Francis IC, Kappagoda MB, Dick AD. Westmead Hospital, Sydney, Australia. Chorioretinitis and subsequent choroidal and retinal pigment epithelial atrophy following herpes zoster ophthalmicus (HZO) have rarely been reported. We report two patients, who several months following attacks of acute HZO, developed posterior fundus features of yellow, non-pigmented, punched-out areas of retinal pigment epithelial and choroidal pigment atrophy, which we have termed herpes zoster chorioretinopathy. An occlusive vasculitic process is proposed as the pathogenesis for this chorioretinopathy, and may be similar to that seen in the delayed cerebral vasculitis following HZO. A previous history of HZO should be sought in patients with a unilateral, multifocal, non-pigmented chorioretinopathy, as this may represent a characteristic delayed feature. PMID: 8543079 [PubMed - indexed for MEDLINE] 3294. Ann Dermatol Venereol. 1995;122(6-7):436-8. [Post-Herpes Zoster calcinosis] [Article in French] Puskás M, Schneider I, Dull G, Zombai E. Clinique Dermatologique, Faculté de Médecine de Pécs Hôpital Départemental de Nagykanizsa (Hongrie). INTRODUCTION. Cutaneous calcinosis, without any disturbance of phosphocalcic metabolism, secondary to circumscribed previous skin lesions are quite common. Those secondary to viral skin lesions are rare and worth of publication. CASE REPORT. A 73-year old female patient disclosed progressive calcinosis in the scar of a cervico-thoracic herpes zoster which occurred 20 years ago. DISCUSSION. The occurrence of a secondary calcinosis in an old scar is common and non specific: the eliciting role of a previous herpes virus infection (VZV) may be discussed in the reported case and in few other cases reported in the literature (HSV, CMV) PMID: 8526428 [PubMed - indexed for MEDLINE] 3295. Ann Med Interne (Paris). 1995;146(5):292-4. [Varicella-zoster virus pancreatitis in hematologic diseases] [Article in French] Pulik M, Teillet F, Teillet-Thiebaud F, Lionnet F, Genet P, Petitdidier C. Service d'Hématologie, Hôpital Victor-Dupouy, Argenteuil We report four cases of varicella-zoster pancreatitis in immunocompromised hosts. All 4 patients presented a severe immunodeficiency because of chronic lymphoproliferative disorders (mainly lymphoma and Hodgkin disease) and long-term immunosuppressive therapy. Varicella zoster pancreatitis is a very unusual presentation of varicella-zoster infection. Few cases of pancreatitis occurring after bone marrow transplantation have been reported. All 4 patients presented with acute epigastric pain associated with transient elevation of serum amylase. The vesicular rash followed the presenting symptoms of severe abdominal pain by 8 days. This clinical presentation, occurring in immunocompromised patients, defines a set of symptoms which should lead the physician to suspect varicella-zoster pancreatitis, even in the initial absence of the characteristic skin vesicular eruption. Early institution of antiviral therapy seems mandatory. PMID: 8526311 [PubMed - indexed for MEDLINE] 3296. Rev Med Interne. 1995;16(10):792-3. [Herpes zoster ophthalmicus and oculomotor involvement] [Article in French] Granel F, Maignan M, Canton P. PMID: 8525163 [PubMed - indexed for MEDLINE] 3297. Nurse Pract. 1995 Jan;20(1):80. Famciclovir approved for shingles. [No authors listed] PMID: 7898796 [PubMed - indexed for MEDLINE] 3298. Nippon Jibiinkoka Gakkai Kaiho. 1995 Jan;98(1):112-8. [Evaluation of the plasma endothelin levels in facial nerve paralysis] [Article in Japanese] Iijima M, Ikeda M. Department of Otolaryngology, Nihon University School of Medicine, Tokyo. The etiology of so-called Bell's palsy is still unknown. Based on the hypothesis that endothelin, with its potent vasoconstricting action, is in some way involved in the etiological mechanism of facial nerve paralysis, we measured the blood endothelin levels of 62 patients with Bell's palsy in the acute stage (within one week following onset). The measurements were extended to include 10 patients with Ramsay Hunt syndrome and 14 patients with zoster sine herpete. To determine endothelin content, blood samples were drawn into blood collecting tubes, containing EDTA-2Na+aprotinin at any time desired during the day. The samples were immediately chilled and centrifuged to separate the plasma portion, and 2ml of this plasma sample was preserved by freezing. ET-1 was extracted using silica-ODS and analyzed by RIA using anti-ET 1 antibody. An age-matched comparison between the Bell's palsy patients and 36 normal individuals using the Mann-Whitney U test showed a significant difference (p < 0.01). The patients with Ramsay Hunt syndrome and zoster sine herpete also tended to have elevated endothelin levels. This finding suggests that disorders of the microcirculatory system in which endothelin is in some way involved may play a role in the pathogenesis of facial nerve paralysis. PMID: 7897568 [PubMed - indexed for MEDLINE] 3299. Enferm Infecc Microbiol Clin. 1995 Jan;13(1):6-11. [Neurologic manifestations of varicella herpes zoster infection] [Article in Spanish] de Otero J, Suriñach JM, Ribera E, Alegre J, Juste C, Río J. Unidad de Enfermedades Infecciosas, Hospital General Universitari de la Vall d'Hebron, Universidad Autónoma, Barcelona. Comment in: Enferm Infecc Microbiol Clin. 1996 Jun-Jul;14(6):396-7. BACKGROUND: The aim of the present study was to analyze the clinical characteristics and fluid alterations in neurologic infection by varicella herpes zoster virus in hospitalized patients. METHODS: A retrospective study of the cases with neurologic involvement by the varicella herpes zoster virus in patients admitted in the authors' hospital from March 1991 to March 1993 was carried out. RESULTS: Our of the 14 patients studied with neurologic involvement by the varicella herpes zoster virus, 10 were males (71%) with a mean age of 38 years (range: 13-83 years). Only 4 patients (28%) presented a base disease (diabetes mellitus in 2 cases and HIV infection in another 2). In 10 cases (71%) the appearance of cutaneous lesions was prior to neurologic manifestations (between 1 and 30 days before neurologic clinical manifestations). All the patients presented hyperthermia at some time. The most common symptoms were: headache, vomiting, confusion and/or neck stiffness, with meningitis, encephalitis and neurologic foci and mixed pictures. In 4 cases (28%) the cephalorhachidian fluid did not present analytical changes suggestive of viral meningitis. All the patients underwent i.v. acyclovir treatment at a dosis of 10-15 mg/kg/8 h with good evolution, with no deaths being observed. In 3 out of the 6 cases presenting neurologic foci the evolution was slow with sequelae following treatment completion. CONCLUSIONS: Neurologic involvement by the varicella herpes zoster virus does not clinically defer from other neutrotropic virus. Fluid alterations were compatible with benign lymphocytary meningitis although some cases of encephalitis showed normal LCR. Taking into account that none of the patients herein reported died and considering the mortality associated with meningitis or encephalitis by varicella herpes zoster referred in the literature in untreated patients, the authors believe that the use of acyclovir is obligatory in these cases. PMID: 7893793 [PubMed - indexed for MEDLINE] 3300. Transpl Int. 1995;8(1):58-60. Herpes zoster-associated idiopathic thrombocytopenic purpura in a liver transplant recipient: a case report and overview. Singh N, Gayowski T, Yu VL. Department of Veterans Affairs Medical Center, Pittsburgh, PA 15240. Idiopathic (autoimmune) thrombocytopenic purpura has been previously reported as a rare complication in children and in a few adults following chickenpox. We report a case of varicella zoster virus-associated idiopathic thrombocytopenic purpura in an adult liver transplant recipient following dermatomal zoster. Idiopathic thrombocytopenic purpura developed 3 days after the onset of herpes zoster in our patient, with a nadir platelet count of 3000/mm3. The patient was treated with intravenous gamma globulin with recovery of thrombocytopenia after 3 weeks. Transplant clinicians need to be aware that this serious and potentially life-threatening complication may occur with herpes zoster in transplant recipients. PMID: 7888054 [PubMed - indexed for MEDLINE] 3301. Br J Obstet Gynaecol. 1995 Jan;102(1):79. Fetal immunological and haematological changes in intrauterine infection. Michie CA, Harvey D. Comment on: Br J Obstet Gynaecol. 1994 May;101(5):418-21. PMID: 7833325 [PubMed - indexed for MEDLINE] 3302. Arch Dermatol. 1995 Jan;131(1):24-6. The treatment of acyclovir-resistant herpes zoster with trifluorothymidine and interferon alfa. Rossi S, Whitfeld M, Berger TG. University of British Columbia, Vancouver. PMID: 7826092 [PubMed - indexed for MEDLINE] 3303. J Am Acad Dermatol. 1995 Jan;32(1):127-8. Zosteriform cutaneous T-cell lymphoma. Ricci RM, Latham PL, Soong V, Mullins D. Maxwell Air Force Base, Birmingham, Alabama. PMID: 7822504 [PubMed - indexed for MEDLINE] 3304. Invest Ophthalmol Vis Sci. 1995 Jan;36(1):41-51. Ocular inoculation of monkeys with simian varicella virus: clinical and histopathologic observations. Metcalf JF, Christianson MD, Brady AG. Department of Ophthalmology, College of Medicine, University of South Alabama, Mobile 36688. PURPOSE. To explore the possibility that inoculation of the eyes of African green monkeys with simian varicella virus (SVV) induces the symptoms of herpes zoster ophthalmicus (HZO), as seen in humans, and to develop a realistic and reproducible animal model of herpes zoster ophthalmicus for experimental studies. METHODS. In the first experiment, the right eyes of three African green monkeys were inoculated by intrastromal and subconjunctival injections with a suspension of SVV-infected Vero cells. In the second experiment, three additional monkeys were pretreated with intramuscular injections of methylprednisolone (41 mg/kg) for 7 days before ocular inoculation with SVV and for 3 weeks at 14 mg/kg after virus inoculation. The eyes were examined by slit-lamp biomicroscopy. Histologic, immunohistochemical, and electron microscopic studies were performed. RESULTS. In the first experiment, all three animals developed high titers of anti-SVV antibodies (IgG). Diffuse stromal opacity, with keratitic precipitates, stromal edema, and mild vascularization of the cornea, appeared 12 to 14 days after inoculation. The onset of ocular disease was correlated with the rise in serum antibody levels. There was no clinical evidence of a systemic viral infection resulting from the corneal inoculations in these monkeys. In the second experiment, all three animals treated with methylprednisolone developed severe ocular pathology within 1 week of inoculation. The clinical appearance of the diseased eyes strongly indicated that local viral infection had occurred. Dendritiform keratitis, corneal erosion, and stromal necrosis with vascularization of the cornea was seen in all the eyes. The disease resolved within 4 to 5 weeks of inoculation, leaving opaque, vascularized corneas. Histologic studies showed that inflammatory cells and viral antigens were widespread throughout the diseased corneas. A high titer of anti-SVV antibody (IgG) was detected in the immunosuppressed monkeys, but no evidence of systemic viral infection was observed. CONCLUSIONS. The authors propose that inoculation of the eyes of methylprednisolone-treated African green monkeys with simian varicella virus provides an appropriate animal model for studies of the virology and immunopathology of ocular varicella virus infection. PMID: 7822158 [PubMed - indexed for MEDLINE] 3305. Am Fam Physician. 1995 Jan;51(1):57. Topical chloroform and postherpetic neuralgia. Kaye R. PMID: 7810481 [PubMed - indexed for MEDLINE] 3306. Br J Gen Pract. 1995 Jan;45(390):39-45. Primary care management of acute herpes zoster: systematic review of evidence from randomized controlled trials. Lancaster T, Silagy C, Gray S. University Department of Public Health and Primary Care, Radcliffe Infirmary, Oxford. Although a number of randomized controlled trials of treatment for herpes zoster have been performed, there is no consensus on how it should be managed in general practice. A systematic review of existing trials, including meta-analysis, was performed to determine the efficacy of available therapies in reducing the incidence of postherpetic neuralgia. The treatments studied included antiviral agents, corticosteroids and other drugs which had been studied in randomized trials. Trials were included if the subjects were immunocompetent adults and the intervention was feasible in general practice. The main outcome measure was prevalence of pain at one, three and six months after onset of the acute herpetic rash. Data for each time point were not available for all trials. The quality of studies was also assessed. Pooled analyses of trials with acyclovir failed to detect a significant reduction of pain in the treatment group at one or six months, but found a 35% reduction at three months. Confidence limits were wide, and a modest benefit of treatment cannot be ruled out at one and six months. Pooled analyses were not possible for other treatments, either because too few trials had been performed, or because completed trials demonstrated significant heterogeneity. Many clinical trials in this area have been too small to give reliable results. Variations in the definition and reporting of postherpetic neuralgia create difficulties in combining data from different studies. Firm recommendations for clinical practice are not possible because existing evidence neither confirms nor refutes the hypothesis that treatment during the acute phase of herpes zoster reduces pain later. PMCID: PMC1239112 PMID: 7779475 [PubMed - indexed for MEDLINE] 3307. Retina. 1995;15(1):14-20. Progressive outer retinal necrosis secondary to varicella zoster virus in acquired immune deficiency syndrome. Greven CM, Ford J, Stanton C, Shogreen M, Feldman S, Pegram S, Slusher MM. Department of Ophthalmology, Wake Forest University Eye Center, Winston-Salem, North Carolina, USA. BACKGROUND: A syndrome consisting of rapidly progressive outer retinitis in patients with suppressed immune systems has been described. The etiologic agent appears to be a member of the herpes virus family. METHODS: A 41-year-old man with acquired immune deficiency syndrome (AIDS) developed bilateral outer retinitis and choroiditis, which progressed despite antiviral treatment. A transscleral eye wall biopsy specimen and whole globe were submitted for microbiologic and histologic study. RESULTS: Polymerase chain reaction of a transscleral eye wall biopsy specimen and of the enucleated specimen determined the etiologic agent to be varicella zoster virus (VZV). Histologic studies demonstrated intranuclear inclusions consistent with viral particles in choroidal cells. CONCLUSION: Our study revealed intranuclear inclusions in choroidal cells, a previously undocumented finding in progressive outer retinal necrosis. Polymerase chain reaction was very useful in identifying the causative agent. PMID: 7754241 [PubMed - indexed for MEDLINE] 3308. J Mal Vasc. 1995;20(1):1-7. [Vasculitis of viral origin. Pathogenesis and therapeutic implications] [Article in French] Genereau T, Tri N'Guyen Q, Lortholary O, Cohen P, Guillevin L. Service de Médecine Interne, Hôpital Avicenne, Bobigny. Some viruses are unquestionably the cause of vasculitis, by different mechanisms: circulating immune complexes, cryoglobulinemia and/or direct infection of the blood vessel. The main viruses responsible for vasculitis are hepatitis B & C viruses, cytomegalovirus, parvovirus B19 and human immunodeficiency virus. Viral vasculitis are clinically protean, most of the time similar to idiopathic vasculitis. The manifestations due to the virus itself are sometimes hidden and vasculitis may reveal the viral infection. In some cases of viral vasculitis, particularly in hepatitis virus-induced vasculitis, antiviral therapy may help in controlling the disease. A viral etiology must be considered during atypical vasculitis. PMID: 7745353 [PubMed - indexed for MEDLINE] 3309. Clin Infect Dis. 1995 Jan;20(1):206-8. Myelitis due to varicella-zoster virus in an immunocompromised patient without a cutaneous rash. Meylan PR, Miklossy J, Iten A, Petignat C, Meuli R, Zufferey J, Sahli R. PMID: 7727664 [PubMed - indexed for MEDLINE] 3310. Adv Pediatr Infect Dis. 1995;10:93-124. Varicella-zoster virus: prospects for control. Gershon AA. Department of Pediatrics, Columbia University College of Physicians & Surgeons, New York, New York, USA. There have been a number of new developments in the field of VZV concerning pathogenesis, diagnosis, prevention, and treatment. These include improved understanding of how latent infection develops and is maintained, the development and, we hope, licensure of live attenuated varicella vaccine for routine use in children and in adults who have not had varicella, an increased availability of antiviral therapy for healthy and immunocompromised patients, and the development of newer diagnostic techniques, including PCR to diagnose illnesses caused by VZV and LA for rapid, sensitive, and accurate determination of immune status to VZV. Even as vaccine use becomes more and more widespread, we will continue to need effective antiviral therapy for VZV for use in immunocompromised persons and in those in whom zoster develops. Eventually it may be possible to develop either a vaccine or an antiviral drug that prevents the development of latent VZV infection. Until that time, however, VZV will remain with us, and we will continue to need an effective antiviral armamentarium, including diagnostic techniques, passive immunization, antiviral therapy, and vaccine. PMID: 7718215 [PubMed - indexed for MEDLINE] 3311. ORL Head Neck Nurs. 1995 Winter;13(1):10. What are the primary nursing diagnoses to be considered when planning care for the patient with Ramsay Hunt syndrome? McCall M. PMID: 7627869 [PubMed - indexed for MEDLINE] 3312. An Otorrinolaringol Ibero Am. 1995;22(4):339-48. [Epidemic outbreak of herpes zoster oticus (Ramsay-Hunt syndrome)] [Article in Spanish] Mochón A, Esteban F, Solano J, González-Moles MA, Mendoza J, Domínguez C. Servicio de Otorrinolaringología del Hospital Virgen de las Nieve de Granada. In this paper are reported 5 cases of herpes zoster oticus diagnosed in our surroundings, all of them presented independently, in a two weeks term. Discussion of the disease's etiopathogeny besides the possibility of its spreading as outbreaks. PMID: 7573854 [PubMed - indexed for MEDLINE] 3313. Retina. 1995;15(3):233-40. Interpretation of intraocular and serum antibody levels in necrotizing retinitis. Davis JL, Feuer W, Culbertson WW, Pflugfelder SC. Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami School of Medicine, Florida, USA. BACKGROUND: Intraocular antibodies have been measured as a diagnostic aid in necrotizing retinitis but interpretation of results may be difficult. METHODS: Vitreous or aqueous and serum immunoglobulin G antibodies to toxoplasmosis, cytomegalovirus, herpes simplex virus I and II, and varicella zoster virus were subjected to enzyme-linked immunosorbent assay in 27 patients with necrotizing retinitis and 15 control patients. A quotient was derived quantitating the amount of excess antibody in the eye compared to serum. Different interpretative rules were analyzed to determine which yielded the highest sensitivity and specificity. RESULTS: The highest intraocular antibody relative to serum among the 4 antibodies correctly predicted the final clinical diagnosis in 21 of 27 patients, for a sensitivity of 78% and a specificity of 90%. Interpretive rules that relied on a high numeric value of the antibody quotient or did not consider the relative ranking of the four antibody quotients were less sensitive and specific because multiple antibodies were detected in most eyes. The technique was safe and rapid. CONCLUSION: Interpretation of antibody titers in intraocular fluids is facilitated by testing several relevant antibodies and comparing the results. The technique may be helpful to diagnose necrotizing retinitis and to ascertain viral cause in acute retinal necrosis. PMID: 7569351 [PubMed - indexed for MEDLINE] 3314. Eye (Lond). 1995;9 ( Pt 3):390-2. Oral acyclovir in herpes zoster ophthalmicus. Harding SP. Comment on: Eye (Lond). 1994;8 ( Pt 1):70-4. PMID: 7556765 [PubMed - indexed for MEDLINE] 3315. Eye (Lond). 1995;9 ( Pt 3):271-6. Progressive outer retinal necrosis (PORN) in AIDS patients: a different appearance of varicella-zoster retinitis. Pavesio CE, Mitchell SM, Barton K, Schwartz SD, Towler HM, Lightman S. Uveitis and Acquired Immunodeficiency Syndrome Clinics, Moorfields Eye Hospital, London, UK. Retinal infections caused by the varicella-zoster virus (VZV) have been reported in immunocompetent and immunocompromised individuals. Two cases of a VZV-related retinitis are described with the characteristic features of the recently described progressive outer retinal necrosis (PORN) syndrome. Both patients suffered from the acquired immunodeficiency syndrome (AIDS) with greatly reduced peripheral blood CD4+ T lymphocyte counts, and presented with macular retinitis without vitritis. The disease was bilateral in one case and unilateral in the other. The clinical course was rapidly progressive with widespread retinal involvement and the development of rhegmatogenous retinal detachment with complete loss of vision in the affected eyes despite intensive intravenous antiviral therapy. VZV DNA was identified in vitreous biopsies, by molecular techniques based on the polymerase chain reaction (PCR), in both patients. At present, the use of very high-dose intravenous acyclovir may be the best therapeutic option in these patients for whom the visual prognosis is poor. Intravitreal antiviral drugs could also contribute to the management of these cases. PMID: 7556731 [PubMed - indexed for MEDLINE] 3316. Arch Virol. 1995;140(11):2055-66. Detection of latent varicella zoster virus DNA and human gene sequences in human trigeminal ganglia by in situ amplification combined with in situ hybridization. Dueland AN, Ranneberg-Nilsen T, Degré M. Institute of Bacteriology, National Hospital, University of Oslo, Norway. Varicella zoster virus (VZV) establishes latency in sensory ganglia following primary infection (chickenpox) and may reactivate decades later to produce zoster (shingles). The presence of VZV DNA in latently infected ganglia has been demonstrated by Southern blot hybridization as well as by polymerase chain reaction of DNA extracted from latently infected ganglia. Conflicting results have been obtained by in situ hybridization studies to determine the cell type in the ganglia harboring the latent VZV. To address this controversy we have utilized a more sensitive method than the previous studies. We have applied the technique of polymerase chain reaction to sections of ganglia from latently infected individuals and combined this with in situ hybridization to detect the amplified product. Primers specific for VZV were used to amplify VZV DNA in latently infected human trigeminal ganglia and demonstrated the presence of VZV DNA in neurons only. Sections from human kidney and ganglia from neonates as well as monkey ganglia served as controls and did not show amplification of VZV sequences. Amplification using primers for human genes, alpha tubulin and the oncogene Bcl-2, demonstrated the presence of these sequences in nearly all cells in the human tissues while only weak signals were seen in the monkey tissue. This is the first report where in situ amplification has been utilized to detect latent VZV in human ganglia. PMID: 7503701 [PubMed - indexed for MEDLINE] 3317. Rev Med Panama. 1995 Jan-May;20(1-2):54-7. [Herpes zoster in infants] [Article in Spanish] Rivas de La Lastra E, Lasso Bonilla MA. CHMAAM, Caja de Seguro Social de Panamá. The authors present the clinical history of four children under two years of age who were hospitalized in the Arnulfo Arias Madrid Medical Complex with the diagnosis of herpes zoster. The mothers of these children had varicella when in the third, sixth, eight and fifth month of pregnancy respectively and the children were 3, 24, 14 and 8 months old when they had herpes zoster. The first child (whose mother had varicella when she was three months pregnant) was born underweight, dysphagic and premature. The fourth (whose mother had varicella in the 5th. month of gestation) was only underweight. The other two (mothers had varicella in the 6th and 8th month of pregnancy, respectively) were born without apparent abnormality. The authors, based on their findings, believe that there is risk for the child to have a congenital malformation when the mother develops varicella in the first months of pregnancy. PMID: 7480905 [PubMed - indexed for MEDLINE] 3318. Br J Hosp Med. 1994 Dec 14-1995 Jan 17;52(11):565-7, 570. Postherpetic neuralgia: current concepts and management. Lee JJ, Gauci CA. Pain Relief Clinic, Whipps Cross Hospital, London. Postherpetic neuralgia (PHN) is the most feared complication of herpes zoster and remains one of the most common and intractable chronic pain disorders. Recent evidence has shed some light on the possible mechanisms of pain, and on the prophylactic and treatment approaches to PHN. This article reviews the current concepts and management of PHN. PMID: 7719579 [PubMed - indexed for MEDLINE] 3319. Eur Arch Otorhinolaryngol. 1994 Dec:S530-1. Therapeutic policy for Bell's palsy and Hunt syndrome. Kinishi M, Hosomi H, Amatsu M. Department of Otolaryngology, Kobe University School of Medicine, Japan. PMID: 10774441 [PubMed - indexed for MEDLINE] 3320. Eur Arch Otorhinolaryngol. 1994 Dec:S493-4. Herpes zoster of the geniculate ganglion: therapeutic concepts. Darrouzet V, Gharbi F, de Bonfils C, Rognon C, Bebear JP. ENT Department, Pellegrin Hospital, Bordeaux, France. PMID: 10774432 [PubMed - indexed for MEDLINE] 3321. Eur Arch Otorhinolaryngol. 1994 Dec:S491-2. Recent treatment of Ramsay Hunt syndrome. Inamura H, Aoyagi M, Tojima H, Maeyama H, Koike Y. Department of Otolaryngology, Yamagata University School of Medicine, Japan. PMID: 10774431 [PubMed - indexed for MEDLINE] 3322. Eur Arch Otorhinolaryngol. 1994 Dec:S432-3. Detection of varicella zoster virus DNA by polymerase chain reaction in clinical samples from patients with Hunt's syndrome. Kawasaki Y, Aruga H, Ogino S, Hashimoto K, Yamanishi K, Matsunaga T. Department of Otolaryngology, Osaka University Medical School, Japan. PMID: 10774415 [PubMed - indexed for MEDLINE] 3323. Arch Ophthalmol. 1994 Dec;112(12):1515-6. Differentiating zosteriform herpes simplex from ophthalmic zoster. Yamamoto S, Shimomura Y, Kinoshita S, Tano Y. PMID: 7993204 [PubMed - indexed for MEDLINE] 3324. South Med J. 1994 Dec;87(12):1227-31. Acyclovir neurotoxicity: clinical experience and review of the literature. Adair JC, Gold M, Bond RE. Department of Neurology, Shands Hospital, University of Florida, Gainesville 32610. Acyclovir produces neurologic symptoms that resemble extension of viral infection into the central nervous system. We discuss our observations in the cases of two patients with acyclovir neurotoxicity and review the findings of all previous reports in the English language literature. Systemic disease, most commonly renal dysfunction, preceded all 30 reported cases of acyclovir neurotoxicity. The most common symptoms were mental status disorder and involuntary movements. Measurement of serum acyclovir levels substantiated the diagnosis in only a subset of patients. Although all patients recovered, hemodialysis hastened the rate of recovery. PMID: 7973922 [PubMed - indexed for MEDLINE] 3325. Postgrad Med J. 1994 Dec;70(830):940. Herpes zoster encephalitis in the elderly. Gillanders I, MacKay J, Campbell F, MacLennan WJ. PMCID: PMC2398002 PMID: 7870650 [PubMed - indexed for MEDLINE] 3326. Qual Life Res. 1994 Dec;3(6):431-5. The Nottingham Health Profile as a measure of quality of life in zoster patients: convergent and discriminant validity. Mauskopf J, Austin R, Dix L, Berzon R. Economics Research Department, Burroughs Wellcome Co., Research Triangle Park, NC 27709. The main symptoms of zoster, a disease caused by the reactivation of the varicella zoster virus (that causes chicken-pox) are: rash, associated with pain, burning, or itching, and pain that outlasts the rash sometimes by months or years. The uncomfortable and long-lasting symptoms of herpes zoster are likely to compromise the patient's quality of life. However, the impact of zoster on health-related quality of life has not previously been measured directly. Recent papers have demonstrated the ability of generic measures to discriminate among patients with different clinical symptoms. In this paper, we demonstrate the convergent validity for zoster of a generic measure, the Nottingham Health Profile (NHP), by measuring its correlation with rash progression, pain levels, and pain medications. The discriminant validity of the NHP was demonstrated by its ability to distinguish between different levels of pain severity. The NHP dimensions most highly correlated with the pain measures, were pain (0.42-0.50), energy (0.34-0.38) and sleep (0.32-0.38). The NHP scores in all six dimensions show large differences at different levels of pain severity that are statistically significant. These results demonstrate the NHP's validity as a measure of health-related quality of life in zoster patients. PMID: 7866361 [PubMed - indexed for MEDLINE] 3327. Am J Dermatopathol. 1994 Dec;16(6):588-92. Viral glycoproteins in herpesviridae granulomas. Nikkels AF, Debrus S, Delvenne P, Sadzot-Delvaux C, Piette J, Rentier B, Piérard GE. Department of Dermatopathology, University of Liège, Belgium. Granulomatous reactions after varicella zoster virus (VZV) and herpes simplex virus (HSV) infections are rare, and their pathogenesis remains unclear. We studied by immunohistochemistry and in situ hybridization early granulomatous reactions after VZV and HSV infections. In the five cases studied, the VZV glycoproteins gp I and gp II were present in cells abutted to altered vessels, but the corresponding genome sequences were disclosed in similar locations in only one of these cases. In an immunocompromised patient with diffuse HSV eruption, HSV I antigens were present in cells of the reticular dermis, while viral nucleic acids were not evident. Immunophenotyping of the granulomas showed strong Mac 387 and CD68 positive labelings of macrophages/monocytes, without any involvement of Factor XIIIa-positive cells. These findings suggest that the major viral envelope glycoproteins, rather than complete viral particles could trigger granuloma formation following HSV and VZV skin infections. PMID: 7864296 [PubMed - indexed for MEDLINE] 3328. Rev Clin Esp. 1994 Dec;194(12):1062-3. [Pontine infarction and cervical herpes zoster] [Article in Spanish] Sempere AP, Fernández A, Calabuig MJ, Duarte J. PMID: 7863060 [PubMed - indexed for MEDLINE] 3329. Drugs Aging. 1994 Dec;5(6):411-8. Post-herpetic neuralgia in older patients. Incidence and optimal treatment. Bowsher D. Pain Research Institute, Walton Hospital, Liverpool, England. Post-herpetic neuralgia (PHN) is a disease caused by having had herpes zoster; it is not a continuation of shingles. Up to 50% of elderly patients who have had shingles may develop PHN. PHN is defined as pain recurring or continuing at the site of shingles, 1 or more months after the onset of the rash. Because many cases resolve spontaneously in the early stages, no claims of 'pharmacological cure' can be entertained before 3 months post-rash. In fact, some authorities will not accept claims made before 6 months. Antivirals administered systemically within the appropriate time-window greatly relieve the pain of acute shingles, and to a large extent prevent scarring. There is no evidence that they prevent the subsequent development of PHN. However, patients with PHN whose acute shingles were treated with aciclovir obtain pain relief with antidepressants in half the time required by those patients who did not receive aciclovir for their acute shingles. If patients with acute shingles are given low dose amitriptyline from the onset, only half as many are in pain at 6 months as a group not so treated, irrespective of the antiviral treatments given. The most effective treatment of established PHN to date consists of adrenergically active antidepressants. There is a strict correlation with the brevity of the interval between acute shingles and initiation of such treatment. 75% of patients starting treatment with antidepressants within 3 to 6 months after shingles obtain pain relief, whereas if antidepressants are not started for 2 years, only 25% obtain pain relief.(ABSTRACT TRUNCATED AT 250 WORDS) PMID: 7858367 [PubMed - indexed for MEDLINE] 3330. J Gerontol Nurs. 1994 Dec;20(12):42-6. Herpes zoster and the aging. McMahon MA. PMID: 7852712 [PubMed - indexed for MEDLINE] 3331. Yan Ke Xue Bao. 1994 Dec;10(4):248-50. [Herpes zoster keratoendotheliitis] [Article in Chinese] Huang Y, Cheng B, Guan Z. Department of Ophthalmology, Zhongshan People's Hospital, Guangdong, China. Herpes zoster keratoendotheliitis is related to autoimmunity or herpes zoster virus infection. It is characterised by K.P. and interstitial edema. The disease responds well to the administration of steroids and a good result is often achieved. PMID: 7774702 [PubMed - indexed for MEDLINE] 3332. S Afr Med J. 1994 Dec;84(12):873. Recurrent herpes zoster and high-dose inhaled steroids for asthma. Bruning AH, Samie MH. PMID: 7570247 [PubMed - indexed for MEDLINE] 3333. Lakartidningen. 1994 Nov 23;91(47):4348. [Bandage for relief in Herpes zoster] [Article in Swedish] Bölander L. PMID: 7808136 [PubMed - indexed for MEDLINE] 3334. Am J Ophthalmol. 1994 Nov 15;118(5):589-600. Clinical and histopathologic study of varicella zoster virus retinitis in patients with the acquired immunodeficiency syndrome. Kuppermann BD, Quiceno JI, Wiley C, Hesselink J, Hamilton R, Keefe K, Garcia R, Freeman WR. Department of Ophthalmology, University of California, San Diego, La Jolla 92093-0946. Varicella zoster virus retinitis in patients with the acquired immunodeficiency syndrome is known to be a devastating disease. We studied a series of six consecutive patients that sheds new light on the clinical manifestations and treatment options of this disorder. All patients had episodes of cutaneous zoster, long-term exposure to oral acyclovir, and CD4+ T lymphocyte counts less than 50 cells/mm3. Two of the six patients had simultaneous radiographically demonstrable and histologically proven varicella zoster virus encephalitis; this is an important association. Histologic examination of autopsy specimens disclosed that the retinal infection by varicella zoster virus involves the retinal pigment epithelium more heavily than the inner retina, which is consistent with the characteristic clinical impression of an outer retinal necrosis. PMID: 7977572 [PubMed - indexed for MEDLINE] 3335. Dtsch Med Wochenschr. 1994 Nov 4;119(44):1526-7. [The efficacy of acyclovir and glucocorticoids in the treatment of herpes zoster and postzoster neuralgias] [Article in German] Bruch D, Ruzicka T. Hautklinik der Universität, Düsseldorf. PMID: 7956784 [PubMed - indexed for MEDLINE] 3336. Am J Gastroenterol. 1994 Nov;89(11):2092-3. Colonic pseudo-obstruction: a complication of herpes zoster. Oldfield EC 3rd. Division of Infectious Diseases, Eastern Virginia Medical School, Norfolk. PMID: 7942751 [PubMed - indexed for MEDLINE] 3337. Clin Infect Dis. 1994 Nov;19(5):975. Multidermatomal herpes zoster in an AIDS patient. Edelstein H. Comment on: Clin Infect Dis. 1993 Sep;17(3):431-6. PMID: 7893895 [PubMed - indexed for MEDLINE] 3338. Vaccine. 1994 Nov;12(15):1485. Diagnosis of varicella-zoster and evaluation of varicella vaccine by passive haemagglutination by non-invasive procedures. Arya SC. PMID: 7887029 [PubMed - indexed for MEDLINE] 3339. Am J Otolaryngol. 1994 Nov-Dec;15(6):387-408. Acute facial paralysis: evaluation and early management. Selesnick SH, Patwardhan A. Department of Otolaryngology, New York Hospital-Cornell University Medical College, New York 10021. PMID: 7872475 [PubMed - indexed for MEDLINE] 3340. Aust Fam Physician. 1994 Nov;23(11):2157-61, 2164-6. Treatment of herpes simplex and varicella zoster infections. Kainer M, Mills J. Fairfield Infectious Diseases Hospital, Victoria. The introduction of antiviral agents such as acyclovir has had a remarkable impact on management of patients with viral infections. In this article the authors outline the management of herpes simplex and varicella zoster infections, giving specific guidelines for treatment with acyclovir. PMID: 7864771 [PubMed - indexed for MEDLINE] 3341. J Med Virol. 1994 Nov;44(3):258-62. Activation of a varicella-zoster virus-specific IgA response during acute Epstein-Barr virus infection. Karner W, Bauer G. Abteilung Virologie, Universität Freiburg, Germany. The influence of an acute Epstein-Barr virus (EBV) infection on the serological parameters of persistent varicella-zoster virus (VZV) and herpes simplex virus (HSV) was studied. Sera from 161 patients with infectious mononucleosis caused by EBV and 178 age-matched controls were tested for HSV- and VZV-specific IgA. 98.7 percent of VZV-IgG-positive controls were negative for VZV-IgA, pointing to the stringent control of latent VZV in healthy individuals. During acute EBV infection, 33.8% of VZV-IgG-positive infectious mononucleosis patients produced VZV-specific IgA. This result may be explained either by reactivation of VZV due to transient suppression of cellular immune functions during acute EBV infection or by polyclonal stimulation caused by EBV. Due to the high incidence of HSV-IgA in healthy HSV-IgG-positive individuals, only a marginal effect of acute EBV infection on the appearance of HSV-specific IgA was found. PMID: 7852970 [PubMed - indexed for MEDLINE] 3342. J Clin Pathol. 1994 Nov;47(11):1054-6. Varicella zoster gastritis in a bone marrow transplant recipient. McCluggage WG, Fox JD, Baillie KE, Coyle PV, Jones FG, O'Hara MD. Department of Pathology, Royal Group of Hospitals, Belfast. A case is reported of a patient who had previously undergone autologous bone marrow transplantation for recurrent Hodgkin's disease. The patient developed a generalised vesicular skin eruption. The clinical diagnosis was of disseminated shingles. Herpes viral particles were identified within the vesicular fluid by electron microscopy and using a specific monoclonal antibody to varicella zoster virus (VZV), positive immunofluorescence was detected in scrapings from the base of a vesicle. Gastroscopy and biopsy were performed because of severe abdominal pain and vomiting. The histological features were of non-specific active inflammation. Despite the histological absence of viral inclusions electron microscopy of the gastric biopsy revealed the presence of intranuclear herpes viral particles with a diameter of 90-100 nm. VZV specific DNA was detected by the polymerase chain reaction in the gastric biopsy extract. The patient was treated with acyclovir and made a full recovery. PMCID: PMC503076 PMID: 7829687 [PubMed - indexed for MEDLINE] 3343. Ear Nose Throat J. 1994 Nov;73(11):850-2. Cephalic zoster with laryngeal paralysis. Rothschild MA, Drake W 3rd, Scherl M. Department of Otolaryngology, Mount Sinai School of Medicine, New York, New York. Comment in: Ear Nose Throat J. 1995 Feb;74(2):128. Herpes zoster reactivaction in the head and neck region is often associated with multiple cranial neuropathies, the most common one being facial paralysis. Laryngeal paralysis has also been occasionally reported with zoster infection. We present two such cases, and discuss the relevant literature on the pathophysiology, evaluation and management of this disease. Recent advances in antiviral therapy have allowed for specific medical treatment, thus making it all the more imperative to suspect zoster, even in clinically atypical cases. We suggest aggressive treatment with intravenous acyclovir for cephalic zoster complicated by vocal cord paralysis. PMID: 7828480 [PubMed - indexed for MEDLINE] 3344. Nippon Ganka Gakkai Zasshi. 1994 Nov;98(11):1141-6. [Rapidly progressive outer retinal necrosis in a patient with acquired immunodeficiency syndrome] [Article in Japanese] Oshitari K, Arimoto H, Suzuki S, Oguchi Y. Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan. We report a case of rapidly progressive varicella zoster virus retinitis, which is distinct from acute retinal necrosis syndrome. The patient was a 52-year-old male and suffered acquired immunodeficiency syndrome. Two months after the varicella zoster dermatitis in the distribution of the first division of the left trigeminal nerve, pseudodendritic keratitis and iridocyclitis were observed in the left eye. After 5 weeks, multifocal and patchy white exudates were observed in the peripheral deeper layer of the retina in the left eye, but retinal vasculitis in the exudative lesions was slight. Despite systemic administration of acyclovir, white exudates progressed confluently from the periphery to the post pole of the retina and reached the macula in 10 weeks. Eight weeks after the observation of lesions in the left eye, we found the same lesions in the right eye. After the white exudative lesions disappeared, the retina became atrophic and the retinal vessels were narrowed, but no retinal detachment was observed. Recently, Foster and associates described the rapidly progressive outer retinal necrosis as a new entity of varicella zoster virus retinitis in AIDS patients. We think our case was very similar to the rapidly progressive outer retinal necrosis. This case shows that we must carefully follow up the rapidly progressive outer retinal necrosis in the AIDS patients with a varicella zoster dermatitis. PMID: 7825511 [PubMed - indexed for MEDLINE] 3345. Gesundheitswesen. 1994 Nov;56(11):599-601. [The epidemiologic significance of varicella] [Article in German] Hofmann F, Sydow B, Michaelis M. Arbeitsmedizin, Personalärztliche Untersuchungsstelle, Univ.-Klinikum Freiburg. A total of 552 persons working in the university hospital of Freiburg, Germany (nurses, pediatric nurses, administration--and technical personnel) was screened for antibodies to varicella zoster virus. Prevalence of antibodies to VZV among men was higher than among women. While the degree of immunity of nurses and administration/technical personnel was comparable, pediatric nurses had a significantly higher seroprevalence (< 20 years 89.3%, -30 years 95.7%, > 30 years 98.6%). Therefore, pediatric nurses should be screened and susceptible persons should be vaccinated. PMID: 7819671 [PubMed - indexed for MEDLINE] 3346. Nihon Kyobu Shikkan Gakkai Zasshi. 1994 Nov;32(11):1073-7. [A case of limited Wegener's granulomatosis with hemophilia A, complicated by empyema, bronchopleural fistula and herpes zoster during therapy] [Article in Japanese] Tao Y, Hayashi T, Nagatomo H, Yoshii C, Nikaido Y, Nagata N, Kido M. Division of Respiratory Diseases, University of Occupational and Environmental Health, Japan. A 36-year-old man with hemophilia A was admitted to hospital because of otalgia, hearing loss, nasal obstruction, nonproductive cough, and high fever. His laboratory data showed high-grade acute inflammatory reactions. His chest X-ray and CT films showed multiple cavitary masses in the right lower lung field. Bronchoscopy performed at our institution revealed bronchial nodules in the intermediate truncus, and BAL revealed increases in the neutrophils and an IgG index (BAL IgG/albumin divided by serum IgG/albumin). Biopsy specimens obtained from nasal mucosa showed epithelioid granulomas with Langerhans' giant cells and necrotizing vasculitis. Antineutrophil cytoplasmic antibodies were also positive, but no evidence of glomerulonephritis was observed. The diagnosis of limited Wegener's granulomatosis was thus made. He was treated with standard therapy (daily cyclophosphamide and glucocorticoids), but within 1 month he had complications of empyema with herpes zoster, and bronchopleural fistula. The complications resolved with appropriate treatment. PMID: 7815760 [PubMed - indexed for MEDLINE] 3347. Ophthalmology. 1994 Nov;101(11):1801-4. Herpes zoster ophthalmicus in Malawi. Lewallen S. International Eye Foundation, Blantyre, Malawi, Africa. OBJECTIVE: The objective was to describe the complications and outcomes of herpes zoster ophthalmicus in a population of young Africans with a high seroprevalence of human immunodeficiency virus type 1 in which treatment often is delayed and in which antiviral drugs are not available. METHODS: Twenty-seven patients with herpes zoster ophthalmicus presenting consecutively to a large urban hospital were examined and followed. Treatment was limited to that which was locally available. RESULTS: Visual outcomes were poor. Sixty-six percent of eyes had final visual acuity less than 20/60. Forty percent had light perception or no light perception visual acuity. Severe keratouveitis and corneal perforation were common and responsible for most poor visual outcomes. CONCLUSION: Young Africans with herpes zoster ophthalmicus are at a high risk for significant visual loss. PMID: 7800359 [PubMed - indexed for MEDLINE] 3348. J Clin Epidemiol. 1994 Nov;47(11):1271-6. The accuracy of self-report of herpes zoster. Schmader K, George LK, Newton R, Hamilton JD. Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA. The accuracy of self-report of herpes zoster was investigated in the Duke Established Populations for Epidemiological Studies of the Elderly, a longitudinal study of 4162 community-dwelling elderly persons residing in North Carolina, 1986-1993. The authors compared self-reports of zoster with physician diagnosis of zoster and with a zoster verification questionnaire (ZVQ). Compared to physician diagnosis, 3.2% (95% confidence interval 0-61%) of self-reports of zoster (n = 31) were false-positive and no denials of zoster (n = 63) were false-negative. The agreement of self-reports to physician diagnosis was 98.9%, the sensitivity and negative predictive value were 100%, the specificity was 98.4% and the positive predictive value was 96.7%. The ZVQ comparisons were similarly high. These data suggest that the frequency of false-positive and false-negative reports of zoster is low in this elderly population. Zoster self-reports appear to be accurate and suitable for epidemiological investigations. PMID: 7722563 [PubMed - indexed for MEDLINE] 3349. Ann Acad Med Singapore. 1994 Nov;23(6 Suppl):139-44. Management of postherpetic neuralgia. Lefkowitz M, Marini RA. Pain Management Service, Long Island College Hospital, Brooklyn 11201, USA. Postherpetic neuralgia is a perplexing disorder in which pain develops as a result of herpes zoster. It is a common cause of neuropathic pain and may render its effects especially on the elderly and immunocompromised. Once established, postherpetic neuralgia is resistant to most treatment modalities and can lead to much despair. Many therapeutic approaches have been attempted through the years, most with varying results. This review describes clinical manifestations including allodynia, hyperaesthesia and anaesthesia. It also reviews pharmacologic and non-pharmacologic treatment modalities including a review of anaesthetic nerve blocks, neurostimulation, acupuncture and surgical techniques. PMID: 7710224 [PubMed - indexed for MEDLINE] 3350. Haematologica. 1994 Nov-Dec;79(6):513-8. Cyclophosphamide (3.6 g/m2) therapy with G-CSF support for resistant myeloma. Palumbo A, Boccadoro M, Bruno B, Triolo S, Pileri A. Dipartimento di Medicina ed Oncologia Sperimentale, Università di Torino, Ospedale Molinette, Italy. BACKGROUND. In myeloma patients resistance to both melphalan- and doxorubicin-containing regimens has been related to very short survival (approximately 6 months). The development of effective regimens combined with a low toxicity rate is mandatory in this patient subgroup. METHODS. Fourteen resistant myeloma patients were treated with cyclophosphamide (a total of 3.6 g/m2 was delivered in 2 doses on days 1 and 3) and prednisone (2 mg/kg, days 1-4) every month for 4 cycles. G-CSF support was administered to reduce myelosuppression. RESULTS. This combination was well tolerated. Granulocyte levels fell below 0.1 x 10(9)/L in all patients after a median of 9 days (range 8-11), followed by recovery to 0.5 x 10(9)/L after a median of 12 days from the start of treatment (range 10-13 days). Platelets never fell below 50 x 10(9)/L. All patients were treated on an outpatient basis and only 2 required hospitalization for major complications (pneumonia and heart failure). Response to cyclophosphamide was observed in 6/14 patients: 2 achieved complete remission, 4 showed a 50% or greater reduction of the M-component. Five patients are still in remission after 2, 6, 7, 9 and 10 months; 1 relapsed after 10 months. All patients except one are alive 4-16 months from the start of treatment. CONCLUSIONS. This schedule may represent a new approach for resistant myeloma, and its very low toxicity allows it to be delivered on an outpatient basis. PMID: 7534745 [PubMed - indexed for MEDLINE] 3351. BMJ. 1994 Oct 29;309(6962):1124. Acyclovir and post-herpetic neuralgia and ocular involvement. McGill JI, White JE. Southampton University Hospitals. Comment in: BMJ. 1995 Apr 15;310(6985):1005. BMJ. 1995 Apr 15;310(6985):1005. PMCID: PMC2541944 PMID: 7987104 [PubMed - indexed for MEDLINE] 3352. Med Lett Drugs Ther. 1994 Oct 28;36(934):97-8. Famciclovir for herpes zoster. [No authors listed] PMID: 7935158 [PubMed - indexed for MEDLINE] 3353. Rev Prat. 1994 Oct 15;44(16):2133-6. [Acyclovir and infections caused by varicella-zoster viruses] [Article in French] Vildé JL, Longuet P. Service des maladies infectieuses et tropicales, hôpital Bichat--Claude-Bernard, Paris. PMID: 7984909 [PubMed - indexed for MEDLINE] 3354. Brain. 1994 Oct;117 ( Pt 5):987-99. Varicella-zoster virus infection of the central nervous system in the acquired immune deficiency syndrome. Gray F, Bélec L, Lescs MC, Chrétien F, Ciardi A, Hassine D, Flament-Saillour M, de Truchis P, Clair B, Scaravilli F. Département de Pathologie (Neuropathologie), Hôpital Henri Mondor, Faculté de Médecine de Créteil, Université Paris-Val de Marne, France. Productive varicella-zoster virus (VZV) infection of the central nervous system (CNS) was demonstrated in 11 acquired immune deficiency syndrome (AIDS) patients using immunocytochemistry and in situ hybridization. A characteristic zoster skin eruption was seen in only four cases. From our own series and 11 other cases in the literature, we identified five clinico-pathological patterns of VZV infection of the CNS in AIDS patients which could occur simultaneously. (i) Multifocal encephalitis predominantly involving the white matter, likely to be due to haematogenous spread of the infection was found in four cases. (ii) Ventriculitis was found in three cases. In two cases there was complete acute or chronic necrosis of the ventricular wall with marked vasculitis; in the third, the ependymal lining appeared irregular with foci of VZV-infected ependymal cells, some of which protruded into the ventricular lumen. (iii) Acute haemorrhagic meningo-myeloradiculitis with necrotizing vasculitis was observed in two cases. In one, this was associated with ventriculitis and was possibly due to shedding of infected ependymal cells into the ventricular lumen and secondary seeding of the CSF. (iv) Focal necrotizing myelitis was seen in one case. It followed cutaneous herpes zoster and was considered to result from neural spread from the diseased dorsal root ganglion similar to cases previously described of encephalitis limited to the visual system following VZV ophthalmicus, or bulbar encephalitis following a trigeminal zoster. (v) Vasculopathy involving leptomeningeal arteries and causing cerebral infarcts was seen in four cases, it was associated with meningitis in most cases. These findings are in keeping with the observation in non-AIDS patients that VZV spread to the CNS may follow different routes. Our study tends to show that VZV infection of the CNS occurs more frequently in AIDS than previously suspected and suggests that it must be considered as a diagnosis in cases of encephalitis, ventriculitis, focal myelitis, acute myeloradiculitis and cerebral infarcts in these patients. PMID: 7953606 [PubMed - indexed for MEDLINE] 3355. Am J Epidemiol. 1994 Oct 1;140(7):632-42. Shingles, allergies, family medical history, oral contraceptives, and other potential risk factors for systemic lupus erythematosus. Strom BL, Reidenberg MM, West S, Snyder ES, Freundlich B, Stolley PD. Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia 19104-6095. The authors undertook a case-control study to explore the many factors that have been postulated to be related to the etiology of systemic lupus erythematosus. A total of 195 cases of systemic lupus diagnosed in the Philadelphia, Pennsylvania, metropolitan area between 1985 and 1987 were compared with 143 controls, friends of the cases matched to them according to age (+/- 5 years) and sex. Through personal interviews and chart reviews, data were collected on demographic factors, personal and familial medical history, reproductive history, medication history, and environmental exposures. Associations were found between systemic lupus erythematosus and having a family history of autoimmune disease (age-, sex-, and race-adjusted odds ratio (OR) = 2.3, 95% confidence interval (CI) 1.2-4.6), a history of shingles (adjusted OR = 6.4, 95% CI 1.4-28.0), a history of hives (adjusted OR = 1.8, 95% CI 1.1-3.0), and a history of medication allergies (adjusted OR = 2.6, 95% CI 1.5-4.5). No association was present between systemic lupus erythematosus and either any use or recent use of oral contraceptives (e.g., OR = 0.6 (95% CI 0.2-1.4) for use in the 3 years prior to diagnosis), family history of multiple other diseases, or a history of numerous other infections or various other types of allergies. Thus, these data indicate that systemic lupus erythematosus is associated with a family history of autoimmune diseases, a history of shingles, and a history of allergies. In contrast, if the development of systemic lupus is affected by use of oral contraceptives, this effect must be extremely modest. These findings may help clarify the possible pathogenesis of systemic lupus erythematosus, and they provide clues as to when the presence of systemic lupus should be suspected. PMID: 7942763 [PubMed - indexed for MEDLINE] 3356. Neurology. 1994 Oct;44(10):1818-23. Varicella-zoster virus myelitis: an expanding spectrum. Gilden DH, Beinlich BR, Rubinstien EM, Stommel E, Swenson R, Rubinstein D, Mahalingam R. Department of Neurology, University of Colorado School of Medicine, Denver. We report four cases of varicella-zoster virus (VZV)-associated myelopathy in adults. Myelopathy was remitting-exacerbating in two remarkable instances, once acute and once chronic. VZV myelopathy was diagnosed based on the close temporal relationship between rash and onset of myelopathy, and for the first time, by polymerase chain reaction, which revealed VZV DNA in the cerebral spinal fluid of three patients with pleocytosis weeks to months later. Magnetic resonance imaging was abnormal in three of four patients. Although all four patients were treated at some time with intravenous acyclovir, concomitant treatment with steroids and the presence of acquired immunodeficiency syndrome in one patient prevented conclusions about a favorable response to therapy. Myelopathy after VZV infection may be remitting-exacerbating in addition to acute or chronic. Detection of VZV DNA in cerebral spinal fluid months after rash was useful for diagnosis and suggests a role for virus in the pathogenesis of myelopathy. PMID: 7936229 [PubMed - indexed for MEDLINE] 3357. Am J Hosp Pharm. 1994 Oct 1;51(19):2326. Famciclovir released for shingles treatment. [No authors listed] PMID: 7847396 [PubMed - indexed for MEDLINE] 3358. Antimicrob Agents Chemother. 1994 Oct;38(10):2454-7. Safety of famciclovir in patients with herpes zoster and genital herpes. Saltzman R, Jurewicz R, Boon R. SmithKline Beecham Pharmaceuticals, Philadelphia, Pennsylvania. Safety reporting from individual ongoing and completed clinical studies has demonstrated that famciclovir, the well-absorbed oral form of the antiherpesvirus agent penciclovir, has been well tolerated by more than 3,000 individuals worldwide. An integrated safety evaluation has been performed and includes over 1,600 patients from 11 completed, randomized, double-blind clinical trials and 2 open trials. The famciclovir population consisted of 816 herpes zoster patients (four trials), 409 patients with acute genital herpesvirus infections (seven trials), and 382 patients from two genital herpes suppression studies. Overall, the famciclovir-treated patient population was 57.7% female and ranged in age from 15 to 102 years (mean, 42.6 years), with 31.2% aged 50 years or more and 15.7% aged 65 years or more. The mean duration of exposure to famciclovir was 28.8 days (5.8 days excluding suppression studies). The total daily doses ranged from 125 mg to 2.25 g. The most common adverse experiences reported as related to study medication (famciclovir and placebo) were headache, nausea, and diarrhea. The frequencies of adverse experiences and laboratory abnormalities (hematology, clinical chemistry, and urinalysis parameters) were similar in both famciclovir and placebo recipients. Thus, safety data from the analysis of 13 completed clinical studies demonstrate that famciclovir is tolerated well by patients with either herpes zoster or genital and has a safety profile comparable to that of placebo. PMCID: PMC284761 PMID: 7840587 [PubMed - indexed for MEDLINE] 3359. Anaesthesist. 1994 Oct;43(10):682. [Therapy of post-zoster neuralgia] [Article in German] Hügler P, Laubenthal H. PMID: 7818052 [PubMed - indexed for MEDLINE] 3360. Clin Nucl Med. 1994 Oct;19(10):877-9. Incidental finding of herpes zoster infection by Tc-99m HMPAO. Hirano T, Otake H, Kanuma M, Mogi Y, Tatezawa T, Endo K. Department of Nuclear Medicine, Gunma University, School of Medicine, Japan. Tc-99m HMPAO brain SPECT study incidentally demonstrated a large area of increased accumulation in the soft tissue of the face and fronto-parietal region of the head, corresponding to the distribution of the ophthalmic and maxillary branches of the trigeminal nerve, which had been infected by herpes zoster. PMID: 7805321 [PubMed - indexed for MEDLINE] 3361. Drugs. 1994 Oct;48(4):528-48. Recognition and treatment of shingles. Nikkels AF, Piérard GE. Department of Dermatopathology, University of Liège, Belgium. Varicella zoster virus (VZV) is responsible for a primary infection (varicella) followed by a latency, eventually resulting in herpes zoster (shingles). The replication cycle of VZV is normally interrupted after varicella. Consequently, VZV remains dormant in the organism. Reactivation occurs after viraemia, and the development of tissue alterations (skin and viscera) depends on the immunological status of the patient. Diagnosis of herpes zoster relies on clinical recognition and cytological and histological evaluations combined with immunohistochemistry and molecular biology techniques. Treatment of herpes zoster primarily relies upon antiviral drugs and incidentally on immunomodulating agents, specific immunoglobulins, antimicrobial agents, antiviral enzymes and corticosteroids. Drugs with a clinically relevant activity against varicella zoster virus infections include aciclovir, adenosine monophosphate, bromodeoxyuridine, desciclovir, fiacitabine, idoxuridine, interferon-alpha and vidarabine. Among them, aciclovir appears to be a first-line agent. Its efficacy has been well established by many clinical studies. Promising drugs for the future include famciclovir, penciclovir, valaciclovir and other molecules currently under investigation. Recent and promising improvements in antiviral drug development may increase patient compliance, cost-benefit ratios and therapeutic efficacy. PMID: 7528128 [PubMed - indexed for MEDLINE] 3362. Arch Intern Med. 1994 Sep 26;154(18):2109. (Mis)treatment of acute herpes zoster. Tyring SK. PMID: 8092916 [PubMed - indexed for MEDLINE] 3363. Tidsskr Nor Laegeforen. 1994 Sep 10;114(21):2486-8. [Varicella zoster complications] [Article in Norwegian] Chelsom J, Langeland N. Medisinsk avdeling, Haukeland Sykehus. Varicella zoster virus is known to cause varicella in children and to reactivate years later as shingles. Both the primary disease and the reactivation can cause complications, both in the form of serious affection of organs by the virus itself, and through secondary bacterial infections owing to temporary immune deficiency. Relatively frequent complications include secondary bacterial skin infections, pneumonitis, complications affecting the central nervous system, and hepatitis. We describe a few typical cases seen recently in our department, and review important points connected to treatment and prophylaxis. PMID: 7940450 [PubMed - indexed for MEDLINE] 3364. Tidsskr Nor Laegeforen. 1994 Sep 10;114(21):2484-6. [Varicella zoster infections and neurologic complications] [Article in Norwegian] Vatne A, Vedeler C, Tysnes OB, Myrmel H. Nevrologisk Avdeling, Haukeland Sykehus, Bergen. We describe three patients who suffered from neurological complications to varicella-zoster virus infections. One had polyradiculoneuritis, another myelitis, and a third suffered from focal encephalitis. These patients were all treated with acyclovir, and showed good recovery within a few days. The diagnosis must be based on clinical characteristics, together with virological and immunological tests. The indications for antiviral treatment are discussed. PMID: 7940449 [PubMed - indexed for MEDLINE] 3365. Nature. 1994 Sep 8;371(6493):89-90. Blaming somebody else. [No authors listed] PMID: 8072549 [PubMed - indexed for MEDLINE] 3366. Science. 1994 Sep 2;265(5177):1383-5. Vaccines for varicella-zoster virus and cytomegalovirus: recent progress. Plotkin SA. Pasteur-Mérieux-Connaught, Marnes-la-Coquette, France. PMID: 8073277 [PubMed - indexed for MEDLINE] 3367. Ophthalmology. 1994 Sep;101(9):1488-502. The progressive outer retinal necrosis syndrome. A variant of necrotizing herpetic retinopathy in patients with AIDS. Engstrom RE Jr, Holland GN, Margolis TP, Muccioli C, Lindley JI, Belfort R Jr, Holland SP, Johnston WH, Wolitz RA, Kreiger AE. UCLA Ocular Inflammatory Disease Center. Comment in: Ophthalmology. 1995 Dec;102(12):1737-9. BACKGROUND: The progressive outer retinal necrosis syndrome is a recently recognized variant of necrotizing herpetic retinopathy. This report characterizes more fully its clinical features and course. METHODS: Using standardized clinical criteria, patients with progressive outer retinal necrosis syndrome from four institutions were identified. Patient records were reviewed retrospectively for the following data: medical and demographic characteristics, presenting symptoms, physical findings, course, responses to treatment, and outcomes. RESULTS: Thirty-eight patients (65 involved eyes) were studied. All had acquired immune deficiency syndrome. A known history of cutaneous zoster was documented in 22 (67%) of 33 patients. Median CD4 lymphocyte count was 21/mm3 (range, 0-130/mm3). Median follow-up was 12 weeks. The most common presenting symptom was unilateral decreased vision (35 of 65 eyes, 54%); median visual acuity at presentation was 20/30 (range, 20/20 to no light perception [NLP]). Anterior chamber and vitreous inflammatory reactions were absent or minimal in all patients. Typical retinal lesions were multifocal, deep opacities scattered throughout the periphery, although macular lesions also were present in 21 eyes (32%) at diagnosis. Lesions progressed rapidly to confluence. Initial intravenous antiviral therapy appeared to reduce disease activity in 17 (53%) of 32 eyes, but treatment did not alter final visual outcome. Visual acuity was NLP in 42 (67%) of 63 eyes within 4 weeks after diagnosis. Retinal detachment occurred in 43 (70%) of 61 eyes, including 13 (93%) of 14 eyes that received prophylactic laser retinopexy. CONCLUSION: The progressive outer retinal necrosis syndrome is characterized by features that distinguish it from cytomegalovirus retinopathy, acute retinal necrosis syndrome, and other necrotizing herpetic retinopathies. Visual prognosis is poor with current therapies. PMID: 8090452 [PubMed - indexed for MEDLINE] 3368. Arch Dermatol. 1994 Sep;130(9):1207-8. Lichenoid chronic graft-vs-host disease. Reisfeld PL. Comment on: Arch Dermatol. 1994 Jan;130(1):70-2. PMID: 8085882 [PubMed - indexed for MEDLINE] 3369. Arch Dermatol. 1994 Sep;130(9):1193, 1196. Asymptomatic vesicles in a patient with the acquired immunodeficiency syndrome. Disseminated varicella-zoster virus (VZV) infection. Blankenship W, Herchline T, Hockley A. Keesler Air Force Base, Miss. PMID: 8085878 [PubMed - indexed for MEDLINE] 3370. No To Shinkei. 1994 Sep;46(9):849-54. [Sequential change of cerebral angiography in a case of cerebral angiitis following herpes zoster ophthalmicus] [Article in Japanese] Tomiyama N, Mukawa J, Yamashiro K, Kinjo T, Momoji J, Arakaki H, Nagataki S. Department of Neurosurgery, University of Ryukyus School of Medicine, Okinawa, Japan. Delayed neurological symptoms and signs following herpes zoster ophthalmicus (HZO) such as "Delayed contralateral hemiplegia with HZO" are supposed to be due to ipsilateral intracranial angiitis and ischemic disorder. We experienced a rare case with ipsilateral cerebral hemorrhage following HZO. Under the diagnosis of cerebral angiitis associated with HZO, we treated her conservatively and observed sequential change of angiography for four months. A 54-year-old female, who had been treated for systemic lupus erythematosus (SLE), developed HZO on left ophthalmic nerve area. Seven weeks after the onset of HZO, she complained of headache, mild right hemiparesis, and disturbance of consciousness. Computed tomography revealed subcortical hemorrhage at the left temporo-occipital lobe. Cerebral angiography showed vascular irregularities such as segmental narrowing and sausage-like dilation on proximal portion of the ipsilateral anterior, middle and posterior cerebral arteries. Same findings were seen on peripheral portions of the posterior cerebral artery on the same side. Moreover sequential angiograms showed appearance of an aneurysm in the left middle cerebral artery (M2 potion). Under the diagnosis of cerebral angiitis associated with HZO, she was treated with antiviral agents, antiplatelet drugs, steroid and stellate ganglion block. Those irregularities were found to diminish on the sequential angiograms, and the aneurysm disappeared four month later. PMID: 7999442 [PubMed - indexed for MEDLINE] 3371. J R Soc Med. 1994 Sep;87(9):526-30. Effects of lymphoma on the peripheral nervous system. Hughes RA, Britton T, Richards M. Department of Neurology, UMDS, Guy's Hospital, London, UK. Peripheral nervous system abnormalities occur in 5% of patients with lymphoma and have a wide differential diagnosis. Herpes zoster is the commonest cause. Vinca alkaloids are the only drugs used in lymphoma which commonly cause neuropathy. Compression or infiltration of nerve roots by lymphoma is a rare presenting feature but becomes more common with advanced disease. Radiation plexopathy does not usually develop until at least 6 months after irradiation and can be difficult to distinguish from neoplastic infiltration. Either multifocal infiltration of nerves or lymphoma-associated vasculitis may present as a peripheral neuropathy. The incidence of Guillain-Barré (GBS) syndrome, and possibly chronic idiopathic demyelinating polyradiculoneuropathy, appears to be increased in association with lymphoma, especially Hodgkin's disease. Subacute sensory neuronopathy and subacute lower motor neuronopathy have both been reported as paraneoplastic syndromes associated with Hodgkin's disease. Treatment of the underlying lymphoma is only rarely followed by recovery of the associated neuropathy. PMCID: PMC1294770 PMID: 7932460 [PubMed - indexed for MEDLINE] 3372. J Acquir Immune Defic Syndr. 1994 Sep;7(9):972-7. Progression to AIDS or death following diagnosis with a class IV non-AIDS disease: utilization of a surveillance database. Maden C, Hopkins SG, Lafferty WE. Seattle-King County Department of Public Health, Washington 98104. Time to progression to an AIDS-defining disease or death was analyzed for residents of King County, Washington State, with selected class IV non-AIDS diagnoses. Relative to people with constitutional symptoms, the risk of progression to an AIDS-defining diagnosis was 1.4 [95% confidence interval (CI), 0.8-2.2), 1.6 (95% CI, 1.0-2.5), and 2.1 (95% CI, 1.3-3.5) times greater for people with a diagnosis of oral hairy leukoplakia, oral candidiasis, and multiple diseases, respectively. Relative to subjects with CD4 counts of > or = 200, the risk of progression to AIDS was greater for subjects with CD4 counts < 200; relative risks ranged from 2.3 (95% CI, 0.8-6.6) for subjects with constitutional symptoms and CD4 counts < 200 to 6.7 (95% CI, 3.3-13.6) for subjects diagnosed with oral hairy leukoplakia and CD4 counts > 200. However, the statistical test for interaction between CD4 count and diagnostic group was not significant (p = 0.62). Our findings are in general agreement with results from previous cohort studies and suggest the utility of surveillance databases for natural history studies of the course of HIV illness. PMID: 7914234 [PubMed - indexed for MEDLINE] 3373. Clin J Pain. 1994 Sep;10(3):240-2. Successful treatment of postherpetic neuralgia with oral ketamine. Hoffmann V, Coppejans H, Vercauteren M, Adriaensen H. Department of Anesthesia, University Hospital of Antwerpen, Edegem, Belgium. OBJECTIVE: To demonstrate the possibilities of the use of oral ketamine in the treatment of postherpetic neuralgia. SETTING: A pain clinic in a university hospital. PATIENT: A patient with postherpetic neuralgia of the ophthalmic nerve. INTERVENTION: Subcutaneous and later oral ketamine after classical treatment had failed. RESULTS: A complete recovery was accomplished without any sign of side effects. CONCLUSIONS: Oral ketamine may provide an alternative in the treatment of postherpetic neuralgia. The possible mechanism of action by its N-methyl-D-aspartate (NMDA) blocking properties is discussed. PMID: 7833583 [PubMed - indexed for MEDLINE] 3374. J Antimicrob Chemother. 1994 Sep;34(3):307-11. Successors to acyclovir. Easterbrook P, Wood MJ. Department of Infection and Tropical Medicine, Birmingham Heartlands Hospital, UK. PMID: 7829405 [PubMed - indexed for MEDLINE] 3375. Rinsho Shinkeigaku. 1994 Sep;34(9):928-9. [A case of isolated vagus nerve palsy with herpes zoster] [Article in Japanese] Ohashi T, Fujimoto M, Shimizu H, Atsumi T. Department of Neurology, Seirei Hamamatsu General Hospital. A case of isolated vagus nerve palsy with herpes zoster was reported. A 31-year-old woman was admitted to our hospital with six days' history of difficulty of swallowing of fluid and hoarseness with a painful vesicle on the right ear. Neurological examination revealed poor elevation of soft palate on the right side, but the pharyngeal reflex was preserved. Herpetic vesicles were present on the right concha, within posterior wall of the external auditory meatus. No facial palsy, loss of hearing and mucosal lesions in the mouth or pharynx were present. This is the first case of isolated vagus nerve palsy due to varicella-zoster infection, showing the distribution of the auricular branch of the vagus (Arnold's nerve) in the ear. PMID: 7820972 [PubMed - indexed for MEDLINE] 3376. Infect Dis Clin North Am. 1994 Sep;8(3):637-54. Dermatologic manifestations of infectious diseases in cardiac transplant patients. Gentry LO, Zeluff B, Kielhofner MA. Baylor College of Medicine, Houston, Texas. Infection remains a significant cause of morbidity and mortality in cardiac transplant patients. Skin infections are not uncommon in these patients. Although usually caused by secondary dissemination after initial infection of another organ system, some skin infections may be primary infections, such as bacterial infections caused by the use of intravenous catheters or fungal infections in severely immunosuppressed patients. Nevertheless, the presence of skin lesions in a transplant patient may indicate infection in a primary site or another deep-seated focus of infection. PMID: 7814838 [PubMed - indexed for MEDLINE] 3377. Semin Neurol. 1994 Sep;14(3):247-54. Postherpetic neuralgia. Rowbotham MC. Department of Neurology, University of California, San Francisco 94143. PMID: 7701125 [PubMed - indexed for MEDLINE] 3378. N Engl J Med. 1994 Aug 18;331(7):481-2. Trifluridine for herpes zoster. Harris DJ Jr. Comment on: N Engl J Med. 1994 Mar 31;330(13):906. PMID: 8035857 [PubMed - indexed for MEDLINE] 3379. N Engl J Med. 1994 Aug 18;331(7):481. Acyclovir for herpes zoster. Tangeman JC, Kuzminski AM, Svahn DS. Comment on: N Engl J Med. 1994 Mar 31;330(13):896-900. PMID: 8035856 [PubMed - indexed for MEDLINE] 3380. N Engl J Med. 1994 Aug 18;331(7):481. Acyclovir for herpes zoster. van den Broek PJ, Stuyt PM, van der Meer JW. Comment on: N Engl J Med. 1994 Mar 31;330(13):896-900. PMID: 8035855 [PubMed - indexed for MEDLINE] 3381. Br J Radiol. 1994 Aug;67(800):819-21. Case report: prolonged contrast enhancement of the inner ear on magnetic resonance imaging in Ramsay Hunt syndrome. Downie AC, Howlett DC, Koefman RJ, Banerjee AK, Tonge KA. Department of Radiology, St Thomas' Hospital, London, UK. There have been recent reports of enhancement of the inner ear in acute labyrinthitis on gadolinium enhanced magnetic resonance imaging (MRI). However, none has described persistence of enhancement beyond 6 weeks. We report a case of Ramsay Hunt syndrome with labyrinthitis, sensorineural hearing loss and facial nerve palsy in which marked enhancement of the inner ear structures was observed on MRI 6 months after the onset of symptoms. Enhancement on delayed or repeated imaging after a period of months does not exclude labyrinthitis from the differential diagnosis of the small intracanalicular acoustic neuroma, and care should be taken not to confuse them. PMID: 8087491 [PubMed - indexed for MEDLINE] 3382. J Am Acad Dermatol. 1994 Aug;31(2 Pt 1):284-6. Zosteriform inflammatory metastatic carcinoma from transitional cell carcinoma of the renal pelvis. Ando K, Goto Y, Kato K, Murase T, Matsumoto Y, Ohashi M. Department of Dermatology, Nagoya First Red Cross Hospital, Japan. PMID: 8040420 [PubMed - indexed for MEDLINE] 3383. AIDS. 1994 Aug;8(8):1115-7. Successful treatment of varicella zoster virus meningoencephalitis in patients with AIDS: report of four cases and review. Poscher ME. Department of Medicine, University of California/Mount Zion Medical Center, San Francisco. OBJECTIVE: Neurologic complications are common in patients with AIDS. Herpes zoster is a common early manifestation of HIV infection, but there have been few reports of encephalitic complications and nearly all have been postmortem. We report four cases of varicella zoster virus (VZV) meningoencephalitis diagnosed and treated antemortem, and briefly review the relevant literature. SETTING: Mount Zion Medical Center, San Francisco, California, USA. PATIENTS: Four HIV-positive male patients with antibodies to VZV in their cerebrospinal fluid. INTERVENTION: Treatment with intravenous acyclovir (three cases) and intravenous ganciclovir (one case), which resulted in resolution of all symptoms except blindness in one patient. CONCLUSION: Antibodies to VZV in the cerebrospinal fluid of HIV-positive individuals may allow early diagnosis and lifesaving treatment of VZV meningoencephalitis. PMID: 7986408 [PubMed - indexed for MEDLINE] 3384. Klin Monbl Augenheilkd. 1994 Aug;205(2):103-8. [Varicella zoster virus infections of the retina in patients with and without immune suppression] [Article in German] Helbig H, Bornfeld N, Bechrakis NE, Kellner U, Foerster MH. Universitäts-Augenklinik, Klinikum Steglitz, Freie Universität Berlin. BACKGROUND. Infections of the retina with the varicella-zoster virus can lead to severe visual impairment. Patients with immunodeficiency are particularly predisposed to viral infections, and the alterations of the immune system may lead to a modified clinical picture. PATIENTS. Two cases of infections of the retina with the varicella-zoster virus in an immunocompromised and an immunocompetent patient are presented. The first otherwise healthy patient showed the typical clinical picture of the "acute retinal necrosis syndrome" with orbital pain and decrease of vision. He had inflammatory infiltration of the vitreous and the anterior chamber, retinal vasculitis, optic disc edema and whitening of the peripheral retina with full thickness retinal necrosis. The second patient with AIDS presented with a history of sudden painless loss of vision in one eye. He had a swollen optic disc, inflammatory infiltrates in the choroid and virtually no cellular infiltration of the vitreous or the anterior chamber. The diagnosis of varicella-zoster virus infection of the retina was confirmed in both patients by polymerase chain-reaction of aqueous and vitreous humor, by determination of intraocular antibody titers and immunohistochemistry on retinal biopsy material, respectively. In both patients no inflammation in the fellow eye developed under therapy with aciclovir. The first patient regained full vision after vitrectomy with membrane dissection. CONCLUSIONS. Varicella-zoster virus infections of the retina can present with different clinical pictures in immunocompromised and immunocompetent patients. Early diagnosis and adequate medical and surgical therapy can significantly improve visual prognosis. PMID: 7967403 [PubMed - indexed for MEDLINE] 3385. J Med Virol. 1994 Aug;43(4):331-5. Detection of varicella-zoster virus-specific DNA sequences in cerebrospinal fluid from patients with acute aseptic meningitis and no cutaneous lesions. Echevarría JM, Casas I, Tenorio A, de Ory F, Martínez-Martín P. Servicio de Microbiología Diagnóstica, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain. Acute aseptic meningitis (AAM) is considered as an uncommon manifestation of varicella-zoster virus (VZV) recrudescence and is usually regarded as a complication of the cutaneous infection in patients with impaired cellular immunity. Indirect evidence suggests, however, that VZV-associated AAM may also respond to direct spread of the virus to the leptomeninges from the cells supporting the latency. The polymerase chain reaction (PCR) was used to amplify VZV-specific DNA sequences in serial cerebrospinal fluid (CSF) samples from 21 patients with AAM, who presented laboratory evidence of intrathecal production of VZV-specific antibody on follow-up. Eleven of these patients never showed cutaneous zosteriform lesions. VZV-DNA sequences were detected in the CSF from all patients with cutaneous zoster, as well as from six patients (55%) lacking skin lesions. Viral DNA sequences were present in six cases before the rise in specific antibody was seen in CSF, disappearing during follow-up in the seven positive cases. These results support the proposed involvement of VZV in the etiology of AAM seen among normal young adults and strongly suggest that the virus can reach directly and infect the CNS from the latently infected spinal ganglia. PMID: 7964642 [PubMed - indexed for MEDLINE] 3386. J Dermatol. 1994 Aug;21(8):560-70. Scanning and transmission electron microscopic studies of lesional epidermis in herpes zoster. Tanaka K, Tsuda S, Sasai Y. Department of Dermatology, Kurume University School of Medicine, Japan. The epidermal skin lesions of herpes zoster were studied by scanning (SEM) and transmission electron microscopy (TEM). When erythematous lesions were observed by TEM, many of the infected keratinocytes showed evidence of cell degeneration, being characterized by swollen nuclei, disappearance of desmosomes, and widening of intercellular spaces. Macrophages and/or lymphocytes migrated through the intercellular spaces between degenerated keratinocytes. In the vesicular lesions, SEM and TEM showed some infiltrating neutrophils, directly adhering to the virus-infected keratinocytes, with swollen nuclei and irregularly clumped chromatin. In some specimens, balloon-degenerated keratinocytes were observed in the cavity. In the pustular stage, ruptured keratinocytes and numerous neutrophils were observed in the reticular-degenerated epidermal tissue. These results suggest that, in herpes zoster, the epidermal damage may be due, at least in part, to cell-mediated host immunity as well as to the cytopathic effect of varicella-zoster virus. PMID: 7962953 [PubMed - indexed for MEDLINE] 3387. Acta Paediatr Jpn. 1994 Aug;36(4):341-6. Effect of varicella zoster virus antigen-antibody complexes on hydrogen peroxide generation by human polymorphonuclear leukocytes. Fujiwara T, Ihara T, Yamawaki K, Ito M, Kamiya H, Sakurai M. Department of Pediatrics, Mie University, Japan. Hydrogen peroxide (H2O2) generation by human polymorphonuclear leukocytes (PMN) incubated with varicella zoster virus (VZV) antigen was studied by cytofluorography. Hydrogen peroxide generation was detected in the presence of VZV-seropositive sera. When seropositive sera were heat-inactivated, H2O2 generation was reduced. When PMN were pre-incubated with Leu-11b, a monoclonal antibody to the Fc receptor on PMN, H2O2 generation was also reduced. These results suggest that VZV antigen-antibody-complement complexes induce H2O2 generation by PMN after these complexes attach to Fc receptors on PMN. PMID: 7941996 [PubMed - indexed for MEDLINE] 3388. Ther Umsch. 1994 Aug;51(8):538-44. [Clinical aspects and therapy of Herpes simplex and Varicella-Zoster virus infections in practice] [Article in German] Nadal D, Vogt M. Abteilung Immunologie/Hämatologie, Universitäts-Kinderklinik Zürich. Primary infections with herpes simplex virus are usually localized, whereas those with varicella-zoster virus always disseminate. Both viruses persist within the host and may cause recurrent infections. Newborns and immunocompromised individuals have a risk for severe disease. Acyclovir is the drug of choice for complications or in immunodeficiency. PMID: 7940410 [PubMed - indexed for MEDLINE] 3389. Pharmacoeconomics. 1994 Aug;6(2):142-8. The cost of treatment for post-herpetic neuralgia in the UK. Davies L, Cossins L, Bowsher D, Drummond M. Centre for Health Economics, University of York, England. Post-herpetic neuralgia (PHN) following acute shingles caused by the herpes simplex virus is a painful and often disabling condition. Treatment of the condition can involve a range of drug therapies. In addition, patients with continuing pain may make several visits to general practitioners and hospital outpatient departments. The costs of treatment for these patients may be substantial. The main objective of this study was to estimate the costs and consequences to the UK National Health Service (NHS) of the treatment of PHN following shingles, and the effect of the condition on patients' lives in terms of pain and time off usual activities such as work. The lifetime direct treatment costs of a cohort of people from onset of PHN to resolution of the disease or death were calculated. These costs were estimated from data on the type and quantity of health resources used, and the unit costs or prices of those resources. This study has shown that PHN can be a costly consequence of acute shingles. For patients attending a tertiary referral centre the lifetime cost was 770 British pounds sterling. For a 1-year incidence cohort of people with shingles in the UK, the lifetime costs of treating PHN are between 4.8 million British pounds sterling (incidence of 21 000 people) and 17.9 million British pounds sterling (incidence of 78 200 people). Efforts are needed to reduce the incidence or severity of PHN.(ABSTRACT TRUNCATED AT 250 WORDS) PMID: 10147439 [PubMed - indexed for MEDLINE] 3390. JAMA. 1994 Jul 6;272(1):47-52. Effect of hypnotic suggestion on the delayed-type hypersensitivity response. Locke SE, Ransil BJ, Zachariae R, Molay F, Tollins K, Covino NA, Danforth D. Department of Psychiatry, Beth Israel Hospital, Boston, MA 02215. OBJECTIVE--To determine whether individuals selected for good general health, high hypnotizability, and the ability to alter skin temperature under hypnotic suggestion can influence the delayed-type hypersensitivity (DTH) response to varicella-zoster (VZ) antigen under hypnotic suggestion. DESIGN--A blinded clinical trial using a repeated measures design with subjects serving as their own controls. Subjects were randomly assigned to undergo a predetermined sequence of four different experimental conditions, occurring at weekly intervals, with each condition including VZ skin testing: (1) hypnosis with suggestions to enhance the DTH response to VZ antigen; (2) hypnosis with suggestions to suppress the DTH response; (3) hypnosis with suggestions for relaxation only; and (4) skin testing without hypnosis. SETTING--A National Institutes of Health-supported clinical research center in a teaching hospital. SUBJECTS--A stratified sample of 24 ambulatory, healthy, highly hypnotizable, volunteer college students selected for their above-average ability to alter skin temperature after hypnotic suggestions and their positive baseline responses to VZ antigen. There were 11 males and 13 females with a mean +/- SD age of 22 +/- 6 years. The mean +/- SD hypnotizability score (Harvard Group Scale of Hypnotic Susceptibility) was 11 +/- 1. INTERVENTIONS--Intradermal skin testing with VZ antigen (Mantoux method) and hypnotic suggestion. MAIN OUTCOME MEASURES--Areas of induration of the DTH response measured at 24 and 48 hours after injection of antigen. RESULTS--The area of the DTH response was not affected by the experimental interventions. The area of erythema was likewise unaffected. CONCLUSIONS--Our subjects were unable to alter their DTH responses using hypnotic suggestion. PMID: 8007079 [PubMed - indexed for MEDLINE] 3391. Eur J Haematol. 1994 Jul;53(1):51-3. The Ch1VPP regimen, a risk factor for herpes zoster virus infection in patients treated for Hodgkin's disease. Norum J, Bremnes RM, Wist E. PMID: 8062898 [PubMed - indexed for MEDLINE] 3392. Aust Fam Physician. 1994 Jul;23(7):1355-6. The mark of Zorro. Colquhoun JP. PMID: 8060283 [PubMed - indexed for MEDLINE] 3393. South Med J. 1994 Jul;87(7):758-61. Linear and dermatomal cutaneous graft-versus-host disease. Cohen PR, Hymes SR. Department of Dermatology, University of Texas Medical School, Houston 77030. A 17-year-old girl had linear and dermatomal lichenoid chronic graft-versus-host disease (GVHD) 18 months after receiving an allogeneic bone marrow transplantation for aplastic anemia. The cutaneous GVHD lesions appeared on previously normal skin. PMID: 8023213 [PubMed - indexed for MEDLINE] 3394. Chest. 1994 Jul;106(1 Suppl):22S-27S. Varicella-zoster virus pneumonitis. Feldman S. Department of Pediatrics, University of Mississippi Medical Center, Jackson. PMID: 8020329 [PubMed - indexed for MEDLINE] 3395. Chest. 1994 Jul;106(1 Suppl):15S-21S; discussion 34S-35S. Herpesvirus infections in burn patients. Hayden FG, Himel HN, Heggers JP. Department of Internal Medicine, University of Virginia School of Medicine, Charlottesville. PMID: 8020328 [PubMed - indexed for MEDLINE] 3396. J Infect Dis. 1994 Jul;170(1):68-75. Phenotypic and genotypic characterization of acyclovir-resistant varicella-zoster viruses isolated from persons with AIDS. Boivin G, Edelman CK, Pedneault L, Talarico CL, Biron KK, Balfour HH Jr. Dept. of Laboratory Medicine and Pathology, Minneapolis, MN 55455-0392. Phenotypic and genotypic analyses were done on 17 varicella-zoster virus (VZV) isolates recovered from 10 persons with AIDS (mean CD4 cell count, 16.4/mm3) who had chronic VZV lesions. Eleven acyclovir-resistant isolates were recovered from 10 patients after a mean of 20.1 weeks of therapy. Six susceptible isolates were recovered before acyclovir treatment (n = 1), early during therapy (n = 4; mean time, 4.2 weeks), or after discontinuation of acyclovir (n = 1). Acyclovir-resistant VZV isolates were deficient in thymidine kinase (TK) or induced a TK with altered substrate specificity; all isolates were susceptible to foscarnet. Ten of 11 acyclovir-resistant mutants contained tk gene mutations, including single nucleotide substitutions in highly conserved binding sites (n = 2) as well as nucleotide deletions (n = 4) and insertions (n = 4). These findings suggest that multiple, nonuniform mutations within the tk gene are associated with acyclovir-resistant VZV phenotypes. PMID: 8014522 [PubMed - indexed for MEDLINE] 3397. Rinsho Shinkeigaku. 1994 Jul;34(7):720-3. [A case of herpes zoster meningoencephalitis followed by involvement of cranial nerves IX, X, XI] [Article in Japanese] Kondo M, Hokezu Y, Nagai M, Mori T, Nagamatsu K. Department of Neurology, Oita Prefectural Hospital. The patient is a 64-year-old woman with herpes zoster meningo-encephalitis followed by involvement of cranial nerves IX, X, XI. On admission, she had severe neck pain on the left side and mild nuchal rigidity. Three days later, herpetic vesicles on the left side of her neck (C2, C3, area). Herpes zoster meningoencephalitis was diagnosed based on CSF pleocytosis, high serum and CSF titers of herpes zoster antibody, and EEG abnormality. During hospitalization, paralysis of the left vocal cord, rightward deviation of the uvula, and gradual paralysis of the left sternocleidomastoideus and trapezius muscles developed. On cranial magnetic resonance imaging (MRI), T2-weighted image clearly revealed a high-signal lesion in left dorsal part of the medulla oblongata. This area appeared to correspond to the nucleus ambiguous and vagal nucleus. In this case, we believe that the inflammation originated in the C2, C3 posterior ganglion cells, extended to the IX, X, XI cranial nerves and to the part of the medulla oblongata. It is likely that the number of patients in whom a lesion of the cranial nucleus is revealed by MRI will increase in the future. PMID: 7955732 [PubMed - indexed for MEDLINE] 3398. Arzneimittelforschung. 1994 Jul;44(7):866-71. Management of viral infections with thymopentin. Sundal E, Bertelletti D. Recurrent herpes simplex-, herpes zoster- and human papilloma virus infections are sometimes difficult to control by traditional antiviral therapy. Although detectable immune disturbances are not regularly associated with the clinical presentation, a compromised cellular immunity has been found to play an important role in the pathogenesis of those diseases. Thymopentin (Arg-Lys-Asp-Val-Tyr) is a synthetic pentapeptide corresponding to the active structure of the natural 49 amino acids containing thymic hormone thymopoietin, which has shown impressive immunoregulatory activity in many animal model systems and human in-vitro tests. Cumulative clinical experience with this drug has suggested that it would be of particular value in certain recurrent viral diseases. This report summarizes some of the individual studies performed so far, and discusses the mechanisms of action within the context of relevant published articles in this field. Contrary to antiviral drugs, thymopentin's effect appears to be long-lasting also after discontinuation of treatment. The drug seems to be extremely safe and no serious adverse reactions have been reported to date. PMID: 7945525 [PubMed - indexed for MEDLINE] 3399. Wiad Lek. 1994 Jul;47(13-14):527-32. [Capsaicin in pain therapy] [Article in Polish] Sokołowski P. Katedry i Kliniki Neurologii Ak. Med. w Lodzi. In the paper the possibilities of therapeutic use of capsaicin are presented. This drug seems to be very effective in neuralgia after zoster, and less effective in painful diabetic neuropathy. Attempts are also undertaken at its use in cluster headache, trigeminal neuralgia and arthralgia. Confirmation of the effectiveness of the discussed drug in these pain syndromes requires further studies. PMID: 7716941 [PubMed - indexed for MEDLINE] 3400. Lancet. 1994 Jun 25;343(8913):1648. Proposed classification of herpes zoster pain. Dworkin RH, Portenoy RK. PMID: 7911959 [PubMed - indexed for MEDLINE] 3401. JAMA. 1994 Jun 22-29;271(24):1948-52. Viral imitations of host defense proteins. Flattery that turns to battery. Murphy PM. Laboratory of Host Defenses, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md 20892. PMID: 8201740 [PubMed - indexed for MEDLINE] 3402. Lancet. 1994 Jun 18;343(8912):1548-51. Consequences of varicella and herpes zoster in pregnancy: prospective study of 1739 cases. Enders G, Miller E, Cradock-Watson J, Bolley I, Ridehalgh M. Institut für Virologie, Infektiologie und Epidemiologie, Stuttgart, Germany. Comment in: Lancet. 1994 Oct 1;344(8927):950-1. In a joint prospective study in Germany and the United Kingdom between 1980 and 1993, 1373 women who had varicella and 366 who had herpes zoster during the first 36 weeks of gestation were followed up. 9 cases of congenital varicella syndrome were identified, all occurring after maternal varicella during the first 20 weeks of gestation. The highest risk (2.0%) was observed between 13-20 weeks gestation, with 7 affected infants identified among 351 pregnancies (95% CI of risk 0.8-4.1%). Only 2 cases of congenital varicella syndrome were identified among 472 pregnancies in which maternal varicella occurred before 13 weeks (observed risk 0.4%, 95% CI 0.05-1.5%). Herpes zoster in infancy was reported in 10 children whose mothers had had varicella in pregnancy. No infants with clinical evidence of intrauterine infection were born to the 366 women with herpes zoster in pregnancy (upper 95% confidence limit of estimated risk 1.0%). Varicella-zoster-specific IgM antibody was found at birth in 4 of 16 (25%) infants with clinical manifestations of intrauterine infection and persistent specific IgG antibody in 5 of 7 infants tested. The corresponding rates in asymptomatic infants whose mothers had varicella were 12% (76/615) and 7% (22/335) respectively. No serological evidence of intrauterine infection was found in infants who mothers had herpes zoster in pregnancy. In 97 pregnant women, varicella occurred after post-exposure prophylaxis with anti-varicella-zoster immunoglobulin. No cases of congenital varicella syndrome or zoster in infancy occurred in this group. Our estimates provide a sound basis for counselling women with varicella in pregnancy. Although the risk of congenital varicella syndrome is small, the outcome for the affected infant is so serious that a reliable method of prenatal diagnosis would be valuable. In the long term, prevention of maternal varicella would be an option if a safe and effective vaccine were to become routinely available. PMID: 7802767 [PubMed - indexed for MEDLINE] 3403. Minerva Med. 1994 Jun;85(6):333-7. [Herpes zoster and post-herpetic neuralgia. Comparison between elderly patients and young adults treated with acyclovir] [Article in Italian] Bilora F, Genovese R, Presotto F, Saccaro G, Vettore G, San Lorenzo I, Dazzi A. Dipartimento di Emergenza, Complesso Ospedale-Università degli Studi di Padova. Herpes zoster (HZ) is a common skin disease due to a virus identical to that responsible for chickenpox. In a variable number of cases neuritic pain persist after cutaneous healing. Aim of this investigation was to analyze zoster clinical evolution in 102 immunocompetent patients, subdivided by age (< 60 years and > or = 60 years) and sex, after treatment with acyclovir (4 g/die x 10 days). Signs and symptoms of the disease were evaluated, with particular attention to pain and the duration of post-herpetic neuralgia. Vescicular eruption was most frequently found in the thoraco-abdominal region and in the trigeminal one, with no significant differences among the subgroups. Two thirds of the subjects complained of pain and it was prevalent in female sex (84% of cases vs 53%, p < 0.01) but not in any age-class. After 1 months from the episode (and its pharmacological treatment), post-herpetic neuralgia was still present in about 20% of the patients, above all in those > or = 60 years; this last difference reached statistical significance after 6 months (9.7% vs 1.4% for subjects > or = 60 years and < 60 years respectively, p < 0.05). No patient showed any adverse pharmacological effect after treatment. We conclude that acyclovir is well accepted both in young and elderly immune-competent subjects suffering from HZ, but it necessitates further efficacy investigations in sight of its broader utilization. PMID: 8084437 [PubMed - indexed for MEDLINE] 3404. J Clin Microbiol. 1994 Jun;32(6):1610-3. Comparison of techniques and evaluation of three commercial monoclonal antibodies for laboratory diagnosis of varicella-zoster virus in mucocutaneous specimens. Pérez JL, García A, Niubò J, Salvà J, Podzamczer D, Martín R. Service of Microbiology, Hospital Prínceps d'Espanya, Ciutat Sanitària i Universitària de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain. A comparison of direct antigen detection in cell scrapings with culture techniques (tube culture and shell vial method) for diagnosis of varicella-zoster virus (VZV) mucocutaneous infections was done in parallel in two groups of specimens. A total of 100 specimens were from patients with clinical diagnosis of VZV infection (group 1), and 69 were from patients with no suspicion of VZV infection (group 2) but mainly with herpes simplex virus infections. In addition, three commercially available monoclonal antibodies (Whittaker, Biosoft Clone 2013, and Ortho 3B3) directed against VZV antigens were evaluated in parallel in the last 87 group 1 specimens. Overall, 80% of the group 1 specimens were confirmed positive by direct detection, in comparison with 56% positive by tube culture and/or shell vial. None of the group 2 specimens were positive for VZV by any of the methods, and none of the monoclonal antibodies assayed reacted with any herpes simplex virus stock strains. Antiviral therapy and the length of evolution time of lesions affected negatively the performance of all laboratory methods, but to a lesser extent in direct detection techniques than in culture techniques. The Whittaker and Biosoft reagents (indirect immunofluorescence assay) showed statistically significant differences in sensitivity with respect to the Ortho antibody (P = 0.002 and P = 0.039, respectively; two-tailed binomial test). Direct antigen detection is a rapid, easy-to-perform, sensitive, and specific technique and appears to be the method of choice for laboratory confirmation of VZV mucocutaneous infections. PMCID: PMC264053 PMID: 8077417 [PubMed - indexed for MEDLINE] 3405. Nippon Jibiinkoka Gakkai Kaiho. 1994 Jun;97(6):1019-27. [Detection of varicella-zoster virus DNA by polymerase chain reaction in patients with Hunt syndrome and clinical progression] [Article in Japanese] Bessho K, Ogino S. Department of Otolaryngology, Osaka University, School of Medicine. Varicella-zoster virus (VZV) is known to be associated with Hunt syndrome. In this study, the detection of VZV-DNA in peripheral blood, throat swabs, urine and crusts was performed, in 6 cases of Hunt syndrome, by the polymerase chain reaction (PCR) method. For DNA-extraction, glass-powder was used. As a primer, an oligonucleotide, which specifically amplifies 1201-1424 in the Sst-Ig region, was used. Amplification was performed by repeating 30 cycles of the following procedures: denaturing at 94 degrees C, annealing at 60 degrees C, and extension at 72 degrees C. In one case, VZV-DNA was detected in all samples, in another case it was detected in a throat swab, urine and crust, and in another case in peripheral blood, urine and crust. The other 3 cases showed VZV-DNA only in crusts. These results indicate that viremia might occur in Hunt syndrome, and that those patients in whom VZV-DNA was detected in peripheral blood and urine showed a tendency for slow recovery. The present results indicate that this method provides a valuable tool for the early diagnosis of Hunt syndrome and zoster sine herpes and that it is useful for predicting the progression of Hunt syndrome. PMID: 8051589 [PubMed - indexed for MEDLINE] 3406. Nippon Sanka Fujinka Gakkai Zasshi. 1994 Jun;46(6):539-42. [A case report of aplasia cutis congenita] [Article in Japanese] Ikeda Y, Masuzaki H, Yamabe T, Maekawa H, Murakami M, Koide E, Nakashita Y, Yamamoto K. Department of Obstetrics and Gynecology, Nagasaki University School of Medicine. PMID: 8040628 [PubMed - indexed for MEDLINE] 3407. Insight. 1994 Jun;19(2):14-6. Recognition of herpes zoster ophthalmicus. Krimmer JE. Herpes zoster ophthalmicus is a form of herpes zoster. Approximately 10 to 25 percent of zoster cases are ophthalmicus. The process is caused by reactivation of latent varicella virus affecting the fifth cranial nerve. Recognition of signs and symptoms leading to early diagnosis and treatment with acyclovir may alter the course and diminish damage to ocular structures. PMID: 8006487 [PubMed - indexed for MEDLINE] 3408. Am J Dermatopathol. 1994 Jun;16(3):268-74. Clinical application of polymerase chain reaction amplification to diagnosis of herpes virus infection. Thomas CA, Smith SE, Morgan TM, White WL, Feldman SR. Department of Dermatology, Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, North Carolina. Amplification of viral DNA offers a potentially sensitive and specific method for identifying herpes viruses in pathologic specimens. The purpose of this study is to assess the value of polymerase chain reaction amplification of DNA as a diagnostic test for herpes virus in pathologic specimens. The purpose of this study is to assess for herpes virus infections. We examined 79 paraffin-embedded tissue samples from 43 patients and 55 viral culture samples from 45 patients. Herpes virus DNA in the specimens was amplified by polymerase chain reaction. Using paraffin-embedded tissue on which a diagnosis of herpes virus was made by morphologic criteria, 11 of 19 patients had herpes virus DNA identified by PCR; herpes virus DNA was not identified in any of 35 negative control specimens. Herpes virus DNA was also identified by polymerase chain reaction in all of the positive herpes virus culture specimens. Of 29 culture negative specimens, herpes virus DNA was identified in six. We conclude that polymerase chain reaction is useful to establish or confirm the presence of a herpes virus infection in paraffin-embedded tissue samples and that it is more sensitive than viral culture. PMID: 7943633 [PubMed - indexed for MEDLINE] 3409. J Antimicrob Chemother. 1994 Jun;33(6):1245-9. Trough plasma acyclovir concentrations and safety of oral acyclovir, 800 mg five times daily for 7 days in elderly patients with herpes zoster. Wood MJ, McKendrick MW, Freris MW, Jeal SC, Jones DA, Gilbert AM. Department of Infection and Tropical Medicine, Birmingham Heartlands Hospital, UK. PMID: 7928819 [PubMed - indexed for MEDLINE] 3410. Asian Pac J Allergy Immunol. 1994 Jun;12(1):51-8. IN vitro cell-mediated immune reactions in herpes zoster patients treated with cimetidine. Komlos L, Notmann J, Arieli J, Hart J, Levinsky H, Halbrecht I, Sendovsky U. B Gattegno Research Institute for Human Reproduction and Fetal Development, Hasharon Hospital, Golda Medical Center, Petah-Tiqva, Israel. In a double-blind placebo-control study the immunomodulating effect of cimetidine treatment for one week and placebo was investigated for cell-mediated immune reactions of 22 patients with herpes zoster (HZ). The mitogen induced leukocyte migration inhibition test (LMIT) and the in vitro proliferation of the patients' lymphocytes to exogenous IL-2 were used. Before any treatment, the mitogen induced leukocyte migration inhibition capacity (LMIC) of HZ patients was found to be significantly reduced (p < 0.02) as compared to healthy blood bank donors (controls). After one week, within the same treatment, the LMIC was significantly improved (p < 0.01). The patients' lymphoproliferative response to IL-2, before any treatment, was not significantly different from that of controls (p < 0.05). However, significantly higher values (p < 0.001) were found in patients tested 7 days after the disease onset as compared to those tested after 12 days. One-week cimetidine treatment significantly improved (p < 0.05) the lymphoproliferative response to IL-2 of initially low responders and had no effect on higher responder patients. In contrast to this, after one week of placebo treatment, a significant decrease in the patients' lymphoproliferative response to IL-2 could be observed as compared to patients' initial responses (p < 0.05) or to those of controls (p < 0.05). Although the number of cases is very small. The data suggest that after cimetidine treatment, as compared to placebo, healing from skin rash and pain was achieved in a significantly shorter time (p < 0.01). PMID: 7872992 [PubMed - indexed for MEDLINE] 3411. Lancet. 1994 May 28;343(8909):1363. Varicella-zoster vaccination for health care workers. Simini B. Comment on: Lancet. 1994 Apr 16;343(8903):928-9. PMID: 7910352 [PubMed - indexed for MEDLINE] 3412. Dtsch Med Wochenschr. 1994 May 6;119(18):679. [Acyclovir treatment] [Article in German] Maass G. Deutsche Vereinigung zur Bekämpfung der Viruskrankheiten e.V., Münster. PMID: 8187617 [PubMed - indexed for MEDLINE] 3413. Arch Dermatol. 1994 May;130(5):661-3. Postzoster cutaneous pseudolymphoma. Roo E, Villegas C, Lopez-Bran E, Jimenez E, Valle P, Sanchez-Yus E. Comment in: Arch Dermatol. 1995 Feb;131(2):226. PMID: 8179351 [PubMed - indexed for MEDLINE] 3414. Ann Neurol. 1994 May;35(5):530-3. Zoster sine herpete, a clinical variant. Gilden DH, Wright RR, Schneck SA, Gwaltney JM Jr, Mahalingam R. University of Colorado School of Medicine, Department of Neurology, Denver 80262. Two otherwise healthy immunocompetent men, ages 62 and 66 years, experienced years of radicular pain without zoster rash. An extensive search for systemic disease and malignancy was negative. Varicella-zoster virus DNA, but not herpes simplex virus DNA, was found in the cerebrospinal fluid of the first patient 5 months after the onset of pain, and in the second patient 8 months after the onset of pain. Prolonged radicular pain without zoster rash combined with the presence of varicella-zoster virus in the cerebrospinal fluid indicates that both men had zoster sine herpete, and strongly supports this syndrome as a clinical variant. PMID: 8179298 [PubMed - indexed for MEDLINE] 3415. J Am Acad Dermatol. 1994 May;30(5 Pt 1):757-67. Treatment of the cutaneous pain of acute herpes zoster with 9% lidocaine (base) in petrolatum/paraffin ointment. Riopelle J, Lopez-Anaya A, Cork RC, Heitler D, Eyrich J, Dunston A, Riopelle AJ, Johnson W, Ragan A, Naraghi M. Department of Anesthesiology, Louisiana State University Medical Center, New Orleans. BACKGROUND: Treatment of the pain of acute herpes zoster by local anesthetic injections has drawbacks. Topical percutaneous local anesthesia (TPLA) may offer another strategy of providing regional analgesia in affected patients. OBJECTIVE: We evaluate the analgesic efficacy and safety of 9% (wt/vol) lidocaine (base) in petrolatum/paraffin ointment in patients with acute herpes zoster. METHODS: Ointment was applied to the affected skin of 22 patients. Pain, tenderness, sensitivity to pinprick and cold, and blood lidocaine concentration were measured repeatedly during a 20-hour interval and intermittently thereafter. RESULTS: Mean pain, tenderness, and cutaneous sensation scores were reduced at measurements taken from 4 to 20 hours after ointment application (p < 0.05), but not every patient obtained relief. No patient had local skin irritation or systemic toxic effects related to the local anesthetic. CONCLUSIONS: TPLA is a promising therapy for control of cutaneous pain of acute herpes zoster. Controlled studies should be performed to prove efficacy, determine optimal TPLA formulation, and define dosage limits. PMID: 8176016 [PubMed - indexed for MEDLINE] 3416. Clin Infect Dis. 1994 May;18(5):810-2. Development of myelopathy before herpes zoster rash in a patient with AIDS. Gómez-Tortosa E, Gadea I, Gegúndez MI, Esteban A, Rábano J, Fernández-Guerrero ML, Soriano F. Department of Neurology, Fundación Jimenez Díaz, Madrid, Spain. We describe the case of a patient with AIDS who developed progressive myelopathy due to varicella-zoster virus 2 months before the appearance of skin lesions typical of herpes zoster. Varicella-zoster virus was isolated from his CSF. Therapy with acyclovir failed to control his neurological complications despite its in vitro efficacy against the isolates. PMID: 8075278 [PubMed - indexed for MEDLINE] 3417. Ann Pharmacother. 1994 May;28(5):585-7. Acyclovir excretion in human breast milk. Taddio A, Klein J, Koren G. Division of Clinical Pharmacology and Toxicology, Hospital for Sick Children, Toronto, Ontario. OBJECTIVE: To measure acyclovir concentrations in the breast milk of a lactating woman using the drug for herpes zoster while nursing her 7-month-old infant. METHODS: The maternal dosage of acyclovir was 800 mg five times daily for seven days. Three random breast milk samples collected on the fifth and sixth days of therapy were analyzed for acyclovir concentrations with radioimmunoassay (RIA). RESULTS: Acyclovir concentrations in breast milk ranged from 18.5 mumol (4.16 micrograms/mL) to 25.8 mumol (5.81 micrograms/mL). An estimate of the infant's dosage ingested through nursing was 0.73 mg/kg/d, or approximately 1 percent of the maternal dose in milligrams/kilograms/day. The baby was nursed without any signs of adverse effects. CONCLUSIONS: Acyclovir was measured in clinically insignificant concentrations in the milk of a woman receiving large dosages for herpes zoster. Breast feeding continued without adverse effects to the nursing infant. PMID: 8068994 [PubMed - indexed for MEDLINE] 3418. J Am Board Fam Pract. 1994 May-Jun;7(3):245-7. Fatal Pasteurella septicemia associated with herpes zoster lesions. Carr RJ, Gonzalez G, Lin T. Department of Family Medicine, Georgetown University School of Medicine, Washington, DC 20017. PMID: 8059630 [PubMed - indexed for MEDLINE] 3419. Klin Monbl Augenheilkd. 1994 May;204(5):440-9. [Acute retinal necrosis syndrome. Lausanne cases, review of the literature and new physiopathogenetic hypothesis] [Article in French] Rochat C, Herbort CP. Hôpital Jules Gonin, Service d'ophtalmologie, Université de Lausanne. PURPOSE: The purpose of this study was to analyse our ARN-patients, perform an extensive review of the literature, suggest a physiopathogenic hypothesis for the disease that should influence the therapeutical approach of these cases. PATIENTS AND METHODS: From 1985 to 1993, 15 HIV-negative cases of ARN were seen in our clinic. Eleven cases were analysed prospectively: the herpetic agent involved in each case was searched for by the determination of intraocular specific antibody production and a complete immunological work-up was performed. RESULTS: Our collective included 4 cases of bilateral ARN (BARN). In 9 cases the clinical presentation was that of a typical ARN, in 3 cases ARN was of the "mild-type" and in 3 cases lesions were multifocal involving initially the posterior pole resembling the clinical picture of PORN (progressive outer retinal necrosis). The viral agent was varicella-zoster virus in 7 cases, herpes simplex virus in 3 cases, cytomegalovirus in 1 case and was not determined in 4 cases. In the 216 published cases a state of immunodepression was found in 15.7%. In our group with systematic immunological work-up this rate was 46%. CONCLUSION: This is in support of the thesis that an immune dysfunction is probably at the origin of ARN. We therefore suggest to avoid to add systemic steroids to the specific antiviral therapy but to treat inflammation by periocular steroids. PMID: 8051895 [PubMed - indexed for MEDLINE] 3420. J Can Dent Assoc. 1994 May;60(5):450-3. Herpes zoster of the trigeminal nerve: the dentist's role in diagnosis and management. Millar EP, Troulis MJ. Royal Victoria Hospital, Montreal, Quebec. Herpes zoster is caused when the varicella/zoster virus that has remained latent since an earlier varicella infection is reactivated. During the prodromal stage, the only presenting symptom may be odontalgia, which may prove to be a diagnostic challenge for the dentist. He or she may carry out emergency treatment that might be irreversible or inappropriate, as well as delay appropriate treatment. With an ever-increasing number of elderly and immunocompromised patients attending the dentist, the dental profession can expect to encounter an increased number of herpes zoster patients. The practising dentist must be familiar with the presenting signs and symptoms of patients experiencing the prodromal manifestations of herpes zoster of the trigeminal nerve. PMID: 8004523 [PubMed - indexed for MEDLINE] 3421. Med Microbiol Immunol. 1994 May;183(2):105-17. Characterization and immunogenicity of a candidate subunit vaccine against varicella-zoster virus. Davies J, Hallworth JA, McLeish P, Randall S, Martin BA, Buchan A, Skinner GR. Vaccine Research Foundation, Lapworth, Warwickshire, UK. This study describes the properties of an inactivated subunit antigen preparation from varicella-zoster virus (VZV)-infected MRC-5 cells by treatment with detergent and formaldehyde, ultracentrifugation over sucrose and acetone precipitation. The method preserved the antigenicity of VZV proteins and several VZV-specific glycoproteins, while virus DNA was less than 20 pg/250 micrograms protein--a putative vaccine dose. The vaccine was immunogenic in rabbits and stimulated antibodies to the major capsid protein as well as to glycoproteins; an immunoprecipitin was shared with a known immune human serum. The preparation contained no infectious VZV with no evidence of side effects in a rabbit or in five human vaccinees during a follow-up period of 6-10 years. PMID: 7935160 [PubMed - indexed for MEDLINE] 3422. Infection. 1994 May-Jun;22(3):216-8. Severe pneumonia in pregnancy three months after resolution of cutaneous zoster. Moling O, Mayr O, Gottardi H, Mian P, Zanon P, Oberkofler F, Gramegna M, Colucci G. Sektion für Infektionskrankheiten, Medizinische Abt. I, Allgemeines Regionalkrankenhaus Bozen, Italy. A 22 weeks pregnant women was affected by a life-threatening pneumonia and a paresis of the proximal muscles with cerebrospinal fluid pleocytosis. Her past medical history had been unremarkable except for recurrent episodes of paraumbilical herpes zoster. The clinical findings suggested a dissemination of varicella-zoster virus without skin lesions. Acyclovir was added to the therapy, and the clinical picture began to improve. Varicella-zoster virus DNA was detected in placental tissue by DNA-hybridisation analysis. PMID: 7927822 [PubMed - indexed for MEDLINE] 3423. Clin Neurol Neurosurg. 1994 May;96(2):156-60. Vasculitic, hypoxic-ischemic leukoencephalopathy. Heye N, Terstegge K, Gosztonyi G. Institute of Neuropathology and Radiological Clinic, Freie Universität Berlin, Germany. The case of a 67-year-old woman with terminal renal insufficiency, who developed extensive encephalopathy with predominant involvement of the white matter is reported. The encephalopathy was the consequence of preexisting hypertensive alterations, acidosis, hypoxia, ischemia, bacteremia and varicella-zoster meningoencephalitis. The vasculitic alterations associated with meningoencephalitis had a major influence on the development and the extent of the leukoencephalopathy. PMID: 7924081 [PubMed - indexed for MEDLINE] 3424. Fortschr Med. 1994 Apr 30;112(12):172-3. [Current developments in antiviral chemotherapy. 3: Vidarabine, ganciclovir] [Article in German] Stamminger T, Fleckenstein B. Institut für Klinische und Molekulare Virologie, Universität Erlangen-Nürnberg. PMID: 8200604 [PubMed - indexed for MEDLINE] 3425. Fortschr Med. 1994 Apr 20;112(11):159-60. [Current developments in antiviral chemotherapy. 2: Acyclovir] [Article in German] Stamminger T, Fleckenstein B. Institut für Klinische und Molekulare Virologie, Universität Erlangen Nürnberg. PMID: 8200599 [PubMed - indexed for MEDLINE] 3426. Am J Ophthalmol. 1994 Apr 15;117(4):536-8. Varicella-zoster virus retinitis as the initial manifestation of the acquired immunodeficiency syndrome. Friedman SM, Margo CE, Connelly BL. PMID: 8154542 [PubMed - indexed for MEDLINE] 3427. Zhonghua Hu Li Za Zhi. 1994 Apr 5;29(4):212-3. [Analysis and comparison of different methods in topical treatment of herpes zoster] [Article in Chinese] Xu WP, Zheng W. PMID: 7788775 [PubMed - indexed for MEDLINE] 3428. Union Med Can. 1994 Apr;123(4):221-4. [What use is made of acyclovir in immunocompetent patients?] [Article in French] Pineau MC. l'Hôpital Royal-Victoria. PMID: 8203043 [PubMed - indexed for MEDLINE] 3429. Internist (Berl). 1994 Apr;35(4):392-4. [Recurrent burning pain, erythema, cutaneous edema and hyperthermia of both lower legs after herpes zoster thoracalis] [Article in German] Jabs HU, Drüke P. Innere Abteilung, St. Vincenz Hospital Coesfeld. PMID: 8200764 [PubMed - indexed for MEDLINE] 3430. Harefuah. 1994 Apr 1;126(7):380-3, 426. [Herpes zoster treated with acyclovir] [Article in Hebrew] Grempel H, Rozenman D, Zuckerman F. Dermatology Dept., Central Emek Hospital, Afula. During the past 5 years, 99 patients with herpes zoster were hospitalized and followed. Age, sex, localization of rash, complications, duration of hospitalization and treatment were analyzed. Most patients were in their 6th and 7th decades. Cranial nerve involvement was frequent (35%). A generalized rash was more common in those with immunodeficiency. Acyclovir (Zovirax) inhibited to some extent the spreading of the rash and reduced the frequency of herpetic neuralgia. Our findings are in accord with those in the literature. PMID: 8200584 [PubMed - indexed for MEDLINE] 3431. Neurology. 1994 Apr;44(4):773-4. Absence of auricular lesions in Ramsay Hunt syndrome. Shapiro BE, Slattery M, Pessin MS. Department of Neurology, Tufts University School of Medicine, New England Medical Center, Boston, MA. PMID: 8164846 [PubMed - indexed for MEDLINE] 3432. J Med Virol. 1994 Apr;42(4):338-47. Meningoradiculoneuritis due to acyclovir-resistant varicella zoster virus in an acquired immune deficiency syndrome patient. Snoeck R, Gérard M, Sadzot-Delvaux C, Andrei G, Balzarini J, Reymen D, Ahadi N, De Bruyn JM, Piette J, Rentier B, et al. Rega Institute for Medical Research, Katholieke Universiteit Leuven, Belgium. Varicella zoster virus (VZV) is recognized as one of the major viral pathogens reactivated in patients with the acquired immune deficiency syndrome (AIDS). We report the case of meningoradiculoneuritis in an AIDS patient,associated with the isolation in the cerebrospinal fluid (CSF) of a thymidine kinase (TK)-deficient, acyclovir (ACV)-resistant strain of VZV. Although the virus was sensitive in vitro to phosphonoformate (PFA), the patient did not improve during PFA therapy and finally died. Several VZV strains isolated from this patient (including two isolates from the patient's CSF) were analyzed for their TK activity and subsequently the viral TK gene was sequenced showing a major deletion leading to a truncated protein. Their susceptibility to several antiviral agents including ACV, PFA, (E)-5-(2-bromovinyl)-2'-deoxyuridine (BVDU), 9-beta-D-arabinofuranosyladenine (vidarabine), (S)-1-(3-hydroxy-2-phosphonylmethoxypropyl) cytosine (HPMPC), and (S)-9-(3-hydroxy-2-phosphonyl-methoxypropyl)adenine (HPMPA) was evaluated. All the virus strains isolated from this patient remained sensitive to HPMPA and HPMPC, pointing to the potential usefulness of these acyclic nucleoside phosphonates for the treatment of ACV-resistant VZV infections in immunocompromised patients. PMID: 8046424 [PubMed - indexed for MEDLINE] 3433. An Med Interna. 1994 Apr;11(4):203. [Vesiculo-papular lesions and peripheral facial paralysis. Ramsay-Hunt syndrome] [Article in Spanish] Lanzas G, Ruiz de Ocenda M, Pardo I, Abu-Shams J, Tiberio G. PMID: 8043745 [PubMed - indexed for MEDLINE] 3434. Anesthesiology. 1994 Apr;80(4):950-2. Repeated stellate ganglion blockade using a catheter for pediatric herpes zoster ophthalmicus. Elias M, Chakerian MU. Department of Anesthesiology, University of California, San Diego Medical Center 92103-8812. Comment in: Anesthesiology. 1994 Sep;81(3):785. PMID: 8024151 [PubMed - indexed for MEDLINE] 3435. Klin Monbl Augenheilkd. 1994 Apr;204(4):235-40. [Bilateral acute retinal artery necrosis--healing of the second affected eye] [Article in German] Kalman A, Vogt M, Bernasconi E, Gloor B. Augenklinik, Universitätsspitales Zürich. BACKGROUND: The acute retinal necrosis syndrome (ARN) is caused by the Varicella zoster virus or the Herpes simplex virus. However the dosage and duration of the antiviral therapy for prevention of an infection in the second eye or treatment of an infection on an affected fellow eye is still not known. We discuss the timing of a possible steroid treatment and demonstrate in a case report how an acute retinal necrosis syndrome in a fellow eye was successfully treated. PATIENT: First eye: A 27-year-old not immunocompromised patient (HIV-negative) showed 2 months after a febrile state an acute iritis in the right eye. 14 days later an acute retinal necrosis syndrome was observed. The patient received Acyclovir 3 x 750 mg i.v. for 6 days, and afterwards 5 x 200 mg orally for 5 days. The patient developed an inoperable retinal detachment despite therapy. Second eye: Eight days later the fellow eye developed a localized retinal necrosis. Varicella zoster DNA was found in the aqueous humor using the polymerase chain reaction (PCR). The antiviral therapy with Acyclovir was increased from 1.1 g q 12 h (2 x 15 mg/kg/d) to 1.0 g q 8 h (3 x 12.5 mg/kg/d). After 4 weeks the i.v. therapy was followed by an oral therapy of 5 x 800 mg for 12 weeks. This dosage was reduced to 5 x 400 mg for another 12 weeks. The oral therapy with corticosteroids started on the 11th day with 100 mg Prednisone, in slowly reducing dosage during 18 weeks. The fellow eye recovered fully with a visual acuity of 20/20 after 6 months. CONCLUSION: The disease started in the fellow eye with an acute iritis and a secondary glaucoma. These symptoms can be a characteristic prodroma of an acute retinal necrosis syndrome caused by a varicella zoster- or Herpes simplex virus infection, which was not recognized first. Whether a long-term therapy (as described above) is necessary or not is unclear on the basis of a single case report, but we currently recommend the high-dose treatment regimen until further data emerge. PMID: 8022154 [PubMed - indexed for MEDLINE] 3436. Int J Dermatol. 1994 Apr;33(4):268-9. Granulomatous vasculitis in herpes zoster scars. Baalbaki SA, Malak JA, al-Khars MA, Natarajan S. Dermatology Service, Saudi Aramco-Dhahran Health Center, Saudi Aramco Medical Services Organization, Dhahran, Saudi Arabia. PMID: 8021084 [PubMed - indexed for MEDLINE] 3437. Int J Dermatol. 1994 Apr;33(4):227-32. Pathophysiology and clinical manifestations of varicella zoster virus infections. Rockley PF, Tyring SK. Department of Dermatology, University of Texas Medical Branch, Galveston 77555-0783. PMID: 8021075 [PubMed - indexed for MEDLINE] 3438. Transfus Med Rev. 1994 Apr;8(2):96-116. The risk of varicella-zoster infections in different patient populations: a critical review. Rusthoven JJ. Department of Medical Oncology, Ontario Cancer Treatment and Research Foundation, Hamilton Regional Cancer Centre, Canada. PMID: 8003859 [PubMed - indexed for MEDLINE] 3439. N Engl J Med. 1994 Mar 31;330(13):932-4. Herpes zoster with postherpetic neuralgia--persisting pain and frustration. Gilden DH. Comment on: N Engl J Med. 1994 Mar 31;330(13):896-900. PMID: 8114868 [PubMed - indexed for MEDLINE] 3440. N Engl J Med. 1994 Mar 31;330(13):906. Images in clinical medicine. Herpes zoster. Rosencrance G. West Virginia University Health Sciences Center, Charleston 25304. Comment in: N Engl J Med. 1994 Aug 18;331(7):481-2. PMID: 8114862 [PubMed - indexed for MEDLINE] 3441. N Engl J Med. 1994 Mar 31;330(13):896-900. A randomized trial of acyclovir for 7 days or 21 days with and without prednisolone for treatment of acute herpes zoster. Wood MJ, Johnson RW, McKendrick MW, Taylor J, Mandal BK, Crooks J. Department of Infection and Tropical Medicine, Birmingham Heartlands Hospital, United Kingdom. Comment in: N Engl J Med. 1994 Aug 18;331(7):481. N Engl J Med. 1994 Aug 18;331(7):481. N Engl J Med. 1994 Mar 31;330(13):932-4. BACKGROUND. Acyclovir given for 7 to 10 days is of proved benefit in acute herpes zoster, but studies of its effectiveness in preventing postherpetic neuralgia have had conflicting results. The role of corticosteroids in the treatment of herpes zoster is also controversial. METHODS. We conducted a double-blind, controlled trial in patients with acute herpes zoster to determine whether either 21 days of acyclovir therapy or the addition of prednisolone offered any improvement over 7 days of acyclovir therapy. Patients with a rash of less than 72 hours' duration were assigned to receive acyclovir (800 mg orally, five times daily) for 7 days with either prednisolone or placebo, or acyclovir for 21 days with either prednisolone or placebo. Prednisolone therapy was initiated at a dose of 40 mg per day and tapered over a three-week period. Patients were assessed frequently through day 28 and then monthly through month 6 to assess postherpetic neuralgia. RESULTS. Of 400 patients recruited, 349 completed the study. No significant differences were detected between the four groups in the progression of the rash (P > 0.1). With steroid therapy, a significantly higher proportion of the rash area had healed on days 7 and 14 (P = 0.02). Pain reduction was greater during the acute phase of disease in patients treated with steroids or 21 days of acyclovir (P < 0.01 and P = 0.02, respectively, on day 7; P < 0.01 for steroid therapy on day 14). However, on follow-up there were no significant differences between any of the groups in the time to a first or a complete cessation of pain. The steroid recipients reported more adverse events. CONCLUSIONS. In acute herpes zoster, treatment with acyclovir for 21 days or the addition of prednisolone to acyclovir therapy confers only slight benefits over standard 7-day treatment with acyclovir. Neither additional treatment reduces the frequency of postherpetic neuralgia. PMID: 8114860 [PubMed - indexed for MEDLINE] 3442. Bone Marrow Transplant. 1994 Mar;13(3):277-83. Varicella zoster infection after bone marrow transplantation: incidence, risk factors and complications. Han CS, Miller W, Haake R, Weisdorf D. Department of Medicine, University of Minnesota, Minneapolis. The cellular immunoincompetence which follows bone marrow transplantation (BMT) allows both primary and reactivation infection with herpes viruses. We report the overall incidence and timing of varicella zoster virus (VZV) infections after BMT, including the clinical course, complications and associated clinical risk features. Of 1186 patients undergoing BMT through 1989, 216 patients developed VZV infection between 4 days and 10.8 years after BMT; 86% of them within the first 18 months. Of all patients transplanted, 15 +/- 3% by 6 months and 52 +/- 14% by 5 years had developed VZV infection. Dermatomal zoster represented 62% of the infections, while 32% had complicated VZV infection--CNS, disseminated or visceral zoster. All serious infections occurred within 7 months of BMT but only two patients died, both from VZV pneumonitis. Allogeneic and autologous recipients had a similar incidence of VZV infection. VZV seropositive patients had more frequent, earlier and often more complicated or disseminated infections. Age > or = 10 years and radiation in the pre-transplant conditioning were significantly and independently associated with higher rates of VZV infection within a multivariate regression model. Using this model, we could define clinical risk groups with distinctly different hazards of VZV infection: age > 10 years, radiation pre-BMT and VZV seropositive patients had a 44% incidence by 3 years versus age < 10 years, no radiation and VZV seronegative had a 0% incidence by 3 years. Acyclovir assigned for prophylaxis of CMV or HSV infection had no effect on the timing or incidence of VZV infection.(ABSTRACT TRUNCATED AT 250 WORDS) PMID: 8199570 [PubMed - indexed for MEDLINE] 3443. AJNR Am J Neuroradiol. 1994 Mar;15(3):479-85. Idiopathic, herpetic, and HIV-associated facial nerve palsies: abnormal MR enhancement patterns. Sartoretti-Schefer S, Wichmann W, Valavanis A. Department of Neuroradiology, University Hospital of Zurich, Switzerland. PURPOSE: To determine specific criteria that can be used to define normal versus abnormal MR contrast enhancement of the facial nerve. METHODS: Twenty-three patients with acute unilateral inflammatory peripheral facial nerve palsy were examined on a 1.5-T MR using multiplanar T1-weighted spin-echo sequences before and after injection of gadopentetate dimeglumine. These MR patterns were compared with those of healthy control subjects. RESULTS: The normal facial nerve usually showed a mild to moderate enhancement of the geniculate ganglion and the tympanic-mastoid segment. The intracanalicular-labyrinthine segment did not enhance. All patients showed abnormal enhancement of the distal intracanalicular and the labyrinthine segment. An intense enhancement could be observed in the geniculate ganglion and the proximal tympanic segment, especially in herpetic palsy. Associated enhancement of the vestibulocochlear nerve was seen in herpetic and idiopathic palsy. Enhancement of the inner ear structures was detected only in herpetic palsy. CONCLUSIONS: Abnormal contrast enhancement of the distal intracanalicular and the labyrinthine facial nerve segment is observed in all patients and is the only diagnostically reliable MR feature proving an inflammatory facial nerve lesion. The intense enhancement of the geniculate ganglion and the proximal tympanic segment is possibly correlated with the reactivation of the latent infection in the sensory ganglion. The abnormal enhancement results from breakdown of the blood-peripheral nerve barrier and/or from venous congestion in the venous plexuses of the epi- and perineurium. PMID: 8197944 [PubMed - indexed for MEDLINE] 3444. Electromyogr Clin Neurophysiol. 1994 Mar;34(2):125-8. An electromyographic evaluation of motor complications in thoracic herpes zoster. Cioni R, Giannini F, Passero S, Paradiso C, Rossi S, Fimiani M, Battistini N. Institute for Nervous and Mental Diseases, University of Siena, Italy. Motor complications in thoracic herpes zoster were evaluated in 52 patients by electromyographic examination of the paraspinal muscles. At the initial EMG examination, abnormal findings were observed in 18 patients (35%). In 8 patients the myomers involved coincided in location with affected dermatomes, while in 10 patients, in addition to the involvement of myomers corresponding to affected dermatomes, there also appeared an involvement of one or more contiguous myomers not corresponding to affected dermatomes. Our study demonstrated that motor involvement in thoracic HZ is much more common than previously suggested and its incidence (35%) appears to be greater than that reported in both cervical and lumbosacral HZ. PMID: 8187679 [PubMed - indexed for MEDLINE] 3445. Masui. 1994 Mar;43(3):405-8. [Unknown fever and abnormal liver functions after repeated epidural blocks with lidocaine for management of herpes zoster pain] [Article in Japanese] Uematsu H, Hiei K, Kawasaki H. Department of Anesthesiology, Ibi General Hospital, Gifu. We present a case of unknown fever and abnormal liver functions which developed during the course of pain management for herpes zoster with repeated epidural blocks with 0.5% lidocaine 10 ml. The patient was a 67 year old woman. At her first admission to dermatology, there were no abnormal findings in her blood examinations. She complained of severe pain from herpes zoster. She was admitted to the pain clinic. She received thoracic epidural blocks with 0.5% lidocaine 10 ml repeatedly three or four times a week. Two weeks later, she developed general fatigue, appetite loss, nausea and a high fever. Blood examinations revealed the elevation of glutamic oxalacetic transaminase (GOT), glutamic pyruvic transaminase (GPT), alkaline phosphatase (ALP), and gamma glutamyltrans peptidase (gamma-GTP), C reactive protein (CRP), and blood sedimentation rate (BSR). Many examinations including abdominal and thoracic computer tomography and abdominal echograph could not reveal the cause of high fever and abnormal blood examinations. We continued the thoracic epidural block for her herpes zoster pain. GOT, GPT, ALP, and gamma-GTP gradually went down to normal values in next two weeks, though fever still persisted. At this time, lymphocyte cell simulation test with 0.5 % lidocaine was positive and eosinophylic cell had increased to 5%. After ceasing the epidural block, fever resolved and blood examinations returned to normal values. These findings suggest strongly that 0.5% lidocaine induced fever and hepatitis. PMID: 8182888 [PubMed - indexed for MEDLINE] 3446. J Acquir Immune Defic Syndr. 1994 Mar;7(3):254-60. Management of acyclovir-resistant herpes simplex and varicella-zoster virus infections. Balfour HH Jr, Benson C, Braun J, Cassens B, Erice A, Friedman-Kien A, Klein T, Polsky B, Safrin S. Department of Laboratory Medicine & Pathology, University of Minnesota Health Sciences Center, Minneapolis. Persons with AIDS who have CD4+ counts < or = 100 and transplant patients, especially bone marrow allograft recipients, may experience clinically significant infections with acyclovir-resistant herpes simplex virus (HSV) or varicella-zoster virus (VZV). Patients who have received prior repeated acyclovir treatment appear to be at the highest risk of harboring acyclovir-resistant strains. Algorithms for the management of these infections were developed at a recent roundtable symposium. The consensus of the panelists was that treatment with foscarnet should be initiated within 7-10 days in patients suspected to have acyclovir-resistant HSV or VZV infections. Foscarnet therapy should be continued for at least 10 days or until lesions are completely healed. PMID: 8106965 [PubMed - indexed for MEDLINE] 3447. Med J Malaysia. 1994 Mar;49(1):29-35. Varicella in children with haematological malignancy--outcome of treatment and prevention. Ho CM, Khuzaiah R, Yasmin AM. Department of Paediatrics, Hospital Besar, Kuala Lumpur. Primary varicella-zoster virus infection in children with haematological malignancy is a life threatening disease. In one year, there were 10 cases of varicella and 2 cases of zoster among these children as well as 5 mothers who were accompanying their children who developed varicella in the oncology ward. Two children died of fulminating disease despite aggressive antiviral and supportive treatment. Acyclovir can be used in treatment and prophylaxis in exposed susceptible children. Varicella -zoster immune globulin is not available in this country. Vaccination with live virus has been shown to be protective in immunocompromised children and needs consideration. PMID: 8057987 [PubMed - indexed for MEDLINE] 3448. J Infect. 1994 Mar;28(2):167-73. Epidemic of herpes zoster following HIV epidemic in Manipur, India. Panda S, Sarkar S, Mandal BK, Singh TB, Singh KL, Mitra DK, Sarkar K, Tripathy SP, Deb BC. ICMR Unit for Research on AIDS in north eastern states of India, Calcutta. Since 1989, injecting drug use (IDU) related HIV infection has affected thousands of young adults in Manipur, a north eastern state of India bordering Myanmar following a similar kind of epidemic in adjoining countries like Thailand and Myanmar. During a clinical surveillance of a group of HIV positive IDUs for a natural history study at Manipur, herpes zoster (HZ) emerged as the most specific early HIV related illness (positive predictive value of 100%) in patients belonging to the age group of 12-45 years. Data collected from the dermatology departments of the two main hospitals of the state revealed that there had been an epidemic of HZ since 1990 (rate of 1990 being 11.3/1000 compared to 6.5/1000 in 1989, P value < 0.0001) among males of 12-45 years. The epidemic of HZ has been attributed to the preceding epidemic of IDU related HIV in the same age and gender group occurring 1 year earlier. HZ should be recognised as a marker condition similar to tuberculosis indicating the necessity of screening for HIV in regions where the dual problem of IDU and HIV exist in young adults. PMID: 8034996 [PubMed - indexed for MEDLINE] 3449. J Neuroophthalmol. 1994 Mar;14(1):12-4. Multifocal choroidal lesions. A rare complication of herpes zoster ophthalmicus. McElvanney AM, Murray PI. Birmingham and Midland Eye Hospital, United Kingdom. We document the case of a 76-year-old woman who developed mutifocal choroidal lesions as an unusual complication of herpes zoster ophthalmicus. PMID: 8032472 [PubMed - indexed for MEDLINE] 3450. Natl Med J India. 1994 Mar-Apr;7(2):63-4. Herpes zoster in an HIV-positive 14-month-old baby. Panda S, Nabachandra T, Sarkar S, Chakraborty S, Naik TN, Deb BC. Indian Council of Medical Research Unit, Manipur. BACKGROUND. In Manipur, a state in northeast India bordering Myanmar, within one year of reports of a high human immunodeficiency virus (HIV) seroprevalence among young injecting drug users, there has been a rapid spread of HIV infection in the general population. METHODS. Since 1990 our unit, together with the Medical Directorate, Government of Manipur, has studied different aspects of this epidemic, especially the natural history of HIV in this setting. RESULTS. Here we report the first case of herpes zoster in a 14-month-old HIV-positive baby (diagnosed by the polymerase chain reaction). The case was referred to our clinic by one of our patients residing in the same locality as the child and presently working as a counsellor in a drug detoxification-cum-rehabilitation centre at Imphal, Manipur. Dual infection of HIV and herpes zoster was also found in several other members of the same family. CONCLUSION. This report of perinatally acquired HIV infection in an environment of injecting drug users in India might help in understanding the course of paediatric HIV infection here. PMID: 8019397 [PubMed - indexed for MEDLINE] 3451. Ryoikibetsu Shokogun Shirizu. 1994;(4):712-4. [Ramsay Hunt syndrome; a special feature of acute respiratory failure] [Article in Japanese] Komori T. Department of Neurology, Tokyo Metropolitan Neurological Hospital. PMID: 8007285 [PubMed - indexed for MEDLINE] 3452. Ger J Ophthalmol. 1994 Mar;3(2):116-9. Dys- and paraproteinaemias in patients suffering from ophthalmic herpes zoster. Pintér E, Pék L. Central Laboratory and Ophthalmology Department of Szent László Kórház, Budapest, Hungary. Humoral immune parameters were measured in 93 patients suffering from ophthalmic herpes zoster. The control group consisted of 31 other ophthalmic patients. In all cases, electrophoresis, immunoglobulins, acutephase proteins, immune complexes, antinuclear antibody and complement components were determined as well. In patients suffering from ophthalmic herpes zoster the main immunological deviations among the humoral parameters were found in the non-specific immune response. These alterations were comparable with the extent and severity of the pathological processes. Para-proteins were detected in 12% of the patients. In contrast they were not present in the control group. PMID: 7514916 [PubMed - indexed for MEDLINE] 3453. Laryngoscope. 1994 Feb;104(2):127-34. Cloning and sequencing of genomic DNA extracted from archival human temporal bone sections. Kerner MM, Wackym PA, Popper P, Tabor DE, Grody WW. Laboratory of Molecular Biology, UCLA School of Medicine 90024-1794. Cloning techniques allow the engineering and production of highly purified DNA. Further advances in molecular biology have provided the means to identify DNA sequences in a rapid fashion. Sequencing methods can identify mutations, deletions, polymorphisms, or confirm a known genetic sequence. The use of these techniques in clinical medicine has made it possible to accurately diagnose infectious diseases and determine the molecular etiology of many genetic disorders and malignancies. In this study, DNA extracted from archival, celloidin-embedded temporal bone sections has been cloned and sequenced using these techniques. We amplified, cloned, and sequenced varicella-zoster viral DNA extracted from archival temporal bone sections from patients who had herpes zoster oticus. The application of cloning and sequencing techniques to DNA extracted from archival temporal bones provides the methodology to study temporal bone pathology at the molecular level. PMID: 8302113 [PubMed - indexed for MEDLINE] 3454. Phys Ther. 1994 Feb;74(2):129-42. Physical therapy management of peripheral vestibular dysfunction: two clinical case reports. Gill-Body KM, Krebs DE, Parker SW, Riley PO. Physical Therapy Services, Massachusetts General Hospital, Boston 02114. We describe the treatment of two patients with peripheral vestibular dysfunction using a novel, staged exercise program. Response to treatment was documented. The first patient, a 62-year-old woman with unilateral vestibular dysfunction (UVD) and a 6-month history of disequilibrium following herpes zoster oticus resulting in damage to the right inner ear, was treated with an 8-week course of vestibular physical therapy. During the 8 weeks, the patient attended weekly physical therapy sessions and was trained to perform vestibular adaptation exercises on a daily basis at home. The second patient, a 53-year-old woman with progressive disequilibrium secondary to profound bilateral vestibular hypofunction (BVH), was treated with a 16-week course of vestibular physical therapy. During the first 8 weeks, the patient attended weekly physical therapy sessions and was trained to perform vestibular adaptation and substitution exercises on a daily basis at home. During the second 8 weeks, the patient continued performing vestibular physical therapy exercises at home independently. Vestibular function (sinusoidal vertical axis rotation testing), postural control (clinical tests and posturography), stability during the performance of selected activities of daily living (ADLs), and self-perception of symptoms and handicap were measured prior to and at the conclusion of treatment for both patients and at the midpoint of treatment for the patient with BVH. After 8 weeks of treatment, both patients reported improvements in self-perception of symptoms and handicap and demonstrated objective improvements in clinical balance tests, posturography, and several kinematic indicators of stability during the performance of selected ADLs. Further improvements were noted in the patient with BVH after 16 weeks of treatment. Improvements in postural control were noted after 8 weeks of treatment for the patient with UVD and after 16 weeks for the patient with BVH. Vestibular function improved during the course of treatment for the patient with UVD only. These case reports describe two different individualized treatment programs and document self-reported and laboratory-measured functional improvements in two patients with vestibular deficients--one with unilateral damage and one with bilateral damage. PMID: 8290618 [PubMed - indexed for MEDLINE] 3455. J Chir (Paris). 1994 Feb;131(2):96-8. [Acute pancreatitis caused by varicella-zoster virus after liver transplantation] [Article in French] Coelho JC, Wiederkehr JC, Campos AC, Zeni Neto C, Oliva V. Services de Chirurgie, l'Hôpital des Cliniques de l'Université Fédérale du Parana, Curitiba, Brésil. Twenty-six days after liver transplantation for primary biliary cirrhosis, a 52 year-old patient was rehospitalized for viral infection. The clinical features were fatigue, anorexia and vomiting. On physical examination, vesicular skin lesions involving the left 8 th intercostal space were suggestive of herpes-zoster infection. The following day the patient was extremely tired and dyspnoeic. The abdomen was distended with moderate abdominal epigastric pain. The clinical picture worsened rapidly and the patient died a few hours later. Autopsy revealed acute haemorrhagic necrosis of the pancreas due to herpes-zoster virus. PMID: 8207103 [PubMed - indexed for MEDLINE] 3456. Med Microbiol Immunol. 1994 Feb;183(1):1-11. Reactivity of varicella-zoster virus subunit antigens in enzyme-linked immunosorbent assay to sera from varicella, zoster, and herpes simplex virus infections. Takayama M. Department of Virology I, National Institute of Health, Tokyo, Japan. Serological responses to varicella-zoster virus (VZV) subunit antigens, such as capsid, envelope, and soluble (S) antigens, in patients with VZV and herpes simplex virus (HSV) infections were studied by comparing with responses to virion (V) antigens using an enzyme-linked immunosorbent assay (ELISA). S antigen, prepared by concentrating supernatant of VZV or HSV type 1 (HSV-1)-infected cell culture fluid, reacted strongly to sera from patients with secondary infection but reacted poorly to those from patients with a primary infection of VZV or HSV. Antibody titers to VZV-S antigen persisted for a long period in patients with VZV infections. Patients infected with VZV showed antibody increase to HSV-1, when tested by complement fixation or complement-enhanced neutralization test, in cases with a history of prior HSV infection. However, such a cross-reaction was only observed to a minor extent in ELISA test using S antigen. S antigen reaction was stronger in secondary infections in tests with various subunit antigens. Almost no cross-reactivity was observed in an immunoblotting test with S antigen. Differentiation between infections with either varicella or zoster or HSV can be made by comparison of antibody responses to V and S antigens. PMID: 8202026 [PubMed - indexed for MEDLINE] 3457. Contact Dermatitis. 1994 Feb;30(2):119-20. Allergic contact dermatitis from propylene glycol in Zovirax cream. Kim YJ, Kim JH. Department of Dermatology, Hanyang University Hospital, Seoul, Korea. PMID: 8187495 [PubMed - indexed for MEDLINE] 3458. Ann Pharmacother. 1994 Feb;28(2):208-9. Oral acyclovir in immunocompetent patients with varicella. Croze SM, Stoukides CA. University Hospital, Boston, Massachusetts. PMID: 8173138 [PubMed - indexed for MEDLINE] 3459. Acta Paediatr Jpn. 1994 Feb;36(1):53-6. Cytotoxicity against varicella zoster virus infected targets in children with acute leukemia. Ihara T, Oitani K, Torigoe S, Kitamura K, Ito M, Kamiya H, Sakurai M. Department of Pediatrics, Mie National Hospital, Japan. To eliminate the role of natural killer (NK), antibody-dependent cell-mediated cytotoxicity (ADCC), and polymorphonuclear leukocyte (PMN)-mediated cytotoxicity in Varicella zoster virus (VZV) infections, peripheral blood mononuclear cell (PBMC)-mediated NK and ADCC, and phorbol myristate acetate-stimulated PMN-mediated cytotoxicity against VZV-infected targets were studied in children with leukemia. Natural killer and PMN-mediated cytotoxic activity was depressed for 6 months after complete remission and ADCC activity was depressed for 1 year after complete remission. The magnitude of three cytotoxic mechanisms in leukemic children gradually increased while they continued in complete remission. These results suggested that decreased cytotoxic activities of PBMC and PMN might contribute to serious VZV infections and susceptibility to herpes zoster in leukemic children. PMID: 8165909 [PubMed - indexed for MEDLINE] 3460. Arch Dis Child. 1994 Feb;70(2):133-5. Acyclovir resistant varicella zoster and HIV infection. Lyall EG, Ogilvie MM, Smith NM, Burns S. Department of Haematology, Royal Hospital for Sick Children, Edinburgh. A child infected with HIV who developed chronic varicella zoster virus infection resistant to acyclovir is presented. The clinical course of the infection, treatment, virological investigations, and relationship of the infection to the child's immunodeficient state are discussed. PMCID: PMC1029717 PMID: 8129436 [PubMed - indexed for MEDLINE] 3461. J Indian Med Assoc. 1994 Feb;92(2):64-6. Acyclovir in paediatrics. Sharma A. Department of Paediatrics, Medical College, Rohtak. PMID: 8071563 [PubMed - indexed for MEDLINE] 3462. Aust N Z J Ophthalmol. 1994 Feb;22(1):77-80. Herpes zoster ophthalmicus and the orbital apex syndrome. Bourke RD, Pyle J. Royal Brisbane Hospital, Herston, Queensland. Herpes zoster ophthalmicus (HZO) commonly causes isolated ophthalmoplegic syndromes. Visual loss caused by optic neuritis secondary to HZO can be reversible or irreversible. HZO rarely presents as an orbital apex syndrome, when an association with meningo-encephalitis has been reported. We report a case of orbital apex syndrome secondary to HZO treated with systemic steroids and acyclovir. Our patient suffered no systemic complications and displayed a rapid resolution of optic neuropathy. We discuss this case in the light of previous reports and explore the possible pathogenic mechanisms involved. PMID: 8037920 [PubMed - indexed for MEDLINE] 3463. Can Fam Physician. 1994 Feb;40:321-6, 329-32. Pharmacologic management of herpes zoster and postherpetic neuralgia. Mamdani FS. Department of Pharmacy, Vancouver General Hospital. Herpes zoster is an infection caused by reactivation of dormant varicella-zoster virus. The acute course of herpes zoster is generally benign; however, some patients will experience postherpetic neuralgia characterized by severe, relentless, and at times disabling pain that is often refractory to treatment. While herpes zoster responds to acyclovir, cost-benefit considerations limit the drug's usefulness to only a select group. Postherpetic neuralgia requires a holistic approach, including pharmacologic therapy using several different classes of drugs. PMCID: PMC2380046 PMID: 7907508 [PubMed - indexed for MEDLINE] 3464. Med J Aust. 1994 Jan 17;160(2):93-4. Varicella-zoster vaccine. Haski AL. Comment on: Med J Aust. 1993 Oct 4;159(7):439-40. PMID: 7508543 [PubMed - indexed for MEDLINE] 3465. Neurosci Lett. 1994 Jan 3;165(1-2):97-100. Axon-reflex reactions in affected and homologous contralateral skin after unilateral peripheral injury of thoracic segmental nerves in humans. Baron R, Saguer M. Klinik für Neurologie, Christian-Albrechts-Universität Kiel, Germany. Transection and regeneration of a rat peripheral nerve on one side reduces the ability of the contralateral nerve to evoke plasma extravasation after antidromic excitation of afferent C-fibers induced by electrical nerve stimulation (afferent axon reflex). An unknown transneuronal signalling substance was postulated. In humans, axon-reflex vasodilatation was studied using cutaneous iontophoresis of histamine for C-fiber stimulation and laser Doppler flowmetry for measuring vasodilatation. As a model of peripheral nerve lesion with regeneration, patients with severe unilateral zoster neuropathy of thoracic segmental nerves were examined. Axon-reflex reactions were considerably impaired within the affected dermatome compared with the unaffected side and compared with controls. In contrast, no significant differences could be found between the unaffected corresponding sites of patients and similar dermatomes of healthy controls, indicating that this type of nerve injury does not influence the ability of the contralateral nerve to evoke axon-reflex vasodilatation. PMID: 8015746 [PubMed - indexed for MEDLINE] 3466. Beitr Infusionsther Transfusionsmed. 1994;32:197-9. [Increase of post-infection cold agglutinins after infection with Mycoplasma pneumoniae, varicella-zoster and rubella virus] [Article in German] Leo A, Enders G, Roelcke D. Institut für Immunologie, Heidelberg. Cold agglutinins (CA) are observed during acute infections as transiently occurring postinfection autoantibodies directed against erythrocyte antigens. Distinct infectious agents induce CA of distinct specificity. A common association is the infection with Mycoplasma pneumoniae and the production of CA with anti-I specificity. In infections with varicella-zoster virus (VZV) and rubella virus (RV) a few cases of CA appearance are reported, all of them showing specificity for the Pr antigens. We examined the frequency of CA with the anti-Pr specificity in patients suffering from acute infections with VZV and RV (table 1). The known association of anti-I in about 70% of the cases with acute Mycoplasma pneumoniae infection is confirmed by our results. The occurrence of CA in infections with VZV and RV is a rare event. Based on published data, the specificity of these CA apparently is anti-Pr. Three of 5 anti-Pr examples were found in newborns with rubella embryopathy. Possibly, anti-Pr can be observed more frequently in these patients compared to adults. PMID: 9480085 [PubMed - indexed for MEDLINE] 3467. Folia Med (Plovdiv). 1994;36(4):45-9. Herpes zoster in infants. Dobrev H. Department of Dermatology, University of Medicine, Plovdiv, Bulgaria. The author reported four cases of herpes zoster in infants without history of chickenpox but with positive history of maternal varicella either in the early life or during pregnancy. One of the infants had been in a close contact with his father who had varicella. Herpes zoster in infancy develops secondary to an asymptomatic foetal varicella zoster virus infection or to an unrecognized subclinical varicella in infants born to varicella zoster virus immune mothers. PMID: 8698285 [PubMed - indexed for MEDLINE] 3468. J Infect Dis. 1994 Jan;169(1):91-4. Detection of varicella-zoster virus DNA in air samples from hospital rooms. Sawyer MH, Chamberlin CJ, Wu YN, Aintablian N, Wallace MR. Department of Pediatrics, University of California, San Diego, La Jolla 92093-0672. Varicella-zoster virus (VZV) is a highly contagious infectious agent that causes outbreaks in institutional settings. Transmission of VZV is felt to occur following direct contact with an infected individual and by aerosol spread. To document the aerosolization of VZV, a polymerase chain reaction (PCR) assay was used to detect VZV DNA in air samples obtained from hospital rooms of patients with active VZV infection. VZV DNA was detected in 64 (82%) of 78 air samples from rooms housing patients with active varicella and 9(70%) of 13 samples from rooms of patients with herpes zoster. VZV was detected 1.2-5.5 m from patients' beds and for 1-6 days following onset of rash. On some occasions, VZV DNA could be detected outside the hospital isolation rooms housing patients. This PCR-based method allows the detection and semiquantitation of VZV aerosolization and can be a useful tool for monitoring efforts to control VZV aerosols in the environment. PMID: 8277202 [PubMed - indexed for MEDLINE] 3469. Acta Otolaryngol Suppl. 1994;511:170-4. Gd-DTPA enhanced MRI in Ramsay Hunt syndrome. Tada Y, Aoyagi M, Tojima H, Inamura H, Saito O, Maeyama H, Kohsyu H, Koike Y. Department of Otolaryngology, Yamagata University School of Medicine, Japan. Ten patients with Ramsay Hunt syndrome underwent magnetic resonance (MR) scans. In many examinations, abnormal enhancement of the 7th nerve in the internal acoustic meatal segment through the mastoid segment was observed. Out of seven patients with cochlear and/or vestibular symptoms, only one showed abnormal enhancement of the 8th nerve, in addition to the 7th. The other 6 patients showed the same findings as in Bell's palsy, showing no enhancement of the 8th nerve. This suggests that clinical symptoms have no relation to the results of MRI. Enhanced MRI is the most sensitive means of making differential diagnoses between Hunt's syndrome and tumors, but it is impossible to detect all lesion sites corresponding to the symptoms in Hunt's syndrome. PMID: 8203224 [PubMed - indexed for MEDLINE] 3470. Acta Otolaryngol Suppl. 1994;511:161-4. Electrophysiological study on the pathology of synkinesis after facial nerve paralysis. Maeyama H, Aoyagi M, Tojima H, Inamura H, Kohsyu H, Koike Y. Department of Otolaryngology, Yamagata University School of Medicine, Japan. By conducting electrophysiological tests on patients with facial nerve paralysis, the characteristics of synkinesis and the mechanisms of its manifestations were examined. The subjects were 114 patients of facial nerve paralysis on whom electroneurography (ENoG) and the blink reflex were conducted. As a result, it was indicated that synkinesis could be determined by the blink reflex, and that the frequency of synkinesis manifestation increased with severity of paralysis. From examination during the latent period, early component (SI) recognized in the cases of synkinesis was found to be the waveform which passed the fibers with a slow conducting speed. It was not related to the degree of degeneration of nerves for either the severe or light degeneration of nerves. From the above result it was concluded that synkinesis is generated as a misdirection of reproduced nerves. PMID: 8203222 [PubMed - indexed for MEDLINE] 3471. Acta Otolaryngol Suppl. 1994;511:156-60. Recording of single fiber electromyography in patients with peripheral facial palsy. Takeda K, Tojima H, Aoyagi M, Koike Y. Department of Otolaryngology, Yamagata University School of Medicine, Japan. We determined muscle fiber density with single fiber electromyography (SFEMG) to discuss the condition of re-innervation after the recovery of facial movement in cases of peripheral facial palsy. Muscle fiber density was then compared with electroneurography (ENoG) which is thought to correlate with the severity of facial neuropathy in the early stage after the onset. The degree of neuropathy and subsequent recovery of innervation was also discussed. The subjects were 36 patients with peripheral facial palsy (30 patients with Bell's palsy and 6 with Hunt's syndrome), treated at our hospital, in whom ENoG could be recorded within 2 weeks after the onset. Muscle fiber density was determined after the recovery of facial movement. As a control, muscle fiber density was determined in 11 normal adults, and muscles on the healthy side in 23 patients with Bell's palsy. Muscle fiber density was 1.44 +/- 0.15 (mean +/- S.D.) in normal adults and 1.51 +/- 0.18 on the healthy side in patients, showing no significant difference. Data on the affected side were divided into 4 groups according to the minimum ENoG level within 2 weeks after onset and were compared with the normal group. In all cases with an ENoG level of 40% or more, muscle fiber densities were normal, and no significant differences were noted between the affected side and the healthy side. In cases with an ENoG level of less than 40%, muscle fiber density increased significantly with increasing severity of denervation. These findings suggest that collateral sprouting is absent in cases of peripheral facial palsy who show an ENoG level of 40% or more, or no wallerian degeneration. PMID: 8203221 [PubMed - indexed for MEDLINE] 3472. Ann Neurol. 1994;35 Suppl:S69-72. New antivirals with activity against varicella-zoster virus. Gnann JW Jr. University of Alabama at Birmingham 35294. Herpes zoster is a serious medical problem, not only because of the discomfort associated with the acute rash, but also because of the potential for post-herpetic neuralgia. Acyclovir is currently the antiviral drug of choice for the treatment of herpes zoster. Efforts are underway to develop new drugs that have improved activity against varicella-zoster virus as well as more favorable pharmacokinetic properties. The goal of these efforts is to develop an orally administered antiviral drug that will accelerate the events of cutaneous healing as well as reduce the frequency and severity of post-herpetic neuralgia. Investigational drugs currently under evaluation include valaciclovir and famciclovir, the prodrugs of acyclovir and penciclovir, respectively. Two new uracil derivatives, sorivudine and BW882C87, with increased anti-varicella-zoster virus activity in vitro are also being studied. PMID: 8185303 [PubMed - indexed for MEDLINE] 3473. Ann Neurol. 1994;35 Suppl:S62-4. Otological complications of herpes zoster. Adour KK. Department of Head and Neck Surgery, Kaiser Permanente Medical Center, Oakland, CA 94611. Otological complications of varicella-zoster virus (Ramsay Hunt syndrome) include facial paralysis, tinnitus, hearing loss, hyperacusis (dysacousis), vertigo, dysgeusia, and decreased tearing. Cranial nerves V, IX, and X are often affected. Gadolinium-enhanced magnetic resonance imaging demonstrates enhancement of the geniculate ganglion and facial nerve. These manifestations are identical to Bell's palsy but are more severe and carry a graver prognosis. Eight percent of Bell's palsy patients eventually are diagnosed as "zoster sine herpete." A new case of Ramsay Hunt syndrome will occur every 52 minutes, compared to every 10 minutes for a new case of Bell's palsy. PMID: 8185302 [PubMed - indexed for MEDLINE] 3474. Ann Neurol. 1994;35 Suppl:S57-61. Other neurological complications of herpes zoster and their management. Elliott KJ. Department of Neurology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021. PMID: 8185301 [PubMed - indexed for MEDLINE] 3475. Ann Neurol. 1994;35 Suppl:S54-6. Chronic opioid therapy as alternative treatment for post-herpetic neuralgia. Pappagallo M, Campbell JN. Dept of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD 21287. Neurosurgical procedures such as the dorsal root entry zone operation, ganglionectomy, and spinal-cord stimulation have been offered to patients with intractable post-herpetic neuralgia (PHN). Poor efficacy or high morbidity have limited the overall usefulness of these procedures. We recently conducted a preliminary open-label study with long-acting oral opioids. The mean pretreatment pain score, on a scale of 0 to 10 (0 = no pain) was 9.0 +/- 0.3 (mean +/- SEM, N = 20). At two months of treatment the average pain score was 4.0 +/- 0.4 (p < 0.001, paired t test), and at six months the average pain score was 3.8 +/- 0.2 (p < 0.001, N = 16). These observations warrant a controlled opioid trial for patients affected by PHN. PMID: 8185300 [PubMed - indexed for MEDLINE] 3476. Ann Neurol. 1994;35 Suppl:S50-3. Treatment of post-herpetic neuralgia: antidepressants. Max MB. Clinical Trials Unit, National Institute of Dental Research, National Institutes of Health, Bethesda, MD 20892. Five controlled clinical trials and extensive clinical experience have shown that amitriptyline and several other antidepressants reduce the severity of post-herpetic neuralgia. Studies in post-herpetic neuralgia and in painful diabetic neuropathy suggest that blockade of norepinephrine reuptake is the most important action accounting for pain relief; selective agents such as desipramine may be useful in patients unable to tolerate amitriptyline side effects. The selective serotonin reuptake inhibitors, zimelidine and paroxetine, have shown little effectiveness in neuropathic pain, but small studies in diabetic neuropathy have shown that paroxetine and citalopram have modest effects. Studies of the latter agents in post-herpetic neuralgia, concentration-response studies of amitriptyline, and studies of drug combinations including antidepressants may lead to improved treatment. PMID: 8185299 [PubMed - indexed for MEDLINE] 3477. Ann Neurol. 1994;35 Suppl:S46-9. Managing post-herpetic neuralgia with opioids and local anesthetics. Rowbotham MC. Department of Neurology, University of California, San Francisco, School of Medicine 94143-0114. PMID: 8185298 [PubMed - indexed for MEDLINE] 3478. Ann Neurol. 1994;35 Suppl:S42-5. Pain modulation and the action of analgesic medications. Fields H. University of California, Department of Neurology and Physiology, San Francisco 94143-0114. A general approach to improving the treatment of patients with post-herpetic neuralgia is outlined. Pain-generating processes initiated by injury to peripheral nerve and new treatments that target these processes are discussed. Another described approach is to use knowledge of central nervous system pain-modulating networks to improve the effectiveness of centrally acting analgesics such as opioids and tricyclic antidepressants. PMID: 8185297 [PubMed - indexed for MEDLINE] 3479. Ann Neurol. 1994;35 Suppl:S4-8. Overview: the biology of varicella-zoster virus infection. Straus SE. Laboratory of Clinical Investigation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892. Varicella-zoster virus infection is manifested initially as chickenpox. The virus persists for life in sensory nerve ganglia, from which it reactivates in many people to cause zoster. Among the many recognized complications of these infections, post-zoster neuralgia is the most frequently debilitating. The molecular events of virus replication, latency, and reactivation, and the pathogenesis of post-zoster neuralgia, are incompletely understood and inadequately addressed by current therapeutic strategies. PMID: 8185296 [PubMed - indexed for MEDLINE] 3480. Ann Neurol. 1994;35 Suppl:S38-41. Hypotheses on the pathogenesis of herpes zoster-associated pain. Bennett GJ. Neurobiology and Anesthesiology Branch, National Institute of Dental Research, National Institutes of Health, Bethesda, MD 20892. PMID: 8185295 [PubMed - indexed for MEDLINE] 3481. Ann Neurol. 1994;35 Suppl:S35-7. Immune senescence. Weksler ME. Department of Medicine, Cornell University Medical College, New York, NY 10021-4896. The immune system changes dramatically with age. There is a decline in the production of naive lymphocytes by the central lymphoid organs, the thymus and bone marrow. This leads to a reduced diversity and altered repertoire of antigen specificities recognized by the immune system. Thus, with age there is a progressive decline in the capacity of the immune system to react with foreign antigens associated with an increased reactivity with autoantigens. As T cells specific for certain microbial antigens decline with age, their capacity to prevent reactivation of certain chronic infections such as herpes zoster diminishes. This results in the increased reactivation of herpes zoster in persons over 45 years old. PMID: 8185294 [PubMed - indexed for MEDLINE] 3482. Ophthalmologica. 1994;208(2):61-4. Bilateral retrobulbar neuritis following unilateral herpes zoster ophthalmicus. Gündüz K, Ozdemir O. Eye Clinic, Faculty of Medicine, University of Ankara, Turkey. A 48-year-old male diagnosed with right-onset herpes zoster ophthalmicus developed visual acuity loss in the left eye during the following 3 weeks. Visually evoked cortical potential recordings revealed a marked increase in P100 latency and a marked decrease in its amplitude in both eyes. Pattern electroretinography suggested diffuse pathology with reduced positive and negative components. A possible transsynaptic or intraneural spread of the varicella-zoster virus in the optic nerve might be responsible for this unexplained contralateral loss of visual acuity. PMID: 8183526 [PubMed - indexed for MEDLINE] 3483. J Rheumatol. 1994 Jan;21(1):84-6. Herpes zoster infections in systemic lupus erythematosus: risk factors and outcome. Kahl LE. Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO. OBJECTIVE. To determine factors that influence the frequency and outcome of herpes zoster infection in patients with systemic lupus erythematosus (SLE). METHODS. In this case-central retrospective study, patients with a history of zoster infection were identified from our computerized database of 348 patients with SLE. Medical records were reviewed to establish activity of SLE at the time of zoster, as well as complications of the zoster infection. RESULTS. Fifty-five episodes of zoster occurred among 47 (13.5%) patients, at a rate of 16 episodes/1000 patient-years of followup. Dissemination occurred in 6 episodes (11%), and was more frequent during immunosuppressive therapy [odds ratio (OR) = 4.0]. Bacterial superinfection occurred in 5 (9%), resulting in one death from sepsis, and was increased among patients receiving prednisone > or = 60 mg daily (OR = 4.1). Compared to those without zoster, patients with zoster were significantly more likely to have previously had serious disease manifestations including nephritis, thrombocytopenia or hemolytic anemia, and to have received treatment with cyclophosphamide (all p < or = 0.05). However, 65% of zoster episodes occurred during mild or inactive SLE, when the majority of patients were receiving less than 20 mg prednisone daily and no immunosuppressive therapy. CONCLUSION. Herpes zoster infections occur at increased frequency among patients with SLE compared to the general population, and carry significant morbidity. Patients who have had severe manifestations of lupus are at greatest risk of zoster, though not necessarily at the time of disease flare or immunosuppressive therapy. If disease activity allows, a reduction in prednisone dosage may reduce the risk of bacterial superinfection during zoster episodes. PMID: 8151595 [PubMed - indexed for MEDLINE] 3484. J Child Neurol. 1994 Jan;9(1):56-8. Disseminated multifocal herpes zoster leukoencephalitis and subcortical hemorrhage in an immunosuppressed child. Herrold JM, Hahn JS. Department of Neurology, Stanford University, Palo Alto, CA. We describe a rare case of multifocal varicella-zoster leukoencephalitis in an immunosuppressed adolescent boy who developed a herpetiform rash on his groin and subsequently presented with a subacute encephalopathy, aphasia, and hemiparesis. Magnetic resonance imaging scan of the brain revealed multifocal bi-hemispheric target-like lesions predominantly in the white matter. A magnetic resonance imaging scan 2 weeks later showed a subcortical hemorrhage in the left insular region. He received long-term high-dose intravenous acyclovir and had significant improvement in his neurologic status. PMID: 8151085 [PubMed - indexed for MEDLINE] 3485. Ophthalmologica. 1994;208(1):41-3. Detection of varicella-zoster virus DNA in conjunctivas of patients with herpes zoster. Tamura T, Yoshida M, Tezuka T. Department of Dermatology, School of Medicine, Kinki University, Osaka, Japan. Detection of varicella-zoster virus (VZV) DNA was carried out in the conjunctivas of 18 patients with herpes zoster by polymerase chain reaction. The rate of VZV DNA detection in conjunctivas was 3/4 in herpes zoster ophthalmicus associated with eruption on the dorsum nasi, 2/5 in herpes zoster ophthalmicus without eruption on the dorsum nasi, 1/2 in herpes zoster with eruption on the cheek and lower jaw, 1/2 in generalized herpes zoster and 0/5 in herpes zoster associated with eruption on the trunk or extremities, respectively. The reason for the detection of VZV DNA in conjunctivas is discussed. PMID: 8145984 [PubMed - indexed for MEDLINE] 3486. Dermatol Clin. 1994 Jan;12(1):51-68. Tests for detecting herpes simplex virus and varicella-zoster virus infections. Cohen PR. Department of Dermatology, University of Texas-Houston Medical School. Several laboratory diagnostic methods are available for the diagnosis, differentiation, and subtyping of HSV and VZV infections. In the office or at the bedside of a hospitalized patient, a positive Tzanck smear preparation is an inexpensive, rapid, and morphologic technique for confirming a suspected diagnosis of a herpesvirus infection. An expedient, slightly more expensive, reliable technique for establishing a HSV infection, yet not able to differentiate the subtype of that infection, is a recently marketed monoclonal antibody-based filtration type enzyme immunoassay (Kodak SureCell Herpes Test Kit). Serologic tests traditionally do not have a major role in the diagnosis of HSV infection; yet, new type-specific methods using Western blot assays may be useful for confirming the presence of unrecognized, subclinical HSV2 infections that are presently being underdiagnosed by current procedures. The gold standard for establishing the diagnosis of HSV infection has been the viral tissue culture. The fluorescent antibody to membrane antigen test and viral tissue culture have been the principal methods for diagnosing VZV infection. Immunomorphologic techniques have been useful adjuvant methods for both the diagnosis and the differentiation of HSV and VZV infections. Molecular virology techniques (particularly those using PCR) are likely to become the diagnostic methods of choice for both HSV infection and VZV infection once these tests become commercially available. PMID: 8143385 [PubMed - indexed for MEDLINE] 3487. Infect Control Hosp Epidemiol. 1994 Jan;15(1):61-2. Valaciclovir more effective than acyclovir in reducing pain from shingles. [No authors listed] PMID: 8133011 [PubMed - indexed for MEDLINE] 3488. Anaesthesist. 1994 Jan;43(1):53-4. [Comments on the paper by P. Hügler et al. The therapy of postherpetic zoster neuralgia] [Article in German] Maier C, Baron R, Hertel D, Hildebrandt J, Simgen WL, Sprotte G, Werkmeister J, Wulf H, Zech D. Comment on: Anaesthesist. 1992 Dec;41(12):772-8. PMID: 8122726 [PubMed - indexed for MEDLINE] 3489. Ann Med Interne (Paris). 1994;145(3):194-6. [Herpes zoster meningoradiculitis in AIDS] [Article in French] Debourdeau P, Blum L, Cabane J, Picard O, Imbert JC. PMID: 8092636 [PubMed - indexed for MEDLINE] 3490. Acta Otolaryngol Suppl. 1994;514:132-4. Detection of human alpha-herpesvirus DNA using consensus primers and specific probes. Aono T, Murakami S, Yanagihara N, Yamanishi K. Department of Virology, Osaka University, Japan. A simple and rapid diagnostic assay system was developed for detecting and identifying human alpha-herpesviruses, such as herpes simplex virus types 1 and 2 and varicella-zoster virus, by polymerase chain reaction. This system was based on an amplification step, using primers that bind the DNA polymerase consensus sequence of alpha-human herpesviruses, and a detection step, using non-radioactive virus-specific probes. This method could be used to amplify any human alpha-herpesviruses, and each virus-specific probe was highly specific for identification of the amplified product. This system is readily applicable for implementation in the clinical laboratory. PMID: 8073876 [PubMed - indexed for MEDLINE] 3491. Acta Clin Belg. 1994;49(2):104-7. Atypical varicella zoster infection in persons with HIV infection. Colebunders R, Van Damme L, Van den Abbeele K, Fleerackers Y, Van den Enden E, Dockx P. Instituut voor Tropische Geneeskunde, Antwerpen, Belgie. Four patients with HIV infection and severe immunodeficiency are described who developed atypical varicella zoster lesions. Three of the patients presented with chronic varicella zoster lesions. In two of them such lesions were hyperkeratotic. All three patients had been treated initially with subtherapeutic doses of acyclovir. In one of the patients the lesions were clinically resistant to high dose acyclovir treatment and disappeared only when renal insufficiency developed during foscarnet-famcyclovir treatment. One patient developed a disseminated varicella zoster infection. PMID: 8067171 [PubMed - indexed for MEDLINE] 3492. J Int Med Res. 1994;22 Suppl 1:3A-12A; discussion 12A-13A. Clinical aspects of chickenpox and herpes zoster. Balfour HH Jr. Department of Laboratory Medicine and Pathology, University of Minnesota Health Sciences Center, Minneapolis. Chickenpox in immunocompromised individuals is potentially fatal and should be treated with intravenous acyclovir as soon as it is recognized. Data from four double-blind, placebo-controlled trials in the USA provide a sound scientific basis for using acyclovir to treat chickenpox in immunocompetent individuals. Three studies in children and a fourth study in US naval recruits showed statistically significant reductions in the duration of fever, constitutional illness, and time to cutaneous healing, when treatment was initiated within 24 h of rash onset. Although chickenpox is generally mild in children the severity of the disease increases with age and secondary cases in the family tend to be more ill than the primary case. It is recommended that secondary and tertiary cases in a family, and adolescents and adults with chickenpox be treated with acyclovir. In immunocompromised hosts, intravenous acyclovir halts the progression of herpes zoster and is recommended as therapy during new lesion formation. Herpes zoster in otherwise normal hosts is rarely accompanied by visceral dissemination, but carries an increasing risk of post-herpetic neuralgia with increasing age. Published clinical trials have shown a reduction in the duration and severity of acute pain during herpes zoster for patients treated with acyclovir, but results for chronic pain are conflicting with some, but not all, studies showing a beneficial effect. PMID: 8063022 [PubMed - indexed for MEDLINE] 3493. Rev Assoc Med Bras. 1994 Jan-Mar;40(1):71. [Psychiatric disorders related to acyclovir use in a patient with renal insufficiency] [Article in Portuguese] Nishioka Sde A, Manfrim RF. PMID: 8061702 [PubMed - indexed for MEDLINE] 3494. Eye (Lond). 1994;8 ( Pt 1):70-4. Influence of oral acyclovir on ocular complications of herpes zoster ophthalmicus. Aylward GW, Claoué CM, Marsh RJ, Yasseem N. Bascom Palmer Eye Institute, Miami, FL 33101. Comment in: Eye (Lond). 1995;9 ( Pt 3):390-2. The role of oral acyclovir (ACV) in the management of immunocompetent patients with herpes zoster ophthalmicus remains controversial. We have performed a retrospective, comparative, case-control study of cases seen in the Zoster Clinic at Moorfields Eye Hospital over the last 5 years. A standard proforma was used during this period to collect data on the rash, ocular involvement and treatment. There were 419 immunocompetent patients of whom 77 were treated with oral ACV prior to attending the clinic. We compared these with paired controls matched for age, sex and severity of rash. No difference in the rate of ocular complications between treated and untreated patients could be detected. This suggests that oral ACV as currently prescribed has little or no preventive effect on the ocular complications of ophthalmic zoster. PMID: 8013722 [PubMed - indexed for MEDLINE] 3495. Klin Med (Mosk). 1994;72(3):66-8. [Clinical classification of herpes zoster] [Article in Russian] Shishov AS. PMID: 7990365 [PubMed - indexed for MEDLINE] 3496. Viral Immunol. 1994;7(1):31-6. Immune response to secondary immunization with live or inactivated VZV vaccine in elderly adults. Hayward AR, Buda K, Levin MJ. Department of Pediatrics, University of Colorado School of Medicine, Denver. Healthy varicella zoster virus (VZV) immune subjects > 55 years old, were immunized with 4,000 PFU of Oka strain VZV live vaccine or a similar amount of heat-inactivated vaccine. A subset of each group was also immunized with tetanus toxoid (TT) 3 months before receiving the VZV vaccine. The live and inactivated VZV vaccine groups had similar ages, sex distribution, and previous immunity to VZV. The live and inactivated VZV vaccines elicited similar increases in the frequency in blood of VZV-specific T cells, in vitro interferon-gamma production, and serum antibody levels both 3 and 12 months after immunization. Individuals with the highest responder cell frequency (RCF) at entry had the highest postimmunization RCF following either vaccine. There was no correlation at entry between the RCF to TT or RCF to VZV. There was a weak (P = 0.05) correlation in the incremental response to TT and VZV among individuals who responded to both vaccines. Entry variables that did not correlate with the response included percent of T cells or the CD45R0 (memory) T cell subset in blood, serum antibody levels, or amount of interferon-gamma production. The results indicate that the inactivated vaccine is safe for VZV-immune subjects and boosts their antibody and T-cell responses as effectively as the live vaccine for at least 1 year following immunization. PMID: 7986334 [PubMed - indexed for MEDLINE] 3497. Vox Sang. 1994;67(1):85. Cold agglutinin syndrome and liver transplantation. Nydegger U, Hardegger T, Tobler A, Rieder H, Cerniak A, Lämmle B. PMID: 7975463 [PubMed - indexed for MEDLINE] 3498. Dermatology. 1994;189(3):312. Herpes zoster and Ogilvie's syndrome. Alpay K, Yandt M. PMID: 7949493 [PubMed - indexed for MEDLINE] 3499. J Formos Med Assoc. 1994 Jan;93(1):75-7. Herpes zoster in infancy after intrauterine exposure to varicella zoster virus: report of two cases. Huang JL, Sun PC, Hung IJ. Department of Pediatrics, Chang Gung Memorial Hospital, Taipei, Taiwan, R.O.C. Herpes zoster occurs very rarely in infancy. We report two infants who developed zoster-like lesions at three and seven months of age. They had no history of chickenpox after birth. Both mothers acquired varicella infection during their sixth month of pregnancy. The crops of vesicular rashes appeared in right L1-3 dermatomes in one patient and left V3, C2 dermatomes in the other. Laboratory findings demonstrated a four-fold rise in varicella zoster virus (VZV) IgG antibody in one patient and positive VZV IgM antibody in the other. Both infants received acyclovir treatment and the skin lesions healed rapidly without sequela. In infancy, herpes zoster may be the primary clinical manifestation of reactivation of latent VZV infection acquired transplacentally during intrauterine life. PMID: 7915587 [PubMed - indexed for MEDLINE] 3500. Ann Neurol. 1994;35 Suppl:S1-72. Varicella-Zoster Virus Infection: New Insights into Pathogenesis and Post-Herpetic Neuralgia. Workshop proceedings. Bethesda, Maryland, May 13-14, 1993. [No authors listed] PMID: 7910447 [PubMed - indexed for MEDLINE] 3501. Curr Med Res Opin. 1994;13(4):207-13. Herpes zoster: a comparative study of general practitioner and patient experience. Henry T. Spectrum Research Limited, Cheltenham, England. A study was carried out to compare attitudes, perceptions and experiences of general practitioners and patients who had treated/suffered from herpes zoster, or shingles, in the recent past. Randomized samples of 224 general practitioners and 236 patients were drawn from different locations in Italy, Germany and the United Kingdom, and interviews were undertaken as semi-structured face-to-face discussions with the subjects. Most of the discussion questions were the same for both samples but specifically targeted either towards the professional or the patient group. Analysis of the findings showed that although there was a high level of correlation between the two groups on opinions and attitudes on a number of issues, there were significant, important differences on others. For example, prodromal symptoms acknowledged by patients were not always recognized by general practitioners and there appeared to be an inability of some to diagnose early enough to take advantage of appropriate anti-viral therapy whilst they acknowledged the need to do so. This in turn led to a number of patients either not receiving specific therapy or having inadequate therapy. Similarly, whilst general practitioners mainly reflected the current medical view that shingles is a benign and self-limiting condition, patients tended to consider shingles and post-herpetic neuralgia as a painful and serious condition that adversely affected their quality of life and to a greater extent than appreciated by many doctors. The findings of the survey indicate that there is need for improved understanding of the disease and its effects by both doctors and patients.(ABSTRACT TRUNCATED AT 250 WORDS) PMID: 7882700 [PubMed - indexed for MEDLINE] 3502. Eye (Lond). 1994;8 ( Pt 6):688-91. Comparison of topical and oral acyclovir in early herpes zoster ophthalmicus. Neoh C, Harding SP, Saunders D, Wallis S, Tullo AB, Nylander A, Nelson ME. St Paul's Eye Unit, Royal Liverpool University Hospital, UK. Poor systemic absorption has limited the efficacy of early oral acyclovir in herpes zoster ophthalmicus (HZO). Aqueous humour levels are substantially higher if the drug is administered topically to the eye. A multicentre open randomised study was performed to compare the ocular prophylactic effects of topical and oral acyclovir. Fifty-seven patients with HZO within 72 hours of the onset of rash received either topical acyclovir ointment or 800 mg oral acyclovir, both 5 times daily for 7 days, and were followed for 12 months. Patients receiving ointment were significantly more likely to have ocular complications (p < 0.02) and anterior uveitis was significantly more frequent (p < 0.01) and severe (p < 0.01). Corneal hypoaesthesia was significantly more frequently (p < 0.05) and severe (p < 0.02) at 1 month. From 2 weeks patients receiving ointment were more likely to have pain and at all times their pain was more severe, but these differences were not statistically significant. In spite of its apparently better penetration topical acyclovir appears to have no prophylactic value in the management of early HZO. PMID: 7867830 [PubMed - indexed for MEDLINE] 3503. Eye (Lond). 1994;8 ( Pt 6):684-7. Detection of varicella-zoster virus DNA in ocular samples from patients with uveitis but no cutaneous eruption. Stavrou P, Mitchell SM, Fox JD, Hope-Ross MW, Murray PI. Birmingham & Midland Eye Hospital, UK. Herpes zoster ophthalmicus is a well-recognised cause of intraocular inflammation, which may become recurrent or chronic after the acute phase has elapsed. Although it commonly presents with the typical rash, cases of ocular zoster with no cutaneous eruption have been well documented. We present two patients with unilateral anterior uveitis complicated by cataract, in whom molecular techniques based on the polymerase chain reaction detected varicella-zoster virus DNA in intraocular material obtained during cataract surgery. Neither patient gave a history of cutaneous eruption. PMID: 7867829 [PubMed - indexed for MEDLINE] 3504. Int Ophthalmol. 1994;18(3):163-5. The progressive outer retinal necrosis syndrome. Holland GN. UCLA School of Medicine, Jules Stein Eye Institute 90024-7003. The progressive outer retinal necrosis (PORN) syndrome is a recently described clinical variant of necrotizing herpetic retinopathy in patients with the acquired immunodeficiency syndrome (AIDS). It is caused by varicellazoster virus infection of the retina. Its course and clinical features distinguish it from the acute retinal necrosis syndrome and CMV retinopathy. Early disease is characterized by multifocal deep retinal opacification. Lesions rapidly coalesce and progress to total retinal necrosis over a short period of time. Despite aggressive therapy with intravenous antivirial drugs, prognosis is poor; disease progression and/or recurrence is common, and the majority of patients develop no light perception vision. Total retinal detachments are common. Prophylaxis against retinal detachment using laser retinopexy has not been useful in most cases. PORN syndrome is an uncommon, but devastating complication of AIDS. PMID: 7852023 [PubMed - indexed for MEDLINE] 3505. Eye (Lond). 1994;8 ( Pt 5):577-9. Orbital disease in herpes zoster ophthalmicus. Vardy SJ, Rose GE. Orbital and Adnexal Service, Moorfields Eye Hospital, London, UK. Three cases of orbital inflammatory disease caused by herpes zoster are described. This extremely rare complication occurred between 5 days and 14 days following the skin eruption and slowly resolved with or without treatment. Biopsy of a chronic inflammatory lesion on the cheek of one patient demonstrated a sterile vasculitis and granulomatous liponecrosis, a process which may underlie the orbital disease in these patients. PMID: 7835456 [PubMed - indexed for MEDLINE] 3506. Nephron. 1994;68(2):262-4. Syndrome of inappropriate antidiuretic hormone secretion and herpes zoster infection: 1. Report of this association in a patient suffering from AIDS. Arzuaga JA, Estirado E, Roman F, Perez-Maestu R, Masa C, de Letona JM. Servicio de Medicina Interna II, Clínica Puerta de Hierro, Universidad Autonoma de Madrid, España. The syndrome of inappropriate secretion of antidiuretic hormone is a common consequence of neurologic and pulmonary infections as well as drug intake and many other clinical situations. Its association with herpes varicella-zoster virus infections is scarcely reported in the literature. It generally appears in immunosuppressed patients suffering from serious underlying diseases. There are also a few cases of syndrome of inappropriate secretion of antidiuretic hormone related to vidarabine use. We report the case of a man infected by human immunodeficiency virus who developed a disseminated herpes varicella-zoster virus infection and symptoms due to hyponatremia caused by antidiuretic hormone excess. The patient was cured with saline hypertonic infusion, water restriction, and intravenous administration of acyclovir. To the best of our knowledge, this is the first case of this association in a human immunodeficiency virus infected patient. We propose the use of acyclovir instead of vidarabine in the management of these situations. PMID: 7830868 [PubMed - indexed for MEDLINE] 3507. J Fr Ophtalmol. 1994;17(12):784-8. [Neurological complications of zona. Apropos of a case] [Article in French] Mariotti JM, Fanton Y, Jomaa A. Service d'Ophtalmologie, C.H.G. Ajaccio, Corse. A 70 year old woman had left sixth nerve palsy, following an ophthalmic zona. Later she had controlateral hemiplegia with expression aphasia. Corticosteroid therapy improved the situation. The pathogenesis of this complication is discussed in this article. Ischaemic vasculitis is now a well known complication of herpes zoster which has already appeared in the literature. The case presented was related to ischaemia of the anterior artery of the troncus infero-lateral of Heubner's artery confirmed by further exploration. PMID: 7722241 [PubMed - indexed for MEDLINE] 3508. Int Ophthalmol. 1994-1995;18(6):361-2. Wegener's granulomatosis, pituitary adenoma and BARN. Murray PI. Academic Unit of Ophthalmology, Birmingham and Midland Eye Hospital, UK. A 53-year-old man with Wegener's granulomatosis and a co-existing pituitary adenoma developed bilateral acute retinal necrosis (BARN), probably secondary to varicella-zoster virus (VZV) infection as IgM antibodies were detected in the serum. Intravenous acyclovir and ganciclovir limited the spread of necrosis, but to prevent recurrence he was maintained on oral acyclovir. A left cataract developed 17 months later which was extracted and replaced with a heparin surface modified intraocular lens. Intraocular specimens removed at the time of surgery were analysed by the polymerase chain reaction (PCR) using primers specific for a number of the herpes group of viruses, but no herpesviral DNA could be detected. PMID: 7642338 [PubMed - indexed for MEDLINE] 3509. Duodecim. 1994;110(19):1789-91. [Vitamin B 12 in zoster neuralgia] [Article in Finnish] Kaipainen WJ. PMID: 7555774 [PubMed - indexed for MEDLINE] 3510. Biotherapy. 1994;8(1):63-8. Transfer factor prevents relapses in herpes keratitis patients: a pilot study. Pizza G, Meduri R, De Vinci C, Scorolli L, Viza D. Immunodiagnosis and Immunotherapy Unit, S. Orsola-Malpighi Hospital, Bologna, Italy. Transfer Factor is a dialysable moiety obtained from immune lymphocytes. It has been successfully used for the treatment of several viral infections including labial and genital herpes. In the present study, thirty-three patients with low immune response to HSV antigens and suffering from herpes ocular infections were orally treated with HSV-specific transfer factor (TF). Their relapse index was reduced from 20.1 before treatment to 0.51 after TF administration, with only 6/33 patients relapsing. Although this is not a placebo-controlled-randomized study, the results suggest that TF specific for HSV antigens may be efficacious for preventing relapses of ocular herpes infections as has been the case with genital and labial localisations. PMID: 7547082 [PubMed - indexed for MEDLINE] 3511. Methods Mol Biol. 1994;33:243-56. Detection of virus nucleic acids by radioactive and nonisotopic in situ hybridization. Gowans EJ, Blight K, Arthur J, Higgins GD. Division of Medical Virology, Institute of Medical and Veterinary Science, Adelaide, Australia. PMID: 7534581 [PubMed - indexed for MEDLINE] 3512. Dermatology. 1994;188(4):305-9. Localization of perforin in viral vesicles and erythema multiforme. Sayama K, Watanabe Y, Tohyama M, Miki Y. Department of Dermatology, Ehime University School of Medicine, Japan. Comment in: Dermatology. 1994;188(4):249-50. BACKGROUND: Perforin (Pf), a pore-forming protein, is a cytolytic protein of killer cells. Its deposition in lesioned skin has not been studied. OBJECTIVE: The purpose of this study is to show Pf deposition in the lesioned skin and Pf expression in the dermal infiltrates of various inflammatory skin diseases. METHODS: Frozen specimens obtained from 29 patients with 5 different diseases were immunohistochemically stained. RESULTS: Granular deposition of Pf was found in the lesioned skin in 2 out of 5 cases of viral vesicles and in 3 out of 7 cases of erythema multiforme. In the cases with Pf deposition, the percentages of Pf+ cells in the dermis were higher than in those without deposition. CONCLUSION: Pf released from natural killer cells or cytotoxic T lymphocytes may play a role in tissue damage. PMID: 7514909 [PubMed - indexed for MEDLINE] 3513. Ann Neurol. 1994;35 Suppl:S65-8. Current experience with antiviral therapy for acute herpes zoster. Wood MJ. Birmingham Heartlands Hospital, United Kingdom. Inhibition of varicella-zoster virus replication during acute herpes zoster would, theoretically, accelerate cutaneous healing and reduce the pain, both acute and chronic, associated with shingles. Early antiviral drugs were of limited efficacy, excessively toxic, or needed to be given parenterally, and were unsuitable for use in immunocompetent individuals. Acyclovir was a significant advance and remains the antiviral drug of choice for herpes zoster. There is ample evidence for its efficacy in acute illness, but its ability to influence post-herpetic neuralgia is controversial. This review also discusses the role of adjunctive therapy with steroids in acute shingles. PMID: 7514385 [PubMed - indexed for MEDLINE] 3514. Mov Disord. 1994 Jan;9(1):13-21. The syndrome of painful legs and moving toes. Dressler D, Thompson PD, Gledhill RF, Marsden CD. MRC Human Movement and Balance Unit, Institute of Neurology, London, England. The clinical presentation, symptoms, and signs in 20 new patients with the painful legs and moving toes syndrome are presented. Painful legs and moving toes may develop in the setting of spinal cord and cauda equina trauma, lumbar root lesions, injuries to bony or soft tissues of the feet, and peripheral neuropathy. In 4 of the 20 cases in the present study, no definite cause was found. Pain preceded the onset of toe movements in 18 cases, but in 2 the reverse sequence occurred. The pain had many of the characteristics of causalgia, but none of the patients exhibited the full picture of reflex sympathetic dystrophy, and peripheral trauma was the trigger in only 5 cases. Several patients reported that the occurrence of toe movements was closely related to the pain, although abolition of pain with lumbar sympathetic blocks was not necessarily associated with disappearance of the movements. Several features suggest a central origin for the movements. Symptoms may begin on one side and become bilateral; movements may be momentarily suppressed by voluntary action or exacerbated by changing posture; and electromyography reveals complex patterns of rhythmic activity with normal recruitment of motor units involving several myotomes. Three other patients with similar moving toes but no pain are also described. The occurrence of similar movements in the absence of pain raises the possibility that these cases represent examples at one end of a spectrum of disorders, with pain alone (causalgia) at the other end and the syndrome of painful legs and moving toes in between.(ABSTRACT TRUNCATED AT 250 WORDS) PMID: 7511213 [PubMed - indexed for MEDLINE] 3515. Dig Dis Sci. 1994 Jan;39(1):15-8. Decreased incidence of viral infections in liver transplant recipients. Possible effects of FK506? Singh N, Mieles L, Yu VL, Starzl TE. Department of Medicine, VA Medical Center, Pittsburgh, Pennsylvania 15240. Cytomegalovirus (CMV) is a major infectious complication of organ transplantation and its incidence is influenced by the type and intensity of immunosuppressive therapy employed. Using a new immunosuppressive agent FK506, CMV infection was observed in 30% and CMV disease in 15% of the 26 liver transplant recipients. Delayed onset of CMV disease was noted; the mean time to the occurrence of CMV disease being 137 days posttransplantation. No graft loss or mortality could be attributed to CMV infection. Mucocutaneous herpes simplex virus (HSV) infections were encountered in 19% of the patients, while no disease could be attributed to varicella zoster virus or Epstein-Barr virus (EBV). The contribution of FK506 to a decrease in viral morbidity and associated mortality bears further investigation. PMID: 7506641 [PubMed - indexed for MEDLINE] 3516. Lancet. 1993 Dec 18-25;342(8886-8887):1555. Varicella-zoster DNA in temporal bones of patients with Ramsay Hunt syndrome. Wackym PA, Popper P, Kerner MM, Grody WW. PMID: 7902926 [PubMed - indexed for MEDLINE] 3517. J Clin Microbiol. 1993 Dec;31(12):3260-3. Simultaneous detection of and differentiation between herpes simplex and varicella-zoster viruses with two fluorescent probes in the same test system. Brumback BG, Farthing PG, Castellino SN. Virology Department, American Medical Laboratories, Inc., Chantilly, Virginia 22021. Specimens from skin lesions were examined simultaneously for herpes simplex virus (HSV) and varicella-zoster virus (VZV) by direct specimen testing and shell vial culture in single-test systems. For direct testing, cells in a single specimen well were stained with a combination direct-indirect immunofluorescence stain by using two fluorescent tags. A total of 203 fresh specimens were tested in parallel. Of these, 100 specimens contained too few cells for the direct VZV comparison and 91 contained too few cells for the HSV comparison. After these specimens were eliminated, the sensitivities and specificities, respectively, of the dual direct test were 86.1 and 97.3% for HSV compared with single culture and 92.2 and 100% for VZV compared with single direct testing. Shell vial monolayers in the combined cultures were stained for both viruses by the same method. A total of 305 fresh specimens were cultured in parallel by dual- and single-culture methods. The sensitivities and specificities, respectively, of the combined culture compared with separate cultures were 100 and 98.4% for HSV and 87.9 and 99.2% for VZV. The combined methods gave a performance comparable to those of single tests, required less specimen volume, and were less costly to perform. PMCID: PMC266393 PMID: 8308120 [PubMed - indexed for MEDLINE] 3518. Spine (Phila Pa 1976). 1993 Dec;18(16):2523-4. Herpes zoster radiculopathy. Helfgott SM, Picard DA, Cook JS. Center for Spine Disorders, Brigham and Women's Hospital, Boston, Massachusetts. Herpes zoster-related radiculopathy usually can be easily diagnosed in the presence of cutaneous lesions. Before development of the skin rash, the diagnosis may be in doubt, particularly if motor symptoms and signs are a major clinical feature. We report a patient with herpes zoster-related radiculopathy whose clinical features mimicked other spinal disorders. PMID: 8303458 [PubMed - indexed for MEDLINE] 3519. Brain. 1993 Dec;116 ( Pt 6):1477-96. Postherpetic neuralgia. Are C-nociceptors involved in signalling and maintenance of tactile allodynia? Baron R, Saguer M. Klinik für Neurologie, Christian-Albrechts-Universität Kiel, Germany. Under normal conditions acute stimulation and sensitization of polymodal nociceptive C-fibres cause pain and, due to afferent axon reflex activation, a local skin vasodilatation, flare reaction and skin temperature increase. Two questions arise: (i) Do sensitized C-nociceptors signal allodynia in chronic postherpetic neuralgia? (ii) If not, does ongoing peripheral nociceptive C-fibre input maintain a central process that accounts for allodynia? Ten patients with postherpetic neuralgia and tactile allodynia and 10 control subjects were studied using a laser Doppler perfusion monitor. Peripheral nociceptive C-fibre function was assessed by quantitative measurement of the axon reflex vasodilatation and flare reaction induced by histamine iontophoresis and compared with non-neural vasodilatation induced by local skin heating. Resting skin temperature, skin resistance and resting skin blood flow were the same in the allodynic area and the contralateral homologous skin area. The histamine responses (vasodilatation and flare) were significantly reduced or nearly abolished in the allodynic area compared with the contralateral side, whereas the temperature-dependent vasodilatation in patients and the histamine responses in healthy controls showed no side differences. C-fibre mediated pain and itch sensations were also decreased in the allodynic area. These findings indicate a considerable impairment of cutaneous nociceptive C-fibre function in the allodynic area. Allodynic stimuli of 20 s did not cause any local blood flow change. Impairment of C-fibre function was positively correlated with intensity of neuropathic pain. We conclude that sensitized nociceptive C-fibres are not involved in signalling allodynia. Changes in CNS processing may occur after zoster infection that strengthen the synaptic ties between central pain signalling pathways and low-threshold mechanoreceptors with A beta-fibres. This altered central processing is not maintained by ongoing cutaneous nociceptive C-fibre input, at least in some patients with postherpetic neuralgia. On the contrary, an anatomical synaptic reorganization depending on afferent C-fibre degeneration seems to be more likely, particularly in advanced stages of postherpetic neuralgia. PMID: 8293282 [PubMed - indexed for MEDLINE] 3520. Am J Gastroenterol. 1993 Dec;88(12):2110-1. Acyclovir-associated colitis. Moshkowitz M, Konikoff FM, Arber N, Baratz M, Gilat T. Department of Gastroenterology, Ichilov Hospital, Tel-Aviv Medical Center, Israel. PMID: 8249983 [PubMed - indexed for MEDLINE] 3521. Am Fam Physician. 1993 Dec;48(8):1384, 1388. Oral corticosteroids and postherpetic neuralgia. Woolner E. Comment on: Am Fam Physician. 1993 May 1;47(6):1445-50. PMID: 8249767 [PubMed - indexed for MEDLINE] 3522. J Am Acad Dermatol. 1993 Dec;29(6):970-3. Herpes zoster: daily marking of new vesicles in therapeutic studies. A clinical method for objective assessment of the end of the eruptive phase. Runne U, Ochsendorf FR. Department of Dermatology, J.W. Goethe University, Frankfurt/Main, Germany. BACKGROUND: The efficacy of a therapeutic agent must be evaluated by objective criteria. However, in herpes zoster (HZ) studies there has been no generally accepted objective clinical criterion. OBJECTIVE: Our purpose was to establish a clinical method for determining objectively the point in time at which the eruptive phase of HZ is completed (no new vesicle formation). This point is said to be a clinical criterion for the end of viral replication in the skin and thus for measuring the efficacy of a virustatic agent. METHODS: Newly formed vesicles were marked with differently colored permanent marker pens each day. This method was evaluated by comparing the results of acyclovir therapy in two groups of patients with HZ. (Group A, no underlying malignancy; n = 9. Group B, underlying malignancy; 64% of these patients were undergoing cytostatic polychemotherapy or had immunodeficiency; n = 22). RESULTS: In both groups, acyclovir stopped the eruption of new vesicles within 1.8 and 2.8 days, respectively (not statistically significant). Group B showed a tendency toward more protracted hematogenous dissemination and a longer duration of therapy. The total duration of the eruptive phase depended solely on the length of the interval between the onset of the HZ and the beginning of therapy. CONCLUSION: The method of marking new vesicles is independent of laboratory facilities, simple, and cost effective; in addition, this method is suitable for statistical evaluation. It is thus superior to other clinical methods for objective assessment of the progression of HZ. PMID: 8245263 [PubMed - indexed for MEDLINE] 3523. J Clin Neuroophthalmol. 1993 Dec;13(4):250-3. Herpes zoster ophthalmicus as a cause of Horner syndrome. Smith EF, Santamarina L, Wolintz AH. Department of Ophthalmology, State University of New York, Health Science Center at Brooklyn. Herpes zoster ophthalmicus is a disease in which the varicella-zoster virus replicates and produces inflammation in the skin of the face supplied by the sensory branches of the ophthalmic division of the trigeminal nerve. It can also cause a conjunctivitis, keratitis, uveitis, extraocular muscle paralysis, and acute retinal necrosis. We found only a single report of this disease as a cause of Horner syndrome. Here we report a case of herpes zoster ophthalmicus that progressed to a sixth nerve palsy and, subsequently, a Horner syndrome. We discuss how the anatomic relationship of the fifth, sixth, and sympathetic nerves in the cavernous sinus provides a route whereby the varicella-zoster virus may produce a Horner syndrome. To our knowledge this is the first fully documented case of Horner syndrome caused by herpes zoster ophthalmicus. PMID: 8113436 [PubMed - indexed for MEDLINE] 3524. Rev Clin Esp. 1993 Dec;193(9):480-2. [Neurological disease due to the varicella-zoster virus without a skin lesion] [Article in Spanish] Monzón Monguilod MJ, Ayuso Blanco T, Velilla Marco I, Gracia Naya M, López Gastón JI, Calderón CR. Servicio de Neurología, Hospital Miguel Servet, Zaragoza. We studied three cases of inflammatory neurological disease and serological evidence of varicella-zoster viral (VZV) infection without cutaneous manifestation. They corresponded to a case of cranial multi-neuritis, a case of aseptic meningitis, and another case of meningoencephalitis. Despite the infrequency of any such association, the spectrum of the neurological diseases associated with VZV without skin lesions is quite wide. We are motivated to present our experience by the belief that it is important to think about this possible etiology based on inflammatory areas at different levels of the Nervous System in patients who are still immunocompetent. PMID: 8108579 [PubMed - indexed for MEDLINE] 3525. Pediatrics. 1993 Dec;92(6):838-42. Varicella-zoster virus infection in Romanian children infected with the human immunodeficiency virus. Leibovitz E, Cooper D, Giurgiutiu D, Coman G, Straus I, Orlow SJ, Lawrence R. Department of Pediatrics, New York University School of Medicine, NY. OBJECTIVE. Varicella-zoster virus (VZV) infections can cause severe disease in immunocompromised individuals. To evaluate the spectrum of VZV infections in human immunodeficiency virus (HIV)-infected children, we retrospectively analyzed all the cases of VZV infection in a cohort of children cared for at a hospital for infectious diseases in Bucharest, Romania. METHODS. The records of 391 HIV-infected children admitted to the acquired immunodeficiency syndrome pavilion of Colentina Hospital during the period January 1, 1991, through March 31, 1992, were reviewed for evidence of VZV infection. The diagnosis of varicella or zoster was made clinically and information was collected concerning course of the illness, number of skin lesions, and clinical evidence of complications. Lymphocyte subpopulation typing, as an estimate of immune function, was performed by either a standard fluorescent activated flow cytometric method or by immunofluorescent technique. RESULTS. Thirty-eight cases of varicella (9.7%) and seven cases of zoster (1.8%) were adequately documented among the 391 records reviewed. The duration of varicella was prolonged; in 57% of the children it was greater than 10 days. Forty percent of children with varicella developed a complication, including superinfection of the skin, pneumonia, or thrombocytopenia. None of the children developed clinical hepatitis or encephalitis. Two children (5%) died during varicella, both of respiratory failure. None of the 7 children with zoster had chronic, recurrent, or disseminated lesions. Lymphocyte subset analysis was available for 22 of 38 children with varicella and 3 of 7 children with zoster. Fifteen of the 22 children had normal, age-adjusted, absolute CD4 counts within 3 months of the diagnosis of varicella. All 3 children with zoster who had lymphocyte subset analysis had low CD4 counts and absolute numbers. None of the 45 children received antiretroviral therapy and only 1 child with varicella and 1 with zoster received acyclovir. CONCLUSIONS. The spectrum of VZV infection in this hospitalized group of HIV-infected children was broad. The majority (57%) experienced a prolonged course of disease and a higher rate of complications than normal children hospitalized with varicella. PMID: 7901834 [PubMed - indexed for MEDLINE] 3526. J Am Acad Dermatol. 1993 Nov;29(5 Pt 2):859-62. Granuloma annulare perforans in herpes zoster scars. Krahl D, Hartschuh W, Tilgen W. Universitäts-Hautklinik, Ruprecht-Karls-University, Heidelberg, Germany. Granuloma annulare perforans limited to a thoracic dermatome that was previously involved by herpes zoster occurred in a 51-year-old woman who also had Lennert's lymphoma. Of the various local granulomatous infiltrates described after herpes zoster, granuloma annulare perforans is unique, although ordinary granuloma annulare has been described in a few patients. A high incidence of specific and nonspecific reaction patterns in herpes zoster scars has been described in patients with malignant lymphoma. In contrast to previous patients, all of whom had chronic lymphatic leukemia, our patient had Lennert's lymphoma. PMID: 8408827 [PubMed - indexed for MEDLINE] 3527. Elder Care. 1993 Nov-Dec;5(6):33. Surviving shingles. Hutt A. PMID: 8298601 [PubMed - indexed for MEDLINE] 3528. Am J Perinatol. 1993 Nov;10(6):463-4. Disseminated herpes zoster in a pregnant woman positive for human immunodeficiency virus. Petrozza JC, Monga M, Oshiro BT, Graham JM, Blanco JD. Department of Obstetrics, Gynecology and Reproductive Sciences, Lyndon B. Johnson General Hospital, University of Texas Health Science Center, Houston 77026. We report a case of disseminated herpes zoster in a pregnant patient positive for the human immunodeficiency virus (HIV). Disseminated zoster was the first manifestation of HIV infection in this patient. In HIV-positive patients, zoster may be complicated by cutaneous dissemination, visceral involvement, and death. Intravenous acyclovir may prevent serious sequelae in both mother and fetus. PMID: 8267815 [PubMed - indexed for MEDLINE] 3529. Pediatr Infect Dis J. 1993 Nov;12(11):960-1. Characteristics of herpes zoster in otherwise normal children. Terada K, Kawano S, Yoshihiro K, Miyashima H, Morita T. Department of Pediatrics, Kawasaki Medical School, Okayama, Japan. PMID: 8265292 [PubMed - indexed for MEDLINE] 3530. Am J Emerg Med. 1993 Nov;11(6):633-8. Hemorrhagic varicella: a case report and review of the complications of varicella in children. Miller HC, Stephan M. Division of Emergency Medicine, Children's Hospital Medical Center, Cincinnati, OH 45229. The case of a previously healthy child who developed progressive systemic varicella with purpura is reported. The clinical course of this patient is outlined, and the range of potential complications of chickenpox in children is reviewed. Familiarity with the usual uncomplicated natural history of primary varicella infection should alert the clinician to signs and symptoms that signal significant systemic involvement. PMID: 8240570 [PubMed - indexed for MEDLINE] 3531. J Infect Dis. 1993 Nov;168(5):1264-8. Herpes zoster in patients with advanced human immunodeficiency virus infection treated with zidovudine. Zidovudine Epidemiology Study Group. Glesby MJ, Moore RD, Chaisson RE. Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205. To determine the prevalence, incidence, and effects on disease progression and survival of herpes zoster in patients with advanced human immunodeficiency virus (HIV) disease, data from a multicenter observational cohort study of 1044 patients with AIDS or AIDS-related complex (ARC) and CD4 cell count < or = 0.25 x 10(9)/L treated with zidovudine were analyzed. Of 163 patients (16%) with a history of herpes zoster at enrollment, 22 (13%) had a recurrence during the 2-year follow-up. For those without prior herpes zoster, the probability of its development was 6.3% at 1 and 8.8% at 2 years. Progression to AIDS was not associated with herpes zoster. By proportional hazards analysis, an initial occurrence of herpes zoster was associated with prolonged survival independent of baseline CD4 cell count and disease stage; however, recurrence tended to be associated with death. Thus, herpes zoster is relatively common in advanced HIV infection and its initial occurrence late in disease may indicate improved prognosis. PMID: 8228361 [PubMed - indexed for MEDLINE] 3532. Clin Infect Dis. 1993 Nov;17(5):943-4. Necrotizing retinitis and cerebral vasculitis due to varicella-zoster virus in patients infected with the human immunodeficiency virus. Rousseau F, Perronne C, Raguin G, Thouvenot D, Vidal A, Leport C, Vildé JL. Comment on: Clin Infect Dis. 1993 Feb;16(2):208-12. PMID: 8135942 [PubMed - indexed for MEDLINE] 3533. Leuk Lymphoma. 1993 Nov;11(5-6):447-52. Patient education for self-referral and on-demand treatment for herpes zoster in lymphoma patients. Maung ZT, Taylor PR, Robinson P, Moore J, Lucraft HH, Evans RG, Proctor SJ. Department of Haematology, Royal Victoria Infimary, Newcastle upon Tyne, UK. The aim of this study is to evaluate the benefit of educating lymphoma patients in early self-diagnosis of zoster and subsequent self-referral for prompt treatment. Each of 337 patients attending an out-patient lymphoma clinic was given an explanatory leaflet and photograph about shingles when they first presented with lymphoma. One to two years following the completion of therapy for lymphoma an assessment was made on these patients using a combination of questionnaire survey and retrospective analysis of case notes. Fifty-six (16.6%) of the study population developed zoster following the diagnosis of lymphoma; 29 had had zoster prior to the diagnosis (8.6%). There was an increased incidence of herpes zoster in patients with Hodgkin's disease as compared to those with non-Hodgkin's lymphoma (P < 0.01). Patients who remembered having received the shingles education leaflets were more likely to make self-referral to hospital for prompt treatment (P < 0.001). Long-term complications, eg post-herpetic neuralgia, were less prevalent in patients presenting to hospital for prompt on-demand therapy, compared to those treated in the community. Education of lymphoma patients regarding awareness of early features of zoster is beneficial in preventing complications, but the shingles information episode needs subsequent reinforcement for maximum benefit. PMID: 8124217 [PubMed - indexed for MEDLINE] 3534. Eur J Clin Microbiol Infect Dis. 1993 Nov;12(11):875-9. Evaluation of a monoclonal antibody for detection of varicella-zoster virus infections using a shell vial technique. Pérez JL, Niubò J, Mariscal D, Tubaú F, Salvà J, Martín R. Servicio de Microbiología, Hospital Princeps d'Espanya, Ciutat Sanitària i Universitària de Bellvitge, Barcelona, Spain. Standard cell culture and a shell vial technique using a monoclonal antibody were compared for the detection of varicella-zoster virus in 167 mucocutaneous specimens. Of 75 specimens from patients clinically diagnosed with varicella or zoster, a total of 40 (53.3%) were positive by either method (4 positive only by conventional culture and 4 only by shell vial). No false-positive results were obtained with shell vials stained after 48 h of incubation. This technique is rapid, 100% specific, and should be a good alternative to cell culture. Both techniques are equally influenced by antiviral treatment or by the time of evolution of disease. PMID: 8112364 [PubMed - indexed for MEDLINE] 3535. Intern Med. 1993 Nov;32(11):854-6. Disseminated herpes zoster with multifocal neurologic involvement in an HTLV-1 carrier. Fujii N, Itoh Y, Tomoda H. Department of Neurology, Iizuka Hospital, Fukuoka. A 56-year-old previously healthy man suffered from an attack of disseminated herpes zoster, followed by multifocal neurologic involvement. The patient was a human T-cell lymphotropic virus type 1 (HTLV-1) carrier. HTLV-1 infection, even though normally asymptomatic, has been suggested to be one of the risk factors for severe herpes virus infection and its associated neurologic disorders. PMID: 8012086 [PubMed - indexed for MEDLINE] 3536. Med Clin (Barc). 1993 Oct 16;101(12):477. [Herpes zoster during foscarnet treatment in an AIDS patient] [Article in Spanish] Ricart Olmos C, López Aldeguer J, Marino Blanes Juliá F, Sinelni E. PMID: 8231374 [PubMed - indexed for MEDLINE] 3537. Presse Med. 1993 Oct 2;22(29):1352-6. [Generalized BCG infection after intravesical instillations of Calmette-Guerin bacillus] [Article in French] de Saint Martin L, Boiron C, Poveda JD, Herreman G. Service de Médecine interne, Hôpital Saint Joseph, Paris. BCG has been disappointing as immunotherapy of numerous cancers, but it has been clinically successful in the intravesical treatment of bladder carcinomas sparing the muscle coat; it has indeed become the reference treatment for this type of cancer. However, complications are repeatedly reported, including generalized BCGitis. We report such a case with positive BCG culture. From the cases already published there emerges a homogeneous and often subacute clinical presentation suggestive of an ordinary pathogen. Bacteriology is not very helpful, even when recent techniques are used, and therefore the diagnosis rests on the context and, when samples are taken, on suggestive histological findings. To discuss the physiopathology of BCGitis--generalized immune reaction or multifocal BCG proliferation--is not useless since treatment depends on it. It is probable that these 2 mechanisms working together can be incriminated justifying the prescription of both antibiotics and corticosteroids. When this is done, the prognosis seems to be favourable in most patients. Yet a strict respect of contra-indications and a very careful subsequent radiotherapy should reduce the risks. PMID: 8248067 [PubMed - indexed for MEDLINE] 3538. Ned Tijdschr Tandheelkd. 1993 Oct;100(10):463. [Misleading pain complaints due to herpes zoster] [Article in Dutch] Meijndert L, Rittersma J. PMID: 11822148 [PubMed - indexed for MEDLINE] 3539. Gastroenterology. 1993 Oct;105(4):1254-5. Varicella virus in achalasia. Schulze-Delrieu K. PMID: 8405874 [PubMed - indexed for MEDLINE] 3540. J Oral Pathol Med. 1993 Oct;22(9):391-401. Acyclovir: is it an effective virostatic agent for orofacial infections? Lavelle CL. University of Manitoba, Department of Oral Biology, Winnipeg, Canada. Oral and intravenous acyclovir formulations provide effective virostasis against many herpes viruses infections, especially severe herpes simplex or varicella-zoster infections in ambulatory and immunocompromised patients. The therapeutic virostatic efficacy of topical acyclovir formulations requires further development, however, especially for orolabial herpetic infections. PMID: 8301603 [PubMed - indexed for MEDLINE] 3541. Kidney Int Suppl. 1993 Oct;43:S87-90. Immunizations for pediatric transplant patients. Gershon AA. Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, New York. Infection remains a major cause of morbidity and mortality in transplant patients. Many infections, however, can be successfully prevented by immunization. This presentation reviews the problems associated with, and the questions that arise concerning the use of routine pediatric vaccines, such as diphtheria-pertussis-tetanus (DPT) and measles-mumps-rubella (MMR). It also reviews the use of special vaccines such as hepatitis B, pneumococcal, and influenza vaccines in transplant patients. Data concerning the use of two experimental, live-attenuated virus vaccines, against cytomegalovirus (CMV) and varicella, are discussed. The live-attenuated varicella vaccine can be predicted to decrease the morbidity and mortality of varicella-zoster virus infection in transplant patients. It has already been given successfully to immunocompromised children and is highly effective in the prevention of varicella. PMID: 8246377 [PubMed - indexed for MEDLINE] 3542. Fukuoka Igaku Zasshi. 1993 Oct;84(10):436-9. Acyclovir-resistant herpes zoster encephalitis successfully treated with vidarabine: a case report. Washio M, Hamada T, Goda H, Yoshimitsu T, Kajioka T, Koga H, Shogakiuchi Y, Fujishima M, Okayama M. Imazu Red Cross Hospital, Fukuoka. A 78-year-old man developed herpes zoster virus (HZV) encephalitis. Initially, treatment with aciclovir (750 mg per day) improved CSF cell count and protein level. During the treatment, however, encephalitis in the patient deteriorated in spite of the treatment with aciclovir, suggesting that HZV in the patient had become resistant to aciclovir. Subsequent treatment with vidarabine (600 mg per day, for 15 days) resulted in dramatic improvement in CSF pleocytosis. About two months after the discontinuation of vidarabine, the CSF cell count was normal. The patient became alert gradually, but his amnestic syndrome remained unchanged. Vidarabine may be recommended in the treatment of HZV encephalitis when aciclovir is not effective. PMID: 8225157 [PubMed - indexed for MEDLINE] 3543. Arch Neurol. 1993 Oct;50(10):1046-53. Topical aspirin in chloroform and the relief of pain due to herpes zoster and postherpetic neuralgia. King RB. Department of Neurosurgery, State University of New York Health Science Center, Syracuse, NY 13210. OBJECTIVE--To determine pain patterns and relationships in patients with herpes zoster and postherpetic neuralgia before and after topical application of aspirin dissolved in chloroform applied to the painful skin surface. DESIGN--A consecutive series of 42 patients examined and treated in a uniform manner and followed up until their pain subsided or this management mode failed. SETTING--An ambulatory referral private practice. PATIENTS--All patients had pain due to herpes zoster or postherpetic neuralgia and were referred for management of severe pain. None refused. INTERVENTION--Topical application of crushed aspirin tablets dissolved in chloroform. OUTCOME MEASURES--Short-Form McGill Pain Questionnaire. RESULTS--All patients reported substantially decreased pain promptly after treatment, with maximum relief at 20 to 30 minutes and lasting 2 to 4 hours. Patients gradually decreased the use of aspirin in chloroform as pain abated. CONCLUSIONS--Topical aspirin dissolved in chloroform is an effective means of reducing pain due to herpes zoster and postherpetic neuralgia in most patients. The locus of pain origin and analgesia induced by topical aspirin is most likely at cutaneous free-nerve ending pain receptors. The mechanism responsible for the analgesic properties of aspirin is probably not the same as that responsible for its anti-inflammatory properties. PMID: 8215962 [PubMed - indexed for MEDLINE] 3544. Semin Oncol. 1993 Oct;20(5 Suppl 6):80-7. Infections in allogeneic bone marrow transplant recipients. Wingard JR. Department of Medicine, Emory University School of Medicine, Atlanta, GA. Remarkable strides have been made in the management of infectious complications after bone marrow transplantation. Improved understanding of patterns of infection, the introduction of new antimicrobials, the advent of cytokines to enhance immune recovery, the development of better strategies to control graft-versus-host disease, and the availability of more accurate and rapid diagnostic assays have all contributed to reducing the morbidity and mortality from infection after allogeneic marrow transplantation. PMID: 8211220 [PubMed - indexed for MEDLINE] 3545. Fortschr Med. 1993 Sep 30;111(27):423-5. [Oral combination therapy of zoster neuralgia. Pain reduction by 1-adamantanamine sulfate and carbamazepine per os] [Article in German] Kunzelmann V. Dermatologische Klinik und Poliklinik, Univ.-Klinikums Charité, Berlin. In four patients hospitalized with severe neuralgic complaints in conjunction with a Zoster infection, the pain-relieving effect of oral 1-adamantanamine sulfate used in combination with carbamazepine was studied. From the results obtained, the oral administration of 1-adamantanamine sulfate also appears to have a reliable analgesic effect, so that ambulatory treatment is readily possible. PMID: 8225147 [PubMed - indexed for MEDLINE] 3546. Am J Ophthalmol. 1993 Sep 15;116(3):297-301. Association of herpes zoster ophthalmicus with acquired immunodeficiency syndrome and acute retinal necrosis. Sellitti TP, Huang AJ, Schiffman J, Davis JL. Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, FL 33101. We conducted a review to investigate the prevalence of human immunodeficiency virus (HIV), or acquired immunodeficiency syndrome (AIDS), in patients with herpes zoster ophthalmicus, as well as the incidence of acute retinal necrosis after herpes zoster ophthalmicus. All charts of patients seen at our institution between 1987 and 1992 with a primary diagnosis of herpes zoster ophthalmicus were reviewed. Of 112 patients with herpes zoster ophthalmicus, 29 (26%) had HIV or AIDS. All these patients were younger than 50 years at the time of diagnosis. Five of 29 (17%) immunocompromised patients had acute retinal necrosis after herpes zoster ophthalmicus. No acute retinal necrosis was identified in the nonimmunocompromised patients after herpes zoster ophthalmicus. We recommend that all patients younger than 50 years who have herpes zoster ophthalmicus at initial examination be tested for HIV. Additionally, HIV-infected patients should be monitored closely after herpes zoster ophthalmicus for development of acute retinal necrosis. Long-term oral prophylactic as well as initial high-dose intravenous acyclovir may be appropriate in HIV-infected individuals with herpes zoster. PMID: 8357053 [PubMed - indexed for MEDLINE] 3547. Presse Med. 1993 Sep 11;22(26):1226-31. [Diagnosis of diffuse encephalopathies in adults with HIV infection. I] [Article in French] Gray F, Bélec L, Geny C, Schouman-Claeys E. Laboratoire d'Anatomie pathologique (Neuropathologie), Hôpital Raymond Poincaré et Faculté de Médecine Paris-Ouest, Garches. The diagnostic approach of focal central nervous system lesions in AIDS patients is now well established. In contrast, it is extremely difficult to determine the cause of diffuse encephalopathies, occurring frequently at the terminal stage of AIDS. Imaging is usually non specific and laboratory investigations are seldom contributive. In most cases, the aetiological diagnosis is provided by post mortem examination. In this first part of the study the authors deal with viral encephalitides which represent a classical and frequent cause of diffuse encephalopathy in AIDS. HIV encephalitis usually causes a progressive brain disease resulting in severe dementia; imaging may show diffuse leucoencephalopathy and/or cortico-subcortical atrophy. CMV encephalitis is often asymptomatic, discovered at autopsy; however, this diagnosis should be considered in patients with an encephalopathy of rapid onset, discrete signs of meningitis, symptoms of myelo-radiculitis, or a systemic CMV infection. Varicella-zoster virus encephalitis is not uncommon and may occur in the absence of characteristic rash. Infections by herpes simplex and measles viruses are exceptional. PMID: 8248044 [PubMed - indexed for MEDLINE] 3548. Br J Hosp Med. 1993 Sep 15-Oct 5;50(6):301-8. Herpesvirus infections in childhood: 2. Nathwani D, Wood MJ. Infection and Immunodeficiency Service, King's Cross Hospital, Dundee. Infections due to herpesviruses have received increasing attention over the past decade, culminating in the isolation in 1986 of human herpesvirus-6. This is the second of two articles in which we examine the clinical spectrum of acquired herpesvirus infections in children and review developments in our understanding of the molecular biology, pathogenesis, treatment and prevention of these infections. PMID: 8242213 [PubMed - indexed for MEDLINE] 3549. J Neurol Neurosurg Psychiatry. 1993 Sep;56(9):1001-3. Focal weakness following herpes zoster. Cockerell OC, Ormerod IE. Department of Neurology, St Thomas' Hospital, London, UK. Three patients presented with focal weakness of an arm which followed segmental herpes zoster affecting the same limb. Neurophysiological investigations suggest that the site of the lesion lay at the root, plexus, or peripheral nerve level. This reflects the various ways in which the virus may affect the peripheral nervous system. PMCID: PMC489737 PMID: 8410022 [PubMed - indexed for MEDLINE] 3550. Elder Care. 1993 Sep-Oct;5(5):41-4; quiz 45-6. Herpes zoster (shingles). Garrett G. PMID: 8401445 [PubMed - indexed for MEDLINE] 3551. J Pediatr. 1993 Sep;123(3):418-22. Unsuspected varicella-zoster virus encephalitis in a child with acquired immunodeficiency syndrome. Silliman CC, Tedder D, Ogle JW, Simon J, Kleinschmidt-DeMasters BK, Manco-Johnson M, Levin MJ. Department of Pediatrics, University of Colorado School of Medicine, Denver. We report a case of progressive encephalitis caused by varicella-zoster virus (VZV) in an adolescent with hemophilia and acquired immunodeficiency syndrome but without cutaneous signs of VZV infection. Magnetic resonance imaging of the brain demonstrated an abnormally increased periventricular signal in T2-weighted images. Infection with VZV was proved by in situ hybridization and immunofluorescence staining of brain tissue, which showed histologic evidence of herpesvirus infection. Encephalitis caused by infection with VZV is a potentially treatable complication of acquired immunodeficiency syndrome and requires a high index of suspicion for diagnosis. PMID: 8394901 [PubMed - indexed for MEDLINE] 3552. Reg Anesth. 1993 Sep-Oct;18(5):277-82. Relationship between time of treatment of acute herpes zoster with sympathetic blockade and prevention of post-herpetic neuralgia: clinical support for a new theory of the mechanism by which sympathetic blockade provides therapeutic benefit. Winnie AP, Hartwell PW. Department of Anesthesiology & Critical Care, Cook County Hospital, Chicago, IL 60612. BACKGROUND AND OBJECTIVES. Since Rosenak's original report more than 50 years ago as to the efficacy of sympathetic blocks in terminating acute herpes zoster, many investigators have reported that a more important benefit of this form of therapy is the prevention of post-herpetic neuralgia. However, most of these reports have indicated that sympathetic blocks are effective in preventing post-herpetic neuralgia only if applied soon after the onset of the acute phase of the disease; in fact, if applied too late, this form of therapy failed to prevent the development of post-herpetic neuralgia. The present study was carried out to determine more precisely the relationship between the time of treatment of acute herpes zoster and the prevention of post-herpetic neuralgia and to attempt to correlate this time with the authors' previously published theory on the mechanism by which sympathetic blocks provide the therapeutic benefit. METHODS. The present study was a retrospective review of 122 patients treated at variable intervals after the onset of acute herpes zoster. Data tabulated included the duration of symptoms at the time of treatment, the number of sympathetic blocks required to provide relief, and the efficacy of the sympathetic blockade in terminating the acute phase of herpes zoster and then preventing the development of post-herpetic neuralgia. RESULT. According to the data obtained in this retrospective study, sympathetic blocks terminated the pain of acute herpes zoster and prevented or relieved post-herpetic neuralgia in more than 80% of patients treated within 2 months of the onset of the acute phase of the disease, after which time the success rate decreased drastically. CONCLUSION. Sympathetic blockade applied within the first 2 months after the onset of acute herpes zoster terminated the acute phase of the disease, probably by restoring intraneural blood flow, thus preventing the death of the large fibers and avoiding the development of post-herpetic neuralgia. If sympathetic blocks were to be carried out after 2 months, the damage to the large fibers would be irreversible, and this therapeutic modality would not be able to prevent the development of post-herpetic neuralgia. PMID: 8268115 [PubMed - indexed for MEDLINE] 3553. Reg Anesth. 1993 Sep-Oct;18(5):271-3. The sympathetic nervous system in post-herpetic neuralgia. Hogan QH. PMID: 8268114 [PubMed - indexed for MEDLINE] 3554. Masui. 1993 Sep;42(9):1343-6. [Herpes zoster and malignancy] [Article in Japanese] Zaha M, Hayashi I, Odashiro M, Mizoguchi H, Fujiwara M, Kato H, Kawamura J. Department of Anesthesia, Hokkaido Kinikyou Chuo Hospital, Sapporo. A retrospective survey was conducted regarding the relationship between hospitalized patients with herpes zoster and malignancy based on clinical records. A total of 220 patient were hospitalized for treatment of herpes zoster during the past 15 years, and 23 of them had involvement with malignant tumors. Malignancy was found during hospitalization in 4 cases (1.8%). This was significantly higher than 0.27, the predicted number of malignancy cases. Three of the 4 cases were gastric cancer. The discovery rate of gastric cancer through screening at admittance was 2.4%, which was higher than 0.14%, the discovery rate in gastric cancer checkups in Hokkaido. Examination for malignant tumors should be required for all patients with herpes zoster who need to be hospitalized. PMID: 8230723 [PubMed - indexed for MEDLINE] 3555. HNO. 1993 Sep;41(9):449-52. [Treatment of zoster oticus with acyclovir. Report from general practice and a small hospital department] [Article in German] Haass HG. HNO-Abteilung, Diakonissenkrankenhauses Mannheim. Findings in patients having zoster oticus infection are reported following treatment in an oto-rhino-laryngological practice connected to a small hospital department. Treatment involved intravenous administration of acyclovir and-in most cases-additional infusions of dextran, cortisone and naftidrofuryl, as adapted from a drug regimen proposed by Stennert. Although treatment was not effective in all cases, several very good results and some partial results were found that justified continued use of this combination therapy. PMID: 8226133 [PubMed - indexed for MEDLINE] 3556. Clin Infect Dis. 1993 Sep;17(3):431-6. Gastrointestinal visceral motor complications of dermatomal herpes zoster: report of two cases and review. Tribble DR, Church P, Frame JN. Infectious Diseases Division, Naval Medical Research Unit No. 3, Cairo, Egypt. Comment in: Clin Infect Dis. 1994 Nov;19(5):975. Motor complications are uncommon manifestations of herpes zoster. This report describes two cases of gastrointestinal visceral motor manifestations associated with dermatomal herpes zoster and reviews the English-language literature since 1900. The 17 cases reviewed were divided clinically into two groups: colonic pseudo-obstruction and localized colonic spasm. Characteristics of the patients, radiographic study results, endoscopic findings, proposed pathogenesis, and management options are discussed. It is important to recognize this manifestation in order to institute proper management and avoid unnecessary surgery, given the complete resolution with conservative management in most cases. PMID: 8218686 [PubMed - indexed for MEDLINE] 3557. Arthritis Rheum. 1993 Sep;36(9):1329. Isolation of varicella zoster virus from the synovial fluid of a patient with herpes zoster arthritis. Amoura I, Fillet AM, Huraux JM, Bourgeois P. Pitié-Salpêtrière Hospital, Paris, France. PMID: 8216427 [PubMed - indexed for MEDLINE] 3558. Orv Hetil. 1993 Aug 29;134(35):1927-30. [Ophthalmoplegia in herpes zoster: clinical review based on two case reports] [Article in Hungarian] Pál E, Szekeres V, Vécsei L. Pécsi Orvostudományi Egyetem Neurológiai Klinika. The authors describe two cases of ophthalmic herpes zoster complicated with ophthalmoplegia. This rare complication developed in the 2nd week after beginning of the disease and it is only slightly influenced by antiviral therapy, but improvement was observed after the administration of corticosteroids. A short overview summarizes the diagnostic possibilities, the therapy and the complication of the disease. PMID: 8361748 [PubMed - indexed for MEDLINE] 3559. JAMA. 1993 Aug 11;270(6):710. Acute herpes zoster: sympathetic nerve block unsupported by prospective trial. McGuinness JP. Comment on: JAMA. 1993 Apr 14;269(14):1836-9. PMID: 8336372 [PubMed - indexed for MEDLINE] 3560. AAOHN J. 1993 Aug;41(8):369-73. Varicella zoster virus in the health care setting: risk and management. Lund J. 1. Varicella zoster poses a threat to clients and staff in health care settings because of its ease of transmission and incidence of complications in those over age 20, neonates, and the immunocompromised. 2. Risk surveillance of personnel via a comprehensive screening program will establish the pool of seronegative (or "at risk") health care workers. 3. Clear policies on restricting client admission or visitors, and work restrictions for health care workers related to varicella will aid in preventing outbreaks in the health care setting. 4. Prompt follow up of exposures is best accomplished using an established protocol for loss control. PMID: 8397553 [PubMed - indexed for MEDLINE] 3561. Nippon Jibiinkoka Gakkai Kaiho. 1993 Aug;96(8):1329-39. [MRI enhancement of the facial nerve with Gd-DTPA--second report--investigation of enhanced nerve portions in patients with facial palsy] [Article in Japanese] Yanagida M. Department of Otorhinolaryngology, Kansai Medical University, Osaka. We performed enhanced MRI using Gd-DTPA in 84 patients with facial palsy. After assessing enhancement of the normal facial nerve, we examined enhancement in patients with Bell's palsy and Ramsay Hunt syndrome. The following results were obtained. 1. In 95% of patients with Bell's palsy, enhancement was obtained in the distal IAC and labyrinthine portions. In 72%, enhancement was significant from the distal IAC portion through the vertical portion. In some of the patients who underwent enhanced MRI twice, increased signal intensity was observed in distal portions such as the vertical portion. 2. In many cases with Ramsay Hunt syndrome, enhancement was seen extensively in the IAC portion through the vertical portion. In the subjects with internal auditory symptoms such as vertigo and tinnitus, enhancement of the IAC portion was seen not only in the facial nerve but also in the vestibular and the cochlear nerves. These results suggest that the vascular permeability of lesions in Bell's palsy may be increased from the distal IAC portion to the vertical portion. Judging from the present findings with Ramsay Hunt syndrome, symptoms related to the enhanced portions suggest that accompanying internal auditory symptoms occur due to inflammation of the IAC portions of cochlear and vestibular nerves. PMID: 8377065 [PubMed - indexed for MEDLINE] 3562. Masui. 1993 Aug;42(8):1171-6. [Transdermal application of 10% lidocaine-gel for management of pain associated with herpes zoster] [Article in Japanese] Shimoda O, Kano T, Takaki M, Tashima T, Tashiro M, Ikuta Y, Morioka T, Nakano M, Mishima M. Department of Anesthesiology, Kumamoto Rosai Hospital, Yatsushiro. We have developed transdermally applicable 10% lidocaine aqueous gel containing an absorption promoter and applied it for 15 patients suffering from severe pain in acute or subacute phase of herpes zoster. The patients, consisting of 7 males and 8 females with a mean age 58.5 +/- 13.0 (SD) yrs, had skin eruptions of herpes zoster for the past 2 months. Lidocaine-gel was applied locally to the diseased skin with or without an occlusive dressing. In 14 of the 15 patients (93%), a remarkable reduction of pain (below 10% of pretreatment level) was obtained after 9.9 +/- 5.6 (SD) times of lidocaine-gel treatments. There was no adverse systemic reactions or local skin damages. None of them developed post-herpetic neuralgia. The lidocaine-gel treatment appears to be very useful for reduction of pain associated with acute or subacute phase of herpes zoster. PMID: 8366557 [PubMed - indexed for MEDLINE] 3563. Aging (Milano). 1993 Aug;5(4):325-32. FRAR course on laboratory approaches to aging. "Orphan" phenotypes in gerontological research. Martin GM. Department of Pathology, University of Washington, Seattle 98195. It is argued that, in addition to investigations of life span parameters, a large number of biomedically important phenotypes can be profitably studied from a gerontological perspective. These would include "private" patterns of aging, especially in our own species, which exhibits extraordinary genetic heterogeneity. These, as well as a number of relatively common age-associated phenotypes, have been comparatively neglected by the gerontological community, and therefore warrant the designation as "orphan" phenotypes. From a tabulation of examples from each of the major body systems, five are elaborated upon: "hyperhippocampals," defined as individuals with intrinsically enhanced functional reserve in relevant neural circuitry; patients with a heterogeneous set of pathologies collectively referred to as "normal pressure hydrocephalus"; patients with late life activation of herpes zoster; individuals with unusually early onset of loss of olfactory function; and geriatric subjects with unusual sensitivity to "jet lag." PMID: 8297936 [PubMed - indexed for MEDLINE] 3564. J Med Virol. 1993 Aug;40(4):339-42. Comparative analysis of the restriction endonuclease profiles of the Dumas and Singapore strains of varicella-zoster virus. Chow VT, Wan SS, Doraisingham S, Ling AE. Department of Microbiology, Faculty of Medicine, National University of Singapore. The incidence of varicella in Singapore has been increasing since 1984. In 1991, 17,930 cases were reported in a population of about 3 million. A serological survey completed in 1990 demonstrated that only 43% of the cohort had antibodies to varicella-zoster virus (VZV), indicating inadequate herd immunity. To exclude novel VZV strains, representative VZV isolates from 9 chicken pox and 4 zoster patients were characterised by restriction endonuclease analysis. DNAs were extracted from viral isolates propagated in MRC5 human embryo lung cells and were digested separately with BglII, EcoRI, PstI, SalI, and XbaI enzymes. The cleavage profiles of these VZV strains derived from both chicken pox and zoster lesions revealed no distinct differences. This observation implies that the current upsurge of chicken pox most likely stems from closely related VZV genotypes infecting a susceptible population with insufficient herd immunity. Comparison of the restriction fragments of the Singapore and the Dumas strains revealed polymorphisms of the SalI-D, SalI-E, and XbaI-I fragment lengths, which correlated with variable regions I, II, and III of the VZV genome, thereby representing geographically distinct genotypic variants of VZV. PMID: 8228928 [PubMed - indexed for MEDLINE] 3565. J La State Med Soc. 1993 Aug;145(8):333-5. Herpes zoster oticus: diagnosis and management. Muecke M, Amedee RG. Tulane University Medical Center, Dept of Otolaryngology, Head & Neck Surgery, New Orleans. Herpes zoster oticus (Ramsay Hunt syndrome) is recognized as a polycranial neuritis caused by the DNA virus Herpes zoster and characterized by damage to sensory and motor nerves, including the audio-vestibular apparatus. Common presenting symptoms include cutaneous auricular vesicles, severe otalgia, inflammation of the pinna, and occasionally unilateral sudden facial paralysis. This article reviews the medical management of this disease, including the efficacy of antibiotics, corticosteroids, and acyclovir, along with the role of surgical decompression of the facial nerve. PMID: 8228542 [PubMed - indexed for MEDLINE] 3566. J Cutan Pathol. 1993 Aug;20(4):317-9. Antibody deposits in Tzanck smears in pemphigus vulgaris. Verma KK, Khaitan BK, Singh MK. Department of Dermatology, All India Institute of Medical Sciences, New Delhi. Forty-three patients, including 24 males and 19 females between 5 and 62 years of age, having pemphigus vulgaris (27), pemphigus foliaceus (1), bullous pemphigoid (3), chronic benign bullous dermatosis of childhood (2) and herpes zoster (10) were included in this study. Tzanck smears were prepared from the floor of the blisters in these patients by deroofing the bullae, and the slides were stored without fixation at room temperature for 1 to 10 days. Immunofluorescence staining was done with FITC-conjugated anti-human IgG. Twenty-one cases having pemphigus vulgaris and 1 case having pemphigus foliaceus showed bright green fluorescence on the membrane of acantholytic cells. No epithelial cells were seen in smears from bullous pemphigoid and chronic benign bullous dermatosis of childhood, whereas epithelial cells were seen in 10 cases of herpes zoster. These stained negative with anti-IgG. Storage of the prepared smears for 1-10 days did not seem to affect the results of immunofluorescence. Tzanck smears can be used as an easy substitute for skin/mucosal biopsy for the direct immunofluorescence test. PMID: 8227607 [PubMed - indexed for MEDLINE] 3567. Ann Med. 1993 Aug;25(4):329-33. Herpes virus infections in immunocompromised patients: problems and therapeutic interventions. Ljungman P. Huddinge University, Sweden. Herpes virus infections are responsible for morbidity and mortality among immunosuppressed patients. During the last decade substantial advances have been achieved through improvement of diagnostic techniques, development of effective antiviral agents and the use of different strategies for prophylaxis and treatment. Cytomegalovirus infection and disease can today be prevented and treated effectively; however, antiviral resistance is beginning to emerge as a potential major clinical problem. Similarly, infections with herpes simplex virus and varicella-zoster virus can be effectively treated, but antiviral resistance has also emerged for these viruses. Two new herpes viruses, human herpes viruses 6 and 7, have been discovered, and it is possible that these viruses can also cause significant problems in immunosuppressed individuals. New antiviral agents will be needed during the next decade to allow further advances in the treatment of herpes virus infections. PMID: 8217097 [PubMed - indexed for MEDLINE] 3568. Am J Dermatopathol. 1993 Aug;15(4):320-5. Ultrastructural findings in mucocutaneous infections of patients seropositive to HIV. Cavicchini S, Brezzi A, Alessi E. First Clinic of Dermatology, Milan, Italy. Tissue samples from 19 HIV-seropositive immunocompromised patients suffering from oral hairy leukoplakia, chronic vesicular or ulcerative herpes simplex, chronic nonmetameric herpes zoster, secondary syphilis, condylomata acuminata, molluscum contagiosum, or disseminated cutaneous mycobacteriosis were examined ultrastructurally in order to better define the fine structure of the causative organisms in parasitic conditions and to clarify the host-parasite relationships. Taking into account the few data in the literature regarding the same disorders in immunocompetent subjects, no striking differences in the morphology of the infectious agents or in the types of parasitism were found. Nevertheless, isolated herpesvirus and papillomavirus virions were found outside the infected cells, and this observation, if confirmed in a larger series of cases, could suggest a persistent infectivity of the lesions in immunocompromised patients. Moreover, electron microscopy proved to be useful for diagnostic purposes; in one case of disseminated cutaneous mycobacteriosis, repeated cultures failed to grow the organism. PMID: 8214389 [PubMed - indexed for MEDLINE] 3569. Genitourin Med. 1993 Aug;69(4):273-5. Detection of varicella-zoster virus DNA using the polymerase chain reaction in an immunocompromised patient with transverse myelitis secondary to herpes zoster. Grant AD, Fox JD, Brink NS, Miller RF. Department of Medicine, University College and Middlesex School of Medicine, London, UK. A case of herpes zoster transverse myelitis is described in which the clinical diagnosis was confirmed by demonstrating the presence of varicella-zoster virus (VZV) DNA in the cerebrospinal fluid (CSF) by amplification using the polymerase chain reaction. This case illustrates the potential role of the selective amplification of VZV DNA from CSF in contributing to the diagnosis of neurological complications associated with VZV infection. PMCID: PMC1195086 PMID: 7721287 [PubMed - indexed for MEDLINE] 3570. Am J Ophthalmol. 1993 Jul 15;116(1):42-50. Recurrence of presumed varicella-zoster virus retinopathy in patients with acquired immunodeficiency syndrome. Johnston WH, Holland GN, Engstrom RE Jr, Rimmer S. University of California, Los Angeles. Five patients with acquired immunodeficiency syndrome (AIDS) and presumed varicella-zoster virus retinopathy had recurrence of retinopathy after stabilization with initial intravenous antiviral therapy. Recurrences were recognized as increased retinal opacification at the borders of preexisting lesions or as new lesions. In four of the five patients, recurrences were temporally associated with a reduction in the amount of antiviral medication being received. Changes included switch from intravenous to oral acyclovir (two patients), taper of oral acyclovir (one patient), and discontinuation of medications (one patient). In four patients disease was initially unilateral; in three of these four, disease subsequently developed in the previously unaffected fellow eye at the time of recurrence. The median time from stabilization of disease to recurrence was 51 days (range, 14 to 90 days). In contrast to the management of varicella-zoster virus retinopathy in immunocompetent patients and varicella-zoster virus lesions of the skin, varicella-zoster virus retinopathy in patients with AIDS appears to require chronic suppressive antiviral therapy to prevent recurrences. In this respect it is similar to other opportunistic retinal infections in patients with AIDS. The best drugs and optimal treatment regimens for maintenance antiviral therapy remain unknown. PMID: 8328542 [PubMed - indexed for MEDLINE] 3571. N Z Med J. 1993 Jul 14;106(959):296. Post herpetic neuralgia. Jones D. Comment on: N Z Med J. 1993 Jun 9;106(957):233-4. PMID: 8321460 [PubMed - indexed for MEDLINE] 3572. J Infect Dis. 1993 Jul;168(1):245. Herpes zoster and human immunodeficiency virus infection: a cohort study of 101 coinfected patients. Groupe d'Epidémiologie clinique du SIDA en aquitaine. Rogues AM, Dupon M, Ladner J, Ragnaud JM, Pellegrin JL, Dabis F. Comment on: J Infect Dis. 1992 Nov;166(5):1153-6. PMID: 8515121 [PubMed - indexed for MEDLINE] 3573. J Pharm Belg. 1993 Jul-Aug;48(4):270-4. [From herpes to zona] [Article in French] Poot F. Service de Dermatologie, Cliniques St-Luc U.C.L. PMID: 8410632 [PubMed - indexed for MEDLINE] 3574. J Med Virol. 1993 Jul;40(3):241-3. Infection of human fetal dorsal root neurons with wild type varicella virus and the Oka strain varicella vaccine. Somekh E, Levin MJ. Pediatric Infectious Diseases, University of Colorado School of Medicine, Denver 80262. The relative ability of a varicella-zoster virus (VZV) clinical isolate and a live attenuated VZV vaccine strain (Oka) to infect human neurons was determined in vitro. VZV infection of neurons prepared in culture from dorsal root ganglia of fetuses was assessed using an infectious center assay. Cultures were infected with 50-5,000 pfu of either VZV and assayed at either 24 or 48 hours post-VZV infection. Cultures infected with the clinical VZV isolate had seven-fold more infected neurons than cultures infected with the vaccine strain VZV. PMID: 8394874 [PubMed - indexed for MEDLINE] 3575. Acta Pharm Hung. 1993 Jul;63(4):181-7. [Clinical experience with Hevizos ointment] [Article in Hungarian] Makleit L. Biogal Gyógyszergyár Rt., Debrecen. After a brief summary of the effects of Hevizos ointment, major clinical studies conducted in Hungary are described. In a double-blind comparative clinical study involving the dermatological departments of three medical universities, Hevizos has been found more effective than Virungent ointment in herpes simplex labials and herpes zoster. In herpes genitalis the two products were of identical efficacy. Both Hevizos and Virungent proved to be more effective than placebo in all three indications. By the evidence of an open clinical trial Hevizos is not superseded by Zovirax ointment: confirmation of these findings in a double-blind study is underway. PMID: 8379333 [PubMed - indexed for MEDLINE] 3576. Rev Med Liege. 1993 Jul 1;48(7):401-5. [Diagnosis of skin infections caused by simplex-type herpes virus and by varicella zona] [Article in French] Nikkels AF, Hermanns-Lê T, Nikkels-Tassoudji N, Piérard GE. Service de Dermatopathologié, CHU du Sart Tilman. PMID: 8367639 [PubMed - indexed for MEDLINE] 3577. Mayo Clin Proc. 1993 Jul;68(7):652-5. Herpes zoster-associated meningoencephalitis in patients with systemic cancer. Hughes BA, Kimmel DW, Aksamit AJ. Department of Neurology, Mayo Clinic Rochester, MN 55905. We reviewed the experience at the Mayo Clinic with neurologic complications related to herpes zoster in patients with systemic cancer. Aside from pain, the most common neurologic complication was zoster-associated meningoencephalitis, which occurred in 9 of 1,125 patients. In these nine patients, the most common underlying malignant lesions were chronic lymphocytic leukemia and lymphoma. All patients in whom meningoencephalitis developed had trigeminal zoster or disseminated zoster. The primary neurologic symptoms were headache, confusion, and somnolence. Nuchal rigidity and fever were uncommon. The response to treatment with acyclovir was generally favorable. PMID: 8350638 [PubMed - indexed for MEDLINE] 3578. Br J Ophthalmol. 1993 Jul;77(7):459-61. A case of presumed congenital herpes zoster ophthalmicus. Singh J, Gibson JM. Department of Ophthalmology, East Birmingham Hospital. PMCID: PMC504565 PMID: 8343481 [PubMed - indexed for MEDLINE] 3579. N Z Med J. 1993 Jun 9;106(957):233-4. Treatment of postherpetic neuralgia with topical piroxicam gel. Nicholls DS. Comment in: N Z Med J. 1993 Jul 14;106(959):296. PMID: 8305013 [PubMed - indexed for MEDLINE] 3580. Am J Phys Med Rehabil. 1993 Jun;72(3):144-50. Intercostal somatosensory-evoked potentials. A new technique. Dreyfuss P, Dumitru D, Prewitt-Buchanan L. University of Texas Health Science Center, Department of Rehabilitation Medicine, San Antonio. Presently, there are few electrodiagnostic medicine techniques to evaluate lesions affecting the thoracic nerve roots or spinal cord. A new electrophysiologic technique to assess these structures, intercostal somatosensory-evoked potentials (SEPs), is described. Thirty neurologically normal subjects were used in this investigation to generate intercostal SEPs. Bilateral intercostal SEPs were easily elicited after stimulation of the third intercostal nerves just lateral to the sternum anteriorly. Intercostal SEPs were also easily elicited from the fifth, seventh and ninth intercostal nerves along the anterior axillary line bilaterally. Intercostal SEPs are not only easily and painlessly obtained, but are specific for individual spinal levels. This SEP method will provide the clinician with another neural stimulation procedure to assist in the diagnosis of both central and peripheral thoracic neural compromise. PMID: 8512676 [PubMed - indexed for MEDLINE] 3581. Klin Monbl Augenheilkd. 1993 Jun;202(6):491-9. [Ophthalmologic findings in graft versus host disease (GvHD)] [Article in German] Käsmann B, Ruprecht KW. Augenklinik und Poliklinik, Universität des Saarlandes. BACKGROUND: Since the era of bone marrow transplantation, the picture of acute and/or chronic transplant reaction of the host cells against grafted bone marrow has become more frequent. The so-called adaptive immune therapy bases on the fact that patients who present with a low grade of GvHD less often suffer from a relapse of the malignant leukaemic disease. Therefore, new therapeutic regimen are now performed which keep the patient on a low level of GvHD to prevent a recurrence of leukaemia. Here a close cooperation of oncologists and ophthalmologists becomes more and more important to estimate the stage of GvHD. PATIENTS: Demonstrating two case reports, we report on the ophthalmological symptoms of acute and chronic GvHD. Both patients presented with acute ocular GvHD as well as with signs of chronic ocular GvHD. Concerning the ophthalmological symptoms, in acute or chronic GvHD the conjunctival involvement is most important. There is a lymphocytic infiltration of the conjunctiva and of the lacrimal glands which leads to an extreme sicca-syndrome. The acute GvHD of the conjunctiva can be classified into 4 stages: injection/exudation and chemosis/formation of pseudomembranes/defects of the corneal epithelium. These stages correlate directly to the prognosis of the survival time of the patient. A pathognomonic sign for the chronic GvHD of the conjunctiva are the fibrous-scarry Arlt-lines of the tarsal conjunctiva. CONCLUSIONS: All patients who underwent a bone marrow transplantation for leukaemia need to be followed up closely to estimate the level of GvHD they are in. This applies especially to those patients who are treated according to the regimen of adaptive immune therapy. A close cooperation of oncologists and ophthalmologists during adaptive immune therapy is mandatory, as the ophthalmologist can provide important information to help to grade the level of GvHD, judging by the morphological picture at the slit lamp. PMID: 8397319 [PubMed - indexed for MEDLINE] 3582. Ann Ophthalmol. 1993 Jun;25(6):208-15. Herpes zoster ophthalmicus: the virus strikes back. Karlin JD. Department of Ophthalmology, UCLA School of Medicine. The objective of this article is (1) to review the range of anterior segment ocular disease caused by varicella-zoster virus (VZV), (2) to discuss the pathophysiology of the mechanisms involved in the ensuing tissue damage, and (3) to bring the reader up to date on the current management and therapy of herpes zoster ophthalmicus (HZO). The design of this article is a review of the literature with special emphasis on the ocular manifestations of HZO. The conclusions reached by this review include that HZO is a common form of the recurrent form of HZ infection caused by VZV. Although HZO is generally benign in most nonimmunocompromised patients, the incidence of ocular complications is high. Immunocompromised hosts manifest HZ (and HZO) in much higher frequencies and develop more severe sequelas, which may lead to loss of vision, dissemination of the virus, or death. An increased incidence of acquired and iatrogenic immunodeficiency states has given rise to a greater occurrence of recurrent VZV infection. Thus, there is a greater need for earlier diagnosis and appropriate management of the protean manifestations of this potentially disastrous disease. PMID: 8393312 [PubMed - indexed for MEDLINE] 3583. Clin J Pain. 1993 Jun;9(2):135-7. Combined stellate ganglion and sphenopalatine ganglion block in acute herpes infection. Prasanna A, Murthy PS. Department of Anaesthesia, Pain Relief and Palliative Care Medicine, Kasturba Medical College Hospital, Manipal, India. PMID: 8358137 [PubMed - indexed for MEDLINE] 3584. J R Soc Med. 1993 Jun;86(6):360. Acute proximal myopathy due to herpes zoster. Joseph TP, Chand RP, Tariq SM, Johnston WJ, Muirhead D, Buhl L. Department of Medicine, Sultan Qaboos University Hospital, Muscat, Sultanate of Oman. PMCID: PMC1294492 PMID: 8315636 [PubMed - indexed for MEDLINE] 3585. Lancet. 1993 May 22;341(8856):1342. Failure of foscarnet in disseminated herpes zoster. Bendel AE, Gross TG, Woods WG, Edelman CK, Balfour HH Jr. PMID: 8098465 [PubMed - indexed for MEDLINE] 3586. J Comput Assist Tomogr. 1993 May-Jun;17(3):495-7. Ramsay-Hunt syndrome and high-resolution 3DFT MRI. Rovira Cañellas A, Sánchez Torres C, Grivé Isern E, Capellades Font J, Castellá Fierro E, Gili Planas J. Centre de Ressonància Magnètica, Hospital Universitari Vall d'Hebrón, Barcelona, Spain. A case of Ramsay-Hunt syndrome has been studied with pre- and postcontrast MR imaging, using a three-dimensional Fourier transform fast imaging with steady precession sequence with axially oriented sections and coronal reformatted images. A clear demonstration of the abnormal enhancement of the labyrinth and of the intratemporal cranial nerves was obtained. This demonstration assisted us in establishing the diagnosis of Ramsay-Hunt syndrome. PMID: 8491921 [PubMed - indexed for MEDLINE] 3587. Am Fam Physician. 1993 May 1;47(6):1445-50. Common dermatoses in the elderly. Beacham BE. University of Maryland School of Medicine, Baltimore. Comment in: Am Fam Physician. 1994 Apr;49(5):1080, 1083. Am Fam Physician. 1993 Dec;48(8):1384, 1388. Common dermatoses in the elderly include xerosis, pruritus, contact dermatitis, acne rosacea, stasis dermatitis, bullous pemphigoid and herpes zoster. Physicians must be able to recognize these pathologic changes superimposed on the intrinsic and extrinsic effects of aging. Diagnosis is dependent on clinical appearance and supportive laboratory studies. Management is based on correct diagnosis. PMID: 8480566 [PubMed - indexed for MEDLINE] 3588. Pediatr Infect Dis J. 1993 May;12(5):402-6. Multifocal leukoencephalitis caused by varicella-zoster virus in a child with leukemia: successful treatment with acyclovir. Carmack MA, Twiss J, Enzmann DR, Amylon MD, Arvin AM. Department of Pediatrics, Stanford University School of Medicine, CA 94305-5119. PMID: 8392165 [PubMed - indexed for MEDLINE] 3589. Clin Ther. 1993 May-Jun;15(3):510-26. A randomized vehicle-controlled trial of topical capsaicin in the treatment of postherpetic neuralgia. Watson CP, Tyler KL, Bickers DR, Millikan LE, Smith S, Coleman E. Department of Neurology, University of Toronto, Ontario, Canada. A large double-blind, vehicle-controlled study of 143 patients with chronic postherpetic neuralgia (PHN) was performed to evaluate the degree of efficacy of topically applied capsaicin 0.075% cream. In addition, the safety and efficacy of long-term application of topical capsaicin in PHN was assessed by following patients in an open-label study for up to 2 years. In the double-blind phase, 143 patients with PHN of 6 months' duration or longer were enrolled. Since epidemiologic studies of patients who receive no treatment have shown that only 10% to 25% of those with PHN after 1 month will still have pain at 1 year, two separate efficacy analyses were performed: one with all evaluable patients (n = 131) and the other with 93 patients whose PHN lasted for longer than 12 months prior to study startup. All efficacy variables, including the physician's global evaluation of reduction in PHN pain, changes in pain severity on the categoric scale, visual analogue scale for pain severity, visual analogue scale for pain relief, and functional capacity scale, showed significant improvement at nearly all time points throughout the study for both patient groups, based on duration of PHN pain. In contrast, the group receiving vehicle cream remained essentially unchanged. Data from the long-term, open-label phase (up to 2 years, n = 77), which immediately followed the 6-week blinded phase, showed that the clinical benefit in patients treated for a short (6-week) period with topical capsaicin could be maintained or amplified in most patients (86%) during prolonged therapy. There were no serious adverse effects observed or reported throughout the trial; in fact, the only side effect associated with capsaicin treatment was the burning or stinging at local sites of application (in 9% of patients) during exposures of up to 2 years (long-term phase). On the basis of these data, we conclude that capsaicin 0.075% cream is a safe and effective treatment for the pain of postherpetic neuralgia and should be considered for initial management of patients with this condition. PMID: 8364943 [PubMed - indexed for MEDLINE] 3590. Hinyokika Kiyo. 1993 May;39(5):459-61. [Severe central nervous system symptoms following oral administration of acyclovir in a patient with chronic renal failure: a case report] [Article in Japanese] Niibori D, Fujisawa M, Matsuzaki M. Department of Urology, Fukagawa Municipal General Hospital. A case of renal failure in a patient with severe central nervous system symptoms during oral acyclovir medication is reported. A 68-year-old man maintained on hemodialysis was given oral acyclovir 4,000 mg daily in divided doses because of herpes zoster affecting the left C3/5 dermatomes. He had vomiting and confusion 36 hours after administration. He had no focal neurological signs. The symptoms resolved 4 days after cessation of acyclovir administration and blood purification every day. Because of its high therapeutic index the use of acyclovir is associated with few side effects. In patients with renal failure the half-life of acyclovir is prolonged, this report indicates the importance of adhering to the dosage reductions in patients with renal failure. PMID: 8322628 [PubMed - indexed for MEDLINE] 3591. Ann Acad Med Singapore. 1993 May;22(3 Suppl):441-2. Low energy laser therapy for treatment of post-herpetic neuralgia. Yaksich I, Tan LC, Previn V. Neurosurgical Unit, Allamanda Private Hospital, Southport, Queensland, Australia. Post-herpetic neuralgia is a significant and severe disability that afflicts some patients following the acute manifestation of the disease despite what may be considered adequate pharmacological treatment at the time of onset of the vesicular rash. Surgery in general has little to offer in this condition although dorsal route entry zone lesions may be appropriate in some situations. Low dose laser therapy has been of value in a small series, to date, of cases that the treatment has been used on. This has been both in the early phase soon after the vesicles have cleared and often late, many years after the onset of the pain. Reported is a good improvement rate in approximately 60% of cases. The treatment is non-invasive and consideration of initial laser therapy is advocated. PMID: 8215196 [PubMed - indexed for MEDLINE] 3592. Rev Prat. 1993 Apr 15;43(8):1023-7. [Chickenpox and herpes zoster. Epidemiology, physiopathology, diagnosis, development, treatment] [Article in French] Raffi F. Maladies infectieuses et tropicales, service de médecine interne, Hôtel-Dieu, Nantes. PMID: 8341968 [PubMed - indexed for MEDLINE] 3593. JAMA. 1993 Apr 14;269(14):1836-9. Shingles. Sorrows, salves, and solutions. Straus SE. Laboratory of Clinical Investigation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md. 20892. Comment in: JAMA. 1993 Aug 11;270(6):710. PMID: 8459517 [PubMed - indexed for MEDLINE] 3594. Dtsch Med Wochenschr. 1993 Apr 2;118(13):481. [Thrombocytopenia following Varicella zoster infection] [Article in German] Schneider W. Medizinische Klinik und Poliklinik A der Universität, Düsseldorf. PMID: 8467749 [PubMed - indexed for MEDLINE] 3595. Clin Infect Dis. 1993 Apr;16(4):497-9. Fatal noncutaneous visceral infection with varicella-zoster virus in a patient with lymphoma after autologous bone marrow transplantation. Stemmer SM, Kinsman K, Tellschow S, Jones RB. Bone Marrow Transplant Program, University of Colorado Health Sciences Center, Denver 80262. After undergoing high-dose chemotherapy and autologous bone marrow transplantation, a patient developed fatal disseminated infection due to varicella-zoster virus (VZV) with no coincident skin lesions. This article describes this unusual case and briefly reviews the English-language literature on the abdominal presentation of VZV infection as well as that on VZV infection after bone marrow transplantation. In the severely immunocompromised host, visceral infection with VZV may uncommonly occur in the absence of skin lesions. The possibility of such infection should be considered when immunocompromised patients develop unusual symptoms or other evidence of visceral disease (e.g., cholecystitis). PMID: 8513054 [PubMed - indexed for MEDLINE] 3596. Dermatol Nurs. 1993 Apr;5(2):122-3. What's your assessment? Herpes zoster. Bielan B. PMID: 8507535 [PubMed - indexed for MEDLINE] 3597. J R Soc Med. 1993 Apr;86(4):212-6. The genetic mosaic. Findlay G. University of Pretoria, South Africa. Blaschko's lines are the acknowledged markers which represent the patterns of systematized naevi. Their interpretation has remained mysterious, because certain special features which they exhibit are impossible to reconcile with any known anatomical system in the human body. It is proposed that by changing one's views on the nature and growth of the dermatome, the patterns of zoster, and the behaviour of tissue mosaicism, the major difficulties hitherto experienced will be overcome. PMCID: PMC1293952 PMID: 8505730 [PubMed - indexed for MEDLINE] 3598. Acta Paediatr Jpn. 1993 Apr;35(2):141-3. A case of congenital herpes zoster. Kusuhara K, Miyazaki C, Ise K, Hidaka Y, Tokugawa K, Ueda K. Department of Pediatrics, Faculty of Medicine, Kyushu University, Fukuoka, Japan. A 5 day old girl was transferred to the pediatric ward of Kyushu University Hospital because of papules noted since birth. The papules were distributed on her skin corresponding to the dermatomes innervated by the left Th1-Th3 and the left L1-L3. Varicella-zoster virus antigens were detected in scrapings of incised papules. The diagnosis of herpes zoster was made and acyclovir (ACV) was administered. She responded to ACV well, but she experienced a recurrence twice after discontinuation of ACV. This is the first report of 'congenital herpes zoster', which supports the hypothesis that varicella embryopathy is the sequelae of herpes zoster in utero. PMID: 8503271 [PubMed - indexed for MEDLINE] 3599. J Virol. 1993 Apr;67(4):2381-4. Quantitation of latent varicella-zoster virus DNA in human trigeminal ganglia by polymerase chain reaction. Mahalingam R, Wellish M, Lederer D, Forghani B, Cohrs R, Gilden D. Department of Neurology, University of Colorado School of Medicine, Denver 80262. Competitive polymerase chain reaction was used to quantitate latent varicella-zoster virus (VZV) DNA in human trigeminal ganglia. Ganglionic DNA from five subjects was amplified with oligonucleotide primers specific for VZV gene 28. Two of the samples were also analyzed with primers specific for VZV gene 62. Our results indicated that there are 6 to 31 copies of the VZV genome in every 100,000 ganglionic cells. PMCID: PMC240405 PMID: 8383249 [PubMed - indexed for MEDLINE] 3600. Acta Derm Venereol. 1993 Apr;73(2):123-5. Atypical varicella-zoster infection in AIDS. Løkke Jensen B, Weismann K, Mathiesen L, Klem Thomsen H. Department of Dermato-Venereology, Bispebjerg Hospital, Copenhagen, Denmark. A case of atypical varicella zoster in a 33-year-old AIDS patient is reported. The patient had had two attacks of herpes zoster within a year and was given high-dose acyclovir several times. Thereafter he developed small keratotic pellucid papules on fingers, wrists and face, which were found to contain varicella-zoster antigen by the ELISA test. Skin biopsy showed acanthosis and lack of vesication, as is usually seen in herpes infections. The atypical varicella-like lesions persisted despite repeated doses of acyclovir but cleared temporarily when the patient was given foscarnet. We believe that the prolonged therapy may have allowed selection of acyclovir-resistant varicella-zoster strains, resulting in the atypical clinical course. PMID: 8103257 [PubMed - indexed for MEDLINE] 3601. Arch Dis Child. 1993 Apr;68(4):521-4. HIV infection in haemophilia--a European cohort. Aronstam A, Congard B, Evans DI, Gazengel CF, Herberg U, Hill FG, Jones PM, Ljung R, Mauser-Bunschoten EP, Scheibel E, et al. Basingstoke District Hospital, UK. Ten haemophilia centres in northern Europe have pooled data on 202 haemophilic children who were infected with HIV between 1979 and 1986. All cases were under 16 years of age on 1 July 1985. The age at infection ranged from 1-15 years. Thirty seven cases (18%) had progressed to AIDS by 1 July 1991 and 15 of these have died. Persistent generalised lymphadenopathy has been noted in 102 patients of whom 18 (17%) have developed AIDS. Twenty three of the remaining patients (23%) have not. CD4+ T cell counts have fallen steadily. Of 36 patients who have had shingles since seroconversion, 19 (53%) had counts below 0.2 x 10(9)/l. Thirty five out of 145 patients without shingles (24%) had similar values. The mean IgA concentration in patients with CD4+ T cell counts above 0.5 x 10(9)/l was 2.38 g/l, between 0.2 and 0.5 was 3.07 g/l, and in those with CD4+ T cell counts below 0.2 x 10(9)/l the mean IgA concentration was 4.58 g/l. Treatment patterns have altered between 1989 and 1991, with increased use of zidovudine in patients without AIDS and a marked increase in primary prophylaxis against pneumocystis pneumonia. This has been associated with a decline in the incidence of pneumocystis as an indicator disease in new AIDS cases from 56% in 1989 to 20% in 1991. These observations indicate that persistent generalised lymphadenopathy does not worsen the outlook, but shingles does. Rising IgA concentrations are markers for disease progression. Modern prophylactic regimens are delaying the onset of indicator disease, but CD4 values continue to fall steadily. PMCID: PMC1029282 PMID: 8099271 [PubMed - indexed for MEDLINE] 3602. Oftalmologia. 1993 Mar-May;37(2):124-9. [Ocular complications in zona ophthalmica] [Article in Romanian] Cernea P, Mocanu C, Tenea C. Clinica Oftalmologică Craiova. 81 cases of herpes zoster ophthalmicus with ocular affection, hospitalized in the clinic of ophthalmology between 1980-1991, are presented. The most frequent ocular complications were dendritic keratitis and punctate epithelial keratitis in 12 cases, neurotrophic keratitis in 7 cases, keratoendothelitis in 22 cases, iritis and iridocyclitis in 26 cases posterior uveitis in 3 cases. Seldom complications, presented each with a single case, were secondary glaucoma, optical postnevritical atrophy, oculomotor nerves palsy. The lesions were equally distributed between the two eyes. The associations of these complications determined visual acuity diminishing below 1/10 in 27 cases. In spite of association of classical treatment with recent antiviral medication and due to serious ocular complications which appear at most of 50% of the patients with herpes zoster ophthalmicus, the functional prognosis remains reserved. PMID: 8507622 [PubMed - indexed for MEDLINE] 3603. Changgeng Yi Xue Za Zhi. 1993 Mar;16(1):75-80. [Oral complications following a herpes zoster infection of trigeminal nerve] [Article in Chinese] Lin JR, Huang CC. Department of Dentistry, Chang Gung Memorial Hospital, Taiwan, R.O.C. A case of herpes zoster involving the ophthalmic and maxillary divisions of the trigeminal nerve is reported. It presented as a oral herpes zoster infection with prodromal odontalgia and progressed to spontaneous exfoliation and devitalization of teeth and osteonecrosis of the maxilla. The literature is reviewed and the pathophysiology of tooth exfoliation, tooth devitalization and osteonecrosis by V-Z viruses are discussed in addition to the management of herpes zoster and post-zoster complications. PMID: 8490779 [PubMed - indexed for MEDLINE] 3604. Clin Exp Dermatol. 1993 Mar;18(2):196. The treatment of herpes zoster with flamazine--a double-blind placebo-controlled trial. Mallett RB, Staughton RC. PMID: 8482003 [PubMed - indexed for MEDLINE] 3605. Rev Clin Esp. 1993 Mar;192(4):203-4. [Herpes zoster involving multiple cranial nerves] [Article in Spanish] de la Fuente Aguado J, Bordón JM, Prieto López I, Sopeña Pérez-Argüelles B. PMID: 8480073 [PubMed - indexed for MEDLINE] 3606. No To Hattatsu. 1993 Mar;25(2):128-34. [Neurological complications of varicella-zoster virus (VZV) infection] [Article in Japanese] Shiihara H. Department of Pediatrics, Koshigaya Hospital, Dokkyo University School of Medicine, Saitama. Sixty cases with varicella-associated neurological disorders from Japanese literature during recent 11 years were analyzed and compared with previous reports. Chief diseases were encephalitis (encephalopathy) (23.3%), cerebellar ataxia (21.7%), meningitis (18.3%), cerebral infarction (13.3%) and facial palsy (8.3%). Cerebellar ataxia, meningitis and cerebral infarction were found in young children under 9 years, and other disorders were seen also in older children and adults. Some cases had neurological symptoms before the appearance of skin rash. The number of cells in cerebrospinal fluid was increased in meningitis, encephalitis and myelitis. Though neurological complications due to varicella were rare, prognosis was not necessarily good, including several cases with death or severe sequelae. In our 4 cases of herpes zoster meningitis, marked intrathecal VZV-specific antibody production was found and they showed high antibody index. Oligoclonal band was found in one case. The pathogenesis of neurological complications of VZV infection was considered to be caused by direct viral invasion in herpes zoster and at least in some cases of varicella. Therapy with antiviral agents is necessary and vaccination is recommended for prevention. PMID: 8461162 [PubMed - indexed for MEDLINE] 3607. Cornea. 1993 Mar;12(2):131-7. Detection of varicella zoster virus DNA and viral antigen in human cornea after herpes zoster ophthalmicus. Wenkel H, Rummelt C, Rummelt V, Jahn G, Fleckenstein B, Naumann GO. Department of Ophthalmology, University of Erlangen-Nürnberg, Germany. This article describes the histopathology, immunohistochemistry, and varicella zoster virus DNA in situ hybridization of 14 corneal buttons obtained from 14 patients (average age 69.0 years) after perforating keratoplasty (four patients) or surgical enucleation (10 patients) at different times after the clinical onset of herpes zoster ophthalmicus (average 58.7 months). The main histopathologic features were intense stromal vascular scarring (12 patients) and granulomatous reaction to Descemet's membrane (nine patients). Using the peroxidase-antiperoxidase method, varicella zoster virus (VZV) antigen could be detected by immunohistochemistry in two patients within epithelial cells of the cornea and in the limbal episclera during the active phase of herpes zoster ophthalmicus. For in situ hybridization we used the 35S-labeled HindIII A and C fragment of VZV and identified viral DNA in five corneal buttons obtained 1 day to 8 years after the clinical onset of infection. Viral DNA was mainly found in mononuclear cells with eosinophilic intracytoplasmic inclusions within vascular stromal scars, in keratocytes, and in epithelial cells of the cornea. Our results show that VZV DNA is detectable in human cornea even 8 years after the clinical onset of herpes zoster ophthalmicus and may indicate VZV persistence in a latent form in corneal tissue or reactivation of the virus from an endogenous or exogenous source causing a severe and often recurrent keratitis in the progress of herpes zoster ophthalmicus. PMID: 8388787 [PubMed - indexed for MEDLINE] 3608. Pediatr Neurol. 1993 Mar-Apr;9(2):134-6. Reye syndrome associated with subclinical varicella zoster virus and influenza A infection. Hukin J, Junker AK, Thomas EE, Farrell K. Department of Pediatrics, University of British Columbia, Vancouver, Canada. An association is reported between Reye syndrome and varicella zoster virus (VZV) infection in a 10-year-old boy who had serologic evidence of coinfection with VZV and influenza A H3N2, and exposure to salicylates. He developed VZV reinfection without skin lesions after family exposure and influenza A was community-acquired. Recent chickenpox contact should initiate VZV serologic studies in Reye syndrome patients, regardless of the chickenpox history or evidence of infection with other viruses. PMID: 8388687 [PubMed - indexed for MEDLINE] 3609. Surv Ophthalmol. 1993 Mar-Apr;37(5):313-52. Systemic viral infections and their retinal and choroidal manifestations. Yoser SL, Forster DJ, Rao NA. Doheny Eye Institute, University of Southern California School of Medicine, Los Angeles. Viruses are one of the most common causes of infections involving the posterior segment of the eye. Such infections can occur either on a congenital or an acquired basis, and may affect primarily the retina or the choroid. Congenital cytomegalovirus (CMV) and rubella infections may result in retinitis. CMV retinitis is also the most common cause of acquired viral retinitis, primarily because of the acquired immunodeficiency syndrome (AIDS). Other types of viral retinitis, such as those caused by herpes simplex or herpes zoster, can occur in immunocompromised or immunocompetent individuals. Retinitis or choroiditis caused by viruses such as measles, influenza, Epstein-Barr virus, and Rift Valley fever virus, typically occurs subsequent to an acute viral systemic illness. The systemic and ocular manifestations, as well as the histopathology, laboratory tests, differential diagnoses, and treatment regimens for each of the individual viruses are discussed in detail. PMID: 8387231 [PubMed - indexed for MEDLINE] 3610. Gut. 1993 Mar;34(3):299-302. Varicella-zoster virus DNA in the oesophageal myenteric plexus in achalasia. Robertson CS, Martin BA, Atkinson M. Department of Surgery, University of Nottingham. In a search for past or present infection with herpes viruses, serum antibody titres to herpes simplex type 1 virus, cytomegalovirus, and varicella-zoster virus were measured by complement fixation test in 58 patients with achalasia. Serum was also taken from 40 age and sex matched patients without oesophageal symptoms who formed a control group. All titres were low, and those for herpes simplex type 1 virus and cytomegalovirus did not differ in the achalasia patients and the controls. However, the incidence of varicella-zoster virus antibodies was significantly greater in the achalasia than in the control group (p < 0.05). Using oesophageal tissue containing myenteric plexus removed at the time of cardiomyotomy in nine patients with achalasia, in situ DNA hybridisation showed evidence of varicella-zoster virus in three, but all were negative for the other two viruses. No positive results were obtained for herpes simplex type 1 virus, cytomegalovirus, or varicella-zoster virus in oesophageal tissue from 20 patients undergoing oesophageal resection for diseases other than achalasia. The incidence of positivity for varicella-zoster virus was significantly increased in the achalasia group compared with the controls (p < 0.02). The findings indicate that varicella-zoster virus DNA may persist in the oesophageal myenteric plexus in some patients with achalasia and raise the possibility that this virus is of aetiological importance in achalasia. PMCID: PMC1374131 PMID: 8386130 [PubMed - indexed for MEDLINE] 3611. J Med Virol. 1993 Mar;39(3):242-5. Depressed immune functions in the early phase of varicella-zoster virus reactivation. Saibara T, Maeda T, Onishi S, Yamamoto Y. First Department of Medicine, Kochi Medical School, Nankoku, Japan. Varicella-zoster virus (VZV) infections are among the most common viral diseases characterized by recurrent episodes alternating with asymptomatic periods. VZV reactivation is believed to be induced by the impairment of the host's cell-mediated immune system; however, the precise mechanisms involved in the latency period and reactivation of herpes viruses in the infected host are not yet fully elucidated. We assessed the immune functions in noncompromised patients with typical herpes zoster to investigate the immunological status during the process of reactivation of VZV. The results indicated depressed immune functions in the early stage of VZV reactivation with gradual improvement during the recovery phase. These findings are in accord with the clinical course of herpes zoster and suggest a possible therapeutic trial. PMID: 8385706 [PubMed - indexed for MEDLINE] 3612. J Comput Assist Tomogr. 1993 Mar-Apr;17(2):313-6. MRI in varicella-zoster virus leukoencephalitis in the immunocompromised host. Lentz D, Jordan JE, Pike GB, Enzmann DR. Department of Radiology, Stanford University School of Medicine, CA 94305-5105. Immunocompromised patients are at increased risk for CNS and disseminated varicella zoster virus (VZV) infection. In this report we present the MR findings in a leukemic patient with active, biopsy-proven VZV leukoencephalitis. The characteristic MR features of this infection were clustered subcortical plaque-like lesions demonstrating rapid demyelination. Active lesions enhanced with intravenous contrast medium administration. Edema and hemorrhage were not prominent early findings but developed as the infection evolved. These findings were strikingly similar to those reported in prior autopsy studies of immunocompromised patients with VZV leukoencephalitis. PMID: 8384224 [PubMed - indexed for MEDLINE] 3613. Chin Med Sci J. 1993 Mar;8(1):38-40. Treatment of herpes zoster: recombinant alpha-2a-interferon versus acyclovir and vitamin therapy. Clinical Study Group on Interferon. Yu B. PUMC Hospital, CAMS, Beijing. The efficacy of r-interferon alpha 2a (IFM) versus acyclovir (ACV) and vitamin therapy in the treatment of herpes zoster is reported. A total of 305 patients were randomly divided into 3 groups. One million units of IFN were administered i.n. once a day for 6 days in 223 cases, oral ACV 200 mg five times daily for 7 days in 34 cases, and vitamin B12, B1 and B2 therapy at conventional doses for 7-14 days in 48 cases. The results showed that both IFN and ACV could reduce pain in patients with herpes zoster and cut the total duration of symptoms, in comparison with vitamin therapy (P < 0.01). In the IFN group, 45 patients (20.2%) experienced side effects, including mild fever in 35 cases (15.7%) and a slightly depressed leukocyte count or increased serum ALT level (3 cases each). In the ACV group, one complained of discomfort in the gastroenteric tract, and another patient reported lumbodynia. PMID: 8274720 [PubMed - indexed for MEDLINE] 3614. J Assoc Physicians India. 1993 Mar;41(3):178. Unilateral ataxia following herpes zoster of spinal C4 segment. Keswani P, Gupta R, Singh KP, Juneja P, Chablani P. Department of Medicine, Monilek Hospital & Research Centre, Jawahar Nagar, Jaipur. Focal lesions of central nervous system are extremely rare following cutaneous herpes zoster. A 55 year old male developed cerebellar speech, right sided ataxia and intention tremor, three weeks after herpes zoster of right spinal C4 segment. Clinical examination and investigations confirmed a focal vascular lesion in the midbrain suggestive of granulomatous angiitis which can cause focal neurological defect after herpes zoster. PMID: 8226607 [PubMed - indexed for MEDLINE] 3615. Ugeskr Laeger. 1993 Feb 22;155(8):536-40. [Neurological complications of herpes zoster in the central nervous system] [Article in Danish] Andersen B. Neuromedicinsk afdeling, Københavns Amts Sygehus i Glostrup. The Varicella zoster virus may affect the central nervous system (CNS) as a complication of herpes zoster (HZ). A series of neurological syndromes are described and, on the basis of a review of the literature and two illustrative case histories, the symptomatology, pathogenesis, therapeutic possibilities and the diagnostic difficulties in HZ-associated cerebral vasculitis and HZ-associated encephalitis are reviewed. Progressive multifocal encephalopathy in immune-insufficient individuals is briefly mentioned. The diagnosis is most frequently established on the basis of the clinical picture when the characteristic symptoms develop in connection with cutaneous HZ. A long latent period may result in defective recognition of the connection. Immuno-suppression and dissemination are critical determinants for the course of the condition but, in immune-competent individuals, the morbidity and mortality are low. Treatment with acyclovir is employed to an increasing extent with good results but the conditions are rare and clinically controlled investigations are not available. It is important that the possibility of HZ-associated CNS-disease is borne in mind, in view of the therapeutic possibilities. The pathogeneses of these complications is little understood but there is increasing evidence that a direct viral invasion is the mechanism responsible. A post-infectious immune-mediate mechanism is also another popular opinion. PMID: 8451785 [PubMed - indexed for MEDLINE] 3616. Ugeskr Laeger. 1993 Feb 22;155(8):528-32. [Human herpesvirus infections. A clinical review] [Article in Danish] Peterslund NA. Medicinsk haematologisk afdeling, Arhus Amtssygehus. PMID: 8383894 [PubMed - indexed for MEDLINE] 3617. Lancet. 1993 Feb 13;341(8842):447. Zoster after shiatsu massage. Mumm AH, Morens DM, Elm JL, Diwan AR. PMID: 8094222 [PubMed - indexed for MEDLINE] 3618. J Indian Med Assoc. 1993 Feb;91(2):46-7. Postherpetic neuralgia and its managements. Rudra A, Mitra A, Pan AK, Roy M. Department of Anaesthesiology, NRS Medical College, Calcutta. PMID: 8501317 [PubMed - indexed for MEDLINE] 3619. Pediatr Emerg Care. 1993 Feb;9(1):33-5. Pediatric herpes zoster with mild cutaneous dissemination. Courter BJ. Department of Emergency Medicine, Greenville Hospital System, South Carolina. The textbook division of herpes zoster into segmental or disseminated is too simple and limited. Like all diseases, herpes zoster presents as a spectrum of disease. Mild cutaneous dissemination represents a "transition zone" in this spectrum and appears to be a benign clinical variant. This case of pediatric herpes zoster with mild cutaneous dissemination did not need aggressive inpatient treatment with IV agents; appropriate treatment included close follow-up. Optional treatment with high-dose oral acyclovir was also instituted. PMID: 8488143 [PubMed - indexed for MEDLINE] 3620. Klin Monbl Augenheilkd. 1993 Feb;202(2):102-9. [Tarsoconjunctival advancement--a surgical procedure in cicatricial entropion with marginal tarsus deformation] [Article in German] Kuckelkorn R, Becker J, Reim M. Augenklinik der Medizinischen Fakultät, Rheinisch-Westfälischen Technischen Hochschule RWTH. BACKGROUND: After severe chemical and thermal burns, and in chronic inflammatory conditions of the conjunctiva frequently scarring of the tarsal plate with distortion of the eyelid margin and keratinization of the tarsal conjunctiva could be found. This condition is accompanied with chronic inflammation and malposition of the eyelids resulting in entropion and trichiasis. PATIENTS AND METHODS: A surgical procedure is introduced separating the scarred and shortened tarsal plate from the cutis-muscle sheet. After excision of tarsal scar tissue and of the marginal metaplastic tarsus a new eyelid margin is formed by tarso-conjunctival advancement, correcting trichiasis and cicatricial entropion. During the time from August 1984 to December 1991 this surgical procedure was conducted on 16 patients, correcting 18 upper and 4 lower eyelids. 11 patients suffered from severe chemical and thermal burns, 2 patients from Stevens-Johnson-syndrome, 2 patients from ocular pemphigoid and 1 patient from herpes zoster infection. RESULTS: All patients were examined at least once in the first 6 postoperative months, 11 patients are still under continuing outpatient review. The mean follow-up time is 27 months, the minimum follow-up period is 7 months. In 7 patients the surgical procedure prepared conditions for a successful keratoplasty and in 5 other cases the keratopathy healed. In 4 cases a recurrence of the entropion occurred (18% recurrence rate). CONCLUSIONS: The presented surgical procedure is a promising alternative to more complicated procedures for correcting cicatricial entropion with keratinization of the marginal tarsus. PMID: 8487462 [PubMed - indexed for MEDLINE] 3621. Med J Aust. 1993 Feb 1;158(3):186-7. Unusual features of herpes simplex or zoster infection that suggest HIV infection. Crowe SM. Macfarlane Burnet Centre for Medical Research, Fairfield Hospital, Vic. Patients with herpes simplex or zoster infections are common in most medical practices. These infections are also very important in HIV medicine, often presenting in an otherwise well person. Knowledge of the effects of immune deficiency on herpes simplex and zoster infection assists in determining when to consider HIV. PMID: 8450787 [PubMed - indexed for MEDLINE] 3622. Aust Fam Physician. 1993 Feb;22(2):195. A case of unilateral painful eye. Thomas P. Emergency Department, Princess Alexandra Hospital, Queensland. A 24 year old man presented with a painful eye that had been treated empirically with steroid drops. The case is presented to illustrate that before prescribing steroid eye drops, a definitive diagnosis must be reached and this often requires the services of an ophthalmologist. PMID: 8447789 [PubMed - indexed for MEDLINE] 3623. J Am Acad Dermatol. 1993 Feb;28(2 Pt 2):306-8. Chronic hyperkeratotic herpes zoster and human immunodeficiency virus infection. Grossman MC, Grossman ME. Department of Dermatology, College of Physicians and Surgeons, New York, NY 10032. A patient with human immunodeficiency virus infection had hyperkeratotic papules in the T 11 and T 12 dermatomes in which she previously had papulovesicular herpes zoster. Findings of a biopsy specimen and viral culture of these papules subsequently revealed varicella-zoster that eventually responded to prolonged high-dose acyclovir therapy and debridement. A review of reported cases of hyperkeratotic varicella-zoster infections is presented, in addition to our recommendations for the treatment of varicella-zoster infection in patients who have acquired immunodeficiency syndrome. PMID: 8436645 [PubMed - indexed for MEDLINE] 3624. Arch Ophthalmol. 1993 Feb;111(2):167-8. Detection of varicella-zoster virus DNA in disciform keratitis using polymerase chain reaction. Yu DD, Lemp MA, Mathers WD, Espy M, White T. PMID: 8431148 [PubMed - indexed for MEDLINE] 3625. Am J Med. 1993 Feb;94(2):212-5. Acyclovir-induced neurotoxicity: concentration-side effect relationship in acyclovir overdose. Haefeli WE, Schoenenberger RA, Weiss P, Ritz RF. Department of Internal Medicine, University Hospital (Kantonsspital), Basel, Switzerland. PURPOSE: To investigate the concentration-side effect relationship in a patient with severe acyclovir-induced neurotoxicity and to summarize the information available in the literature about central nervous system side effects due to acyclovir. METHODS: Repeated blood samples were drawn in a patient with severe acyclovir overdose who developed coma and nonoliguric renal failure. The acyclovir levels measured by radioimmunoassay were related to the level of consciousness. RESULTS: We measured the highest acyclovir serum levels reported so far (229.9 mumol/L = 51.8 mg/L). Impairment of consciousness developed with a remarkable temporal delay of 24 to 48 hours after occurrence of peak serum concentrations and resolved with a comparable delay after reaching the therapeutic range (anticlockwise hysteresis). Six days after discontinuation of the drug, central nervous system symptoms had resolved, and, 4 days later, renal function returned to pretreatment values. CONCLUSIONS: The observation that neurotoxicity developed with a delay of 24 to 48 hours after acyclovir peak serum concentrations could explain the wide range of acyclovir levels reported in similar cases. Single drug level measurements may therefore be of little diagnostic value. Since toxicity develops with a remarkable delay, early removal of the drug (by hemodialysis) could possibly prevent central nervous toxicity. PMID: 8430717 [PubMed - indexed for MEDLINE] 3626. Blood. 1993 Feb 1;81(3):828-34. Human immunodeficiency virus-related conditions in children and adults with hemophilia: rates, relationship to CD4 counts, and predictive value. Eyster ME, Rabkin CS, Hilgartner MW, Aledort LM, Ragni MV, Sprandio J, White GC, Eichinger S, de Moerloose P, Andes WA, et al. Department of Medicine, Pennsylvania State University School of Medicine, Hershey. To further elucidate the natural history of human immunodeficiency virus (HIV) infection, we studied intermediate HIV-related conditions occurring before acquired immunodeficiency syndrome (AIDS) in a prospectively observed multicenter cohort of 738 HIV-infected persons with hemophilia. We analyzed the frequency in adults and children of common HIV-related conditions and the relative risk of AIDS after occurrence of these conditions, controlling for age at seroconversion and the percentage of CD4+ lymphocytes. Thrombocytopenia was the most frequently observed condition with cumulative incidences of 43% +/- 7% in adults and 27% +/- 6% in children and adolescents by 10 years after seroconversion. Oral candidiasis, fever, weight loss, and non-AIDS pneumonia were two to four times more common in adults than children, whereas herpes zoster risk was similar in the two age groups. HIV-related conditions were infrequent during the first 4 years of infection, particularly in children. With the exception of thrombocytopenia, mean CD4 counts were less than 350 cells/microL at the onset of the conditions. The relative hazard of AIDS after oral candidiasis was 18 in children and 3.8 in adults. Relative hazard in adults was also increased after persistent fever (10), weight loss (3.2), and non-AIDS pneumonia (2.2). Herpes zoster and thrombocytopenia were not significantly associated with AIDS in either age group. We conclude that intermediate HIV-related conditions occur more frequently in adults than in children with hemophilia. Persistent fever is the strongest predictor of AIDS in adults, whereas oral candidiasis is the strongest predictor in children. These findings should facilitate the design and conduct of clinical trials as well as the management of HIV-infected children and adults. PMID: 8427974 [PubMed - indexed for MEDLINE] 3627. J Cutan Pathol. 1993 Feb;20(1):28-33. Varicella-zoster virus DNA in granulomatous skin lesions following herpes zoster. A study by the polymerase chain reaction. Serfling U, Penneys NS, Zhu WY, Sisto M, Leonardi C. Granulomatous reactions at sites of previous cutaneous herpes zoster lesions occur, but their etiology is not known. Three tissue specimens from 5 cases identified clinically and histologically as post-zosteric granulomatous reactions were studied for the presence of varicella-zoster virus (VZV) deoxyribonucleic acid (DNA) by the polymerase chain reaction using specific primers for VZV. VZV DNA was detected in 1 of 3 cases where the granulomatous reaction occurred immediately in the wake of resolving vesicular herpes zoster lesions. Finding viral DNA in earlier reactions probably represents residue from the active herpetic process. VZV DNA was not identified in granulomatous reactions arising between 1 month and up to 4 years after resolved herpes zoster. The negative result in these cases supports the hypothesis that there is no association between persistence of VZV DNA and granuloma formation. How long VZV DNA is detectable at sites of resolved herpes zoster lesions could be the subject of further studies. PMID: 8385680 [PubMed - indexed for MEDLINE] 3628. Clin Infect Dis. 1993 Feb;16(2):208-12. Varicella-zoster virus retinitis in a patient with AIDS-related complex: case report and brief review of the acute retinal necrosis syndrome. Hellinger WC, Bolling JP, Smith TF, Campbell RJ. Section of Infectious Diseases, Mayo Clinic Jacksonville, Florida 32224. Comment in: Clin Infect Dis. 1993 Nov;17(5):943-4. Retinitis reminiscent of the acute retinal necrosis syndrome was recognized in a patient with AIDS-related complex after he had experienced several episodes of a sacral, dermatomic zosteriform eruption. Varicella-zoster virus (VZV) was subsequently recovered from cell culture of retinal tissue. The literature on VZV retinitis, including that on acute retinal necrosis, is reviewed. Dissemination of VZV infection in AIDS is also reviewed. Features that differentiate the findings and course of VZV retinitis in patients with AIDS from those in otherwise healthy adults are noted and related to potentially different pathogenic mechanisms. This unusual and recently recognized complication of herpesvirus infection may be promoted by AIDS-related immunosuppression. Acute retinal necrosis and other more-recently described forms of VZV retinitis, which have primarily been subjects of the ophthalmologic literature, merit the attention of clinicians and investigators of infectious diseases. PMID: 8382963 [PubMed - indexed for MEDLINE] 3629. Oral Surg Oral Med Oral Pathol. 1993 Feb;75(2):173-5. Zoster sine herpete of the trigeminal nerve. Barrett AP, Katelaris CH, Morris JG, Schifter M. Westmead Hospital Dental Clinical School, New South Wales, Australia. Zoster sine herpete infection that involves the trigeminal nerve is rarely reported. The present case details a case of varicella zoster virus infection of the mandibular division of the left trigeminal nerve without evidence of a vesicular eruption. The diagnosis was established on clinical findings and was supported by the demonstration of an IgG antibody titer of > 1:640 during the acute phase of the disease. PMID: 8381216 [PubMed - indexed for MEDLINE] 3630. J Assoc Physicians India. 1993 Feb;41(2):113-4. Ramsay Hunt syndrome with aseptic meningitis. Bhattacharyya PC, Kakati S. Assam Medical College, Dibrugarh. A case of Ramsay Hunt Syndrome with characteristic vesicles on the lateral aspect of the left pinna, evidence of infranuclear palsy of the left 7th cranial nerve, associated with same sided loss of taste sensation in the presulcal area of the tongue and perceptive deafness without vestibular disturbances is reported here. The patient had evidence of aseptic meningitis. PMID: 8335601 [PubMed - indexed for MEDLINE] 3631. Lik Sprava. 1993 Feb-Mar;(2-3):128-31. [Herpes zoster in hematology patients] [Article in Ukrainian] Turkot LA, Donets' IA, Kmita VV. A clinical course of herpes zoster in hematological patients (chronic lympholeukosis, lymphogranulomatosis, acute leucosis, myeloma disease, chronic agranulocytosis) is presented. These patients exhibited a more severe course of herpes zoster that is caused by immunodeficiency state. It is judicious to treat the patients with reaferon. PMID: 8191711 [PubMed - indexed for MEDLINE] 3632. J Hosp Infect. 1993 Feb;23(2):161-2. Susceptibility of hospital staff to varicella-zoster virus infection in Hong Kong. Bassett DC, Ho AK, Cheng AF. Comment on: J Hosp Infect. 1992 Feb;20(2):125-6. PMID: 8097220 [PubMed - indexed for MEDLINE] 3633. Dtsch Med Wochenschr. 1993 Jan 12;118(1-2):30-7. [Skin and mucosal infections caused by viruses of the herpesvirus group in HIV infections] [Article in German] Plettenberg A, Stoehr A, Meigel W. Interdisziplinäre HIV-Ambulanz des Allgemeinen Krankenhauses St. Georg, Hamburg. PMID: 8380556 [PubMed - indexed for MEDLINE] 3634. Rom J Virol. 1993 Jan-Jun;44(1-2):91-5. [Beneficial effects of immunostimulant and antiviral therapy of ophthalmic herpes zoster] [Article in French] Topciu V, Chercotă G, Mihăilescu R, Nadolnic A. Université de Médecine et Pharmacie, Timişoara, Roumanie. A group of 16 patients with ophthalmic zona zoster received antiviral and immunostimulative treatment with Romanian specific products. Results were spectacular. The problem of the identity of the varicella and zoster viruses is discussed. PMID: 9702254 [PubMed - indexed for MEDLINE] 3635. Rom J Virol. 1993 Jan-Jun;44(1-2):17-20. [Moroxidine, an antiviral agent used for the treatment of shingles (herpes zoster)] [Article in French] Athanasiu P, Petrescu A, Vulcan V. Institut de Virologie Stefan S. Nicolau, Bucarest, Roumanie. Treatment with moroxidine, Romanian preparation with virustatic effects, was applied in 350 patients with different localisation herpes zoster lesions. Treatment had good effects, especially when it was applied early. PMID: 9702246 [PubMed - indexed for MEDLINE] 3636. Neuroradiology. 1993;35(4):269. Gadolinium-enhanced MRI in a patient with AIDS and the Ramsay-Hunt syndrome. Li J, Xiong L, Jinkins JR. Neuroradiology Section, University of Texas Health Science Center, San Antonio 78284-7800. PMID: 8492890 [PubMed - indexed for MEDLINE] 3637. Acta Otolaryngol Suppl. 1993;504:125-9. A case of Bickerstaff's encephalitis. With special reference to neurotological findings. Omura A, Watanabe Y, Kobayashi H, Shojaku H, Mizukoshi K. Department of Otorhinolaryngology, Faculty of Medicine, Toyama Medical and Pharmaceutical University, Japan. The case of a 60-year old male with prodromal common cold symptoms and progression of brain stem involvement with no cardiac or respiratory complications is described. This conformed to the criteria of Bickerstaff's encephalitis. Neurotological examinations, including the OKN test, the caloric test, and the GBST were performed from onset to recovery of the disease. The results of these tests closely reflected the central nervous system disorders each time, but there was a discrepancy in the results of the two test batteries of equilibrium function, the caloric test and the GBST. The caloric test showed bilateral canal paresis while the GBST showed normal responses. These results suggested that the involved area of the vestibular nucleus was localized to the superior portions. Form our clinical observations, we can conclude that neurotological examinations provide more vital information for localized diagnosis and follow-up of the brain stem lesion in Bickerstaff's encephalitis. PMID: 8470517 [PubMed - indexed for MEDLINE] 3638. Eur Neurol. 1993;33(2):156-8. Guillain-Barré syndrome after herpes zoster infection: a report of 2 cases. Ormerod IE, Cockerell OC. Department of Neurology, St Thomas' Hospital, London, UK. We report 2 patients with Guillain-Barré syndrome following infection with the varicella-zoster virus. Evidence from neurophysiological studies is provided and the literature is reviewed on the association between these conditions. PMID: 8467824 [PubMed - indexed for MEDLINE] 3639. J Infect. 1993 Jan;26(1):87-8. Aseptic arthritis associated with herpes zoster. Aarons EJ, Beeching NJ. Regional Infectious Disease Unit, Fazakerley Hospital, Liverpool, U.K. Arthritis associated with herpes zoster is rarely reported. We describe the clinical features of an immunocompromised 54-year-old woman who developed sterile arthritis of a knee in association with acute ipsilateral zoster of the L1/L2 dermatomes. PMID: 8454892 [PubMed - indexed for MEDLINE] 3640. Ostomy Wound Manage. 1993 Jan-Feb;39(1):44-5, 48, 50-1. Case study: a hydrogel for infected herpes zoster lesions. Harvey MJ. PMID: 8452622 [PubMed - indexed for MEDLINE] 3641. Acta Otolaryngol Suppl. 1993;500:58-61. Enhanced MRI in patients with Ramsay-Hunt's syndrome. Yanagida M, Ushiro K, Yamashita T, Kumazawa T, Katoh T. Department of Otolaryngology, Kansai Medical University, Osaka, Japan. Enhanced MRI was performed in 14 patients with Ramsay-Hunt's syndrome to investigate the pathogenesis of this syndrome. All MRI studies were performed on a 0.5T superconductivity MRI system using a head coil with Gd-DTPA. Enhancement was observed in the areas of the distal internal auditory canal and labyrinthine segment in many patients, and was especially prominent in patients suffering from vertigo, tinnitus, and hearing loss. In some patients it involved not only the facial nerve of the internal auditory canal but also the cochlear nerve and vestibular nerves. Since histological changes of the facial nerve in patients with Ramsay-Hunt's syndrome are assumed to occur in the distal internal auditory canal and labyrinthine segment, which is more proximal than the geniculate ganglion, and the possibility is suggested that inflammation may spread to the vestibular and cochlear nerve via the internal auditory canal. PMID: 8452022 [PubMed - indexed for MEDLINE] 3642. Clin Infect Dis. 1993 Jan;16(1):190-1. Acute abdominal pain as a presenting symptom of varicella-zoster virus infection in recipients of bone marrow transplants. Verdonck LF, Cornelissen JJ, Dekker AW, Rozenberg-Arska M. PMID: 8448313 [PubMed - indexed for MEDLINE] 3643. Clin Exp Dermatol. 1993 Jan;18(1):92-3. An unusual distribution of an acneiform rash due to herpes zoster infection. Stubbings JM, Goodfield MJ. Department of Dermatology, General Infirmary, Leeds, UK. Acne can affect unusual sites and occur at unusual ages with little involvement of the commonly affected sites. Discrete areas can be affected by acne which has been reported to occur in a naevoid form. We report a patient who developed an acneiform rash in the site of a previous herpes zoster infection. PMID: 8440068 [PubMed - indexed for MEDLINE] 3644. Ann Ophthalmol. 1993 Jan;25(1):20-3. Superior altitudinal hemianopia and herpes zoster. Miyashita K, Kigasawa K, Mashima Y, Fujino T. Department of Opthalmology, School of Medicine, Tokai University, Kanagawa, Japan. A healthy 41-year-old women had acute retrobulbar optic neuritis with superior altitudinal hemianopia four weeks after cutaneous herpes zoster. Her visual acuity decreased to 0.04 OD, and mild iritis was noticed. However, ophthalmoscopic examination and fluorescein angiography disclosed no remarkable change. She had a low amplitude during flash visual-evoked potential testing with almost normal latency time in the acute stage. Corticosteroid therapy was administered, and her visual acuity and visual-field defect rapidly improved. Complete recovery, including the pattern-reversal visual-evoked potential results, was obtained. PMID: 8427486 [PubMed - indexed for MEDLINE] 3645. Ann Ophthalmol. 1993 Jan;25(1):14-5. Posttraumatic herpes zoster ophthalmicus as a presenting sign of human immunodeficiency virus infection. Netland PA, Zierhut M, Raizman MB. Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston. We present the case of a 38-year-old man who developed herpes zoster ophthalmicus after orbital blunt trauma. Additional evaluation revealed human immunodeficiency virus type 1 (HIV-1) infection. This case shows that varicella-zoster may be activated by local trauma and that herpes zoster ophthalmicus in young patients may indicate underlying HIV-1 infection. PMID: 8427484 [PubMed - indexed for MEDLINE] 3646. AJNR Am J Neuroradiol. 1993 Jan-Feb;14(1):203-4. MR of the spinal cord in a patient with herpes zoster. Esposito MB, Arrington JA, Murtaugh FR, Coleman JM, Sergay SM. Department of Radiology, University of South Florida College of Medicine, Tampa 33612. Increased signal intensity on initial magnetic resonance images of the spinal cord in a patient with herpes zoster demonstrated that this virus caused inflammation of the cervical spinal cord. This pathology corresponded well with neurologic deficits seen clinically, but the extent of the neurologic deficits ultimately could not be determined by magnetic resonance of the spinal cord alone because the nerve roots were also affected. PMID: 8427090 [PubMed - indexed for MEDLINE] 3647. AJNR Am J Neuroradiol. 1993 Jan-Feb;14(1):185-90. Herpes zoster ophthalmicus with orbital pseudotumor syndrome complicated by optic nerve infarction and cerebral granulomatous angiitis: MR-pathologic correlation. Lexa FJ, Galetta SL, Yousem DM, Farber M, Oberholtzer JC, Atlas SW. Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia 19104. The authors describe a 41-year-old woman with herpes zoster ophthalmicus and extensive intracranial and orbital involvement as documented by MR and pathologically. MR showed all of the lesions that led to the ophthalmoplegia and pseudotumor syndrome, the periaxial infarct of the distal optic nerve, pontine infarcts, and granulomatous angiitis of the meningeal vessels. MR is useful in both detection and monitoring of the disease. PMID: 8427086 [PubMed - indexed for MEDLINE] 3648. Int J Dermatol. 1993 Jan;32(1):24-6. Urinary retention associated with herpes zoster infection. Cohen LM, Fowler JF, Owen LG, Callen JP. Department of Medicine, University of Louisville School of Medicine, Kentucky. BACKGROUND. Herpes zoster infection particularly involving the sacral dermatomes has been associated with bladder and bowel dysfunction, most commonly urinary retention. CASE REPORTS. We report two patients who developed acute urinary retention, one of whom also had constipation, within days of herpes zoster skin lesions of the S2-S4 dermatomes. CONCLUSIONS. Herpes zoster is a reversible cause of neurogenic bladder and bowel dysfunction and should be considered in a patient that presents with acute urinary retention and/or constipation. Sensory abnormalities and flaccid detrusor paralysis are most likely involved in the pathogenesis. PMID: 8425796 [PubMed - indexed for MEDLINE] 3649. Int Ophthalmol Clin. 1993 Winter;33(1):81-93. The biology of herpes simplex and varicella zoster virus infections. Liesegang TJ. Department of Ophthalmology, Mayo Clinic Jacksonville, FL 32224. PMID: 8394293 [PubMed - indexed for MEDLINE] 3650. J Infect Dis. 1993 Jan;167(1):78-83. Investigation of the pathogenesis of varicella-zoster virus infection in guinea pigs by using polymerase chain reaction. Lowry PW, Sabella C, Koropchak CM, Watson BN, Thackray HM, Abbruzzi GM, Arvin AM. Department of Pediatrics, Stanford University School of Medicine, California 94305. The polymerase chain reaction method (PCR) was used to investigate events in the pathogenesis of varicella-zoster virus (VZV) infection in strain 2, Hartley, and euthymic hairless guinea pigs. VZV was detected in peripheral blood mononuclear cells (PBMC) obtained 2-5 days after infection in 8 (50%) of 16 strain 2, 4 (40%) of 10 hairless, and 10 (34%) of 29 Hartley guinea pigs. The frequency of VZV-infected PBMC was estimated to be at least 1/200,000, which is comparable to that observed in human infection. When VZV PCR was used to test ganglia from hairless guinea pigs, samples from 6 of 8 animals were positive. Of 45 VZV-infected guinea pigs that were tested for cellular immunity by VZV T lymphocyte proliferation assay, 44 developed a stimulation index > 2.0. Control animals had no detectable virus by PCR and did not develop cellular immunity to VZV. These experiments showed that viremia was detectable by PCR during primary VZV infection of guinea pigs in about half of the animals regardless of the strain of guinea pig. Acquisition of cellular immunity provided a consistent marker of infection in all guinea pig strains. PCR was also useful for demonstrating VZV in guinea pig ganglia tissue, with VZV gene sequences being detectable for at least 80 days after infection. With the combination of PCR and immunologic assays, various guinea pig strains should be useful for studies of VZV pathogenesis and for the evaluation of antiviral agents and vaccine strategies. PMID: 8380293 [PubMed - indexed for MEDLINE] 3651. Eur Urol. 1993;24(2):244-7. Urological manifestations of herpes zoster. Broseta E, Osca JM, Morera J, Martinez-Agullo E, Jimenez-Cruz JF. Department of Urology, La Fe Hospital, Valencia, Spain. Herpes zoster is an infection caused by the varicella virus. Inflammatory reaction can involve the spinal cord and anterior horn cells causing varied neurological disorders including urological alterations. We reviewed 57 patients who suffered herpes zoster between 1984 and 1991. 15 of them (26%) showed urological manifestations: 2 cases acute urinary retention, 3 patients urinary incontinence and 10 cases had a cystitis-like syndrome. The clinical findings and diagnostic procedures are studied. The possible etiological mechanisms are discussed. The literature is reviewed. PMID: 8375446 [PubMed - indexed for MEDLINE] 3652. Bull Soc Pathol Exot. 1993;86(2):87-9. [Herpes Zoster, predictive element of human immunodeficiency virus infection (HIV). Epidemio-clinical study in Cotonou (Benin)] [Article in French] Yedomon HG, Doango-Padonou F, Adjibi A, Latoundji S, Zohoun I. Service de Dermatologie-Vénérologie, CNHU Cotonou, Bénin. An epidemio-clinical study of Herpes Zoster in 39 healthy patients of Benin has permitted to the authors to evaluate the positive predictive value of Herpes Zoster for HIV infection on West Africa; and to compare it with results of central Africa. The mean age of patients is 34.74 years. The positive predictive value of Herpes Zoster for HIV infection is 41.02%. It is increased by the cranial site of Herpes Zoster. PMID: 8353480 [PubMed - indexed for MEDLINE] 3653. Int Ophthalmol Clin. 1993 Winter;33(1):129-43. Acute retinal necrosis and similar retinitis syndromes. Culbertson WW, Atherton SS. Bascom Palmer Eye Institute, Miami, FL 33101. PMID: 8349421 [PubMed - indexed for MEDLINE] 3654. Schweiz Monatsschr Zahnmed. 1993;103(6):742-51. [Acute ulcerous-mucocutaneous skin and mucosal changes. The clinical picture, diagnosis and differential diagnosis] [Article in French, German] Gottsauner AJ, Hardt N. Kantonsspital Luzern, Klinik für Mund-Kiefer-Gesichts-Chirurgie. PMID: 8322059 [PubMed - indexed for MEDLINE] 3655. Acta Neuropathol. 1993;86(6):659-65. Acute varicella-zoster virus ventriculitis and meningo-myelo-radiculitis in acquired immunodeficiency syndrome. Chrétien F, Gray F, Lescs MC, Geny C, Dubreuil-Lemaire ML, Ricolfi F, Baudrimont M, Levy Y, Sobel A, Vinters HV. Départment de Pathologie (Neuropathologie), Hôpital Henri Mondor, Faculté de Médecine de Créteil, Université Paris XII, France. A 30-year-old AIDS patient with no history of cutaneous eruption, presented with rapidly progressive flaccid paraplegia, hypoesthesia, urinary retention, moderate psychomotor slowing and fever (39.8 degrees C), leading to death within 1 week. CD4 count was 290/mm3. Cerebrospinal fluid contained 210 white blood cells and 238 mg/100 ml protein. Neuropathology revealed HIV encephalitis and diffuse ventriculitis with Cowdry type A inclusions in the ependymal cells. Extensive necrotic and hemorrhagic changes with marked recrotizing vasculitis involved the entire spinal cord and spinal roots. Immunocytochemistry revealed numerous inclusion bodies positive for varicella-zoster virus (VZV) and negative for cytomegalovirus (CMV) and herpes simplex virus type 1 and 2, in ependymal cells, subpial glial cells, endothelial cells and Schwann cells. Electron microscopy confirmed herpes virus-like particles. In situ hybridization confirmed VZV genome in leptomeninges, brain, spinal cord and spinal roots. Comparable neuropathological findings and numerous VZV inclusion bodies were also found in the brain, spinal cord, and spinal roots of a 40-year-old AIDS patient who died from a fulminant ascending myeloradiculopathy previously reported as "necrotizing vasculitis of the nervous system". Direct infection of the brain by VZV, in AIDS patients, has been shown to cause leukoencephalitis and cerebral non-inflammatory vasculopathies. Our observations demonstrate that, in AIDS patients, VZV infection of the central nervous system may also be responsible for meningo-myelo-radiculitis possibly secondary to ventriculitis as in CMV infection. The role of VZV in the pathogenesis of some AIDS-related vasculitides seems also very likely. PMID: 8310822 [PubMed - indexed for MEDLINE] 3656. Ann Dermatol Venereol. 1993;120(8):563-70. [Capsaicin in dermatology] [Article in French] Paul C, Chosidow O, Francès C. Unité de Dermatologie, Groupe Hospitalier Pitié Salpétrière, Paris. PMID: 8304717 [PubMed - indexed for MEDLINE] 3657. Wien Klin Wochenschr. 1993;105(21):611-3. [Infective pathogens as a possible etiology of idiopathic peripheral facial paralysis] [Article in German] Imarhiagbe D, Prodinger WM, Schmutzhard E. Universitätsklinik für Neurologie, Innsbruck. A prospective clinical study was carried out from 1988 until 1990 on 38 consecutive patients with Bell's palsy at the Neurological Department of Innsbruck University Hospital. The age range was between 16 and 88 years, the female:male ratio was 18:20. Serological methods were employed to study the impact of infectious agents on the aetiology of this disease. 11 out of 38 cases (= 29%) were probably infectious in origin, whereby 6 cases were due to Borrelia burgdorferi, 4 to Varicella zoster virus (VZV) and 1 to Herpes simplex virus (HSV), as determined by elevation of antibody titre or presence of specific IgM. Patients with a significant serological finding were treated with ceftriaxon or tetracycline for borreliosis or with acyclovir for VZV or HSV infection. Altogether, in 36 of the 38 cases a full recovery was seen at the last follow-up investigation. PMID: 8273359 [PubMed - indexed for MEDLINE] 3658. Rev Neurol (Paris). 1993;149(5):353-4. [Jugular foramen syndrome caused by herpes zoster] [Article in French] Kahane P, De Saint Victor JF, Besson G, Hommel M, Perret J. Département des Neurosciences Cliniques et Biologiques, Centre Hospitalier Régional et Universitaire de Grenoble. Multiple cranial nerve palsies frequently occur in patients with cephalic zoster. Nevertheless, to our knowledge, involvement of the glossopharyngeal (IXth), vagus (Xth) and accessory (XIth) nerves has not yet been reported. We report a case of jugular foramen syndrome with palatolaryngeal herpetic eruption, aseptic meningitis and a high level of serum antibody to varicella-zoster virus. PMID: 8272734 [PubMed - indexed for MEDLINE] 3659. Recent Results Cancer Res. 1993;132:175-84. Varicella zoster infections in bone marrow transplants. Feldman S. UMC Children's Hospital, University of Mississippi Medical Center, Jackson 39216. PMID: 8265859 [PubMed - indexed for MEDLINE] 3660. Vaccine. 1993;11(11):1151-3. Diagnosis of zoster and evaluation of varicella vaccine with a passive haemagglutination assay. Kino Y, Minamishima Y. Chemo-Sero-Therapeutic Research Institute, Kumamoto, Japan. A passive haemagglutination (PHA) assay for the detection of varicella-zoster virus (VZV) antibody was prepared with purified viral glycoproteins. Serum samples from vaccinees with live attenuated varicella vaccine, and of zoster patients, were measured for antibody titres against VZV with PHA, complement fixation (CF) and immune adherence haemagglutination (IAHA) assays, and the results compared. Antibody development could be detected as early as 3 weeks after vaccination, by both PHA and IAHA tests, but not with the CF test. Significant rises in VZV antibody in zoster patients were detected by both PHA and CF tests several days after onset. No cross-reaction was observed using HSV PHA among the vaccinees and the zoster patients. The VZV PHA assay could be used as a monitor of vaccination and a tool for differential diagnosis. PMID: 8249435 [PubMed - indexed for MEDLINE] 3661. Scand J Infect Dis. 1993;25(4):521-4. Natural killer cell activity in herpes zoster in children without underlying disease. Terada K, Kawano S, Yoshihiro K, Morita T. Department of Pediatrics, Kawasaki Medical School, Okayama, Japan. We determined natural killer cell (NKC) activity in 10 otherwise normal children with herpes zoster. NKC activity values in children with vs. without varicella-zoster virus specific IgM antibodies and in controls were 28.3 +/- 8.6%, 11.9 +/- 3.6% and 20.2 +/- 3.8% (mean +/- SD), respectively. There were significant differences between the children with and without IgM antibodies during the acute phase (p < 0.005) and between children without IgM antibodies and controls (p = 0.005). NKC values in children with mild vs. moderate morbidity were 11.7 +/- 4.1% and 25.7 +/- 9.9%, respectively (p < 0.05). The morbidity was moderate in all children with IgM antibodies, but in only 2 of the 5 children without IgM antibodies. Children who contracted varicella when a few months old had the highest IgM antibody titers and the highest value of NKC activity. NKC activity was related both to the presence of IgM antibodies and to the morbidity of herpes zoster. PMID: 8248754 [PubMed - indexed for MEDLINE] 3662. J Med Virol. 1993;Suppl 1:97-101. Management of ophthalmic zoster. Harding SP. St. Paul's Eye Unit, Royal Liverpool University Hospital, UK. The natural history of herpes zoster ophthalmicus and aspects of its treatment and prevention are presented. Intraocular complications occur in 50 percent of cases. Anterior uveitis and the various varieties of keratitis are commonest, affecting 92% and 52% of patients with ocular involvement, respectively. Sight-threatening complications include neuropathic keratitis, perforation, secondary glaucoma, posterior scleritis/orbital apex syndrome, optic neuritis, and acute retinal necrosis. Twenty-eight percent of initially involved eyes develop long-term ocular disease (6 months), with chronic uveitis, keratitis, and neuropathic ulceration being the commonest. Acute pain occurs in 93% of patients and is still present in 31% at 6 months. Of patients aged 60 and over pain persists in 30% for 6 months or longer, and this rises to 71% in those aged 80 and over. Current evidence favours the use of topical acyclovir alone for treatment of established ocular complications, with topical steroids being withheld in all but the most severe cases. Stellate ganglion block has proved useful in the treatment of established acute pain. Amitryptiline, and to a lesser extent sodium valproate, are useful in established chronic pain. Evidence of the efficacy of early oral acyclovir on ocular complications is conflicting, with two studies reporting significant improvement in differing disease parameters. A similar situation exists for pain, with published studies showing differing effects on pain at varying times after the onset of disease. The use of systemic steroids to prevent pain is not supported by currently available evidence, but its therapeutic relationship with acyclovir requires further evaluation.(ABSTRACT TRUNCATED AT 250 WORDS) PMID: 8245902 [PubMed - indexed for MEDLINE] 3663. J Med Virol. 1993;Suppl 1:93-6. Effect of oral acyclovir on pain resolution in herpes zoster: a reanalysis. Huff JC, Drucker JL, Clemmer A, Laskin OL, Connor JD, Bryson YJ, Balfour HH Jr. University of Colorado Health Sciences Center, Denver. The most frequent complication of herpes zoster is postherpetic neuralgia, usually defined as chronic pain in the area of the exanthem that persists for at least a month after the skin lesions have healed. Several clinical studies of acyclovir showed a reduction in severity and duration of acute pain, but provided no definitive data for chronic pain. In order to determine if acyclovir therapy could reduce chronic pain, we reanalyzed data from the largest U.S. placebo-controlled treatment trial of 187 immunocompetent persons with herpes zoster. By considering pain as a continuum, we found that the median duration of pain in acyclovir recipients was 20 days vs. 62 days for their placebo counterparts (P = 0.02). Thus, acyclovir has been shown to reduce chronic zoster-associated pain. We also noted that the absence of pain at the onset of cutaneous herpes zoster did not preclude its later development. PMID: 8245901 [PubMed - indexed for MEDLINE] 3664. J Med Virol. 1993;Suppl 1:82-4. Varicella-zoster virus infection in immunocompromised patients. Masaoka T, Hiraoka A, Teshima H, Tominaga N. Department of 5th Internal Medicine, Centre for Adult Diseases, Osaka, Japan. The prophylactic effect of acyclovir (ACV) on varicella-zoster virus (VZV) infection in leukaemia patients who have undergone bone marrow transplantation (BMT) was reviewed. The benefits of the use of the laminar air flow (LAF) room in the prevention of nosocomial VZV infections in the haematological ward are also discussed. Since 1986 ACV has been administered to BMT patients to prevent herpes simplex virus (HSV) infections. Of 98 patients with leukaemia who underwent BMT, 73 received ACV (200 mg five times daily) and 25 were not given ACV. In the untreated group, 9 patients (36.0%) developed VZV infection by day 67 (median) and 3 patients died due to disseminated VZV infection. In the ACV-treated group, 18 patients (24.6%) developed VZV infection by day 150 (median) and there were no deaths. From July to December 1989, nine cases of VZV infections (eight patients and one nurse) were reported in the haematological ward of the hospital. All cases originated in the conventionally ventilated areas of the ward while no VZV infections were reported in the 14 patients who occupied the LAF rooms during the same period. PMID: 8245898 [PubMed - indexed for MEDLINE] 3665. J Med Virol. 1993;Suppl 1:74-81. Current management of varicella zoster virus infections. Balfour HH Jr. Department of Laboratory Medicine, University of Minnesota Health Sciences Center, Minneapolis 55455-0392. A series of randomized, placebo-controlled, double-blind clinical trials conducted from 1980 to the present provide the basis for appropriate management of varicella-zoster virus (VZV) infections. Placebo recipients in these studies have also provided valuable natural history data on the clinical course of VZV infections. The protocols in toto have shown acyclovir (ACV) to be safe and effective for treatment of nearly all forms of acute VZV infection. A number of issues still need to be addressed, including appropriate dosage, importance of early initiation of therapy, cost-benefit ratio, and viral resistance. Considering the data in aggregate, the author recommends ACV treatment for all acute VZV infections in immunocompromised hosts; for acute herpes zoster infections in all adults; and for varicella in otherwise healthy adults and adolescents, and children who contract it from a sibling. PMID: 8245897 [PubMed - indexed for MEDLINE] 3666. J Med Virol. 1993;Suppl 1:154-7. Preliminary pharmacokinetics and safety of 882C87 in patients with herpes zoster. Wood MJ, McKendrick MW, Bannister B, Mandal BK, Peck RW, Crooks RJ. East Birmingham NHS Trust, UK. 882C87 [1-(beta-D-arabinofuranosyl)-5-propynyluracil] is a nucleoside analogue with potent and specific antiviral activity against varicella-zoster virus (VZV). The IC50 of 882C87 against VZV ranges from 0.6 to 3.8 microM. Potentially therapeutic plasma concentrations are readily achieved in humans; the pharmacokinetics have been previously evaluated in healthy young and elderly (> 65 years) volunteers following single oral doses of 50-400 mg. Thirty immunocompetent patients with localised herpes zoster were treated with 882C87. Groups of patients received 50 mg, 100 mg, or 200 mg tablets of 882C87 every 12 hours for 7 or 7.5 days (14 or 15 doses). Six patients in each group were over 60 years of age. Blood samples for determination of 882C87 concentrations were taken at entry, steady state, and during the elimination phase following the last dose. After the final doses of the 50 mg 100 mg, and 200 mg dosage regimens, the Cmax of 882C87 in patients over 60 years old was 7.7 +/- 3.1 microM, 12.6 +/- 3.5 microM, and 24.8 +/- 14.0 microM, respectively, and the AUCs 0-12 were 78.4 +/- 31.8 microM.hr, 137.5 +/- 22.8 microM.hr, and 272.5 +/- 170.5 microM.hr, respectively. Preliminary estimates of the elimination half-life ranged from 15.1 to 20.0 hr. These preliminary pharmacokinetic data confirmed good dose proportionality for AUC and Cmax with values between those predicted from single dose data in the young and those in elderly volunteers. The plasma concentration profiles at these doses were in excess of IC50 values and support the use of once- or twice-daily regimens in future studies of 882C87 in herpes zoster. PMID: 8245884 [PubMed - indexed for MEDLINE] 3667. J Med Virol. 1993;Suppl 1:102-5. A retrospective and an observational study with acyclovir. Malin JP. Neurologische Klinik und Poliklinik, Ruhr-Universität Bochum, Germany. Retrospective analysis: This open controlled non-randomized study was carried out to investigate the influence of intravenous acyclovir (ACV) on the incidence of post-herpetic neuralgia (PHN). Twelve women and 11 men (mean age 52 years, range 19-89) received ACV 5 mg/kg every 8 hours) for 10 days (I). Twenty-seven untreated patients (mean age 62 years, range 20-89) were taken as a control group (II). Six to 24 months after the onset of herpes zoster (shingles) the patients were reexamined. The analysis revealed a significantly lower incidence of both general pain and severe pain (P < 0.05, chi 2 = 5.55 and 4.39) for (I) compared to (II). For 21 patients who were treated for a period of 10 days, the significance level was 1% (chi 2 = 7.82 and 8.62). Observational study: Fifteen thousand eight hundred and thirty-one non-hospitalized patients with shingles (mean age 55.2 years) received oral ACV (800 mg five times daily) for 7 days. At the onset of therapy, 15,420 patients (97.6%) reported pain (severe 42.6%, moderate 43.1%, mild 14.3%). The pain during treatment was documented by the patients (n = 5,728) in a diary and transferred to a scoring system (0 = none, 1 = mild, 2 = moderate, 3 = severe). From day 1 to day 7 there was a decrease in the pain score level from 2.3 to 0.9. Three months after the onset of herpes zoster, 2,519 of 14,858 patients (16.95%) reported pain; 311 patients (2.1%) complained of continuous pain, typical for PHN.(ABSTRACT TRUNCATED AT 250 WORDS) PMID: 8245873 [PubMed - indexed for MEDLINE] 3668. Arch Immunol Ther Exp (Warsz). 1993;41(2):137-40. Vratizolin in treatment of mouth and ear herpetic infections: comparison with conventional therapy. Rostkowska B, Pośpiech L, Jankowska M. Department of Clinic of Otolaryngology, Medical Academy, Wrocław. Vratizolin is a new non-steroidal anti-inflammatory drug registered for use on humans in Poland. Published and unpublished data on Vratizolin showed that it has anti-inflammatory, antiviral, antibacterial, antimycotic, analgesic and immunomodulating activities. The purpose of these randomized, parallel-group studies was to compare Vratizolin with other standard drugs, used for the treatment of mouth and ear infections. The study involved 193 patients with recurrent Herpes simplex, Herpes zoster oticus, Stomatitis herpetica and infections of the external ear canal. Vratizolin was used topically, as 3% hydrophilic cream or ointment, four times daily. Standard treatment included zinc ointment, Aphtin (boric acid plus glycerin), Oxycort and Dicortinef. In almost all of the treated patients the efficacy of Vratizolin treatment was superior to the drugs mentioned above. It was assessed by measuring disappearance of both objective (edema, erythema, crusting) and subjective symptoms (pain, burning and itching). PMID: 8239918 [PubMed - indexed for MEDLINE] 3669. Ann Otolaryngol Chir Cervicofac. 1993;110(3):170-2. [Oral manifestations of zona. Apropos of a case] [Article in French] Eury J, Gilain L, Peynegre R. Service d'ORL et de chirurgie cervico-faciale, Hôpital intercommunal de Créteil. Oral manifestations of herpes zoster are very less common than cutaneous. Only a few cases of oral herpes zoster in children had been already described. Authors report a case of maxillary superior nerve's herpes zoster. Oral lesions are encountered in case of viral disease of the second and third branch of trigeminal nerve (VII, VIII). Dental pain is usually the first sign and can induce misdiagnosis. The diagnosis is based on the specific ulcerative lesions, strictly unilateral, developed in the field of sensitive innervation of the maxillary nerves. The use of antiviral drugs seems to be actually the best treatment. PMID: 8239338 [PubMed - indexed for MEDLINE] 3670. Eye (Lond). 1993;7 ( Pt 3):350-70. Ophthalmic herpes zoster. Marsh RJ, Cooper M. Department of Clinical Ophthalmology, Moorfields Eye Hospital, London, UK. A current review of ophthalmic zoster is presented including its virology, immunology, epidemiology and pathogenesis. We give our findings in 1356 patients referred to the Zoster Clinic at Moorfields Eye Hospital, London. The treatment of the disease and its ocular complications is discussed. PMID: 8224290 [PubMed - indexed for MEDLINE] 3671. Ann Otolaryngol Chir Cervicofac. 1993;110(6):337-40. [Herpes of the larynx. Apropos of 3 cases] [Article in French] Mesolella M, Testa B, Mesolella C, Giuliano A, Testa G. Medico interno Clinica ORL, Università degli Studi di Napoli 2, Italy. Herpes laryngis is a rare inflammatory disease, caused by herpes simplex (HSV) or herpes zoster virus (HZV). Three cases of acute viral laryngitis are described. The first case of laryngitis is caused by HZV, with involvement of VII., VIII., IX. and X. cranial nerves. In the second and third cases, caused by HSV, only the laryngeal mucosa is involved. Laryngeal symptoms, diagnostic criteria and therapeutic results are described. PMID: 8210094 [PubMed - indexed for MEDLINE] 3672. Leuk Lymphoma. 1993;11 Suppl 2:115-25. Viral infections in leukemia and bone marrow transplant patients. Wingard JR. Bone Marrow Transplant Program, Emory University School of Medicine, Atlanta, Georgia 30322. Infections by herpesviruses are common phenomena in patients being treated for acute leukemia and those undergoing bone marrow transplantation. Reactivation of endogenous latent virus caused by the immunosuppressive and cytotoxic effects of cytoreductive therapies is a common mechanism of infection. With cytomegalovirus (CMV), acquisition of exogenous virus by transfusion of blood products containing virus and from the bone marrow graft in the case of bone marrow transplantation can occur. Serious morbidity can result and occasional mortality. CMV infections in allogeneic BMT recipients have high case fatality rates. Treatment and preventive strategies for herpes simplex virus (HSV), CMV, and varicella zoster virus (VZV) have been developed to reduce morbidity. Acyclovir, either given prophylactically or as treatment of active infection, has been highly successful in reducing illness from HSV and VZV infection. For CMV, provision of CMV-seronegative blood products is the mainstay of prevention of morbidity in seronegative patients and is especially important in the care of patients undergoing allogeneic BMT. Ganciclovir given either prophylactically or as early therapy for patients detected to be shedding CMV appears to be a promising strategy. Bolstering host immunity through augmentation of anti-CMV cytotoxic T-cell responses appears to be an exciting candidate therapy under development. PMID: 8124223 [PubMed - indexed for MEDLINE] 3673. Australas J Dermatol. 1993;34(3):113-4. Cerebral infarction following thoracic herpes zoster. Kumar A, Mollison L. Department of Medicine, Alice Springs Hospital, N.T., Australia. OBJECTIVE: To present a case of cerebral infarction following thoracic herpes zoster presenting as Gerstmann's syndrome. CLINICAL FEATURES: A 61 year old male developed herpes zoster of T 1-2 dermatomes. Four months later he developed a confusional state together with expressive aphasia, dyscalculia, dysgraphia and finger agnosia with no long tract signs. CT scan of head showed recent infarction of this left parietal lobe. He received a five day course of acyclovir 800 mg four times daily and showed slow but steady improvement. CONCLUSION: Herpes zoster is uncommonly followed by cerebral infarction. Acyclovir may have a role in therapy of this complication. PMID: 8080412 [PubMed - indexed for MEDLINE] 3674. Scand J Infect Dis. 1993;25(6):775-8. Proliferative response to varicella-zoster virus is inverse related to development of high levels of varicella-zoster virus specific IgG antibodies. Terada K, Kawano S, Yoshihiro K, Morita T. Department of Pediatrics, Kawasaki Medical School, Okayama, Japan. We examined specific humoral and cellular immunity from varicella-zoster virus (VZV) in 10 pediatricians, 8 healthy immune adults, 2 non-immune adults, and 15 patients with acute lymphocytic leukemia (ALL) in order to investigate the mechanism of resistance to VZV and the booster effect of frequent re-exposure. The responder cell frequency (RCF) against VZV antigen was determined by lymphoproliferative response with limiting dilution. Four of the 10 children with ALL and receiving maintenance therapy did not have VZV-specific cellular immunity according to our positive criteria (Stimulation Index > 2.0 and RCF > 1:150,000), but 3 of these 4 patients had VZV-specific IgG antibody. In both healthy adults and ALL patients re-exposure to VZV or reactivation of the virus enhanced VZV-specific immunity. Individuals with very high RCF values (> 1:10,000) had the lowest IgG antibody titers. PMID: 8052820 [PubMed - indexed for MEDLINE] 3675. Rev Roum Virol. 1993 Jan-Jun;44(1-2):91-5. [The beneficial effects of immunostimulating and antiviral therapy on ophthalmic zona] [Article in French] Topciu V, Chercotă G, Mihăilescu R, Nadolnic A. Université de Médecine et Pharmacie, Timişoara, Roumanie. A group of 16 patients with ophthalmic zona zoster received antiviral and immunostimulating treatment with Romanian specific products. Results were spectacular. The problem of the identity of the varicella and zoster viruses is discussed. PMID: 8043484 [PubMed - indexed for MEDLINE] 3676. Rev Roum Virol. 1993 Jan-Jun;44(1-2):17-20. [Moroxidine, an antiviral used for the treatment of zona (herpes zoster)] [Article in French] Athanasiu P, Petrescu A, Vulcan V. Institut de Virologie Stefan S. Nicolau, Bucarest, Roumanie. Treatment with moroxidine, Romanian preparation with virustatic effects, was applied in 350 patients with different localisation herpes zoster lesions. Treatment had good effects, especially when it was applied early. PMID: 8043474 [PubMed - indexed for MEDLINE] 3677. An Med Interna. 1992 Dec;9(12):624-5. [Transient intestinal and bladder atonies in a geriatric patient with disseminated herpes zoster] [Article in Spanish] Revenga F, Ruiz R, Vanaclocha F. Comment on: An Med Interna. 1992 Mar;9(3):155-6. PMID: 1486175 [PubMed - indexed for MEDLINE] 3678. Semin Neurol. 1992 Dec;12(4):322-8. Herpes zoster. Hirschmann JV. Seattle VA Medical Center, University of Washington School of Medicine 98108. PMID: 1485041 [PubMed - indexed for MEDLINE] 3679. J Emerg Nurs. 1992 Dec;18(6):547-8. A 72-year-old woman with severe lower back pain and malaise. Childs SA. PMID: 1469824 [PubMed - indexed for MEDLINE] 3680. Anesthesiology. 1992 Dec;77(6):1223-5. Segmental reflex sympathetic dystrophy involving the thumb: a rare complication of a varicella zoster infection. Chester MH. Department of Family and Community Medicine, University of California, School of Medicine, San Francisco. PMID: 1466473 [PubMed - indexed for MEDLINE] 3681. Am J Kidney Dis. 1992 Dec;20(6):647-9. Neurotoxicity of acyclovir in patients with end-stage renal failure treated with continuous ambulatory peritoneal dialysis. Davenport A, Goel S, Mackenzie JC. Department of Renal Medicine, Southmead Hospital, Westbury-on-Trym, Bristol, England. We report two cases of herpes-zoster in which the administration of acyclovir to patients with end-stage renal failure treated by continuous ambulatory peritoneal dialysis (CAPD) resulted in acyclovir neurotoxicity, even though the doses administered were within those recommended by the manufacturer's data sheet for patients with renal failure. Acyclovir removal was negligible with peritoneal dialysis and one patient died. The other patient was successfully treated with hemodialysis, which effectively reduced plasma concentrations, resulting in an improvement in conscious state. Acyclovir neurotoxicity should be considered in patients with renal failure who have been treated for viral infections, in whom the conscious state has deteriorated despite normal brain computed tomography (CT) scan and lumbar puncture investigations. Hemodialysis is the preferred treatment for the rapid removal of acyclovir. PMID: 1462997 [PubMed - indexed for MEDLINE] 3682. Bone Marrow Transplant. 1992 Dec;10(6):495-8. Long-term acyclovir prophylaxis for prevention of varicella zoster virus infection after autologous blood stem cell transplantation in patients with acute leukemia. Sempere A, Sanz GF, Senent L, de la Rubia J, Jarque I, López F, Arilla MJ, Guinot M, Martín G, Martínez J, et al. Department of Hematology, La Fe University Hospital, Valencia, Spain. Twenty-one adult patients with acute leukemia who underwent autologous blood stem cell transplantation (ABSCT) and who received acyclovir during the first 6 months after transplant to prevent varicella zoster virus (VZV) infection were studied retrospectively to determine the incidence and outcome of VZV infection after ABSCT. The cumulative risk of VZV infection was 32% by 1 year after transplant. No patient developed VZV while on prophylactic acyclovir but five (24%) had localized herpes zoster within 1 month of acyclovir withdrawal. There were no deaths related to VZV infection and only one patient had disseminated disease and post-herpetic neuralgia. These preliminary results suggest that the incidence and outcome of VZV infection after ABSCT largely parallel those reported in marrow transplant patients and that long-term acyclovir prophylaxis delays but does not prevent VZV infection. Prophylaxis of VZV infection after ABSCT requires new therapeutic approaches. PMID: 1362686 [PubMed - indexed for MEDLINE] 3683. Cent Afr J Med. 1992 Dec;38(12):466-7. Herpes zoster treated by acupuncture. Coghlan CJ. Seventh Avenue, Surgical Unit, Mutare. The treatment of Herpes zoster by acupuncture is described. These were four patients with acute zoster and four with post-herpetic neuralgia. In a majority of the cases electro-acupuncture was found to be effective, and this treatment should be instigated as early as possible. Since the treatment of Herpes zoster by drugs is not routinely successful and can prove expensive, acupuncture, whose side effects are minimal, merits a trial. PMID: 1340799 [PubMed - indexed for MEDLINE] 3684. Pediatr Res. 1992 Dec;32(6):699-703. Latency in vitro of varicella-zoster virus in cells derived from human fetal dorsal root ganglia. Somekh E, Tedder DG, Vafai A, Assouline JG, Straus SE, Wilcox CL, Levin MJ. Department of Pediatrics, University of Colorado School of Medicine, Denver 80262. A potential in vitro model of varicella-zoster virus (VZV) latency was developed. Dissociated human dorsal root ganglion cultures were infected with VZV and maintained for 1 wk in the presence of bromovinyl arabinosyl uracil, a potent inhibitor of VZV. Seven to 21 d after removing the inhibitor (> or = 14 d after infection), the cells were trypsinized, passed to monolayers of human embryonic lung fibroblasts, and observed for VZV reactivation as indicated by typical cytopathic effects and the appearance of VZV antigens. VZV reactivated from 56% of the cultures containing both neurons and satellite cells but not from cultures specifically enriched for either neurons, satellite cells, or ganglion-derived fibroblasts. The failure to isolate VZV from cell suspensions that were sonicated before cocultivation with fibroblasts indicated that infectious VZV was not present before reactivation. Moreover, immunohistochemical and immunoprecipitation studies revealed no VZV-specific antigens in any cultures before the reactivation stimulus. VZV antigens were detected after trypsinization and cocultivation. These findings suggest that cultures containing both neurons and satellite cells provide a model system for VZV persistence that possesses many properties of a latent infection. PMID: 1337586 [PubMed - indexed for MEDLINE] 3685. Anaesthesist. 1992 Dec;41(12):772-8. [Therapy of post-herpetic neuralgia. Pain therapy using an anti-varicella zoster immunoglobulin] [Article in German] Hügler P, Heimann R, Laubenthal H. Klinik für Anaesthesiologie, St. Josef Hospital Bochum. Comment in: Anaesthesist. 1994 Jan;43(1):53-4. After remission of the dermatological symptoms of herpes zoster infection, post-zoster neuralgia (PZN) can persist or recur for months and years. Most frequently, satisfactory therapy of PZN is not possible. During recent years the persistence of viruses on the surface of neuronal cells has been discussed as the possible reason for chronic pain. Virostatic therapy as well as polyvalent 7s-IgG-immunoglobulins exerted a minimal effect on the pain level. In an open trial we therefore used a specific anti-varicella zoster immunoglobulin (VZI) for treatment of PZN. METHODS. In our study ten patients (six female, four male; age 55-87 years) with latencies between the acute infection and onset of immunoglobulin therapy between 10 months and 3 years were included. PZN was located according to the dermatomes involved: one trigeminal nerve, one cervical, four thoracic and four lumbal segments. All patients had received more than two different drugs or had had therapeutic procedures without success. On the visual analogue scale (VAS: 0-100%) all patients rated their subjective pain with at least 49%. Before starting the study the preexisting specific drug therapy was discontinued in all patients. VZI infusion was given i.v. at a dose of 2 ml/kg body weight within 120 min. All patients had to rate their pain at the VAS every 10 min during the 120 min infusion time, at day 1, 2, 7, 14, 30 and than every month after therapy with VZI. RESULTS. Even during the infusion all ten patients reported a sharp decrease in pain of at least 47% (average 87%) on the VAS. Fourteen days later the remaining pain level averaged 6% VAS. Only the first of the 10 patients reported twice a recurring increase of pain. He therefore received the standard dosage of VZI again at day 2 and day 214, respectively. Thereafter until day 566 the pain level of this patient was lower than 10% VAS. The maximum surveillance interval has so far been 600 days. No side-effects due to the infusion of VZI have been encountered. CONCLUSIONS. Treating pain in persistent PZN is extremely difficult and mostly results in a small diminution of the pain level. Persistence of viruses on the neuronal cell surface and resulting reduction of "luxury functions" of those cells may explain algogenesis by PZN and resistance to therapeutic efforts. We used VZI for the first time for therapy of PZN and observed a striking analgesic effect in all patients for the entire surveillance time. PMID: 1336934 [PubMed - indexed for MEDLINE] 3686. Antimicrob Agents Chemother. 1992 Dec;36(12):2747-57. Mode of antiviral action of penciclovir in MRC-5 cells infected with herpes simplex virus type 1 (HSV-1), HSV-2, and varicella-zoster virus. Earnshaw DL, Bacon TH, Darlison SJ, Edmonds K, Perkins RM, Vere Hodge RA. SmithKline Beecham Pharmaceuticals, Epsom, Surrey, England. The metabolism and mode of action of penciclovir [9-(4-hydroxy-3-hydroxymethylbut-1-yl)guanine; BRL 39123] were studied and compared with those of acyclovir. In uninfected MRC-5 cells, low concentrations of the triphosphates of penciclovir and acyclovir were occasionally just detectable, the limit of detection being about 1 pmol/10(6) cells. In contrast, in cells infected with either herpes simplex virus type 2 (HSV-2) or varicella-zoster virus (VZV), penciclovir was phosphorylated quickly to give high concentrations of the triphosphate ester. Following the removal of penciclovir from the culture medium, penciclovir-triphosphate remained trapped within the cells for a long time (half-lives, 20 and 7 h in HSV-2- and VZV-infected cells, respectively). In HSV-2-infected cells, acyclovir was phosphorylated to a lesser extent and the half-life of the triphosphate ester was only 1 h. We were unable to detect any phosphates of acyclovir in VZV-infected cells. (S)-Penciclovir-triphosphate inhibited HSV-1 and HSV-2 DNA polymerase competitively with dGTP, the Ki values being 8.5 and 5.8 microM, respectively, whereas for acyclovir-triphosphate, the Ki value was 0.07 microM for the two enzymes. Both compounds had relatively low levels of activity against the cellular DNA polymerase alpha, with Ki values of 175 and 3.8 microM, respectively. (S)-Penciclovir-triphosphate did inhibit DNA synthesis by HSV-2 DNA polymerase with a defined template-primer, although it was not an obligate chain terminator like acyclovir-triphosphate. These results provide a biochemical rationale for the highly selective and effective inhibition of HSV-2 and VZV DNA synthesis by penciclovir and for the greater activity of penciclovir than that of acyclovir when HSV-2-infected cells were treated for a short time. PMCID: PMC245539 PMID: 1336346 [PubMed - indexed for MEDLINE] 3687. Hautarzt. 1992 Dec;43(12):767-71. [Detection of varicella zoster virus infections using polymerase chain reaction] [Article in German] Eis-Hübinger AM, Kaiser R, Kleim JP, Dlugosch D, Estor A, Kleemann E, Lange CE, Schneweis KE. Institut für Medizinische Mikrobiologie und Immunologie Rheinischen Friedrich-Wilhelms-Universität Bonn. The polymerase chain reaction (PCR) was used to detect varicella zoster virus (VZV) DNA in vesicle samples from patients with varicella and zoster. Primers and the oligonucleotide probe were chosen from the region of the immediate early gene 63. Procedures for preparing the DNA from the specimens were omitted, and the amplified DNA was directly detected in ethidium bromide-stained polyacrylamide or agarose gels, thus providing a rapid and less laborious assay. A total of 66 vesicle specimens including 3 crusts (collected on days 1-14 after the onset of exanthem) were tested by the simplified VZV-PCR, and 64 (97%) were positive. When the direct visualization of the amplified DNA was confirmed by DNA hybridization, a non-radioactive hybridization assay involving a digoxigenin-labelled oligonucleotide probe and detection by chemiluminescence proved as adequate as a radioactive hybridization assay. Thus, the VZV PCR described appears to be a useful diagnostic test for detecting and identifying varicella zoster virus. PMID: 1335444 [PubMed - indexed for MEDLINE] 3688. Infect Dis Clin North Am. 1992 Dec;6(4):831-49. Viral keratitis. Mader TH, Stulting RD. Department of Ophthalmology, Madigan Army Medical Center, Tacoma, Washington. Viruses that affect the cornea produce changes that range from benign, self-limited conjunctivitis to sight-threatening scarring and vascularization of the cornea. In this article, the forms of viral keratitis most commonly encountered by the clinician are reviewed. The epidemiology, clinical presentation, and treatment of infection by Herpes simplex virus, varicella zoster virus, and the adenoviruses are discussed. Also included are other viral infections of the cornea. PMID: 1334105 [PubMed - indexed for MEDLINE] 3689. Rev Prat. 1992 Dec 1;42(19):2495-7. [Herpes zoster. Epidemiology, physiopathology, diagnosis, development, treatment] [Article in French] Guillet PG, Plantin P. Service de dermatologie-allergologie, CHRU de Brest, hôpital Augustin Morvan. PMID: 1296327 [PubMed - indexed for MEDLINE] 3690. Am J Ophthalmol. 1992 Nov 15;114(5):603-9. Polymerase chain reaction for the detection of the varicella-zoster genome in ocular samples from patients with acute retinal necrosis. Nishi M, Hanashiro R, Mori S, Masuda K, Mochizuki M, Hondo R. Department of Ophthalmology, Escola Paulista de Medicina, São Paulo, Brazil. We used the polymerase chain reaction to detect the virus genome in ocular samples from patients with clinically diagnosed acute retinal necrosis. Four samples from four patients with acute retinal necrosis, and five samples from three patients with other ocular diseases (sarcoidosis, rhegmatogenous retinal detachment, and epiretinal membrane of unknown origin) were evaluated. The samples consisted of aqueous humor, vitreous, or subretinal fluid. Primers were specific for varicella-zoster virus, herpes simplex virus, or cytomegalovirus. The varicella-zoster virus genome was detected in three of the four samples from patients with acute retinal necrosis. Among these three positive samples, two had PstI-site-less point mutation, strains that have been described only in Japan and of low prevalence. Samples from patients with diagnoses other than acute retinal necrosis yielded negative results when varicella-zoster virus primer was used. No sample was positive for herpes simplex virus or cytomegalovirus primers. PMID: 1332482 [PubMed - indexed for MEDLINE] 3691. JAMA. 1992 Nov 11;268(18):2541-4. Comparison of Tzanck smear, viral culture, and DNA diagnostic methods in detection of herpes simplex and varicella-zoster infection. Nahass GT, Goldstein BA, Zhu WY, Serfling U, Penneys NS, Leonardi CL. Department of Internal Medicine, St Louis University School of Medicine, MO 63104. OBJECTIVE--To compare Tzanck smears, viral cultures, and DNA diagnostic methods using the polymerase chain reaction (PCR) in detection of herpes simplex virus (HSV) or varicella-zoster virus (VZV) infection in clinically suspected cases. DESIGN--A 12-month trial comparing PCR with viral cultures and Tzanck smears in patients with clinically suspected HSV or VZV infection. SETTING--Both ambulatory and hospitalized patients were recruited from a tertiary referral center and the Miami (Fla) Veterans Affairs Medical Center. PATIENTS--Convenience samples of patients clinically suspected to have HSV (n = 48) or VZV (n = 35). To be included in the final analysis patients needed to have a positive Tzanck smear, viral culture, or PCR result. Patients who were clinically suspected to have HSV but had VZV by viral culture or PCR were analyzed in the VZV group. Similarly, patients who were clinically suspected to have VZV, but had HSV by viral culture or PCR were analyzed in the HSV group. Seventy-seven patients were available for final analysis: HSV (n = 30), VZV (n = 32), and 15 control cases who did not have evidence of viral infection. RESULTS--For HSV, PCR detected HSV DNA sequences in 73% of stained smears and 83% of unstained smears. For VZV infection, VZV DNA sequences were detected in 88% of stained smears and 97% of unstained smears. Viral DNA sequences were not detected in the 15 control cases. Viral cultures were positive in 83% and 44% of HSV and VZV cases, respectively. The Tzanck smear was positive in 60% and 75% of HSV and VZV cases, respectively. CONCLUSIONS--PCR is a reliable method for detecting HSV and VZV DNA sequences from single stained and unstained Tzanck smears. It is clearly superior to viral culture in identifying VZV infection and is equivalent to conventional culture techniques in identifying cases of HSV. PMID: 1328700 [PubMed - indexed for MEDLINE] 3692. Med Clin (Barc). 1992 Nov 7;99(15):596-7. [Acute meningitis caused by reactivation of the varicella-zoster virus without cutaneous lesions. Contribution to the serologic diagnosis] [Article in Spanish] Guerrero M, Gutiérrez J, Maroto MC, González Maldonado R. PMID: 1334174 [PubMed - indexed for MEDLINE] 3693. Br J Ophthalmol. 1992 Nov;76(11):646-50. Deep lamellar keratoplasty on air with lyophilised tissue. Chau GK, Dilly SA, Sheard CE, Rostron CK. St George's Hospital & Medical School, London. Comment in: Br J Ophthalmol. 1993 Aug;77(8):538. Deep lamellar keratoplasty on air involves injecting air into the corneal stroma to expand it to several times its normal thickness. This method is designed to facilitate dissection of the deep stroma and reduce the risk of perforation of Descemet's membrane when carrying out deep lamellar keratoplasty. We have modified the technique by using prelathed freeze-dried donor tissue and report our results in a series of patients with corneal stromal scarring owing to a variety of corneal problems, namely, keratoconus, pterygium, and herpes zoster ophthalmicus. All patients achieved best corrected postoperative visual acuity of 6/12 or better without problems associated with graft failure or rejection. Histopathological examination of corneal tissue following air injection showed surgical emphysema within the cornea and separation of deep stromal fibres from the underlying Descemet's membrane. PMCID: PMC504366 PMID: 1477037 [PubMed - indexed for MEDLINE] 3694. Br J Gen Pract. 1992 Nov;42(364):493-4. Acute herpes zoster, postherpetic neuralgia, acyclovir and amitriptyline. Avery AJ, Reeves J. Comment on: Br J Gen Pract. 1992 Jun;42(359):244-6. PMCID: PMC1372284 PMID: 1472405 [PubMed - indexed for MEDLINE] 3695. Clin Geriatr Med. 1992 Nov;8(4):735-43. Viral infections. Cesario TC, Yousefi S. University of California School of Medicine, Irvine. Viral infections may cause serious morbidity as well as death in elderly patients. Of the RNA viruses, influenza virus is the most important pathogen; the majority of influenza-related deaths occur in older patients. Respiratory syncytial virus appears to be gaining increasing importance in elderly persons. Herpes zoster or shingles is caused by the DNA virus, varicella-zoster virus, and its major morbidity in older patients is postherpetic neuralgia. PMID: 1330279 [PubMed - indexed for MEDLINE] 3696. J Infect Dis. 1992 Nov;166(5):1153-6. Herpes zoster and human immunodeficiency virus infection. Buchbinder SP, Katz MH, Hessol NA, Liu JY, O'Malley PM, Underwood R, Holmberg SD. AIDS Office, San Francisco Department of Public Health, California. Comment in: J Infect Dis. 1993 Jul;168(1):245. The interaction of herpes zoster and the human immunodeficiency virus (HIV) was evaluated in a cohort study of 287 homosexual men with well-defined dates of HIV seroconversion and 499 HIV-seronegative homosexual men. The incidence of herpes zoster was significantly higher among HIV-seropositive men (29.4 cases/1000 person-years) than among HIV-seronegative men (2.0 cases/1000 person-years); the overall age-adjusted relative risk (RR) was 16.9 (95% confidence interval [CI], 8.7-32.6). When compared with that of age-matched population controls from 1945 to 1959, the incidence of zoster was significantly higher among seropositive men (RR, 26.7; 95% CI, 19.3-37.1) and slightly higher among seronegative men (RR, 1.85; 95% CI, 1.0-3.3); the latter may reflect increasing background rates over several decades. The risk of herpes zoster was not associated with duration of HIV infection and was not predictive of faster progression to AIDS. PMID: 1308664 [PubMed - indexed for MEDLINE] 3697. J Gen Virol. 1992 Nov;73 ( Pt 11):2969-73. Human sera from varicella-zoster virus (VZV) infections cross-react with human T cell leukaemia virus type 1 (HTLV-1): common epitopes in VZV gene 22 protein and HTLV-1 p19 gag protein. Sato A, Isaka Y, Morita F, Ishii A, Goto Y, Imai J, Igarashi H, Yoshie O, Hinuma Y. Shionogi Institute for Medical Science, Osaka, Japan. Twenty-nine of 100 sera from patients recently infected with varicella-zoster virus (VZV) were found to cross-react with human T cell leukaemia virus type 1 (HTLV-1) antigen in the particle agglutination (PA) assay using HTLV-1 antigen-coated gelatin particles. Anti-VZV IgM antibodies were shown to be responsible for this cross-reactivity. Western blot analysis revealed that PA-positive anti-VZV sera reacted with the HTLV-1 gag p19 protein in HTLV-1-infected cells and recombinant p19 protein produced in Escherichia coli. By using a truncated p19, the cross-reactive region was located to the C-terminal 17 amino acids of p19. One oligopeptide derived from the C terminus, PQIPPPYVEPT (amino acids 115 to 125), was capable of inhibiting PA, suggesting that this peptide carries the cross-reactive epitope. A homologous sequence was found in the VZV gene 22 protein by database analysis, and the oligopeptide TNIPPPLALLR (amino acids 1330 to 1340) had the ability to inhibit PA. These findings suggest that some IgM antibodies against the VZV gene 22 protein produced in the early phase of VZV infection are cross-reactive with the HTLV-1 gag p19 protein because they recognize an antigenic determinant containing an IPPP tetrapeptide. PMID: 1279104 [PubMed - indexed for MEDLINE] 3698. Pain. 1992 Oct;51(1):111-8. T-lymphocyte subsets in otherwise healthy patients with herpes zoster and relationships to the duration of acute herpetic pain. Higa K, Noda B, Manabe H, Sato S, Dan K. Department of Anesthesiology, School of Medicine, Fukuoka University, Japan. T-lymphocyte subsets (CD3, CD4, and CD8 lymphocytes) in peripheral blood, parameters of cell-mediated immunity, were serially measured in 62 otherwise healthy Japanese patients with herpes zoster (HZ), and the findings were compared with those of 20 age-matched healthy controls who had had varicella but not HZ. Our objective was to elucidate whether there were changes in cell-mediated immunity, even in immunocompetent patients with HZ, and to investigate relationships between these variables and the duration of acute herpetic pain (AHP). All the patients underwent repeated sympathetic nerve blocks until pain was relieved. As compared with controls, there were slight increases in the percentages of CD4 lymphocytes (helper/inducer) and highly significant increases in the percentages of CD8 lymphocytes (suppressor/cytotoxic), resulting in marked decreases in CD4/CD8 ratios in the acute phase of HZ. The percentages of CD3 lymphocytes (pan-T lymphocytes) did not differ significantly. The duration of AHP was analyzed in 49 patients in whom T-lymphocyte subsets were measured more than twice. There was a weak but statistically significant positive linear correlation between age and the duration of AHP (r = 0.43, P < 0.01). There were statistically highly significant positive linear correlations between the number of days on which percentages of CD3 (r = 0.72, P < 10(-8)) and CD4 lymphocytes (r = 0.60, P < 10(-5)), and CD4/CD8 ratios (r = 0.62, P < 10(-5)) reached the maximum values after the onset of HZ and the duration of AHP. These correlation coefficients were higher than that between age and the duration of AHP.(ABSTRACT TRUNCATED AT 250 WORDS) PMID: 1454393 [PubMed - indexed for MEDLINE] 3699. Br J Ophthalmol. 1992 Oct;76(10):639. Acyclovir in herpes zoster ophthalmicus. Herbort CP. Comment on: Br J Ophthalmol. 1991 Sep;75(9):542-6. PMCID: PMC505253 PMID: 1420049 [PubMed - indexed for MEDLINE] 3700. Transplant Proc. 1992 Oct;24(5):1926. Safe use of acyclovir (Zovirax) in renal transplant patients on cyclosporine A therapy: case reports. Hayes K, Shakuntala V, Pingle A, Dhawan IK, Masri MA. Faculty of Medicine and Health Sciences, Jazera Central Hospital, Abu Dhabi, United Arab Emirates. PMID: 1412913 [PubMed - indexed for MEDLINE] 3701. Int J Dermatol. 1992 Oct;31(10):745-6. Granuloma annulare arising after herpes zoster. Hayakawa K, Mizukawa Y, Shiohara T, Nagashima M. PMID: 1399211 [PubMed - indexed for MEDLINE] 3702. Dermatol Clin. 1992 Oct;10(4):741-61. Ocular and periocular infections. Holzberg M, Stulting RD, Drake LA. Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia. The eye is an important site for infectious disease because an incorrect diagnosis can cause loss of vision or loss of life. An approach to accurate diagnosis, intervention, and therapy is outlined. PMID: 1395156 [PubMed - indexed for MEDLINE] 3703. Minerva Pediatr. 1992 Oct;44(10 Suppl 1):147-54. [Perinatal viral infections of the central nervous system] [Article in Italian] Midulla M, Bavastrelli M. Istituto di Clinica Pediatrica, Università degli Studi La Sapienza, Roma. PMID: 1335110 [PubMed - indexed for MEDLINE] 3704. West J Med. 1992 Oct;157(4):448-9. Medical treatment of retinal infections in patients with AIDS. Holland GN. The Council on Scientific Affairs of the California Medical Association presents the following inventory of items of progress in ophthalmology. Each item, in the judgment of a panel of knowledgeable physicians, has recently become reasonably firmly established, both as to scientific fact and important clinical significance. The items are presented in simple epitome, and an authoritative reference, both to the item itself and to the subject as a whole, is generally given for those who may be unfamiliar with a particular item. The purpose is to assist busy practitioners, students, researchers, and scholars to stay abreast of these items of progress in ophthalmology that have recently achieved a substantial degree of authoritative acceptance, whether in their own field of special interest or another. The items of progress listed below were selected by the Advisory Panel to the Section on Ophthalmology of the California Medical Association, and the summaries were prepared under its direction. PMCID: PMC1011308 PMID: 1334299 [PubMed - indexed for MEDLINE] 3705. Neuropathol Appl Neurobiol. 1992 Oct;18(5):502-14. Varicella-zoster virus encephalitis in acquired immunodeficiency syndrome: report of four cases. Gray F, Mohr M, Rozenberg F, Belec L, Lescs MC, Dournon E, Sinclair E, Scaravilli F. Département de Pathologie Cellulaire et Tissulaire, Faculté de Médecine de Créteil, Université Paris-Val de Marne France. Four patients with acquired immunodeficiency syndrome, a 27-year-old female intravenous drug abuser and three males (two drug addicts aged 27 and 33 years and a 40-year-old homosexual) presented with a rapidly progressive encephalopathy. Two had generalized varicella-zoster virus skin infection, one had had a regressive thoracic zoster rash 7 months previously and one had no history of cutaneous eruption. Neuropathological examination revealed, in each case, multifocal necrotic changes with numerous, intranuclear Cowdry type A inclusion bodies in glial cells, endothelial cells, macrophages and neurons, within and around the lesions. These inclusion bodies were stained positively for varicella-zoster virus by immunocytochemistry and contained herpes virus nucleocapsids by electron microscopy. Molecular biology using the polymerase-chain-reaction method demonstrated viral genome. In one case, zoster-induced non-inflammatory vasculopathy involved medium sized leptomeningeal vessels and was associated with circumscribed areas of cortico-subcortical infarction. In another case, varicella-zoster virus encephalitis was associated with human immunodeficiency virus encephalitis and a secondary cerebral lymphoma. Multinucleated giant cells expressing human immunodeficiency virus proteins in their cytoplasm, were found in the lymphomatous deposits and in the varicella-zoster virus necrotic lesions. In these latter lesions, Cowdry type A inclusion bodies could be seen in the nuclei of some multinucleated giant cells confirming previous observations of MGCs co-infected by HIV and CMV, and supporting the hypothesis that DNA viruses interact with HIV, thus increasing its effect. PMID: 1333572 [PubMed - indexed for MEDLINE] 3706. J Assoc Physicians India. 1992 Oct;40(10):706. Viral encephalitis--overdiagnosed, undertreated. Bhatia RS. Comment on: J Assoc Physicians India. 1992 Mar;40(3):210-1. PMID: 1307373 [PubMed - indexed for MEDLINE] 3707. N Engl J Med. 1992 Sep 10;327(11):782-9. Acyclovir: a decade later. Whitley RJ, Gnann JW Jr. Department of Pediatrics, University of Alabama, Birmingham. Erratum in: N Engl J Med 1993 Mar 4;328(9):671. N Engl J Med 1997 Dec 4;337(23):1703. PMID: 1288525 [PubMed - indexed for MEDLINE] 3708. Arch Dermatol. 1992 Sep;128(9):1278-9. The clinical spectrum from classic varicella zoster to zoster sine herpete: the missing link. Nahass GT, Penneys NS, Leonardi CL. PMID: 1519950 [PubMed - indexed for MEDLINE] 3709. Southeast Asian J Trop Med Public Health. 1992 Sep;23(3):541-2. Herpes zoster myelitis treated with acyclovir. Chotmongkol V, Phankingthongkum R. Department of Medicine, Faculty of Medicine, Khon Kaen University, Thailand. PMID: 1488716 [PubMed - indexed for MEDLINE] 3710. Clin Ter. 1992 Sep;141(9 Pt 2):11-6. [Immunoglobulins in the treatment of herpes zoster] [Article in Italian] Agostini G, Agostini S. Instituto di Clinica Dermatologica, Università degli Studi di Pisa. We have treated 20 patients with Herpes Zoster with "hyperimmune anti-Zoster immunoglobulins" (Uman-VZIG) by intralesional administration, 20 patients with Uman-VZIG by intramuscular administration and 23 patients with acyclovir by intravenous administration. The results of treatment in both groups of patients treated with Uman-VZIG were clinically satisfactory with disappearance of fever, local pain and amelioration of cutaneous lesions after two days from the start of treatment and with a mean duration of disease of five days. In patients treated with acyclovir, signs and symptomatology of disease ameliorated slowly and we have observed a longer mean duration of disease (about 8 days). We concluded that Uman-VZIG, both by intralesional and intramuscular administration, is effective and safe in Herpes Zoster treatment. PMID: 1468193 [PubMed - indexed for MEDLINE] 3711. Int J Dermatol. 1992 Sep;31(9):672. Granuloma annulare following herpes zoster. Wright AL. Comment on: Int J Dermatol. 1992 Jan;31(1):55-7. PMID: 1459773 [PubMed - indexed for MEDLINE] 3712. Br J Gen Pract. 1992 Sep;42(362):398. Acute herpes zoster, postherpetic neuralgia, acyclovir and amitriptyline. Herxheimer A. Comment on: Br J Gen Pract. 1992 Jun;42(359):244-6. PMCID: PMC1372130 PMID: 1457182 [PubMed - indexed for MEDLINE] 3713. Surv Ophthalmol. 1992 Sep-Oct;37(2):151-2; author reply 152-3. Readers comment on "Herpes zoster ophthalmicus". Juzych MS, McHenry J, Spoor TC. Comment on: Surv Ophthalmol. 1992 May-Jun;36(6):395-410. PMID: 1455301 [PubMed - indexed for MEDLINE] 3714. Surv Ophthalmol. 1992 Sep-Oct;37(2):151; author reply 152-3. Readers comment on "Herpes zoster ophthalmicus". Harper DG. Comment on: Surv Ophthalmol. 1992 May-Jun;36(6):395-410. PMID: 1455300 [PubMed - indexed for MEDLINE] 3715. Surv Ophthalmol. 1992 Sep-Oct;37(2):150; author reply 152-3. Readers comment on "Herpes zoster ophthalmicus". Seiff SR, Margolis T. Comment on: Surv Ophthalmol. 1992 May-Jun;36(6):395-410. PMID: 1455299 [PubMed - indexed for MEDLINE] 3716. J Laryngol Otol. 1992 Sep;106(9):839-40. Isolated bilateral paralysis of the soft palate in an adult. Izzat M, Sharma PD. A case of bilateral paralysis of the soft palate occurring in a 42-year-old patient is presented. Idiopathic paralysis of the soft palate as an isolated clinical entity was first described by Edin et al. 1976. Since then 22 similar cases have been reported, all in children and all unilateral. A search of the English language literature has not revealed a case of bilateral palatal palsy in an adult. PMID: 1431530 [PubMed - indexed for MEDLINE] 3717. AJNR Am J Neuroradiol. 1992 Sep-Oct;13(5):1404-6. Herpes zoster myelitis: MR appearance. Friedman DP. Department of Radiology, Jefferson Medical College, Philadelphia, PA. The author describes a 71-year-old woman in whom cutaneous cervical herpes zoster was complicated by the development of cervical myelitis. T2-weighted MR showed two focal areas of hyperintensity in the cervical cord and suggested a slight enlargement at C2-C3 and C7. PMID: 1414833 [PubMed - indexed for MEDLINE] 3718. J Am Acad Dermatol. 1992 Sep;27(3):403-5. The Tzanck smear: can dermatologists accurately interpret it? Grossman MC, Silvers DN. Department of Dermatology, College of Physicians and Surgeons, Columbia University, New York, NY 10032. BACKGROUND: The Tzanck preparation is a standard technique for the rapid diagnosis of herpes simplex and varicella-zoster virus infections. OBJECTIVE: This study was designed to determine the ability of practicing dermatologists to interpret Tzanck preparations accurately. METHODS: Dermatologists at different levels of training interpreted a series of Tzanck preparations under test conditions. RESULTS: Second- and third-year residents had a pooled average for correct responses of 91%; dermatologists in practice less than 10 years, 84%; dermatologists in practice more than 10 years, 67%. CONCLUSION: Dermatologists are able to use the Tzanck preparation effectively for diagnosing herpetic infections. Second- and third-year residents who are most likely to be diagnosing blistering eruptions in immunosuppressed or otherwise critically ill patients are especially accurate interpreters. PMID: 1401275 [PubMed - indexed for MEDLINE] 3719. Hautarzt. 1992 Sep;43(9):576-9. [Erosive pustular dermatosis of the scalp after zoster ophthalmicus and trauma] [Article in German] Wollenberg A, Heckmann M, Braun-Falco O. Dermatologische Klinik und Poliklinik, Ludwig-Maximilians-Universität München. Erosive pustular dermatosis of the scalp (EPDS), first described in 1979, is a rare, chronic, pustular condition with scarring alopecia, and nonspecific histological findings. While the initial responded to steroids is good, it can be treated successfully by oral administration of zinc sulphate. Local trauma has recently been suggested to play a role in the pathogenesis of EPDS. The differential diagnosis of EPDS includes folliculitis decalvans, sterile eosinophilic pustulosis Ofuji, pustular psoriasis vulgaris, trichophytosis, Perifolliculitis capitis abscedens et suffodiens, pemphigus vulgaris and cicatricial pemphigoid. We present the cases of a 74-year-old woman suffering from EPDS following herpes zoster ophthalmicus and of a 54-year-old man in whom EPDS followed a head injury. PMID: 1399604 [PubMed - indexed for MEDLINE] 3720. Ir Med J. 1992 Sep;85(3):115-6. Herpes zoster oticus-diagnosis and treatment. O'Driscoll KJ, McShane DP. Royal Victoria Eye and Ear Hospital, Dublin. Four cases of Herpes Zoster Oticus (HZO) with facial paralysis are presented. HZO is a Herpes Zoster viral infection of the Geniculate Ganglion of the facial nerve. It presents classically with severe otalgia, a vesicular rash in the Concha or on the Pinna of the affected ear in association with a lower motor neurone lesion of the homolateral facial nerve. There also may be labyrinthine symptoms, sensineural hearing loss and vesicular eruptions in the regions supplied by the vagus and glossopharyngeal nerves viz, hypopharynx and oropharynx as these nerves communicate with the facial nerve. Treatment consists of Acyclovir. One reference in the past refers to a clustering of the condition and its predisposition for females. Interestingly all cases presented were referred with incorrect diagnoses. PMID: 1399478 [PubMed - indexed for MEDLINE] 3721. Br J Psychiatry. 1992 Sep;161:411-2. Delusional infestation associated with post-herpetic neuralgia and EEG abnormalities. Harper R, Moss G. University Department of Psychiatry, Leicester Royal Infirmary. An 80-year-old widow with delusional infestation in association with post-herpetic neuralgia and EEG abnormalities in the left anterior parietal lobe responded to combined pimozide and carbamazepine. Aetiological factors are reviewed in relation to the literature. PMID: 1393315 [PubMed - indexed for MEDLINE] 3722. Semin Dermatol. 1992 Sep;11(3):256-60. Rational use of acyclovir in the treatment of mucocutaneous herpes simplex virus and varicella zoster virus infections. Beutner KR. Department of Dermatology, University of California San Francisco, Vallejo 94589. The herpes family of viruses establishes latent infection in neurons and produces a spectrum of acute and recurrent clinical disease. Therapies to terminate the neurolatency or to enhance host responses are not yet available. Current therapy consists of antiviral drugs, which interfere with viral replication, can favorably alter the signs and symptoms of symptomatic disease, and act as prophylaxis against recurrent disease. Because the severity of acute and recurrent herpes group infection varies greatly between individuals, proper selection of patients to be treated with antiviral therapy is important. In general in immunocompetent patients, antiviral therapy has the greatest potential benefit for patients early in the course of primary or initial disease, or for patients with frequent and/or severe recurrent disease. Patients late in acute disease or with infrequent and/or mild recurrent disease are very unlikely to benefit from antiviral therapy. With immunocompromised patients, antiviral therapy is of the greatest potential value. By careful selection of patients, the clinician can maximize the benefits of antiviral therapy for patients with cutaneous herpes group viral infections. PMID: 1390038 [PubMed - indexed for MEDLINE] 3723. Semin Dermatol. 1992 Sep;11(3):218-25. Treatment of postherpetic neuralgia. Rowbotham MC. Department of Neurology, University of California, San Francisco 94143. Postherpetic neuralgia (PHN) is the most common and feared complication of herpes zoster. The more severe and painful the initial zoster outbreak, the more likely that PHN will develop, with elderly patients being at greatest risk. There are no proven treatments that have a large impact in reducing the risk of PHN. Tricyclic antidepressants are the mainstay of treatment for established PHN, aided by transcutaneous electrical nerve stimulation, physical therapy techniques, and cautious use of other medications. Topical agents, such as capsaicin, aspirin, and lidocaine, may soon become one of the mainstays of therapy for PHN. PMID: 1390037 [PubMed - indexed for MEDLINE] 3724. Semin Dermatol. 1992 Sep;11(3):211-7. Natural history of varicella zoster virus. Tyring SK. Department of Microbiology, University of Texas Medical Branch, Galveston 77550. The varicella zoster virus (VZV) is a herpesvirus responsible for two distinct clinical disorders, primary varicella (chickenpox) and zoster (shingles). Primary varicella is a common childhood disease in Western countries, which presents as pruritic macules, papules, vesicles, pustules, and crusts, usually on the back, chest, face, and abdomen. In immunocompetent children, chickenpox is generally a mild disease with little morbidity and rare mortality. Primary varicella is associated with more morbidity in adults. Following resolution of primary varicella, VZV persists in a latent form in dorsal ganglion cells for what is usually an extended period of time. For reasons that are still poorly understood, VZV can later start replicating in the ganglion, producing severe neuralgia and spread of the virus down the sensory nerve. Vesicles then appear on the skin in the distribution of this nerve, producing the characteristic dermatomal rash of shingles. The vesicles progress to pustules, then to crusts that eventually are lost. Scarring and changes in pigmentation can result, but the most frequent sequela of zoster is postherpetic neuralgia, which is usually most severe in the elderly. Primary varicella or herpes zoster in immunocompromised patients can sometimes involve internal organs (eg, lungs, liver, brain) resulting in high rates of morbidity and mortality. Congenital VZV infection is uncommon but can result in severe congenital malformations. A Tzanck smear can be useful to demonstrate a herpesvirus infection, but confirmation of VZV as the cause of the infection requires at least one of the following tests: culture, serology, direct immunofluorescence staining, or molecular techniques. PMID: 1390036 [PubMed - indexed for MEDLINE] 3725. Surv Ophthalmol. 1992 Sep-Oct;37(2):150-1; author reply 152-3. Readers comment on "Herpes zoster ophthalmicus". Herbort CP. Comment on: Surv Ophthalmol. 1992 May-Jun;36(6):395-410. PMID: 1333645 [PubMed - indexed for MEDLINE] 3726. Rev Med Liege. 1992 Sep;47(9):447-55. [Varicella and pregnancy] [Article in French] Paquet P, Piérard GE. CHU Sart Tilman, Service de Dermatopathologie, Université de Liège. PMID: 1329173 [PubMed - indexed for MEDLINE] 3727. Ophthalmology. 1992 Sep;99(9):1408-13. Comparison of immunocytology to tissue culture for diagnosis of presumed herpesvirus dendritic epithelial keratitis. Simon MW, Miller D, Pflugfelder SC, Murchison JF, Huang AJ, Atherton SS. Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, FL 33136. OBJECTIVE: The objective of this study is to prospectively compare the sensitivity and specificity of immunodetection of herpes simplex virus (HSV) in impression cytology specimens obtained directly from presumed herpesvirus dendritic epithelial keratitis with virus isolation by tissue culture of cells scraped from the same lesion. METHODS: Corneal impression cytology and tissue culture were performed on 29 consecutive patients presenting with presumed herpesvirus dendritic epithelial keratitis during a 6-month period. Impression cytology of dendritic epithelial keratitis lesions with Millipore Biopore membranes were evaluated for the presence of antigens specific to HSV type I (HSV-1), HSV-2, and varicella-zoster virus (VZV) using monoclonal antibodies specific to these herpesviruses and immunofluorescent staining techniques. RESULTS: Tissue culture was positive for HSV-1 in 52% (13 of 25) of dendritic epithelial keratitis patients without skin lesions, and was negative for VZV in 4 patients with dendritic epithelial keratitis and skin lesions in the distribution of the first division of the trigeminal nerve. The remaining 12 tissue cultures showed no cytopathic effect. Compared with tissue culture, impression cytology was 100% sensitive (13 of 13) and 92% specific (11 of 12) for the diagnosis of HSV-1 dendritic epithelial keratitis (Kappa coefficient of agreement 0.92). Although our sample size for VZV dendritic epithelial keratitis was small, the impression cytology findings correlated with our clinical diagnosis more often than tissue culture (2 of 4 versus 0 of 4). CONCLUSION: Impression cytology allows simultaneous debridement of dendritic epithelial keratitis and, when combined with immunocytologic staining procedures, provides a simpler, more rapid, and less expensive alternative to tissue culture for the diagnosis of dendritic epithelial keratitis caused by HSV or VZV. PMID: 1328982 [PubMed - indexed for MEDLINE] 3728. J Clin Microbiol. 1992 Sep;30(9):2487-91. Immunoelectron microscopy for rapid diagnosis of varicella-zoster virus in a complicated case of human T-cell lymphotropic virus type 1 infection. Folkers E, Vreeswijk J, Wagenaar F, Kapsenberg JG, Hulsebosch HJ, Oranje AP. Department of Dermatology, Hospital de Heel, Zaandam, The Netherlands. Rapid techniques for the detection of herpes simplex virus (HSV) and varicella-zoster virus (VZV) are needed for optimal therapeutic management. VZV infection poses a serious threat, especially to seriously ill patients, for instance, immunocompromised patients. We report a case of human T-cell lymphotropic virus type 1-positive leukemia complicated by atypical multidermatomal herpes zoster. Viral culture and standard serological tests failed to prove VZV infection. Herpesvirus infection was confirmed by cytodiagnosis (Tzanck test). The final diagnosis of VZV was made by immunoelectron microscopy (IEM), which can differentiate between HSV and VZV. Immunoglobulin M antibodies in serum directed against VZV were detected by IEM but not by immunofluorescence. Because IEM was able to identify virus and analyze sera in only 2 h, it is considered a valuable additional tool for the rapid diagnosis of HSV and VZV infections. PMCID: PMC265531 PMID: 1328289 [PubMed - indexed for MEDLINE] 3729. Schweiz Med Wochenschr. 1992 Aug 4;122(31-32):1178-84. [Neurogenic pain syndrome] [Article in German] Sturzenegger M. Neurologische Universitätsklinik, Inselspital Bern. Several pathophysiologic mechanisms are known which induce neuropathic pain in presence of peripheral nerve damage. They help to explain the clinical features of neuropathic pain syndromes and why causal and symptomatic treatments can be effective. However, careful analysis of every pain syndrome is necessary in order to select the type of pain management required. PMID: 1496346 [PubMed - indexed for MEDLINE] 3730. J Infect Dis. 1992 Aug;166 Suppl 1:S42-7. Varicella in pregnancy, the fetus, and the newborn: problems in management. Brunell PA. Ahmanson Pediatric Center, Cedars Sinai Medical Center, Los Angeles, California 90048. Comment in: J Infect Dis. 1993 Jan;167(1):254. As many as 9000 pregnancies annually may be complicated by varicella, which creates management problems for the woman and her fetus or newborn. Estimates on risk to the fetus and to neonates vary widely, making counseling difficult. Likewise, the efficacy of passive immunization of pregnant women or their exposed newborns is not precisely known. In addition to these problems in clinical management, questions remain about the developmental immunology of varicella-zoster virus infection. For example, why do infants exposed in utero to the virus get zoster at an early age and why does passive immunization of newborns appear to be less effective than immunization of older individuals? PMID: 1624811 [PubMed - indexed for MEDLINE] 3731. Curr Opin Neurol Neurosurg. 1992 Aug;5(4):549-53. Myelitis and toxic, inflammatory and infectious disorders. Cumming WJ. Department of Neurology, University Hospital of South Manchester, UK. Developments in our understanding of the anatomical-clinical and pathological correlates of spinal cord disorders have greatly enhanced our understanding of the clinical presentation. The impact of viral disease on the spinal cord is reviewed. The value of magnetic resonance (MR) scanning of the brain and spinal cord in the evaluation, both in the short and long term, of patients with myelopathy is underlined. PMID: 1515693 [PubMed - indexed for MEDLINE] 3732. Nihon Kyobu Shikkan Gakkai Zasshi. 1992 Aug;30(8):1569-73. [Case of adult primary varicella pneumonia] [Article in Japanese] Uemura A, Okano A, Iwata M, Satou A. Division of Internal Medicine, Kakegawa General Hospital, Shizuoka Pref., Japan. We report a case of adult primary varicella pneumonia. A 34-year-old man was admitted to our hospital with fever, dry cough and eruptions. He had no history of chicken pox and his sons had contracted varicella 2 weeks before the onset of his symptoms. Chest X-ray showed diffuse nodular shadows in both lungs. The diagnosis of primary varicella pneumonia was made based on family history, typical eruptions and high titer of antibody against Varicella zoster virus. An electron micrograph indicated this case to be primary varicella pneumonia with fibrosis and edema of interstitial spaces and the presence of virus-like particles in cells. The patient was treated with antibiotics, an antiviral agent and immunoglobulin. The clinical symptoms and diffuse nodular shadows resolved with this treatment. PMID: 1434232 [PubMed - indexed for MEDLINE] 3733. Masui. 1992 Aug;41(8):1322-6. [Herpes zoster of the right cervical region associated with right facial nerve palsy and hoarseness] [Article in Japanese] Dehara K, Takeda S, Nakamizo N, Morimoto F, Ikeda T, Tomaru T. Department of Anesthesiology, Showa University Fujigaoka Hospital, Yokohama. A 69-year-old man was suffering from herpes zoster on his 2nd and 3rd right cervical spinal segments and 3rd branch of the trigeminal nerve. He came to our hospital on his 10th illness day and was treated with continuous cervical epidural block, intravenous infusion of acyclovir for five days, and oral paramethasone and Vitamin B12. Oh his 18th illness day, right facial nerve palsy and hoarseness became clear. His cerebrospinal fluid showed no abnormality except cell count 23 x 3 mm-2. No clear paralysis of vocal cords was detected on laryngoscopy. He was also treated with right stellate ganglion block starting on his 21st illness day. His pain and facial nerve palsy recovered completely by his 68th illness day, but hoarseness continued about two months. The hoarseness might be a result of spread of the disease 1) by cerebrospinal fluid, 2) by contact with the 3rd cervical nerve and vagal nerve via accessory nerve, and 3) direct effect on the vocal cords and the muscles controlling them. Herpes zoster on the head and neck region shows various complications and we should follow its course cautiously. PMID: 1433860 [PubMed - indexed for MEDLINE] 3734. J Infect Dis. 1992 Aug;166 Suppl 1:S51-7. Therapeutic approaches to varicella-zoster virus infections. Whitley RJ. Department of Pediatrics, University of Alabama, Birmingham. Varicella-zoster virus (VZV) infections, the cause of chickenpox and shingles, are usually benign but are associated with morbidity and mortality, especially in immunocompromised hosts. Significant advances have been achieved in the treatment of VZV infections. In immunocompromised patients, both vidarabine and acyclovir have proved useful for the therapy of chickenpox and herpes zoster. Acyclovir, administered intravenously, is the treatment of choice for these infections. Both chickenpox and herpes zoster in the normal host are amenable to therapy with orally administered acyclovir. For older individuals with herpes zoster, acceleration of cutaneous healing can be accomplished at dosages of 800 mg five times a day for 10 days. Acyclovir therapy of chickenpox is recommended for adolescents and young adults with infection. In the future, improved therapies for VZV infections may include such newer antiviral drugs as bromovinyl arabinosyl uracil and acyclovir prodrugs. PMID: 1378081 [PubMed - indexed for MEDLINE] 3735. Acta Derm Venereol. 1992 Aug;72(4):314. A high incidence of venereal diseases and a rapid increase of herpes zoster in Africa. Lomholt G. PMID: 1357902 [PubMed - indexed for MEDLINE] 3736. J Infect Dis. 1992 Aug;166 Suppl 1:S1-68. The 1st International Conference on the Varicella-Zoster Virus. Harriman, New York, 29-31 October 1991. [No authors listed] PMID: 1352533 [PubMed - indexed for MEDLINE] 3737. J Infect Dis. 1992 Aug;166(2):253-9. Immune response of elderly individuals to a live attenuated varicella vaccine. Levin MJ, Murray M, Rotbart HA, Zerbe GO, White CJ, Hayward AR. Department of Pediatrics, University of Colorado School of Medicine, Denver 80262. The Oka strain live attenuated varicella-zoster virus (VZV) vaccine was administered subcutaneously to 202 VZV-immune individuals who were 55 to greater than 87 years old. The dose administered varied from 1100 to 12,000 pfu. One cohort received 3000 pfu with a 3000 pfu booster 3 months later. The vaccine was well tolerated. VZV-specific immunologic responses were evaluated over a 24-month period. The mean anti-VZV antibody level was significantly increased for 12 months after vaccination. Interferon-gamma production in vitro by peripheral blood mononuclear cells (PBMC) of vaccinees was also increased for 6 months after vaccination. Most significantly, VZV-specific proliferating T cells in PBMC of vaccinees were increased in frequency from 1 in 68,000 to 1 in 40,000. This vaccine-enhanced frequency of VZV-responding T cells is similar to the frequency observed in 35- to 40-year-old adults. Dose and age of the vaccinees did not significantly influence the magnitude of the mean cell-mediated immune response. The data indicate that VZV immunity in the elderly can be boosted by active immunization. If the increased incidence of herpes zoster that accompanies aging results from the natural waning of immunity, active immunization may prevent or attenuate zoster in the elderly. PMID: 1321859 [PubMed - indexed for MEDLINE] 3738. J Infect Dis. 1992 Aug;166 Suppl 1:S63-8. Varicella vaccine: the American experience. Gershon AA, LaRussa P, Hardy I, Steinberg S, Silverstein S. Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, NY 10032. Live attenuated varicella vaccine is safe and effective in preventing chickenpox. The best immune responses occur in healthy children. Leukemic children have a 50% incidence of mild-to-moderate adverse effects but have a high degree of protection once immune reactions to varicella-zoster virus (VZV) have developed. Adult vaccinees have a lower degree of protection (70%) than children. Vaccinees who develop breakthrough varicella usually have a modified infection. Another significant advantage of vaccination is that in leukemic children it leads to a lower incidence of zoster than after natural chickenpox. It is possible to differentiate between vaccine-type and wild-type VZV using a combination of polymerase chain reaction and restriction endonuclease digestion. A new assay for antibodies to VZV measured by latex agglutination reveals that 8-10 years after vaccination antibodies are detectable in greater than 90% of leukemic children who have not had breakthrough varicella. PMID: 1320652 [PubMed - indexed for MEDLINE] 3739. J Infect Dis. 1992 Aug;166 Suppl 1:S58-62. Immunization of the elderly and patients with collagen vascular diseases with live varicella vaccine and use of varicella skin antigen. Takahashi M, Iketani T, Sasada K, Hara J, Kamiya H, Asano Y, Baba K, Shiraki K. Research Institute for Microbial Diseases, Osaka University, Japan. Elderly subjects and patients with collagen vascular diseases were immunized with a live varicella vaccine to assess the vaccine's potential for preventing herpes zoster. An improved varicella-zoster virus (VZV) skin test antigen was then used to assess cell-mediated immunity to VZV. The antigen was prepared from culture fluid of VZV-infected cells and had far less protein content than crude antigen prepared by sonication of infected cells. In 11 of 12 patients with ophthalmic zoster and 17 of 21 with dermal zoster, the skin reaction was negative at the beginning of the disease but became positive later. After two doses of VZV vaccine, 8 of 12 elderly subjects (greater than 60 years old) and 4 of 6 patients with collagen vascular diseases, who were VZV-skin test negative but purified protein derivative tuberculin test-positive, became VZV skin test-positive. PMID: 1320651 [PubMed - indexed for MEDLINE] 3740. J Infect Dis. 1992 Aug;166 Suppl 1:S35-41. Cell-mediated immunity to varicella-zoster virus. Arvin AM. Department of Pediatrics, Stanford University School of Medicine, California. Natural varicella-zoster virus (VZV) infection and immunization with live attenuated varicella vaccine elicits T lymphocytes that recognize VZV glycoproteins, gpI-V, and the immediate early/tegument protein, the product of gene 62 (IE62). Proliferation or cytotoxicity assays, done under limiting dilution conditions to estimate responder cell frequencies, indicate no preferential recognition of VZV proteins by human T cells. Analysis of the primary cytotoxic T lymphocyte (CTL) response after vaccination demonstrates that both gpI and IE62 are targets of the early response. CD4(+)- and CD8(+)-mediated CTL recognition of these viral proteins can be detected with natural and vaccine-induced immunity. Responder cell frequencies for protein-specific T cell proliferation and CTL function are generally comparable in subjects with natural and vaccine-acquired immunity to VZV. Exogenous reexposure to VZV results in enhanced T cell proliferation and may be an important mechanism for maintaining virus-specific cellular immunity. Providing exogenous reexposure by giving varicella vaccine to individuals who have preexisting natural immunity markedly increases the responder cell frequencies of T cells that proliferate in response to VZV antigen and the numbers of circulating CTL that recognize VZV proteins. PMID: 1320649 [PubMed - indexed for MEDLINE] 3741. J Infect Dis. 1992 Aug;166 Suppl 1:S30-4. Varicella-zoster virus reactivation without rash. Gilden DH, Dueland AN, Devlin ME, Mahalingam R, Cohrs R. Department of Neurology, University of Colorado School of Medicine, Denver 80262. Reactivation of varicella-zoster virus (VZV) leads to localized zoster (shingles), a syndrome characterized by pain and a vesicular rash. Rarely, patients experience radicular pain without zosteriform rash, cases that have been regarded as zoster sine herpete (zoster without rash). Virologic evidence for zoster sine herpete is sparse. However, VZV can produce other neurologic and visceral diseases in the absence of rash or radicular pain. The clinical and virologic features of zoster sine herpete and other disorders produced by VZV without rash are reviewed. Evidence is also presented for the detection of VZV DNA in human blood mononuclear cells of elderly individuals in the absence of skin lesions or other VZV-associated neurologic or systemic disease. PMID: 1320648 [PubMed - indexed for MEDLINE] 3742. J Infect Dis. 1992 Aug;166 Suppl 1:S24-9. Restricted transcription of varicella-zoster virus in latently infected human trigeminal and thoracic ganglia. Cohrs R, Mahalingam R, Dueland AN, Wolf W, Wellish M, Gilden DH. Department of Neurology, University of Colorado School of Medicine, Denver 80262. Normal human trigeminal and thoracic ganglia latently infected with varicella-zoster virus (VZV) were identified by polymerase chain reaction (PCR). Total RNA was extracted from these ganglia and treated with DNase until ganglionic RNA was free of VZV DNA as determined by PCR. Radiolabeled cDNA synthesized by priming with random oligonucleotides was hybridized to Southern blots containing recombinant clones that spanned greater than 95% of the VZV genome. The single region of the VZV genome detected was the 12.5-kb SalI C fragment located in the unique long segment of the viral genome. Two additional regions of the VZV genome, EcoRI G and SalI B, were detected in RNA from adult dorsal root ganglia and infant nervous system tissue. PMID: 1320647 [PubMed - indexed for MEDLINE] 3743. J Infect Dis. 1992 Aug;166 Suppl 1:S13-23. Comparative biology of latent varicella-zoster virus and herpes simplex virus infections. Meier JL, Straus SE. Medical Virology Section, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland 20892. The clinicoepidemiologic features of varicella-zoster virus and herpes simplex virus latency are clearly distinctive. These differences indicate that each virus has evolved a unique strategy to ensure the establishment and maintenance of latency and to reactive therefrom. Indeed, current data reveal divergent pathogenetic and molecular biologic properties that may account for the clinicoepidemiologic characteristics that distinguish recurrent infections with these herpesviruses. PMID: 1320646 [PubMed - indexed for MEDLINE] 3744. J Infect Dis. 1992 Aug;166 Suppl 1:S1-6. Varicella and herpes zoster: a perspective and overview. Weller TH. Department of Tropical Public Health, Harvard School of Public Health, Boston, Massachusetts. The events leading to the isolation of varicella-zoster virus (VZV) are described beginning with the pioneering contributions of Ernest Tyzzer and Ernest Goodpasture and the early epidemiologic observations that indicated a relationship between varicella and zoster. Isolation, propagation, and immunologic proof of the coidentity of the viruses from the two clinical entities evolved from the introduction of human cell culture systems, a development that revolutionized virus research. Now the social significance of VZV is increasing. This reflects an aging population, increasing use of immunosuppressive therapeutic procedures, and the advent of a biologic immunosuppressive agent, the virus that causes AIDS. Currently there are unsolved problems: For unknown reasons varicella is often an adult disease in the tropics, and cell cultures fail to demonstrate VZV in throat washings from cases. These peculiarities warrant elucidation. PMID: 1320645 [PubMed - indexed for MEDLINE] 3745. Med J Aust. 1992 Jul 20;157(2):80-2. Antiviral agents: problems and promises. Smith DW. State Health Labortory Services, Queen Elizabeth II Medical Centre, Nedlands, WA. PMID: 1378525 [PubMed - indexed for MEDLINE] 3746. J Pain Symptom Manage. 1992 Jul;7(5):320-3. Postherpes simplex type 1 neuralgia simulating postherpetic neuralgia. Gonzales GR. Patients with prodromal neuralgia associated with recurrent herpes simplex type 1 (HST1) infection and chronic facial pain following years of relapsing HST1 have been described. Chronic neuralgia following a single clinical HST1 infection and simulating postherpetic neuralgia has not been previously reported. Such a case is described: A 49-yr-old woman with a 2-mo history of oral-facial dyskinesia developed burning pain and hypersensitivity of the left side of the tongue, lower gum, and inner cheek, followed 1 day later by a vesicular rash in the same painful distribution. Viral cultures of the lesions identified HST1 but not herpes zoster. Cerebrospinal fluid analyses during the vesicular lesion stage and 1 mo later were normal with no viral growth. Oral and facial lesions resolved after 10 days; acyclovir was given for 3 wk. Brain and brainstem magnetic resonance imaging (MRI), electroencephalogram, and brainstem evoked potential studies were normal. Hyperesthesias, allodynia, and burning pain persisted despite nonsteroidal antiinflammatory agents, codeine and hydrocodone. Oral opioids were administered until sedation occurred, with no relief of pain. The burning pain and hyperesthesia resolved after the 16th day of amitriptyline use, 75 mg/day. A trial off amitriptyline 6 mo later resulted in recurrence of pain, and amitriptyline was restarted with good pain control. Post-HST1 neuralgia may simulate postherpetic neuralgia clinically, and painful symptoms may respond to amitriptyline. PMID: 1624816 [PubMed - indexed for MEDLINE] 3747. Behav Res Ther. 1992 Jul;30(4):359-65. An application of the fear avoidance model to three chronic pain problems. Rose MJ, Klenerman L, Atchison L, Slade PD. Department of Clinical Psychology, University of Liverpool, England. The Fear Avoidance Model of Exaggerated Pain Perception was developed in an attempt to explain how, and why, some individuals develop a more substantial psychological overlay to their low back pain problem than do others. The present paper describes a study in which three chronic pain groups, consisting of Post-Herpetic neuralgia patients, Reflex Sympathetic Dystrophy patients and chronic low back pain patients were compared with three pain-free comparison groups using the Fear Avoidance Model of Exaggerated Pain Perception. The results show statistically significant differences between the chronic groups and the recovered comparison groups. These results demonstrate the usefulness of the Fear Avoidance Model as an explanation of psychological overlay in chronic pain conditions regardless of pathology. PMID: 1535497 [PubMed - indexed for MEDLINE] 3748. Ophthalmology. 1992 Jul;99(7):1062-70; discussion 1070-1. Oral acyclovir for herpes zoster ophthalmicus. Hoang-Xuan T, Büchi ER, Herbort CP, Denis J, Frot P, Thénault S, Pouliquen Y. Hôpital Hôtel-Dieu, Paris, France. BACKGROUND: Reports on the natural history of herpes zoster ophthalmicus stress its high morbidity related to vicious scars on eyelids, ocular complications, and post-herpetic neuralgia. Early treatment with oral acyclovir is effective, but the optimal duration of treatment has not been defined. METHODS: The authors performed a bicentric, prospective, randomized, double-masked study of 86 patients with acute herpes zoster ophthalmicus, within 72 hours of skin eruption, who received oral acyclovir (800 mg 5 times daily), either for 7 days (plus 7 days oral placebo) or for 14 days. All patients concomitantly received ophthalmic 3% acyclovir ointment; follow-up was at least 6 months. RESULTS: Statistical analyses of subjective symptoms, skin lesions, and ocular complications showed no significant differences between the groups, suggesting that a 7-day course of treatment was sufficient. Drug tolerance was good. Pooled data from both groups corroborated earlier reports that prompt treatment with oral acyclovir reduces the severity of the skin eruption, the incidence and severity of late ocular manifestations, and the intensity of postherpetic neuralgia. At 6 months, late ocular inflammatory complications were seen in 29.1% of our 86 patients, versus 50% to 71% of untreated patients described by others. Only 13% of our patients experienced post-herpetic neuralgia, which in no case required the use of analgesics. CONCLUSION: The authors believe it is not useful to prolong treatment with 800 mg of oral acyclovir 5 times daily for more than 7 days in herpes zoster ophthalmicus. This study confirms the efficacy of oral acyclovir not only against skin lesions and ocular complications, but also against postherpetic neuralgia in herpes zoster ophthalmicus. PMID: 1495785 [PubMed - indexed for MEDLINE] 3749. J Assoc Physicians India. 1992 Jul;40(7):496-7. Herpes zoster opthalmicus with complete external ophthalmoplegia. Garg RK, Kar AM, Jain AK. PMID: 1484059 [PubMed - indexed for MEDLINE] 3750. Nippon Rinsho. 1992 Jul;50 Suppl:166-9. [The detection of VZV DNA by in situ hybridization using biotin-labeled DNA probe] [Article in Japanese] Kazuyama Y. Research and Development Center of Hygienic Science, Kitasato University. PMID: 1328708 [PubMed - indexed for MEDLINE] 3751. Nippon Rinsho. 1992 Jul;50 Suppl:160-5. [Application of PCR to DNA diagnosis and molecular epidemiology of varicella-zoster virus infection] [Article in Japanese] Hondo R, Ito S. PMID: 1328707 [PubMed - indexed for MEDLINE] 3752. Nippon Rinsho. 1992 Jul;50 Suppl:104-10. [Titration of viral genome in clinical specimens by polymerase chain reaction and microplate hybridization] [Article in Japanese] Hondo R, Inouye S, Ito S. PMID: 1328703 [PubMed - indexed for MEDLINE] 3753. Ann Pharmacother. 1992 Jul-Aug;26(7-8):955-62. Treatment of herpesvirus infections in HIV-infected individuals. Fletcher CV. Department of Pharmacy Practice, College of Pharmacy, University of Minnesota, Minneapolis 55455. OBJECTIVE: To discuss strategies available for the treatment of herpesvirus infections in individuals infected with HIV. DATA SOURCES: Information was obtained from controlled and uncontrolled clinical trials, abstracts, conference proceedings, and review articles. STUDY SELECTION: Emphasis was placed on controlled investigations in subjects infected with HIV. DATA EXTRACTION: Data from human studies were extracted by the author and evaluated according to the patient population studied, sample size, dosage regimen, and therapeutic response. DATA SYNTHESIS: Herpes group viruses are common opportunistic pathogens in HIV-infected individuals. Zoster, caused by varicella-zoster virus (VZV), is an early indication of the loss of cell-mediated immunity and HIV disease progression. Anorectal mucocutaneous disease is the most common manifestation caused by herpes simplex virus (HSV). Acyclovir is the drug of choice for treatment of both VZV and HSV infections. Cytomegalovirus (CMV) is the most common life-threatening viral infection in patients with AIDS; retinitis is the most frequent clinical manifestation. The response rate of CMV retinitis to initial treatment with either ganciclovir or foscarnet is equivalent, approximately 60-90 percent. Recent data suggest that the survival benefit may be greater with foscarnet. CONCLUSIONS: Advances in the development and application of antiviral drugs for herpes group viruses have made treatment and, in some cases, prevention of infections possible. Future efforts, aimed at earlier intervention and suppression of latent virus, may offer additional improvement in quality of life for the HIV-infected individual. PMID: 1324033 [PubMed - indexed for MEDLINE] 3754. Pediatrics. 1992 Jul;90(1 Pt 2):144-8. Varicella vaccine: still at the crossroads. Gershon AA. Department of Pediatrics, Columbia University, College of Physicians and Surgeons, New York, NY 10032. PMID: 1318541 [PubMed - indexed for MEDLINE] 3755. Med Lett Drugs Ther. 1992 Jun 26;34(873):62-3. Capsaicin--a topical analgesic. [No authors listed] PMID: 1608346 [PubMed - indexed for MEDLINE] 3756. Clin Infect Dis. 1992 Jun;14(6):1270-1. Herpes zoster-induced acute hyperparathyroid crisis. Martínez E, Domingo P. PMID: 1623092 [PubMed - indexed for MEDLINE] 3757. Rev Clin Esp. 1992 Jun;191(2):109-10. [Acute aseptic meningitis caused by herpes zoster] [Article in Spanish] Pacios Martínez EC, Fernández Capitán MC, Pantoja Zarza L, Sánchez Muñoz Torrero J, Rubio Batlles M. PMID: 1502381 [PubMed - indexed for MEDLINE] 3758. Oral Surg Oral Med Oral Pathol. 1992 Jun;73(6):664-6. Maxillary osteomyelitis and spontaneous tooth exfoliation after herpes zoster. Mintz SM, Anavi Y. Detroit Receiving Hospital, Mich. Reports of spontaneous tooth exfoliation and osteonecrosis trigeminal herpes zoster are extremely rare and have been sporadic. This article reports a pertinent case of a 50-year-old man who exhibited prodromal odontalgia before the appearance of vesicular mucocutaneous lesions, together with severe destruction of the maxillary bone and exfoliation of multiple teeth. This patient was successfully treated using a unique closed nasal-vestibular drainage system for the ultimate control of maxillary bone viability. A review and analysis of the clinical aspects and the pathogenesis of herpes zoster and bone necrosis are discussed. PMID: 1437032 [PubMed - indexed for MEDLINE] 3759. Br J Gen Pract. 1992 Jun;42(359):244-6. Acute herpes zoster and postherpetic neuralgia: effects of acyclovir and outcome of treatment with amitriptyline. Bowsher D. Pain Research Institute, Liverpool. Comment in: Br J Gen Pract. 1992 Sep;42(362):398. Br J Gen Pract. 1992 Nov;42(364):493-4. This retrospective study was designed to assess the effects of acyclovir treatment of acute herpes zoster on subsequent postherpetic neuralgia, and to examine the effects of amitriptyline in the treatment of postherpetic neuralgia. Eighty seven patients with postherpetic neuralgia of three or more months' duration were studied: 24 of them had had their herpes zoster treated with oral acyclovir. At first presentation, only 25% of the 24 patients who had had their herpes zoster treated with acyclovir selected the word group containing burning on the McGill pain questionnaire compared with 76% of the 63 patients who had not received acyclovir. A higher proportion of patients who had had acyclovir than had not selected the word group which contains the word aching (63% versus 49%). Acyclovir thus appears to change the nature of postherpetic neuralgia. Postherpetic neuralgia was treated with amitriptyline, alone or in combination with distigmine and/or sodium valproate. There was a strong correlation between pain relief and the interval between the occurrence of herpes zoster and the initiation of treatment with amitriptyline--early treatment is almost twice as likely to be successful as late. Since conventional analgesics and sympatholytic drugs are of no benefit in the treatment of established postherpetic neuralgia, the sequelae of herpes zoster must, therefore, be recognized and treated with amitriptyline as soon as possible. PMCID: PMC1372061 PMID: 1419247 [PubMed - indexed for MEDLINE] 3760. Ann Hematol. 1992 Jun;64 Suppl:A152-7. Prevention of viral infections after bone marrow transplantation. Schuler U, Ehninger G. Medizinische Klinik, Universität Tübingen, Federal Republic of Germany. After bone marrow transplantation, a number of viral infections contribute to the morbidity and mortality of the procedure. Established preventive measures to avoid primary infection and reactivation of herpes-and cytomegaloviruses are outlined. Possible future strategies against these viruses (e. g., monoclonal antibodies, transfer of T-lymphocytes) and the possible role of improved diagnostic tools are briefly discussed. PMID: 1322188 [PubMed - indexed for MEDLINE] 3761. Epidemiol Infect. 1992 Jun;108(3):513-28. The epidemiology of varicella-zoster virus infections: the influence of varicella on the prevalence of herpes zoster. Garnett GP, Grenfell BT. Department of Animal and Plant Sciences, Sheffield University. This paper uses mathematical models and data analysis to examine the epidemiological implications of possible immunologically mediated links between patterns of varicella and herpes-zoster incidence in human communities. A review of previously published reports does not clarify whether or not there is a relationship between the incidence of varicella and the incidence of zoster. However, new analysis of data collected by the Royal College of General Practitioners provides indirect evidence for the hypothesis that a high intensity of varicella transmission suppresses viral reactivation. The significance of this finding for proposed varicella vaccination campaigns is explored by a review of published data on the use of the vaccine. No significant difference is shown to exist between the risk of zoster caused by the vaccine and the wild virus. A mathematical model is then developed to take into consideration the influence of the prevalence of varicella on viral reactivation and the impact of vaccination with attenuated virus, which may be able to recrudesce. Under some conditions, mass application of such vaccines may have the impact of increasing zoster incidence. The results presented here indicate that, before starting any vaccination programme against varicella, its consequences need to be assessed in much more depth. PMCID: PMC2272211 PMID: 1318219 [PubMed - indexed for MEDLINE] 3762. Epidemiol Infect. 1992 Jun;108(3):495-511. The epidemiology of varicella-zoster virus infections: a mathematical model. Garnett GP, Grenfell BT. Department of Animal and Plant Sciences, Sheffield University. Herpes-zoster is caused by the reactivation of varicella-zoster virus (VZV). In this paper different hypotheses of how this re-emergence of virus comes about are reviewed and discussed. From these hypotheses, and epidemiological data describing the initial transmission of the virus, a mathematical model of primary disease (varicella) and reactivated disease (zoster) in developed countries is derived. The steady-state age distributions of zoster cases predicted by this model are compared with the observed distribution, derived from a review and analysis of published epidemiological data. The model allows differentiation between published hypotheses in which age of host may or may not influence the probability of viral reactivation. The results indicate that the probability of reactivation must increase with age to allow the observed pattern of zoster cases. The basic mathematical model presented provides a conceptual framework, which may be extended to assess possible control programmes. PMCID: PMC2272210 PMID: 1318218 [PubMed - indexed for MEDLINE] 3763. Am J Otolaryngol. 1992 May-Jun;13(3):145-55. Infections of the external ear. Hirsch BE. Department of Otolaryngology, University of Pittsburgh School of Medicine, Montefiore University Hospital, PA. PMID: 1626615 [PubMed - indexed for MEDLINE] 3764. Can J Psychiatry. 1992 May;37(4):271-3. Encephalitis associated with herpes zoster: a case report and review. McKenna KF, Warneke LB. Alberta Heritage Foundation for Medical Research; Edmonton. Comment in: Can J Psychiatry. 1993 Nov;38(9):631. This paper describes the case of a patient with a history of affective disorder who developed encephalitis associated with herpes zoster which presented as a delirium with prominent manic symptoms. Published reports of encephalitis following herpes zoster infections are reviewed. The diagnosis of herpes zoster-associated encephalitis should be suspected in individuals with changes in his or her mental state, an abnormal electroencephalogram and an abnormal cerebrospinal fluid examination which closely follow a cutaneous herpes zoster lesion. PMID: 1611590 [PubMed - indexed for MEDLINE] 3765. Surv Ophthalmol. 1992 May-Jun;36(6):395-410. Herpes zoster ophthalmicus. Karbassi M, Raizman MB, Schuman JS. New England Deaconess Hospital, Department of Surgery, Boston, Massachusetts. Comment in: Surv Ophthalmol. 1992 Sep-Oct;37(2):151; author reply 152-3. Surv Ophthalmol. 1992 Sep-Oct;37(2):150-1; author reply 152-3. Surv Ophthalmol. 1992 Sep-Oct;37(2):151-2; author reply 152-3. Surv Ophthalmol. 1992 Sep-Oct;37(2):150; author reply 152-3. Herpes zoster ophthalmicus occurs worldwide, usually in healthy adults, but, increasingly in patients who are immunocompromised. After primary varicella infection (chickenpox), the virus lies dormant in the sensory ganglion until it becomes reactivated as zoster. Involvement of the ophthalmic branch of the trigeminal nerve is characterized early by corneal dysesthesia and dendritiform keratopathy, and these are self-limited. However, smoldering disease may cause pathological changes in the ocular structures through direct invasion of virus, secondary inflammation, and alterations of autoimmune mechanisms. Antiviral agents have demonstrated some success in resolving early signs and symptoms, but their role in preventing and treating late complications remains to be fully studied. Until a definitive antiviral agent is established, the benefits of steroid use in certain acute inflammatory processes outweight its risk of reducing host immunity. Corneal complications of herpes zoster ophthalmicus sometimes require surgical intervention. PMID: 1589855 [PubMed - indexed for MEDLINE] 3766. Neurology. 1992 May;42(5):1122-3. Segmental motor involvement in herpes zoster: an EMG study. Greenberg MK, McVey AL, Hayes T. Department of Neurology, Wilford Hall USAF Medical Center, Lackland AFB, TX 78236. PMID: 1579243 [PubMed - indexed for MEDLINE] 3767. J Neurosurg. 1992 May;76(5):888. Geniculate neuralgia. Young RF. Comment on: J Neurosurg. 1991 Oct;75(4):505-11. PMID: 1520357 [PubMed - indexed for MEDLINE] 3768. Ear Nose Throat J. 1992 May;71(5):207-8. Acyclovir for the treatment of idiopathic vocal fold paralysis. Benninger MS. PMID: 1505368 [PubMed - indexed for MEDLINE] 3769. Rinsho Shinkeigaku. 1992 May;32(5):524-6. [A case of multiple cranial nerve palsy with severe dysphagia due to herpes zoster infection] [Article in Japanese] Maeda A, Shiojiri T, Tsuchiya K, Watabiki S. Department of Neurology, Musashino Red Cross Hospital. A case of multiple cranial nerve palsy by herpes zoster was reported. A 79-year-old man showed fever, sore throat, and dysphagia. No vesicle was noted at ear and pharynx. The patient developed, later, left peripheral facial nerve palsy. The cerebrospinal fluid revealed pleocytosis with increased protein. The viral antibody titer of herpes zoster was significantly elevated both in cerebrospinal fluid and in serum. The left facial palsy was slightly improved. But his dysphagia didn't improve during at least 10 months after the onset. Among the cranial nerves, trigeminal and facial nerves are the most commonly affected by herpes zoster. But there are a few cases of the 9th and 10th cranial nerve involvement in the literature. However, dysphagia has rarely been reported in these previous cases, only four cases developed severe dysphagia like the present patient. All of these cases including our case were over sixty years old, while cases with slight dysphagia were under sixty years old. No other differentiating factor is noted between these two groups with regard to sites of vesicles, findings of cerebrospinal fluid and mode of therapy. PMID: 1458731 [PubMed - indexed for MEDLINE] 3770. Klin Oczna. 1992 May-Jun;94(5-6):135-6. [Oral acyclovir treatment of viral eye infections] [Article in Polish] Moszczyńska-Kowalska A, Kecik T, Dróbecka-Brydak E, Stanisławska A. Kliniki Okulistycznej AM, Warszawie. Forty four patients with virus conjunctivitis, keratitis, uveitis and retinitis were treated by acyclovir in tablets--5 times a day 400 mg.; the results were satisfactory. The drug was well tolerated and it could be used also in patients who showed hypersensitivity for acyclovir after ++intra-conjunctival application in the form of ointment. PMID: 1453671 [PubMed - indexed for MEDLINE] 3771. J Formos Med Assoc. 1992 May;91(5):508-12. Dorsal root entry zone lesions in the treatment of pain following brachial plexus avulsion and herpes zoster. Chen HJ. Department of Surgery, Chang Gung Memorial Hospital, Kaohsiung, Taiwan, R.O.C. Fifteen patients with brachial plexus avulsion injury and four patients with postherpetic pain submitted to dorsal root entry zone surgery. Nashold's method was used in all cases. The initial results in the group with brachial plexus avulsion injury were satisfactory. Twelve patients experienced pain relief. Only one patient had a poor result. Ten patients (66%) continued to have good pain relief in the follow-up period of 15-48 months. Three patients with postherpetic pain had good pain relief in the initial stage after surgery. Two of these four cases were found to have a recurrence of some pain, which could be relieved more or less by oral analgesics. No mortality or major complications were found in this series, although eight patients complained postoperatively of mild sensory weakness which disappeared within two weeks. PMID: 1358329 [PubMed - indexed for MEDLINE] 3772. Acta Neurol Scand. 1992 May;85(5):372-5. Recurrent herpes zoster myelitis treated with human interferon alpha: a case report. Nakano T, Awaki E, Araga S, Takai H, Inoue K, Takahashi K. Division of Neurology, Tottori University, Yonago, Japan. Recurrent herpes zoster myelitis is very rare. However, a case was recently observed in our hospital. A 43-year-old woman developed myelitis 2 weeks after development of shingles. Her condition was improved by methylprednisolone. Seven months later, she developed myelitis after development of shingles again. Antibody against varicella-zoster (VZV), increased in the serum, but was negative in the cerebrospinal fluid. Methylprednisolone was not sufficiently effective against this attack. The refractory sensory disturbance was improved by human interferon alpha (IFN-alpha). Natural killer cell activity, the helper T-cell/suppressor T-cell ratio and the kappa/lambda ratio of B-cells increased with clinical improvement. In this case, delayed-type hypersensitivity after VZV infection played a role in the occurrence of myelopathy and clinical improvement resulted from the immunosuppressive effects of IFN-alpha. PMID: 1320320 [PubMed - indexed for MEDLINE] 3773. Virology. 1992 May;188(1):193-7. Prevalence and distribution of latent simian varicella virus DNA in monkey ganglia. Mahalingam R, Clarke P, Wellish M, Dueland AN, Soike KF, Gilden DH, Cohrs R. Department of Neurology, University of Colorado School of Medicine, Denver 80262. We used polymerase chain reaction to analyze the prevalence and distribution of latent simian varicella virus (SVV) in ganglionic and nonganglionic tissues from nine African green monkeys experimentally infected with SVV. Primers specific for three different regions of the SVV genome were used for amplification. SVV DNA sequences were detected in trigeminal ganglia from seven of nine monkeys and in thoracic ganglia from seven of nine monkeys. Analysis of DNA from nonneuronal tissues of three monkeys and from adrenal glands of nine monkeys revealed the presence of SVV-specific sequences in the adrenal gland of one monkey. The results indicate that, like human varicella, SVV becomes latent primarily in ganglia at multiple levels of the neuraxis, and more than one region of the SVV genome is present in latently infected ganglia. SVV latency in primates may be a useful model for varicella latency in humans. PMID: 1314451 [PubMed - indexed for MEDLINE] 3774. Schweiz Med Wochenschr. 1992 Apr 18;122(16):569-75. [Antiviral drug therapy of infections caused by Herpes simplex and Varicella Zoster viruses] [Article in German] Vogt M, Huss R, Wunderli W. Departement für Innere Medizin, Universitätsspital Zürich. Herpes simplex virus type 1 and 2 may cause painful mucocutaneous lesions in both immunosuppressed and immunocompetent patients. Indications for the use of acyclovir (ACV) are reviewed. In the second part the management of infections caused by varicella-zoster virus are discussed. Primary varicella (chickenpox) in immunosuppressed children should be treated with i.v. ACV without delay. In healthy patients varicella pneumonia needs to be treated with ACV. Healthy patients with herpes zoster are not usually candidates for antiviral therapy. The only exception is herpes zoster ophthalmicus. In patients with severe immunosuppression, such as transplant recipients, ACV therapy is recommended in order to reduce the rate of dissemination. First reports and our own observations on the development of ACV-resistant HSV and VZV isolates stress the importance of discriminating use of ACV and other antiviral compounds in immunosuppressed patients. PMID: 1579862 [PubMed - indexed for MEDLINE] 3775. N Z Med J. 1992 Apr 8;105(931):135. Herpes zoster. King AS. PMID: 1560929 [PubMed - indexed for MEDLINE] 3776. Rev Clin Esp. 1992 Apr;190(7):375-6. [Lethal meningitis caused by varicella-zoster virus in a patient with AIDS] [Article in Spanish] Soriano V, Bru F, González-Lahoz J. PMID: 1620928 [PubMed - indexed for MEDLINE] 3777. Trop Doct. 1992 Apr;22(2):68-70. Herpes zoster as an indicator of HIV infection in Africa. Dehne KL, Dhlakama DG, Richter C, Mawadza M, McClean D, Huss R. Tropical Health Unit, Academic Unit of Public Health Medicine, Leeds. In areas where resources for health information are limited, the incidence of herpes zoster can usefully be monitored as an indicator of HIV infection. A sudden parallel rise of the number of symptomatic HIV cases and herpes zoster cases was observed in a northern district of Zimbabwe. Herpes zoster was made locally reportable. Three years later the incidence of herpes zoster and HIV in the hospital and of herpes zoster in the surrounding rural health centres was analysed. The herpes zoster attack rate and the HIV seropositivity rate of herpes zoster patients resembled those elsewhere in Africa. The distribution of cases of zoster was comparable with that of HIV infection. PIP: In 1987, Karoi district in northern Zimbabwe made herpes zoster a reportable disease because of an unusual increase in the number of cases in the district. Health workers at the hospital had seen an increase in the number of patients with HIV associated symptoms between June 1986 and March 1989. Herpes zoster cases rose from 0 to 100 between 1986 and 1987. HIV cases increased from 10 to 300 between 1986 and 1987. By 1988, these numbers increased to 500 and 450, respectively. 89% of herpes zoster cases at the hospital in 1988-89 were HIV positive. About 66% of these HIV positive cases had no sign or symptom of HIV infection other than herpes zoster. The percentage of confirmed HIV cases with a current or previous history of herpes zoster was 15% in 1987, 32% in 1988, and 17% in 1989. The decrease after 1988 was due to hospital staff telling health centers' staff that they no longer needed to refer all herpes zoster cases to the hospital since almost all young herpes zoster cases were HIV positive. Based on a herpes zoster attack rate of 15%, a positive predictive value of 90%, and the cumulative herpes zoster incidence for 1986-89 of 250/1200 inhabitants, the researchers calculated that there were about 1500 HIV positive cases or 12.5% of the total population living in the area. This would bring the number of HIV positive cases in the district to 3600 or 4 times the number who came to the hospital with HIV associated symptoms and were indeed HIV positive. Health workers can monitor expansion of the HIV epidemic in northern Zimbabwe based on the number of herpes zoster cases. PMID: 1604717 [PubMed - indexed for MEDLINE] 3778. Pediatrics. 1992 Apr;89(4 Pt 1):685-6. A varicella-induced pupil abnormality. Caputo AR, Mickey KJ, Guo S. PMID: 1557256 [PubMed - indexed for MEDLINE] 3779. Rinsho Shinkeigaku. 1992 Apr;32(4):451-3. [Varicella-zoster virus-associated spinal myoclonus without skin lesions] [Article in Japanese] Ogata A, Honma S, Tashiro K. Department of Neurology, Hokkaido University School of Medicine. A 50-year-old woman was admitted to our hospital because of abnormal involuntary movement of upper abdomen. Three months before admission, she had suffered from left lateral chest pain without skin lesions for one week. The neurological examination on admission revealed myoclonus of upper abdomen, and hyperalgesia and thermohyperesthesia from T4 to T9. There was no weakness, the tendon reflexes were symmetrical and the plantar responses were flexor. The surface EMG disclosed the symmetrical, synchronous contractions of m. rectus abdominis and m. obliques externus abdominis. This spinal myoclonus reduced during sleep. The EEG, CT and MRI showed no abnormalities. Serum varicella-zoster virus (VZV) titers increased significantly on follow-up examinations. Clonazepam, 1.5 mg daily was effective in this patient. The myoclonus spontaneously disappeared without clonazepam in six weeks after onset, and at the same time the sensory disturbance also improved. From the neurological findings and clinical course, we consider this spinal myoclonus was probably elicited by involvement of the inhibitory interneurons of the dorsal horns, due to immune response to latent VZV infection but not to direct neuronal destruction by VZV. Spinal myoclonus should be recognized as the spectrum of neurological disease associated with VZV even in the absence of skin lesions. PMID: 1395336 [PubMed - indexed for MEDLINE] 3780. Br J Ophthalmol. 1992 Apr;76(4):244-5. Ophthalmic zoster. Marsh RJ. PMCID: PMC504239 PMID: 1390496 [PubMed - indexed for MEDLINE] 3781. J Gen Virol. 1992 Apr;73 ( Pt 4):811-9. Immunity in strain 2 guinea-pigs inoculated with vaccinia virus recombinants expressing varicella-zoster virus glycoproteins I, IV, V or the protein product of the immediate early gene 62. Lowry PW, Solem S, Watson BN, Koropchak CM, Thackray HM, Kinchington PR, Ruyechan WT, Ling P, Hay J, Arvin AM. Department of Pediatrics, Stanford University School of Medicine, California 94305. The immunogenicity of specific varicella-zoster virus (VZV) proteins, with emphasis upon cell-mediated immune responses, was evaluated by immunizing strain 2 guinea-pigs with vaccinia virus recombinants that express gpI (vac-gpI), gpIV (vac-gpIV) and gpV (vac-gpV) or the IE-62 protein (vac-IE-62). Vac-gpI elicited the highest initial mean T cell proliferation response [stimulation index (S.I.) 3.8 +/- 0.9 S.E.M.] whereas inoculation with vac-gpV produced the lowest primary T cell response (S.I. 2.5 +/- 1.1 S.E.M.). T cell proliferation was detected for a shorter period after immunization with vac-gpV compared to vac-gpI, vac-gpIV or vac-IE-62. A comparison of the immunogenicity of vac-gpI and vac-IE-62 with the same proteins prepared by immunoaffinity purification showed that immunization with these proteins in either form elicited virus-specific IgG antibodies and T cell recognition. The presence or absence of IgG antibodies to the IE-62 protein was used to assess protection against challenge with guinea-pig cell-adapted infectious VZV in animals that had been inoculated with vac-gpI, vac-gpIV or vac-gpV. Immunization with vac-gpI and vac-gpIV restricted VZV replication but all animals given vac-gpV developed antibodies to IE-62 after challenge with infectious VZV. Priming of the T lymphocyte response was observed in all animals immunized with VZV-vaccinia virus recombinants after subsequent exposure to infectious VZV. These experiments with VZV vac-gpI, vac-gpIV and vac-gpV in guinea-pigs suggest variability in the capacity of herpesviral glycoproteins to elicit cell-mediated immunity in vivo. Induction of virus-specific immunity using IE-62 means that this major tegument protein of VZV could be a useful component for vaccine development. PMID: 1321876 [PubMed - indexed for MEDLINE] 3782. Brain. 1992 Apr;115 ( Pt 2):383-98. Presence, distribution and spread of productive varicella zoster virus infection in nervous tissues. Schmidbauer M, Budka H, Pilz P, Kurata T, Hondo R. Neurological Institute, University of Vienna, Austria. Nervous tissue lesions were retrospectively studied for detection of productive varicella zoster virus (VZV) infection in 33 autopsied cases, including 19 herpes zoster (HZ) (10 trigeminal, nine spinal) and 14 cases of nodular brainstem encephalitis without HZ. Immunocytochemistry for VZV antigens and in situ hybridization with a biotinylated VZV DNA probe were used on formol-fixed paraffin sections. Peripheral and central nervous system, skin and striated muscle were investigated in serial sections; available tissue blocks, however, varied between cases. Varicella zoster virus production (both antigen and DNA) in nervous tissue was found in HZ cases but only of short survival after a rash of up to 7 wks (eight out of 12 patients). Varicella zoster virus was visualized in nerve cells, glial cells, Schwann cells and blood vessels. In the central nervous system (CNS), VZV was detected in trigeminal nuclei (one out of 10 brains) or disseminated nodular brainstem lesions (one out of 10 brains), in subependymal microvessels (one out of 10 brains) or vasculitic arteries (two out of 19 brains or spinal cords). In the peripheral nervous system (PNS), VZV (DNA and antigen) was found in neurons and satellite cells of sensory ganglia (four out of seven cases with sampling of ganglia), and in damaged nerve fibres including a muscle nerve in one case; myositis with VZV in affected muscle fibres was found in the latter case. In nodular brainstem encephalitis, one case contained VZV within nodular lesions. We conclude that (i) VZV neural spread is suggested by detectable virus in ganglia, nerve fibres and CNS target nuclei; (ii) haematogenous spread of VZV is suggested by detection of virus in CNS microvessels and in disseminated brainstem encephalitis; (iii) VZV myositis may occur in zosteric myotomes; and (iv) VZV is a possible agent in nodular brainstem encephalitis. PMID: 1318768 [PubMed - indexed for MEDLINE] 3783. Rinsho Ketsueki. 1992 Apr;33(4):483-7. [Disseminated varicella-zoster virus infection without vesicles in a patient with malignant lymphoma] [Article in Japanese] Matsui T, Maruyama F, Miyazaki H, Nomura T, Ezaki K, Hirano M, Mizoguchi Y. Department of Medicine, Fujita Health University School of Medicine. A 76-year-old man was diagnosed as having malignant lymphoma (non-Hodgkin's lymphoma, diffuse medium cell-sized, B cell type). He was treated with CHOP therapy but with no response. In the terminal stage, he had continuous high temperature despite the administration of anti-bacterial and anti-fungal agents. Paralytic ileus, liver and pancreas dysfunction, and gastrointestinal bleeding developed. No skin eruptions occurred throughout the clinical course. He died on day 36 of treatment. Postmortem examination revealed foci of hemorrhagic necrosis containing many multinuclear giant-cells some of which with intranuclear inclusion bodies (Cowdry type A), in the liver, pancreas, gastrointestinal tract, bone marrow and other organs. Electron microscopy showed viral particles in the cytoplasm but not the nuclei of infected cells which were covered with a capsule, which was characteristic of varicella-zoster virus infection. Cells of the above organs were positive for immunohistochemical staining using antivaricella-zoster antibodies. The multiorgan failure seen in the terminal stage was considered to be due to disseminated varicella-zoster infection. PMID: 1318430 [PubMed - indexed for MEDLINE] 3784. Med Clin (Barc). 1992 Mar 28;98(12):476-7. [Diaphragmatic paralysis and respiratory insufficiency due to cervical herpes zoster] [Article in Spanish] González-Moreno M, Llibre JM, Roset J, Gutiérrez U. PMID: 1573919 [PubMed - indexed for MEDLINE] 3785. Am J Ophthalmol. 1992 Mar 15;113(3):248-56. Herpesvirus antibody levels in the etiologic diagnosis of the acute retinal necrosis syndrome. Pepose JS, Flowers B, Stewart JA, Grose C, Levy DS, Culbertson WW, Kreiger AE. Department of Ophthalmology, Washington University School of Medicine, St. Louis, Missouri 63110. Quantitative antibody levels to three herpesviruses in acute and chronic sera from six patients with clinical signs of the acute retinal necrosis syndrome were consistent with a specific etiologic diagnosis only in the two cases associated with cutaneous herpes zoster. Available data on acute and convalescent antibody titers to herpes group viruses from these six patients in addition to data from 27 acute retinal necrosis cases from the literature disclosed that only 13 of the 33 patients (39%) had a diagnostic increase or decrease in herpes group viral antibody levels on serial sampling. Three patients had nondiagnostic changes in viral antibody levels despite positive vitreous cultures for herpesviruses. In contrast, a review of 25 cases from the literature with paired antiviral serum and intraocular fluid antibody levels suggested a more promising approach to the etiologic diagnosis of the acute retinal necrosis syndrome. By calculating the ratio of antiviral antibodies in intraocular fluid and serum, an etiologic diagnosis could be made in 12 of 14 (86%) of subacute and convalescent samples. The sensitivity of this method decreased to 72% (13 of 18) when fluids were obtained earlier in the course of the disease. PMID: 1311902 [PubMed - indexed for MEDLINE] 3786. J Infect Dis. 1992 Mar;165(3):450-5. Disseminated herpes zoster in the immunocompromised host: a comparative trial of acyclovir and vidarabine. The NIAID Collaborative Antiviral Study Group. Whitley RJ, Gnann JW Jr, Hinthorn D, Liu C, Pollard RB, Hayden F, Mertz GJ, Oxman M, Soong SJ. Department of Pediatrics, University of Alabama, Birmingham. Seventy-three immunocompromised patients with disseminated herpes zoster were evaluated in a double-blind controlled trial of acyclovir (n = 37) versus vidarabine (n = 36) therapy. Acyclovir was administered at 30 mg/kg/day at 8-h intervals and vidarabine was given as a continuous 12-h infusion at 10 mg/kg/day for 7 days (longer if resolution of cutaneous or visceral disease was incomplete). No demographic differences existed between treatment groups. No deaths attributable to varicella-zoster virus infection occurred within 1 month of treatment. Neither rates of cutaneous healing, resolution of acute neuritis, and frequency of postherpetic neuralgia nor adverse clinical and laboratory events differed between treatment groups. Acyclovir recipients were discharged from the hospital more promptly than vidarabine recipients (P = .04, log rank test). These data indicate that disseminated herpes zoster is amenable to therapy with either acyclovir or vidarabine; resultant mortality is low. PMID: 1538151 [PubMed - indexed for MEDLINE] 3787. Med Clin (Barc). 1992 Mar 7;98(9):339-41. [Acute pancreatitis associated with varicella-zoster virus infection in a patient with acquired immunodeficiency syndrome] [Article in Spanish] Fernández de la Puebla Giménez RA, Lechuga Varona T, Kindelan Jaquotot JM, Jurado Jiménez R, Delgado Blanco M, de Non-Louis y Persson E. Unidad de Enfermedades Infecciosas, Hospital Regional Universitario Reina, Sofía, Córdoba. A patient with the acquired immunodeficiency syndrome (AIDS) who developed acute pancreatitis (AP) during the course of a disseminated herpes zoster is presented. Diagnosis was based on the simultaneity of abdominal pain with hyperamylasemia, the dissemination of the cutaneous lesions and the positive varicella-zoster virus serology at titres 1/640. Response to acyclovir treatment was spectacular. To our knowledge this is the second case of AP produced by the varicella-zoster virus and the first described in the course of disseminated herpes zoster. We believe that the varicella-zoster virus should be included within the causes of AP in patients with the human immunodeficiency virus. PMID: 1583963 [PubMed - indexed for MEDLINE] 3788. J Assoc Physicians India. 1992 Mar;40(3):201-3. Herpes zoster associated encephalitis. Raju D, Mathew T, Kathirvel H, Vijayalekshmy N, Abhayambika K. Department of Medicine, Medical College Trivandrum. Herpes zoster associated encephalitis is a very rare complication of herpes zoster. We are reporting a young healthy man who developed this complication along with the usual cutaneous presentation of herpes zoster. He was successfully treated with acyclovir. PMID: 1634491 [PubMed - indexed for MEDLINE] 3789. Rinsho Shinkeigaku. 1992 Mar;32(3):314-6. [A case of herpes zoster associated with multiple cranial nerve involvement] [Article in Japanese] Kobayashi Y, Riku S, Ieda T, Aoki S. Department of Neurology, Shakaihoken Chukyo Hospital. A 74-year-old man who had suffered from right herpes zoster ophthalmicus developed ipsilateral multiple cranial nerve involvement two weeks later. He showed right visual disturbance, total ophthalmoplegia and peripheral facial palsy. Pleocytosis and increased protein were found in CSF. Titer of VZV antibody increased in serum and CSF. CT and MRI demonstrated no abnormal findings in the brain stem. Within a month, peripheral facial palsy improved. Severe extra-ophthalmoplegia began to improve after three months, and moderately recovered. After two and a half year, visual disturbance and mydriasis showed no improvement. In this case, we speculate that localized leptomeningitis caused multiple cranial nerve involvement. PMID: 1628455 [PubMed - indexed for MEDLINE] 3790. Acta Otorrinolaringol Esp. 1992 Mar-Apr;43(2):117-20. [The incorporation of acyclovir into the treatment of peripheral paralysis. A study of 45 cases] [Article in Spanish] Ramos Macías A, de Miguel Martínez I, Martín Sánchez AM, Gómez González JL, Martín Galán A. Servicio de ORL, Hospital Clínico Universitario de Salamanca. The relation between use of acyclovir and facial nerve palsy prognosis was studied. In a randomised study, steroids or steroids + acyclovir (oral doses for Bell's palsy, and intravenous doses for Ramsay Hunt's syndrome) were given to 45 patients with facial palsy. There was a significant reduction of sequelae in patients treated with acyclovir in the group of Ramsay Hunt's syndrome (n = 15) (p less than 0.05). There were no significant differences in the group of Bell's palsy (n = 30) (p greater than 0.05), treated with acyclovir compared with steroids. PMID: 1605959 [PubMed - indexed for MEDLINE] 3791. J Tradit Chin Med. 1992 Mar;12(1):71. 34 cases of herpes zoster treated by moxibustion at dazhui (du 14). Li H. Section of Acupuncture, Zhaotong District Hospital, Yunnan Province. PMID: 1598005 [PubMed - indexed for MEDLINE] 3792. Pain. 1992 Mar;48(3):383-90. A new topical treatment for acute herpetic neuralgia and post-herpetic neuralgia: the aspirin/diethyl ether mixture. An open-label study plus a double-blind controlled clinical trial. De Benedittis G, Besana F, Lorenzetti A. Pain Research and Treatment Unit, University of Milan, Italy. Erratum in: Pain 1992 Aug;50(2):245. Topical aspirin/diethyl ether (ADE) mixture was used to treat 45 consecutive patients with acute herpetic neuralgia (AHN) (n = 28) and with post-herpetic neuralgia (PHN) (n = 17) in an open-label study. Good-to-excellent results were achieved by 93% of AHN patients and by 65% of PHN patients. Earlier treatment yielded better results for the AHN but not the PHN group. The topical treatment seemed to accelerate the healing of acute herpetic skin lesions and possibly modulate the severity of the herpetic infection. Furthermore, a striking reduction in the percentage of AHN patients developing PHN was observed in the treated group, as compared with the disease natural history reported in the literature (4 vs. 50-70%). Treatment tolerance was excellent with no adverse effect observed. In addition to the open trial, a pilot double-blind crossover placebo-controlled study (n = 11) compared the analgesic efficacy of ADE with two other NSAID (indomethacin and diclofenac) drug/ether mixtures. Aspirin (but not indomethacin and diclofenac) was significantly superior to placebo as regards pain relief (P less than 0.05). PMID: 1594261 [PubMed - indexed for MEDLINE] 3793. Reg Anesth. 1992 Mar-Apr;17(2):107-9. Intrapulmonary placement of a pleural catheter. Lefever EB, Rosenthal RM, Ramamurthy S. Audie Murphy Veterans Administration Hospital, San Antonio, Texas. OBJECTIVE AND CONCLUSION. A case of intrapulmonary placement of a pleural catheter is described that was likely due to the presence of focal pleural thickening at the site of catheter insertion. PMID: 1581248 [PubMed - indexed for MEDLINE] 3794. An Med Interna. 1992 Mar;9(3):155-6. [Neurological complications caused by varicella zoster in geriatric patients] [Article in Spanish] Castrillo Viguera C, Ramos Rincón JM, López de Andrés M, Sánchez Portocarrero J. Comment in: An Med Interna. 1992 Dec;9(12):624-5. PMID: 1567957 [PubMed - indexed for MEDLINE] 3795. J Reprod Med. 1992 Mar;37(3):280-2. Early-second-trimester use of acyclovir in treating herpes zoster in a bone marrow transplant patient. A case report. Horowitz GM, Hankins GD. Department of Obstetrics and Gynecology, Wilford Hall United States Air Force Medical Center, Lackland Air Force Base, Texas 78236-5300. Bone marrow transplantation from a human leukocyte antigen (HLA)-identical sibling for treatment of severe aplastic anemia among women of reproductive age is becoming more common. Successful pregnancy has been reported to occur in several such patients. A woman delivered a healthy, term, female infant 18 months after a transplant from her HLA-identical sister. Her pregnancy was complicated by disseminated herpes zoster, treated with intravenous acyclovir at 14 weeks' gestation, before the diagnosis of pregnancy. While there have been several case reports involving the use of acyclovir in the third trimester, primarily in the treatment of varicella infections, there have been no previous reports of such an early utilization of this antiviral drug. PMID: 1564715 [PubMed - indexed for MEDLINE] 3796. J Clin Neuroophthalmol. 1992 Mar;12(1):37-40. Herpes zoster ophthalmicus. Anterior ischemic optic neuropathy and acyclovir. Borruat FX, Herbort CP. Hôpital Ophthalmique Jules Gonin, University Eye Clinic of Lausanne, Switzerland. A healthy 56-year-old man developed left-sided herpes zoster ophthalmicus, accompanied initially by ipsilateral anterior uveitis and increased intraocular pressure. Although he was treated in the subacute phase (5 days after skin eruption) with adequate oral doses of acyclovir for 10 days, the condition was later complicated by a left sectorial anterior ischemic optic neuropathy. The pathogenesis of this rare complication is discussed in this article. PMID: 1532599 [PubMed - indexed for MEDLINE] 3797. Bone Marrow Transplant. 1992 Mar;9(3):217. Abdominal presentation of varicella zoster infection after bone marrow transplantation. Perez-Oteyza J, Pascual C, Garcia-Larana J, Odriozola J, Rocamora A, Navarro JL. Comment on: Bone Marrow Transplant. 1991 Jun;7(6):489-91. PMID: 1511259 [PubMed - indexed for MEDLINE] 3798. J Gen Virol. 1992 Mar;73 ( Pt 3):521-30. Characterization of the varicella-zoster virus gene 61 protein. Stevenson D, Colman KL, Davison AJ. MRC Virology Unit, University of Glasgow, U.K. The protein predicted to be encoded by varicella-zoster virus (VZV) gene 61 exhibits limited amino acid sequence similarity to the herpes simplex virus type 1 nuclear phosphoprotein Vmw110, which functions as a transcriptional activator. The gene 61 protein was expressed in its entirety, or as an amino- or carboxy-terminal fragment in Escherichia coli and vaccinia virus recombinants, and monospecific rabbit antisera were raised against an E. coli fusion between beta-galactosidase and the majority of the gene 61 protein. Use of the antisera showed that the gene 61 protein is present in VZV-infected cell nuclei as a heterogeneous phospho-protein of Mr62K to 65K. Phosphorylation occurs in the amino- and, to a lesser extent, carboxy-terminal portions of the protein. The carboxy-terminal region directs transport of the protein to the nucleus, whereas the amino-terminal region, which contains a potential zinc-binding domain, is responsible for a punctate distribution. Preliminary mapping data indicated that gene 61 is transcribed as a 1.8 kb mRNA which initiates about 65 bp upstream from the translation initiation codon, at a position located appropriately with respect to potential regulatory elements. PMID: 1312115 [PubMed - indexed for MEDLINE] 3799. Med Clin (Barc). 1992 Feb 22;98(7):245-9. [A topical solution of 40% idoxuridine in dimethyl sulfoxide compared to oral acyclovir in the treatment of herpes zoster. A double-blind multicenter clinical trial] [Article in Spanish] Aliaga A, Armijo M, Camacho F, Castro A, Cruces M, Díaz JL, Fernández JM, Iglesias L, Ledo A, Mascaró JM, et al. Hospital General Universitario, Valencia. BACKGROUND: Both topical 40% idoxuridine in dimethylsulfoxide (IDU) and oral acyclovir (ACV) are useful in herpes zoster (HZ). This is the first clinical trial which compares the efficacy of both drugs in the course of the disease and in the prevention of post-herpetic neuralgia (PHN). METHODS: Patients of both sexes older than 18 years, with a HZ of less than 4 days were selected. Patients with otic or ophthalmic zoster, serious concomitant illness or pregnant or breast-feeding women were excluded. Following a double dummy design, the patients received at random topical IDU and oral placebo, or oral ACV and topical placebo. Topical treatment was applied during 4 days and oral treatment during 7 days. The evolution of the disease (number of individual lesions, evolution of symptoms, use of analgesic drugs and eventual appearance of complications) was controlled on days 0, 2, 4, 6, 8, and weekly until its resolution. RESULTS: The group of patients treated with IDU (85) showed a better evolution of the disease than those treated with ACV (86) in some of the parameters controlled: day of first and all vesicles drying (p less than 0.05), last day of moderate-intense pain (p less than 0.05), hyperaesthesia (p less than 0.05) and itching (p less than 0.05) and last day of analgesic use (p less than 0.01). The appearance of new vesicles during treatment was lower in the IDU treated group (p less than 0.01). A tendency favouring IDU can be observed in the appearance of PHN. CONCLUSIONS: In our study topical 40% idoxuridine in DMSO was better than oral acyclovir in 7 of the 14 clinical parameters studied. PMID: 1560699 [PubMed - indexed for MEDLINE] 3800. Am J Med. 1992 Feb 14;92(2A):1S-2S. Clinical implications of herpesvirus infections in patients with AIDS. Introduction. Masur H. National Institutes of Health, Bethesda, Maryland 20892. PMID: 1310568 [PubMed - indexed for MEDLINE] 3801. Am J Dermatopathol. 1992 Feb;14(1):1-7. Chronic verrucous varicella-zoster virus infection in patients with the acquired immunodeficiency syndrome (AIDS). Histologic and molecular biologic findings. LeBoit PE, Límová M, Yen TS, Palefsky JM, White CR Jr, Berger TG. Department of Pathology, School of Medicine, University of California, San Francisco 94143-0506. Verrucous skin lesions have been attributed to various herpes viruses in immunosuppressed patients, including those with human immunodeficiency virus infection (HIV). We examined such lesions from six HIV-infected patients to determine the range of microscopic findings present and to establish which herpesviruses were present. Verrucous epidermal hyperplasia, pseudocarcinomatous hyperplasia, and massive hyperkeratosis correlate with the warty clinical appearance of the lesions. Herpetic cytopathic changes, including multinucleated epidermal giant cells, steel-gray nuclei, necrotic acantholytic keratinocytes, and Cowdry type A nuclear inclusions were seen most prominently in the dells between papillations and in adnexal epithelium. In two cases, increased numbers of spindled cells were seen in the dermis. Immunoperoxidase staining with anti-type IV collagen antibodies demonstrated that these findings were not those of Kaposi's sarcoma, but represent a fibrotic reaction to the infection. Viral cultures of four of the cases demonstrated the presence of varicella-zoster virus, whose presence was detected by the polymerase chain reaction in paraffin-embedded lesional tissue from all six cases. Polymerase chain reaction did not show the presence of cytomegalovirus, herpes simplex, Epstein-Barr, or human papillomavirus. We conclude that these unusual verrucous lesions are a chronic manifestation of herpes zoster infection and that the reported presence of other agents in such lesions is probably coincidental. PMID: 1324620 [PubMed - indexed for MEDLINE] 3802. Ugeskr Laeger. 1992 Feb 10;154(7):425-6. [Herpes zoster complicated by myelitis] [Article in Danish] Christensen B. Neurologisk Afdeling, Holstebro Centralsygehus. PMID: 1536056 [PubMed - indexed for MEDLINE] 3803. Harefuah. 1992 Feb 2;122(3):182-5. [Postherpetic neuralgia--therapeutic approaches] [Article in Hebrew] Niv D, Wolman I, Geller E. PMID: 1563673 [PubMed - indexed for MEDLINE] 3804. Ann Otol Rhinol Laryngol. 1992 Feb;101(2 Pt 1):161-2. Herpes zoster oticus: treatment with acyclovir. Uri N, Greenberg E, Meyer W, Kitzes-Cohen R. Department of Otolaryngology, Lady Davis Carmel Hospital, Haifa, Israel. Herpes zoster oticus produces facial paralysis with a low recovery rate. Acyclovir, a specific virostatic drug, was given intravenously in five herpes zoster oticus patients, and in three of them was followed by oral therapy. In follow-ups of 1 to 24 months, one patient had grade I recovery, three patients grade II, and one grade III. These good results encourage the use of acyclovir in herpes zoster oticus patients. PMID: 1739262 [PubMed - indexed for MEDLINE] 3805. J Dermatol. 1992 Feb;19(2):94-8. Significance of monocytosis in varicella and herpes zoster. Tsukahara T, Yaguchi A, Horiuchi Y. Division of Dermatology, Kashima Rosai Hospital, Ibaraki, Japan. Percent ratios and absolute numbers of peripheral blood monocytes in patients with varicella and herpes zoster were determined and compared with those in patients with herpes simplex virus infection, measles and rubella. Monocytosis during the acute stage (p less than 0.01) was statistically significant in varicella and generalized and localized herpes zoster, compared with the levels in herpes simplex virus infection, measles and rubella. Absolute monocyte counts in varicella and HZ were significantly increased (p less than 0.02) beyond those of measles and rubella. The high % ratios of monocytes in varicella and herpes zoster during the acute stage decreased to normal ranges with cure. PMID: 1619111 [PubMed - indexed for MEDLINE] 3806. Ann Ophthalmol. 1992 Feb;24(2):50-3. Optic neuropathy and central retinal artery occlusion in a patient with herpes zoster ophthalmicus. Atmaca LS, Ozmert E. Department of Retinal Diseases, Ankara University, Turkey. We present the case of a patient with herpes zoster ophthalmicus and optic neuropathy followed by central retinal artery occlusion. In those with herpes zoster ophthalmicus, in addition to the known usual complications, the possibility of this rare complication also should be considered, and the patient should be followed closely for a prolonged time. PMID: 1562124 [PubMed - indexed for MEDLINE] 3807. N C Med J. 1992 Feb;53(2):71-3. Prodrome of disseminated varicella zoster in an immunocompromised adult. Beaty O 3rd, Engel J, Jones B, Raab M. Department of Internal Medicine, East Carolina University School of Medicine, Greenville 27858-4354. PMID: 1557136 [PubMed - indexed for MEDLINE] 3808. J Abnorm Psychol. 1992 Feb;101(1):200-5. A high-risk method for studying psychosocial antecedents of chronic pain: the prospective investigation of herpes zoster. Dworkin RH, Hartstein G, Rosner HL, Walther RR, Sweeney EW, Brand L. College of Physicians and Surgeons, Columbia University. Although patients with chronic pain are often psychologically distressed, it has been difficult to determine whether this distress is an antecedent of chronic pain or whether it is caused by the experience of living with chronic pain. The aim of this investigation was to develop a method that would allow individuals who are at risk for the development of chronic pain to be studied before their pain has become chronic. Patients with acute herpes zoster were assessed with demographic, medical, pain, and psychosocial measures. Pain was assessed in follow-up interviews at 6 weeks and 3, 5, 8, and 12 months after these initial assessments. There were no significant differences between patients who developed short-term herpes zoster pain and patients who did not develop short-term pain for any of the measures at the initial assessment, except for one measure of pain intensity. Patients who developed chronic herpes zoster pain, however, had significantly greater pain intensity, higher state and trait anxiety, greater depression, lower life satisfaction, and greater disease conviction at the initial assessment than patients who did not develop chronic pain. In discriminant analyses, disease conviction, pain intensity, and state anxiety each made a unique contribution to discriminating patients who did and who did not develop chronic pain. This study demonstrates the feasibility of investigating psychosocial antecedents of the development of chronic pain by prospectively examining the longitudinal course of herpes zoster. PMID: 1537967 [PubMed - indexed for MEDLINE] 3809. J Dermatol Surg Oncol. 1992 Feb;18(2):97-100. Zosteriform and epidermotropic metastasis. Report of two cases. Manteaux A, Cohen PR, Rapini RP. Department of Dermatology, University of Texas Medical School, Houston 77030. We report two cases of zosteriform metastasis to the skin. One patient had epidermotropic papulovesicular metastases from a presumed cutaneous adnexal neoplasm. The second patient had painful zoster-like papulovesicles from metastatic breast cancer. Previously reported dermatomal or zosteriform metastases are reviewed. PMID: 1537956 [PubMed - indexed for MEDLINE] 3810. Riv Eur Sci Med Farmacol. 1992 Feb;14(1):45-7. ["Chronic paroxysmal hemicrania" following ophthalmic herpes zoster] [Article in Italian] Giacovazzo M, Di Sabato F, Gallo MF, Granata M, Martelletti P. Istituto di Clinica Medica VI, Università La Sapienza, Roma. The authors report the first observation of a 73-year-old woman affected from CPH (Chronic Paroxysmal Hemicrania) which following an ophthalmic herpes-zoster infection. The improvement with a 5-HT 1-like agonist receptors (Sumatriptan) and with Timostimulin is discussed. PMID: 1529145 [PubMed - indexed for MEDLINE] 3811. Cent Afr J Med. 1992 Feb;38(2):86-8. Human immunodeficiency virus and Guillain 'Barre' syndrome in intensive care unit patients. Chinyanga HM, Danha RF. Department of Anaesthetics, University of Zimbabwe Medical School, Avondale, Harare. Among 155 medical admissions to the intensive care unit during the period 1989 to 1990, 16 patients had Guillain-'Barre' Syndrome (GBS), five of whom were HIV positive. Out of the five cases, three had manifested herpes zoster and one had TB. The impact of HIV infection o GBS is discussed. PMID: 1505017 [PubMed - indexed for MEDLINE] 3812. J Hosp Infect. 1992 Feb;20(2):125-6. Transmission of chickenpox to two intensive care unit nurses from a liver transplant patient with zoster. Wreghitt TG, Whipp PJ, Bagnall J. Comment in: J Hosp Infect. 1993 Feb;23(2):161-2. PMID: 1348758 [PubMed - indexed for MEDLINE] 3813. Epidemiol Infect. 1992 Feb;108(1):165-74. Antibody-capture enzyme-linked immunosorbent assays that use enzyme-labelled antigen for detection of virus-specific immunoglobulin M, A and G in patients with varicella or herpes zoster. van Loon AM, van der Logt JT, Heessen FW, Heeren MC, Zoll J. Department of Medical Microbiology, University of Nijmegen, The Netherlands. Antibody-capture enzyme-linked immunosorbent assays (AC-ELISA) which use enzyme-labelled antigen were developed for detection of varicella-zoster virus-(VZV) specific IgM, IgA and IgG antibody in patients with varicella or herpes zoster and in sera from healthy individuals. All 18 patients with varicella developed a VZV-IgM and a VZV-IgG response, 17 also a VZV-IgA response. In contrast, all 19 patients with herpes zoster were shown to be positive for VZV-IgA whereas only 13 of these reacted positively for VZV-IgM. A VZV-IgM response was detected in only two sera from 100 healthy individuals and an IgA response in only one. The presence of virus-specific IgA and IgG in the cerebrospinal fluid as determined by AC-ELISA was a useful indicator of VZV infection of the central nervous system. By AC-ELISA, VZV-IgG was detected predominantly in sera from patients with acute or recent VZV infection. Only 14 sera from 100 healthy individuals were positive for VZV-IgG by AC-ELISA, whereas all were positive by an indirect ELISA. These results indicate that AC-ELISA's may be useful assays for determination for acute or recurrent VZV infection, but are not suitable for determination of past infection with this virus. PMCID: PMC2272196 PMID: 1312479 [PubMed - indexed for MEDLINE] 3814. Pediatrics. 1992 Feb;89(2):353-4. Varicella vaccine reflux. Mangano MF. Comment on: Pediatrics. 1991 May;87(5):604-10. PMID: 1310355 [PubMed - indexed for MEDLINE] 3815. Presse Med. 1992 Jan 4-11;21(1):27-30. [CD8 hyperlymphocytosis in HIV infection. 63 cases. GECSA (Groupe d'Epidémiologie Clinique du SIDA en Aquitaine)] [Article in French] Constans J, Ladner J, Dabis F, Brossard G, Commenges D, Leng B, Conri C. Service de Médecine interne, Hôpital Saint-André, CHRU de Bordeaux. A group of 63 patients infected by HIV and presenting with CD8 hyperlymphocytosis (CD8+) has been studied. CD8 hyperlymphocytosis was defined by the presence, during at least three months, of at least 1,500 CD8 circulating lymphocytes. The CD8+ patients (n = 63) were identified and followed within the cohort (1,444 patients) of the "Groupe d'Epidémiologie Clinique du SIDA en Aquitaine " (GECSA). CD8+ patients were compared with a control group of 126 HIV infected patients without CD8 hyperlymphocytosis recruited within the GECSA cohort and followed in the same manner during two years. The occurrence of opportunistic infections was less frequent in CD8+ patients. The proportion of patients with a CD4 lymphocyte count below 200/mm3 was lower in the CD8+ group than in the CD8- group at inclusion and at the last check-up (P less than 0.01). A tendency for longer survival and delayed onset of AIDS was noted in CD8+ patients. Such a difference in prognosis might be due to a peculiar cytotoxic response against HIV among CD8+ patients. Further follow-up of a larger group of patients is needed to confirm this hypothesis. PMID: 1531260 [PubMed - indexed for MEDLINE] 3816. Pain. 1992 Jan;48(1):29-36. Amitriptyline versus maprotiline in postherpetic neuralgia: a randomized, double-blind, crossover trial. Watson CP, Chipman M, Reed K, Evans RJ, Birkett N. Irene Eleanor Smythe Pain Clinic, University of Toronto, Ont., Canada. Amitriptyline (AT) relieves some patients with postherpetic neuralgia (PHN). Many patients suffer side effects and better therapies are necessary. The aim of this study was to evaluate the efficacy of maprotiline (MT) (noradrenergic) compared to AT (mixed noradrenergic and serotonergic) in this disorder. Thirty-five patients entered a randomized, double-blind, crossover trial of these two agents. We found that MT relieved PHN in many patients but was not as effective as AT. Side effects were troublesome with both agents. Relief of steady pain, brief pain and pain on tactile stimulation occurred. Four groups of responses were identified. Some patients reported relief with both agents, some with neither agent and others with only one of the drugs. Most patients were not depressed and analgesia was observed to occur without change in depression ratings in most patients who responded. This result provides evidence that in some patients AT may act via a selective noradrenergic mechanism in relieving PHN and that individuals may differ in the balance and type of neurotransmitters inhibiting pain. Selective noradrenergic agents may be effective if AT fails. PMID: 1738571 [PubMed - indexed for MEDLINE] 3817. Int J Dermatol. 1992 Jan;31(1):55-7. Granuloma annulare and disseminated herpes zoster. Zanolli MD, Powell BL, McCalmont T, White WL, Jorizzo JL. Department of Dermatology, Wake Forest University, Bowman Gray School of Medicine, Winston-Salem, North Carolina 27103. Comment in: Int J Dermatol. 1992 Sep;31(9):672. A 71-year-old man was admitted to the Wake Forest University/Baptist Hospital Medical Center on February 1, 1989, with pharyngitis and a cutaneous eruption that began that day. The past history was significant for a diagnosis of chronic lymphocytic leukemia (CLL) made in 1984, and for longstanding hypertension, severe coronary artery disease, and prostatic hypertrophy. The patient had required no therapy for his CLL until August, 1988, when he developed hemolytic anemia and was treated with oral chlorambucil, 4 mg/day, and a tapering course of prednisone. By December, 1988, the prednisone therapy had been discontinued, but the patient required hospital admission for pneumococcal pneumonia, which responded well to intravenous antibiotic therapy. One day prior to the current admission the patient complained of persistent fevers, sore throat, productive cough, and headache. He noted a new cutaneous eruption on the day of admission in February, 1989. The past history was positive for occasional herpes stomatitis. The patient did not know if he had previously been infected with varicella. Skin examination revealed multiple (greater than 20), single, and grouped vesicles in a generalized distribution involving the bilateral trunk, head, neck, arms, and legs. The heaviest involvement was on the right posterior auricular area and on the neck. A Tzanck preparation obtained from an early lesion was positive for multinucleated giant cells. Viral culture was negative at 24 hours and at 1 week. A skin biopsy of an early vesicular lesion was performed and revealed intraepidermal vesicles with acantholysis and giant cells.(ABSTRACT TRUNCATED AT 250 WORDS) PMID: 1737692 [PubMed - indexed for MEDLINE] 3818. Cutis. 1992 Jan;49(1):27-31. Chronic varicella zoster in a child infected with human immunodeficiency virus: case report and review of the literature. Leibovitz E, Kaul A, Rigaud M, Bebenroth D, Krasinski K, Borkowsky W. Department of Pediatrics, New York University Medical Center, Bellevue Hospital, New York. Chronic zoster represents an infrequent presentation of varicella zoster virus infection. It is observed with increased frequency in patients infected with human immunodeficiency virus, especially when their lymphocyte counts are depressed. We report a child infected with human immunodeficiency virus who showed a long-standing cutaneous zoster lesion and was treated for a prolonged period of time with acyclovir. The occurrence of resistance to acyclovir by varicella zoster virus was suspected based on the clinical picture. The clinical and laboratory features of this case and a review of the literature are presented. PMID: 1733656 [PubMed - indexed for MEDLINE] 3819. J Assoc Physicians India. 1992 Jan;40(1):45-6. Herpes zoster oticus associated with facial, auditory and trigeminal involvement. Garg RK, Agrawal A, Nag D, Jha S. Department of Neurology, KG'S Medical College, Lucknow. We report a case of herpes zoster oticus with involvement of the mandibular division of the trigeminal nerve and loss of taste sensation in the anterior two third of the tongue. Infranuclear facial palsy and sensorineural deafness were also present. PMID: 1634465 [PubMed - indexed for MEDLINE] 3820. Respiration. 1992;59(2):94-6. Herpes zoster in patients with sarcoidosis. Miyagawa Y, Miyazaki M, Inutsuka S, Hayashi S, Yagawa K, Ikeda T. Research Institute for Diseases of the Chest, Faculty of Medicine, Kyushu University, Fukuoka, Japan. 108 patients with sarcoidosis were retrospectively studied for the development of herpes zoster. Five of these patients (4.6%), 2 of whom were in their twenties, developed herpes zoster. Only 1 patient had been treated with an oral steroid. All 5 had extrathoracic lesions. Zoster tended to occur during the inactive stage of sarcoidosis and did not exacerbate the activity of the sarcoidosis. The clinical course of their zoster infection was typically benign. There have been few reports of herpes zoster in patients with sarcoidosis. Further studies are required to determine whether sarcoidosis predisposes to herpes zoster infection. PMID: 1620988 [PubMed - indexed for MEDLINE] 3821. Clin Infect Dis. 1992 Jan;14(1):46-8. Chronic maxillary sinusitis associated with the mushroom Schizophyllum commune in a patient with AIDS. Rosenthal J, Katz R, DuBois DB, Morrissey A, Machicao A. Division of Infectious Diseases, Case Western Reserve University, Cleveland, Ohio. Invasive infection with fungi of the Basidiomycota (rusts, smuts, toadstools, mushrooms, and puffballs) is extremely rare. We report such an infection in a patient with human immunodeficiency virus disease who presented with chronic maxillary sinusitis associated with the mushroom Schizophyllum commune. The organism was isolated from the surgical drainage material, and septate hyphae were seen invading the maxillary submucosa. The limited literature on this subject is reviewed. PMID: 1571461 [PubMed - indexed for MEDLINE] 3822. Cornea. 1992 Jan;11(1):44-6. The use of conjunctival flaps in the treatment of herpes keratouveitis. Brown DD, McCulley JP, Bowman RW, Halsted MA. Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas. Conjunctival flaps have been used in the treatment of corneal diseases since the 1800s, although in recent years their use has decreased. In selected cases, however, the placement of a conjunctival flap still may be the treatment of choice. We report our experience with the use of conjunctival flaps in patients with herpes keratouveitis who had persistent corneal epithelial defects. Preoperatively, all patients had chronic or recurrent epithelial defects and intraocular inflammation with or without recurrent live viral infection requiring frequent medicine application and office visits. Postoperatively, all patients had an intact, healthy ocular surface and a noninflamed eye requiring few to no medications and infrequent office visits. No patient has had recurrent live viral activity. PMID: 1559346 [PubMed - indexed for MEDLINE] 3823. Minerva Pediatr. 1992 Jan-Feb;44(1-2):55-6. [Visceral leishmaniasis complicated by herpes zoster. An unusual case in the pediatric age] [Article in Italian] Di Martino L, Nocerino A, Pettoello M, Toscano P, Franzese A, Di Maio S. Dipartimento di Pediatria, Università Federico II di Napoli. The Authors describe a case report of a girl of 7 years affected by visceral leishmaniasis (VL) complicated by herpes zoster (Hz). Hz infection is unusual in paediatric age, but it may complicate immunodeficiency states. VL causes, as well known, T cell immunity depression: Hz infection could be facilitated by this situation. PMID: 1552880 [PubMed - indexed for MEDLINE] 3824. J R Soc Med. 1992 Jan;85(1):60. Myocarditis--a controversial disease. Appleby M, Kon P, Davidson C. Comment on: J R Soc Med. 1991 Jan;84(1):1-2. PMCID: PMC1293474 PMID: 1548669 [PubMed - indexed for MEDLINE] 3825. Masui. 1992 Jan;41(1):106-10. [Thoracic and lumbar sympathetic ganglion block for post herpetic neuralgia] [Article in Japanese] Kageshima K, Wakasugi B, Shiotani M, Ooseto K, Yuda Y, Karasawa H, Ohno K. Department of Anesthesiology, Jikei University School of Medicine, Tokyo. Of 2,667 patients with herpes zoster who visited our hospital between January 1972 and March 1989, 136 patients whose treatments were started after more than 6 months following the onset were subjects of the present study. Thus we performed a retrospective study of the therapeutic effects of sympathetic ganglion block (using alcohol) on postherpetic neuralgia left untreated for more than 6 months after the onset. After more than 1 year following the onset, the disease was nearly or completely cured in 9 of 37 patients (24%) treated with sympathetic ganglion block with alcohol and in 6 of 34 (17.6%) without the treatment. Thus the patients who underwent sympathetic ganglion block with alcohol tended to show better results. The above findings suggest that, in patients with postherpetic neuralgia in whom the initiation of treatment was delayed, treatment mainly consisting of thoracic or lumbar sympathetic ganglion block using alcohol in combination with antidepressants and antianxiety drugs can greatly improve patients' activities of daily life and that, at present, this method is most effective in relieving postherpetic neuralgia. PMID: 1545488 [PubMed - indexed for MEDLINE] 3826. Nippon Jibiinkoka Gakkai Kaiho. 1992 Jan;95(1):65-70. [Conservative treatment of Hunt syndrome] [Article in Japanese] Kinishi M, Hosomi H, Amatsu M, Tani M, Koike K. Department of Otolaryngology, Kobe University School of Medicine. Based on the pathophysiology of Bell's palsy that edema as well as ischemia lead to both compression and hypoxia, Stennert employed high doses of cortisone and dextran and reported a high recovery rate. In the past 5 years, we have been treating patients with Bell's palsy and Hunt syndrome with a high dose of steroids or low-molecular dextran (SD therapy). SD therapy was administrated in 71 cases of Hunt syndrome, and the results were compared with those of a group of 36 patients who had been treated with orally administrated low-dose steroids. All patients with incomplete palsies recovered completely, regardless of the mode of treatment. In cases of complete palsy, 62% of patients recovered completely when treated with SD therapy. In contrast, 29% of the patients treated with orally administrated steroids recovered completely. These results indicate that for patients with complete palsy SD therapy is more effective than oral steroid therapy, while patients with incomplete palsy recover completely with oral steroids. On the basis of this study, oral steroids are best used in cases of incomplete palsy unless complete palsy develops. In these latter cases, we now believe that SD therapy should be started immediately. PMID: 1545312 [PubMed - indexed for MEDLINE] 3827. J Nurse Midwifery. 1992 Jan-Feb;37(1):17-24. Management of varicella-zoster virus infection during pregnancy and the peripartum. Russell LK. Midwifery Service, Dartmouth Hitchcock Medical Center, Hanover, New Hampshire. This paper reviews the important concepts about varicella-zoster virus (VZV) infection, varicella (chickenpox), and herpes zoster (shingles, zoster) during pregnancy and the peripartum period. The majority of the U.S. population has had chickenpox during childhood, leaving only about 10% of adults over the age of 15 susceptible to the virus. However, nonimmune adults, including pregnant women, are at greater risk for complications and mortality when they contract varicella. The virus is also teratogenic. The implication of VZV infection during pregnancy and the perinatal period are presented. Risks such as varicella pneumonia and congenital defects can be serious even though the incidence during pregnancy is low, one to five per 10,000 pregnancies. Management and treatment plans are presented. Counseling and education aimed at prevention or modification of the infection in the mother and baby is outlined. PMID: 1538264 [PubMed - indexed for MEDLINE] 3828. Eur Neurol. 1992;32(5):264-6. Segmental myoclonus preceding herpes zoster radiculitis. Koppel BS, Daras M. Department of Neurology, New York Medical College, Valhalla. Segmental myoclonus arising in the spinal cord occurs with several viral infections, including herpes zoster radiculitis. Usually, abnormal movements follow the rash and require drug treatment to suppress. We report a patient with AIDS in whom arm and shoulder myoclonus preceded herpes zoster involving the same segments contralaterally on two occasions. Myoclonus remitted promptly with antiviral treatment. Unlike in other immunosuppressed patients, encephalitis did not occur after the second episode. PMID: 1521547 [PubMed - indexed for MEDLINE] 3829. Scand J Immunol Suppl. 1992;11:67-8. Herpes zoster ophthalmicus: an early pointer to HIV-1 positivity in young African patients. Palexas GN, Welsh NH. Department of Ophthalmology, University of the Witwatersrand, Johannesburg, South Africa. We studied prospectively 30 patients, seen over 10 months, who had herpes zoster ophthalmicus (HZO) and who were classified by age, sex, ophthalmological observations and HIV-1 status. Of patients who presented with HZO, 40% were HIV positive, and the majority were less than 40 years of age. The clinical manifestation of HZO has a high positive predictive value for HIV positivity in young patients with this viral infection. PMID: 1514054 [PubMed - indexed for MEDLINE] 3830. Dermatology. 1992;184(4):314-6. Systemic corticosteroids do not prevent postherpetic neuralgia. Calza AM, Schmied E, Harms M. Clinique de Dermatologie, Hôpital Cantonal Universitaire, Genève, Suisse. We review the use of corticosteroids in preventing postherpetic neuralgia (PHN) in a retrospective study over 5 years and 10 months. Out of 113 patients evaluable, 46 (40%) had PHN. 21 of these 46 patients (38%) had received prednisone (p = 0.49; n.s.). Duration and intensity of PHN were not different in the prednisone-treated group. This long-term study does not support the use of prednisone for preventing PHN. PMID: 1498407 [PubMed - indexed for MEDLINE] 3831. Acta Oncol. 1992;31(6):681-3. Simultaneous disseminated herpes zoster and bacterial infection in cancer patients. Maiche AG, Kajanti MJ, Pyrhönen S. Department of Radiotherapy and Oncology, Helsinki University Central Hospital, Finland. PMID: 1466899 [PubMed - indexed for MEDLINE] 3832. Nephron. 1992;62(3):280-3. Neurotoxicity associated with oral acyclovir in patients undergoing dialysis. MacDiarmaid-Gordon AR, O'Connor M, Beaman M, Ackrill P. Department of Nephrology, University Hospital of South Manchester, UK. Comment in: Nephron. 1994;66(3):362-3. Neurotoxicity associated with intravenous acyclovir therapy is well documented. We report 4 cases of acyclovir-induced neurotoxicity in dialysis patients receiving oral therapy at a reduced dose. PMID: 1436338 [PubMed - indexed for MEDLINE] 3833. J Urol (Paris). 1992;98(2):105-7. [Complete urinary retention secondary to lumbosacral zona] [Article in French] Punga A, Zemrag J, Galas JM, Hubert J, Six A, Guillemin P. Service d'Urologie, CHRU Nancy, Vandoeuvre-lès-Nancy. A case of complete urinary retention related to a HZV neurogenic bladder is reported. Different findings of the disease are discussed, e.g., urodynamics and physiopathology. PMID: 1431183 [PubMed - indexed for MEDLINE] 3834. Clin Neurol Neurosurg. 1992;94(3):253-5. Iatrogenic acute spinal epidural abscess with septic meningitis: MR findings. Shintani S, Tanaka H, Irifune A, Mitoh Y, Udono H, Kaneda A, Shiigai T. Department of Neurology, Toride Kyodo General Hospital, Ibaraki, Japan. A contaminated catheter used in epidural anesthesia in a 71-year-old female produced acute epidural abscess and septic meningitis. Methicillin-resistant Staphylococcus aureus (MRSA) was detected in a culture of the epidural pus. Both T1- and T2-weighted MR images showed low intensity mass lesion compressing the thecal sac behind the vertebral body L3. The low intensity lesion was probably pus with gas component. In these low intensity lesions in MR findings with gas component, MR was superior to myelography because it visualized both the degree of compression to the thecal sac and extension of the lesion in all directions. PMID: 1382912 [PubMed - indexed for MEDLINE] 3835. Br J Ophthalmol. 1992 Jan;76(1):43-4. Dual appearance of fluorescein staining in vivo of diseased human corneal epithelium. A non-contact photomicrographic study. Tabery HM. University of Lund, Department of Ophthalmology, Malmö, Sweden. Adherence of fluorescein sodium dye to diseased epithelial cells, a hitherto unreported phenomenon, was captured in photomicrographs in severe herpes zoster and keratoconjunctivitis sicca keratopathies. It is notable that this phenomenon differs completely from the well known fluorescent property of the dye penetrating into defective corneal epithelium, and that the staining pattern shown by adherent fluorescein correlates well with the staining pattern shown by rose bengal dye. PMCID: PMC504148 PMID: 1371224 [PubMed - indexed for MEDLINE] 3836. Duodecim. 1992;108(19):1689-92. [Sore throat and vertigo in herpes zoster oticus] [Article in Finnish] Kuttila S, Suonpää J. TYKS:n korva-, nenä-ja kurkkutautien klinikka, Turku. PMID: 1366197 [PubMed - indexed for MEDLINE] 3837. Rev Cubana Med Trop. 1992;44(1):47-9. [Infections and other opportunistic processes in a group of Cuban stage-IV HIV patients] [Article in Spanish] Menéndez Capote R, Millán Marcelo JC. Instituto de Medicina Tropical Pedro Kourí. Forty Cuban patients affected by the human immunodeficiency virus (HIV), belonging to Group IV, assisted during a year at the Pedro Kourí Tropical Medicine Institute, are reported. Pneumocystis carinii, cryptosporidiosis, mucocutaneous herpes simplex, oral candidiasis and multidermatoma herpes zoster were the most commonly found infections. Other non-opportunistic diseases such as dermatitis seborrhoeica and onychomycosis were also present. PMID: 1344688 [PubMed - indexed for MEDLINE] 3838. Zhen Ci Yan Jiu. 1992;17(4):257-9. [Recent progress in the treatment of zoster by moxibustion] [Article in Chinese] Hui K. PMID: 1340421 [PubMed - indexed for MEDLINE] 3839. Microbiol Immunol. 1992;36(11):1217-21. Detection of herpes simplex and varicella-zoster virus DNA by field-inversion gel electrophoresis from clinical materials. Arao Y, Yoshida M, Sata T, Nakatsukasa A, Miyoshi K, Yamada M, Uno F, Kurata T, Nii S. Department of Pathology, National Institute of Health, Tokyo, Japan. A simple method using field-inversion gel electrophoresis (FIGE) was applied to detect herpes simplex virus (HSV) and varicella-zoster virus (VZV) genomes in clinical specimens. The whole genomes of these viruses could be detected in small vesicle tissues by the FIGE method regardless of their clinical stages of skin lesions. And the sensitivity of the FIGE method was equivalent to that of an immunofluorescent (IF) method. These data indicated usefulness of the FIGE method to detect the whole genomes of HSV and VZV in clinical specimens. PMID: 1337135 [PubMed - indexed for MEDLINE] 3840. Ger J Ophthalmol. 1992;1(6):388-93. Diagnosis and management of the acute retinal necrosis syndrome. Gerling J, Neumann-Haefelin D, Seuffert HM, Schrader W, Hansen LL. Universitäts-Augenklinik, Freiburg, Federal Republic of Germany. The acute retinal necrosis (ARN) syndrome is an increasingly occurring entity characterized by the triad of acute confluent peripheral retinitis with papillitis and anterior-chamber uveitis. We present case reports on four patients (age, 12-65 years) with an ARN syndrome caused by herpes simplex or varicella zoster virus and discuss diagnostic and therapeutic modalities. Immediate antiviral therapy in three patients exhibiting the typical clinical features reduced the intraocular inflammation. However, due to proliferative vitreoretinopathy with peripheral retinal necrosis, vitrectomy with encircling band and silicone oil instillation was necessary in all patients. The suspected diagnosis of an ARN syndrome induced by herpes simplex virus (HSV) was confirmed in one case during the early stage of the disease by the detection of increased levels of HSV-IgA in the vitreous and in another case by the measurement of increased titers of HSV-IgG in the vitreous. For the first time, we found intraocular HSV DNA sequences using the polymerase chain reaction (PCR) in one of these patients. In a fourth patient intraocular varicella zoster virus (VZV) infection was confirmed by the detection of elevated VZV-IgA levels and by positive PCR in the intraocular fluids. Two patients who were diagnosed and treated early retained a visual acuity of 0.4 and 0.5, respectively, whereas in the other two patients, whose diagnosis and therapy were delayed (> 6 weeks), visual acuity was reduced to light perception. We conclude that use of the PCR in the intraocular fluids together with detection of autochthonous antibodies in the vitreous seem to be the most important diagnostic laboratory tools.(ABSTRACT TRUNCATED AT 250 WORDS) PMID: 1337004 [PubMed - indexed for MEDLINE] 3841. Vaccine. 1992;10(14):1007-14. Current status and prospects of live varicella vaccine. Takahashi M. Research Institute for Microbial Diseases, Osaka University, Japan. Since its development in 1974 the Oka strain live attenuated varicella vaccine has been tested in healthy and immunocompromised adults and children. Its safety and efficacy have been established and it is now licensed for general use in Japan and Korea, and for immunocompromised patients in several other countries. Possibilities for the future include its use to prevent zoster in the elderly, its incorporation in a multivalent vaccine and its use as a vehicle to express foreign genes in recombinant vaccines. PMID: 1335196 [PubMed - indexed for MEDLINE] 3842. Zh Nevropatol Psikhiatr Im S S Korsakova. 1992;92(2):47-9. [Virolex in the treatment of herpetic diseases of the nervous system] [Article in Russian] Umanskiĭ KG, Dekonenko EP, Shishov AS, Kupriianova LV, Rudometov IuP. The authors relate the results of the use of virolex (acyclovir), a new etiotropic agent, for the treatment of some herpetic lesions of the nervous system. The use of the drug for the treatment of herpetic encephalitis, one of the gravest forms of encephalitides, exerts a beneficial effect. In the course of the treatment, it is of paramount importance to adhere to the established time of therapy, since the disease may recur. The treatment with virolex of different forms of herpes zoster in children and adults brings about positive results as well. PMID: 1326174 [PubMed - indexed for MEDLINE] 3843. Clin Investig. 1992 Jan;70(1):28-37. The diagnostic significance of antibody specificity indices in multiple sclerosis and herpes virus induced diseases of the nervous system. Felgenhauer K, Reiber H. Klinik und Poliklinik für Neurologie, Georg-August-Universität, Göttingen. The antibody specificity index (ASI) indicates the cerebrospinal fluid (CSF)/serum difference of antibody amounts per weight unit IgG (normal less than 1.5). It has proven to be the most sensitive inflammation parameter in CSF analysis so far, more sensitive than the Western blot, the "oligoclonal" response, and the empirical differentiation of CSF immunoglobulins. By this diagnostic criterion, several benign viral meningitis cases were found to be caused by the varicella/zoster virus. The diagnostic relevance of local zoster antibody synthesis was greatest in ganglionitis cases, e.g., in zoster oticus sine herpete (facial paresis) and acute radicular syndromes of the elderly. The diagnostic significance of the local immune response against measles, rubella, and zoster antigens (MRZ response) was ascertained further. Together with oligoclonal gamma-globulin fractionation, there is now only 1 out of 100 multiple sclerosis (MS) patients left who has been found to have a normal CSF. PMID: 1318123 [PubMed - indexed for MEDLINE] 3844. Prog Med Virol. 1992;39:19-75. Herpes zoster: pathogenesis and latency. Gilden DH, Mahalingam R, Dueland AN, Cohrs R. Department of Neurology, University of Colorado School of Medicine, Denver. PMID: 1317598 [PubMed - indexed for MEDLINE] 3845. Arch Virol. 1992;123(1-2):13-27. Localization of herpes simplex virus type 1 in sebaceous glands of mice. Moriyama K, Imayama S, Mohri S, Kurata T, Mori R. Department of Virology, School of Medicine, Kyushu University, Fukuoka, Japan. The distribution of HSV-1 during the development of zosteriform skin lesions in SCID mice was analyzed by immunofluorescence and electron microscopy. The virus initially appeared within certain keratinocytes, sometimes surrounded by keratinocytes whose surfaces were also positive for the antigens, in the lower epidermal layers including the hair follicles, and then extended upward to the entire epidermis and downward to the sebaceous glands 1-2 days later, when no macroscopic skin lesion was seen. The affected epidermal cells subsequently degenerated and lost their viral antigens within a day, when the zosteriform lesion then became evident. This was followed by a degeneration of the dermis. The sebaceous glands eventually degenerated in 10 days, but some glands in the necrotic skin areas preferentially retained HSV-1. The horizontal spread of the virus in the epidermis beyond the first invaded dermatome occurred much later. In mice passively immunized with specific immune serum, viral antigens were observed even 20 days after the infection in sebaceous glands in necrotized areas. Therefore, HSV-1 appears to spread first via the extracellular fluid among the keratinocytes after being shed from nerve endings, and then produces a successive degeneration of the affected keratinocytes which may prevent any further extension of horizontal viral spread. The pilosebaceous apparatus is possibly acting as a site not only for the replication of HSV-1 with a delayed cytopathic effect, but also as an area that is temporarily sheltered from host defense mechanisms. PMID: 1312819 [PubMed - indexed for MEDLINE] 3846. Virchows Arch A Pathol Anat Histopathol. 1992;420(1):71-6. Immunohistochemical study of skin lesions in herpes zoster. Muraki R, Baba T, Iwasaki T, Sata T, Kurata T. Department of Dermatology, University of Tsukuba, Ibaraki, Japan. Thirty-seven biopsy skin tissues of herpes zoster taken from 27 patients were analysed immunohistochemically using two monoclonal antibodies detecting either nucleocapsid or glycoproteins of varicella-zoster virus (VZV) on paraffin sections of formalin fixed tissues. Skin lesions of herpes zoster were divided clinically into four stages: erythematous, vesicular, pustular and ulcerative. In the erythematous stage, VZV antigens, if detected, were found only within ballooning cells in the lower epidermis or follicular epithelium. In the vesicular stage, antigens were detected in the cells around and within the intraepidermal vesicles and in histiocytes or fibrocytes of the dermis in all cases and in the endothelial or perineural cells in 10 of 14 cases. In the pustular stage, the antigens were observed in degenerated or necrotic keratinocytes and multinucleated giant cells within pustules and some necrotic cells in the dermis. In the ulcerative stage, the viral antigens were detected only at the ulcer margin and around the hair shaft in 2 of 7 cases. These results suggest that VZV initially involves the epidermis in the erythematous stage, subsequently invades the dermis in the vesicular stage, and disappears in the early ulcerative stage. PMID: 1311486 [PubMed - indexed for MEDLINE] 3847. Heart Lung. 1992 Jan;21(1):85-91. Varicella zoster and herpes simplex virus infections. Gurevich I. Infection Control Section, Winthrop-University Hospital, Mineola, NY 11501. There are six herpes viruses, three of which, the varicella-zoster virus and the herpes simplex viruses types 1 and 2, are of particular concern to patients and staff in critical care units. These viruses, especially in their reactivated states, may present atypically in critically ill and immune-suppressed patients, and, by the time the diagnosis is made, exposures of other patients and clinicians may have occurred. Pregnancy and immunosuppressed states can result in severe, even life-threatening varicella-zoster virus infections in susceptible adults. Similarly, nosocomial herpes simplex virus infections can have serious consequences for exposed patients and staff. An additional problem after herpes simplex virus infection is the potential of lifelong and possibly frequent recurrences. In this article, the manifestations, modes of transmission, and treatment will be discussed. Special emphasis will be placed on describing the types of patients who are at high risk of presenting with varicella-zoster virus or herpes simplex virus infection so that physicians and nurses can use appropriate preventive measures to avert nosocomial infections in patients and staff. PMID: 1310493 [PubMed - indexed for MEDLINE] 3848. J Infect Dis. 1992 Jan;165(1):119-26. Subclinical varicella-zoster virus viremia, herpes zoster, and T lymphocyte immunity to varicella-zoster viral antigens after bone marrow transplantation. Wilson A, Sharp M, Koropchak CM, Ting SF, Arvin AM. Department of Pediatrics, Stanford University School of Medicine, CA 94305. Bone marrow transplant (BMT) recipients were evaluated for subclinical varicella-zoster virus (VZV) viremia and symptoms of herpes zoster after transplantation. Viremia was demonstrated by testing peripheral blood mononuclear cells using polymerase chain reaction and was documented in 19% of 37 patients. When reactivation was defined as herpes zoster and/or subclinical VZV viremia, 41% of VZV-seropositive BMT recipients experienced VZV reactivation. None of 12 patients tested before VZV reactivation had T lymphocyte proliferation to VZV antigen (mean stimulation index, 1.0 +/- 0.42 [SD] at less than 100 days; 12.0 +/- 6.03 at greater than 100 days [P = .003]). Among patients tested at greater than 100 days, 5 (63%) of 8 with detectable T cell proliferation had subclinical or clinical VZV reactivation compared with none of 6 who lacked VZV T cell responses. Recovery of VZV-specific cytotoxic T lymphocyte function was observed in 50% of BMT patients, but BMT recipients had significantly fewer circulating cytotoxic T lymphocytes that recognized VZV immediate early protein (P = .03) or glycoprotein I (P = .004) than did healthy VZV immune subjects. In vivo reexposure to VZV antigens due to subclinical VZV viremia or symptomatic VZV reactivation may explain the recovery of virus-specific T cell immunity after BMT. PMID: 1309369 [PubMed - indexed for MEDLINE] 3849. Przegl Epidemiol. 1992;46(3):237-44. [Ophthalmic zoster in clinical material from the clinic of infectious diseases PAM in Szczecin during 1985-1989] [Article in Polish] Niścigorska J, Mozolewska K. Klinika Chorób Zakaźnych PAM, Szczecinie. Clinical course, early and late complications as well as treatment of ophthalmic zoster in 70 hospitalized patients are presented. Authors pay the attention to early treatment (general and topical) with Zovirax in prevention of ocular complications. PMID: 1284257 [PubMed - indexed for MEDLINE] 3850. Am J Ophthalmol. 1991 Dec 15;112(6):735-6. Magnetic resonance imaging in a patient with herpes zoster keratouveitis and contralateral acute retinal necrosis. Farrell TA, Wolf MD, Folk JC, Pulido JS, Yuh WT. PMID: 1957917 [PubMed - indexed for MEDLINE] 3851. Lancet. 1991 Dec 14;338(8781):1527. Ophthalmic zoster. Marsh RJ. Comment on: Lancet. 1991 Nov 16;338(8777):1244-5. PMID: 1683948 [PubMed - indexed for MEDLINE] 3852. Med Clin (Barc). 1991 Dec 7;97(20):789-90. [Treatment of herpes zoster and post-herpetic neuralgia] [Article in Spanish] Aguilar Sánchez JL. Servicio de Anestesiología, Hospital Germans Trias i Pujol, Badalona, Barcelona. PMID: 1795575 [PubMed - indexed for MEDLINE] 3853. JAMA. 1991 Dec 4;266(21):3019-22. Ocular manifestations of AIDS. de Smet MD, Nussenbatt RB. Laboratory of Immunology, National Eye Institute, Bethesda, Md 20892. PMID: 1668177 [PubMed - indexed for MEDLINE] 3854. Clin J Pain. 1991 Dec;7(4):323-9. Measurement of tissue impedance in dorsal root entry zone surgery for pain after brachial plexus avulsion and herpes zoster. Chen HJ. Department of Surgery, Chang Gung Medical School, Taiwan, R.O.C. Fifteen patients with brachial plexus avulsion and five patients with postherpetic pain underwent dorsal root entry zone surgery with intraoperative impedance monitoring. The usual range of initial impedance values recorded in the superficial layers of the normal cord is from 1,000 to 1,500 omega. The recordings usually decrease to less than 1,000 omega in the segments of root avulsion injuries. Some variation in recordings occurs owing to atrophy and scarring of the damaged cord. In postherpetic neuralgia, measurements of impedance are abnormally low in the involved area, in which the roots appear macroscopically abnormal. In this study, tissue impedance was correlated with gross pathologic changes in the spinal cord. PMID: 1809446 [PubMed - indexed for MEDLINE] 3855. J Neurol Sci. 1991 Dec;106(2):153-7. Lhermitte's sign in a patient with herpes zoster. Vollmer TL, Brass LM, Waxman SG. Department of Neurology, Yale University School of Medicine, New Haven, CT 06510. A 34-year-old, previously healthy man developed herpes zoster (shingles) involving the C4 dermatome. This was accompanied by Lhermitte's sign, i.e. an electric shock-like sensation radiating from the neck to the sacrum, elicited by flexion of the neck. Lhermitte's sign resolved in this patient after several days, and probably reflected acute inflammation together with changes in sensory axon excitability. This positive manifestation of dorsal column dysfunction can be present in the absence of fixed neurological deficits, and can reflect dorsal column dysfunction caused by a wide spectrum (demyelinating, traumatic, compressive, toxic/deficiency, infectious and inflammatory) of etiologies. PMID: 1802963 [PubMed - indexed for MEDLINE] 3856. Voen Med Zh. 1991 Dec;(12):26-7. [A rare etiological variant of a disorder in cerebral circulation] [Article in Russian] Morozov NS, Mikhaĭlenko AA, Kiselev VF, Grabchuk MA, Ovchinnikova SP. PMID: 1799064 [PubMed - indexed for MEDLINE] 3857. J Tradit Chin Med. 1991 Dec;11(4):302-3. What are the common acupuncture methods for treating herpes zoster? Hu J. PMID: 1795549 [PubMed - indexed for MEDLINE] 3858. J Neurol. 1991 Dec;238(8):452-6. Topical 0.025% capsaicin in chronic post-herpetic neuralgia: efficacy, predictors of response and long-term course. Peikert A, Hentrich M, Ochs G. Neurologische Klinik und Poliklinik, Technischen Universität, München, Federal Republic of Germany. In order to evaluate the efficacy, time-course of action and predictors of response to topical capsaicin, 39 patients with chronic post-herpetic neuralgia (PHN), median duration 24 months, were treated with 0.025% capsaicin cream for 8 weeks. During therapy the patients rated their pain on a visual analogue scale (VAS) and a verbal outcome scale. A follow-up investigation was performed 10-12 months after study onset on the patients who had improved. Nineteen patients (48.7%) substantially improved after the 8-week trial; 5 (12.8%) discontinued therapy due to side-effects such as intolerable capsaicin-induced burning sensations (4) or mastitis (1); 15 (38.5%) reported no benefit. The decrease in VAS ratings was significant after 2 weeks of continuous application. Of the responders 72.2% were still improved at the follow-up; only one-third of them had continued application irregularly. Treatment effect was not dependent on patient's age, duration or localization of PHN (trigeminal involvement was excluded), sensory disturbance or pain character. Treatment response was not correlated with the incidence, time-course or severity of capsaicin-induced burning. If confirmed in controlled trials, the long-term results of this open, non-randomized study might indicate that the analgesic effect of capsaicin in PHN is mediated by both interference with neuropeptide metabolism and morphological changes (perhaps degeneration) of nociceptive afferents. PMID: 1779253 [PubMed - indexed for MEDLINE] 3859. Zahnarztl Mitt. 1991 Dec 1;81(23):2396-400. [Virus statics in dental practice] [Article in German] Knolle G. PMID: 1667884 [PubMed - indexed for MEDLINE] 3860. Am J Obstet Gynecol. 1991 Dec;165(6 Pt 1):1727-30. In utero diagnosis of congenital varicella zoster virus infection by chorionic villus sampling and polymerase chain reaction. Isada NB, Paar DP, Johnson MP, Evans MI, Holzgreve W, Qureshi F, Straus SE. Department of Obstetrics and Gynecology, Hutzel Hospital/Wayne State University, Detroit, MI 47201. Comment in: Am J Obstet Gynecol. 1992 Nov;167(5):1480-1. Varicella zoster virus infection acquired in pregnancy is reported to cause fetal damage in 5% to 10% of cases. We used polymerase chain reaction to attempt molecular diagnosis of fetoplacental varicella zoster virus infection in two patients. Tissue obtained by chorionic villus sampling in the second trimester was analyzed by polymerase chain reaction with a varicella zoster virus-specific primer, ORF-63, and was found to be positive in both patients. Viral cultures were negative. One patient elected pregnancy termination at 23 weeks. Southern blot hybridization of neonatal brain tissue for varicella zoster virus was negative. The second patient carried the pregnancy to term and was delivered of a normal infant. Varicella zoster virus immunoglobulin M and viral cultures were negative. The presence of viral deoxyribonucleic acid sequences in placental tissue does not correlate with fetal disease. PMID: 1661069 [PubMed - indexed for MEDLINE] 3861. N Engl J Med. 1991 Nov 28;325(22):1577-9. Chickenpox--examining our options. Brunell PA. Comment in: N Engl J Med. 1992 Apr 30;326(18):1224; author reply 1225-6. Comment on: N Engl J Med. 1991 Nov 28;325(22):1539-44. N Engl J Med. 1991 Nov 28;325(22):1545-50. PMID: 1658651 [PubMed - indexed for MEDLINE] 3862. N Engl J Med. 1991 Nov 28;325(22):1545-50. The incidence of zoster after immunization with live attenuated varicella vaccine. A study in children with leukemia. Varicella Vaccine Collaborative Study Group. Hardy I, Gershon AA, Steinberg SP, LaRussa P. Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, NY 10032. Comment in: N Engl J Med. 1991 Nov 28;325(22):1577-9. BACKGROUND. The Oka strain of live attenuated varicella vaccine is immunogenic and highly protective, but there has been concern about the risk of zoster after immunization. METHODS. We examined the incidence of zoster, risk factors for it, and measures of immune response in children with leukemia who received the vaccine and in appropriate controls. RESULTS. After a mean follow-up of 4.1 years, zoster was documented in 13 of the 548 vaccinated children with leukemia (2.4 percent). In a subgroup of 96 vaccinated children matched prospectively with 96 children with leukemia who had had natural varicella infections, there were 4 cases of zoster among the vaccinated children and 15 among the controls, for crude incidence rates of 0.80 and 2.46 cases per 100 person-years, respectively (P = 0.01). Of the total of 13 vaccinated children who had zoster, 11 had a skin rash due to varicella-zoster virus, either from the vaccine itself or from breakthrough varicella after household exposure in the period between immunization and the documentation of zoster. In the 268 children who had any type of rash caused by varicella-zoster virus after vaccination, as compared with those who did not have a rash, the relative risk of subsequent zoster was 5.75. For the 21 vaccinated children who received bone marrow transplants, as compared with those who did not, the relative risk of zoster was 7.5. Cell-mediated immunity as assessed by lymphocyte stimulation was lower in 4 children in whom zoster later developed than in 29 controls who had been vaccinated but who did not have zoster (mean stimulation index, 5.1 vs. 23.8; P = 0.0001). CONCLUSIONS. In children with leukemia who receive the live attenuated varicella vaccine, the subsequent incidence of zoster is lower than in children who have natural varicella infections. PMID: 1658650 [PubMed - indexed for MEDLINE] 3863. Lancet. 1991 Nov 16;338(8777):1244-5. Treatment of ocular herpes zoster. [No authors listed] Comment in: Lancet. 1991 Dec 14;338(8781):1527. PMID: 1682651 [PubMed - indexed for MEDLINE] 3864. Presse Med. 1991 Nov 16;20(38):1904-5. [Phrenic nerve paralysis caused by zona] [Article in French] Morcamp D, Sibille C. PMID: 1661421 [PubMed - indexed for MEDLINE] 3865. J ET Nurs. 1991 Nov-Dec;18(6):198-200. Herpes zoster: implications for ET nurses. Brown CS, Doubleman J. PMID: 1954299 [PubMed - indexed for MEDLINE] 3866. Neurology. 1991 Nov;41(11):1846. Thalamic infarction following lingual herpes zoster. Geny C, Yulis J, Azoulay A, Brugieres P, Saint-Val C, Degos JD. Department of Neurosciences, Hôpital Henri Mondor, Créteil, France. PMID: 1944922 [PubMed - indexed for MEDLINE] 3867. Infection. 1991 Nov-Dec;19(6):401-5. Antiviral therapy of varicella-zoster virus infection in immunocompromised children--a prospective randomized study of aciclovir versus brivudin. Heidl M, Scholz H, Dörffel W, Hermann J. Institut für Infektionskrankheiten im Kindesalter, Jena, Germany. Both aciclovir and brivudin are effective in the treatment of immunocompromised children with varicella-zoster virus infection. To determine which drug is preferable, a prospective randomized trial aciclovir vs. brivudin was conducted. Forty-three immunocompromised children were randomly assigned to receive aciclovir intravenously at a dose of 1,500 mg/m2/d and brivudin orally at a dose of 15 mg/kg/d, respectively. Twenty-two patients were treated with aciclovir and 21 with brivudin. In all children the general status improved within two days. The eruption of new lesions stopped within one to five days, fever stopped within one to nine days, complete remission occurred within five to six days after introduction of the virustatic therapy. There was no difference in therapeutic efficacy between aciclovir and brivudin. Two children in each group did not respond to the medication. No myelo-, hepato- and nephrotoxic side effects due to aciclovir or brivudin were observed. All obviously immunocompromised children with varicella or zoster may be treated with aciclovir or brivudin. PMID: 1816110 [PubMed - indexed for MEDLINE] 3868. Rinsho Shinkeigaku. 1991 Nov;31(11):1245-7. [Monoparesis due to the brachial plexus neuritis by herpes zoster virus--report of a case] [Article in Japanese] Ohtake T, Komori T, Hirose K, Tanabe H. Department of Neurology, Tokyo Metropolitan Neurological Hospital. A 73-year-old woman suffering from the acute onset monoparesis of her right arm which followed the skin eruption with mild sensory disturbance of right C4-6 level, was reported. Electrophysiological examinations revealed the brachial plexus neuritis and axonal degeneration of the proximal portion, with the evidence of herpes zoster infection. Her paresis of the right arm gradually improved without any medication during her hospital course. It was concluded that herpes zoster should be considered to be one of the causes of acute onset brachial plexopathy. PMID: 1813197 [PubMed - indexed for MEDLINE] 3869. J Parodontol. 1991 Nov;10(4):359-69. Aggressive periodontal destruction and herpes zoster in a suspected AIDS patient. [Article in English, French] Moskow BS, Hernandez G. Center for Clinical Research in Dentistry, School of Dental and Oral Surgery, Columbia University, New York, N.Y. An unusual case of spontaneous and rapidly destructive lesions involving the periodontal structures is described in a 54 year old, bi-sexual patients suspected of having AIDS. Concomitant with the periodontal breakdown, the patient developed a severe case of Herpes Zoster involving the area of the face innervated by the 5th cranial nerve. The dermal lesions involved the face, nose, eyes and scalp. Similar lesions were noted on the gingival and palatal mucosa on the same side of the jaw as the skin lesions. The differences between this type of periodontal destruction and more conventional forms of periodontitis are discussed. PMID: 1811045 [PubMed - indexed for MEDLINE] 3870. Physiol Behav. 1991 Nov;50(5):1027-31. A taste illusion: taste sensation localized by touch. Todrank J, Bartoshuk LM. Psychology Department, University of Pennsylvania, Philadelphia 19104. Taste sensations appear to come from all over the inner surface of the mouth, yet the taste receptors are restricted to relatively small particular areas of the oral surface. In addition, even if a relatively large (e.g., one half) proportion of the taste field is damaged, subjective taste experience may be unaffected. The touch system contributes to this constancy because taste sensations appear to be localized by touch. If a taste solution is painted from the side of the tongue (an area of low receptor density) past the tip (an area of high receptor density) and on to the second side, the taste sensation begins weak, gets stronger at the tip, and retains much of its intensity. The strong taste from the tip follows the tactile path of the stimulus sweep. This illusion occurs for all four stimuli tested: sucrose, sodium chloride, citric acid, and quinine hydrochloride. PMID: 1805264 [PubMed - indexed for MEDLINE] 3871. J Am Acad Dermatol. 1991 Nov;25(5 Pt 1):852-4. Phaeohyphomycosis caused by Exserohilum rostratum mimicking hemorrhagic herpes zoster. Tieman JM, Furner BB. Division of Dermatology, University of Texas Health Science Center, San Antonio 78284-7876. PMID: 1802911 [PubMed - indexed for MEDLINE] 3872. Nippon Ronen Igakkai Zasshi. 1991 Nov;28(6):837-8. [Herpes zoster associated encephalitis with rapid response to a combination therapy with acyclovir, prednisolone and human gamma-globulin] [Article in Japanese] Toyoda H, Tomeoku M, Fujioka H, Hamada M, Kanamaru M. PMID: 1795448 [PubMed - indexed for MEDLINE] 3873. Nippon Ronen Igakkai Zasshi. 1991 Nov;28(6):817-22. [An elderly case of systemic lupus erythematosus associated with herpes zoster, anemia, and hemiparesis] [Article in Japanese] Hashizume K, Sato M, Saeki S, Takamoto S, Mino Y, Onishi T. Department of Internal Medicine, Hanwa-Senboku Hospital. An elderly case of systemic lupus erythematosus (SLE) with suspected hemolytic anemia was experienced. A 70 year-old female was admitted to our hospital on December 31 with complaints of herpetic eruption. She complained of arthralgia since 3 month prior to her admission. The positive findings on examination were skin eruption in the left chest, a systolic heart murmur and a palpable elastic hard liver. Laboratory data showed raised erythrocyte sedimentation rate of 149 mm per hour, decreased Hb (10.1 g/dl), decreased hematocrit (30.0%), increased reticulocytes (33%1000), decreased thrombocytes (73,000/mm3), increased gamma-globulin (33%) and positive rheumatoid factor. During admission, she developed anemia. A stool test for occult blood was negative. The haptoglobin was 38.8 mg/dl and bone marrow aspiration showed increased erythropoiesis, suggesting features of immune hemolytic anemia, except she was negative on Coomb'test. Eye fundi were similar to case of typical bleeding observed in SLE. Concerning immunological findings, the antinuclear factor was x 1280 and the anti-dsDNA antibody was x 80, on which a diagnosis of SLE was based. She experienced numbness of the left arm and developed left hemiparesis 2 days later. Therapy with 15 mg/day prednisone obtained a good response and anemia, abnormal immunological findings and hemiparesis disappeared. PMID: 1795445 [PubMed - indexed for MEDLINE] 3874. Kansenshogaku Zasshi. 1991 Nov;65(11):1389-93. [Herpes zoster in connective tissue diseases: II. Rheumatoid arthritis and mixed connective tissue disease in comparison with systemic lupus erythematosus] [Article in Japanese] Yamauchi Y, Nagasawa K, Tada Y, Tsukamoto H, Yoshizawa S, Mayumi T, Niho Y, Kusaba T. First Department of Internal Medicine, Faculty of Medicine, Kyushu University. We investigated the incidence of herpes zoster (HZ) and the immunological state to HZ in patients with rheumatoid arthritis (RA) and mixed connective tissue disease (MCTD) in comparison with systemic lupus erythematosus (SLE). HZ occurred in 6 (25%) out of 24 patients with RA and 4 (22%) out of 18 patients with MCTD. One patient had had HZ before the diagnosis of RA. On the other hand, all 4 patients with MCTD had had HZ before the diagnosis of MCTD. The patients with RA and MCTD showed normal or higher antibody titers to varicella zoster virus (VZV) than normal subjects as assayed by both complement fixation technique and neutralization test. However, the antibody levels were not very high compared to those in patients with SLE. On the other hand, only 7 (50%) of 14 patients with RA and 4 (40%) of 10 patients with MCTD showed positive skin reactions to VZV antigen, whereas all 15 normal subjects had positive reactions. Thus, cellular immunity to VZV was thought to be impaired in these diseases. In the patients who were receiving less than 10 mg/day of prednisolone, 7 (64%) of 11 had positive skin reactions in RA patients and 3 (60%) out of 5 patients with MCTD, whereas none (0%) out of 3 patients with RA and 1 (20%) out of 5 patients with MCTD who were receiving 10 mg/day or more prednisolone showed positive skin reactions. These results suggest that the high incidence of HZ in patients with RA and MCTD is probably due to an impaired cellular immunity as in the case of SLE. PMID: 1791339 [PubMed - indexed for MEDLINE] 3875. Vestn Otorinolaringol. 1991 Nov-Dec;(6):33-5. [Herpes zoster oticus] [Article in Russian] Nikitin KA. In 1985-89, 8 patients with Herpes zoster oticus were examined in the ENT department of the First Leningrad Medical Institute named after I.P. Pavlov. All the patients were treated, taking into consideration the severity of injury of cerebrocranial nerves. It is emphasized that the pathology may have many clinical forms and that it deserves special attention in AIDS diagnosis. PMID: 1788891 [PubMed - indexed for MEDLINE] 3876. Med Hypotheses. 1991 Nov;36(3):206-10. Are recurrent oral aphthous ulcers of viral etiology? Pedersen A. Dental Department, University Hospital-Rigshospitalet, Copenhagen, Denmark. The etiology of recurrent oral aphthous ulcers (RAU) remains unsolved. The present article relates previous immunopathologic findings in RAU to a possible viral etiopathogenesis with special reference to the herpes virus family. It is concluded that RAU might be of viral etiology, and it is furthermore speculated that the aphthous ulcers may be the clinical manifestation of 'latent' varicella-zoster virus reactivation (reinfection). PMID: 1664908 [PubMed - indexed for MEDLINE] 3877. N Engl J Med. 1991 Oct 17;325(16):1178-9. Acute renal failure and coma after a high dose of oral acyclovir. Eck P, Silver SM, Clark EC. PMID: 1891032 [PubMed - indexed for MEDLINE] 3878. Neurology. 1991 Oct;41(10):1685-6. A case of C2 herpes zoster with delayed bilateral pontine infarction. Ross MH, Abend WK, Schwartz RB, Samuels MA. Division of Neurology, Brigham and Women's Hospital, Boston, MA 02115. PMID: 1922821 [PubMed - indexed for MEDLINE] 3879. Geriatrics. 1991 Oct;46(10):64-6, 69-71. Ophthalmic herpes zoster: diagnosis and antiviral therapy. Liesegang TJ. Mayo Medical School, Mayo Clinic Jacksonville, Jacksonville, FL. Elderly patients, whether of normal or depressed immune status, are at increased risk of herpes zoster infection. Ocular complications occur in 50% of patients with zoster that reactivates in the ophthalmic division of the trigeminal ganglion. Early intervention with high-dose oral acyclovir has been effective in preventing many of these complications, while reducing the duration of the acute infection. Postherpetic neuralgia remains a difficult therapeutic problem, and options are offered. PMID: 1916303 [PubMed - indexed for MEDLINE] 3880. Acta Neurol Scand. 1991 Oct;84(4):344-7. Abdominal muscle paralysis associated with herpes zoster. Gottschau P, Trojaborg W. Medical Department, Roskilde County Hospital, Køge, Denmark. We describe a 77-year-old women with cutaneous herpes zoster in the area of the right T9-T11 dermatomes complicated by abdominal muscle paralysis. Four months after onset of paralysis, stimulation of appropriate intercostal nerves failed to evoke responses from the corresponding segments of the rectus abdominis muscle. Three months later EMG of these muscle segments revealed profuse denervation activity and spontaneous long-lasting burst of high frequency discharges. Magnetic stimulation applied transcranially and peripherally at T10 evoked responses from the left, but not from the right paralytic rectus abdominis muscle. Electric stimulation of right T10 elicited a markedly delayed, prolonged and polyphasic response in the transverse abdominis muscle and EMG revealed polyphasia and increased motor unit potential duration in muscle segments underlying herpes zoster eruption. One and a half years after onset, the paralysis of the rectus abdominis muscle was still present. A survey of the literature concerning this rare type of zoster paralysis is presented. PMID: 1837649 [PubMed - indexed for MEDLINE] 3881. J Dermatol. 1991 Oct;18(10):613-5. Trigeminal trophic syndrome--a report of three patients. Tada J, Ueda M, Abe Y, Fujiwara H, Arakawa K, Arata J. Department of Dermatology, Okayama University Medical School, Japan. Three Japanese patients with trigeminal trophic syndrome, a rare dermatosis in Japan, were reported. Cutaneous lesions were a long-standing ulcer and destruction of the right ala nasi in case 1, a persistent deep ulceration on the forehead after a small trauma in case 2, and development of small, discrete ulcers on the right forehead during the treatment of a postherpetic neuralgia in case 3. A protective device was very effective in one patient. PMID: 1791243 [PubMed - indexed for MEDLINE] 3882. Bone Marrow Transplant. 1991 Oct;8(4):245-51. Influence of total body irradiation on infections after autologous bone marrow transplantation. Callum JL, Brandwein JM, Sutcliffe SB, Scott JG, Keating A. University of Toronto Autologous Bone Marrow Transplant Program, Toronto Hospital, Canada. Infectious complications were analysed in 50 consecutive autologous bone marrow transplant (ABMT) patients treated with high dose etoposide and melphalan, 30 of whom also received total body irradiation (TBI). Fever developed in 44 patients and bacteremia was documented in 13 (26%). Patients given TBI had increased susceptibility to bacteremia; 11 of 30 patients who received TBI had positive blood cultures, in contrast to two of the 20 who did not (p = 0.035). In addition, patients who received TBI had significantly more severe diarrhea (p = 0.037) when compared with those who received chemotherapy alone. Thirty-five patients treated with trimethoprim-sulfamethoxazole prophylaxis had a signficantly lower incidence of gram-negative bacteremia (p = 0.024). However, when those patients who received trimethoprim-sulfamethoxazole until neutrophil recovery were analysed alone, those who were also given TBI still had significantly more bacteremia (p = 0.047). Forty-seven patients with follow-up of more than 12 months are available for analysis of varicella zoster (VZV) infections. Of the 29 patients who received TBI, 11 (38%) developed VZV infections, in contrast to one of 18 patients (6%) treated with chemotherapy alone (p = 0.013). These results suggest that addition of TBI to the intensive therapy regimen for ABMT is associated with significantly more bacteremia and late VZV infections. PMID: 1756321 [PubMed - indexed for MEDLINE] 3883. Clin Dermatol. 1991 Oct-Dec;9(4):497-503. Capsaicin and substance P. Bernstein JE. GenDerm Corporation, Lincolnshire, IL 60069. PMID: 1726584 [PubMed - indexed for MEDLINE] 3884. DICP. 1991 Oct;25(10):1077-9. Topical aspirin for postherpetic neuralgia. Brady SI, Middleton RK. School of Pharmacy, University of California, San Francisco 94143. PMID: 1725080 [PubMed - indexed for MEDLINE] 3885. Anaesthesist. 1991 Oct;40(10):523-9. [The treatment of zoster neuralgia] [Article in German] Wulf H, Maier C, Schele HA. Klinik für Anaesthesiologie und operative Intensivmedizin, Kiel. Neuralgic pain during or following herpes zoster infection is a common problem in pain therapy. The current management of neuralgias due to zoster is discussed with reference to patients in a chronic pain clinic within an anesthesiology department. The courses of 80 patients followed up for at least 3 months from the pain clinic at the University Hospital in Kiel were analyzed. The mean age was 69 years. The predominant locations for zoster lesions were the thoracic segments (65%) and the first branch of the trigeminal nerve (19%). Diabetes mellitus was present in 20% of the patients and malignant disease in 18%. In 2 patients recurrent postherpetic neuralgia was the first symptom of HIV infection. Despite pretreatment, the mean initial pain score was 8 on an analog scale (range 0-10). Acute herpes zoster pain during the infection was treated with virustatic agents, corticosteroids and sympathetic blocks. Postherpetic neuralgias required a more sophisticated approach, depending on the stage of the disease and the type of pain involved: sympathetic blockade with local anesthetic agents or injections of very low dose opioids to sympathetic ganglia, transcutaneous electrical nerve stimulation, and antidepressants or anticonvulsants. The success of the therapy is correlated with the duration of pain. If the history of zoster pain was less than 1 month, the majority of patients showed good or excellent results. On the other hand, only one-third of patients with a history longer than 6 months had adequate pain relief. Therefore, early and appropriate treatment is desirable for patients suffering from zoster neuralgias. PMID: 1684093 [PubMed - indexed for MEDLINE] 3886. Enferm Infecc Microbiol Clin. 1991 Oct;9(8):514. [Aseptic meningitis caused by varicella-zoster virus. Isolation of the virus from CSF] [Article in Spanish] Falcó V, Alegre J, García A, Fernández de Sevilla T. PMID: 1666842 [PubMed - indexed for MEDLINE] 3887. J Med Virol. 1991 Oct;35(2):136-41. Diagnosis of acute and latent varicella-zoster virus infections using the polymerase chain reaction. Dlugosch D, Eis-Hübinger AM, Kleim JP, Kaiser R, Bierhoff E, Schneweis KE. Institute of Medical Microbiology and Immunology, University of Bonn, Germany. A simplified assay for the diagnosis of varicella-zoster virus (VZV) infections based on the polymerase chain reaction (PCR) is described. Omitting the procedures for extraction and purification of DNA, the crude vesicle fluid materials were used for PCR. Moreover, hybridization was not necessary for detection of the amplification products because they were already visible after ethidium bromide staining of the electrophoresis gel. Results could therefore be obtained within one day. In comparison to virus isolation, PCR proved much more rapid, highly sensitive, and specific. DNA extraction and a double PCR assay with nested primers were necessary for detection of latent VZV infections in trigeminal and thoracic ganglia. The data suggest that the procedures described are universally applicable to several types of specimens dependent on the calculated amount of target DNA. PMID: 1662705 [PubMed - indexed for MEDLINE] 3888. Mol Gen Mikrobiol Virusol. 1991 Oct;(10):13-6. [Detection of herpes simplex virus by DNA-DNA hybridization method] [Article in Russian] Diorditsa SV, Zaĭtsev IZ, Mal'tseva NN, Ebralidze LK. Eight recombinant clones were obtained by insertion of BamHI fragments of herpes simplex type I viral DNA into a vector plasmid pUC19o. Of the obtained clones 5 were found to hybridize with herpes simplex type I and 2 viral DNA while 3 clones revealed a positive reaction with the Vero cells DNA. A constructed DNA-probe possessing the highest level of activity was selected for further studies. The probe is a BamHI fragment of herpes simplex type I viral DNA labelled with 32P dTTP. Probe sensitivity in blot hybridization is 10 pg for identification of type I viral DNA and 50 pg for type 2 viral DNA. The DNAs of cytomegalovirus and herpes zoster virus do not show positive signals with the probe. The increased sensitivity of the used dot hybridization as compared with biological or IEA antigen identification of the virus was confirmed with the clinical material from 59 patients with the different clinical manifestations of the herpes viral infection. PMID: 1661848 [PubMed - indexed for MEDLINE] 3889. Tidsskr Nor Laegeforen. 1991 Sep 20;111(22):2751-3. [Treatment of herpesvirus infections] [Article in Norwegian] Moeland A, Bruun JN. PMID: 1658973 [PubMed - indexed for MEDLINE] 3890. Am J Ophthalmol. 1991 Sep 15;112(3):326-30. The effect of corneal hypesthesia on the duration of proparacaine anesthetic eyedrops. Weiss JS, Goren MB. Division of Ophthalmology, University of Massachusetts Medical Center, Worcester 01655. The duration of action of proparacaine is known in the normal cornea but not in the hypesthetic cornea. To determine this, we examined both eyes in seven patients with documented unilateral corneal hypesthesia associated with inactive herpetic disease. Cochet-Bonnet measurements were made in both eyes before and at two- to five-minute intervals after the instillation of one drop of 0.5% proparacaine until baseline corneal sensitivity levels were again achieved. Mean recovery time was 34.86 minutes in eyes with normal corneal sensitivity, compared to 45.43 minutes in hypesthetic corneas. In all patients, the recovery time was remarkably longer in the hypesthetic eye than it was in the normal fellow eye. These data demonstrate the need to wait up to one hour after the instillation of proparacaine in eyes suspected of having corneal hypesthesia if corneal sensitivity is to be determined accurately. Additionally, the duration of action of topically instilled anesthetic may be a useful method of discovering subtle differences in corneal sensitivity. PMID: 1882944 [PubMed - indexed for MEDLINE] 3891. Pediatr Dermatol. 1991 Sep;8(3):236-42, 246-7. Oral acyclovir therapy for varicella and zoster infections in pediatric and pregnant patients: a brief review. Rothe MJ, Feder HM Jr, Grant-Kels JM. Department of Medicine, University of Connecticut Health Center, Farmington 06030. Oral acyclovir recently was approved for the treatment of herpes zoster and has been shown to be effective in the treatment of varicella. Studies of the use of high-dose oral acyclovir in the management of varicella-zoster infections in immunocompetent pediatric patients are reviewed. Guidelines are provided for the drug's use in immunocompetent children and adolescents, pregnant patients, and pediatric atopic patients receiving systemic steroids. PMID: 1745635 [PubMed - indexed for MEDLINE] 3892. Med J Aust. 1991 Sep 2;155(5):344-6. Contralateral hemiplegia following thoracic herpes zoster. Rawlinson WD, Cunningham AL. Department of Infectious Diseases and Microbiology, Westmead Hospital, NSW. OBJECTIVE: To suggest interim therapeutic guidelines for stroke following truncal herpes zoster on the basis of the first reported Australian case, in a patient who showed good clinical response related temporally to antiviral therapy. CLINICAL FEATURES: A 70-year-old patient with no known underlying immune disorder presented with left-sided hemiplegia one week after right-sided truncal herpes zoster. In all probability the neurological deficit was due to large artery vasculopathy with thrombosis. INTERVENTION AND OUTCOME: Clinical improvement (not to pre-morbid levels) was noted soon after commencement of antiviral therapy with acyclovir. CONCLUSION: Stroke following herpes zoster may be a treatable condition. In view of the previously described occurrence of viral antigen within the walls of intracerebral vessels, the occasional progression of the syndrome over months, the generally low toxicity of acyclovir and the clinical response of the few patients treated with antiviral agents to date, early antiviral therapy in patients presenting with delayed contralateral hemiplegia associated with herpes zoster is recommended as prudent. PMID: 1895982 [PubMed - indexed for MEDLINE] 3893. Aten Primaria. 1991 Sep;8(8):654; author reply 654-5. [Peripheral facial paralysis and the herpes chickenpox-zoster virus] [Article in Spanish] Ponce de León M. Comment on: Aten Primaria. 1990 Nov;7(10):681-2. PMID: 16986251 [PubMed - indexed for MEDLINE] 3894. Arch Neurol. 1991 Sep;48(9):900. Delayed varicella vasculopathy. Liu GT. Comment on: Arch Neurol. 1990 Sep;47(9):1033-5. PMID: 1953409 [PubMed - indexed for MEDLINE] 3895. Clin Nephrol. 1991 Sep;36(3):155-6. Acute renal failure induced by oral acyclovir. Hernandez E, Praga M, Moreno F, Montoyo C. PMID: 1934676 [PubMed - indexed for MEDLINE] 3896. Br J Ophthalmol. 1991 Sep;75(9):542-6. Double-masked trial of topical acyclovir and steroids in the treatment of herpes zoster ocular inflammation. Marsh RJ, Cooper M. Department of Clinical Ophthalmology, Moorfields Eye Hospital, London. Comment in: Br J Ophthalmol. 1992 Oct;76(10):639. Ninety seven new patients with ophthalmic zoster were randomly allocated to three topical treatment groups: acyclovir (ACV) ointment and placebo drops (AP), placebo ointment with steroid drops (PS), and acyclovir ointment with steroid drops (AS). The dosage administered was determined by the score of the ocular inflammation. Follow-up was for at least one year. The results showed that topical ACV alone is insufficient for severe ocular inflammation but is not inclined to lead to recurrences in milder cases. Topical steroid alone is effective but tends to necessitate prolonged treatment. Combined steroid and ACV is questionably better than steroid alone and causes marginally fewer rebound inflammations. PMCID: PMC1042470 PMID: 1911657 [PubMed - indexed for MEDLINE] 3897. Vrach Delo. 1991 Sep;(9):92-5. [The clinical and treatment characteristics of patients with herpes zoster in different locations] [Article in Russian] Vinichuk SM, Unich PP, Ivanenko ZI, Barabanchik VG. An analysis is presented of the clinical course and results of treatment of 102 patients with herpes zoster. The spinal ganglia of the thoracic region and trigeminal nerve ganglia were most frequently involved. The disease was manifested not only in local disorders but also in generalized systemic vegetative-trophic and vascular disorders. The authors report a high therapeutic efficiency of complex treatment of patients with herpes zoster using antiviral, antiherpetic and detoxification agents, immunostimulators, vegetotropic drugs, physiotherapy and ointment applications. PMID: 1759444 [PubMed - indexed for MEDLINE] 3898. J Infect. 1991 Sep;23(2):169-74. Herpes zoster associated encephalitis in dialysis patients. Cheung WC, Yuen KY, Chang CM, Cheng KP. University Medical Unit, University of Hong Kong, Queen Mary Hospital, Pokfulam. Two patients on dialysis because of chronic renal failure who developed herpes zoster associated encephalitis are reported. Both developed overt encephalopathy despite treatment with oral acyclovir for the preceding herpes zoster eruption. The encephalopathy responded rapidly to intravenous acyclovir. PMID: 1753116 [PubMed - indexed for MEDLINE] 3899. Schweiz Med Wochenschr. 1991 Aug 24;121(34):1194-204. [Ambulatory therapy and prevention of the most frequent HIV-associated opportunistic infections] [Article in German] Malinverni R, Blatter M. Medizinische Universitätspoliklinik, Inselspital Bern. Earlier diagnosis and improved therapies for the opportunistic infections have led to improved quality of life as well as survival time of patients with advanced HIV-related immunodeficiency. Most of the therapies can be administered on an outpatient basis. Outpatient treatment further contributes to improving the quality of life of the patients. Presentation, clinical aspects, treatment and prophylaxis of the five most frequent opportunistic infections in HIV-infected patients with advanced immunodeficiency in our outpatient clinic (oral and esophageal candidiasis, pneumocystis carinii pneumonia, herpes zoster, herpes simplex virus infection and cerebral toxoplasmosis) are discussed with respect to the practical implications. PMID: 1925448 [PubMed - indexed for MEDLINE] 3900. Am J Ophthalmol. 1991 Aug 15;112(2):206-7. Human immunodeficiency virus, herpes zoster, and the retina. Nussenblatt RB, Palestine AG. PMID: 1867307 [PubMed - indexed for MEDLINE] 3901. Am J Ophthalmol. 1991 Aug 15;112(2):151-8. Clinical patterns and associated conditions in chronic uveitis. Weiner A, BenEzra D. Department of Ophthalmology, Hadassah Medical Center, Hebrew University Medical School, Jerusalem, Israel. We determined the relative frequencies of the different types of chronic uveitis, and the possible associated conditions, among 400 consecutive patients with chronic uveitis examined during the years 1982 through 1988. Of the 400 patients, 183 (45.75%) had anterior uveitis, 98 (24.5%) ahd panuveitis, 61 (15.3%) had intermediate uveitis, and 58 (14.5%) had isolated posterior uveitis. Only four of the 98 patients with panuveitis (4.1%) were considered idiopathic after a comprehensive examination, whereas 94 of the 183 patients with anterior uveitis (51.4%) were similarly classified. We found an associated condition in 242 of the 400 patients of the study group (60.5%). Of these 242 patients, 61 had Behçet's disease, which constituted the most frequently encountered associated condition in this study. Of the 61 patients with Behçet's disease, 58 had panuveitis and constituted 59.2% of the panuveitis group. Of the 61 patients with intermediate uveitis, 17 (27.9%) had a concurrent disease. An associated condition was found in 95% and 96.2% of patients with unilateral and bilateral panuveitis, respectively, but in none of the patients with unilateral intermediate uveitis. Environmental, cultural, or genetic factors may be accountable for the differences discovered between our findings and those of previously published studies from the United States and England with respect to relative frequencies of some of the associated diseases in patients with chronic uveitis. PMID: 1867298 [PubMed - indexed for MEDLINE] 3902. Am J Ophthalmol. 1991 Aug 15;112(2):119-31. Varicella-zoster virus retinitis in patients with the acquired immunodeficiency syndrome. Margolis TP, Lowder CY, Holland GN, Spaide RF, Logan AG, Weissman SS, Irvine AR, Josephberg R, Meisler DM, O'Donnell JJ. University of California Los Angeles Ocular Inflammatory Disease Center. We examined five patients infected with the human immunodeficiency virus who developed a rapidly progressive necrotizing retinitis characterized by early patchy choroidal and deep retinal lesions and late diffuse thickening of the retina. In all but one case, the retinitis began in the posterior pole with little or no clinical evidence of vasculitis. All five patients had relentless progression of disease and were left with atrophic and necrotic retinae, pale optic-nerve heads, and narrowed vasculature. None of the patients developed aqueous or vitreal inflammation or retinal detachment. Clinical and laboratory evidence suggested that varicella-zoster virus was the causal agent in all five cases. First, the onset of retinitis in four cases either succeeded or was coincident with an eruption of dermatomal zoster. Second, varicella-zoster virus was cultured from the two chorioretinal specimens and varicella-zoster virus antigen was detected in the vitreal aspirate from one case. Third, by means of immunocytochemistry, varicella-zoster virus antigen was found in the outer retinae of both enucleation specimens. Fourth, viral capsids with the size and shape of herpesviridae were found in the outer retinae of both enucleation specimens. The clinical features observed in this study are distinct from those described for the acute retinal necrosis syndrome and appear to constitute a new and highly characteristic pattern of varicella-zoster virus-induced disease. PMID: 1651054 [PubMed - indexed for MEDLINE] 3903. Med J Aust. 1991 Aug 5;155(3):206-7. EMLA Cream and herpetic neuralgia. Collins PD. Comment on: Med J Aust. 1991 Jun 3;154(11):781. PMID: 1875823 [PubMed - indexed for MEDLINE] 3904. Acta Neurol Scand. 1991 Aug;84(2):146-52. Pain and allodynia in postherpetic neuralgia: role of somatic and sympathetic nervous systems. Nurmikko T, Wells C, Bowsher D. Department of Neurology, University Central Hospital, Tampere, Finland. The immediate effects of selective sympathetic and somatic blockades on pain and tactile allodynia in 12 patients with long-standing ophthalmic or high cervical postherpetic neuralgia were compared. For the duration of the somatic blockade, pain was completely abolished in 11 patients and allodynia in 8 patients. In contrast, during the sympathetic blockade only one patient reported total pain relief and three a marginal attenuation of pain while eight remained unchanged; and no patient reported clear alleviation of allodynia. After successful somatic blockade, pain and allodynia reappeared with tactile sensation while thermal sensation was still absent. Pain and allodynia appear to be related to sensory impulses travelling along the large rather than the small diameter fibres; and the sympathetic system may only have a limited role. PMID: 1950450 [PubMed - indexed for MEDLINE] 3905. J Rheumatol. 1991 Aug;18(8):1172-5. Complications of immunosuppression associated with weekly low dose methotrexate. Shiroky JB, Frost A, Skelton JD, Haegert DG, Newkirk MM, Neville C. Department of Pathology, Montreal General Hospital, McGill University, Canada. Complications of immunosuppression are thought to be rare with the use of low dose pulse methotrexate (MTX) for nonneoplastic conditions. We describe 4 complications of immunosuppression observed in a group of 41 patients who had received MTX for at least 6 months, during a 2-year period. We report the first case of a reversible lymphoproliferative disorder similar to that reported with immunosuppressive therapy associated with organ transplantation. Two cases of disseminated herpes zoster and 1 case with Pneumocystis carinii pneumonia are described. As the indications for the use of low dose MTX broaden and older patients with other comorbid diseases are included, our experience suggests that complications of immunosuppression with prolonged use of MTX may be seen more commonly. PMID: 1941818 [PubMed - indexed for MEDLINE] 3906. Masui. 1991 Aug;40(8):1256-60. [Iontophoretic administration of indomethacin in the treatment of postherpetic neuralgia] [Article in Japanese] Morimoto M, Hakuto T, Morimoto E, Kato H, Iwasaku K, Kurioka M, Hyodo M. Department of Anesthesiology, Osaka Medical College. Iontophoretic administration of indomethacin (IND) was applied to investigate its effect in 21 cases of postherpetic neuralgia (PHN), which showed no response to other treatment such as nerve blocks. Iontophoretic therapy of IND was applied for 20 minutes once a week up to 5 time (series 1). When pain relief was unsatisfactory in series 1, the same treatment was given once again (series 2). Long term follow-up results were obtained 3 months after the final treatment in series 1 or 2. We used visual analog scale (VAS) to measure their pain intensity. VAS was reduced clearly at the end of the treatment in each series. The average improvement rate of the VAS in each series was as follows; series 1:60.3 +/- 8.2%, series 2:73.7 +/- 7.0%, long term follow-up results: 73.7 +/- 7.0% (mean +/- S.E.) We concluded from the present results that iontophoretic administration of IND was one of the effective and useful treatments for PHN. PMID: 1920805 [PubMed - indexed for MEDLINE] 3907. J R Soc Med. 1991 Aug;84(8):501-2. Contralateral hemiplegia complicating herpes zoster ophthalmicus. McNeil JD, Horowitz M. Department of Medicine, Royal Adelaide Hospital, South Australia. PMCID: PMC1293387 PMID: 1886125 [PubMed - indexed for MEDLINE] 3908. Br J Ophthalmol. 1991 Aug;75(8):510. Bilateral simultaneous spontaneous acute angle closure glaucoma in a herpes zoster patient. al Halel A, Hirsh A, Melamed S, Blumenthal M. PMCID: PMC1042448 PMID: 1873277 [PubMed - indexed for MEDLINE] 3909. Am J Med. 1991 Aug;91(2):201-2. Excessive salivation as an anginal equivalent: a sequela to Ramsay Hunt syndrome. Cozzi PJ, Talano JV. PMID: 1867247 [PubMed - indexed for MEDLINE] 3910. Neurology. 1991 Aug;41(8):1215-8. Preherpetic neuralgia. Gilden DH, Dueland AN, Cohrs R, Martin JR, Kleinschmidt-DeMasters BK, Mahalingam R. Department of Neurology, University of Colorado School of Medicine, Denver. We have encountered six zoster patients whose pain preceded rash by 7 to more than 100 days. Pain was severe, burning, and radicular, and located both in dermatomes different from, as well as in, the area of eventual rash. Two patients ultimately developed disseminated zoster with neurologic complications, one of zoster paresis, and the other, a fatal zoster encephalitis; both had been taking long-term, low-dose steroids. A third case of preherpetic neuralgia developed in a patient with prior metastatic carcinoma, and another case in a patient with an earlier episode of brachial neuritis. The final two cases of preherpetic neuralgia developed in individuals with no underlying disease. An extended period of pain before the onset of zoster rash has gone largely unrecognized. PMID: 1866008 [PubMed - indexed for MEDLINE] 3911. Nihon Kyobu Shikkan Gakkai Zasshi. 1991 Aug;29(8):1037-41. [A case of Ramsey Hunt syndrome with multiple cranial nerve paralysis and acute respiratory failure] [Article in Japanese] Sato K, Nakamura S, Koseki T, Yamauchi F, Baba M, Mikami M, Kobayashi R, Fujikawa T, Nagaoka S. Department of Pneumology, Tokyo Metropolitan Hiroo General Hospital, Japan. The authors report a 56-year-old woman with Ramsey Hunt syndrome with multiple cranial nerve paralysis and acute respiratory failure. Five days before admission, she experienced right otalgia and right facial pain and consulted an otolaryngologist of our hospital, who diagnosed the illness as acute parotitis and laryngopharyngitis. One day before admission, she experienced mild dyspnea and general fatigue and came to our hospital emergency room. A chest X-ray film revealed no abnormalities but some blisters were observed around her right ear. The next day, her dyspnea became more severe and she was admitted. A chest X-ray film on admission revealed right lower lobe consolidation, and neurological examination disclosed multiple cranial nerve paralysis, i.e., paralysis of the right fifth, seventh, eighth, ninth, tenth, eleventh, twelfth and left tenth cranial nerve. The serum titer of anti-herpes zoster antibody was elevated to 1,024, and the patient was diagnosed as having Ramsey Hunt syndrome with multiple cranial nerve paralysis. Arterial blood gas analysis revealed hypoxemia with hypercapnea, which was considered to be due to aspiration pneumonia and central airway obstruction caused by vocal cord paralysis. Mechanical ventilation was soon instituted and several antibiotics and acyclovir were administered intravenously, with marked effects. Three months after admission, the patient was discharged with no sequelae except mild hoarseness. Patients with herpes zoster oticus, facial nerve paralysis and auditory symptoms are diagnosed as having Ramsey Hunt syndrome. This case was complicated by lower cranial nerve paralysis and acute respiratory failure, which is very rare.(ABSTRACT TRUNCATED AT 250 WORDS) PMID: 1753519 [PubMed - indexed for MEDLINE] 3912. Pain. 1991 Aug;46(2):195-9. The prognosis with postherpetic neuralgia. Watson CP, Watt VR, Chipman M, Birkett N, Evans RJ. Irene Eleanor Smythe Pain Clinic, Department of Anaesthesia, University of Toronto, Ont., Canada. One hundred and fifty-six patients with moderate to severe postherpetic neuralgia (PHN) were followed for up to 11 years. Nearly half of all patients were doing well at the final assessment (median 2 years) and more than half of these were on no therapy at this time. The most commonly used agents associated with a good outcome were antidepressants, topical capsaicin and analgesics of various kinds. Longer duration PHN appeared to have a worse prognosis. More of these patients were noted to be using some form of treatment at follow up. A group of patients seemed to follow a progressive course and were refractory to all treatments used in this study. PMID: 1749643 [PubMed - indexed for MEDLINE] 3913. Ophthalmology. 1991 Aug;98(8):1216-29. Diagnosis and therapy of herpes zoster ophthalmicus. Liesegang TJ. Division of Ophthalmology, Mayo Clinic, Jacksonville, FL 32224. Studies in the basic and clinical sciences have yielded new information about the biology, infection, latency, and recurrence of the varicella-zoster virus. Contrast is made with the herpes simplex virus. The host-viral relationship is an extremely dynamic one with clinical disease being determined primarily by the host cellular immune system. The complications of herpes zoster ophthalmicus are related to multiple mechanisms including viral growth, vascular and neural damage, and the host-immune response to infection. There are several laboratory tests available for confirming the diagnosis or determining the immune status. Systemic acyclovir administered early in the course alleviates many of the symptoms of herpes zoster ophthalmicus. Acute and postherpetic neuralgia remain significant and enigmatic problems; an update of therapeutic options is offered. The role of corticosteroids in herpes zoster ophthalmicus is scrutinized along with the potential and uncertainties of a varicella-zoster virus vaccine. PMID: 1656354 [PubMed - indexed for MEDLINE] 3914. Lakartidningen. 1991 Jul 24;88(30-31):2504-5. [Why increase the indications for Zovirax?] [Article in Swedish] Pers M. PMID: 1865714 [PubMed - indexed for MEDLINE] 3915. J Pediatr. 1991 Jul;119(1 ( Pt 1)):129-35. Acyclovir therapy in neonates. Englund JA, Fletcher CV, Balfour HH Jr. Department of Pediatrics, University of Minnesota Hospital, Minneapolis. Comment in: J Pediatr. 1992 Apr;120(4 Pt 1):665. STUDY OBJECTIVE: To determine the pharmacokinetic parameters of acyclovir disposition in neonates with renal dysfunction. DESIGN: Prospective sequential open enrollment of neonates with presumed herpes group virus infections. SETTING: Neonatal intensive care units in the greater Minneapolis-St. Paul metropolitan area. PATIENTS: Sixteen neonates with gestational ages between 27 and 40 weeks (median 38 weeks) were given acyclovir between days 1 and 56 of life to treat presumed herpes virus infections. Six infants were critically ill with multisystem disease, five infants had hepatic failure and underwent blood exchange transfusion, and five infants had renal failure. A mean of four (range 1 to 19) serum acyclovir concentrations per patient were measured by radioimmunoassay. Pharmacokinetic parameters were calculated from acyclovir concentrations in 46 samples from 16 patients. MEASUREMENTS AND MAIN RESULTS: The pharmacokinetic disposition of acyclovir was described as a two-compartment model. Although the ranges for acyclovir clearance and terminal elimination (t 1/2 beta) were wide, a statistically significant relationship was demonstrated between clearance and beta versus serum creatinine concentration. The average t 1/2 beta for infants with serum creatinine level less than 1 mg/dl (88 mumol/L) was 5.0 hours, and 15.6 hours for those with serum creatinine level greater than 1 mg/dl. CONCLUSIONS: Neonates with hepatic or renal dysfunction or young premature infants accumulate acyclovir when dosed without adjustment for organ dysfunction. Measurement of serum creatinine or creatinine clearance can be useful in the dosing of acyclovir in neonates. PMID: 2066845 [PubMed - indexed for MEDLINE] 3916. Am J Dis Child. 1991 Jul;145(7):722-3. Herpes zoster oticus. Rathore MH, Friedman AD, Barton LL, Dunkle LM. PMID: 2058599 [PubMed - indexed for MEDLINE] 3917. Minerva Anestesiol. 1991 Jul-Aug;57(7-8):433-6. [The rationale for the use of peridural local anesthetics in the therapy of herpes zoster] [Article in Italian] Pasqualucci V, Del Sindaco F, Cirulli P. Istituto di Anestesiologia e Rianimazione, Università degli Studi di Perugia. PMID: 1944968 [PubMed - indexed for MEDLINE] 3918. Neurology. 1991 Jul;41(7):1024-8. Both intravenous lidocaine and morphine reduce the pain of postherpetic neuralgia. Rowbotham MC, Reisner-Keller LA, Fields HL. Department of Neurology, University of California, San Francisco 94143. We studied the analgesic efficacy of an intravenous infusion of lidocaine and morphine in 19 adults with well-established postherpetic neuralgia in a three-session, randomized, double-blind, placebo-controlled trial. Compared with saline placebo, both lidocaine and morphine reduced pain intensity. Reductions in pain did not correlate with side effects produced by the infusions. For morphine, there was a significant correlation between reductions in pain intensity and blood level achieved. In the majority of subjects who reported definite pain relief, allodynia also disappeared. The results show that neuropathic pain can respond to opioids and to systemically administered local anesthetic drugs. PMID: 1712433 [PubMed - indexed for MEDLINE] 3919. Am Fam Physician. 1991 Jul;44(1):203-10. Treatment of herpes zoster and postherpetic neuralgia. Carmichael JK. University of Arizona College of Medicine, Tucson. Herpes zoster results from reactivation of latent varicella-zoster virus. It is most common in elderly patients and immunosuppressed patients, especially those with human immunodeficiency virus (HIV) infection. Zoster is often the earliest indicator of HIV infection. The acute course of herpes zoster is generally benign, but systemic complications may be fatal. Postherpetic neuralgia is the major chronic complication and is a difficult management problem. High-dose acyclovir (800 mg orally five times daily) has recently been approved for treatment of herpes zoster and, if started early, decreases the duration and severity of symptoms. In the prevention of postherpetic neuralgia, acyclovir does not appear to be effective, and the efficacy of steroids is questionable. The best therapy currently available for postherpetic neuralgia is amitriptyline, topical capsaicin and transcutaneous electrical stimulation. PMID: 1676237 [PubMed - indexed for MEDLINE] 3920. Kansenshogaku Zasshi. 1991 Jul;65(7):851-6. [Herpes zoster in connective tissue diseases: I. Association with systemic lupus erythematosus and its immunological abnormalities] [Article in Japanese] Yamauchi Y, Nagasawa K, Tada Y, Tsukamoto H, Yoshizawa S, Mayumi T, Niho Y, Kusaba T. First Department of Internal Medicine, Faculty of Medicine, Kyushu University. We determined the incidence of herpes zoster (HZ) in 119 patients with systemic lupus erythematosus (SLE). HZ occurred in 56 patients (47%), and 9 patients had had HZ even before SLE developed. After diagnosis of SLE, an incidence of zoster was high, 5.45 cases per 100 person-years. It was found that the susceptibility to HZ was not related to the presence of renal disorder or maximum dose of corticosteroids. The patients with SLE who had had HZ showed significantly higher antibody titers than those without a history of HZ and normal subjects as assayed by both complement fixation technique and neutralization test. On the other had, only 17 of 55 patients (31%) with SLE showed positive skin reactions to varicella zoster virus (VZV) antigen, whereas all 15 normal subjects had positive reactions. In the patients who were receiving less than 10 mg/day of prednisolone, 11 of 17 (65%) had positive skin reactions to VZV antigen, whereas only 4 of 31 (13%) patients who were receiving 10 mg/day or more prednisolone showed positive reactions. It was of interest that in 7 patients with SLE who had not received corticosteroids, only 2 (29%) patients showed positive skin reactions to VZV antigen. These results suggest that high incidence of HZ in patients with SLE is probably due to an impaired cellular immunity because of both underlying disease and corticosteroid treatment. PMID: 1655920 [PubMed - indexed for MEDLINE] 3921. J Clin Microbiol. 1991 Jul;29(7):1513-6. Detection of varicella-zoster virus DNA by polymerase chain reaction in the cerebrospinal fluid of patients suffering from neurological complications associated with chicken pox or herpes zoster. Puchhammer-Stöckl E, Popow-Kraupp T, Heinz FX, Mandl CW, Kunz C. Institute of Virology, University of Vienna, Austria. The polymerase chain reaction (PCR) was used to detect varicella-zoster virus (VZV) DNA in the cerebrospinal fluid of patients with VZV infection associated with neurological symptoms. Positive results were obtained in three of five children with post-chicken pox cerebellitis and in seven of seven herpes zoster patients with neurological symptoms. The PCR thus provides a useful tool for the early diagnosis of VZV-associated neurological disease. PMCID: PMC270144 PMID: 1653267 [PubMed - indexed for MEDLINE] 3922. Scand J Immunol. 1991 Jul;34(1):45-52. Strong donor mononuclear cell reactivity for herpes simplex virus (HSV) antigen in HSV immune donors combined with recipient seropositivity for HSV is associated with acute graft-versus-host disease. Boström L, Ringdén O, Forsgren M. Department of Clinical Immunology, Karolinska Institute, Huddinge Hospital, Stockholm, Sweden. Prior to bone marrow transplantation (BMT) titres of IgG antibodies for cytomegalovirus (CMV), herpes simplex virus (HSV) and varicella zoster virus (VZV) were analysed in 51 donors and recipients of allogeneic bone marrow. Donor mononuclear cells from peripheral blood and bone marrow cells were stimulated with antigen prepared from CMV, HSV and VZV. High IgG titres for HSV in the recipient were associated with grade II-III acute graft-versus-host disease (GVHD) (P = 0.05). Furthermore, the combination of positive IgG titre for HSV antibodies in the recipient, and strong donor blood mononuclear cell reactivity to HSV antigen in HSV immune donors, significantly increased the incidence of grade II-III acute GVHD (P = 0.04). The data suggest that HSV immune donor mononuclear cells may initiate a GVH reaction. PMID: 1648786 [PubMed - indexed for MEDLINE] 3923. Arch Dermatol. 1991 Jul;127(7):1069-71. Acyclovir-resistant varicella zoster responsive to foscarnet. Smith KJ, Kahlter DC, Davis C, James WD, Skelton HG, Angritt P. PMID: 1648341 [PubMed - indexed for MEDLINE] 3924. Ann Intern Med. 1991 Jul 1;115(1):19-21. Foscarnet therapy in five patients with AIDS and acyclovir-resistant varicella-zoster virus infection. Safrin S, Berger TG, Gilson I, Wolfe PR, Wofsy CB, Mills J, Biron KK. University of California, San Francisco. OBJECTIVE: To determine whether foscarnet has potential efficacy in the treatment of acyclovir-resistant mucocutaneous varicella-zoster infection in patients with the acquired immunodeficiency syndrome (AIDS). DESIGN: Open-label study. SETTING: Three university medical centers. PATIENTS: Five patients with AIDS who were infected with thymidine-kinase-deficient or -altered strains of varicella-zoster virus. INTERVENTION: Foscarnet, 40 mg/kg body weight every 8 hours in 1-hour infusions for 10 or more days. MAIN RESULTS: Four patients had healing in response to foscarnet therapy, and each of four tested patients became culture negative for virus during foscarnet therapy. Results of fluorescent antigen testing remained positive during therapy in two patients; one of these patients had concomitant clinical failure but the other patient healed fully. One patient had complete healing despite the emergence of resistance to foscarnet in serial specimens obtained during foscarnet therapy. CONCLUSION: Foscarnet is a potentially effective and tolerable antiviral agent for patients with acyclovir-resistant, varicella-zoster virus infection; however, the optimal dosage and duration of therapy require further study, as does the relation between clinical findings and in-vitro susceptibility results. PMID: 1646585 [PubMed - indexed for MEDLINE] 3925. Lakartidningen. 1991 Jun 26;88(26-27):2381-2. [Zoster should be treated with peroral acyclovir] [Article in Swedish] Molin L. Hudkliniken, regionsjukhuset, Orebro. PMID: 1857160 [PubMed - indexed for MEDLINE] 3926. Med J Aust. 1991 Jun 3;154(11):781. EMLA cream and herpetic neuralgia. Wheeler JG. Comment in: Med J Aust. 1991 Aug 5;155(3):206-7. PMID: 2046584 [PubMed - indexed for MEDLINE] 3927. Enferm Infecc Microbiol Clin. 1991 Jun-Jul;9(6):385. [Diaphragmatic paralysis in cervical herpes zoster] [Article in Spanish] Agustí A, Cortes P, Bisbe J. PMID: 1932254 [PubMed - indexed for MEDLINE] 3928. Neurologia. 1991 Jun-Jul;6(6):228-9. [Cranial multineuritis caused by the varicella-zoster virus without cutaneous lesion] [Article in Spanish] Castro-Salomó A, Royo I, Tintoré M, Montalbán J, Codina A. PMID: 1931104 [PubMed - indexed for MEDLINE] 3929. Int J Dermatol. 1991 Jun;30(6):432-4. Cutaneous malignancies mimicking herpes zoster. Williams LR, Levine LJ, Kauh YC. Department of Dermatology, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania 19107. Cutaneous metastases occur in 2.5% to 5% of patients with malignant disease. The relative frequency of the primary site roughly parallels the frequency of the various malignancies in each sex. We present two cases of cutaneous malignancy occurring in a dermatomal distribution and masquerading as herpes zoster. The differential diagnosis of zosteriform eruptions is reviewed and the possible pathogenesis of metastatic disease in this cutaneous distribution is discussed. Skin biopsy is recommended in these cases to determine the etiology of the eruption. PMID: 1894409 [PubMed - indexed for MEDLINE] 3930. Bone Marrow Transplant. 1991 Jun;7(6):435-7. Early herpes zoster infection in adult patients with Hodgkin's disease undergoing autologous bone marrow transplant. Christiansen NP, Haake RJ, Hurd DD. Department of Medicine, University of Minnesota Health Sciences Center, Minneapolis. The incidence of varicella-zoster-virus infection/reactivation in adult patients with Hodgkin's disease undergoing autologous bone marrow transplantation (BMT) at the University of Minnesota Hospital and Clinic was determined. Seven of 28 evaluable patients (25%) developed varicella-zoster infections in the first 150 days post-transplant. Two additional patients developed zoster after day 150 for a total incidence of 32%. We evaluated analysed risk factors to determine if there were any characteristics that could identify patients at risk for zoster early (less than 150 days) in their post-transplant course. Sex, age, prior radiation, and lack of immunity as determined by viral antibody titers were not associated with an increased incidence. Ten of the 28 patients had a history of zoster at some time after the diagnosis of Hodgkin's disease. Six of these 10 patients (60%) again developed zoster post-transplant. This compared to only one episode of varicella-zoster post-transplant among the 18 patients without a history of zoster following the diagnosis of Hodgkin's disease (p less than 0.01, Fisher's exact). We conclude that a prior history of zoster any time after diagnosis of Hodgkin's disease is strongly associated with developing zoster in the first 150 days after autologous BMT. PMID: 1873590 [PubMed - indexed for MEDLINE] 3931. Bone Marrow Transplant. 1991 Jun;7(6):489-91. Abdominal presentation of varicella-zoster infection in recipients of allogeneic bone marrow transplantation. Schiller GJ, Nimer SD, Gajewski JL, Golde DW. Department of Medicine, UCLA School of Medicine 90024-1678. Comment in: Bone Marrow Transplant. 1992 Mar;9(3):217. We report here three recipients of allogeneic bone marrow transplantation in whom visceral varicella-zoster virus infection preceded cutaneous dissemination producing life-threatening complications including hepatitis, pancreatitis and haemorrhage. PMID: 1843181 [PubMed - indexed for MEDLINE] 3932. Klin Med (Mosk). 1991 Jun;69(6):69-72. [Acyclovir in the treatment of severe generalized forms of herpes zoster] [Article in Russian] Shishov AS, Leshchinskaia EV, Martynenko IN. Aciclovir administration in 8 herpes zoster patients aged 14-74 to manage resistant generalized herpetic eruption, serous meningitis, meningoencephalitis resulted in a pronounced response in 5 of them. Aciclovir has the advantage of its effectiveness in spite of late treatment (on herpes zoster day 6-22). This is particularly important for those forms of the disease which manifest severe symptoms during the second phase, i.e. disseminated eruption, involvement of brain matter, etc. Two lethal outcomes due to pulmonary artery embolism were unrelated to the drug administration. PMID: 1774918 [PubMed - indexed for MEDLINE] 3933. J Hosp Infect. 1991 Jun;18 Suppl A:317-29. Natural history and treatment of varicella-zoster in high-risk populations. Gnann JW, Whitley RJ. Department of Medicine, University of Alabama, Birmingham. Rigorous clinical trials have established that both acyclovir and vidarabine favourably alter the clinical course of herpes zoster and chicken-pox in immunocompromised patients. In one comparative study, acyclovir was shown to be superior to vidarabine for zoster in bone marrow transplant recipients. These data, plus the fact that acyclovir is easier to administer than vidarabine, and perhaps less toxic, have made intravenous acyclovir the recognized drug of choice for treatment of herpes zoster in immunocompromised patients. Acyclovir sodium sterile powder received Federal Drug Administration (FDA) approval for this indication in 1990 in the United States. Since complications of zoster occur in only a minority of immunocompromised patients, most physicians would prefer to initiate therapy with an orally-administered drug and avoid the cost and inconvenience of hospitalization. Future studies will compare the efficacy and safety of orally administered bromovinyl arabinosyl uracil and acyclovir in treatment of varicella-zoster virus infections. PMID: 1679798 [PubMed - indexed for MEDLINE] 3934. Pediatr Infect Dis J. 1991 Jun;10(6):476. Volume of varicella-zoster immune globulin. Marchant CD, Leszczynski J. Comment on: Pediatr Infect Dis J. 1990 Dec;9(12):865-9. PMID: 1649433 [PubMed - indexed for MEDLINE] 3935. Brain. 1991 Jun;114 ( Pt 3):1181-96. Herpes zoster myelitis. Devinsky O, Cho ES, Petito CK, Price RW. Department of Neurology, New York Hospital-Cornell University Medical Center, NY 10003. We studied the clinical (10 patients) and pathological (9 patients) findings in 13 patients with herpes zoster myelitis, all of whom had systemic illnesses associated with immunosuppression. The median interval between the onset of the herpes zoster rash and myelopathic symptoms was 12 days, and the subsequent median interval to maximal deficit was 10.5 days. Presenting neurological symptoms were characteristically ipsilateral to the rash, with motor dysfunction predominating, followed by a spinothalamic and, less often, posterior column sensory deficit. Pathological involvement was most severe in the dorsal root entry zone and posterior horn of the spinal cord segment corresponding to the involved dermatome. There was variable spread both horizontally and vertically in the spinal cord. Direct varicella-zoster virus (VZV) infection of neuroectodermal cells, particularly oligodendrocytes, was demonstrated by immunostaining viral antigens (8 cases), and by the presence of Cowdry type A intranuclear inclusions (7 cases) and often was associated with focal demyelination (6 cases). In 4 patients a VZV vasculitis was associated with leptomeningitis and haemorrhagic necrosis (spinal cord in 1; brainstem or cerebellum in 3). The protracted evolution in many cases and the pathologically documented direct viral infection of the spinal cord provide a rational basis for the use of antiviral therapy in preventing or attenuating the evolving myelopathy. PMID: 1648419 [PubMed - indexed for MEDLINE] 3936. Pediatr Infect Dis J. 1991 May;10(5):412-3. Herpes zoster in a five-month-old infant after intrauterine exposure to varicella. Vachvarichsanong P. Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Thailand. PMID: 2067896 [PubMed - indexed for MEDLINE] 3937. Med Clin North Am. 1991 May;75(3):661-75. Diagnosis and treatment of headache in the elderly. Baumel B, Eisner LS. Neurological Center for Headache, Miami Beach, Florida. The diagnosis and management of some causes of headache in the elderly are reviewed. Etiologic theories have been presented for each condition. Treatment modalities include pharmacologic, nonpharmacologic, and surgical therapies. The treatment course set forth in this article can help the clinician provide proper relief for the patient in pain. PMID: 2020221 [PubMed - indexed for MEDLINE] 3938. Klin Monbl Augenheilkd. 1991 May;198(5):470-3. [Usefulness of the Laser FLare Cell Meter (LFCM, Kowa FC-1000) for evaluating inflammation of the anterior chamber in clinical practice] [Article in French] Herbort CP, Bigar F, Pittet N. Hôpital Ophthalmique Jules Gonin, Département d'Ophtalmologie, Université de Lausanne. The Laser Flare Cell Meter (LFCM, Kowa FC-1000), an instrument measuring aqueous flare and cells in a quantitative, objective and non-invasive way, has been mainly used so far to measure inflammation in clinical and experimental research. In the light of some illustrative examples, its practical clinical usefulness is presented; the LFCM was found to be specially helpful in 3 types of situations. 1. In acute anterior uveitis (AAU) patients, precise LFCM monitoring of inflammation made it possible to avoid excessive corticosteroid therapy, mainly by more rapid and controlled tapering at the end of an inflammatory episode, so possibly minimizing steroid side effects in a group of patients prone to numerous uveitis recurrences. In a steroid-responder patient it allowed successful treatment of a flare-up of AAU with a combination of systemic and topical diclofenac (Voltaren), a potent nonsteroidal antiinflammatory drug. 2. LFCM monitoring of inflammation in patients undergoing laser treatments allowed optimal adjustment of antiinflammatory therapy. Diclofenac drops (Voltarene Ophta), were sufficient to treat inflammation in all patients, undergoing Nd-YAG laser posterior capsulotomy or Argon laser trabeculoplasty. 3. In patients with acyclovir treated herpes simplex or herpes zoster uveitis corticosteroid treatment should be avoided whenever possible, because of the tendency to develop steroid dependency. LFCM monitoring of this group of patients gave a precise evolutionary pattern of inflammation and permitted to avoid steroid treatment in many patients. PMID: 1886388 [PubMed - indexed for MEDLINE] 3939. Klin Monbl Augenheilkd. 1991 May;198(5):358-60. [Prevention of ocular complications of herpes zoster ophthalmicus by adequate treatment with acyclovir] [Article in French] Borruat FX, Buechi ER, Piguet B, Fitting P, Zografos L, Herbort CP. Hôpital Ophtalmique Jules Gonin, Lausanne. We compared the frequency of severe ocular complications secondary to Herpes Zoster Ophthalmicus (HZO) in 232 patients. They were divided into three groups: 1) patients without treatment (n = 164); 2) patients treated adequately (n = 48) with acyclovir (ACV; 5 x 800 mg/d orally and ophthalmic ointment 5 x /d for a minimum of 7 days, given within three days after skin eruption); and, 3) patients treated inadequately (n = 20) with ACV (only topical treatment, insufficient doses, interrupted treatment, delayed treatment). Patients with no treatment or with inadequate treatments showed the same frequency of severe ocular complications (21% (34/164) and 25% (5/20), respectively). In contrast, when adequate treatment of ACV was given complications occurred in only 4% (2/48) of cases. This study emphasizes the need for prompt (within three days after skin eruption) and adequate (5 x 800 mg/d for at least 7 days) treatment of ACV to prevent the severe complications of HZO. PMID: 1886356 [PubMed - indexed for MEDLINE] 3940. Mt Sinai J Med. 1991 May;58(3):257-66. Acute herpetic and postherpetic neuralgia: clinical features and management. Galer BS, Portenoy RK. Department of Neurology, Albert Einstein College of Medicine, Bronx, NY. Herpes zoster is a prevalent disorder that is transitory in most patients. Postherpetic neuralgia is defined by the persistence of pain following herpes zoster for some arbitrarily defined period, such as two months. Although most patients with postherpetic neuralgia experience a gradual remission of the pain, symptoms are prolonged in many, and intractable pain occurs in a few. This review describes the clinical characteristics and management of these syndromes. PMID: 1875964 [PubMed - indexed for MEDLINE] 3941. J Neurol Sci. 1991 May;103(1):101-4. Intrathecal humoral immune reaction in zoster infections. Schädlich HJ, Nekic M, Jeske J, Karbe H. Neurological Clinic, University of Cologne, F.R.G. Intrathecal humoral immune reaction in 26 patients with a reactivation of varicella-zoster virus was analyzed. 11 suffered from ganglionitis, in 7 cases an additional affection of the lower motor neuron was demonstrable. In 8 patients, meningitis, myelitis or cerebral infarctions by zoster angiitis were diagnosed. Intrathecal immune reaction in ganglionitis was weak whereas an intense IgG synthesis became demonstrable in all meningomyelitis/cerebral infarction cases. As demonstrated by immunoblotting, in early stages of the disease immune reaction in serum and cerebrospinal fluid differed only quantitatively. In the further course, most intrathecally synthesized antibodies were directed against low molecular antigens whereas serum pattern did not change. In some patients, additional antibodies not detectable in serum were demonstrable. Though intensity markedly differed, no qualitative differences between the immune response in ganglionitis and more widespread zoster infections of the CNS were detectable. PMID: 1865223 [PubMed - indexed for MEDLINE] 3942. Ann Ophthalmol. 1991 May;23(5):188-9. Treatment for herpes zoster ophthalmicus: stellate ganglion block as a treatment for acute pain and prevention of postherpetic neuralgia. Currey TA, Dalsania J. Eye Specialists Association, Germantown, TN 38138-3653. PMID: 1750737 [PubMed - indexed for MEDLINE] 3943. J Indian Med Assoc. 1991 May;89(5):117-9. Clinical profile of herpes zoster ophthalmicus. Nigam P, Kumar A, Kapoor KK, Sarkari NB, Gupta AK, Lal BB, Mukhija RD. BRD Medical College, Gorakhpur. Herpes zoster ophthalmicus was seen in 22 cases out of 195 cases of herpes zoster (11.3% incidence). It was affecting mainly adults (90.9%). Oedema over the lids (81.8%) was invariably present and lead to ptosis. Mucopurulent conjunctivitis, predominantly mucoid (72.7%) was the commonest manifestation associated with vesicles over the lid margins. Sectorial (22.7%) and diffuse (9.1%) episcleritis appeared in later part of first week, while nodular episcleritis was observed in one case only on 12th day of the disease. Nummular keratitis was seen in 31.8% of cases between 8-10 days. Iritis and iridocyclitis was seen in 45.4% of cases out of which 36.3% had secondary ocular hypertension (glaucoma). Neuroparalytic keratitis and internal ophthalmoplegia were detected in one patient each. Postherpetic neuralgia occurred in 22.7% of cases and was uncommon in younger age group (below 40 years, 4.5%). Carbamazepine was effective in relieving the herpetic pain. PMID: 1748774 [PubMed - indexed for MEDLINE] 3944. Antiviral Res. 1991 May;15(4):341-4. Drug testing for activity against varicella-zoster virus in hairless guinea pigs. Myers MG, Stanberry LR. Division of Infectious Diseases, Children's Hospital Research Foundation, Cincinnati, OH 45229-2899. Inoculation of congenitally hairless guinea pigs with varicella-zoster virus (VZV) (Oka strain) results in a self-limited exanthematous infection analogous to varicella in children. Administration of acyclovir or 6-methoxypurine arabinoside modified the course of infection. This model should facilitate pre-clinical testing of putative anti-VZV agents. PMID: 1659314 [PubMed - indexed for MEDLINE] 3945. Ann Neurol. 1991 May;29(5):569-72. Fatal varicella-zoster virus meningoradiculitis without skin involvement. Dueland AN, Devlin M, Martin JR, Mahalingam R, Cohrs R, Manz H, Trombley I, Gilden D. Department of Neurology, University of Colorado School of Medicine, Denver 80262. A 77-year-old man with T-cell lymphoma developed an acute fatal meningoradiculitis of cranial nerve roots and cauda equina, pathologically and virologically confirmed to be caused by varicella-zoster virus. This is the first report of fatal varicella-zoster virus-induced neurological disease in the absence of skin lesions. Varicella-zoster virus should be included in the differential diagnosis of acute radiculoneuropathy in the immunocompromised patient, particularly because antiviral treatment for varicella-zoster virus exists. PMID: 1650163 [PubMed - indexed for MEDLINE] 3946. Br J Ophthalmol. 1991 May;75(5):292-7. Acute retinal necrosis syndrome. Gartry DS, Spalton DJ, Tilzey A, Hykin PG. St Thomas's Hospital, Department of Ophthalmology, London. Acute retinal necrosis (ARN) is a rare syndrome with characteristic fundal appearances which can have devastating effects on vision. We present six cases (nine eyes) seen in the Medical Eye Unit of St Thomas's Hospital over the past six years and discuss the clinical features, aetiology, and management. Our findings support the present consensus that the condition is caused by varicella zoster virus (VZV) or herpes simplex virus (HSV). One of our patients, who was atypical in having common variable hypogammaglobulinaemia, had suffered a widespread zosteriform rash immediately prior to the onset of ARN, while another had suffered a herpes simplex uveomeningoencephalitis. All cases had characteristic confluent peripheral retinal necrosis, and three of the nine eyes developed retinal detachment. Retinal arteritis was a prominent and helpful diagnostic feature in one case. From combining all reports to date of this rare condition it is possible to conclude that ARN is unilateral in 65% of cases. PMCID: PMC1042358 PMID: 1645179 [PubMed - indexed for MEDLINE] 3947. Nurs Stand. 1991 Apr 24-30;5(31):28-32. Diseases of the herpes viruses. Kedzierski M. PMID: 1645178 [PubMed - indexed for MEDLINE] 3948. J Clin Laser Med Surg. 1991 Apr;9(2):121-6. Evaluation of analgesic effect of low-power He:Ne laser on postherpetic neuralgia using VAS and modified McGill pain questionnaire. Iijima K, Shimoyama N, Shimoyama M, Mizuguchi T. Department of Anesthesiology, Chiba University School of Medicine, Japan. In order to investigate the efficacy of low-power He:Ne laser in treatment of pain, we irradiated 18 outpatients with severe postherpetic neuralgia. The efficacy of the low-power laser treatment was evaluated using a four-grade estimation, visual analog scale (VAS), and modified McGill pain questionnaire (m-MPQ) after every 10 of as many as 50 irradiations. The efficacy rate using a four-grade estimation at the end of 50 treatments was 94.4%. VAS decreased from 6.2 before irradiation therapy to 3.6 after 50 treatments, and the degree of pain relief was reduced to 44.6% and correlated with the number of treatments. The total numbers of words and the total scores of the m-MPQ decreased as the number of treatments increased. No complications attributable to the laser therapy were observed. These results suggest that repeated irradiation with low-power He:Ne laser is an effective and safe therapy for postherpetic neuralgia. PMID: 10149452 [PubMed - indexed for MEDLINE] 3949. Int J Dermatol. 1991 Apr;30(4):288-90. Prevention of post-herpetic neuralgia. Evaluation of treatment with oral prednisone, oral acyclovir, and radiotherapy. Benoldi D, Mirizzi S, Zucchi A, Allegra F. Department of Dermatology, University of Parma, Italy. The effects of prednisone, oral acyclovir, and radiotherapy were compared with placebo in the prevention of post-herpetic neuralgia. No treatment used was able to prevent, with statistical significance, post-herpetic neuralgia, although prednisone and acyclovir showed some pain reduction in the acute phase. Radiotherapy was of no value in either the acute or post-herpetic phase. PMID: 2050460 [PubMed - indexed for MEDLINE] 3950. Clin Pharm. 1991 Apr;10(4):301-2. Preventing recurrent varicella and herpes zoster with oral acyclovir in HIV-seropositive patients. Dellamonica P, Carles M, Lokiec F, Mondain V, Bernard E, Johanson F. Archet Hospital, Nice, France. PMID: 2032448 [PubMed - indexed for MEDLINE] 3951. Arch Ophthalmol. 1991 Apr;109(4):471-2. Orbital myositis associated with herpes zoster. Volpe NJ, Shore JW. PMID: 2012541 [PubMed - indexed for MEDLINE] 3952. J Infect Dis. 1991 Apr;163(4):873-5. Varicella-zoster virus-specific immunity after herpes zoster. Hayward A, Levin M, Wolf W, Angelova G, Gilden D. Department of Pediatrics, University of Colorado School of Medicine, Denver 80262. The frequency of varicella-zoster virus (VZV)-specific T lymphocytes was higher in elderly subjects who had herpes zoster infections than in age-matched controls. This increase in T cell response persisted for at least 2 years while antibody levels to VZV returned to control values at this time. There were no differences in T cell or antibody responses to VZV between individuals with and without postherpetic neuralgia. Elderly subjects who had not had herpes zoster had a comparable increase in VZV-specific T responder cell frequency after immunization with Oka strain VZV. The data suggest that the potential for a boost in T cell response to VZV persists in the elderly, and that immunization can elicit a T cell response in this age group. PMID: 1849165 [PubMed - indexed for MEDLINE] 3953. Clin Ter. 1991 Mar 15;136(5):327-32. [Therapeutic indications in herpes zoster] [Article in Italian] Carcò F, Gili C, Gobber M, Bianchi B, Guazzotti G. Divisione Malattie Infettive, U.S.S.L. 45, Ospedale Provinciale S. Andrea, Vercelli. Fifty-two patients with acute Herpes Zoster were divided into two groups and treated respectively as follows: 25 received i.v. acyclovir and 27 received s.c. thymopentin, an immunomodulating drug. Both drugs proved effective in promoting the recovery from herpetic lesions and in relieving the painful symptomatology within approximately the same period of time. Thymopentin apparently has an antiphlogistic effect and is believed to prevent post-herpetic neuropathy through its immunomodulating activity. Further studies based on a larger number of patients would be necessary to confirm the results achieved and for statistical evaluation. PMID: 1828198 [PubMed - indexed for MEDLINE] 3954. Nippon Naika Gakkai Zasshi. 1991 Mar 10;80(3):477-81. [Virus diseases] [Article in Japanese] Matsumoto K. PMID: 1856570 [PubMed - indexed for MEDLINE] 3955. AIDS. 1991 Mar;5(3):295-300. Perinatal transmission of HIV-1: lack of impact of maternal HIV infection on characteristics of livebirths and on neonatal mortality in Kigali, Rwanda. Lepage P, Dabis F, Hitimana DG, Msellati P, Van Goethem C, Stevens AM, Nsengumuremyi F, Bazubagira A, Serufilira A, De Clercq A, et al. Department of Paediatrics, Centre Hospitalier de Kigali, Rwanda. We present the baseline results of a prospective cohort study on the perinatal transmission of HIV-1 in Kigali, Rwanda. HIV-1-antibody testing was offered to all women of urban origin delivering a live newborn at the maternity ward of the Centre Hospitalier de Kigali from November 1988 to June 1989; 218 newborns of 215 HIV-positive mothers were matched to 218 newborns of 216 HIV-negative mothers. The matching criteria were maternal age and parity. No differences in socioeconomic characteristics were observed between HIV-positive and HIV-negative women. HIV-positive mothers more frequently reported a history of at least one death of a previously born child (P less than 0.01) and a history of abortion (P less than 0.001). Most of the HIV-positive women were asymptomatic, but 72.4% of them had a CD4; CD8 ratio less than 1 versus 10.1% in the HIV-negative group (P less than 0.001). The frequency of signs and symptoms was not statistically different in the two groups, except for a history of herpes zoster or chronic cough, which was more frequent among HIV-positive women. The rates of prematurity, low birth weight, congenital malformations and neonatal mortality were comparable in the two groups. However, infants of HIV-positive mothers had a mean birth weight 130 g lower than the infants of HIV-negative mothers (P less than 0.01). The impact of maternal HIV-1 infection on the infant seems limited during the neonatal period. PMID: 2059369 [PubMed - indexed for MEDLINE] 3956. Vrach Delo. 1991 Mar;(3):86-9. [Experience in treating a herpetic infection with trypsin] [Article in Russian] Sichko ZhV, Kozlova OL. Results are reported of trypsin treatment of 150 patients with herpetic infection (age of the patients: from 7 to 65 years). The results were compared with routine treatment in 200 patients. High efficacy of trypsin treatment as compared with routine treatment methods has been revealed. Trypsin treatment results in control of the pathological signs and symptoms not only in the acute period but also resulted in absence of recurrences of the infection and postherpetic neuralgia for 3 successive years. The efficacy of trypsin treatment has been thus established and the necessity of active detection and treatment of chronic carriers of herpetic infection by the proposed method is advocated. PMID: 2042362 [PubMed - indexed for MEDLINE] 3957. J R Soc Med. 1991 Mar;84(3):184. Epidemiology of shingles. [No authors listed] Comment on: J R Soc Med. 1990 Oct;83(10):617-9. PMCID: PMC1293164 PMID: 2013914 [PubMed - indexed for MEDLINE] 3958. Am J Med. 1991 Mar;90(3):401. Successful acyclovir therapy of severe varicella hepatitis in an adult renal transplant recipient. Morales JM. Comment on: Am J Med. 1990 Jan;88(1):77-80. PMID: 2003524 [PubMed - indexed for MEDLINE] 3959. Am J Med. 1991 Mar;90(3):295-8. Herpes zoster in patients with rheumatoid arthritis treated with weekly, low-dose methotrexate. Antonelli MA, Moreland LW, Brick JE. Section of Rheumatology, West Virginia University School of Medicine, Morgantown 26506. PURPOSE: Herpes zoster occurred in nine patients with methotrexate-treated rheumatoid arthritis. We compared these patients to a large group of methotrexate-treated rheumatoid arthritis patients in order to uncover potential factors explaining the occurrence of herpes zoster. PATIENTS AND METHODS: Data from 187 patients taking methotrexate were reviewed and compared with data from another nine patients who developed herpes zoster while taking the drug for rheumatoid arthritis, all from the same university-based arthritis clinic. Literature pertinent to infection in rheumatoid arthritis patients treated with methotrexate is reviewed. RESULTS: Herpes zoster occurred in 14.5 cases per 1,000 patient-years in our methotrexate-treated rheumatoid arthritis patients, as compared with the general population incidence of 1.3 to 4.8 cases per 1,000 patient-years. The infection was unrelated to duration of methotrexate usage, prednisone treatment, or the co-existence of diabetes mellitus, but appeared to occur in patients with high titers of rheumatoid factor and an overall longer duration of rheumatoid arthritis. There were no cases of systemic dissemination or recurrence of herpes zoster despite 27.4 years cumulative follow-up on continued methotrexate therapy. CONCLUSIONS: Herpes zoster may occur more frequently in patients with rheumatoid arthritis treated with low-dose methotrexate than in the general population. Herpes zoster in rheumatoid arthritis patients treated with methotrexate appears to be self-limited, benign, and statistically related to methotrexate use in the presence of longer-term rheumatoid disease. PMID: 2003511 [PubMed - indexed for MEDLINE] 3960. J Comput Assist Tomogr. 1991 Mar-Apr;15(2):223-7. MR fat suppression combined with Gd-DTPA enhancement in optic neuritis and perineuritis. Tien RD, Hesselink JR, Szumowski J. Department of Radiology, University of California, School of Medicine, San Diego, La Jolla. A fat suppression MR technique used in combination with Gd-DTPA enhancement was investigated to determine its value in cases of inflammatory optic nerve lesions. This technique, the so-called hybrid method, is a derivative of the chopper fat suppression technique and provides water-only images without increasing the imaging or postprocessing time. The study group consisted of four patients with acute visual loss, all of whom received Gd-DTPA. Conventional T2-weighted and fat suppression post-Gd-DTPA T1-weighted images were obtained in all patients; in addition, in one patient a post-Gd-DTPA T1-weighted image without fat suppression was obtained. In three patients, the conventional T2-weighted images failed to reveal any abnormality. In contrast, the enhanced optic nerve and enhanced perineural inflammatory infiltrate were easily identified on T1-weighted images after administration of Gd-DTPA and application of fat suppression technique. The lesions in inflammatory optic neuritis or perineuritis were easily distinguished from the surrounding fat, which had been suppressed. This combined technique resulted in significantly improved definition of normal anatomic structures and made the enhancing lesions more conspicuous, especially in areas with large amounts of fat such as the retrobulbar orbit. PMID: 2002098 [PubMed - indexed for MEDLINE] 3961. Northwest Dent. 1991 Mar-Apr;70(2):31. Extensive endodontic involvements following herpes zoster attack to facial area; report of a case. Wadden JV. PMID: 1870958 [PubMed - indexed for MEDLINE] 3962. Acta Med Port. 1991 Mar-Apr;4(2):91-2. Herpes zoster and controlateral hemiplegia in an African patient infected with HIV-1. Carneiro AV, Ferro J, Figueiredo C, Costa L, Campos J, de Pádua F. Serviço de Medicina IV, Hospital Universitário de Santa Maria, Lisboa. One of the neurologic complications of human immunodeficiency virus infection are cerebrovascular accidents. In HIV infected patients, ischemic strokes have been reported secondary to nonbacterial thrombotic endocarditis and cerebral arteritis. We describe an unusual cause of stroke in HIV-1 infection: Herpes Zoster ophtalmicus with contralateral hemiplegia. PIP: A rare case of ischemic stroke related to Herpes zoster infection of the eye and documented arteritis in an HIV-positive patient is analyzed. The woman, aged 32, who was born in Angola and lived in Zaire, was diagnoses at the Hospital Universitario de Santa Maria, Lisbon. She presented with a 5-month history of sudden hemiplegia, 4 months after onset of herpes zoster ophthalmicus. Among extensive diagnosis tests, she was positive for HIV by ELISA and Western blot, hepatomegaly, and generalized lymphadenopathy. She has left Herpes zoster ophthalmicus with ptosis bulbi and mottled discoloration of the skin over the distribution of the 1st division of the left trigeminal nerve, and right spastic hemiparesis. Her helper T-cell count was 952/cubic mm, and her T-cell ratio was 0.9. She had anemia, hypoalbuminemia, positive serology for cytomegalovirus, Herpes simplex, Epstein Barr virus, and hepatitis B. She had no bacterial infections, but her stool contained Trichuris trichiura eggs and giardia lamblia cysts. Her cardiovascular system and cerebrovascular fluid were negative. Computed tomography of the head showed an old left capsular infarct. Cerebral angiography showed arteritis of the left choroidal artery with occlusion. She was treated with metronidazole and mebendazole, and had surgery for removal of the left eye with a prosthetic replacement. Strokes are common in AIDS patients, resulting from fungal infections, endocarditis, infectious or non-infectious emboli, or arteritis from herpes zoster infections. This is the 1st published case of hemiplegia and Herpes zoster in a European or African patient with HIV-1. PMID: 1867123 [PubMed - indexed for MEDLINE] 3963. Rev Med Interne. 1991 Mar-Apr;12(2):139-40. [Urine retention following herpes zoster meningoencephalitis] [Article in French] Thevenon A, Pollez B, Lemaire JP, Salomez F, Rigot JM, Petit H, Dewailly P. Centre de Soins Pour Personnes âgées, Lille. A case of retention of urine after ophthalmic zoster is reported. The sphincter vesicae disorder was of central origin, being caused by a meningoencephalitis. The patient progressively recovered. The respective responsibilities of brain suffering and meningeal involvement in these urinary tract disturbances are discussed. PMID: 1852996 [PubMed - indexed for MEDLINE] 3964. J Gen Virol. 1991 Mar;72 ( Pt 3):475-86. Varicella-zoster virus. The Fourteenth Fleming lecture. Davison AJ. MRC Virology Unit, University of Glasgow, U.K. PMID: 1848588 [PubMed - indexed for MEDLINE] 3965. Ma Zui Xue Za Zhi. 1991 Mar;29(1):559-63. [Transcutaneous electrical nerve stimulation for the treatment of abdominal zoster paresis] [Article in Chinese] Chan-Liao M, Liao J, Wu YW, Liao CS. PMID: 1836823 [PubMed - indexed for MEDLINE] 3966. Rev Clin Esp. 1991 Mar;188(5):263-4. [Ramsay-Hunt syndrome in primary care] [Article in Spanish] Ponce de León Roca M, Caballero Doménech JC, Asenjo Vázquez C. PMID: 1788463 [PubMed - indexed for MEDLINE] 3967. Southeast Asian J Trop Med Public Health. 1991 Mar;22(1):139-40. Reactivation of varicella-zoster virus during acute malaria. Brown AE, Pipithkul J, Webster HK. Department of Immunology and Biochemistry, Armed Forces Research Institute of Medical Sciences (AFRIMS), Bangkok, Thailand. PMID: 1658946 [PubMed - indexed for MEDLINE] 3968. J Am Acad Dermatol. 1991 Mar;24(3):429-33. Granulomatous vasculitis occurring after cutaneous herpes zoster despite absence of viral genome. Langenberg A, Yen TS, LeBoit PE. Department of Dermatology, School of Medicine, University of California, San Francisco 94143-0506. Granuloma annulare, sarcoidal and other granulomatous dermatitides, pseudolymphoma, lymphoplasmacytoid lymphoma, and Kaposi's sarcoma have been described as sequelae of herpes zoster. We report a new postzoster reaction, granulomatous vasculitis, that caused flat-topped papules restricted to the affected dermatome. Polymerase chain reaction failed to detect varicella-zoster virus in a biopsy specimen. These results suggest that granulomatous vasculitis occurs without persistence of the viral genome and, perhaps, is a reaction to minute amounts of viral proteins. PMID: 1648109 [PubMed - indexed for MEDLINE] 3969. Rev Clin Esp. 1991 Feb;188(2):114-5. [Meningoencephalitis caused by varicella-zoster herpesvirus: treatment with acyclovir] [Article in Spanish] Jiménez Jiménez FJ, Molina Arjona JA, Fernández Ballesteros A, Roldán Montaud A, Santa Velasco J, Zancada Díez de Entresotos F. PMID: 2041899 [PubMed - indexed for MEDLINE] 3970. Can J Neurol Sci. 1991 Feb;18(1):105. Recurrent cerebral infarction and central retinal artery occlusion following mandibular zoster. Pullicino P, Fava S. PMID: 2036611 [PubMed - indexed for MEDLINE] 3971. Aust Dent J. 1991 Feb;36(1):22-8. A case of AIDS presenting as intra-oral malignant lymphoma. Donkor P, Punnia-Moorthy A, Painter DM. Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, University of Sydney, Surry Hills, New South Wales. A range of oral manifestations in a patient who was subsequently confirmed as infected with the human immune deficiency virus are presented. Most of these lesions have been previously reported in the literature, and represent opportunistic infection changes resulting from immune deficiency. The rare occurrence of a malignant large cell lymphoma intra-orally in this patient is also reported. The need for clinicians to treat all oral lesions as potentially infective and to wear gloves routinely is stressed. PMID: 2029228 [PubMed - indexed for MEDLINE] 3972. Int J Cancer. 1991 Feb 1;47(3):352-7. Socio-economic indicators, infectious diseases and Hodgkin's disease. Serraino D, Franceschi S, Talamini R, Barra S, Negri E, Carbone A, La Vecchia C. Epidemiology Unit, Aviano Cancer Centre, Italy. The relationship between socio-economic indicators, family size, history of tonsillectomy, infectious mononucleosis (IM) and other diseases and the risk of Hodgkin's disease (HD) was investigated in a hospital-based case-control study, conducted in the province of Pordenone, North-east Italy, between June, 1985 and March, 1990. One hundred and fifty-two HD cases (88 men and 64 women) and 613 controls (357 men and 256 women) were interviewed. Patients with 14 or more years of education had a 2-fold increased HD risk (95% confidence interval, CI: 1.0-3.9); such risk tended to be higher in patients with nodular sclerosis (NS) HD (odds ratio, OR: 4.4, 95% CI 1.8-11.0). Sibship size, birth order and tonsillectomy were not associated with HD risk. Cases and controls did not differ in the frequency or age at occurrence of common childhood infections. A history of IM, however, was found to be an important predictor of HD risk, in particular among NS HD (OR = 13.1, 95% CI 1.0-176.7). Past episodes of herpes zoster and of skin and genital warts were also associated with significantly increased HD risks. These data lend further support to the role of the IM agent (i.e., the Epstein-Barr virus) and, perhaps, of other viral infections and immunological alterations in the development of HD. PMID: 1993542 [PubMed - indexed for MEDLINE] 3973. Acta Paediatr Jpn. 1991 Feb;33(1):57-60. Incidence of herpes zoster in infancy in Japan. Taki M, Inamochi H. Department of Pediatrics, National Tsu Hospital, Mie, Japan. A search of the literature has revealed only 12 reports of herpes zoster during infancy in Japan. Of these, seven cases were thought to be mother-child infections where the mother had been infected with varicella and transmitted the VZV to the fetus, producing postnatal herpes zoster. The earliest case of maternal varicella infection occurred at 14 weeks of gestation. In the remaining 6 cases infection took place between the 17th and 32nd week of gestation. Postnatal onset of herpes zoster in the infants occurred within three months in two cases and at seven to eight months in the other four cases. In two cases it was unclear whether it was a mother-child infection. In three cases no clinical manifestations of maternal VZV infection were observed, but in these cases during early infancy the patients might have acquired asymptomatic infection. PMID: 1853713 [PubMed - indexed for MEDLINE] 3974. Pediatrics. 1991 Feb;87(2):166-70. Lack of transmission of the live attenuated varicella vaccine virus to immunocompromised children after immunization of their siblings. Diaz PS, Au D, Smith S, Amylon M, Link M, Smith S, Arvin AM. Department of Pediatrics, Stanford University School of Medicine, California 94305. The safety of administering the live attenuated Oka/Merck varicella vaccine to the well siblings of children with malignancy was evaluated as a strategy for reducing the risk of household exposure to varicella among immunocompromised children. Susceptible well children were eligible for vaccination if the child with malignancy had leukemia, lymphoma, or solid tumor in remission for 3 months or longer. No evidence of vaccine virus transmission was found among 30 children with malignancy whose 37 healthy susceptible siblings were immunized with varicella vaccine. Varicella-zoster virus was not isolated from the oropharyngeal secretions taken from 17 vaccinees or their 14 immunocompromised siblings. None of the 30 immunocompromised children had vaccine-related rashes or showed immunologic evidence of subclinical varicella-zoster virus infection based on testing for varicella-zoster virus IgG antibodies and T-lymphocyte proliferation to varicella-zoster virus. Four healthy vaccinees eventually had mild breakthrough cases of varicella, with transmission to the high-risk sibling in 3 cases. However, even in these families, the immunocompromised children had been protected from household exposure varicella for at least 20 months early in the course of their immunosuppressive treatment. PMID: 1846236 [PubMed - indexed for MEDLINE] 3975. J Med Virol. 1991 Feb;33(2):128-32. Differentiation of oka varicella vaccine strain from wild varicella-zoster virus strains isolated from vaccinees and household contact. Shiraki K, Horiuchi K, Asano Y, Yamanishi K, Takahashi M. Department of Virology, Osaka University, Japan. The Oka varicella vaccine strain can be differentiated from wild-type strains by its unique restriction endonuclease fingerprinting (REFP: HpaI-K and EcoRI-P) pattern of the gpV-coding region of the varicella-zoster virus (VZV) genome. VZV-DNAs from patients with complicated clinical courses related to vaccination were examined to determine whether they were vaccine-derived or wild-type. A virus was isolated from a one year-old boy with acute lymphocytic leukemia (ALL) who developed typical varicella 28 days after vaccination (case A). Another virus was isolated from a four-year-old boy without clinical symptoms following household contact with varicella patients at the age of two months, and he developed zoster 14 months after vaccination (case B). Also, two strains (OK1 and OK2) were isolated from household contacts (mother and sister) with a vaccine with ALL in Oklahoma who developed varicella 18 days after vaccination (case C). In case C, BgII-REFP did not determine conclusively whether the two strains (OK1 and OK2) were vaccine-derived or wild-type because the patterns obtained were different from both the Oka varicella vaccine strain and American wild-type strains [Gelb et al., Journal of Infectious Diseases, 155:633-640, 1987]. All VZV strains examined in the present study were identified as wild-type by our method using HpaI-K and EcoRI-P fragments as marker fragments. Thus it is becoming evident that REFP using HpaI and EcoRI endonucleases is a convenient and reliable means of distinguishing between the Oka vaccine virus strain and wild-type viruses isolated from individuals developing vesicular rashes shortly and long after varicella vaccination. PMID: 1675658 [PubMed - indexed for MEDLINE] 3976. J Med Virol. 1991 Feb;33(2):100-5. Antibody avidity following varicella-zoster virus infections. Kangro HO, Manzoor S, Harper DR. Virology Department, St. Bartholomew's Hospital, London, England. The avidity of IgG antibodies following varicella-zoster virus (VZV) infections was investigated using urea treatment of antigen-bound serum antibody by indirect radioimmunoassay (RIA) and immunoblotting techniques. Sequential sera from 16 patients with varicella and 17 patients with zoster were tested, as well as sera from 80 seropositive individuals without a recent history of VZV disease. Both types of assay showed that low-avidity antibodies predominate early after primary infection, but that antibody avidity increases markedly during convalescence. Using RIA, all sera taken up to 12 weeks after the onset of varicella showed greater than 50% reduction in antibody titre after treatment with 8 M urea but thereafter the proportion of urea resistant antibody increased with time. In contrast, after recurrent infection, high avidity antibodies were found to predominate at all times. Only 6 of 47 sera tested from zoster cases showed greater than 30% reduction after urea treatment and all these were taken within 2 weeks after onset of rash. Immunoblotting also showed that the highly immunogenic p32/p36 nucleoproteins appear to induce predominantly low avidity antibodies, even after recurrent VZV infection. The results of this study indicate that treatment with 8 M urea in RIA for IgG antibodies may be a simple and reliable method for distinguishing primary and anamnestic antibody responses against VZV. PMID: 1646852 [PubMed - indexed for MEDLINE] 3977. Ugeskr Laeger. 1991 Jan 14;153(3):197-9. [Herpes zoster induced reversible neurogenic bladder dysfunction. Urodynamic documentation of reversible bladder paralysis] [Article in Danish] Jensen FS, Walter S. Urologisk afdeling, Aalborg Sygehus Nord. A case of sacral herpes zoster with reversible neurogenic bladder dysfunction causing urinary retention is presented. Gradual reversibility of the motoric paralysis of the detrusor was demonstrated in cystometrograms. It is stressed that treatment should be primarily conservative and that repeated urodynamic examinations is essential. PMID: 1998243 [PubMed - indexed for MEDLINE] 3978. Hum Pathol. 1991 Jan;22(1):75-80. Type-specific identification of herpes simplex and varicella-zoster virus antigen in autopsy tissues. Martin JR, Holt RK, Langston C, Gilden DH, Richardson EP Jr, Manz HJ, Singer DB. Laboratory of Experimental Neuropathology, National Institutes of Health, Bethesda, MD 20892. To identify antigens of herpes simplex virus (HSV) types 1 and 2 and varicella-zoster virus (VZV) in human tissue, polyclonal antisera and an immunoperoxidase method were used to examine formalin-fixed, paraffin-embedded tissues from autopsy cases and experimentally infected animals. These antisera readily distinguished between HSV and VZV antigen, with no evident cross-reactivity. Antiser ato HSV-1 and HSV-2 were more strongly reactive with antigen of the homologous virus than with that of heterologous virus. This difference in immunoreactivity was used to discriminate between HSV-1 and HSV-2 antigens in experimentally infected animal tissues containing HSV antigens of known type and, by extrapolation, to distinguish between these antigens in human autopsy tissues. Thus, with appropriate antisera and tissue controls, HSV-1, HSV-2, and VZV can be identified in paraffin sections. PMID: 1845866 [PubMed - indexed for MEDLINE] 3979. Scand J Infect Dis Suppl. 1991;80:69-74. Varicella-zoster virus infections in the immunocompromised host. Natural history and treatment. Balfour HH Jr. Department of Laboratory Medicine and Pathology, and Pediatrics, University of Minnesota Health Sciences Center, Minneapolis 55455. Varicella-zoster virus (VZV) causes significant morbidity and even mortality in immunocompromised patients. Varicella has more serious consequences than herpes zoster, although zoster is more common. This paper reviews the natural history of varicella-zoster infections, as well as strategies for prevention and treatment. Although initial studies supported the use of either vidarabine or acyclovir for treatment of varicella in immunocompromised children, subsequent data have shown acyclovir to be superior for this purpose. Recent data in bone marrow transplant patients indicated that acyclovir was also more effective in preventing progression of herpes zoster in the immunocompromised host. The question of using steroids to prevent postherpetic neuralgia remains controversial. With the advent of effective antiviral chemotherapy, treatment of VZV infections in the immunocompromised host has become a reality. The potential problem of acyclovir-resistant VZV strains justifies continued development of other anti-VZV agents. Several new compounds are presently in or slated for clinical trials. PMID: 1666447 [PubMed - indexed for MEDLINE] 3980. Minerva Anestesiol. 1991 Jan-Feb;57(1-2):17-9. [Therapeutic approach in the treatment of acute cervico-brachial Herpes zoster] [Article in Italian] Viglietti G, Viglietti A, Bignone P. Servizio di Anestesia-Rianimazione, Ospedale Civile, Mondovì, Cuneo. A highly specialized experimental treatment was used in the therapy of Herpes zoster, which was aimed at inducing good control over acute pain and the prevention of post herpic neuritis using poly-pharmacologic al infiltration of ganglia and of relevant roots. PMID: 2057085 [PubMed - indexed for MEDLINE] 3981. Neurol Neurochir Pol. 1991 Jan-Feb;25(1):95-100. [Two cases of ophthalmic zoster follow by hemiplegia] [Article in Polish] Członkowska A, Kruszewska J, Szpakowa G, Tarnowska-Dziduszko E, Kryst-Widźgowska T. Kliniki Chorób Naczyniowych, Instytutu Psychiatrii i Neurologii w Warszawie. Two cases of ophthalmic zoster are reported in which several weeks after the appearance of skin changes hemiplegia developed. In one case the clinical course was unfavourable, and on autopsy extensive vasculitis was found in the brain with ischaemic foci situated mainly on the side of zoster. In the second case with favourable outcome CT demonstrated ischaemic foci probably of vascular origin, again on the side of zoster. PMID: 2034340 [PubMed - indexed for MEDLINE] 3982. Neurol Neurochir Pol. 1991 Jan-Feb;25(1):79-86. [Ophthalmic zoster with contralateral hemiplegia] [Article in Polish] Członkowska A. Klinika Chorób Naczyniowych Układu Nerwowego, Instytut Psychiatrii i Neurologii w Warszawie. Herpes zoster ophthalmicus may be followed several weeks after the appearance of skin changes by contralateral hemiplegia. Local angiitis is the most important cause of the brain ischaemic lesions. Based on the literature, in the present work the clinical, pathological and immunological observations are reviewed. PMID: 2034338 [PubMed - indexed for MEDLINE] 3983. Rev Neurol (Paris). 1991;147(2):164-6. [Polyradiculoneuritis following lumbosacral zona with adrenal cortex adenoma] [Article in French] Ribot C, Flocard F, Escarment J, Straboni JP, Caffin JP, Desportes JC. Service de Neurologie, Hôpital d'Instruction des Armées, Desgenettes, Lyon. We report a case of severe polyradiculoneuritis consecutive to a lumbosacral herpes zoster and concomitant with an adrenal adenoma with hypercorticism. The patient improved after surgery and plasmaphereses. PMID: 2028153 [PubMed - indexed for MEDLINE] 3984. J Tenn Med Assoc. 1991 Jan;84(1):19-20. Unsteady gait and seventh nerve palsy in an elderly woman. [No authors listed] PMID: 1999923 [PubMed - indexed for MEDLINE] 3985. Scand J Infect Dis. 1991;23(3):283-5. Varicella-zoster infection in adults with cystic fibrosis: role of acyclovir. Ong EL, Mulvenna P, Webb KA. Regional Department of Infectious Diseases and Tropical Medicine, Monsall Hospital, University of Manchester School of Medicine, United Kingdom. Of 159 adult patients with cystic fibrosis, 5 were documented to have varicella-zoster infection that resulted in an infective pulmonary exacerbation that required intravenous acyclovir and additional antibiotic treatment. Stable serial pulmonary function values were observed over a 1-year period in 4 patients and no complications resulted from treatment. Early treatment with acyclovir in combination with appropriate antibiotics may prevent pulmonary deterioration in adult patients with cystic fibrosis who develop varicella-zoster infection. PMID: 1882193 [PubMed - indexed for MEDLINE] 3986. Curr Eye Res. 1991;10 Suppl:87-95. External ocular herpesvirus infections in immunodeficiency. Pepose JS. Department of Ophthalmology, Washington University School of Medicine, St. Louis, MO 63110. Infections of the eye with members of the herpes family of viruses (e.g. HSV, CMV, VZV) are frequent manifestations of acquired and inherited defects in cell mediated immunity. Herpesvirus infections in the immunocompromised may reflect frequent viral reactivation from the latent state, as well as extensive productive infection of ocular structures following reactivation or primary infection. A review of experimental and clinical studies of both acquired and inherited immune dysfunction implicates specific immune mechanisms influencing the establishment of latency, viral reactivation and the control of active viral replication in ocular tissues. PMID: 1864093 [PubMed - indexed for MEDLINE] 3987. Curr Eye Res. 1991;10 Suppl:177-82. Oral acyclovir in herpes zoster ophthalmicus. Harding SP, Porter SM. St. Paul's Eye Hospital, Liverpool, UK. 46 patients with acute herpes zoster ophthalmicus of less than 72 hours duration were recruited into a placebo controlled trial to assess the efficacy of oral acyclovir, 800 mg 5 times daily, in preventing or modifying ocular complications and pain. Fewer acyclovir recipients developed intraocular complications and these were less severe but neither difference was statistically significant. However, active ocular disease was significantly less common in the acyclovir group (p = 0.01) at 6 months. Pain was significantly less severe in the acyclovir group between 2 and 6 months. The proportion of patients with pain scores greater than 0 was significantly lower in the acyclovir group between 2 and 3 months. Oral acyclovir appears to modify the disease process in herpes zoster ophthalmicus, to reduce the severity and incidence of postherpetic pain and especially to protect against long-term ocular complications. PMID: 1864092 [PubMed - indexed for MEDLINE] 3988. Curr Eye Res. 1991;10 Suppl:171-5. High-dose oral acyclovir in acute herpes zoster ophthalmicus: the end of the corticosteroid era. Herbort CP, Buechi ER, Piguet B, Zografos L, Fitting P. Hopital Ophtalmique Jules Gonin, Department of Ophthalmology, University of Lausanne, Switzerland. Systemic acyclovir (ACV), a new potent anti-herpes drug, was shown to reduce effectively the morbidity in the acute phase of herpes zoster ophthalmicus (AHZO). Using high dose oral ACV (5 X 800 mg/day) our aim in this study was: (1) to compare disease profiles in the ACV-treated group and in a group of zoster patients having had no ACV, analysed retrospectively; (2) to establish if high-dose ACV was able to prevent severe long term complications of AHZO; and (3) to determine the present role of corticosteroids in AHZO. From 1984 to 1988, 48 patients with AHZO of less than 3 days' duration were included. All patients received at least 7 days of oral ACV (5 X 800 mg/d) associated with topical ACV. Steroids were not given unless severe uveitis occurred. Follow-up was 2 years in 43 patients and 1 year in all 48 patients. Main conclusions from our study are: 1. Ocular involvement occurred in 67% of ACV-treated cases, a rate comparable to our retrospective group (59%) and to the literature (71%). However the rate of severe long term complications was minimal (4%) when compared to our non-treated retrospective group (21%). 2. Steroid treatment was not necessary in any of the ACV-treated patients. 3. ACV was well tolerated and did not have to be discontinued in any of the patients. High dose ACV and avoidance of steroids seems to eliminate the severe complications of AHZO. PMID: 1864091 [PubMed - indexed for MEDLINE] 3989. Curr Eye Res. 1991;10 Suppl:125-30. Chronic ocular zoster. Zaal MJ, Maudgal PC, Rietveld E, Suir EP. Department of Ophthalmology, Academisch Ziekenhuis Vrije Universiteit, Amsterdam, The Netherlands. In a prospective open trial 40 patients suffering from acute herpes zoster ophthalmicus were treated with systemic acyclovir. An additional 10 patients were treated by topical acyclovir alone and dexamethasone eye-drops were administered to 5 of them to suppress ocular inflammation. In the topical treatment group the period of new skin lesion formation and progression of ocular inflammatory signs were significantly prolonged. Therapy with systemic acyclovir however resulted in a quick and complete resolution of ocular inflammation in all patients. Chronic ocular inflammation developed in 4 out of 10 patients treated with topical acyclovir. We consider chronic ocular zoster as a distinct clinical entity, possibly expressing a failing local immune response against VZV. PMID: 1864089 [PubMed - indexed for MEDLINE] 3990. Compendium. 1991 Jan;12(1):46, 48-51. The many faces of adult leukemia. Dreizen S. University of Texas Dental Branch, Houston. This article describes the facial complications of adult leukemia, as derived from a study of more than 3,000 patients treated at the University of Texas M.D. Anderson Hospital during the past 25 years. Facial leukemia cutis, leukemia-associated facial hemorrhages, leukemia-induced cranial nerve facial palsies, and leukemia-provoked pure and mixed facial infections are discussed. PMID: 1860114 [PubMed - indexed for MEDLINE] 3991. Acta Neurol Scand. 1991 Jan;83(1):45-51. Peripheral nervous system and spinal cord involvement in lymphoma. Correale J, Monteverde DA, Bueri JA, Reich EG. Division of Neurology, José María Ramos Mejía, Hospital, Buenos Aires, Argentina. Nine-hundred-eighty-nine patients with diagnosis of lymphoma were studied. Forty-six cases (4.6%) had compressions of the spinal cord or roots. Forty-two patients (4.2%) had Herpes zoster virus infections, which in 6 cases were of disseminated type. The major predisposing factors for infection were: advanced stage of lymphoma, previous systemic chemotherapy and splenectomy. Toxic polyneuropathy secondary to chemotherapy was found in 39 patients (3.9%). In 14 cases, the polyneuropathic symptoms were the main complaint (Group 1), while in the remaining 25 cases the diagnosis was made during neurological consultations because of unrelated symptoms (Group 2). Both groups did not have significant differences in the total dose of chemotherapy received. The electrophysiological studies showed an axonal neuropathy in both groups. The discontinuation of chemotherapy was found to be a limiting factor in the appearance of neuropathic symptoms. Other less frequent forms of involvement were: compression of peripheral nerves or nerve plexi from lymphadenopathies (3 cases), radiation myelopathy (1 case), and Guillain-Barré Syndrome associated with Hodgkin's Lymphoma (1 case). PMID: 1849335 [PubMed - indexed for MEDLINE] 3992. Przegl Epidemiol. 1991;45(4):273-7. [Effect of Bioglobulin on the clinical course of selected diseases of viral and bacterial etiologies] [Article in Polish] Janeczko J, Olejnik Z, Lipowski D, Przyjałkowski W, Romanowska B. Klinika Chorób Zakaźnych dla Dorosych Instytutu Chorób Zakaźnych Pasozytniczych Akademii Medycznej, Warszawie. The therapeutic effect of Bioglobulin was studied in some diseases of viral or bacterial etiology. It was found favorable as it seemed to lessen the clinical and the shorten the acute as well as the hospitalisation periods. Because in the very serious and serious diseases of viral or bacterial etiology the antibodies deficiency, absolute or relative, total or selective is common, Bioglobulin may be a valuable agent in the comprehensive treatment. PMID: 1841402 [PubMed - indexed for MEDLINE] 3993. Dermatologica. 1991;182(3):160-3. HLA-DR antigen expression on peripheral T cell subsets in pityriasis rosea and herpes zoster. Yoshiike T, Aikawa Y, Wongwaisayawan H, Ogawa H. Department of Dermatology, Juntendo University, School of Medicine, Tokyo, Japan. Using 2-color fluorescein-activated cytometric analysis, HLA-DR antigen expression on peripheral blood T cell subsets was studied in patients with herpes zoster (HZ), pityriasis rosea (PR) and psoriasis. In HZ and PR, HLA-DR was found to be significantly expressed on T cell surfaces (CD3+ cells), when compared to that of the normal control (HZ: p less than 0.001, PR: p less than 0.05). Among T cell subsets, such HLA-DR antigen was predominantly expressed on suppressor/cytotoxic cells (CD8+) in HZ (vs. normal control, p less than 0.01). However, in the case of PR, it was predominantly expressed on helper cells (CD4+; vs. control, p less than 0.05). On the other hand, activated T cell antigen (CD25+) was not significantly expressed on T cells (CD3+) in either HZ or PR. In the T cell subsets, HLA-DR antigen expression returned to normal levels during the recovery phases of HZ and PR. PMID: 1831772 [PubMed - indexed for MEDLINE] 3994. Przegl Epidemiol. 1991;45(3):175-81. [Clinical types of herpes zoster in clinical observations 1985-1989] [Article in Polish] Leszczyszyn-Pynka M, Niścigorska J. Klinika Chorób Zakaźnych PAM, Szczecinie. The clinical types of herpes zoster in 286 patients were observed. The differences in the course of disease in persons with and without decreased immunity are described. Some of the neurological complications depending on the localization of the herpes zoster are presented. PMID: 1819813 [PubMed - indexed for MEDLINE] 3995. Scand J Infect Dis Suppl. 1991;80:62-8. Zoster-associated chronic pain: an overview of clinical trials with acyclovir. Crooks RJ, Jones DA, Fiddian AP. Wellcome Research Laboratories, Beckenham, U.K. An overview of all the available placebo-controlled trial data for oral acyclovir in acute herpes zoster infection has confirmed that a dose of 800 mg five times daily for seven to ten days is effective in reducing the incidence of post-herpetic neuralgia and the duration of pain. Although one study failed to demonstrate such an effect, three other studies and a combined analysis, using the log rank test, did so. The duration of pain was shortened from an average of 86 to 49 days (p less than 0.001). Future studies will need to take account of these findings since oral acyclovir is most likely to be used as the standard reference therapy. PMID: 1803501 [PubMed - indexed for MEDLINE] 3996. Scand J Infect Dis Suppl. 1991;80:53-61. Herpes zoster and pain. Wood MJ. Department of Communicable and Tropical Diseases, East Birmingham Hospital, England. Pain is frequently the most distressing symptom of herpes zoster. Pain occurs in most patients during the acute phase and sometimes continues as postherpetic neuralgia (PHN) for months or years after the rash has healed. Both the acute pain and the incidence and duration of postherpetic pain are influenced by the age of the patient and the distribution of the rash. The acute pain is probably related to neuronal inflammation induced by the replicating varicella-zoster virus and can be helped by antiviral agents and by steroids. As yet, the pathophysiology of PHN is poorly understood and may well be multifactorial, perhaps accounting for the two clearly different types of PHN described. Prevention of PHN is not possible but there are some data suggesting the use of antiviral agents during the acute phase may be helpful. Once PHN has become established conventional analgesics are ineffective and tricyclic antidepressants seem to be the optimal therapy. PMID: 1803500 [PubMed - indexed for MEDLINE] 3997. Optom Clin. 1991;1(4):45-58. Herpetic keratitis. Mitchell PC. Herpes simplex and herpes zoster cause a wide range of acute and chronic corneal disease. The primary care clinician should be aware of the varied presentations of these two viruses. This paper presents the clinical features and treatment options that are available. PMID: 1799835 [PubMed - indexed for MEDLINE] 3998. Stereotact Funct Neurosurg. 1991;56(3):166-78. Anatomic examination of a case of open trigeminal nucleotomy (nucleus caudalis dorsal root entry zone lesions) for facial pain. Spiegelmann R, Friedman WA, Ballinger WE, Tedeschi H. Department of Neurosurgery, University of Florida, Gainesville. Nucleus caudalis dorsal root entry zone lesions (open trigeminal nucleotomy) are a surgical procedure which can achieve pain control without major complications in the difficult clinical setting of deafferentation-type facial pain. Two patients are reported, who had relief of pain, but also experienced neurological complications. One patient succumbed to pulmonary complications, which provided the opportunity for anatomic analysis of the lesioned area, which is discussed in detail. Potential modifications of the surgical technique are suggested. PMID: 1796221 [PubMed - indexed for MEDLINE] 3999. Przegl Epidemiol. 1991;45(4):267-71. [Effect of isoprinosine and acyclovir on the clinical course of chickenpox and herpes zoster] [Article in Polish] Janeczko J, Baranowska M, Romanowska B. Klinika Chorób Zakaźnych dla Dorosłych Instytutu Chorób Zakaźnych, Pasozytniczych Akademii Medycznej, Warszawie. The therapeutic effect of isoprinosine and acyclovir have been studied in 352 and 284 patients with chicken-pox and herpes zoster respectively. The patients were divided into 4 groups: the first one was given palliative treatment only, the second--both palliative and isoprinosine ones, the third--palliative and acyclovir treatment, and the fourth group was given all these. The best therapeutic effect was achieved when acyclovir and isoprinosine was applied jointly, the one of acyclovir alone was less pronounced and that of isoprinosine only was the smallest. According to the authors acyclovir should be the treatment of choice in the very severe and severe cases of chicken-pox and herpes zoster; in the early stage of disease it should be supplemented with isoprinosine and passive immunotherapy. PMID: 1726758 [PubMed - indexed for MEDLINE] 4000. Viral Immunol. 1991 Fall;4(3):151-66. Human T cells recognize multiple epitopes of an immediate early/tegument protein (IE62) and glycoprotein I of varicella zoster virus. Bergen RE, Sharp M, Sanchez A, Judd AK, Arvin AM. Department of Pediatrics, Stanford University School of Medicine, California. Infection with varicella zoster virus (VZV) elicits persistent cell-mediated immunity directed against the immediate early (IE62) protein and the glycoprotein I (gp I) in most healthy subjects. In these experiments, synthetic peptides corresponding to residues of the IE62 protein and gp I were used to identify linear amino acid sequences of these immunogenic VZV proteins that were recognized by peripheral blood T lymphocytes from VZV-immune individuals of known major histocompatibility complex (MHC) type. All of 12 VZV-immune donors had T-cell proliferative responses, defined as a stimulation index (SI) greater than or equal to 2.0, to at least two of ten synthetic IE62 peptides; the mean number of IE62 peptides recognized by T cells from VZV-immune donors was seven. Five of the ten IE62 peptides stimulated T cells from 75% to 83% of the VZV-immune donors; the other five IE62 peptides were recognized by T cells from 42% to 67% of the subjects. All VZV-immune donors also had T proliferation responses to at least two of ten synthetic gp I peptides; the mean number of peptides recognized was six. Six of the ten gp I peptides were recognized by T cells from 67% to 92% of the VZV-immune donors; the frequency of donors responding to the other gp I peptides ranged from 42% to 58%. None of five nonimmune donors demonstrated T-cell proliferation to any of the IE62 or gp I peptides. A combination of two IE62 peptides provided epitopes that could be recognized by T cells from all twelve VZV-immune donors, regardless of DR type. Similarly, one gp I peptide in combination with either of two other gp I peptides induced proliferation of T cells from all immune subjects. Memory T cells with specificity for multiple short amino acid sequences of the IE62 protein and gp I were detected in subjects who had had primary VZV infection more than 20 years earlier. These observations indicate that natural VZV infection elicits a diverse cell-mediated immune response to viral proteins that is not restricted to only one or two immunodominant regions. Although the usefulness of peptide vaccines remains to be established, multiple epitopes of the IE62 protein and gp I were identified that could be presented by antigen-presenting cells (APC) and recognized by T cells from most subjects in an "outbred" human population. PMID: 1725699 [PubMed - indexed for MEDLINE] 4001. G Batteriol Virol Immunol. 1991 Jan-Dec;84(1-12):41-52. [Serologic follow-up of cytomegalovirus, herpes simplex and varicella-zoster infections in kidney transplant recipients] [Article in Italian] Merlino C. Istituto di Microbiologia, Università di Torino. In the present paper the characteristics of cytomegalovirus (CMV), herpes simplex virus (HSV) and varicella-zoster virus (VZV) infections were serologically investigated in renal transplant recipients. At transplantation CMV-seropositivity was 88.2%. At the end of the study, the frequency of primary CMV-infections was 58.3% and the frequency of recurrent infections (reinfections or reactivations) was 84.4%. The 57.1% of primary infections and the 64.5% of recurrent infections occurred between the first and the third month after transplantation. There was no correlation between recurrent infections and type of immunosuppressive treatment (CyA vs. Triple). The 70% of pairs of patients who received a kidney from the same CMV-seropositive donor reacted in the same way: or neither had any infection or both had active CMV-infection. There was no correlation between rejection and active CMV-infection. HSV-seropositivity was 96.2%. Primary HSV-infections didn't occur and the frequency of reactivation in seropositive patients was 31.4%. No correlation was found between rejection and active HSV-infection as well. As regards VZV-infection, seropositivity at transplantation was 90%. Primary VZV-infections didn't occur. During the study, seropositive patients showed variations in VZV-antibody titers which returned to initial values. Clinical signs of zoster were observed in 6% of patients at third and ninth month after transplantation and were serologically confirmed. PMID: 1668971 [PubMed - indexed for MEDLINE] 4002. Scand J Infect Dis Suppl. 1991;80:15-20. Herpesvirus infection: an overview of the clinical manifestations. Peterslund NA. Department of Haematology, Aarhus Amtssygehus, Denmark. Herpesviruses include seven human viruses and numerous animal viruses. The human herpesviruses, in addition to their trivial names, are named from 1 to 7. The two most recently discovered herpesviruses thus being Human herpesvirus 6 and 7. Human herpesvirus 6 is the aetiologic agent causing exanthema subitum. Human herpesvirus 7 has, as yet, not been associated with any disease. A characteristic feature of the herpesviruses is the persistence in a latent form after primary infection which may later cause reactivated infection resulting in considerable morbidity, for example, in genital herpes. The clinical spectrum of herpes infections is very broad. In general, the primary infection is more severe than the reactivated. Other important determinants of morbidity are the patients' age and immune status. Many severe herpes infections are almost exclusively seen in immunocompromised patients. This review deals with the clinical manifestations of herpetic infections in normal and immunocompromised hosts with emphasis on the clinical recognition. PMID: 1666443 [PubMed - indexed for MEDLINE] 4003. Zh Nevropatol Psikhiatr Im S S Korsakova. 1991;91(10):117-21. [Cerebrovascular syndromes in ocular herpes zoster convalescents (review of the literature)] [Article in Russian] Smirnov IuK, Shishov AS. PMID: 1665639 [PubMed - indexed for MEDLINE] 4004. Ophthalmologica. 1991;203(4):172-5. Acute retinal necrosis: a new pathophysiological hypothesis. Schwoerer J, Othenin-Girard P, Herbort CP. Hôpital Opthalmique Jules-Gonin, University of Lausanne, Switzerland. A 76-year-old woman with unilateral acute retinal necrosis had an elevated titer of cytomegalovirus (CMV) antibodies with both in the aqueous humor and serum. The serological pattern indicated recent CMV infection, and the Goldmann-Witmer coefficient comparing aqueous and serum titers was above 4 indicating intraocular production of specific antibodies. The clinical characteristics and results as well as a new possible etiopathogenic hypothesis are presented. PMID: 1664506 [PubMed - indexed for MEDLINE] 4005. Clin Neurol Neurosurg. 1991;93(3):245-7. Cervical herpes zoster and delayed brainstem infarction. Willeit J, Schmutzhard E. Department of Neurology, University of Innsbruck, Austria. Varicella-zoster (VZ) virus is a rare cause of CNS angiitis, which commonly presents as herpes zoster ophthalmicus with contralateral hemiplegia due to hemispheric infarction. We report the first case of VZ-angiitis with infarction in the ventral pons, following cervical herpes zoster. PMID: 1660382 [PubMed - indexed for MEDLINE] 4006. Annu Rev Microbiol. 1991;45:265-82. Varicella-zoster virus latency. Croen KD, Straus SE. Department of Medicine, University of Cincinnati College of Medicine, Ohio 45267. PMID: 1660255 [PubMed - indexed for MEDLINE] 4007. Am J Nephrol. 1991;11(3):229-36. Varicella-zoster virus immune status in CAPD and chronic hemodialysis patients. Smetana Z, Leventon-Kriss S, Broide A, Jedwab M, Smetana SS. Central Virology Laboratory, Chaim Sheba Medical Center, Holon, Israel. Patients on chronic dialysis who are supposed to disclose an impairment of the immune potential, seldom show clinical viral illnesses. Since severe varicella-zoster virus (VZV) infection develops in immunocompromised patients, we have examined the proliferative activity to VZV in the blood lymphocytes of 16 patients on continuous ambulatory peritoneal dialysis (CAPD) and compared it to healthy matched controls. The cellular in vitro response of these patients to specific VZV antigens was essentially normal. The mean stimulation index for CAPD patients was 7.06, and for matched controls 3.68 (p greater than 0.05). The mean percentage of lymphocytes in CAPD patients as determined by CD3 monoclonal antibodies was 57%, the CD4 helper and CD8 suppressor cells were 41 and 21%, respectively. When those 16 CAPD patients were followed up for the presence of anti-VZV IgA, IgM and IgG immunofluorescent antibody to membrane antigen antibodies during a period of 6 months, the recrudescence of VZV was documented by the appearance of IgA and IgM antibodies and/or fourfold increase in IgG titer in some patients, but no clinical illness was observed. The frequent reactivation of the virus without clinical symptoms in patients undergoing long-term intermittent chronic hemodialysis (HD) or CAPD was strengthened by the presence of increased anti-VZV geometric mean titers (52.68 and 53.00, respectively) in these patients as compared to control subjects (11.75). PMID: 1660222 [PubMed - indexed for MEDLINE] 4008. Eur Neurol. 1991;31(3):164-7. A case of herpes zoster myelitis: positive magnetic resonance imaging finding. Hwang YM, Lee BI, Chung JW, Ahn JH, Kim KW, Kim DI. Department of Neurology, Asan Medical Center, Ulsan University, Seoul, Korea. A 33-year-old man developed a progressive myelopathy after a characteristic skin lesion of herpes zoster involving the right C3 and C4 dermatomes. The lesions were recognizable in the T2-weighted image of the magnetic resonance imaging (MRI) as increased signal intensities throughout the long segments of the spinal cord with maximal in the cervical portion, which was compatible with the pathological findings reported in autopsy studies. PMID: 1646111 [PubMed - indexed for MEDLINE] 4009. Br Dent J. 1990 Dec 8-22;169(11):370-2. Recognition of oral lesions of HIV infection. 3. Gingival and periodontal disease and less common lesions. Scully C, Epstein JB, Porter S, Luker J. Department of Oral Medicine, Surgery and Pathology, Bristol Dental Hospital and School. Comment in: Br Dent J. 1991 Apr 20;170(8):287. Br Dent J. 1991 Feb 9;170(3):91. This is the last of a series of three articles on the recognition of oral lesions of HIV infection. It deals with the less common, and some rare lesions. PMID: 2275839 [PubMed - indexed for MEDLINE] 4010. Presse Med. 1990 Dec 8;19(42):1950. [Sacral zona complicated by acute bladder retention. One other indication of acyclovir] [Article in French] Caumes E, Katlama C, Bournerias I, Danis M, Gentilini M. Comment on: Presse Med. 1990 Apr 21;19(16):752-4. PMID: 2147766 [PubMed - indexed for MEDLINE] 4011. Med Clin (Barc). 1990 Dec 8;95(20):782-4. [Postherpetic vasculopathy. A study of 3 cases in immunosuppressed patients] [Article in Spanish] Alvarez R, Graus F, Abós J, Miró JM, Carreras J, Mercader JM, Tolosa E. Servicio de Neurología, Hospital Clínic i Provincial, Barcelona. We report three cases of postherpetic vasculopathy in immunologically compromised patients. Two had ophthalmic herpes zoster, contralateral to the physical signs, and the third case developed after disseminated herpes zoster. The initial CT images consisted of small ischemic infarcts in capsular regions and basal ganglia. The arteriography showed images consistent with vasculitis or thrombosis of great vessels of the Willis' polygon, which were ipsilateral to the herpetic lesion in two cases. In one patient the neurological defect remained stable, while the other two developed new ischemic episodes, all in the same cerebral hemisphere. It can be assumed from the delayed development of neurologic disease after cutaneous lesions that some cases go unnoticed if the zoster infection is not specifically looked for in retrospect. PMID: 2131383 [PubMed - indexed for MEDLINE] 4012. Med Clin (Barc). 1990 Dec 8;95(20):774-6. [Neurological disorders following a varicella-zoster virus infection] [Article in Spanish] Polo JM. PMID: 2131380 [PubMed - indexed for MEDLINE] 4013. Minn Med. 1990 Dec;73(12):11-2. AMP for acute and postherpetic neuralgia. Sklar SH. Comment on: Minn Med. 1990 Apr;73(4):37-40. PMID: 2292995 [PubMed - indexed for MEDLINE] 4014. Pediatr Infect Dis J. 1990 Dec;9(12):865-9. Consensus: varicella-zoster infections in pregnancy and the perinatal period. Prober CG, Gershon AA, Grose C, McCracken GH Jr, Nelson JD. Department of Pediatrics, Stanford University Medical Center, CA. Comment in: Pediatr Infect Dis J. 1991 Jun;10(6):476. PMID: 2277741 [PubMed - indexed for MEDLINE] 4015. Pediatr Ann. 1990 Dec;19(12):721-6. Varicella vaccine. Feldman S, Moffitt JE. Pediatric Infectious Diseases, University of Mississippi Medical Center, Jackson 39216. PMID: 2177874 [PubMed - indexed for MEDLINE] 4016. Clin J Pain. 1990 Dec;6(4):284-90. Clinical and neurophysiological observations on acute herpes zoster. Nurmikko TJ, Räsänen A, Häkkinen V. Department of Neurology, University Central Hospital, Tampere, Finland. We studied 31 patients with acute herpes zoster (AHZ) less than 28 days' duration. Clinical characteristics (pain, allodynia, course of disease) and somatosensory perception thresholds (thermal discrimination, hot pain, and vibration) of the affected dermatome and the contralateral homologous area were assessed. Touch-evoked allodynia was found in 17 (55%) and dysesthesia in a further 5 (16%). Thermal and vibration perception thresholds demonstrated significant elevations when compared to the contralateral side. Thermal threshold abnormalities were significantly associated with the prevalence of postherpetic neuralgia (PHN) at 3 months. The effect of nerve blockade was less favorable on allodynia than spontaneous pain. The results of possible pathophysiological mechanisms are discussed. PMID: 2135028 [PubMed - indexed for MEDLINE] 4017. Br J Clin Pract. 1990 Dec;44(12):596-8. Observations on herpes zoster: 1. Residual scarring and post-herpetic neuralgia; 2. Handedness and the risk of infection. Battcock TM, Finn R, Barnes RM. Department of Medicine, Royal Liverpool Hospital. The risk of developing post-herpetic neuralgia is related to the degree of residual scarring. Subjects over the age of 60 with more than 10 cm2 of residual scarring have a very high risk of developing intractable post-herpetic neuralgia. Left-handed subjects are less likely to develop herpes zoster, and this could be due to a more efficient immune system. PMID: 2102153 [PubMed - indexed for MEDLINE] 4018. J Rheumatol. 1990 Dec;17(12):1642-8. C-reactive protein levels during disease exacerbations and infections in systemic lupus erythematosus: a prospective longitudinal study. ter Borg EJ, Horst G, Limburg PC, van Rijswijk MH, Kallenberg CG. Department of Internal Medicine, University Hospital Groningen, The Netherlands. We prospectively studied the value of measuring C-reactive protein (CRP) levels in patients with systemic lupus erythematosus (SLE) to distinguish between disease exacerbation and infection. During a 2 year followup of 71 lupus patients, 38 episodes of disease exacerbation and 36 episodes of infection could be analyzed. Plasma samples were obtained at least once a month. CRP levels were increased (greater than 6 mg/l) during 25 of the 38 exacerbations and during 32 of the 36 infections. Median CRP levels during infection (60 mg/l; range 1-400) were higher than during disease exacerbation (16.5 mg/l; range 1-375) (p less than 0.05). Levels of CRP rose prior to the exacerbation (p less than or equal to 0.01) and fell afterwards (p less than or equal to 0.01). During exacerbations accompanied by serositis, median levels of CRP (76 mg/l; range 2-375) were higher than during exacerbations without serositis (16 mg/l; range 1-53) (p less than 0.02). CRP levels exceeding 60 mg/l during exacerbations without serositis indicated infection in all cases. Thus, measurement of CRP in SLE is valuable to distinguish between infection and exacerbation only in the absence of serositis. PMID: 2084238 [PubMed - indexed for MEDLINE] 4019. Ital J Neurol Sci. 1990 Dec;11(6):559-65. Neurological complications of herpes zoster. Guidetti D, Gabbi E, Motti L, Ferrarini G. Divisione Neurologica, Arcispedale Santa Maria Nuova, Reggio Emilia. We report 31 cases of herpes zoster (HZ) with neurological complications: 14 with cranial nerve deficits, 1 with cranial nerve deficit associated with segmental motor disorder, 3 with segmental motor deficits, 2 with meningoencephalitis, 2 with meningoencephalitis associated with cranial neuropathy or myelitis, 2 with meningitis, 2 with hemiplegia contralateral to the ophthalmic HZ. 1 with hemiplegia and motor deficit and finally 1 with hemiplegia and a cranial neuropathy. Smoking was the putative risk factor in 53% of our patients together with diabetes, which has already been mentioned in the literature. We frequently observed more than one complication in succession (19.3%) that could not easily be related to the cutaneous distribution. Acyclovir had no demonstrable positive effects on neurological complication in our patients. PMID: 2081679 [PubMed - indexed for MEDLINE] 4020. Tanpakushitsu Kakusan Koso. 1990 Dec;35(17):3034-40. [Application of PCR to DNA diagnosis and molecular epidemiology of varicella-zoster virus infection] [Article in Japanese] Hondo R, Inouye S, Ohsawa S, Itho S. Department of Pathology, University of Tokyo, Japan. PMID: 1962869 [PubMed - indexed for MEDLINE] 4021. Med J Aust. 1990 Nov 5;153(9):562. An unusual presentation of herpes zoster. Moorhead RG, Tyllis M. PMID: 2233482 [PubMed - indexed for MEDLINE] 4022. Med J Aust. 1990 Nov 5;153(9):555-6. Diaphragmatic paralysis following cervical herpes zoster. Stowasser M, Cameron J, Oliver WA. Prince Charles Hospital, Chermside, Qld. A 74-year-old man was found to have a paralysed left hemidiaphragm within four months of the appearance of a typical herpes zoster rash involving his left shoulder and neck. Investigations, including bronchoscopy and computed tomography of the chest, failed to detect a cause for the diaphragmatic paralysis. We believe that the cervical zoster and diaphragmatic paralysis were causally related, a rare but recognised association. PMID: 2233481 [PubMed - indexed for MEDLINE] 4023. Kansenshogaku Zasshi. 1990 Nov;64(11):1394-9. Herpes zoster in patients with polymyositis and dermatomyositis. Nagaoka S, Tani K, Ishigatsubo Y, Chiba J, Kato K, Matsunaga K, Narita M, Igarashi T, Okubo T. First Department of Internal Medicine, Yokohama City University, School of Medicine. Twenty-two patients with polymyositis and dermatomyositis (PM-DM) were retrospectively studied with regard to development of herpes zoster. Herpes zoster occurred with high frequency in patients with PM-DM. The clinical courses of zoster infections were uneventful; no severe complications nor deaths occurred, and only one patient had post-therapeutic neuralgia. No specific therapy for this infection was necessary. Zoster tended to occur in the inactive stage of PM-DM. PM-DM patients with herpes zoster had a significantly higher incidence of antinuclear antibody. There seemed to be no relationship between steroid therapy and herpes zoster infection. PMID: 2286782 [PubMed - indexed for MEDLINE] 4024. Int J Dermatol. 1990 Nov;29(9):652-4. Chronic lymphocytic leukemia and cutaneous granulomas at sites of herpes zoster scars. Pujol RM, Matías-Guiu X, Planagumà M, de Moragas JM. Department of Dermatology, Hospital de Sant Pau, Barcelona, Spain. PMID: 2272738 [PubMed - indexed for MEDLINE] 4025. Klin Padiatr. 1990 Nov-Dec;202(6):430-2. [Facial paralysis in a 2 1/2-year-old girl due to herpes zoster oticus. Results of the reactivation of a chickenpox infection in infancy] [Article in German] Bökenkamp A, Laubert A, Heyer R. Kinderklinik, Medizinischen Hochschule Hannover. A case of herpes zoster oticus in a 2 1/2 year-old girl with a history of varicella at the age of 4 months is reported. Peripheral facial palsy was the prominent clinical symptom. Following treatment with Acyclovir 15 mg/kg/day i.v. for 7 days a complete remission was noted. Course, treatment and prognosis of zoster oticus are discussed, as well as the increased incidence of herpes zoster in children who had varicella before the age of 1 year. PMID: 2266711 [PubMed - indexed for MEDLINE] 4026. Ann Ophthalmol. 1990 Nov;22(11):414-5. Herpes zoster ophthalmicus and iris cysts. Karlin JD. Department of Ophthalmology, University of California, Los Angeles 91307. Herpes zoster ophthalmicus has been associated with numerous complications such as neuropathy, keratitis, anterior uveitis, and neuralgia. To my knowledge, there have been no reports of secondary iris cyst formation. I hereby report the case of a patient who developed an iris cyst during a Herpes zoster ophthalmicus infection. PMID: 2264662 [PubMed - indexed for MEDLINE] 4027. Minn Med. 1990 Nov;73(11):7-8. Chronic pain treatment. Yue SK. Comment on: Minn Med. 1990 Apr;73(4):37-40. PMID: 2259308 [PubMed - indexed for MEDLINE] 4028. Can J Anaesth. 1990 Nov;37(8):839-43. Cerebrospinal norepinephrine concentrations and the duration of epidural analgesia. Goto F, Fujita N, Fujita T. Department of Anesthesiology and Resuscitology, Gunma University School of Medicine, Japan. Comment in: Can J Anaesth. 1990 Nov;37(8):836-8. This study was performed to determine whether the addition of norepinephrine to local anaesthetics prolongs epidural analgesia in man. In addition, cerebrospinal fluid norepinephrine (NE) concentrations were measured. In the first part of the study, epidural catheters were inserted in 14 patients before herniotomy. Mepivacaine, 1.5 per cent (0.35 ml.kg-1), was administered and norepinephrine (5 micrograms.ml-1) was added in seven patients. The duration of anaesthesia was prolonged from 54 +/- 11 min to 83 +/- 12 min (P less than 0.05) and CSF NE concentrations increased from 68 +/- 12 pg.ml-1 to 336 +/- 85 pg.ml-1 in the NE group (P less than 0.01). In the second part, eight patients with herpetic neuralgia received epidural analgesia at the fourth to eighth thoracic interspace, using bupivacaine 0.25 per cent, with and without NE. The CSF NE concentrations in this group were greater than in the surgical patients before operation and increased from 254 +/- 58 to 406 +/- 58 pg.ml-1 30 min after administration of bupivacaine with NE. The duration of pain relief was prolonged with NE. These results suggest that adding NE to local anaesthetics prolongs epidural analgesia. Moreover, NE concentrations in surgical patients increased to levels similar to those found in patients suffering from herpetic analgesia. This suggests that the increase of CSF NE in chronic pain states has an antinociceptive effect. PMID: 2253290 [PubMed - indexed for MEDLINE] 4029. Optom Vis Sci. 1990 Nov;67(11):845-9. True posterior ischemic optic neuropathy associated with herpes zoster ophthalmicus. Kothe AC, Flanagan J, Trevino RC. Ecole d'Optométrie, Université de Montréal, Québec, Canada. Although previous reports of ischemic optic neuropathy resulting from herpes zoster have appeared in the literature, these reports have not been convincing of a true optic neuropathy. The case presented is a true posterior ischemic optic neuropathy due to inflammation of the medial posterior ciliary artery, diagnosed on the basis of a deep, steep-sided altitudinal visual field defect. The herpes zoster infection also resulted in retinitis, damage to the iris sphincter, and corneal scarring. The effects of herpes zoster on the visual system are reviewed. PMID: 2250894 [PubMed - indexed for MEDLINE] 4030. J Am Geriatr Soc. 1990 Nov;38(11):1188-94. Are stressful life events risk factors for herpes zoster? Schmader K, Studenski S, MacMillan J, Grufferman S, Cohen HJ. Department of Medicine, Duke University Medical Center, Durham, North Carolina 27710. To determine if psychologically stressful life events are risk factors for herpes zoster, we conducted a case-control study of zoster and self-reported recent negative life events and major changes in spousal relationships. The subjects were 101 healthy community-dwelling cases of zoster and 101 healthy controls matched for age, sex, and race and generated by random digit dialing. The Geriatric Scale of Recent Life Events was administered to case and control subjects, and additional questions were asked regarding the perception of the life event. The results showed that case subjects experienced negative life events significantly more often than subjects in the control groups in the 2 months before zoster onset by analysis of discordant pairs (26 versus 10, odds ratio 2.60, 95% confidence interval [CI] 1.13, 6.27, P = .012), 3 months before (29 versus 11, odds ratio 2.64, 95% CI 1.20, 6.04, P = .007), or 6 months before (35 versus 16, odds ratio 2.00, 95% CI 1.04, 3.93, P = .012). The mean number of total life events was significantly higher in cases at 6 months before zoster (case means = 2.64, control means = 1.82, P = .008), but there were no significant differences at 2, 3, or 12 months before. There were no significant differences between case subjects and control subjects for spousal events, or any given single life event. In conclusion, we found that whereas patients with herpes zoster experienced the same kinds of life events in the year preceding the illness as did control subjects, recent events perceived as stressful were significantly more common among patients with zoster.(ABSTRACT TRUNCATED AT 250 WORDS) PMID: 2246455 [PubMed - indexed for MEDLINE] 4031. Am Surg. 1990 Nov;56(11):691-4. Association of acute colonic pseudo-obstruction (Ogilvie's syndrome) with herpes zoster. Pai NB, Murthy RS, Kumar HT, Gerst PH. Department of Surgery, Bronx-Lebanon Hospital Center, New York 10457. Ogilvie's syndrome, or acute pseudo-obstruction of the colon is characterized by massive distension of the colon in the absence of organic distal obstruction. The syndrome is associated with various unrelated and, most often, extra-abdominal causes. An association between Ogilvie's syndrome and herpes zoster has been reported only once, by Ceccese et al. in 1985. We present a second such case. This patient did not show evidence of any active illness other than the involvement of the T10 dermatome by herpes zoster. The patient's symptoms of colonic obstruction subsided with resolution of the zosteriform rash. PMID: 2240863 [PubMed - indexed for MEDLINE] 4032. J Comput Assist Tomogr. 1990 Nov-Dec;14(6):991-3. MR findings in a patient with Ramsay-Hunt syndrome. Osumi A, Tien RD. Department of Radiology, University of California, San Diego, School of Medicine, La Jolla. A case of Ramsay Hunt syndrome (herpes zoster oticus) was studied with Gd diethylenetriamine pentaacetic acid enhanced magnetic resonance imaging using a surface coil rather than a conventional head coil. This allowed us to demonstrate in detail the inflammatory changes of the multiple structures, involved. PMID: 2229582 [PubMed - indexed for MEDLINE] 4033. J Am Acad Dermatol. 1990 Nov;23(5 Pt 1):928-30. Postsurgical zosteriform herpes simplex 2 in noncontiguous dermatomes. Groisser D, Taylor S, Grossman ME. Columbia-Presbyterian Medical Center, New York, NY 10032. PMID: 2174931 [PubMed - indexed for MEDLINE] 4034. Aten Primaria. 1990 Nov;7(10):681-2. [Postherpetic facial paralysis] [Article in Spanish] Fernández P, Cenoz JA, Jáurequi ML. Comment in: Aten Primaria. 1991 Sep;8(8):654; author reply 654-5. PMID: 2104125 [PubMed - indexed for MEDLINE] 4035. Acta Otorrinolaringol Esp. 1990 Nov-Dec;41(6):387-91. [Ramsay Hunt syndrome. Effects of the treatment with acyclovir (preliminary study)] [Article in Spanish] Ramos Macías A, Gómez González JL, de Miguel Martínez MI, López Alburquerque T, Lavilla Martín MJ, Ruiz Martín F. Servicio de ORL, Hospital Clínico, Facultad de Medicina, Universidad de Salamanca. Herpes zoster oticus has a poor prognosis with permanent facial nerve dysfunction. We have studied 11 patients in a total group of 131 facial palsies seen in our service for a 20 month period. Four patients had no treatment. Two were treated with prednisone, and five were infused with acyclovir (10 mg/kg every 8 hours over a 10 day hospitalization period) and prednisone. These treatments were observed for 3 to 6 months. Patients follow up was, acyclovir group, 2 patients have achieved a House grade I, 1 patient grade II, 1 patient grade III and 1 left this treatment because side effects was observed. The other patients, 1 have achieved grade I, 2 patients grade II, 2 patients grade III and 1 patient grade V. The differences and final results are discussed. PMID: 2092730 [PubMed - indexed for MEDLINE] 4036. Rev Clin Esp. 1990 Nov;187(8):434-5. [Myelitis due to herpes zoster] [Article in Spanish] Sureda Ramis B, Gómez Aranda F, Bautista Lorite J. PMID: 2091145 [PubMed - indexed for MEDLINE] 4037. Nippon Hifuka Gakkai Zasshi. 1990 Nov;100(13):1352-4. [Postherpetic neuralgia] [Article in Japanese] Niimura M. PMID: 2079747 [PubMed - indexed for MEDLINE] 4038. Kansenshogaku Zasshi. 1990 Nov;64(11):1367-71. [The detection of VZV DNA in the smear cells of the patients of herpes zoster by in situ hybridization using biotinylated DNA probe] [Article in Japanese] Takahashi S, Kazuyama Y. Department of Dermatology of Keio University School of Medicine. We performed the in situ hybridization (ISH) study of the smear cells taken from the patients of herpes zoster. We used the biotinylated EcoRI-B, H fragment of varicella-zoster-virus (VZV) DNA as the probe. In the control study of ISH VZV-infected cells showed strong staining, but no staining was observed in the infected cells by other herpes virus. We examined the smear cells of 19 patients of herpes zoster and 2 patients of herpes simplex by ISH. 30 of the 35 specimens of herpes zoster was positive by ISH. We detected VZV DNA in the smear cells of all cases of the bullous stage, but the sensitivity was about 75% in the later stage. Smear cells of herpes simplex was not stained by ISH. We also performed virus isolation of 13 cases of herpes zoster. But the sensitivity of ISH was higher than that of virus isolation in the other stages of herpes zoster. This method is very simple and can be completed in about 1 hour. It also has high specificity and sensitivity. So this method is very useful for the rapid diagnosis of VZV infection. PMID: 1962810 [PubMed - indexed for MEDLINE] 4039. Hautarzt. 1990 Nov;41(11):591-601. [Herpesvirus infections--indications for chemotherapy in dermato-venereology] [Article in German] Gross GE, Schumann J. Universitäts-Hautklinik Hamburg-Eppendorf. Specific antivirals like acyclovir have ameliorated the outcome of severe herpesvirus infections, especially in immunocompromised patients. Varicella can be prevented in high-risk patients after exposure by therapy with varicella-zoster immunoglobulin. Despite this favorable development, there are many unresolved problems in the management of herpesvirus infections, such as the use of acyclovir during pregnancy, the treatment of both motoric neuropathy and postherpetic neuralgia. Chemotherapy-resistant herpesvirus may cause severe syndromes in patients suffering from HIV infection or from iatrogenic immunosuppression. Isolation of resistant viruses provides the stimulus to establish tests of viral resistance and to use antiviral drugs more carefully. PMID: 1703519 [PubMed - indexed for MEDLINE] 4040. Hosp Pract (Off Ed). 1990 Oct 30;25(10A):61-71, 75-6. Zoster and its complications. Krause PR, Straus SE. Medical Virology Section, National Institute of Allergy and Infectious Diseases, Bethesda. PMID: 2120265 [PubMed - indexed for MEDLINE] 4041. Am J Ophthalmol. 1990 Oct 15;110(4):341-8. Rapidly progressive outer retinal necrosis in the acquired immunodeficiency syndrome. Forster DJ, Dugel PU, Frangieh GT, Liggett PE, Rao NA. Department of Ophthalmology, Doheny Eye Institute, University of Southern California School of Medicine, Los Angeles 90033. Comment in: Am J Ophthalmol. 1991 Feb 15;111(2):255-6. Two patients, both seropositive for the human immunodeficiency virus, developed rapidly progressive retinal necrosis associated with a systemic herpes zoster infection. The retinitis in these patients was characterized by primary involvement of the outer retina, with sparing of the inner retina and retinal vasculature until late in the disease process; a rapidly progressive course; poor response to intravenous acyclovir; and development of rhegmatogenous retinal detachment. In one of the patients, the retinitis was initially multifocal. Electron microscopy of a retinal biopsy specimen from one of the patients demonstrated virus particles consistent with a herpesvirus, and polymerase chain reaction disclosed herpesvirus in a retinal biopsy specimen of the other patient. This entity may represent a distinct form of acute retinal necrosis that is seen in immunocompromised individuals. PMID: 2220967 [PubMed - indexed for MEDLINE] 4042. Lancet. 1990 Oct 13;336(8720):947. Corticosteroids and post-herpetic neuralgia. Naldi L, Zucchi A, Brevi A, Cavalierid'Oro L, Cainelli T. Comment on: Lancet. 1990 Sep 1;336(8714):537-8. PMID: 1976963 [PubMed - indexed for MEDLINE] 4043. Nippon Ganka Gakkai Zasshi. 1990 Oct;94(10):889-902. [Viral diseases of the outer eye--rapid diagnosis by immunohistochemistry] [Article in Japanese] Uchida Y. Department of Ophthalmology, Tokyo Women's Medical College. Rapid diagnosis of viral diseases of the outer eye was attempted by means of immunohistochemical methods. Specimens were obtained with a nitrocellulose membrane, used as a blotter of immunoblotting test. An impression of the corneal or conjunctival surface was obtained by anesthetizing the eye and lightly pressing the membrane against the tissues. In some cases, scraping materials were taken on a slide glass. Viral antigens in the specimens were detected by peroxidase-antiperoxidase (PAP) method, ABC system (Vectastain), or immunofluorescence. Four common diseases were studied. Dendritic corneal lesions caused by herpes simplex virus (HSV) were impressed on the membrane, and exhibited exact duplicates of lesions which were composed of PAP-positive epithelial cells. Under a high magnification, pathologic changes such as margination of chromatin, intranuclear inclusion bodies, and multinucleated giant cells were observed. Of 27 cases of epithelial herpetic keratitis, 25 showed positive results. The impression can permit examination of a minute lesion, therefore, is superior to scraping. Dendritic lesions caused by varicella-zoster virus (VZV) have a characteristic morphology different from those of HSV. Impressions showed the virus antigen, when treated with fluorescein-labeled anti-VZV monoclonal antibody. Appearance of such a dendrite in disorders of unknown cause indicates the etiology. Conjunctival impressions of adenovirus (Adv) conjunctivitis examined by the PAP method revealed Adv-antigen containing cells. Of 64 cases analyzed, 24 PAP-positive cases were compared with the 35 culture-proven cases. The sensitivity of PAP method was 69%, and the specificity was 97%. The detection rate varied according to serotype, and was especially low (33%) in type 3. Guinea pig antisera with high titers against enterovirus type 70 (EV70) and a variant of coxsackievirus A type 24 (CA24v), the causative viruses of acute hemorrhagic conjunctivitis (AHC), were obtained. Using these sera as the primary antibody, the antigen of each virus was localized in the cytoplasm of infected HeLa cells by either ABC, or immunofluorescence. Conjunctival cells from patients with EV70 AHC were antigen-positive for 3 days after the onset of disease. Though epidemics of CA24v AHC have only been experienced in Okinawa, sporadic cases have been observed in other districts of Japan. PMID: 2278234 [PubMed - indexed for MEDLINE] 4044. West J Med. 1990 Oct;153(4):445-6. Herpes zoster ophthalmicus--the changing epidemiology and its implications for treatment. Seiff SR, Mehta AM. PMCID: PMC1002590 PMID: 2244385 [PubMed - indexed for MEDLINE] 4045. Rev Odontol Univ Sao Paulo. 1990 Oct-Dec;4(4):349-52. [Simultaneous oral and skin manifestations of herpes zoster. Report of a case] [Article in Portuguese] Consolaro A, Oliveira DT. Departamento de Patología da Faculdade de Odontología de Bauru-USP. A case of herpes zoster involving the trigeminal nerve, with simultaneous skin and oral manifestation is presented. The diagnostic and treatment used are discussed, emphasizing the necessity of an intraoral examination, when skin facial lesions are observed by professionals. PMID: 1966920 [PubMed - indexed for MEDLINE] 4046. J R Soc Med. 1990 Oct;83(10):617-9. Epidemiology of shingles. Glynn C, Crockford G, Gavaghan D, Cardno P, Price D, Miller J. Oxford Regional Pain Relief Unit, Abingdon Hospital, Leeds. Comment in: J R Soc Med. 1991 Mar;84(3):184. One thousand and nineteen patients with acute varicella zoster viral infection were referred to the physiotherapy department for treatment between 1978 and 1986. Sixty per cent were women and 40% were men with a mean age of 58 years (range 9-96 years). The prevalence varied between 1.3 and 1.6 per 1000 per annum. The left side was affected in 52% while the right was affected in 48%. The thoracic dermatomes were the most commonly affected (56%) followed by cervical (17%), lumbar (10%), sacral (5%), and the trigeminal nerve was infected in 12%. There was a significant seasonal (P less than 0.001) variation in the prevalence of acute varicella zoster virus infection, most common in the summer and least common in the spring. There was no clustering in time and space so that it is unlikely that the varicella zoster virus is infective or that re-exposure to the virus causes reactivation of the latent virus. PMCID: PMC1292851 PMID: 1962821 [PubMed - indexed for MEDLINE] 4047. Ned Tijdschr Geneeskd. 1990 Sep 22;134(38):1870-1. [Herpes zoster and acyclovir in normal and dysfunctional general immunity, also that due to AIDS] [Article in Dutch] Van den Broek PJ, Van der Meer JW. PMID: 2215762 [PubMed - indexed for MEDLINE] 4048. Schweiz Rundsch Med Prax. 1990 Sep 11;79(37):1045-6. [What is your diagnosis? Herpes zoster] [Article in German] Flückiger R. Dermatologische Universitätsklinik, Kantonsspital, Basel. PMID: 2218230 [PubMed - indexed for MEDLINE] 4049. J Oral Maxillofac Surg. 1990 Sep;48(9):1000-3. Tooth exfoliation and necrosis of the mandible--a rare complication following trigeminal herpes zoster: report of a case. Muto T, Tsuchiya H, Sato K, Kanazawa M. Department of Oral and Maxillofacial Surgery, School of Dentistry, Higashi-Nippon-Gakuen University, Hokkaido, Japan. PMID: 2395037 [PubMed - indexed for MEDLINE] 4050. Chest. 1990 Sep;98(3):754-6. Fever, pulmonary infiltrates, and pleural effusion following acyclovir therapy for herpes zoster ophthalmicus. Pusateri DW, Muder RR. Department of Medicine, Mercy Hospital of Pittsburgh. A 71-year-old man presented with herpes zoster ophthalmicus and ocular involvement. Following the institution of intravenous therapy with acyclovir, the patient developed fever, hemoptysis, and a pleural friction rub. A ventilation-perfusion lung scan showed no defects; roentgenograms showed bilateral infiltrates and a left-sided pleural effusion. The fever abated promptly following discontinuation of acyclovir, and radiographic abnormalities resolved over ten days. No other anti-infective therapy was given. To our knowledge, the syndrome of fever, pulmonary infiltrates, and pleural effusion following use of acyclovir has not been previously reported. PMID: 2394154 [PubMed - indexed for MEDLINE] 4051. Vestn Oftalmol. 1990 Sep-Oct;106(5):65. [Injury of the cornea by a bee sting complicated by Pseudomonas aeruginosa and herpesvirus infections] [Article in Russian] Babushkin AE, Gimranov RM. PMID: 2264238 [PubMed - indexed for MEDLINE] 4052. Ann Ophthalmol. 1990 Sep;22(9):347-51. Central retinal artery obstruction in herpes zoster ophthalmicus and cerebral vasculopathy. Wilson CA, Wander AH, Choromokos EA. Department of Ophthalmology, University of Cincinnati College of Medicine, Ohio. We present a case of acute central retinal artery obstruction in association with Herpes zoster ophthalmicus and delayed cerebral vasculopathy. Retinal vascular obstruction is rare in zoster, and its occurrence during postherpetic cerebral vasculopathy has not been reported previously to our knowledge. The syndrome of delayed cerebral vasculopathy is discussed as is its possible relationship to central retinal artery obstruction. PMID: 2248493 [PubMed - indexed for MEDLINE] 4053. Masui. 1990 Sep;39(9):1239-44. [Relief of intractable post-herpetic neuralgia with gasserian ganglion block using methyl prednisolone acetate and with TENS] [Article in Japanese] Yamashiro H, Hara K, Gotoh Y. Department of Anesthesia, Hamamatsu Medical Center. A 58 year old man had been suffering from intractable left ophthalmic post herpetic neuralgia (PHN) for 7 years. He has also been treated for polyarteritis nodosa for 10 years. For pain relief, he was treated initially with frequent (4 times a day) stellate ganglion block (SGB) and peripheral ophthalmic nerve block for a month without relief. Then supraorbital nerve block with neurolytics, TENS and acupuncture were done with a slight relief of his pain. Recently his pain became worse even with imipramine 75 mg and carbamazepine 100 mg a day which relieved effectively the patient from the pain for the last 3 years. The pain was so severe to disturb his usual daily activity. Gasserian ganglion block with methyl prednisolone acetate 10 mg was done. After the block, his ADL improved markedly. Three months after the block, he had no spontaneous pain and slight pain with light touch on the injured skin did not annoy him. Several days before the block, electric stimulation to control his pain was tested. Stimulation with the electricity (4.5 mA, 10 cycle and 400 microseconds) brought him complete relief from the pain during the stimulation. Trigeminal SEP showed no response to the stimulation of injured skin. PMID: 2246814 [PubMed - indexed for MEDLINE] 4054. Virology. 1990 Sep;178(1):263-72. Cell surface expression of the varicella-zoster virus glycoproteins and Fc receptor. Litwin V, Sandor M, Grose C. Department of Microbiology, University of Iowa College of Medicine, Iowa City 52242. Varicella-zoster virus (VZV) specifies the synthesis of viral glycoproteins which are important antigens for induction of the host immune response. In this report the technology of laser-activated flow cytometry has been employed to measure the membrane expression of VZV glycoproteins gpI, gpII, gpIII, and gpIV. By use of biotinylated monoclonal antibodies as probes, all four glycoproteins were demonstrated on the infected cell surface. The temporal appearance of the viral glycoproteins was defined in a time course experiment and shown to be maximal about 24 hr postinfection. The issue whether VZV induces the cell surface expression of an Fc receptor (FcR) was investigated with biotinylated nonimmune human IgG, followed by streptavidin-phycoerythrin. By this technique a 10-fold increase in fluorescence intensity was seen in the VZV-infected cells as compared to the mock-infected controls. When the experiment was repeated with purified human Fc fragment rather than whole IgG, a similar degree of binding was seen. Both the VZV glycoproteins and the VZV FcR were exquisitely sensitive to trypsin treatment (1 mg/ml); likewise, the cell surface expression of these VZV products was diminished by treatment of the infected cultures with monensin, an inhibitor of glycoprotein transport. In order to prove that VZV infection was not causing the induction of a cellular Fc gamma R, the VZV-infected and mock-infected cells were stained with monoclonal antibodies directed against each of the three human cellular IgG FcR, but no differences were observed. Therefore, the FcR activity seen in the infected culture was not due to one of the known cellular Fc gamma R. PMID: 2167554 [PubMed - indexed for MEDLINE] 4055. J Infect Dis. 1990 Sep;162(3):627-33. Antibodies to varicella-zoster virus glycoproteins I, II, and III in leukemic and healthy children. LaRussa PS, Gershon AA, Steinberg SP, Chartrand SA. Department of Pediatrics, Columbia University, College of Physicians & Surgeons, New York City, NY 10032. A dot ELISA was used to analyze the antibody response to varicella-zoster virus glycoproteins I, II, and III in leukemic and healthy children who either developed natural varicella or received the live attenuated varicella vaccine. Both groups of children showed an antibody response to these viral glycoproteins. The antibody response to all three glycoproteins showed excellent persistence over the 3-year period of study. None of the glycoproteins provoked an antibody response that could be shown to correlate with protection from breakthrough varicella after household exposure to chickenpox or from zoster in leukemic vaccinees. PMID: 2167335 [PubMed - indexed for MEDLINE] 4056. J Infect Dis. 1990 Sep;162(3):621-6. Subclass distribution of the serum and intrathecal IgG antibody response in varicella-zoster virus infections. Echevarría JM, Téllez A, Martínez-Martín P. Centro Nacional de Microbiología, Virología e Inmunología Sanitarias, Madrid, Spain. The subclass distribution of the varicella-zoster virus (VZV)-specific IgG antibody response was studied in serum samples from 22 patients with primary varicella and 34 with recurrent VZV infections and in cerebrospinal fluid (CSF) samples from 22 patients with recurrent infection who presented with symptoms of aseptic meningitis. IgG1 and 3 were the dominant subclasses among patients with primary and recurrent infections; IgG1 was also prevalent in the CSF samples. The VZV IgG subclass distribution patterns did not allow differentiation between primary and recurrent infections. However, seroconversions for IgG2, 3, or 4 were observed among patients with recurrences who were negative for specific IgM, suggesting that qualitative tests for serum IgG subclass antibody could be helpful for diagnosis in such cases. Herpes simplex virus-specific IgG was found in CSF samples from several patients with meningitis. The results suggest that calculation of the antibody to albumin index is better than IgG subclass antibody assays for discriminating the causative agent in these cases. PMID: 2167334 [PubMed - indexed for MEDLINE] 4057. Int J Dermatol. 1990 Sep;29(7):523-7. Postherpetic neuralgia and systemic corticosteroid therapy. Efficacy and safety. Lycka BA. Department of Dermatology, University of Minnesota School of Medicine, Minneapolis. Corticosteroids are frequently advocated for use in prevention of postherpetic neuralgia (PHN), although their use is replete with controversy. The present study is a meta-analysis of the four well-controlled clinical studies conducted on this issue. The results indicated there is a statistically significant decrease in proportions affected at 6 and 12 weeks. Standard difference scores were -2.0559 and -4.1442, respectively, and 95% confidence intervals were -3.98% to -31.80% and -14.16% to -43.84%, respectively. At 24 weeks, no differences were detectable between placebo- and corticosteroid-treated groups (SD = 0.6603, p greater than 0.05, 95% confidence intervals of -6.78% to 24.67%). Side effects of treatment were rare and mild, affecting only 2.5% of patients treated with corticosteroids. No patients had dissemination of disease. Systemic corticosteroid treatment decreases the proportion of patients affected by PHN, especially when it is defined as pain occurring at 6 or 12 weeks after the acute event. PMID: 2146232 [PubMed - indexed for MEDLINE] 4058. Rev Inst Med Trop Sao Paulo. 1990 Sep-Oct;32(5):364-9. [HIV seropositivity in patients with herpes zoster] [Article in Portuguese] Vasconcellos MR, Castro LG, dos Santos MF. Disciplina de Dermatologia da Escola Paulista de Medicina, Hospital das Clínicas, São Paulo, Brasil. Relationship between zoster and seropositivity for HIV is studied. Serum samples from 66 patients presenting acute zoster infection were tested for HIV antibodies, using ELISA. There was no previous selection of patients, what rendered the population studied unbiased. Seven patients (10.6%) were positive for HIV antibodies. Among them six belonged to AIDS risk groups, all were males and six had ages between 19 and 39 years (mean age value 31.7). Results suggest that the finding of zoster in younger age groups is not necessarily linked to HIV infection. When zoster is diagnosed in patients who belong to AIDS risk groups, independently from their age, the association with HIV infection is statistically significative. In these cases zoster can even be considered as a marker for HIV infection and it is mandatory to test these patients for HIV antibodies. PIP: The relationship between zoster and seropositivity for HIV is studied. Serum samples from 66 patients presenting acute zoster infection were tested for HIV antibodies using ELISA. There was no previous selection of patients, which rendered the population studied unbiased. 7 patients (10.6%) were positive for HIV antibodies; 6 belonged to AIDS risk groups, all were male, and 6 were between the ages of 19 and 39 years (mean age = 31.7). Results suggest that the finding of zoster in younger age groups is not necessarily linked to HIV infection. When zoster is diagnosed in patients who belong to AIDS risk groups. Independently from their age, the association with HIV infection is statistically significant. In these cases, zoster can even be considered as a marker for HIV infection and it is mandatory to test these patients for HIV antibodies. (author's modified) PMID: 2135478 [PubMed - indexed for MEDLINE] 4059. Lancet. 1990 Sep 1;336(8714):537-8. Postherpetic neuralgia. [No authors listed] Comment in: Lancet. 1990 Oct 13;336(8720):947. PMID: 1975041 [PubMed - indexed for MEDLINE] 4060. Brain Pathol. 1990 Sep;1(1):6-10. Neurotropic herpesviruses, neural mechanisms and arteritis. Martin JR, Mitchell WJ, Henken DB. Laboratory of Experimental Neuropathology, National Institutes of Health, Bethesda, MD 20892. Cumulative evidence suggests that varicella-zoster virus (VZV) can infect walls of CNS arteries, causing stroke in man. We review observations relating infection with this neurotropic virus to the development of arteritis in the CNS and note evidence supporting the hypothesis that VZV spreads from ganglionic reactivation sites to the arterial wall by neural pathways. Problems relating to the pathogenesis of arteritis and experimental approaches to their solution are suggested. PMID: 1669695 [PubMed - indexed for MEDLINE] 4061. Schweiz Med Wochenschr. 1990 Aug 18;120(33):1200-3. [Renal and neurological toxicity of acyclovir. Apropos of a case] [Article in French] Fischer A, Fellay G, Regamey C. Clinique médicale, Hôpital cantonal de Fribourg. The occurrence of anuria and stupor in a patient treated with acyclovir afforded the opportunity to discuss the renal and neurological toxicity of this drug. Acute renal insufficiency by crystallization of acyclovir and intratubular obstruction is a not infrequent side effect. The risk depends on the dose, the administration mode, the patient's state of hydration and preexisting renal failure. The evolution is typified by a rapid onset (after 24-48 h) and a prompt recovery after ending the treatment. The demonstration in urinalysis of crystals within leukocytes helps to establish the diagnosis. Neurological involvement can vary from confusion to coma. The cerebrospinal fluid is normal and the electroencephalogram shows diffuse slowing. A favorable outcome after ending treatment is the rule. Awareness of the risk factors associated with renal and neurological toxicity should lead to a reduction of its frequency. PMID: 2396095 [PubMed - indexed for MEDLINE] 4062. Arch Dermatol. 1990 Aug;126(8):1105-6. Chronic localized herpes zoster in the acquired immunodeficiency syndrome. Disler RS, Dover JS. Comment in: Arch Dermatol. 1990 Aug;126(8):1086-8. PMID: 2383039 [PubMed - indexed for MEDLINE] 4063. Z Hautkr. 1990 Aug;65(8):713-6. [Therapy of herpes zoster neuralgia. Acute and residual neuralgia in herpes zoster] [Article in German] Malin JP. Neurologische Klinik und Poliklinik, Ruhr-Universität Bochum. We discuss the latest findings regarding the therapy of acute herpes zoster and postherpetic neuralgia. Aside from the conventional modes of treatment. We especially refer to the therapy with aciclovir. In addition, we present the techniques of transcutaneous electrostimulation and neurosurgery. PMID: 2284830 [PubMed - indexed for MEDLINE] 4064. Aust Dent J. 1990 Aug;35(4):328-32. Herpes zoster virus infection: a clinicopathologic review and case reports. Barrett AP. Westmead Hospital Dental Clinical School, Department of Medicine. Herpes zoster virus (HZV) infection, particularly of the trigeminal nerve, can be a disabling and disfiguring condition with variable clinical presentations. Acyclovir is a highly effective treatment modality during the acute clinical phase; however, pain control may be very difficult particularly with protracted and severe post herpetic neuralgia (PHN). The clinicopathologic features are reviewed and two cases in immunosuppressed patients with HZV infection of different divisions of the trigeminal nerve are presented. PMID: 2275650 [PubMed - indexed for MEDLINE] 4065. Hautarzt. 1990 Aug;41(8):455-7. [Post-zoster-specific skin infiltrates in chronic lymphatic leukemia] [Article in German] Aberer W, Zonzits E, Soyer HP, Kerl H. I. Universitäts-Hautklinik Wien. Eight weeks after suffering from herpes zoster of the right 5th cranial nerve, an 80-year-old woman with chronic lymphocytic leukaemia developed zoster-like pseudovesicular lesions in the same nerve segment. Histological and immunohistological investigations revealed specific infiltrates of chronic lymphocytic leukaemia. Chemotherapy for the underlying disease was intensified, and the cutaneous infiltrates disappeared quickly. The patient died shortly afterwards due to exacerbation of the lymphoma. PMID: 2272830 [PubMed - indexed for MEDLINE] 4066. Aust N Z J Ophthalmol. 1990 Aug;18(3):273-9. Current management of ophthalmic zoster. Marsh RJ. St Mary's Hospital, London, England. Most ophthalmic zoster occurs in healthy people and ocular complications occur in 50%. The mainstay of ocular therapy is topical steroid, but careful follow-up and withdrawal are essential. The place of systemic steroid therapy and acyclovir in immunocompetent patients with zoster is uncertain. PMID: 2261174 [PubMed - indexed for MEDLINE] 4067. Vrach Delo. 1990 Aug;(8):107-10. [The immunomodulating therapy of herpes zoster (a review of the literature)] [Article in Russian] Turkot LA, Andreĭchin MA, Savchak VI. PMID: 2256267 [PubMed - indexed for MEDLINE] 4068. Ther Umsch. 1990 Aug;47(8):653-7. [Antiviral substances: against what? For whom?] [Article in German] Hirschel B. Division des maladies infectieuses, Hôpital cantonal universitaire, Genève. Acyclovir and zidovudine are the two most widely used antiviral drugs. Acyclovir is efficacious against all infections caused by herpes simplex virus, but treatment must start early to be effective. Herpes zoster virus is less susceptible to acyclovir, but high doses shorten the duration of skin lesions, although the effect on post-herpetic neuralgia is uncertain. Zidovudine diminishes short-term mortality in patients with HIV infection and serious opportunistic infections. In those patients, the average increase in life expectancy is about one year. Because of myelotoxicity, frequent monitoring of blood counts is necessary. Recent results in patients who have few or no symptoms of HIV infection indicate that the drug decreases the chance of progressing to AIDS. Therefore, indications for treatment now include asymptomatic patients with unfavourable laboratory parameters. PMID: 2218967 [PubMed - indexed for MEDLINE] 4069. Arch Dermatol. 1990 Aug;126(8):1086-8. Varicella-zoster virus disease in patients with human immunodeficiency virus infection. Gulick RM, Heath-Chiozzi M, Crumpacker CS. Department of Infectious Diseases, Beth Israel Hospital, Boston, MA 02215. Comment on: Arch Dermatol. 1990 Aug;126(8):1033-6. Arch Dermatol. 1990 Aug;126(8):1105-6. Arch Dermatol. 1990 Aug;126(8):1048-50. PMID: 2200349 [PubMed - indexed for MEDLINE] 4070. Z Hautkr. 1990 Aug;65(8):709-12. [Pathophysiology of pain perception and pain transmission in herpes zoster] [Article in German] Malin JP. Neurologische Klinik und Poliklinik, Ruhr-Universität Bochum. PMID: 2178294 [PubMed - indexed for MEDLINE] 4071. Ann Rheum Dis. 1990 Aug;49(8):630-3. High incidence of herpes zoster in patients with systemic lupus erythematosus: an immunological analysis. Nagasawa K, Yamauchi Y, Tada Y, Kusaba T, Niho Y, Yoshikawa H. First Department of Internal Medicine, Faculty of Medicine, Kyushu University Fukuoka, Japan. The incidence of herpes zoster was determined in patients with systemic lupus erythematosus (SLE) and the cellular and humoral immunity to varicella zoster virus (VZV) investigated in 45 of these 92 patients. The incidence of herpes zoster was high, occurring in 40 patients (43%), though it was benign in all. Patients with SLE who had had zoster showed significantly higher antibody titres than normal subjects. On the other hand, only 13 of 43 (30%) patients with SLE showed positive delayed hypersensitivity skin reactions to VZV antigen, despite a history of infections with VZV, whereas all 15 normal subjects had positive reactions. Skin reactions to VZV correlated directly with the ratio of OKT4+ to OKT8+ T cells and inversely with the dose of corticosteroids. These results suggest that the high incidence of herpes zoster in patients with SLE is probably due to defects in cellular immunity and that normal or higher titres of antibodies to VZV will not act as a preventive against zoster. In addition, reactivation of VZV, whether symptomatic or not, seemed often to occur in patients with SLE. PMCID: PMC1004180 PMID: 2168693 [PubMed - indexed for MEDLINE] 4072. Arch Dermatol. 1990 Aug;126(8):1048-50. Prolonged cutaneous herpes zoster in acquired immunodeficiency syndrome. Hoppenjans WB, Bibler MR, Orme RL, Solinger AM. Department of Dermatology, University of Cincinnati, Ohio, College of Medicine. Comment in: Arch Dermatol. 1990 Aug;126(8):1086-8. We described the development of prolonged disseminated cutaneous herpes zoster in two patients with acquired immunodeficiency syndrome. Both patients developed hyperkeratotic, verrucous lesions that progressed despite acyclovir therapy. The biopsy specimens were typical of herpes infection. The development of acyclovir-resistant varicella-zoster virus during therapy was suspected clinically in the first patient and documented in vitro in the second patient. The inability to mount an effective cell-mediated immune response contributed to the prolonged course of cutaneous zoster in our patients. The hyperkeratotic nature of the skin lesions may reflect their chronic nature. Treatment with inadequate doses of acyclovir, allowing viral persistence and the selection of resistant strains of virus, may also be implicated. We recommend prolonged high-dose intravenous acyclovir therapy in the initial management of herpes zoster in patients with acquired immunodeficiency syndrome. PMID: 2166483 [PubMed - indexed for MEDLINE] 4073. Arch Dermatol. 1990 Aug;126(8):1033-6. Varicella in patients infected with the human immunodeficiency virus. Perronne C, Lazanas M, Leport C, Simon F, Salmon D, Dallot A, Vildé JL. Service des Maladies Infectieuses et Tropicales, Hôpital Claude-Bernard, Paris, France. Comment in: Arch Dermatol. 1990 Aug;126(8):1086-8. In a retrospective study of 421 patients infected with human immunodeficiency virus, 15 (3.5%) had varicella. Twelve patients had a typical varicella. Complications were as follows: profuse eruption, 6; hemorrhagic eruption, 1; hepatitis, 5; and pulmonary involvement, 1; 1 patient developed an intravascular disseminated coagulation and died of varicella. Three patients with acquired immunodeficiency syndrome, having a history of varicella, presented with an atypical form of varicella with a small number of disseminated cutaneous poxlike lesions; 1 of these patients experienced three relapses of atypical varicella. Assay of serum antibodies to varicella zoster virus showed that, while typical varicella was the primary varicella zoster virus infection, atypical varicella was a reactivation of varicella zoster virus infection. Acyclovir was given to 11 patients and vidarabine to 1 patient. The one patient who died and the one who suffered a relapse had received acyclovir. Thus, varicella in patients infected with human immunodeficiency virus may be complicated and even lethal. Atypical forms of varicella could be, as is the case with herpes zoster, a reactivation of endogenous varicella zoster virus. PMID: 2166482 [PubMed - indexed for MEDLINE] 4074. Am J Epidemiol. 1990 Aug;132(2):203-10. Risk factors for progression of human immunodeficiency virus (HIV) infection among seroconverted and seropositive homosexual men. van Griensven GJ, de Vroome EM, de Wolf F, Goudsmit J, Roos M, Coutinho RA. Municipal Health Service, Department of Public Health and Environment, Amsterdam, The Netherlands. For identification of risk factors for progression of human immunodeficiency virus (HIV) infection, 746 homosexual men participating in a cohort study in Amsterdam, The Netherlands, were studied since October 1984. A total of 234 of these men were HIV antibody-positive at baseline, and 52 seroconverted during follow-up. These 286 individuals were categorized as high- and low-risk for progression to the acquired immunodeficiency syndrome (AIDS) on the basis of the presence or absence of HIV antigenemia, antibody to HIV core antigen, or a number of T helper lymphocytes less than 0.5 x 10(9)/liter during three or more subsequential blood samples. Ninety-six (41%) of the seropositives and 32 (62%) of those who seroconverted remained low-risk throughout the study period. Bivariate analyses revealed that educational level and a history of herpes zoster were associated with a low- and high-risk status, respectively. In multivariate analyses, a history of herpes zoster and a history of sexual intercourse with a person who had AIDS were associated with a more rapid disease progression. While herpes zoster is considered to be a marker of progressive immunodeficiency, a history of having sexual intercourse with a person who had AIDS points to the more virulent properties of HIV in these persons. Because both seropositives and seroconverters who had sexual intercourse with a person with AIDS had a more rapid disease progression, it seems plausible that being infected by a person with AIDS is a risk factor for a relative short incubation period. PMID: 1973594 [PubMed - indexed for MEDLINE] 4075. Lancet. 1990 Jul 21;336(8708):192. Screening hospital staff for antibodies to varicella-zoster virus. Murray A, Kangro HO, Heath RB. PMID: 1973522 [PubMed - indexed for MEDLINE] 4076. Am J Nurs. 1990 Jul;90(7):15-6. Clues: pain, burning, and itching. Cuzzell JZ. PMID: 2363451 [PubMed - indexed for MEDLINE] 4077. Jpn J Med. 1990 Jul-Aug;29(4):397-8. Guillain Barré syndrome following herpes zoster: a case report and review of literature. Rabbani MU, Gupta D. Department of Medicine, Jawaharlal Nehda Medical College, Aligarh Muslim University, New Delhi. Herpes zoster is known to exhibit various neurological complications. Guillain Barré syndrome following herpes zoster is rare and only 25 cases have been reported to date. In this report, a case is presented and the pertinent literature is reviewed. PMID: 2273623 [PubMed - indexed for MEDLINE] 4078. Vrach Delo. 1990 Jul;(7):71-4. [Nervous system involvement in herpes zoster (a review of the literature)] [Article in Russian] Andreĭchin MA, Savchak VI, Turkot LA. PMID: 2238605 [PubMed - indexed for MEDLINE] 4079. East Afr Med J. 1990 Jul;67(7):522-6. Herpes Zoster Ophthalmicus in a child with acquired immune deficiency syndrome. Awan HR, Adala HS. Department of Surgery, College of Health Sciences, University of Nairobi. A case is described of an 8 year old child who presented with Herpes Zoster Ophthalmicus involving the left eye. He had a positive history of pulmonary tuberculosis, repeated hospital admissions and blood transfusion. He was confirmed to have Acquired Immune Deficiency Syndrome. During the course of his followup, he developed cotton-wool spots and perivasculitis in the right eye. The mother was found to be seropositive while the father was seronegative. PMID: 2226233 [PubMed - indexed for MEDLINE] 4080. J Cardiovasc Surg (Torino). 1990 Jul-Aug;31(4):531-2. Disseminated cutaneous herpes zoster following cardiac surgery. Dirbas FM, Swain JA. Surgery Branch, National Heart, Lung and Blood Institute, Bethesda, MD. Our case report describes disseminated cutaneous Herpes Zoster in the early post-operative period following cardiac surgery with cardiopulmonary bypass. This has not been reported previously in the absence of immunosuppressive therapy. Despite associated neurologic and respiratory impairment, our patient was treated successfully with intravenous Acyclovir and subsequently discharged. PMID: 2211810 [PubMed - indexed for MEDLINE] 4081. Br J Clin Pract. 1990 Jul;44(7):284-5. Zoster sine herpete. Rudra T. Princess of Wales Hospital. A 61-year-old man presented with acute facial pain and subsequently developed the rash of herpes zoster in a distal dermatome. Treatment with acyclovir was commenced before development of the rash. The atypical presentation and the benefits of early diagnosis and treatment are discussed. PMID: 2206828 [PubMed - indexed for MEDLINE] 4082. Pediatr Neurol. 1990 Jul-Aug;6(4):279-81. Varicella with delayed hemiplegia. Ichiyama T, Houdou S, Kisa T, Ohno K, Takeshita K. Division of Child Neurology, Tottori University School of Medicine, Yonago, Japan. We report 4 children who developed acute hemiplegia 7 weeks to 4 months after varicella infection. In 2 patients, carotid angiography demonstrated segmental narrowing and occlusion of the middle cerebral artery. Their clinical and angiographic features were similar to those associated with contralateral hemiplegia after herpes zoster ophthalmicus, the pathogenesis of which comprises cerebral angiitis due to varicella zoster viral infection. We believe that our patients had the same pathogenesis. In a survey of infectious diseases in our region, the frequency of varicella with delayed hemiparesis was roughly 1:6,500 varicella patients. PMID: 2206164 [PubMed - indexed for MEDLINE] 4083. Blood. 1990 Jul 1;76(1):235-44. T-cell-depleted autologous bone marrow transplantation therapy: analysis of immune deficiency and late complications. Anderson KC, Soiffer R, DeLage R, Takvorian T, Freedman AS, Rabinowe SL, Nadler LM, Dear K, Heflin L, Mauch P, et al. Division of Tumor Immunology, Dana-Farber Cancer Institute, Boston, MA 02115. Fourteen patients with T-cell-derived leukemia and lymphoma underwent high-dose chemoradiotherapy and anti-T-cell monoclonal antibody-treated autologous bone marrow transplantation (ABMT). All patients were either in sensitive relapse or had adverse prognostic features, and five patients had a history of bone marrow involvement with disease. Patients received a median of 2 (1 to 3) prior chemotherapy regimens; 10 patients received local radiotherapy. After high-dose ablative therapy, greater than 500/mm3 granulocytes and greater than 20,000 untransfused platelets/mm3 were noted at a median of 23 (13 to 48) and 26 (15 to 43) days post-ABMT, respectively. Natural killer (NK) cells, T cells (predominantly T8+), and monocytes were noted within the first 1 to 2 months post-AMBT, as seen in other series. Disease-free survival was a median of 10.1 months, 5.9 months for patients with T acute lymphoblastic leukemia or lymphoblastic lymphoma and 25.6 months for patients with T non-Hodgkin's lymphoma (NHL). Toxicities were common and severe. Thirty-six percent of patients developed bacteremias early post-BMT. Late complications included a skin rash consistent with graft versus host disease; infections with Herpes zoster, hepatitis, and Pneumocystis carinii; and the development of Epstein-Barr virus associated lymphoproliferative syndrome. Our findings suggest that patients who have undergone T-depleted ABMT have a profound immunodeficiency not reflected in the phenotypic reconstitution of the T and NK cells. Characterization of the functional deficiency may facilitate the development of methods to reduce the long-term toxicity of AMBT in these patients. PMID: 2194591 [PubMed - indexed for MEDLINE] 4084. Contact Dermatitis. 1990 Jul;23(1):43-5. Allergic contact dermatitis from idoxuridine. Senff H, Engelmann L, Kunze J, Hausen BM. Department of Dermatology, St. Barbara-Hospital, Duisburg, FRG. PMID: 2144808 [PubMed - indexed for MEDLINE] 4085. Rev Prat. 1990 Jun 21;40(18):1656-9. [The other types of viral hepatitis] [Article in French] Miguet JP, Coaquette A, Bresson-Hadni S, Lab M. Service d'hépatologie, CHU Jean-Minjoz, Besançon. Hepatitis due to viruses other than A, B, C, D, E are numerous but uncommon in adults. Among the group of Herpesviridae (HSV, CMV, EBV, VZV), clinical hepatitis is usually suggestive of disseminated viral infection. Fulminant hepatitis occasionally observed in immunocompromised hosts are due to HSV, and VZV, but exceptionally to EBV. Many new techniques using specific monoclonal antibodies permit an accurate and fast diagnosis. Three drugs (vidarabine, acyclovir, ribavirine) have been shown to be efficient in the treatment of severe forms of the disease. Hepatitis due to exotic viruses (Amaril, Ebola, Lassa) are exceptional in France, but require specific prophylactic measures. PMID: 2164704 [PubMed - indexed for MEDLINE] 4086. Lancet. 1990 Jun 16;335(8703):1460-1. Varicella and zoster in hospitals. [No authors listed] Comment on: Lancet. 1990 May 5;335(8697):1100-1. PMID: 1972230 [PubMed - indexed for MEDLINE] 4087. Ned Tijdschr Geneeskd. 1990 Jun 2;134(22):1105-6. [The treatment of post-herpetic neuralgia using capsaicin ointment] [Article in Dutch] van Horssen N. PMID: 2352566 [PubMed - indexed for MEDLINE] 4088. Ned Tijdschr Geneeskd. 1990 Jun 2;134(22):1080-4. [Herpes zoster and acyclovir in normal and deficient general immunity, also that due to AIDS] [Article in Dutch] van Joost T. Academisch Ziekenhuis Rotterdam-Dijkzicht, afd. Dermatologie en Venereologie, Rotterdam. PMID: 2191225 [PubMed - indexed for MEDLINE] 4089. Ital J Neurol Sci. 1990 Jun;11(3):297-300. MRI evaluation of a case of herpes zoster ophthalmicus with delayed contralateral hemiplegia. Cavaletti G, Bogliun G, Tagliabue M. Clinica Neurologica, Ospedale S. Gerardo dei Tintori, Monza, Milano. We report the case of a patient affected by contralateral hemiplegia during herpes zoster ophthalmicus (HZO) evaluated both with serial CT scans and with MRI. We suggest that MRI examination of patients affected by HZO could be useful for the detection of early signs of cerebral arterial damage which are not yet clinically and radiologically apparent. PMID: 2387702 [PubMed - indexed for MEDLINE] 4090. J Am Dent Assoc. 1990 Jun;120(6):679-81. Diagnosis and treatment of orofacial herpes zoster: report of cases. McKenzie CD, Gobetti JP. Oral Medicine/Diagnosis Clinic, University of Michigan School of Dentistry, Ann Arbor 48109-1078. Herpes zoster is considered a disease of elderly or immunocompromised patients. These cases are unusual since clinical signs of the disease occurred in two healthy, young adults. Various diagnostic and treatment considerations for herpes zoster infections are presented. PMID: 2191025 [PubMed - indexed for MEDLINE] 4091. Arch Ophthalmol. 1990 Jun;108(6):782-3. Herpes zoster optic neuritis in human immunodeficiency virus infection. Litoff D, Catalano RA. PMID: 2190546 [PubMed - indexed for MEDLINE] 4092. AIDS. 1990 Jun;4(6):577-9. Emergence of acyclovir-resistant varicella zoster virus in an AIDS patient on prolonged acyclovir therapy. Linnemann CC Jr, Biron KK, Hoppenjans WG, Solinger AM. Department of Medicine, University of Cincinnati College of Medicine, Ohio 45267-0560. We demonstrate for the first time the appearance of acyclovir resistance in serial varicella zoster isolates from a patient treated with acyclovir. We recovered varicella zoster virus three times over a period of 5 months from the skin lesions of this patient with AIDS who was treated with three courses of intravenous acyclovir and prolonged low-dose oral acyclovir. The isolate recovered from a typical zoster lesion before acyclovir, and one obtained from a hyperkeratotic lesion 2 months later, after intravenous and oral acyclovir, were sensitive to acyclovir and produced normal amounts of thymidine kinase. In contrast, virus recovered from lesions 5 months after the onset, when the patient had received repeated courses of acyclovir, was acyclovir-resistant and thymidine-kinase-deficient. Resistance to acyclovir was associated with persistence of lesions which failed to improve with intravenous acyclovir, but was not associated with new lesion formation. PMID: 2167103 [PubMed - indexed for MEDLINE] 4093. Virus Res. 1990 Jun;16(2):195-210. Monoclonal antibody to immediate early protein encoded by varicella-zoster virus gene 62. Forghani B, Mahalingam R, Vafai A, Hurst JW, Dupuis KW. Viral and Rickettsial Disease Laboratory, California State Department of Health Services, Berkeley 94704. Monoclonal antibodies (mAbs) were prepared against varicella-zoster virus (VZV)-infected cell proteins, and 10 mAbs which reacted with nuclear antigens were selected. These mAbs recognized a major 175-180 kDa and three minor VZV-specific phosphoprotein species. Immunofluorescence staining of VZV-infected cells showed that the 175-180 kDa protein was synthesized within 6 h after infection. The synthesis of this protein was inhibited by cycloheximide (CH); however, reversal of CH treatment and addition of actinomycin D (ActD) resulted in the synthesis of the 175-180 kDa protein. To determine whether the 175-180 kDa protein seen in the infected cells is encoded by VZV immediate early (IE) gene 62, the predicted open reading frames of VZV genes 61 and 62 were cloned into pGEM transcription vectors. RNA was transcribed from each gene, translated in vitro and immunoprecipitated with a mAb which recognizes a major 175-180 kDa and three minor proteins. The reactivity of the in vitro translation products encoded by gene 62 with this mAb suggested that the 175-180 kDa protein is encoded by VZV IE gene 62. PMID: 2166981 [PubMed - indexed for MEDLINE] 4094. Pathol Biol (Paris). 1990 Jun;38(5 ( Pt 2)):568-71. [Acyclovir and specific anti-varicella-herpes zoster immunoglobulins in the treatment of varicella-zoster virus infection in 113 adults] [Article in French] Senneville E, Chidiac C, Brouillard M, Beuscart C, Leroy O, Sivery B, Beaucaire G, Mouton Y. Service Régional des Maladies Infectieuses, Centre Hospitalier, Tourcoing. From January 1978 to December 1988, 54 males and 59 females were treated for varicella, zoster and disseminated zoster by varicella-zoster immunoglobulin (group I) or acyclovir (group II). 67 patients had immune deficiency disease. Treatment was successful for 92/100 patients in group I and for 100/100 patients in group II. Thrombophlebitis and renal failure were observed in group II and regressed when acyclovir was stopped. Varicella-zoster immunoglobulin and acyclovir are two effective therapeutics in the treatment of varicella and zoster in adults including immunocompromised patients. The use of acyclovir could not reduce the duration of hospitalization. PMID: 2166935 [PubMed - indexed for MEDLINE] 4095. J Clin Microbiol. 1990 Jun;28(6):1469-72. Microplate hybridization of amplified viral DNA segment. Inouye S, Hondo R. Department of Microbiology, University of Tokyo, Japan. We have developed a simple hybridization method for a DNA segment which is amplified by the polymerase chain reaction: after heat denaturation, the amplified DNA segment with a length of more than 300 bases is adsorbed to microplate wells in the presence of 1.5 M NaCl or 0.5 M ammonium sulfate; the immobilized DNA is hybridized with a biotin-labeled DNA probe; then, the hybridization signal is detected by streptavidin-conjugated beta-galactosidase or peroxidase. This method has several advantages over the conventional dot blot hybridization method: (i) radioisotopes are not used, (ii) synthetic oligonucleotide for the probe is not needed, (iii) the time required for washing of the solid phase is greatly reduced, and (iv) the baking and prehybridization procedures are eliminated. By this method, we were able to detect viral genomes in vesicle specimens from patients infected with varicella-zoster virus. PMCID: PMC267960 PMID: 2166086 [PubMed - indexed for MEDLINE] 4096. Hematol Oncol Clin North Am. 1990 Jun;4(3):603-23. Viral infections associated with bone marrow transplantation. Zaia JA. Division of Pediatrics, City of Hope National Medical Center, Duarte, California. Bone marrow transplantation is complicated by a sequential occurrence of viral infections, the predictability of which influences disease management. Among these infections are herpes simplex virus, cytomegalovirus, varicella zoster virus, Epstein-Barr virus, respiratory viral infections, hepatitis viral infections, and gastrointestinal infections. The approach to the treatment and prevention of these infections is discussed. PMID: 2162815 [PubMed - indexed for MEDLINE] 4097. Ann Otol Rhinol Laryngol. 1990 Jun;99(6 Pt 1):461-5. Detection of specific IgA antibodies to varicella zoster virus in serum of patients with Ramsay Hunt syndrome. Hadar T, Tovi F, Sidi J, Sarov B, Sarov I. Department of Otolaryngology and Head and Neck Surgery, Beilinson Medical Center, Petah-Tiqva, Israel. Varicella zoster virus (VZV)-specific IgG and IgA antibody titers were determined in serial serum samples of 23 patients with Ramsay Hunt syndrome by the immunoperoxidase assay. Varicella zoster virus-specific IgG antibodies were found in the first serum samples of all the patients. In 80% of 20 patients in whom a serum sample was available within 5 days after the onset of the disease. VZV-specific IgA antibodies were detected. The second serum sample was VZV-specific IgA-positive in all of the patients. While all the healthy age- and sex-matched control subjects had VZV-specific IgG antibodies, VZV-specific IgA antibodies were detected in a low titer (dilution = 2) in only three of the subjects. By using VZV-specific IgA antibody titers greater than or equal to 2 and greater than or equal to 4 by the immunoperoxidase assay as a "cutoff" for younger and older patients with Ramsay Hunt syndrome, respectively, an early diagnosis of the disease can be obtained in 89% of the younger and in 64% of the older patients by a single serum sample. PMID: 2161635 [PubMed - indexed for MEDLINE] 4098. Lancet. 1990 May 26;335(8700):1279. Acyclovir and post-herpetic neuralgia. Freestone DS, Brigden WD. PMID: 1971343 [PubMed - indexed for MEDLINE] 4099. JAMA. 1990 May 23-30;263(20):2750. Fluphenazine and postherpetic neuralgia. Hurtig HI. PMID: 2332917 [PubMed - indexed for MEDLINE] 4100. Vestn Oftalmol. 1990 May-Jun;106(3):24-7. [Clinical aspects and methods of immunotherapy of ophthalmic herpes in bacterial sensitization] [Article in Russian] Maĭchuk IuF, Kazachenko MA, Mikuli SG, Murav'eva TV. PMID: 2385898 [PubMed - indexed for MEDLINE] 4101. Kinderkrankenschwester. 1990 May;9(5):134-7. [Exanthematic pediatric diseases .1] [Article in German] Peller P. PMID: 2383495 [PubMed - indexed for MEDLINE] 4102. J Neurosci Res. 1990 May;26(1):83-9. An in vivo model of varicella-zoster virus latent infection of dorsal root ganglia. Sadzot-Delvaux C, Merville-Louis MP, Delrée P, Marc P, Piette J, Moonen G, Rentier B. Department of Microbiology-Virology, University of Liège, Belgium. We describe here the first in vivo model of varicella-zoster virus (VZV) latent infection in the adult rat peripheral nervous system. Infected Mewo cells were injected subcutaneously along the spine of healthy adult rats. No clinical sign of infection was observed even 9 months after inoculation. Humoral immune response to VZV was detected in all infected animals throughout the study (9 months). The presence of viral material in dissociated and cultured dorsal root ganglia (DRG) from inoculated animals was studied by immunoperoxidase and in situ hybridization. When DRGs from infected animals were plated in culture from 1 month and up to 9 months after inoculation, viral nucleic acids and proteins were detected in neurons. Furthermore, trypsinization and subcultivation of infected neurons in culture is needed to reactivate infectious virus at least in some of the neurons. This model provides a useful tool for studying 1) the molecular mechanisms leading to an in vivo latency, 2) the role of the immune system, in particular cellular immunity, on the establishment, maintenance, and reactivation of latency, 3) the neurotropism of mutant viruses, and 4) the effects of antiviral agents. PMID: 2359148 [PubMed - indexed for MEDLINE] 4103. Ann Otol Rhinol Laryngol. 1990 May;99(5 Pt 1):327-9. Pathologic findings in the labyrinthine segment of the facial nerve in a case of facial paralysis. Jackson CG, Johnson GD, Hyams VJ, Poe DS. Otology Group, Nashville, Tennessee 37203. The histopathologic findings for a patient with acute facial paralysis caused by herpes zoster oticus who obtained no return of active facial function after 1 year are presented. All imaging studies were nondiagnostic. Biopsy of the labyrinthine segment was performed. Histopathologic analysis showed a sharp line of demarcation between sclerotic nerve proximal to and necrotic nerve distal to the meatal foramen area of the fallopian canal. This finding is consistent with observations that the lesion producing Bell's palsy and herpes zoster oticus usually is situated at the meatal foramen. PMID: 2337309 [PubMed - indexed for MEDLINE] 4104. Am J Med. 1990 May;88(5):550-1. Varicella zoster virus transverse myelitis without cutaneous rash. Heller HM, Carnevale NT, Steigbigel RT. State University of New York, Stony Brook. PMID: 2337114 [PubMed - indexed for MEDLINE] 4105. Laryngoscope. 1990 May;100(5):494-7. Atypical findings in cephalic herpes zoster polyneuritis: case reports and radiographic findings. Golden LI, Deeb ZE, deFries H. Department of Otolaryngology-Head and Neck Surgery, Georgetown University Hospital, Washington, DC. The purpose of this presentation is to report six patients who were seen because of multiple cranial nerve deficits occurring within a clinical picture of herpes zoster of the head and trunk. The clinical behavior, diagnostic methods, treatment, and outcome of the patients in this series are reviewed. The vagus and cochleovestibular nerves were affected in all of the patients. Three patients had radiographic evidence of a mass in the nasopharyngeal region. Malignancies were ruled out by repeated biopsies. PMID: 2329906 [PubMed - indexed for MEDLINE] 4106. Reg Anesth. 1990 May-Jun;15(3):113-7. Interpleural analgesia in the treatment of severe thoracic postherpetic neuralgia. Reiestad F, McIlvaine WB, Barnes M, Kvalheim L, Haraldstad P, Pettersen B. Department of Anesthesiology, University of Colorado Health Sciences Center, Denver. Effective, long-lasting pain relief was produced in 26 patients suffering from severe thoracic postherpetic neuralgia by intermittent administration of local anesthetics into the pleural space through a percutaneously placed interpleural catheter. The duration of treatment varied from seven to 21 days. During this period, 30 ml of 0.5% bupivacaine with epinephrine (5 micrograms/ml) were injected every 24 hours. The injections were continued for three days after the patients were pain free or had reached an analgesic plateau. All patients achieved good to excellent pain relief. During a follow-up period of five to 15 months, their level of pain has not increased from the level achieved at the end of the treatment program. PMID: 2265163 [PubMed - indexed for MEDLINE] 4107. J Dermatol. 1990 May;17(5):326-8. Unusual varicella zoster virus infection in a patient with colon carcinoma and Evans syndrome--delayed virus shedding generalized recurrent necrotic herpes zoster. Hata S, Tamaki T. Department of Dermatology, Osaka Rosai Hospital, Japan. A 53-year-old Japanese woman with Evans syndrome and colon cancer had two episodes of herpes zoster. The first painful vesicular rashes involved the right lower abdomen and buttock and healed in one month. After one more month, a second attack occurred on the right thigh and leg and developed into generalized hemorrhagic lesions, which became crusted in about 90 days. The patient died 131 days after the second attack, when the lesions had almost subsided. Varicella-zoster virus (VZV) was isolated on the 59th day of the second attack. Her intracutaneous reactions to VZV antigen was negative, but the humoral antibodies were continuously positive. PMID: 2166097 [PubMed - indexed for MEDLINE] 4108. Mo Med. 1990 May;87(5):287-90. Viral infection and HIV disease. Bailey TC. Department of Medicine, Washington University School of Medicine. HIV-positive patients are at risk for a number of serious viral infections. The author presents on overview of some common viral infections these patients are susceptible to and stresses the importance of early diagnosis for appropriate treatment. PMID: 2164135 [PubMed - indexed for MEDLINE] 4109. J Neurosci Res. 1990 May;26(1):90-7. Acute and persistent varicella-zoster virus infection of human and murine neuroblastoma cell lines. Bourdon-Wouters C, Merville-Louis MP, Sadzot-Delvaux C, Marc P, Piette J, Delrée P, Moonen G, Rentier B. Department of Microbiology-Virology, University of Liège, Belgium. Human and murine neuroblastoma cell lines were infected in vitro with varicella-zoster virus (VZV). Infected human neuroblastoma cells (IMR-32) supported the synthesis of abundant viral antigens as detected by indirect immunoperoxidase labeling using human serum rich in anti-VZV antibodies and did not survive the infection. In situ hybridization (ISH) with VZV-cloned probes revealed a strong hybridization signal in these infected cells. During cultivation, the virus was released in the culture medium, and viral polypeptides were revealed by Western blotting of infected cells, using either a monoclonal anti-gpI antibody or a rabbit antiserum. All these findings indicate that IMR-32 cells support a productive and lytic infection by VZV, whether infected by cell-free virus or by cocultivation with infected cells. Murine neuroblastoma cells (neuro-2A) survived VZV infection and did not produce any infectious virus. No VZV-specific proteins were detected in infected cells either by immunolabeling or by Western blotting. However, viral nucleic acids could be detected by ISH, indicating that mouse neuroblastoma cells displayed a nonproductive, nonlytic infection. Infected neuro-2A cells have been examined by ISH using probes corresponding to immediate early (IE) genes 4, 62, and 63 and late (L) gene 31 encoding gpII. A strong hybridization signal was detected when infected cells were probed with a fragment containing the IE genes 62 and 63. Lower levels of hybridization were detected with the other probes, corresponding to IE or L genes. These systems allow comparative molecular analysis of persistent and acute infection of nerve cells by VZV. PMID: 2162972 [PubMed - indexed for MEDLINE] 4110. Ugeskr Laeger. 1990 Apr 23;152(17):1214-7. [Herpes zoster paresis. A review of the literature and case reports] [Article in Danish] Lyngberg KK, Svensson BH. Bispebjerg Hospital, København. The incidence of paresis due to herpes zoster (HZ) infections are reported very differently in the literature with rates varying from 0.5 to 31%. Many of the paresis are presumed to be undiagnosed on account of topographic dissociation, variable periods from the cutaneous affection to the muscular involvement, masking of the paresis by pain, paresis of the intercostal and abdominal muscles which are not obvious and difficulties in correlating the visceral symptoms with a herpes zoster eruption. Paresis of the cranial nerves are easily diagnosed and 50% of all HZ paresis are diagnosed from this region. Early acyclovir treatment has improved the prognosis. Four cases of hypotonic herpes zoster paresis in immunocompetent persons are described and the diagnostic difficulties are discussed. PMID: 2158682 [PubMed - indexed for MEDLINE] 4111. Presse Med. 1990 Apr 21;19(16):752-4. [Zona in 50 patients infected by human immunodeficiency virus. Clinical manifestations and prognostic value] [Article in French] Perronne C, Lazanas M, Bellou A, Leport C, Canton P, Vildé JL. Service des Maladies infectieuses et tropicales, Hôpital Claude-Bernard, Paris. Comment in: Presse Med. 1990 Dec 8;19(42):1950. Between January 1981 and April 1989, 50 patients infected with HIV were examined for herpes zoster. Herpes zoster enabled HIV infection to be detected in 23 patients (46 percent). It had only one localisation (involving contiguous dermatomes) in 37 patients, two localisations in 6 patients, three or four localisations in 1 patient each, and was disseminated in 5 patients. Localisations were mostly thoracic and cervicofacial. Herpes zoster was treated with acyclovir in 29 patients. All patients, treated or untreated, recovered from herpes zoster, but 9 of them (18 percent) had sequelae: pain in 8 and hypoacousia in 1. Herpes zoster recurred once in 8 patients and twice in 2. Among the patients with AIDS related complex 20 percent developed AIDS after herpes zoster at one year and 30 percent at two years. Among all the patients, the proportion of deaths after herpes zoster was 13 percent at one year and 34 percent at two years. PMID: 1971106 [PubMed - indexed for MEDLINE] 4112. Rinsho Shinkeigaku. 1990 Apr;30(4):452-4. [A case of herpes zoster myelitis improved with acyclovir] [Article in Japanese] Yasuda Y, Akiguchi I, Kameyama M. Department of Neurology, Kyoto City Hospital. A case of herpes zoster myelitis improved with acyclovir was reported. A 71-year-old female showed a rash over the S2-4 dermatomes on the right side. After that, paraplegia and dysuria progressed. Patellar tendon reflex was exaggerated, but Achilles tendon reflex was normal. Babinski and Chaddock sign were bilaterally elicited. Superficial sense was markedly decreased below the Th12 dermatome. Vibration sense was slightly decreased but position sense was normal on the lower extremities. Cerebrospinal fluid analysis revealed pleocytosis, and an elevation of IgG and varicella-zoster virus antibody titer. Acyclovir (250 mg bid/day) was given for ten days. Paraplegia, sensory disturbance and dyschezia improved but dysuria did not. In this case acyclovir administration was started on the 18th day after the onset of myelopathy. Early initiation of acyclovir treatment might lead to recovery of dysuria. As the pathogenic mechanism of herpes zoster myelitis is considered to be direct viral invasion of the spinal cord with subsequent necrosis, early initiation of acyclovir treatment is necessary for the recovery. PMID: 2387118 [PubMed - indexed for MEDLINE] 4113. J Am Acad Nurse Pract. 1990 Apr-Jun;2(2):64-8. Herpes zoster: etiology, clinical course, and suggested management. Boley T, Curtis J. Herpes zoster is an acute viral infection that results from reactivation of a latent varicella-zoster virus often acquired as chickenpox during childhood. Fifty percent of all people living to the age of 85 will have an attack of zoster. The goal of intervention is to reduce associated pain and discomfort. A prompt diagnosis and appropriate management can best be achieved by understanding the disease and treatment options. While herpes zoster occurs with greater frequency in the geriatric population, it can occur throughout an individual's life span. The nurse practitioner working in any setting is likely to see patients present with herpes zoster. A protocol for patient management is included in this article as a resource for the nurse practitioner who encounters this diagnosis. PMID: 2354080 [PubMed - indexed for MEDLINE] 4114. Ulster Med J. 1990 Apr;59(1):77-81. Cerebral vasculitis associated with shingles. Edgar JD, Crosbie JJ, Hawkins SA. Department of Medicine, Queen's University of Belfast. PMCID: PMC2448273 PMID: 2349753 [PubMed - indexed for MEDLINE] 4115. Arch Dermatol. 1990 Apr;126(4):546-7. Skin lesions as the sole manifestation of the fetal varicella syndrome. Lloyd KM. PMID: 2322006 [PubMed - indexed for MEDLINE] 4116. Minn Med. 1990 Apr;73(4):37-40. Treatment of acute herpetic neuralgia. A case report and review of the literature. Hess TM, Lutz LJ, Nauss LA, Lamer TJ. Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota. Comment in: Minn Med. 1990 Dec;73(12):11-2. Minn Med. 1990 Nov;73(11):7-8. Herpes zoster (shingles) is a viral infection that results from a reactivation of a dormant varicella zoster virus. It has been estimated that more than 300,000 new cases are seen in the United States each year. Several factors influence the incidence of infection, with increasing age being the most consistent. Postherpetic neuralgia is the No. 1 cause of intractable, debilitating pain in the elderly and is the leading cause of suicide in chronic pain patients over the age of 70. PMID: 2186265 [PubMed - indexed for MEDLINE] 4117. Rinsho Shinkeigaku. 1990 Apr;30(4):413-5. [A case of unilateral VIIIth, IXth and Xth cranial nerve involvement with herpes zoster] [Article in Japanese] Yoshioka A, Kitagawa Y, Kawada J, Negami T, Hirose G. Department of Neurology, Asanogawa General Hospital. A 46-year-old healthy man suffered from sore throat, fever and right otalgia. On the next day, he developed hoarseness and difficulty in swallowing. On the 6th day, he suffered from vertigo, nausea and vomiting associated with unsteady gait. He was admitted to the otorhinolaryngology department in our hospital and pointed out to have vesicles at his right ear. On the 13th day, he was referred to our service. On admission, no vesicles were noted at the right ear or pharynx. Neurological examination revealed mild nuchal rigidity and marked hoarseness, associated with poor elevation of soft palate and loss of pharyngeal reflex on the right side. He also had horizontal-clockwise rotatory nystagmus in primary gaze and ataxic gait. There was no hearing loss nor facial palsy. No other abnormal neurological findings were noted. The cerebrospinal fluid showed pleocytosis associated with increased protein. The viral antibody titre for herpes zoster was significantly elevated on 18th day in serum as well as in cerebrospinal fluid. Vertigo, nausea, vomiting, ataxia and difficulty in swallowing were all disappeared by the 25th day, whereas hoarseness was improved but still noted 6 months later. Among cranial nerves, trigeminal and facial nerves are the most commonly affected in patients with herpes zoster, but there have been a few reported cases of the 9th and 10th cranial nerve involvement in the literature. In these previously reported cases, all were written before the era of serological diagnosis, and herpes zoster was diagnosed by the vesicles at the ear or pharynx.(ABSTRACT TRUNCATED AT 250 WORDS) PMID: 2167188 [PubMed - indexed for MEDLINE] 4118. Arch Dermatol. 1990 Apr;126(4):537-9. Cutaneous cytomegalovirus or disseminated verrucous varicella zoster. Berger TG. Comment on: Arch Dermatol. 1989 Sep;125(9):1243-6. PMID: 2157374 [PubMed - indexed for MEDLINE] 4119. Acta Neurol Scand. 1990 Apr;81(4):341-5. Specific in vitro IgG subclass synthesis and lymphocyte proliferation responses in herpes virus encephalitis. Mathiesen T, Olding-Stenkvist E, Linde A, Olsson O, Wahren B. Department of Virology, Karolinska Institute, Stockholm, Sweden. Cerebrospinal fluid, peripheral blood lymphocytes (PBL) and sera from 5 patients with herpes simplex encephalitis (HSVE), 3 with varicellae zoster (VZV) meningoencephalitis and 5 with encephalitis of unknown origin (NUD) were analyzed. Lymphocytes from both blood and CSF were shown to synthesize anti-VZV IgG subclasses in VZV meningoencephalitis and anti-HSV IgG subclasses in HSVE. The subclass patterns of CSF and in vitro synthesized anti-viral IgG were similar, suggesting that a considerable portion of the antiviral IgG subclasses detected are synthesized in the CNS compartment. Antigen presentation in vitro seemed to produce a heterologous IgG4 and/or 3 response in 3 patients. Lymphocyte proliferation was detectable in response to HSV and VZV, respectively. PMID: 2113757 [PubMed - indexed for MEDLINE] 4120. Lancet. 1990 Mar 24;335(8691):732. Advertising acyclovir. Jones K. PMID: 1969091 [PubMed - indexed for MEDLINE] 4121. Orv Hetil. 1990 Mar 11;131(10):529-30. [Herpes zoster infection with acute urinary retention] [Article in Hungarian] Jakab G, Komoly S, Juhász E. Semmelweis Orvostudományi Egyetem, Neurológiai Klinika. The history of a young female patient is presented. She developed urine retention of sudden onset as a complication of herpes zoster infection manifested in the sacral dermatomes. Symptomatic and antiviral treatments were introduced with full recovery of bladder function. The correct diagnosis of this rare and benign complication of herpes zoster infection can help to avoid unnecessary and invasive examinations. PMID: 1690375 [PubMed - indexed for MEDLINE] 4122. Indian J Cancer. 1990 Mar;27(1):28-30. Herpes zoster in mesothelioma. A case report. Dwivedi S, D'Souza C. Department of medicine, Kasturba Medical College Hospital, Karnataka, India. Diffuse mesothelioma with a large pleural effusion was diagnosed nine months after the appearance of herpes zoster in the overlying thoracic segment in a patient presenting with chest pain mimicking post-herpetic neuralgia. Clinical implications of such an association are discussed. PMID: 2391128 [PubMed - indexed for MEDLINE] 4123. Neurologia. 1990 Mar;5(3):98-101. [Granulomatous angiitis of the basilar artery related to herpes zoster of the 7th cranial nerve] [Article in Spanish] Romero López J, Sarasa Corral JL, Yáñez Baña RM, Pareja Grande JA, González-Elipe J. Servicio de Neurología, Fundación Jiménez Díaz, Universidad Autónoma de Madrid. Granulomatous angiitis of the central nervous system is an uncommon condition characterized by vascular wall necrosis, inflammatory exudate and development of giant cells in medium and small size vessels. The pathogenesis of this disease remains unknown, but it has been associated with immune complexes, mechanical factors and infection by the varicella-zoster virus. We report a young patient who presented with herpes zoster involving the VII cranial nerve and contralateral hemiplegia. Subsequently, pontine infarct and fatal subarachnoid hemorrhage developed. The pathological study showed granulomatous angiitis of basilar artery. PMID: 2361047 [PubMed - indexed for MEDLINE] 4124. Clin Exp Dermatol. 1990 Mar;15(2):155-6. Herpes zoster following spinal surgery. Jordaan HF, du Toit G. Comment on: Clin Exp Dermatol. 1989 Jan;14(1):56-7. PMID: 2347111 [PubMed - indexed for MEDLINE] 4125. Minerva Med. 1990 Mar;81(3 Suppl):95-103. [Antalgic treatment of acute herpes zoster. A clinical contribution] [Article in Italian] Di Laura I, Tiboldo F. U.S.S.L. n. 47, Ospedale degli Inferni, Biella (Vercelli). The paper considers the difficulty of pain control in acute herpes zoster and the considerable incidence of NPH in patients given the conventional medical therapies. After a short account of physiopathology of herpetic pain, the treatment of acute cases with epidural or sympathetic blockages using anaesthetics and cortisone is proposed. Personal experience in a series of patients with either acute herpes zoster or NPH who were treated with this method is reported with details of peculiarities and results. PMID: 2325877 [PubMed - indexed for MEDLINE] 4126. Clin Pharmacol Ther. 1990 Mar;47(3):305-12. Desipramine relieves postherpetic neuralgia. Kishore-Kumar R, Max MB, Schafer SC, Gaughan AM, Smoller B, Gracely RH, Dubner R. Neurobiology and Anesthesiology Branch, National Institute of Dental Research, National Institute of Health, Bethesda, MD 20892. Desipramine has the least anticholinergic and sedative effects of the first generation tricyclic antidepressant agents, but its pain-relieving potential has received little study. Other antidepressant agents--notably amitriptyline--are known to ameliorate postherpetic neuralgia, but those agents are often toxic. In a randomized double-blind crossover design, we gave 26 postherpetic neuralgia patients 6 weeks of treatment with desipramine (mean dose, 167 mg/day) and placebo. Nineteen patients completed both treatments; 12 reported at least moderate relief with desipramine and two reported relief with placebo. Pain relief with desipramine was statistically significant from weeks 3 to 6. Psychiatric interview at entry into the study produced a diagnosis of depression for 4 patients; pain relief was similar in depressed and nondepressed patients and was statistically significant in the nondepressed group alone. We conclude that desipramine administration relieves postherpetic neuralgia and that pain relief is not mediated by mood elevation. Blockade of norepinephrine reuptake, an action shared by desipramine, amitriptyline, and other antidepressant agents that have relieved neuropathic pain, may be involved in relief of postherpetic neuralgia. PMID: 2178851 [PubMed - indexed for MEDLINE] 4127. Semin Respir Infect. 1990 Mar;5(1):38-49. Viral pneumonia in recipients of solid organ transplants. Anderson DJ, Jordan MC. Department of Medicine, University of Minnesota Medical School, Minneapolis. Viral pulmonary infections are a major cause of morbidity and mortality in solid organ transplant recipients. The herpes viruses-cytomegalovirus, herpes simplex virus, varicella zoster virus, and Epstein-Barr virus--cause most of the viral infections in this population. Respiratory syncytial virus, adenovirus, and human immunodeficiency virus also cause pneumonitis in the transplant recipient. Differences in the clinical and laboratory presentation of pneumonitis due to the various viral agents can provide clues to the etiology. However, definitive diagnosis requires laboratory identification of the virus or appropriate serologic changes. With cytomegalovirus, herpes simplex virus, Epstein-Barr virus, and adenovirus, one must take care to distinguish between asymptomatic shedding of the virus and disease produced by the virus. Advances in diagnostic techniques such as rapid antigen detection, nucleic acid hybridization, and gene amplification may allow an earlier diagnosis of viral pneumonia. Advances in risk reduction with appropriate pairing of donors and recipients, improved immunosuppressive regimens, vaccination, and prophylactic administration of antiviral agents may reduce the incidence of viral infection. Finally, advances in anti-viral therapy have made possible the successful treatment of pneumonia due to some of the viral agents. PMID: 2160718 [PubMed - indexed for MEDLINE] 4128. Infect Dis Clin North Am. 1990 Mar;4(1):159-73. Prospects for use of a varicella vaccine in adults. Hardy IR, Gershon AA. Department of Pediatrics, Columbia University, College of Physicians and Surgeons, New York, New York. Five to 10% of people reach adulthood still susceptible to VZV, which generally causes more severe primary disease in adults than seen in children. A live attenuated varicella vaccine was developed in Japan in the early 1970s and has now been tested in several trials in healthy children, immunocompromised children, and healthy adults. The vaccine is highly immunogenic in healthy children, conferring immunity for at least 7 to 10 years with a high degree of protective efficacy. In several trial in adults, the vaccine has been shown to be highly immunogenic. Humoral and cell-mediated immunity wanes in vaccinated adults, however, with antibodies to VZV detectable in approximately only 80% of vaccinated individuals after 1 year, and in approximately 70% from 2 to 6 years after vaccination. In leukemic children who have been vaccinated, however, this loss of detectable antibody has not been correlated with a reduction in protection during this time. Similar analyses have not been made in vaccinated adults because the numbers intimately exposed to VZV have been small. Protective efficacy after household exposure is approximately 65% in adults; however, when breakthrough (i.e., in those who have seroconverted) illness has occurred, it has invariably been mild, so that efficacy in preventing severe disease has been 100%. "Vaccine failures," however, may develop full-blown varicella. Side effects of immunization in adults are mild: a transient local reaction occurs in 10 to 21% and a mild rash in 6 to 8%. There is a theoretical risk of transmission of the attenuated virus if a vaccine-induced rash occurs, which has been documented only in contacts of vaccinated leukemics (any secondary disease has also been mild). To date, there has been no evidence that vaccination increases the risk of developing zoster; on the contrary, studies in leukemic children, who may be considered a "sentinel population" in this regard, suggest that the risk of zoster after vaccination may be reduced compared with the risk after natural infection. Susceptible adults who would most benefit from vaccination against VZV include health care workers, those who care for small children, women of child-bearing age prior to pregnancy, military recruits, and college students. PMID: 2155261 [PubMed - indexed for MEDLINE] 4129. AJNR Am J Neuroradiol. 1990 Mar-Apr;11(2):409. Ramsay Hunt syndrome mimicking intracanalicular acoustic neuroma on contrast-enhanced MR. Anderson RE, Laskoff JM. Orlando Regional Medical Center, FL 32806. PMID: 2107729 [PubMed - indexed for MEDLINE] 4130. Rev Chil Pediatr. 1990 Mar-Apr;61(2):77-80. [Varicella-zoster virus infection in children with Hodgkin's disease in advanced stages III and IV] [Article in Spanish] Zolezzi P, Wenzel MS, Delgado MO. Instituto de Pediatría, Facultad de Medicina, Universidad Austral de Chile. Over a 10-year period, among 22 children with Hodgkin's disease (stages III and IV), 10 (45.5%) developed varicella-zoster virus (VZV) infection, varicella in 8 cases (36.4%) and herpes zoster (HZ) in 3 (13.6%) (one patient had varicella and six months later). Three patients with varicella had significant pneumonitis, one of them showed clinical evidence of dissemination and died. Two patients had localized HZ and one had disseminated HZ without visceral involvement. All cases of VZV infections occurred in the first year of treatment: the primary infection presented while patients were under induction therapy and the secondary one after radiotherapy. PMID: 1967047 [PubMed - indexed for MEDLINE] 4131. Lancet. 1990 Feb 3;335(8684):288. Advertising acyclovir. Anderton D. PMID: 1967739 [PubMed - indexed for MEDLINE] 4132. South Med J. 1990 Feb;83(2):247-9. Herpes zoster infection of the chest wall and the syndrome of inappropriate antidiuretic hormone secretion. Sato TL, Jones JS, McGrail MA, MacLean DB. Department of Medicine, Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, NC. The syndrome of inappropriate antidiuretic hormone secretion (SIADH) can result from diverse conditions. There have been only two published reports linking this syndrome with herpes zoster infections--one disseminated and the other confined to the chest wall. We have reported a case in which herpes zoster infection of the chest wall probably precipitated the development of this syndrome. PMID: 2406941 [PubMed - indexed for MEDLINE] 4133. Can J Ophthalmol. 1990 Feb;25(1):42-3. External ophthalmomyiasis associated with herpes zoster ophthalmicus. Verma L, Pakrasi S, Kumar A, Sachdev MS, Mandal AK. Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi. Ophthalmomyiasis is a rare entity caused by infestation with certain dipterous larvae. We describe a 71-year-old farmer with herpes zoster ophthalmicus on the left side of the face in whom the blisters became secondarily infested with Chrysomyia bezziana maggots. The maggots were removed mechanically, and the corneal involvement secondary to zoster ophthalmicus responded to therapy with topical steroids and cycloplegics. To our knowledge this is the first report of external ophthalmomyiasis due to C. bezziana. PMID: 2328437 [PubMed - indexed for MEDLINE] 4134. Masui. 1990 Feb;39(2):248-52. [A case of herpes zoster ophthalmicus with complete ophthalmoplegia] [Article in Japanese] Fujiwara M, Odashiro M, Mizoguchi H, Hayashi I, Kawamura J, Hashimoto T, Tamura K. Department of Anesthesiology, Kin-ikyo Chuo Hospital, Sapporo. A 58-year old man with herpes zoster ophthalmicus developed complete ophthalmoplegia, dissemination of herpetic lesions and meningitis. Eye movements improved two month after the onset of zoster. Five months later, eye movements recovered completely, but his sight was disturbed severely due to corneal ulcer. PMID: 2325259 [PubMed - indexed for MEDLINE] 4135. J Laryngol Otol. 1990 Feb;104(2):104-8. Audiological manifestations of Ramsay Hunt syndrome. Wayman DM, Pham HN, Byl FM, Adour KK. Department of Otolaryngology, Kaiser Permanente Medical Center, Oakland, CA 94611-5693. Ramsay Hunt syndrome is known to cause audiological signs and symptoms, including sudden, unexpected hearing loss. We carried out a retrospective review of the audiological manifestations of 186 patients with Ramsay Hunt syndrome, measuring their hearing loss patterns, hyperacusis, tinnitus, herpetic rash, facial paralysis, pain and vertigo. Statistical correlations of these parameters were equated with prognosis. Prognosis for eventual hearing recovery is, in general, excellent. Prognostic indicators of poor hearing recovery include advanced age, retrocochlear hearing loss, male gender, vertigo, and speech frequency hearing loss. PMID: 2324614 [PubMed - indexed for MEDLINE] 4136. J Neurol Neurosurg Psychiatry. 1990 Feb;53(2):135-41. Somatosensory findings in postherpetic neuralgia. Nurmikko T, Bowsher D. Pain Relief Foundation, Walton Hospital, Liverpool. Somatic sensory perception thresholds (warm, cold, hot pain, touch, pinprick, vibration, two-point discrimination), allodynia and skin temperature were assessed in the affected area of 42 patients with unilateral postherpetic neuralgia (PHN) and 20 patients who had had unilateral shingles not followed by PHN (NoPHN), and in the mirror-image area on the other side. There was no difference between the two groups for age or length of time after the acute herpes zoster infection. The PHN group showed significant changes in all sensory threshold measurements when the affected area was compared with the mirror-image area on the unaffected side, while the NoPHN group exhibited no threshold changes. Mechanical allodynia was present in 87% of the PHN group; half of the 12 patients with ophthalmic PHN showed extension of allodynia to the maxillary distribution. No differences in skin temperature were recorded between affected and unaffected regions in either group. Our findings show a deficit of sensory functions mediated by both large and small primary afferent fibres and also suggest major central involvement in the pathophysiology of the condition. If PHN does not occur following acute herpes zoster, recovery of neural functions appears to be good. PMCID: PMC487954 PMID: 2313300 [PubMed - indexed for MEDLINE] 4137. Pain. 1990 Feb;40(2):131-5. Benzydamine cream for the treatment of post-herpetic neuralgia: minimum duration of treatment periods in a cross-over trial. McQuay HJ, Carroll D, Moxon A, Glynn CJ, Moore RA. Oxford Regional Pain Relief Unit, Abingdon, Oxon, U.K. In a double-blind multiple-dose cross-over study benzydamine 3% cream was compared with placebo for the treatment of post-herpetic neuralgia. Pain relief, pain intensity, sleep, escape analgesic consumption and side effects were assessed by diary methods for the 2 week treatment periods, with 1 week run-in and 1 week wash-out. There were no significant differences between the 2 treatments. The implications of the results for other antiprostaglandin remedies recommended for treatment of post-herpetic neuralgia are discussed. An important observation with methodological significance for similar studies of chronic conditions was that short treatment periods may produce false positive results. Patients' expectations are high, and if the first study treatment is ineffective, initial significant benefit may be noted when crossing over to the next treatment; this may not last longer than 1 week. Cross-over studies in which neither treatment is effective may, therefore, produce erroneous results if treatment periods are shorter than 2 weeks. PMID: 2308759 [PubMed - indexed for MEDLINE] 4138. Ann Intern Med. 1990 Feb 1;112(3):187-91. Acyclovir-resistant varicella zoster virus infection after chronic oral acyclovir therapy in patients with the acquired immunodeficiency syndrome (AIDS). Jacobson MA, Berger TG, Fikrig S, Becherer P, Moohr JW, Stanat SC, Biron KK. University of California, San Francisco. Four patients with human immunodeficiency virus (HIV) infection who received chronic oral acyclovir therapy for suppression of recurrent varicella zoster or herpes simplex virus infection developed persistent disseminated hyperkeratotic papules that failed to heal with intravenous or high-dose oral acyclovir therapy. Varicella zoster virus, resistant to acyclovir in vitro, was isolated from skin lesions of all four patients. Three patients were adults in whom the acquired immunodeficiency syndrome (AIDS) had been diagnosed 12 to 20 months before isolation of acyclovir-resistant varicella zoster virus. The fourth patient was a perinatally HIV-infected child who developed primary varicella infection at age 7 years when profoundly immunosuppressed (absolute CD4+ lymphocyte count less than 50 cells/microL). Mean antiviral susceptibilities (ED50 values) of the four clinical isolates compared with the ED50 values of the reference strain Oka were 85 compared with 3.3 mumol/L for acyclovir, 1.4 compared with 0.8 mumol/L for vidarabine, and 123 compared with 117 mumol/L for foscarnet. When assayed by [125I]-dC plaque autoradiography, 90% to 100% of the viral isolate populations had altered or no measurable thymidine kinase function. Acyclovir-resistant varicella zoster virus infection may complicate long-term oral acyclovir administration in patients with AIDS and may be associated with the appearance of atypical hyperkeratotic papules. PMID: 2297195 [PubMed - indexed for MEDLINE] 4139. J Otolaryngol. 1990 Feb;19(1):46-9. Speculation into the etiologic role of viruses in the development of Bell's palsy and disorders of inner ear dysfunction: a case history and review of the literature. Bance M, Rutka J. Institute of Medical Sciences, University of Toronto, Ontario, Canada. It has long been postulated that Bell's palsy and a number of inner ear disorders may have as their basis a common underlying viral etiology. The change from one recognizable inner ear disorder into another is not unusual in the same patient and has been recognized by neurotologists. The case history of a patient who initially presented with an idiopathic facial palsy that years later developed into a spectrum of vestibular dysfunction associated with the clinical stigmata of herpes zoster is discussed. Although difficult to prove, support for this continuum theory is reviewed, taking into account known viral involvement in other cranial nerves and various histopathologic findings from disorders involving the inner ear and facial nerve. PMID: 2179576 [PubMed - indexed for MEDLINE] 4140. Nippon Rinsho. 1990 Feb;48 Suppl:324-7. [Serodiagnosis of varicella zoster virus infection] [Article in Japanese] Takayama M. Department of Virology and Ricketsiology, National Institute of Health. PMID: 2162422 [PubMed - indexed for MEDLINE] 4141. Kansenshogaku Zasshi. 1990 Feb;64(2):224-30. [A clinical and pathological study on varicella-zoster virus pneumonia] [Article in Japanese] Tashiro T, Masuda M, Saburi Y, Shieno H, Goto J, Nasu M. Second Department of Internal Medicine, Medical College of Oita. A 48-year-old male with Adult T-cell leukemia (case 1) and a 57-year-old with acute lymphocytic leukemia (case 2) died of rapid progressive pneumonia and pleuritis. Histopathological findings of the lungs were multifocal hemorrhagic coagulation necrosis, and typical Cowdry type A and full type intranuclear inclusion bodies were observed in alveolar cells, bronchial cells, fibroblast, endothelial cells of small vessels, bronchial gland cells and pleural cells. Antigen against varicella-zoster virus (VZV) was positive in these cells by immunostaining, and the antigen was also demonstrated in other organs such as liver, spleen, pancreas, kidney, adrenal gland, esophagus, stomach, intestine and so on. Furthermore, cytomegalovirus was simultaneously superinfected lungs of both cases, and concomitant candida gastritis (case 1), aspergillus lung abscess and candida liver abscess (case 2) were observed. In the immunocompromised host VZV may involve the visceral organs and death may result from VZV pneumonia. PMID: 2159968 [PubMed - indexed for MEDLINE] 4142. Kansenshogaku Zasshi. 1990 Feb;64(2):195-201. [Diagnosis of varicella-zoster virus (VZV) infection by using FITC-labeled monoclonal antibodies] [Article in Japanese] Niimura M, Honda M, Kurata T, Sata T, Sakaoka H, Kawana R, Kawana T, Hidano A, Tamaki K, Hondo R, et al. Department of Dermatology, Jikeikai University School of Medicine. Anti-varicella zoster virus (VZV) mouse monoclonal antibodies conjugated with fluorescein isothiocyanate were evaluated for their usefulness as a practical diagnostic tool in the clinical field by examining cells infected with isolated herpes viruses and 431 clinical samples. The kit stained clearly the cells infected with 14 isolated VZV strains without cross reaction to 15 isolated herpes simplex virus type-1 strains (HSV-1) and 14 type-2 (HSV-2) strains. In clinical specimens, viral antigens of VZV were detected in 92/105 (87.6%) cases of varicella and in 176/190 (92.6%) cases of herpes zoster. Specific fluorescence of VZV was also observed in 5 out of 96 cases diagnosed as HSV infections, although these samples had no specific reaction to HSV when tested by the commercially available diagnostic kit. In 24 cases which could not be clinically diagnosed as herpes zoster or herpes simplex, the VZV antigen was demonstrated in 9 cases. All 109 VZV-positive cases in virus isolation by culture were also judged VZV-antigen positive by the kit, while all 69 HSV-positive cases in virus isolation were VZV-antigen negative. Furthermore, the VZV antigen was detected by the kit in 53/60 clinical diagnoses of varicella or herpes zoster without successful virus isolation. These results clearly indicate the usefulness of the kit as a practical VZV diagnostic reagent, especially in terms of specific sensitivity and easy technical manipulation. PMID: 2159967 [PubMed - indexed for MEDLINE] 4143. West J Med. 1990 Feb;152(2):192-4. Herpes zoster phrenic neuritis with respiratory failure. Melcher WL, Dietrich RA, Whitlock WL. Department of Medicine, Letterman Army Medical Center, Presidio of San Francisco 94129-6700. PMCID: PMC1002315 PMID: 2154900 [PubMed - indexed for MEDLINE] 4144. Blood. 1990 Feb 1;75(3):806-9. Studies on transfer of varicella-zoster-virus specific T-cell immunity from bone marrow donor to recipient. Kato S, Yabe H, Yabe M, Kimura M, Ito M, Tsuchida F, Tsuji K, Takahashi M. Department of Pediatrics, Tokai University School of Medicine, Isehara, Japan. The transfer of antigen-specific cellular immunity in human bone marrow transplantation (BMT) was studied in 49 donor-recipient pairs, using a varicella-zoster-virus (VZV) specific lymphoproliferative response (LPR) assay. Posttransplant VZV-LPR could be serially measured in 31 long-term surviving recipients. VZV-specific T-cell immunity was detected in the early posttransplant period in 4 of 16 recipients who were, and whose donors were, immune to VZV before BMT, but two of those positive responses diminished in the first 100 days posttransplant. No positive response was detected in the immediate posttransplant period when either only the recipient or the donor was immune to VZV pretransplant. Herpes zoster or chickenpox developed in the recipients depending on a history of pretransplant VZV infection when the VZV-LPR became negative, and recovery from VZV infection was always followed by quick conversion of VZV-LPR. Long-lasting positive VZV-LPR was observed in the two recipients who experienced VZV infection in the immediate pretransplant period and received marrow graft from an immune donor. Our results indicate that a simple or direct transfer of VZV-specific cellular immunity from a marrow donor to a recipient cannot be expected in usual clinical bone marrow transplantation and that there might be a collaboration or recruitment of immune responses involving both donor and recipient that permits the VZV-LPR to remain positive posttransplant. PMID: 2153426 [PubMed - indexed for MEDLINE] 4145. Otolaryngol Head Neck Surg. 1990 Feb;102(2):177-9. Ramsay-Hunt syndrome in a patient with HIV infection. Mishell JH, Applebaum EL. Department of Otolaryngology-Head and Neck Surgery, University of Illinois College of Medicine, Chicago. PMID: 2113244 [PubMed - indexed for MEDLINE] 4146. Adv Exp Med Biol. 1990;278:243-53. Acyclovir: the past ten years. Whitley RJ, Middlebrooks M, Gnann JW Jr. Department of Pediatrics, University of Alabama, Birmingham 35294. PMID: 1963040 [PubMed - indexed for MEDLINE] 4147. Br Med Bull. 1990 Jan;46(1):113-23. Treatment of post herpetic neuralgia in the elderly. Robertson DR, George CF. Geriatric Medicine, Southampton General Hospital, UK. The incidence of acute herpes zoster and post herpetic neuralgia (PHN) increases with age. PHN resolves spontaneously within three months in approximately 50% of cases, although 22% experience discomfort for more than a year. There is little good evidence that treatment with antiviral agents, corticosteroids, local and regional anaesthesia, amantadine or levodopa in the acute stage can prevent the development of PHN. However, few studies have sufficient statistical power to allow firm conclusions to be drawn. Amitriptyline is beneficial in patients with established PHN and has an analgesic effect which is independent of its antidepressant action. Anticonvulsants and neuroleptics are of unproven efficacy and should be avoided in the elderly as side effects are common. Various local anaesthetic and surgical techniques may provide temporary relief in individual patients although none has been shown to produce consistent benefit. Transcutaneous electrical nerve stimulation (TENS) is free from adverse effects and appears to benefit some patients. Intractable pain often results in over-prescribing with the risk of adverse drug reactions. Drug therapy should be minimized with careful assessment of the risk/benefit ratio for any additional medication. PMID: 2405937 [PubMed - indexed for MEDLINE] 4148. Neurologia. 1990 Jan;5(1):4-10. [Meningitis of viral or possible viral etiology in adults: study of 325 cases] [Article in Spanish] Martínez-Martín P, Herreros A, Téllez A, Echevarría JM. Servicio de Neurología, Hospital del Rey, Majadahonda, Madrid. During five consecutive years, 325 patients older than 14 years with acute possibly viral acute meningitis (VAM) were evaluated. Demographical, clinical and laboratory data were obtained. In 50.5% of cases the etiological investigation of the disease was undertaken with different methods. From the diagnostic point of view, the findings can be nonspecific or equivocal, and only the judicious assessment of clinical, laboratory (blood CRP) and the overall CSF measurements can prevent errors in an early phase. The viral studies demonstrated a specific etiology in 46% of the instances where they were carried out. The viruses accounting for VAM which were more commonly identified included varicella-zoster, enteroviruses, parotiditis and herpes simplex. PMID: 2361032 [PubMed - indexed for MEDLINE] 4149. Ter Arkh. 1990;62(1):99-103. [Herpes zoster in cancer patients] [Article in Russian] Bogomolov BP, Bakhur EG. In cancer patients, the development of herpes zoster (HZ) is accompanied by protracted period of skin rash exudation and by slower scab rejection. Unlike hematological patients, no unfavourable outcomes with infection generalization are observed. The disease is associated with the rise of the content of total IgM, IgA (to a lesser degree) and with the normal level of IgG. There is a tendency towards the reduction of the count of T and B lymphocytes. The cases of primary diagnosis of a malignant tumor in HZ patients are more frequent (2 out of 36). PMID: 2333632 [PubMed - indexed for MEDLINE] 4150. Graefes Arch Clin Exp Ophthalmol. 1990;228(1):1-4. Cutaneous eruption with or without ocular complications in patients with herpes zoster involving the trigeminal nerve. Yamada K, Hayasaka S, Yamamoto Y, Setogawa T. Department of Ophthalmology, Shimane Medical University, Izumo, Japan. We examined 62 patients with acute herpes zoster involving the trigeminal nerve; 13 had eruptions only and 49 (51 eyes) had eruptions with ocular complications. Bilateral involvement was found in two patients. The frequency of the disease appeared to increase with age, and the disease was least active in November. Patients with eruptions only demonstrated affected areas along the first, second, and/or third divisions of the trigeminal nerve. Ocular complications occurred in patients who had eruptions along the first and/or second divisions of the nerve, and they were usually noted in patients with eruptions on the tip and one side of the node. The ocular complications and associated systemic conditions varied. PMID: 2311939 [PubMed - indexed for MEDLINE] 4151. Nervenarzt. 1990 Jan;61(1):46-51. [Post-herpetic neuralgia: clinical predictors and psychopathologic findings] [Article in German] Leplow B, Lamparter U, Risse A, Wassilev SW. Institut für Psychologie, Christian-Albrechts-Universität, Kiel. 48 patients, who had had acute Herpes zoster were screened for a retrospective investigation concerning the development of post-herpetic neuralgia. Subjects with and without neuralgia were compared with respect to medical, demographic and psychological variables. Nine patients were excluded from the investigation because of reported pain, which was not due to Herpes zoster. From the 39 subjects who remained in the analysis, 59% had postherpetic neuralgia for at least three months, and 28% for more than a year. No medical or demographic risk factor was sufficient for a prediction of the pain group. By applying objective criteria to psychometric test protocols, an index was constructed which differed between the groups. The pain-group showed a higher frequency of psychopathological impairment than those without post-herpetic neuralgia. However, the psychopathology was not consistently related to the length of neuralgia or the intensity of persistent pain. PMID: 2308660 [PubMed - indexed for MEDLINE] 4152. Masui. 1990 Jan;39(1):106-10. [A complete relief of intractable postherpetic neuralgia with intrathecal methylprednisolone acetate] [Article in Japanese] Yamashiro H, Ogata R, Kawahara K. Department of Anesthesia, Hamamatsu Medical Center. A 72-year-old man, 154 cm tall, weighing 53 kg was suffering from severe herpetic neuralgia on his left 10th intercostal nerve area. His pain continued even he was treated with frequent epidural nerve block (4 to 5 times per week) by an anesthesiologist. He was referred to our hospital on his 105th pain day. He complained severe continuous pain and numbness on his left 10th intercostal nerve area. Touching the painful skin induced lightning pain. His pain was so severe that his sleeping was disturbed and also he could not maintain his usual life. Epidural nerve block at 10th thoracic nerve was done with 20mg methylprednisolone acetate and 5ml of 1% lidocaine. After the treatment, his pain was reduced to 3/10 of the one he had on admission, and also his sleep was not disturbed further. Epidural nerve blocks with methylprednisolone weekly for a month induced no more remission. At his 154th pain day, a dose of 20mg methyl prednisolone acetate and 1% lidocaine 5ml was given intrathecally through 2nd lumber intervertebral space. The pain was relieved completely after the block. And he complained nothing about the skin area which had been disturbing his life for a long time. Auditory brainstem response which was recorded during the block showed prolongation of the latency of phase III and phase V at 40 minutes after the intrathecal injection of lidocaine. PMID: 2304244 [PubMed - indexed for MEDLINE] 4153. J Am Acad Dermatol. 1990 Jan;22(1):130-1. Lymphoplasmocytoid lymphoma arising in herpes zoster scars. Aloi FG, Appino A, Puiatti P. Department of Dermatology, University of Turin, Italy. PMID: 2298951 [PubMed - indexed for MEDLINE] 4154. Adv Exp Med Biol. 1990;278:267-75. A double-blind clinical study in patients with herpes zoster to establish YN-72 (Brovavir) dose. Niimura M. Department of Dermatology, Jikei University School of Medicine, Tokyo. Double-blind clinical trials were performed with a placebo to determine the optimum dose of YN-72 in patients with herpes zoster. YN-72 at 10, 50, and 100 mg was administered orally three times daily for 7 days. A total of 226 patients entered the present trial. Six of the 226 patients were excluded from statistical analysis of data. Furthermore, seven patients were excluded from the analysis for efficacy and usefulness, and included in the analysis for safety. The numbers of patients included in the analyses for efficacy and usefulness were 50 in the placebo group, 54 in the YN-72 30-mg/day group, 56 in the 150-mg/day group, and 53 in the 300-mg/day group. The numbers of patients included in analysis for safety were 53 in the placebo group, 58 in the YN-72 30-mg/day group, 56 in the 150-mg/day group and 53 in the 300-mg/day group. The effectiveness rate at the end of administration was 42.0% in the placebo group, 79.6% in the YN-72 30-mg/day group, 80.4% in the 150-mg/day group, and 61.5% in the 300-mg/day group. The rates in the YN-72 groups were significantly higher than in the placebo group. Evaluation at the end of the trials revealed that administration of YN-72 was effective. Among skin symptoms, administration of YN-72 accelerated the disappearance of erythema and vesicles and the formation of crust. Administration of YN-72 tended to accelerate the reduction and disappearance of pain. Reduction and disappearance in the YN-72 150-mg/day group occurred significantly earlier than in the placebo group (log-rank test).(ABSTRACT TRUNCATED AT 250 WORDS) PMID: 2288297 [PubMed - indexed for MEDLINE] 4155. Vestn Dermatol Venerol. 1990;(11):48-9. [A case of generalized herpes zoster ending fatally] [Article in Russian] Dovzhanskiĭ SI, Sherstneva VN, Kozbeva VI, Vedishcheva VA, Rozhdestvenskaia EI. PMID: 2288156 [PubMed - indexed for MEDLINE] 4156. Scand J Infect Dis Suppl. 1990;71:30-5. Varicella-zoster infections in late pregnancy. Sterner G, Forsgren M, Enocksson E, Grandien M, Granström G. Department of Infectious Diseases, Danderyd Hospital, Sweden. PMID: 2287913 [PubMed - indexed for MEDLINE] 4157. Vestn Dermatol Venerol. 1990;(10):62-3. [The gangrenous form of herpes zoster in a patient with disseminated psoriasis] [Article in Russian] Romanenko VN, Makhmud D. PMID: 2278201 [PubMed - indexed for MEDLINE] 4158. Curr Med Res Opin. 1990;12(3):169-76. Double-blind, placebo-controlled clinical trial of a mixture of gangliosides ('Cronassial') in post-herpetic neuralgia. Staughton RC, Good J. Skin Department, Westminster Hospital, London, England. A double-blind, parallel-group clinical trial was carried out in 25 patients with post-herpetic neuralgia to determine the efficacy and tolerability of a mixture of gangliosides ('Cronassial') compared with placebo. Patients were allocated at random to receive treatment with either 'Cronassial' (100 mg in 2 ml buffered solution) or placebo given by 11 subcutaneous injections over a period of 27 days, and their symptoms assessed on entry and after 2, 4 and 8 weeks. The four aspects of pain considered (overall pain, hyperaesthesia, stabbing pain and constant ache) all showed maintained reductions in severity with 'Cronassial' treatment, but not with placebo. In the case of hyperaesthesia, this difference between treatments was statistically significant (both during and after the course of injections), even with the relatively small number of patients in this study. Sleep patterns showed significant sustained improvements with 'Cronassial', but not with placebo treatment. Other psychological assessments (general psychological state, appetite and mood) showed little difference between 'Cronassial' and placebo treatment. Although 'Cronassial' was well tolerated systemically, 1 of the 12 patients was withdrawn because of general malaise, and 5 patients had local pain at the injection sites. Two of these 5 patients were withdrawn from the study. There were no withdrawals in the placebo group. It is suggested that further studies employing greater numbers of patients should be carried out to confirm the efficacy of gangliosides in improving symptoms of patients with post-herpetic neuralgia. PMID: 2272191 [PubMed - indexed for MEDLINE] 4159. Med Cutan Ibero Lat Am. 1990;18(3):151-3. [Zosteriform eruption in a girl during resolution of varicella] [Article in Spanish] del Pozo LJ, Vilella J. Servicio de Dermatología, Hospital del Insalud, Soria. We show the case of a six-years-old little girl with a herpes zoster which appeared while a varicella was resolving. We are discussing the diagnosis difficulties of this process. PMID: 2263089 [PubMed - indexed for MEDLINE] 4160. Vestn Dermatol Venerol. 1990;(8):62-4. [Herpes zoster in 2 sisters] [Article in Russian] Bukharovich AM, Kviatkovskaia GV, Kucher LN. Transmission of herpes zoster infection from one sister to the other is described, resultant from close everyday contacts. Clinical manifestations of the disease (severity, dissemination, course and type of involvement) were much more marked in the elder sister, suffering from disseminated Darier's dyskeratosis and marked debility. Herpes was complicated with vasculitis, necrosis, Pseudomonas aeruginosa infection, development of pneumonia and keratitis. Problems of treatment of such patients are discussed. PMID: 2256385 [PubMed - indexed for MEDLINE] 4161. Acta Paediatr Hung. 1990;30(2):263-70. Early relapses of varicella-zoster virus infection in immunocompromised children treated with acyclovir. Mészner Z, Gyarmati E, Nyerges G, Simon M, Koller M. Postgraduate Medical School, Central Municipal Hospital for Infectious Diseases, Budapest. Authors observed one or more early VZV relapses in 8 out of 98 Acyclovir treated immunocompromised children with varicella. None of the 8 children developed VZV antibodies by the end of the 5-day ACV treatment. All VZV relapses were successfully treated with ACV or Vidarabine, but were stopped only after the appearance of VZV antibodies in the patients' sera. The possible role of ACV treatment in pathogenesis of early VZV relapses could be excluded by comparing the VZV antibody production of patients treated with ACV from the first day of varicella on with the antibody response of those, who received ACV as late as on the 5th day of varicella. By prolonging the ACV treatment till the appearance of VZV antibodies, early relapses could be avoided. PMID: 2248805 [PubMed - indexed for MEDLINE] 4162. Ann Otolaryngol Chir Cervicofac. 1990;107(4):270-2. [How many peripheral facial paralyses are manifestations of Lyme disease? A French multicenter study] [Article in French] Ruel M. Service de Médecine II, Centre Hospitalier de Senlis. The diagnosis of Lyme disease is easy on the basis of clinical features only when it combines migrans chronic erythema, severe root pain affecting the limbs and facial paralysis, above all when bilateral. When pain is transient and slight and when erythema and the tick bite are absent facial paralysis may be mistaken for Bell's palsy. The risk is that of failing to recognise Lyme disease which may subsequently manifest itself as severe neurologic complications minimally sensitive to antibiotics. The multicenter study envisaged is designed to determine the incidence of Borrelia burgdorferi seroconversion in all individuals with a non-traumatic peripheral facial paralysis seen between 1.1.90 and 12.31.90. Serology is difficult to interpret on an individual basis. A large series will be necessary in order to be able to draw reliable conclusions. Two control series will be used: one consisting of a sub-group of facial paralyses with herpes zoster vesicles and the other based upon pairing of two control sera for each Borrelia burgdorferi positive serum. This should show whether Lyme disease need really be feared in presence of an apparently isolated FP. PMID: 2221718 [PubMed - indexed for MEDLINE] 4163. Srp Arh Celok Lek. 1990 Jan-Feb;118(1-2):23-8. [Acute meningitis without cutaneous manifestations caused by varicella zoster virus--intrathecal synthesis of specific antibodies] [Article in Serbian] Nikolić S, Vujosević M, Zerajev S, Dulović O. The results of virusologic and cytobiochemical evaluation of CSF and serum samples of four patients with acute viral meningitis (AVM), most probably induced by varicella zoster virus (VZV), are reported. In no case VZV infection was not cutaneously manifested. Aetiologic diagnosis was established according to the presence of specific anti VZV AVM, in spite of their presence in the sera. On samples detected by indirect enzyme immunoassay (EIA). Four different antibody indexes were used to prove that the antibodies were intrathecally synthesized. Other viral antibodies (HSV, mumps) were not evident in the CSF samples of the patients with VZV avm, in spite of their presence in the sera. On the other hand, anti VZV antibodies could not be identified in the CSF samples of the controls (AVM of other aetiology, meningism) in spite of their presence in the sera. A possible aetiologic link between anti VZV antibodies presence in the CSF samples and some neurologic syndromes is discussed. PMID: 2218729 [PubMed - indexed for MEDLINE] 4164. Jpn J Med. 1990 Jan-Feb;29(1):99-103. Herpes zoster ophthalmicus with delayed contralateral hemiparesis. Tojo K, Onozawa T, Toyohara K, Shimojo S, Sakai O. Second Department of Medicine, Jikei University School of Medicine, Tokyo, Japan. A 35-year-old previously healthy woman developed left hemiparesis sixteen weeks after the onset of right herpes zoster ophthalmicus. Cerebral angiography showed complete occlusion of right middle cerebral artery at the origin and segmental narrowing of the right posterior cerebral artery. Computerized tomography (CT) and magnetic resonance imaging (MRI) also revealed a right hemispheric lesion consistent with angiographic findings. Reports from the literature along with the present case suggest that arteritis followed by cerebral infarction is the most probable cause of delayed contralateral hemiparesis. PMID: 2214356 [PubMed - indexed for MEDLINE] 4165. Psychosomatics. 1990 Summer;31(3):287-92. A double-blind, placebo-controlled study of oral acyclovir in postherpetic neuralgia. Surman OS, Flynn T, Schooley RT, Baer L, Parker S, Hirsch MS, Davis LG. Department of Psychiatry, Massachusetts General Hospital, Boston 02114. Twenty-one patients with postherpetic neuralgia of two- to 84-months duration participated in a double-blind, placebo-controlled study of oral acyclovir. Pain perception was assessed with the Melzack Pain Questionnaire at baseline and at two-to six-week intervals during the ensuing six months. Clinically significant pain reduction occurred in eight patients: four received acyclovir, and four received a placebo. Several treatment strategies have been advocated for relief of postherpetic neuralgia. Results of the present study demonstrate the need for a double-blind, placebo-controlled paradigm to substantiate the efficacy of new clinical approaches. The same caveat applies to the more common syndromes encountered in psychiatric practice. PMID: 2201992 [PubMed - indexed for MEDLINE] 4166. Cancer Invest. 1990;8(5):509-21. Herpesvirus and enteric viral infections in bone marrow transplantation: clinical presentations, pathogenesis, and therapeutic strategies. Holland HK, Wingard JR, Saral R. Oncology Center, Johns Hopkins Medical Institutions, Baltimore, Maryland. PMID: 2176125 [PubMed - indexed for MEDLINE] 4167. Arch Virol. 1990;112(3-4):203-13. HSV-1 gB and VZV gp-II crossreactive antibodies in human sera. Kühn JE, Klaffke K, Munk K, Braun RW. Institute for Medical Virology, University of Heidelberg, Federal Republic of Germany. The specificity and prevalence of human IgG antibodies crossreactive between HSV-1 (ANG) and VZV (Ellen) was examined in immunoblots. Using antibody fractions purified on HSV- and VZV-coated affinity chromatography columns and by preadsorption of sera with HSV and/or VZV lysates a crossreactivity between HSV-1 gB and VZV gp-II was demonstrated. Crossreaction of human IgG antibodies among other structural and nonstructural viral proteins, however, was not detected. The frequency of human IgG antibodies crossreactive between HSV-1 gB and VZV gp-II was highest in HSV-seropositive patients experiencing an acute primary VZV infection (4 out of 5 sera tested). In contrast, no crossreactive antibodies were found in sera of HSV-seronegative patients with acute primary VZV infection (0/6) or in sera from individuals with acute recurrent HSV or VZV infection (0/12). Analysis of sera from individuals with previous HSV and/or VZV infection showed the presence of antibodies crossreactive between HSV-1 gB and VZV gp-II in 3 out of 30 sera tested. PMID: 2165766 [PubMed - indexed for MEDLINE] 4168. Microbiol Immunol. 1990;34(4):407-11. Drug susceptibilities of isolates of varicella-zoster virus in a clinical study of oral brovavir. Machida H, Nishitani M. Biology Laboratory, R & D Division, Yamasa Shoyu Co., Ltd., Chiba. Susceptibilities to brovavir [1-beta-D-arabinofuranosyl-E-5-(2-bromovinyl)-uracil] and acyclovir of clinical isolates of varicella-zoster virus obtained from 58 patients with herpes zoster, included in a clinical trial of oral brovavir, were tested by a plaque reduction method. All 101 isolates were significantly susceptible to brovavir; 50% effective dose of brovavir for these isolates ranged between 0.6-4.0 ng/ml (average: 1.29 ng/ml). Brovavir was about 3,000 times more potent than acyclovir against these isolates. No marked change in the susceptibility of isolates from these patients during treatment with brovavir was observed. PMID: 2163486 [PubMed - indexed for MEDLINE] 4169. J Med Virol. 1990 Jan;30(1):45-9. Antibody response to herpes simplex virus glycoproteins gB and gD. Bernstein DI, Frenkel LM, Bryson YJ, Myers MG. Clinical Virology Division, James N. Gamble Institute of Medical Research, Cincinnati, OH 45219. The antibody response to herpes simplex virus (HSV) glycoproteins B and D was evaluated using these cloned glycoproteins in an ELISA assay and compared to a standard Western blotting procedure. The ELISA assay appeared to be more sensitive for detecting gB and gD antibodies. Antibodies to gB but not gD were detected in the acute sera of patients presenting with their first episode of true primary genital herpes. The geometric mean HSV gB titer (log 2) was also significantly higher than the geometric mean gD titer in the convalescent sera of these patients (7.9 +/- 0.7 vs. 5.5 +/- 0.9, P less than .003). A cross-reaction between HSV gB and varicella zoster virus (VZV) gp II was demonstrated. Thus, it is possible that a previous VZV infection could prime the immune system to respond rapidly and more vigorously to HSV gB. Indeed, in this report we demonstrated a significant correlation between the VZV ELISA absorbance and the titer to HSV gB and also detected a higher VZV ELISA absorbance and HSV gB titer in the acute sera of patients with a true primary HSV infection compared to other HSV seronegative VZV seropositive patients. Use of this quantitative assay should allow further investigation into the relationship of the immune response to these important targets and the clinical course of HSV disease. PMID: 2154542 [PubMed - indexed for MEDLINE] 4170. Dermatologica. 1990;181(1):65-7. Contact dermatitis sparing the eruption of herpes zoster and its periphery. Katayama H, Karube S, Ueki Y, Yaoita H. Department of Dermatology, Jichi Medical School, Tochigi-ken, Japan. A 63-year-old male developed allergic contact dermatitis with antibiotic ointment applied to the skin eruptions of herpes zoster. From the result of patch test, fradiomycin sulfate contained in the ointment was identified as the contact sensitizing antigen. Strangely, this contact dermatitis was confined to the area surrounding the sores, sparing the lesions and their periphery. We postulated that a decrease in Langerhans cell activity in the herpes zoster lesions and their peripheral area was primarily responsible for this phenomenon, since an important role of Langerhans cells in host defence against herpes virus infection has recently been demonstrated. PMID: 2144251 [PubMed - indexed for MEDLINE] 4171. Biomed Pharmacother. 1990;44(9):455-9. Acyclovir and postherpetic neuralgia. Klenerman P, Luzzi GA. Nuffield Department of Clinical Medicine, John Radcliffe Hospital, Headington, Oxford, UK. Studies have demonstrated the benefit of acyclovir, given intravenously or orally, on the acute illness in herpes zoster (HZ). Whether or not such treatment influences the subsequent development of postherpetic neuralgia (PHN) has been the subject of recent controversy. Intravenous acyclovir has not been shown to influence PHN significantly in prospective studies. Oral acyclovir in large doses may reduce PHN during the 3 months after acute HZ, but this effect has not been observed consistently in well-designed studies. From 3 months onwards, no trial has demonstrated a significant effect of oral acyclovir in reducing PHN. The way forward is discussed. PMID: 2081273 [PubMed - indexed for MEDLINE] 4172. Acta Derm Venereol. 1990;70(2):121-5. Argon laser induced cutaneous sensory and pain thresholds in post-herpetic neuralgia. Quantitative modulation by topical capsaicin. Bjerring P, Arendt-Nielsen L, Søderberg U. Department of Dermatology, Marselisborg Hospital, Aarhus, Denmark. Sensory and pain thresholds to cutaneous argon laser stimulation were determined in patients with post-herpetic neuralgia before and during treatment with topical capsaicin. Before treatment both thresholds were significantly elevated on the affected side compared to the contralateral normal area. After one week of capsaicin treatment both thresholds were significantly increased compared to the pre-treatment values, and the subjective pain relief, measured on a visual analogue scale (VAS) was 24%. More than 10% decrease in VAS pain score was obtained by 62.5% of the patients. Laser stimulations at levels at which the sensory and pain thresholds are reached were initially described as burning or stinging with pain projecting outside the stimulated area. This allodynia to laser stimulations changed during capsaicin treatment towards normal sensory and pain perception qualities. Both sensory and pain thresholds and the subjective pain score evaluated on a visual analogue scale were attenuated during the capsaicin treatment, suggesting a significant role of the cutaneous sensory and pain receptors in postherpetic neuralgia. PMID: 1969195 [PubMed - indexed for MEDLINE] 4173. J Clin Lab Immunol. 1990 Jan;31(1):17-21. Cytotoxic activity against varicella-zoster virus-infected target cells after marrow transplantation. Ljungman P, Bowden RA, Meyers JD. Fred Hutchinson Research Center, Seattle, Wa. Cytotoxic activity by peripheral blood lymphocytes against varicella-zoster virus (VZV) infected matched and mis-matched fibroblasts and K562 targets was studied in 17 allogeneic marrow transplant recipients during the first 100 days after transplantation. Lysis of HLA mis-matched VZV infected target cells by patient's lymphocytes was significantly reduced after transplant compared to healthy normals (p less than 0.05). In contrast, lysis of K562 targets by peripheral blood lymphocytes from patients was similar or increased compared to controls. Three patients developed herpes zoster during the study. No significant difference was found in the lysis of VZV infected mis-matched target cells between patients who developed herpes zoster compared to those patients who did not. With the exception of in one patient shortly after the occurrence of herpes zoster, no HLA-restricted lysis could be detected. Depressed natural killer cell activity against VZV infected targets might be important for the development and outcome of VZV infection but studies in more patients and with longer follow-up time are needed. PMID: 1966979 [PubMed - indexed for MEDLINE] 4174. Skin Pharmacol. 1990;3(4):268-71. Effect of glycyrrhizin on pain and HLA-DR antigen expression on CD8-positive cells in peripheral blood of herpes zoster patients in comparison with other antiviral agents. Aikawa Y, Yoshiike T, Ogawa H. Department of Dermatology, Juntendo University School of Medicine, Tokyo, Japan. Glycyrrhizin (GL) is a saponin widely used as an anti-inflammatory agent. Pain intensity and HLA-DR antigen expression on CD8+ cells were assessed during and after treatment with GL. Other agents such as acyclovir, gamma-globulin and interferon beta were also administered for comparison. Pain resolved most rapidly among those treated with acyclovir followed by those treated with GL. Pain resolution correlated with the regression of HLA-DR+ in CD8+ subpopulations in peripheral blood. GL is suggested to be an alternative or additive antiviral agent to herpes zoster. PMID: 1707284 [PubMed - indexed for MEDLINE] 4175. Viral Immunol. 1990 Fall;3(3):217-24. Individual NK cell clones lyse both tumor cell targets and herpes simplex virus-infected fibroblasts in the absence of interferon. Canessa A, Chatterjee S, Whitley RJ, Prasthofer EF, Grossi CE, Tilden AB. Department of Pediatrics, University of Alabama. The target specificity of natural killer (NK) cells for either tumor cells or virus-infected cells has been investigated. Lymphocyte clones with the surface phenotype of NK cells (CD3-, CD16+) were obtained by limiting dilution of peripheral blood mononuclear cells stimulated with PHA, Herpes simplex virus type 1 (HSV-1), or Varicella-Zoster antigens. Clones were maintained in media with recombinant interleukin 2 (IL-2). Both NK-sensitive (K562 cells) and NK-resistant (Raji cells) targets were lysed by three cloned lines of NK cells. The ability to lyse NK-resistant target cells was largely lost when the cloned lymphocytes were cultured overnight in the absence of IL-2. Effector cells from all three clones were also capable of specifically lysing HSV-1 infected human fibroblasts in comparison with uninfected fibroblasts. We also showed that lysis of HSV-1 infected targets by NK cloned cells was independent of interferons in the culture system. PMID: 1701642 [PubMed - indexed for MEDLINE] 4176. JAMA. 1989 Dec 22-29;262(24):3455-8. Clinical and biological differences between recurrent herpes simplex virus and varicella-zoster virus infections. Straus SE. Medical Virology Section, National Institute of Allergy and Infectious Diseases, Bethesda, Md 20892. PMID: 2555578 [PubMed - indexed for MEDLINE] 4177. Am J Ophthalmol. 1989 Dec 15;108(6):733-5. Multifocal choroiditis uveitis occurring after herpes zoster ophthalmicus. Bloom SM, Snady-McCoy L. Department of Ophthalmology, Tufts-New England Medical Center, Boston, MA 02111. PMID: 2596557 [PubMed - indexed for MEDLINE] 4178. Ma Zui Xue Za Zhi. 1989 Dec;27(4):377-80. Interpleural analgesia for herpetic neuralgia. Chen JY, Susetio L. PMID: 2633024 [PubMed - indexed for MEDLINE] 4179. J Tradit Chin Med. 1989 Dec;9(4):256-8. Treatment of pain by laser irradiation--a report of 76 cases. Hu GZ. PMID: 2630812 [PubMed - indexed for MEDLINE] 4180. Klin Med (Mosk). 1989 Dec;67(12):91-3. [Variants of the Ramsay Hunt syndrome] [Article in Russian] Mikhaĭlenko AA. Out of 776 patients having polymorphic syndromes caused by herpes simplex or zoster infection 25 patients exhibited Ramsay Hunt syndrome. Altogether 5 clinical variants of the syndrome were recognized. Neurological symptoms and liquor investigations show that the process goes far beyond the ganglion of the facial nerve and therefore can be characterized as multiradiculoganglioneuritis. There are also frequent associated meningeal and encephalitic symptoms. Etiologically, some clinical variants of Ramsay Hunt syndrome arise from herpes simplex infection. PMID: 2628625 [PubMed - indexed for MEDLINE] 4181. Pain. 1989 Dec;39(3):301-5. EMLA cream in the treatment of post-herpetic neuralgia. Efficacy and pharmacokinetic profile. Stow PJ, Glynn CJ, Minor B. Pain Relief Unit, Abingdon Hospital, Oxford, U.K. The analgesic efficacy of 5% of EMLA cream (5 or 10 g) when applied for 24 h periods was evaluated in 5 female and 7 male patients (mean age 69 years, range 50-85 years) with refractory post-herpetic neuralgia (PHN). Mean visual analogue pain intensity scores for all patients were significantly improved 6 h after application (P less than 0.05). In a subgroup of patients with facial PHN receiving EMLA cream, 5 g (n = 4), there were significant improvements in pain intensity scores at 6 h (P less than 0.05). 8 h (P less than 0.01) and 10 h (P less than 0.01) after application. Plasma lignocaine and plasma prilocaine concentrations were well below potentially toxic levels in all patients after application. PMID: 2616182 [PubMed - indexed for MEDLINE] 4182. Masui. 1989 Dec;38(12):1597-604. [Clinical investigation of 200 patients with acute herpes zoster--factor influencing treatment of herpetic pain] [Article in Japanese] Murakawa K, Ishimoto E, Noma K, Kono K, Ishida H, Izumi R. Two hundred patients were treated by various nerve blocks with (A; 100 cases) or without (B; 100 cases) acyclovir (ACV) for acute herpes zoster, and studied retrospectively to determine the factors influencing the duration of pain. All patients started to receive the treatment within 2 weeks after manifestation of herpetic rash, and were divided equally into two groups by the severity of pain. The severe (I) and moderate (II) pain groups had similar locations of skin lesions. Group I had significantly larger population of the aged, and higher proportion of patients who had preherpetic pain than group II. The period of pain was significantly longer in group I B than group I A, in group II B than group II A, in group I A than group II A and in group I B than group II B. However, distribution of the rash, age and occurrence of preherpetic pain were not related to the duration of pain in the groups with the same degree of pain and treatment. These results showed that ACV was effective in inflammatory pain and accelerated healing in the acute phase of herpes zoster. The severity of pain had the greatest influence on the duration of pain. The age and preherpetic pain closely correlated with the severity of pain. PMID: 2614887 [PubMed - indexed for MEDLINE] 4183. Neurology. 1989 Dec;39(12):1640. Cerebral infarction following herpes zoster: the enlarging clinical spectrum. Joy JL, Carlo JR, Vélez-Borrás JR. Department of Neurology, University of Alabama, Birmingham 35244. PMID: 2586782 [PubMed - indexed for MEDLINE] 4184. J Infect Dis. 1989 Dec;160(6):919-28. Cellular and humoral immunity to varicella zoster virus glycoproteins in immune and susceptible human subjects. Giller RH, Winistorfer S, Grose C. Department of Pediatrics, University of Iowa College of Medicine, Iowa City. To further delineate the immune responses that protect against serious primary varicella zoster virus (VZV) infection and inhibit viral reactivation, antibody responses and T lymphocyte reactivity to three major VZV glycoproteins, gpI, gpII, and gpIII, were studied. Individual viral glycoproteins were purified using murine monoclonal antibodies. Cellular immunity was measured by lymphocyte proliferation. Antibody responses were tested in enzyme-linked immunosorbent assays. Individual glycoproteins induced VZV-specific proliferation by mononuclear cells from 15 of 20 immune subjects. Serologic responses to the VZV glycoproteins occurred in 16 of 20 immune subjects. Of note, gpII served as a potent T and B cell antigen during both acute infection and convalescence. Cell-mediated responses to the glycoprotein antigens represented proliferation by T lymphocytes and required antigen presentation by adherent mononuclear cells. These findings indicate that virally encoded glycoproteins contain epitopes that stimulate VZV-specific cellular and humoral immune responses. PMID: 2555419 [PubMed - indexed for MEDLINE] 4185. J Clin Neuroophthalmol. 1989 Dec;9(4):229-33; discussion 234-5. Herpes zoster ophthalmicus, contralateral hemiplegia, and recurrent ocular toxoplasmosis in a patient with acquired immune deficiency syndrome-related complex. Pillai S, Mahmood MA, Limaye SR. Department of Ophthalmology, D.C. General Hospital, Washington, D.C. 20003. A 42-year-old man presented with herpes zoster ophthalmicus on the right side. He was found to have acquired immune deficiency syndrome-related complex. Two weeks later he developed toxoplasmic retinochoroiditis in the left eye. He also presented later with left hemiplegia, which was probably caused by herpes zoster arteritis. Nine months after the retinal lesion resolved he developed another area of toxoplasmic retinochoroiditis adjacent to the first lesion. Herpes zoster may be the first presentation of acquired immune deficiency syndrome-related complex in a young healthy individual. Ophthalmologists are encountering patients with acquired immune deficiency syndrome who may have multiple organisms as the cause for their ocular infections and this might pose a treatment dilemma. The combination of herpes zoster ophthalmicus and ocular toxoplasmosis in this patient makes this case unusual. PMID: 2531159 [PubMed - indexed for MEDLINE] 4186. Acta Paediatr Jpn. 1989 Dec;31(6):702-5. Comparison of acyclovir and vidarabine in immunocompromised children with varicella-zoster virus infection. Kunitomi T, Akazai A, Ikeda M, Oda M, Kodani N. Intravenous acyclovir and vidarabine were compared in the treatment of varicella-zoster virus (VZV) infection in 25 immunocompromised children--13 with acute lymphocytic leukemia, three with other types of cancer, two with immunodeficiency and in seven undergoing prednisolone treatment. Thirteen had varicella and 12 had herpes zoster. Acyclovir was given intravenously to five patients with varicella and to four with herpes zoster at a dose of 5-10 mg/kg every eight hours. Vidarabine was given intravenously to eight patients with varicella and to eight with herpes zoster at a dose of 10 mg/kg/day. In varicella, vidarabine significantly shortened the time from the start of treatment to cessation of new lesion formation compared with acyclovir. However, there was no significant difference in time to complete crusting between the two treatments. In herpes zoster, acyclovir significantly shortened the time from the onset of the skin lesions to complete crusting. A slight raise of GOT in two cases was reported. While acyclovir and vidarabine were equally effective for VZV infection, in herpes zoster acyclovir was more effective. PMID: 2516397 [PubMed - indexed for MEDLINE] 4187. Cornea. 1989 Dec;8(4):270-3. Diagnostic impression cytology for external eye disease. Maskin SL, Heitman KF, Lawton AW, Yee RW. Department of Ophthalmology, University of Texas Health Science Center, San Antonio 78284-7779. The authors describe their experience with the use of impression cytology (IC) as a diagnostic aid in the evaluation of external eye disorders. IC is shown to be useful for diagnosis of epithelial cell storage disorders, infectious diseases, and allergic disorders. PMID: 2509135 [PubMed - indexed for MEDLINE] 4188. An Med Interna. 1989 Dec;6(12):639-40. [Herpes zoster ophthalmicus with contralateral hemiplegia] [Article in Spanish] Sureda Ramis B, Bautista J, Martínez Navarro ML. A 57-year-old patient nonimmunosuppressed who had zoster ophthalmicus associated to contralateral hemiplegia is presented. We noticed on the CT scan an infarction of left caudate nucleus, as well as in the angiography signs of vasculitis. We comment on the clinical and diagnosis features and suggest possible benefit effects of the treatment with acyclovir. PMID: 2491475 [PubMed - indexed for MEDLINE] 4189. Ugeskr Laeger. 1989 Nov 27;151(48):3239-41. [Herpes zoster in immunosuppressed patients with immuno-inflammatory disease] [Article in Danish] Schou M, Andersen V. We analysed 19 episodes of herpes zoster in 16 patients, who received cytotoxic drugs or cyclosporin for immuno-inflammatory disease. Reactivation of varicella-zoster virus was not associated with increased activity of the rheumatic disease nor with increased intensity of immunosuppressive therapy. Six of the patients who had received the largest cumulative doses of cytotoxic drugs had fever and/or vesicles outside the primarily affected dermatome. Two of these patients developed post-herpetic neuralgia. Although not encountered in this material, immunocompromised patients may develop severe complications of herpes zoster, and therefore prompt treatment with acyclovir is recommended in all cases. It is suggested that oral acyclovir therapy is sufficient in uncomplicated cases but this question has not been elucidated in controlled studies. PMID: 2595854 [PubMed - indexed for MEDLINE] 4190. Dtsch Med Wochenschr. 1989 Nov 10;114(45):1729-33. [Differential diagnosis of atypical plasma cells in the cerebrospinal fluid] [Article in German] Kraft R, Altermatt HJ, Nguyen-Tran Q. Abteilung für klinische Zytologie, Universität Bern. 2102 samples of lumbar cerebrospinal fluid (CSF) were examined by qualitative cytology for atypical plasma cells. Samples from seven patients contained such cells. Retrospective investigation of these patients revealed that four of them had had neuroborreliosis, one had multiple sclerosis, one herpes zoster and one malignant non-Hodgkin lymphoma. It is concluded that in a case of unexplained meningoradiculitis with lymphoplasmocytic reaction in the CSF, morphological analysis of the plasma cells can provide important diagnostic pointers. PMID: 2806105 [PubMed - indexed for MEDLINE] 4191. J Hand Surg Br. 1989 Nov;14(4):447-8. Isolated anterior interosseous nerve palsy following herpes zoster infection: a case report and review of the literature. Nee PA, Lunn PG. Department of Orthopaedics, Derbyshire Royal Infirmary, Derby. A 64-year-old lady noticed weakness of her thumb within two weeks of having developed "shingles" causing vesicular lesions on her arm and hand. Clinical and neurophysiological testing confirmed a lesion of the anterior interosseous nerve. Although motor involvement after herpes zoster infection is recognised, this usually has a myotomal distribution; isolated involvement of a branch of a peripheral motor nerve has not previously been described. PMID: 2695590 [PubMed - indexed for MEDLINE] 4192. Bone Marrow Transplant. 1989 Nov;4(6):613-5. A randomized trial of oral versus intravenous acyclovir for treatment of herpes zoster in bone marrow transplant recipients. Nordic Bone Marrow Transplant Group. Ljungman P, Lönnqvist B, Ringdén O, Skinhöj P, Gahrton G. Department of Medicine, Huddinge Hospital, Sweden. Twenty-seven bone marrow transplant patients who developed localized herpes zoster were treated with acyclovir in a randomized study comparing oral and intravenous drug administration. Fourteen patients received oral and 13 patients received intravenous treatment. None of the patients developed disseminated disease. No differences were found between the treatment groups in the number of days that new lesions continued to develop, in number of days with pain, or in the number of days from start of treatment until all lesions were crusted over. We suggest that oral acyclovir may be as effective as intravenous acyclovir in the treatment of localized herpes zoster after bone marrow transplantation. PMID: 2684306 [PubMed - indexed for MEDLINE] 4193. Tandlaegebladet. 1989 Nov;93(16):623-7. Tooth exfoliation and necrosis of the alveolar bone following trigeminal herpes zoster in HIV-infected patient. Schwartz O, Pindborg JJ, Svenningsen A. PMID: 2635428 [PubMed - indexed for MEDLINE] 4194. Minerva Med. 1989 Nov;80(11):1251-2. [A case of Ramsay Hunt syndrome] [Article in Italian] Diamante A, D'Angelo C, Liistro S, Lutri W. U.S.L. Divisione di Medicina Generale. We describe a clinical case of RH syndrome (Auricular Herpes zoster, facial paralysis, hearing loss). PMID: 2601878 [PubMed - indexed for MEDLINE] 4195. Pain. 1989 Nov;39(2):129-44. Post-herpetic neuralgia: the relation of pain complaint, sensory disturbance, and skin temperature. Rowbotham MC, Fields HL. Department of Neurology, School of Medicine, University of California, San Francisco 94143. Twelve otherwise healthy patients with longstanding postherpetic neuralgia (PHN) were prospectively studied using clinical examination, infrared thermography and response to local anesthetic skin infiltration. All had at least 2 of 3 possible components to their PHN pain: continuous, neuralgic, or allodynic. In patients with allodynia, maximal reported pain and the location of maximal allodynia on sensory examination were largely overlapping and were often warm thermographically. Areas of dense sensory loss and skin scarring without allodynia were usually cool thermographically. Local anesthetic skin infiltration produced substantial pain relief in all 9 patients (essentially complete relief in 7) with allodynia: the 3 patients with predominantly continuous pain were not relieved. In 7 of 8 skin infiltration responders, the same dose of lidocaine i.m. in the deltoid muscle also produced significant, though less complete pain relief. These results suggest that PHN patients can be divided into at least 2 clinical groups: those with predominantly continuous pain localized to a region of significant sensory loss and those in whom allodynia is the most prominent sensory disturbance. The latter group has pain localized to areas with relatively preserved sensation. The differences in clinical features and response to lidocaine suggest that there are at least 2 different mechanisms contributing to the pain of PHN. PMID: 2594392 [PubMed - indexed for MEDLINE] 4196. Arteriosclerosis. 1989 Nov-Dec;9(6):877-80. Unlikely association between clinically apparent herpesvirus infection and coronary incidence at older ages. The Framingham Heart Study. Havlik RJ, Blackwelder WC, Kaslow R, Castelli W. National Center for Health Statistics, Hyattsville, MD 20782. Experimental studies in chickens have shown a relationship of a herpesvirus to atherosclerosis. The hypothesis of an association in humans was tested by using data on the history of cold sores and other manifestations of herpes infections reported by 658 male and 919 female participants (ages 58 to 89) in the Framingham Heart Study from 1977 to 1979 and on the prevalence and subsequent 6-year incidence of coronary heart disease (CHD). Approximately 40% of the men and 52% of the women reported a history of ever having "fever blisters or cold sores." Overall, there was no association between a history of such oropharyngeal manifestations and prevalent CHD. Only in the subgroup of women with recurrent infections was there a suggestion of a possible relationship (relative risk = 1.5, 95% confidence interval 1.0 to 2.1). Among members of the cohort without CHD at baseline there was no association between the history of cold sores, chicken pox, shingles, or infectious mononucleosis and 6-year CHD incidence. However, a possible interaction among women with recurrent herpes, lower levels of serum cholesterol, and incidence of angina pectoris without myocardial infarction was suggested in post hoc analyses. These data from the Framingham cohort do not support the notion that any self-reported clinically manifest herpesvirus infection has a strong etiological role in older persons, but they do raise issues to be addressed in any further research. PMID: 2556099 [PubMed - indexed for MEDLINE] 4197. Otolaryngol Head Neck Surg. 1989 Nov;101(5):562-5. MRI findings in two cases of acute facial paralysis. LaBagnara J Jr, Jahn AF, Habif DV Jr, Solomon EM. Department of Surgery, University of New Jersey, Newark. Comment in: Otolaryngol Head Neck Surg. 1990 Oct;103(4):672. This article describes the use of magnetic resonance imaging (MRI) in the evaluation of the facial nerve paralysis of Bell's palsy and herpes zoster oticus. Identification of the nature of inflammatory facial nerve paralysis often presents a diagnostic dilemma. The site of involvement along the course of the nerve may have importance when treatment options are being considered. We have found MRI to be a unique method for localizing the site of nerve injury in both Bell's palsy and Ramsay Hunt syndrome. PMID: 2512536 [PubMed - indexed for MEDLINE] 4198. Ugeskr Laeger. 1989 Oct 30;151(44):2901. [Local therapy of herpes zoster pain] [Article in Danish] Andersen S. PMID: 2588379 [PubMed - indexed for MEDLINE] 4199. Z Hautkr. 1989 Oct 15;64(10):848-50. [Therapy of herpes zoster] [Article in German] Engst R. Dermatologische Klinik und Poliklinik der Technischen Universität München. Regarding the treatment of herpes zoster, aciclovir (ACV) is as the most effective and safe drug available. ACV reduces the viral shedding time and promotes the cutaneous healing and pain resolution. Oral ACV in high doses (5 x 800 mg daily), as well, has proved effective in the treatment of acute herpes zoster. If there is no convincing effect on the pain, additional application of corticoids in high doses may be of benefit. PMID: 2686242 [PubMed - indexed for MEDLINE] 4200. Br Dent J. 1989 Oct 7;167(7):235-8. Rapid diagnosis of oral herpes simplex or zoster virus infections by immunofluorescence: comparison with Tzanck cell preparations and viral culture. Bagg J, Mannings A, Munro J, Walker DM. This study compared viral culture with routine cytology and immunofluorescent staining of oral epithelial cell smears for the diagnosis of orofacial infections due to herpes simplex virus (HSV) or herpes zoster (HZ). Twenty-one patients were studied. Viral culture gave the greatest number of positive results, with an assumed sensitivity and specificity of 100%, but the test took at least 24 hours. For haematoxylin and eosin cytology, the corresponding figures for sensitivity and specificity were 54% and 100%, respectively. Direct staining of epithelial smears with FITC-conjugated monoclonal antibodies to HSV type 1, HSV type 2 and HZ had a sensitivity of 82% and specificity of 71%. Smears prepared from oral washings, and stained with the same fluorescent antibodies, yielded a sensitivity of 83% and specificity of 86%. To allow rapid diagnosis, oral epithelial smears for immunofluorescent examination should also be prepared, since in more than 80% of cases such smears will confirm an herpetic infection in less than one hour. PMID: 2675949 [PubMed - indexed for MEDLINE] 4201. Am J Med Sci. 1989 Oct;298(4):264-6. Herpes zoster myelitis occurring during treatment for systemic lupus erythematosus. Baethge BA, King JW, Husain F, Embree LJ. Department of Medicine, Louisiana State University Medical Center, Shreveport 71130. A 15-year-old girl with systemic lupus erythematosus suddenly developed fever, meningismus, and herpes zoster. Within 48 hours, transverse myelitis developed at the level of the nerve root involvement of the herpes zoster. Since both systemic lupus erythematosus and varicella-zoster have been reported to cause myelitis, therapy was initiated for both. The rapid and simultaneous resolution of both the herpes zoster and the neurologic deficits strongly supports the causal association of both with varicella-zoster. This is the second reported case of herpes zoster-associated transverse myelitis in a patient with systemic lupus erythematosus. PMID: 2801761 [PubMed - indexed for MEDLINE] 4202. Haematologica. 1989 Oct;74(5 Suppl):310-9. [Viral infections in the granulocytopenic patient] [Article in Italian] Moroni M, Esposito R. PMID: 2556334 [PubMed - indexed for MEDLINE] 4203. Turk J Pediatr. 1989 Oct-Dec;31(4):317-21. Erythroblastopenia and leukopenia in the patient with severe herpes zoster treated with intravenous acyclovir. Tuncer AM, Evis B, Kunak B, Akçayöz N, Ertem U. Department of Pediatrics, Dr. Sami Ulus Children's Hospital, Anakara. A seven-year-old girl with transient leukopenia and erythroblastopenia which developed after the administration of acyclovir is presented. Acyclovir infusion was given in a dose of 5 mg/kg/every eight hours. On the third day of therapy the hemoglobin level fell to 9.9 g/dl, the hematocrit was 26%, the white blood cell count 4000 percent/mm3, red blood cells 3.2 million percent/mm3. Bone marrow aspiration showed a decrease in the number of erythoblasts and a relative increase in the number of promyelocytes and myelocytes. Therapy was discontinued on the fifth day, and on the seventh day the findings were normal including the bone marrow aspiration. We could not find any other reason which would cause transient erythroblastopenia and leukopenia in our patient. PMID: 2486432 [PubMed - indexed for MEDLINE] 4204. Am J Med. 1989 Oct;87(4):405-7. Interferon and interferon inhibitor levels in patients infected with varicella-zoster virus, acquired immunodeficiency syndrome, acquired immunodeficiency syndrome-related complex, or Kaposi's sarcoma, and in normal individuals. Ambrus JL, Poiesz BJ, Lillie MA, Stadler I, Di Berardino LA, Chadha KC. Department of Molecular Biology, State University of New York, Buffalo. PURPOSE: Previous studies had reported that normal individuals do not have measurable levels of interferons in their circulation, whereas high levels have been found in patients in the early stages of AIDS (acquired immunodeficiency syndrome) and in those with AIDS-related complex (ARC). This study was undertaken to compare levels of interferon and interferon inhibitors in plasma samples from patients with AIDS, ARC, Kaposi's sarcoma, or varicella-zoster virus infection, and from control subjects. PATIENTS AND METHODS: A total of 206 persons were tested for the presence of interferon and interferon inhibitors in their plasma: 76 with ARC or AIDS, with or without Kaposi's sarcoma or lymphoma; 32 with varicella-zoster infection; 12 with AIDS-unrelated Kaposi's sarcoma; and 86 normal control subjects at high or low risk of AIDS with or without positive antibody levels to human immunodeficiency virus-1. Total interferon activity was measured by bioassay and the subtypes were not separated. RESULTS: Of 86 normal control subjects, 85 had no significant levels of interferon or interferon inhibitor. One disease-free homosexual exhibited measurable interferon levels. Patients acutely infected with varicella-zoster virus showed no measurable interferon or inhibitor levels except if they were in a high-risk group for AIDS. Seventy-six patients with ARC or AIDS exhibited measurable circulating interferon levels. Only patients with AIDS had interferon inhibitors in their circulation. Of 12 patients with Kaposi's sarcoma unrelated to AIDS, none had measurable interferon inhibitor levels, but some exhibited measurable interferon levels. CONCLUSION: It is suggested that levels of interferon inhibitor should be considered when interferon is used therapeutically in viral or neoplastic diseases. PMID: 2478016 [PubMed - indexed for MEDLINE] 4205. Med J Aust. 1989 Sep 18;151(6):360. Treatment of prodromal shingles. Petersons VV. PMID: 2593954 [PubMed - indexed for MEDLINE] 4206. BMJ. 1989 Sep 16;299(6701):740-1. Treatment of shingles and post-herpetic neuralgia. [No authors listed] PMCID: PMC1837499 PMID: 2508905 [PubMed - indexed for MEDLINE] 4207. Am J Ophthalmol. 1989 Sep 15;108(3):327-8. Aqueous chamber tap and serology in acute retinal necrosis. Suttorp-Schulten MS, Zaal MJ, Luyendijk L, Bos PJ, Kijlstra A, Rothova A. Department of Ophthalmology, University of Amsterdam, The Netherlands. PMID: 2549793 [PubMed - indexed for MEDLINE] 4208. Nurs Times. 1989 Sep 13-19;85(37):55-8. Systems of life no. 175. Senior systems--40. Roberts A. PMID: 2813116 [PubMed - indexed for MEDLINE] 4209. Lancet. 1989 Sep 2;2(8662):559. Reduced CD4+ count, infections, and immune thrombocytopenia without HIV infection. Daus H, Schwarze G, Radtke H. PMID: 2570254 [PubMed - indexed for MEDLINE] 4210. Cutis. 1989 Sep;44(3):216-9. Zosteriform porokeratosis: a report of two cases. Veraldi S, Bocor M, Gasparini G. First Department of Dermatology and Pediatric Dermatology, University of Milan, Italy. The authors describe two cases of zosteriform porokeratosis occurring in two female patients, aged seventeen and fourteen years. In both patients the dermatosis was localized to the thigh; one patient also presented with linear lesions in the thoracoabdominal and dorsal regions. Histopathologic examination confirmed the clinical diagnosis and excluded the presence of atypical cells. PMID: 2791643 [PubMed - indexed for MEDLINE] 4211. Vopr Virusol. 1989 Sep-Oct;34(5):630-3. [Use of immunoenzyme analysis for serological study of patients with ophthalmic herpes] [Article in Russian] Ebralidze LK, Gorbovitskaia GE, Mal'tseva NN, Kasparov AA. PMID: 2692304 [PubMed - indexed for MEDLINE] 4212. Prim Care. 1989 Sep;16(3):577-89. Cutaneous viral infections: herpes simplex and varicella-zoster. Pariser DM. Division of Dermatology, Eastern Virginia Medical School, Norfolk. Herpes simplex and varicella-zoster infections of the skin are commonly seen in primary care practice. For the patient to be managed most effectively, clinical diagnoses must be accurately made and supported by laboratory confirmation using the Tzanck smear and/or viral culture. Topical therapy and systemic acyclovir can be of help to most patients with these infections. PMID: 2678171 [PubMed - indexed for MEDLINE] 4213. J Assoc Physicians India. 1989 Sep;37(9):606-9. Contralateral hemiplegia in herpes zoster ophthalmicus. Role of temporal artery biopsy. Behari M, Mishra NK, Sarkar C, Roychowdhery D, Prasad K, Maheshwari MC. We describe clinical, radiological and pathological findings in a case of herpes zoster ophthalmicus who developed contralateral hemiplegia. The CT scan showed discrete infarction of the right internal capsule and the right carotid angiogram showed concentric narrowing of the supraclinoid portion of right internal carotid artery. Superficial temporal artery biopsy showed infiltration by lymphocytes and plasma cells without any granuloma formation or giant cells. The importance of trigemino-vascular connections in the pathogenesis of this complication of herpes zoster ophthalmicus and the role of temporal artery biopsy in the diagnosis of arteritis following herpes zoster are discussed. PMID: 2632564 [PubMed - indexed for MEDLINE] 4214. Acta Virol. 1989 Sep;33(5):428-34. Increased migration inhibition factor production by leukocytes of patients with herpes zoster given the leukocyte ultrafiltrate. Lackovicová M, Zachar V, Necas S, Mayer V. Institute of Virology, Slovak Academy of Science, Bratislava, Czechoslovakia. Using the direct leukocyte migration inhibition assay, the cell-mediated immune response was followed in together 47 patients suffering from herpes zoster. Of these, 19 persons were treated with partially purified and concentrated lysed leukocyte ultrafiltrate. Enhancement and/or earlier production of the leukocyte migration inhibition factor--in the presence of varicella-zoster virus antigen--was observed by leukocytes from patients given the ultrafiltrate on days 2-3 since the onset of the vesicular stage of the disease. Highly significant (alpha = 1%, P less than 0.01) differences in the migration inhibition values were observed between non-treated patients and patients given one dose of the ultrafiltrate during the days 3-12 after appearance of the first herpes zoster vesicles; on days 13-30 these values were not significant. PMID: 2576583 [PubMed - indexed for MEDLINE] 4215. Acta Virol. 1989 Sep;33(5):417-27. Semipurified human leukocyte ultrafiltrate in herpes zoster. I. Large-scale preparation and biochemical analysis. Borvák J, Mayer V, Kotuliak J. Institute of Virology, Slovak Academy of Sciences, Bratislava, Czechoslovakia. Nine batches of lysed human leukocyte ultrafiltrate (LLU) prepared from buffy coats of random healthy donors, as well as their semipurified subfractions--P2/II--were compared in terms of protein, orcinol-reactive material (ORM) content, and ratios of the average values of their ORM and protein contents. Two-step ethanol precipitation and size exclusion chromatography on Sephadex G-15 were used for partial purification and concentration. In comparison to the starting material, approximately 4.4 - fold increase in the ORM/protein ratio of P2/II has been effected. Relatively high variation in both, protein and ORM content of the crude LLU individual batches (ranges: 365 micrograms/1 ml - 962 micrograms/1 ml; 157 micrograms/1 ml - 660 micrograms/1 ml, respectively), as well as of those of P2/II fractions (ranges: 16.5 micrograms/1 ml - 207.5 micrograms/1 ml; 150 micrograms/1 ml - 480 micrograms/1 ml, respectively) could be observed. The suggested combined purification procedure removed from the LLU about 85% proteins and 33% ORM. The removed material contained inhibitors of the cell-mediated immunity (CMI)-inducing and/or augmenting properties of LLU. This is in good agreement with the observed improved therapeutic effect of P2/II fraction in herpes zoster treatment of otherwise noncompromised adults, as described in the companion paper. PMID: 2576582 [PubMed - indexed for MEDLINE] 4216. Hautarzt. 1989 Sep;40(9):582-5. [Disseminated herpes zoster in chronic lymphatic leukemia] [Article in German] Grimm W, Korting HC, Stolz W. Dermatologische Klinik und Poliklinik, Ludwig-Maximilians-Universität München. A 73-year-old woman suffering from chronic lymphatic leukemia presented a rare variant of zoster with disseminated eruptions. Ultrastructural negative staining revealed viruses of the herpes group. Herpes simplex was excluded by means of fluorescence-labelled monoclonal antibodies (HSV-1/HSV-2 direct specimen identification/typing test). It is proposed that the conventional classification of zoster into a segmental and a generalized variant should be supplemented. PMID: 2553644 [PubMed - indexed for MEDLINE] 4217. Br J Dermatol. 1989 Sep;121(3):287-96. Rapid diagnosis in varicella and herpes zoster: re-evaluation of direct smear (Tzanck test) and electron microscopy including colloidal gold immuno-electron microscopy in comparison with virus isolation. Folkers E, Vreeswijk J, Oranje AP, Duivenvoorden JN. Department of Dermatology, Hospital 'de Heel', Zaandam; The Netherlands. The Tzanck test and electron microscopy with the technique of colloidal gold labelling in varicella-zoster virus (VZV) infections were compared with virus isolation in 54 patients with clinically suspected varicella or herpes zoster infection. The Tzanck test and direct electron microscopy can determine whether or not an eruption is herpetic but cannot distinguish between herpes simplex virus (HSV) and VZV infection. However, colloidal gold immuno-electron microscopy, using monoclonal antibodies against HSV and anti-VZV IgG, can distinguish between these two herpes viruses. This achieves the same specificity as virus isolation followed by virus neutralization or virus typing using immunofluorescence techniques. The Tzanck test was positive in 91%, virus isolation, under optimal conditions of sampling and transportation, in 80%, direct electron microscopy (negative staining) in 80%, and colloidal gold immuno-electron microscopy after a virus concentration procedure in 95% of the cases. The colloidal gold technique offers a rapid diagnosis in patients with suspected VZV infection. PMID: 2553095 [PubMed - indexed for MEDLINE] 4218. Pediatr Infect Dis J. 1989 Sep;8(9):584-5. Varicella-zoster virus infections: chronic disease in the immunocompromised host: evidence for persistent excretion of virus. Whitley RJ. Department of Pediatrics, University of Alabama, Birmingham. Comment on: Pediatr Infect Dis J. 1989 Sep;8(9):586-90. PMID: 2552389 [PubMed - indexed for MEDLINE] 4219. Blood. 1989 Sep;74(4):1424-7. Herpes zoster infection after autologous bone marrow transplantation. Schuchter LM, Wingard JR, Piantadosi S, Burns WH, Santos GW, Saral R. Johns Hopkins Oncology Center, Baltimore. One hundred fifty-three patients who underwent autologous bone marrow transplant (ABMT) were studied retrospectively to determine the frequency, outcome, and risk-factors associated with varicella-zoster infections (VZV). Forty-three patients (28%) developed VZV infection after transplant. The median onset of infection was the fifth month, with 91% of cases occurring within the first year. Thirty-three patients (77%) had localized herpes zoster, and ten patients (23%) had varicella. Cutaneous dissemination developed in 15% of patients and probable visceral dissemination developed in 5%. Overall morbidity was 25% and included scarring, alopecia, postherpetic neuralgia, and neurologic dysfunction. There were no deaths from VZV infection. The majority of patients (79%) were treated with intravenous (IV) acyclovir. The only significant risk factor associated with VZV infection was the underlying disease. VZV infection occurred most frequently in patients with Hodgkin's and non-Hodgkin's lymphoma (46%) as compared with patients with leukemia (23%) or solid tumors (9%) (P less than .002). The frequency of VZV infection in ABMT patients appears to be comparable to that reported for allogeneic BMT patients and other immunocompromised patients. PMID: 2548641 [PubMed - indexed for MEDLINE] 4220. J Infect Dis. 1989 Sep;160(3):535-7. Herpes zoster in an adult recipient of live attenuated varicella vaccine. Hammerschlag MR, Gershon AA, Steinberg SP, Clarke L, Gelb LD. Department of Pediatrics, SUNY Health Science Center, Brooklyn, New York. Erratum in: J Infect Dis 1989 Dec;160(6):1095. A healthy 30-y-old female physician who was immunized with two doses of live attenuated varicella vaccine developed a localized case of zoster involving the right T8-10 dermatomes 36 mo after vaccination. The virus isolated from her rash was an unusual wild-type of varicella-zoster virus. After immunization she developed detectable antibodies to varicella-zoster virus, but antibodies were no longer detectable after 20 mo. Six months before development of zoster, she was exposed to a patient with varicella; however, she did not develop a clinical illness although she again became seropositive. To date, this is the only reported case of zoster among 187 healthy adult vaccinees. PMID: 2547882 [PubMed - indexed for MEDLINE] 4221. Arch Esp Urol. 1989 Sep;42(7):686-9. [Neurogenic bladder secondary to herpes zoster. Urodynamic evaluation] [Article in Spanish] Sanromá Ortueta I, Garrido Rivas MC, Garmendía Larrea JC, López García JA, Arocena Lanz F. A case of urinary retention from infranuclear neurogenic bladder secondary to perineal herpes zoster infection is described. We discuss the different urological compromise (neurologic and vesico-prostatic) following herpes zoster infection and the importance of correct diagnosis and patient follow-up. We do not recommend instituting drug therapy. Intermittent use of a catheter is advocated as the only treatment modality for this condition, which is reversible in most of the cases. PMID: 2490355 [PubMed - indexed for MEDLINE] 4222. Reg Anesth. 1989 Sep-Oct;14(5):244-6. Pleural analgesia for the treatment of acute severe thoracic herpes zoster. Reiestad F, Kvalheim L, McIlvaine WB. Department of Anaesthesia, Ulleval Sykehus, Oslo, Norway. Effective pain relief was produced in 18 patients having acute or subacute thoracic herpes zoster by the intermittent administration of local anesthetics into the pleural space via a percutaneously placed catheter. The duration of treatment varied from 16 to 21 days. During this period, the intervals between subsequent doses of 20 ml of 0.5% bupivacaine with 1:200,000 epinephrine increased in all patients from two doses per 24 hours to one dose per 24 hours. Patients became pain-free between 16 and 21 days after the beginning of treatment. The catheters were then removed, and a follow-up period of more than one year showed no signs of postherpetic neuralgia in any of the 18 patients. No side effects were observed during the treatment period. PMID: 2486647 [PubMed - indexed for MEDLINE] 4223. Pain. 1989 Sep;38(3):297-301. Topical lidocaine reduces pain in post-herpetic neuralgia. Rowbotham MC, Fields HL. Department of Neurology, School of Medicine, University of California San Francisco 94143. We report the results of a single session, non-blinded, trial of topical application of 10% lidocaine in gel form to the painful skin of 11 patients with well established post-herpetic neuralgia (PHN). Pain decreased as measured by 100 mm VAS pain scale and 100 mm VAS pain relief scale in both trigeminal and thoracic PHN patients. PMID: 2478945 [PubMed - indexed for MEDLINE] 4224. Fortschr Med. 1989 Aug 30;107(25):541-4. [The significance of herpesviridae in ophthalmology] [Article in German] Sundmacher R. Herpesviruses are the most common causes of infection-related loss of vision or blindness in our part of the world. A better understanding of the underlying pathophysiology, together with major pharmaceutical advances have led to medical and surgical therapy which enables us to preserve or restore useful vision in most patients. PMID: 2553563 [PubMed - indexed for MEDLINE] 4225. Fortschr Med. 1989 Aug 30;107(25):537-40. [Herpes virus infections in immunosuppressed patients. Herpes simplex and varicella zoster virus: prevention and therapy] [Article in German] Mertens T. Herpes simplex virus (HSV) and varicella-zoster virus (VZV) giving rise to primary or recurrent infections still threaten immunocompromised patients. However, such prophylactic measures as passive and active immunisation against VZV infection, and antiviral chemoprophylaxis and chemotherapy of HSV- and VZV-infections have improved the prognosis of these patients considerably. PMID: 2553562 [PubMed - indexed for MEDLINE] 4226. Fortschr Med. 1989 Aug 30;107(25):533-6. [Virus latency in infections with herpesviridae. Herpes simplex and varicella zoster virus: pathogenesis, clinical consequences] [Article in German] Schneweis KE. Once the organism has been invaded, all herpesviruses persist. This is accomplished by a change in the acute productive phase of the infection into the latent form. Reactivation of the latent virus ensures renewed transmissibility of the infection. This pathogenetic principle is ensured by an extremely finely tuned virus-host interrelationship which has developed in a unique specific manner for each herpesvirus. Pathogenetic fundamentals are discussed taking herpes simplex and the varicella-zoster virus as examples, and the resulting clinical consequences are shown. PMID: 2553561 [PubMed - indexed for MEDLINE] 4227. Pol Tyg Lek. 1989 Aug 21-28;44(34-35):799-800. [Results of acyclovir treatment of chickenpox and herpes zoster in children with immune tolerance] [Article in Polish] Jankowska H, Szczepańska-Putz M, Wojnarowski M. Acyclovir was used for the treatment of Varicella-zoster virus infections in 53 children (10 neonates and 43 children aged between 2 an 15 years) with immunological system deficiency hospitalized at the Department of the Infectious Diseases of Childhood in the Medical Academy in Warszawa. The obtained results of therapy were favourable except one fatal case of the child with visceral dissemination of the virus prior to acyclovir treatment. Compared with other antiviral agents used by the authors previously, acyclovir proved to be the most effective. PMID: 2485894 [PubMed - indexed for MEDLINE] 4228. Am J Ophthalmol. 1989 Aug 15;108(2):118-22. Clinical indications for and procedures associated with penetrating keratoplasty, 1983-1988. Brady SE, Rapuano CJ, Arentsen JJ, Cohen EJ, Laibson PR. Cornea Service, Wills Eye Hospital, Philadelphia, Pennsylvania 19107. We reviewed the preoperative clinical indications and associated surgical procedures for 2,299 penetrating keratoplasties performed at our institution from 1983 through 1988. Pseudophakic bullous keratopathy was the most common indication overall, accounting for 526 cases (23%). A marked increase was noted in the incidence of pseudophakic bullous keratopathy as an indication for penetrating keratoplasty beginning in 1985. The association of anterior chamber intraocular lenses in eyes with pseudophakic bullous keratopathy undergoing penetrating keratoplasty increased from 19 of 43 cases (44%) in 1983 to 79 of 108 cases (73%) in 1988. The incidence of intraocular lens exchange at the time of penetrating keratoplasty in cases of pseudophakic bullous keratopathy increased from six of 43 (14%) in 1983 to 63 of 108 (58%) in 1988. Other major indications for penetrating keratoplasty included Fuchs' dystrophy (375 cases, 16%), keratoconus (348 cases, 15%), aphakic bullous keratopathy (331 cases, 14%), and regraft (233 cases, 10%). Cataract extraction, with or without intraocular lens implantation, was combined with penetrating keratoplasty in 397 of 1,532 phakic eyes (26%). The incidence of triple procedure (penetrating keratoplasty, cataract extraction, and intraocular lens implantation) increased from 27 of 248 phakic eyes (11%) in 1983 to 68 of 258 phakic eyes (26%) in 1988. PMID: 2667369 [PubMed - indexed for MEDLINE] 4229. Lancet. 1989 Aug 12;2(8659):371-3. Outcome in newborn babies given anti-varicella-zoster immunoglobulin after perinatal maternal infection with varicella-zoster virus. Miller E, Cradock-Watson JE, Ridehalgh MK. Public Health Laboratory Service Communicable Disease Surveillance Centre, London. 281 newborn babies whose mothers had chickenpox and 25 whose mothers had herpes zoster during the perinatal period were investigated. IgG antibody was present at birth in all babies born more than 7 days after the onset of maternal chickenpox. When the mother's rash appeared 7-3 days before delivery progressively fewer babies were born with antibody, and no infant born less than 3 days after the onset had antibody at birth. Infants were given 100 or 250 mg of anti-varicella-zoster immunoglobulin (VZIG) shortly after birth or the onset of post-natal maternal chickenpox. 1 infant died, without neonatal varicella. Of the 280 surviving infants 169 (60%) were infected--134 (48%) with chickenpox and 35 (13%) without clinical features. The clinical attack rate was highest (60%) in infants whose mothers had chickenpox between 7 days before and 7 days after delivery. Chickenpox was severe in 19 infants, 16 of whom were exposed to maternal chickenpox between 4 days before and 2 days after delivery. There was no evidence that a severe outcome was associated with transplacentally acquired infection. Perinatal maternal herpes zoster did not cause neonatal infection. VZIG should be given to infants at risk, including those whose mothers have chickenpox during the last 7 days of pregnancy. PMID: 2569560 [PubMed - indexed for MEDLINE] 4230. BMJ. 1989 Aug 5;299(6695):392-3. Treatment of shingles and post-herpetic neuralgia. [No authors listed] Comment on: BMJ. 1989 Jun 10;298(6687):1537-8. PMCID: PMC1837217 PMID: 2506989 [PubMed - indexed for MEDLINE] 4231. Am Fam Physician. 1989 Aug;40(2):55. Oral acyclovir in maternal zoster. Crim M. Comment on: Am Fam Physician. 1989 Feb;39(2):89-98. PMID: 2818727 [PubMed - indexed for MEDLINE] 4232. J Trop Pediatr. 1989 Aug;35(4):171-4. Herpes simplex virus type 1 (HSV-1) and varicella-zoster virus (VZV) infections in Saudi Arabia. Hossain A. The seroepidemiology of infection due to herpes simplex type 1 (HSV-1) and varicella-zoster (VZV) viruses was investigated in 224 Saudi children aged from under 1 year to 15 years and 452 adults (healthy male blood donors and pregnant women) using a presently available sensitive indirect immunofluorescence technique to detect antibodies to these viruses in order to determine the age of primary infection. Age-specific prevalence of IgG antibodies to HSV-1 and VZV showed a progressive increase with age in both males and females with no obvious sex-related variation in the level. The overall prevalence of antibodies was 60 per cent for HSV-1 and 68 per cent for VZV in children whereas about 90 per cent of the adults showed the presence of antibodies to both viruses. Virological and serological confirmation of two cases in children of herpes simplex encephalitis (HSE) due to HSV-1 and VZV reactivation in two adults is described. PMID: 2810461 [PubMed - indexed for MEDLINE] 4233. Br J Dermatol. 1989 Aug;121(2):280. Reticulate hyperpigmentation distributed in a zosteriform fashion. Patrizi A, Di Lernia V, Varotti C. Comment on: Br J Dermatol. 1987 Oct;117(4):503-10. PMID: 2775652 [PubMed - indexed for MEDLINE] 4234. J Am Acad Dermatol. 1989 Aug;21(2 Pt 1):265-70. Topical capsaicin treatment of chronic postherpetic neuralgia. Bernstein JE, Korman NJ, Bickers DR, Dahl MV, Millikan LE. Department of Clinical Research, GenDerm Corp., Northbrook, IL. Uncontrolled studies have indicated that topically applied capsaicin may be a safe and effective treatment for postherpetic neuralgia. In a double-blind study 32 elderly patients with chronic postherpetic neuralgia were treated with either capsaicin cream or its vehicle for a 6-week period. Response to treatment was evaluated by visual analogue scales of pain and of pain relief, together with changes in a categoric pain scale and in a physician's global evaluation. Significantly greater relief in the capsaicin-treated group compared with vehicle was observed for all efficacy variables. After 6 weeks almost 80% of capsaicin-treated patients experienced some relief from their pain. Because capsaicin avoids problems with drug interactions and systemic toxicity, we suggest that topical capsaicin be considered for initial management of postherpetic neuralgia. PMID: 2768576 [PubMed - indexed for MEDLINE] 4235. Neurology. 1989 Aug;39(8):1132-3. Topical lidocaine for relief of superficial pain in postherpetic neuralgia. Kissin I, McDanal J, Xavier AV. Department of Anesthesiology, School of Medicine, University of Alabama, Birmingham 35294. PMID: 2761713 [PubMed - indexed for MEDLINE] 4236. J Indian Med Assoc. 1989 Aug;87(8):190. Ramsay Hunt syndrome. Kalam A, Tahseen M, Islam SF, Rahmatullah M, Khan AA, Faruqi NA. PMID: 2621363 [PubMed - indexed for MEDLINE] 4237. Virus Genes. 1989 Aug;2(4):299-305. Persistence of varicella-zoster virus DNA in blood mononuclear cells of patients with varicella or zoster. Gilden DH, Devlin M, Wellish M, Mahalingham R, Huff C, Hayward A, Vafai A. Department of Neurology, University of Colorado School of Medicine, Denver 80262. Varicella-zoster virus (VZV) DNA was detectable by in-situ hybridization in blood mononuclear cells (MNCs) of patients with varicella or zoster for 2-56 days after the onset of a rash. VZV DNA was present in many MNCs from one acute varicella patient 2 days after the onset of the rash and was rarely found in MNCs during acute zoster, convalescent zoster, and convalescent varicella. The morphology of MNCs containing VZV was heterogenous, although most viral-DNA-containing MNCs were large monocytoid cells. Serial examination of blood MNCs from one adult with varicella revealed VZV DNA up until 8 weeks, but not 16 weeks, after the appearance of the rash; parallel studies in four zoster patients showed VZV DNA up until 3 weeks, but not later than 7 weeks after the appearance of the rash. These results indicate that MNCs become infected with VZV during the primary encounter with VZV (varicella) and during reactivation (zoster) and that infection continues for weeks after the onset of the skin rash. Furthermore, the detection of VZV DNA in blood MNCs of uncomplicated zoster patients coincides with the period during which these patients experience pain. PMID: 2554580 [PubMed - indexed for MEDLINE] 4238. Semin Perinatol. 1989 Aug;13(4):278-93. Pathogenesis of congenital infection with three diverse viruses: varicella-zoster virus, human parvovirus, and human immunodeficiency virus. Grose C, Itani O. Department of Pediatrics, University of Iowa College of Medicine, Iowa City. PMID: 2549641 [PubMed - indexed for MEDLINE] 4239. Clin Pediatr (Phila). 1989 Aug;28(8):354. Clinical herpes zoster shortly following primary varicella in two HIV-infected children. Patterson LE, Butler KM, Edwards MS. Department of Pediatrics, Baylor College of Medicine, Houston, Texas 77030. PMID: 2547541 [PubMed - indexed for MEDLINE] 4240. Acta Neurol Scand. 1989 Aug;80(2):142-4. The incidence of herniated disc and varicella zoster virus infection in lumboradicular syndrome. Jensen PK, Andersen EB, Boesen F, Dissing I, Vestergaard BF. Department of Neurology and Radiology, Hvidovre Hospital, Copenhagen, Denmark. 121 patients suffering from lumboradicular syndrome were examined for the presence of varicella zoster virus (VZV) infection. Lumbar myelography was carried out on all. VZV-antibody determination in blood, as well as in spinal fluid, was by indirect ELISA. In 40% of cases lumbar myelography revealed no signs of a herniated disc; none had raised antibody titre in spinal fluid. VZV-antibody titre in blood indicated VZV infection in only 3. PMID: 2530747 [PubMed - indexed for MEDLINE] 4241. Zhonghua Nei Ke Za Zhi. 1989 Aug;28(8):466-8, 509. [Clinical analysis of 4 Chinese hemophiliacs with human immunodeficiency virus infection] [Article in Chinese] Tang DJ, Xu YH, Dai D. Human immunodeficiency virus (HIV-is) now considered the causative agent of acquired immunodeficiency syndrome(AIDS). A high risk of AIDS has been reported among patients with hemophilia who received lyophilized commercial factor VIII and IX concentrates of American origin. In a prevalence survey conducted from September to December 1985, HIV antibodies were found in all the 4 patients with hemophilia treated with the batch number W87307, 955 I.U. of American commercial factor VIII concentrate supplied by Armour pharmaceutical Company U.S.A. One of the seropositive patients developed AIDS-related complex (ARC) and died of cerebral hemorrhage. The other three sero-positive patients had abnormalities in cell mediated immunity; among them two developed left lumbosacral radiculopathy and hemorrhagic herpes zoster and one remains well so far. PMID: 2513171 [PubMed - indexed for MEDLINE] 4242. Practitioner. 1989 Jul 8;233(1472):1005. Herpes ophthalmicus. Burton J, Hood C. Always ensure that patient consent is obtained before any type of photography is undertaken, as the patient has the right to decide what is to happen to the images. PMID: 2594664 [PubMed - indexed for MEDLINE] 4243. J Chemother. 1989 Jul;1(4 Suppl):1304. Thoracic herpes zoster treated with intravenous Acyclovir in three cancer patients. Affronti M, Malta R, Di Rosa S, Maggio AM, Vassallo L, Occhino C, Scardavi M, Renda M, Scarpinati P. Department of Internal Medicine, University of Palermo, Italy. PMID: 16312876 [PubMed - indexed for MEDLINE] 4244. J Chemother. 1989 Jul;1(4 Suppl):1117-8. Efficacy of acyclovir in the treatment of recurring herpes labialis, genitalis and acute herpes zoster. Peralta S, Ribisi La Spina AM, Pirrotta P, Collura D, Formica P, Tinnirello D, Citarrella P, Mansueto S. Cattedra di Patologia Speciale Medica e Metodologia Clinica University of Palermo, Italy. PMID: 16312797 [PubMed - indexed for MEDLINE] 4245. J Chemother. 1989 Jul;1(4 Suppl):873-4. Clinical experience in gynecology on the enhancement of specific therapy using alkyl amino-ethylglycine, an amphoteric surfactant with amino acid structure. Oliveri S, Caruso S, Cianci P, Greco AM, Pinizzotto MR. Institute of Microbiology, University of Catania, Italy. PMID: 16312680 [PubMed - indexed for MEDLINE] 4246. Vrach Delo. 1989 Jul;(7):112-3. [Creatine phosphokinase in the cerebrospinal fluid of patients with acute meningitis] [Article in Russian] Smirnov VV, Skorniakov VI, Popov AS, Shestakova TI, Khot'ko LP. A study is presented of the general activity and isoenzymatic spectrum of creatine phosphokinase (CPK) in the cerebrospinal fluid (CSF) in patients with acute meningitis of different etiology. The enzymatic activity proved to be increased due to the cerebral (CPK-BB) isoform. Liberation of CPK-BB from the brain tissue and its penetration into the intercellular fluid and then into the CSF was related to the functional-structural changes in the cellular membranes of the brain in meningitis. PMID: 2800482 [PubMed - indexed for MEDLINE] 4247. Arch Ophthalmol. 1989 Jul;107(7):960-1. Varicella-zoster retinitis in human immunodeficiency virus infection. Case report. Chambers RB, Derick RJ, Davidorf FH, Koletar SL, Dangel ME. PMID: 2787629 [PubMed - indexed for MEDLINE] 4248. Am J Hematol. 1989 Jul;31(3):221-2. Acyclovir as treatment for aplastic anemia. Tuncer AM. Comment on: Am J Hematol. 1988 Nov;29(3):172-3. PMID: 2741918 [PubMed - indexed for MEDLINE] 4249. Clin Exp Dermatol. 1989 Jul;14(4):273-6. Clinical features of human immunodeficiency virus-associated disseminated herpes zoster virus infection--a review of the literature. Cohen PR, Grossman ME. Some similarities and several differences in the epidemiological, morphological, therapeutic, and prognostic features of HIV-associated disseminated HZV infection and disseminated HZV infection occurring in HIV-seronegative immunosuppressed patients exist. The severity of the cutaneous disseminated HZV infection, the potential for significant HZV-related morbidity, and the poor prognosis associated with this infection in HIV-seropositive patients, warrants prompt therapeutic intervention. The emergence of acyclovir-resistant HZV infection emphasizes the importance of continued investigation of alternative therapies for individuals with coincident HIV infection. PMID: 2686873 [PubMed - indexed for MEDLINE] 4250. Zh Mikrobiol Epidemiol Immunobiol. 1989 Jul;(7):72-4. [The relation of seasonal manifestations of herpes zoster and the seasonal periodicity of normal humoral immunity] [Article in Russian] Dizik GM, Iurik OE, Otrublenko OA. 29 practically healthy persons and 97 herpetic ganglionitis patients were examined at different periods during 1986-1987. The seasonal changes of humoral immunity both in clinically healthy persons and in herpetic ganglionitis patients were established. The conclusion was made that clinical manifestations of herpetic ganglionitis are linked with a decrease in the level of IgG ensuring natural resistance to chickenpox virus. PMID: 2554625 [PubMed - indexed for MEDLINE] 4251. Arch Ophthalmol. 1989 Jul;107(7):1068-72. Ocular varicella-zoster virus infection in the guinea pig. A new in vivo model. Pavan-Langston D, Dunkel EC. Eye Research Institute of Retina Foundation, Boston, MA 02114. Corneal intrastromal inoculation of guinea pigs with approximately 10(4) plaque-forming units of live, adapted varicella-zoster virus (VZV) resulted in reproducible, acute, superficial corneal disease in all animals. The culture-positive VZV ocular infection progressed to involve 30% to 40% of the corneal surface in a diffuse punctate keratitis and 10% to 15% of this surface with microdendrites, characteristic of VZV-induced ocular disease. Retrograde dissemination of VZV to the trigeminal ganglia, midbrain, cerebellum, and superior cervical ganglia was demonstrated by whole-cell coculture VZV recovery. Central nervous system VZV dissemination, manifested by transient neurologic symptoms and pneumonitis, was evident in 60% of the animals. Varicella-zoster virus spread to the trigeminal ganglion during acute and early-latent infection was evident by electron microscopy. PMID: 2546523 [PubMed - indexed for MEDLINE] 4252. BMJ. 1989 Jul 1;299(6690):55. Treatment of shingles and post-herpetic neuralgia. Schieff C. Comment on: BMJ. 1989 Jun 10;298(6687):1537-8. PMCID: PMC1837005 PMID: 2503218 [PubMed - indexed for MEDLINE] 4253. Postgrad Med J. 1989 Jul;65(765):478-80. Algoneurodystrophy following herpes zoster. Foster O, Askaria A, Lanham J, Perry D. Whipps Cross Hospital, Leytonstone, London, UK. Algoneurodystrophy frequently follows an identifiable triggering event. It is not widely recognized that herpes zoster can precipitate algoneurodystrophy and three such cases are described here. In one, the affected dermatome did not correspond to the limb involved by the algoneurodystrophy. PMCID: PMC2429435 PMID: 2481303 [PubMed - indexed for MEDLINE] 4254. Wien Klin Wochenschr. 1989 Jun 23;101(13):448-50. [Human herpesvirus 6 (HHV-6): incidence in healthy blood donors and in patients with acute infections caused by other herpes viruses] [Article in German] Larcher C, Huemer HP, Hönlinger M, Margreiter R, Dierich MP. Institut für Hygiene, Universität Innsbruck. Antibodies to HHV-6 were detected by immunofluorescence in 8.04% of 460 healthy blood donors in West Austria. Testing sera from patients with acute or reactivated infections with other herpesviruses, such as cytomegalovirus (CMV), Epstein-Barr virus (EBV), herpes simplex virus (HSV) and varicella zoster virus (VZV) we observed a remarkably higher prevalence of antibodies to HHV-6 in patients with CMV infections (75%) and also in patients with EBV infections (50%). Patients with HSV and VZV infections were positive for HHV 6 in 12.5% and 6.6% of cases, respectively. Many of the patients with CMV infection were transplant recipients. The high incidence of positive HH 6 serology in these patients could be due to new infection by HHV 6 or to the reactivation of a previous infection with HHV 6 by means of allogenic cell stimulation. Furthermore, preliminary results from our laboratory point to a serological cross-reaction between HHV 6 and CMV, which may also contribute to this result. PMID: 2548350 [PubMed - indexed for MEDLINE] 4255. Med J Aust. 1989 Jun 19;150(12):727. Treatment of prodromal shingles. Bateman PP. PMID: 2733628 [PubMed - indexed for MEDLINE] 4256. BMJ. 1989 Jun 10;298(6687):1537-8. Treatment of shingles and post-herpetic neuralgia. Jolleys JV. Comment in: BMJ. 1989 Aug 26;299(6698):568. BMJ. 1989 Aug 5;299(6695):392-3. BMJ. 1989 Jul 1;299(6690):55. PMCID: PMC1836784 PMID: 2503110 [PubMed - indexed for MEDLINE] 4257. Am J Dermatopathol. 1989 Jun;11(3):259-69. Lichenoid lymphocytic vasculitis with a high component of histiocytes. Histogenetic implications in a specified clinical setting. Ferguson DL, Hawk RJ, Covington NM, Reed RJ. Department of Pathology, Tulane University School of Medicine, New Orleans, LA 70112. PMID: 2729528 [PubMed - indexed for MEDLINE] 4258. Postgrad Med. 1989 Jun;85(8):297-300. Chickenpox and pregnancy. What are the risks? Rosenfeld JA. Family Practice Residency Program, St Francis Hospital, Wilmington, DE 19805. PMID: 2726645 [PubMed - indexed for MEDLINE] 4259. Vrach Delo. 1989 Jun;(6):112-5. [Clinical aspects and treatment of herpes zoster in middle and old age (a review of the literature)] [Article in Russian] Andreĭchin MA, Savchak VI. PMID: 2675465 [PubMed - indexed for MEDLINE] 4260. Higashi Nippon Shigaku Zasshi. 1989 Jun;8(1):47-55. [Report of a case of Herpes zoster] [Article in Japanese] Tanaka T, Murase H, Miyata M, Taira H, Aso T, Harada N, Kitamura K, Tomita K, Kanazawa M. Herpes Zoster is a viral disease of the skin and mucosa characterized by grouped vesicula eruptions and neuralgic pain along a peripheral nerve. A case of Herpes Zoster in the right region along the second and third trigeminal nerve branches of a 24-year-old male was reported. The first disorder appeared as a grouped vesicular eruption in the center of the lower lip. This was followed by a cutaneous lesion in the area of the right second trigeminal nerve branch. From the first day of hospitalization, the patient began receiving a daily dose of 2500mg of immunoglobulin. The administration of immunoglobulin, cured the oral and cutaneous lesion. PMID: 2519919 [PubMed - indexed for MEDLINE] 4261. Med Clin (Barc). 1989 May 27;92(20):797. [Metastasis of an adenocarcinoma of unknown origin as a localizing factor of herpes zoster] [Article in Spanish] Fonseca E, Rugarcía M, Valverde J. PMID: 2796424 [PubMed - indexed for MEDLINE] 4262. N Z Med J. 1989 May 10;102(867):227. Acyclovir resistance. Mansell C. PMID: 2717106 [PubMed - indexed for MEDLINE] 4263. Cas Lek Cesk. 1989 May 5;128(19):590-4. [Iontophoretic administration of vinblastine in the control of refractory spinal root pain and postherpetic neuralgia] [Article in Czech] Opavský J, Pĕnicková V, Jezdinský J. Iontophoretic administration of substances which influence the function of microtubuli in the peripheral nerves is one of the new ways how to suppress some types of refractory chronic pain. Based on a number of experimental data and encouraging clinical results, the authors used in the submitted work repeated iontophoretic administration of 0.01% Vinblastine (G. Richter, Hungary) into the painful zone in a group of 20 patients with several types of non-malignant pain. Objectivization of the evaluation was partly also due to the authors' own version of McGill Pain Questionnaire, along with the graphic presentation of algetic zones. Clinically detectable mitigation of pain was achieved in 14 subjects, in eight improvement persisted for more than six months and one year resp. No serious undesirable side-effects were observed in the investigated subjects. PMID: 2743383 [PubMed - indexed for MEDLINE] 4264. J Rheumatol. 1989 May;16(5):618-22. Rheumatoid factor in patients with systemic lupus erythematosus. Feldman D, Feldman D, Ginzler E, Kaplan D. Department of Medicine, State University of New York, Brooklyn 11203. One hundred sixty-six patients with systemic lupus erythematosus (SLE) were surveyed and their sera tested for the presence of rheumatoid factor (RF). Fifteen were positive whenever tested, with titers of at least 1:40; the remainder were either positive only in titers of 1:20, were inconsistently positive or were persistently negative. The former group were less likely to have severe manifestations of SLE, less likely to have required treatment with "high-dose" steroids or a cytotoxic drug, and less likely to have had an episode of herpes zoster. We conclude that in patients with SLE, RF may be a reflection of relative immune competence so that they are partially protected against the more serious manifestations of SLE and the development of herpes zoster. PMID: 2754666 [PubMed - indexed for MEDLINE] 4265. Acta Neurol Scand. 1989 May;79(5):407-11. Electroencephalographic changes in patients with herpes zoster. Peterslund NA, Hansen JH. Department of Medicine and Infectious Diseases, Marselisborg Hospital, Aarhus, Denmark. EEGs of 42 patients with herpes zoster and 6 with herpes zoster-associated encephalitis were studied to characterize the nature and prevalence of EEG abnormalities in apparently uncomplicated herpes zoster. Thirty-one percent of herpes zoster patients had EEG changes with reduced rhythm frequency ranging from 7 to 2 Hz activity. Frontotemporal localization was observed in 54% of the abnormal EEGs. When compared to EEG in herpes zoster associated encephalitis, the findings were qualitatively the same, but tended to be more severe in the encephalitis cases. No effect of acyclovir on the EEG could be demonstrated. PMID: 2741671 [PubMed - indexed for MEDLINE] 4266. Compr Ther. 1989 May;15(5):3-9. Herpes zoster ophthalmicus. Pavan-Langston D, Dunkel EC. Eye Research Institute, Harvard Medical School, Boston, MA. PMID: 2659251 [PubMed - indexed for MEDLINE] 4267. Neurol Clin. 1989 May;7(2):231-48. Postherpetic neuralgia. Watson CP. Department of Medicine, Irene Eleanor Smythe Pain Clinic, University of Toronto, Ontario, Canada. Postherpetic pain persisting 1 month or longer occurs in only a small percentage of all patients with herpes zoster. In most patients, PHN tends to diminish with time. The incidence is, however, directly related to age. Any therapeutic claim for prophylaxis or treatment of PHN has to be evaluated with these observations in mind. There is some information about the pathologic features and a concept of the pathogenesis can be suggested. There is evidence for an imbalance in fiber input (reduced large, inhibitory fibers, and intact or increased small, excitatory fibers) to an abnormal dorsal horn that may contain hypersensitive neurons. Prevention of PHN remains difficult. There is evidence that systemic steroids exert a preventive effect when employed in the treatment of herpes zoster in the immunocompetent patient. A reasonable regimen is 60 mg of prednisone tapered over 10 to 14 days. One double-blind, controlled study supports the use of amantadine in this situation; this drug is an option in patients for whom steroids are contraindicated, such as those with peptic ulcer, diabetes mellitus or compromised immune function. The dosage of amantadine used in this study was 100 mg twice daily for a month. Although a number of other therapies have been suggested, these remedies remain in need of further, more scientific study. For established PHN, there is firm support for the reduction of pain from severe to mild in two thirds of patients administered low doses of amitriptyline followed by gradual, small increments. In the age group over 65 years, one may use as small a dose as 10 mg with an increase of 10 mg every 5 to 7 days. In those younger than 65, a dose of 25 mg to start is reasonable, with increments of 25 mg. Although unproved, the addition of a phenothiazine, such as fluphenazine, may provide further pain relief. Preliminary studies also indicate that topical capsaicin may be a useful new treatment. Although widely used, there is no good evidence for the use of anticonvulsants alone in this disorder. Studies of local anesthetic sprays with vibration and continuous TENS are uncontrolled, but these modalities may be of some merit. One uncontrolled study reported benefit from epidural steroids. DREZ lesions are a possibility in failed medical cases, but other surgical procedures appear to be of little or no use. Although the measures described here will benefit a number of patients, PHN remains an intractable problem in some cases.(ABSTRACT TRUNCATED AT 400 WORDS) PMID: 2566900 [PubMed - indexed for MEDLINE] 4268. J R Soc Med. 1989 May;82(5):278-80. AIDS: neurological opportunist infections in central London. Guiloff RJ. Department of Neurology, Westminster Hospital, London. Twenty six (41%) of 64 central London cases of AIDS with nervous system involvement during the course of the illness had neurological opportunist infection. Cytomegalovirus and Toxoplasma gondii were the commonest agents in 22 cases with central nervous system (CNS) infection. Eight cases had herpes zoster radiculopathy. Other infections included those caused by Cryptococcus neoformans, Mycobacterium tuberculosis and papova JC virus. Prognosis was generally poor, irrespective of whether the opportunist infection was treatable. PMCID: PMC1292132 PMID: 2547063 [PubMed - indexed for MEDLINE] 4269. J Neurol Neurosurg Psychiatry. 1989 May;52(5):578-82. Antiviral IgM and IgG subclasses in varicella zoster associated neurological syndromes. Mathiesen T, Linde A, Olding-Stenkvist E, Wahren B. Department of Neurosurgery, Karolinska Institute, Stockholm, Sweden. The varicella zoster virus (VZV) and herpes simplex virus (HSV) IgGl-4 subclasses were compared in serum and cerebrospinal fluid (CSF) of 22 patients with VZV-associated neurological symptoms, 12 patients with HSV-associated neurological symptoms and 14 controls. The clinical syndromes of the VZV-associated diseases comprised meningo-encephalitis, myelitis, myelopathies and polyneuropathies, mostly with a favourable outcome. A characteristic finding was an intrathecal synthesis of VZV IgG1 and HSV-3. Commonly also IgG2 and 4 were seen in CSF of VZV patients. Their intrathecally synthesised HSV IgG was restricted to IgG1. VZV IgG3 occurred in serum and/or CFS together with VZV IgM in 14 cases and may be a marker of recent VZV replication. In patients with HSV-associated neurological disease, a multi-IgG subclass HSV response and concomitant VZV antibodies restricted to IgG1 was found. Intrathecal synthesis of both HSV and VZV IgG occurred in 20 patients. Detection of two or more VZV or HSV specific IgG subclasses synthesised intrathecally identified the aetiological agent in 19 of these 20 cases. PMCID: PMC1032163 PMID: 2543794 [PubMed - indexed for MEDLINE] 4270. J Med Virol. 1989 May;28(1):30-7. Antibodies against varicella-zoster virus and herpes simplex virus deoxythymidine kinase in heterologous infections. Källander CF, Torfason EG, Olding-Stenkvist E, Sundqvist VA, Diderholm H, Gronowitz JS. Department of Medical Virology, Uppsala University, Sweden. Antibody responses to varicella-zoster virus (VZV) deoxythymidine kinase (dTK) and herpes simplex virus (HSV) dTK in homologous and heterologous infections were studied. Antibodies blocking the enzymatic activity of VZV-dTK appeared late after varicella and decreased more or less in parallel with the decreasing complement fixing [CF] titre. In herpes zoster, on the other hand, antibodies to VZV-dTK appeared soon after infection. Antibodies against HSV dTKs appeared long after primary infection, but they were subsequently present in all other HSV-CF positive sera. In recurrent HSV, all acute sera were already HSV-dTK antibody positive, and three of nine persons showed an increase in titer between their acute and convalescent sera. Blocking antibodies to VZV-dTK appeared rapidly in specimens from three of 18 individuals positive by an immunofluorescence VZV-immunity test during HSV infection, whereas all other specimens remained devoid of blocking antibodies against VZV-dTK. A rise in antibody titre against HSV-dTK during VZV infections was observed in serum specimens from three of 13 HSV-CF positive patients, whereas an antibody response against HSV-dTK was not found in HSV-CF negative individuals in connection with VZV infections. The relevance of the sporadic increase in the titres of antibodies against heterologous viral dTKs is discussed. PMID: 2542443 [PubMed - indexed for MEDLINE] 4271. J Med Virol. 1989 May;28(1):1-6. Rapid detection of varicella-zoster virus in clinical specimens using monoclonal antibodies on shell vials and smears. Schirm J, Meulenberg JJ, Pastoor GW, van Voorst Vader PC, Schröder FP. Regional Public Health Laboratory, University Hospital, Groningen, The Netherlands. Monoclonal antibodies were used for detecting varicella-zoster virus (VZV) by immunofluorescence (IF) in clinical specimens inoculated on shell vial cultures. Vesicles of 74 patients with varicella or herpes zoster-like eruptions were tested by this method and by conventional cell culture. Further diagnostic tests were direct IF on smears (42 patients), the cytological Tzanck test (28 patients), and serology (30 patients). Both IF assays were performed with the commercial VZV-specific monoclonal antibody 3B3 (Ortho). Using the shell vial technique, we found VZV in 37 (50%) of the patients, on average after 3 days. The conventional culture method yielded 26 positives (35%), on average after 7.5 days. Twenty-nine of the shell vial IF-positive patients were also positive by direct IF on smears (30 tested), while 15 gave positive Tzanck smears (18 tested). The sensitivities of the shell vial IF test, the direct IF test, the conventional culture method, and the Tzanck test were about 95%, 97%, 70%, and 79%, respectively. For the specificities, we found at least 97% for the shell vial IF test, at least 91% for the direct IF test, and about 78% for the Tzanck test. We conclude that both VZV IF tests are much more reliable than the conventional cell culture method and the Tzanck test for the laboratory diagnosis of VZV infections. PMID: 2542440 [PubMed - indexed for MEDLINE] 4272. J Infect Dis. 1989 May;159(5):1000-1. Zoster in normal children after varicella vaccine. Plotkin SA, Starr SE, Connor K, Morton D. PMID: 2540244 [PubMed - indexed for MEDLINE] 4273. J Virol. 1989 May;63(5):2392-5. Investigation of varicella-zoster virus infection of lymphocytes by in situ hybridization. Koropchak CM, Solem SM, Diaz PS, Arvin AM. Department of Pediatrics, Stanford University School of Medicine, California 94305. Peripheral blood mononuclear cells harboring viral gene sequences were detected during primary varicella-zoster virus (VZV) infection of the human host and the strain 2 guinea pig by in situ hybridization with a 3H-labeled VZV DNA probe. Activated T lymphocytes were permissive for VZV infection at low frequency in vitro. PMCID: PMC250665 PMID: 2539528 [PubMed - indexed for MEDLINE] 4274. Chin Med J (Engl). 1989 May;102(5):395-9. Experimental studies on the prevention and treatment of chickenpox and herpes zoster with measles vaccine. Li WH, Ming ZL, Chen Q, Li Y. In 151 chickenpox patients treated with live attenuated measles vaccine, the cure rate was 100%. In 145 cases of herpes zoster, the effective rate was 100% (completely cured in 91.7% and improved in 8.3%). In the treated group, the time needed for the subsidence of fever and skin rash and the duration of the disease were markedly shorter than those in the control group (P less than 0.01). It is particularly effective for alleviating pain, preventing and relieving postherpetic neuralgia in patients with zoster. The application of measles vaccine to the patients in the chickenpox incubation period might prevent the development of the disease, and decrease the incidence and death rate of varicella zoster virus infection in highly susceptible patients. The mechanism of its anti-viral action and production of interferon in the body is discussed. PMID: 2509165 [PubMed - indexed for MEDLINE] 4275. N Z Med J. 1989 Apr 26;102(866):201. Acyclovir and herpes zoster. Thomas MG, Ellis-Pegler RB. PMID: 2710456 [PubMed - indexed for MEDLINE] 4276. Rev Prat. 1989 Apr 20;39(12):1064-6. [Herpes zoster. Epidemiology, physiopathology, diagnosis, course and prognosis] [Article in French] Piette F, Delaporte E. PMID: 2740773 [PubMed - indexed for MEDLINE] 4277. Ugeskr Laeger. 1989 Apr 17;151(16):1005. [Herpesvirus and acute peripheral facial paresis] [Article in Danish] Esmann V. PMID: 2756590 [PubMed - indexed for MEDLINE] 4278. Z Hautkr. 1989 Apr 15;64(4):253-4. [Should every case of herpes zoster be treated immediately with acyclovir (Zovirax)?] [Article in German] Nasemann T. PMID: 2735084 [PubMed - indexed for MEDLINE] 4279. Z Hautkr. 1989 Apr 15;64(4):255-6, 259-62, 265. [New knowledge regarding herpes zoster] [Article in German] Stary A. Ambulatorium für Pilzinfektionen und andere infektiöse venero-dermatologische Erkrankungen, Wien. Zoster is the clinical manifestation of the endogenous reactivation of the varicella-zoster virus. Current observations of viral reactivation emphasize the role of cellular immunity and show an inverse correlation between the specific cellular immune response of the host and the incidence of zoster. Thus, immunocompromised persons like patients with immune deficiency syndrome, lymphoproliferative cancer, or immunosuppressive therapy are at a high risk for the development of disseminated zoster, which may either involve the skin only, or affect more than one organ. During the last few years zoster has been proved a prognostic marker for HIV-positive persons. The incidence of zoster and post-zoster neuralgia increases with advancing age. In young children, immunosuppressive therapy and varicella in utero or during the first year of life are the only risk factors for zoster infection. Prevention of dissemination has been one of the major goals in antiviral chemotherapy of zoster in immunocompromised patients. Among the antiviral drugs available at present, aciclovir has proved especially useful, acting as an inhibitor of viral DNA polymerase. It is well-tolerated and can be applied together with corticoids, analgetics, and retrovir. It is most effective in reducing complications of zoster. PMID: 2660444 [PubMed - indexed for MEDLINE] 4280. Am J Ophthalmol. 1989 Apr 15;107(4):373-80. The spectrum of optic nerve disease in human immunodeficiency virus infection. Winward KE, Hamed LM, Glaser JS. Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami School of Medicine, Florida 33101. We studied four patients with HIV-associated optic neuropathies. One had syphilitic optic perineuritis, which responded promptly and completely to penicillin therapy. The second had cytomegalovirus papillitis and visual acuity subsequently deteriorated to no light perception. The third showed varicella zoster optic neuritis, which improved after intravenous acyclovir treatment. The fourth patient developed cryptococcal retrobulbar neuritis and died shortly thereafter. Optic neuropathy was among the initial symptoms of HIV infection in two of the four cases. PMID: 2539020 [PubMed - indexed for MEDLINE] 4281. N Z Med J. 1989 Apr 12;102(865):168. Treatment of herpes zoster. Humphrey AR. PMID: 2704467 [PubMed - indexed for MEDLINE] 4282. Gan To Kagaku Ryoho. 1989 Apr;16(4 Pt 2-1):1108-14. [Infection and immunosuppression in cancer patients] [Article in Japanese] Kitahara T, Takenaka T, Yoshino M. Dept. of Internal Medicine, National Cancer Center Hospital, Tokyo. Septicemia in hematologic malignancies and infection of herpes zoster in cancer patients were studied, and trend in organisms in a cancer hospital was investigated. 1) Septicemia in hematologic malignancies. The success rate of antibiotic therapy for septicemia was 76% if the patients were not under antibiotic therapy when septicemia developed. But recovery from septicemia was only 25% if the patients were undergoing antibiotic therapy when septicemia developed. Some 90% of neutropenic patients under 500/microliters, who were not under antibiotic therapy when septicemia developed, recovered from septicemia if the neutrophil count increased in the following 5 days. Change in the neutrophil count was an important factor determining the success or failure of antibiotic therapy for septicemia. The use of granulocyte colony-stimulating factor may prevent chemotherapy-induced neutropenia. Shortening of the period of neutropenia or preventing its occurrence should reduce the incidence and the severity of infection. 2) Infection of herpes zoster in cancer patients. Thirty-four cancer patients were associated with herpes zoster. Eleven of them were patients with malignant lymphoma and ten of them were patients of breast cancer. Most patients were heavily pretreated by chemotherapy and/or radiotherapy before the development of herpes zoster. Marked lymphocytopenia was observed at the onset of herpes zoster. Absolute lymphocyte count was under 1000/microliters in 71% of these patients. Development of herpes zoster in cancer patients was considered to be due to the depression of cell-mediated immunity which was the result of repeated and continued anticancer therapy. Acyclovir was found to be effective to treat herpes zoster in these patients. 3) Trend of organisms detected in cancer hospital. The frequency of organisms isolated from clinical materials in the National Cancer Center Hospital was compared during the period from 1978 to 1982 and the period from 1983 to 1987. The most common organism detected in both periods was P. aeruginosa and no change in frequency was observed. But the frequency of gram-negative bacilli, E. coli, Klebsiella and Serratia, decreased significantly in the latter period while the frequency of gram-positive cocci, Enterococcus and Staphylococcus increased markedly in the latter period. The use of cephems of third generation in the latter period could be one reason for the recent change of organisms detected in the hospital. Appropriate therapy for infection based on the latest and accurate information should be used. PMID: 2730015 [PubMed - indexed for MEDLINE] 4283. J Otolaryngol. 1989 Apr;18(3):99-100. Recurrent vestibulopathy: support for a viral etiology. Longridge NS. Department of Otolaryngology, Vancouver General Hospital, B.C., Canada. Over an 18-month period, mother, father and child were seen with dizziness. The mother had Ramsay Hunt syndrome prior to developing recurrent vestibulopathy. A viral cause for recurrent vestibulopathy is suggested. PMID: 2716093 [PubMed - indexed for MEDLINE] 4284. J Am Acad Dermatol. 1989 Apr;20(4):637-42. Disseminated ecthymatous herpes varicella-zoster virus infection in patients with acquired immunodeficiency syndrome. Gilson IH, Barnett JH, Conant MA, Laskin OL, Williams J, Jones PG. Department of Medicine, University of Wisconsin Medical School, Mount Sinai Medical Center, Milwaukee. Herpesvirus infections are among the most common and debilitating opportunistic infections in patients with acquired immunodeficiency syndrome (AIDS), and they may have atypical clinical features. We describe the cases of three patients with AIDS in whom atypical persistent ulcerative skin lesions developed as a result of varicella-zoster virus infection. Two patients had disseminated infection without a vesicular stage; one patient had underlying asteatotic eczema. All responded well to acyclovir. One patient was treated with azidothymidine, and typical dermatomal herpes zoster subsequently developed. The profound loss of helper T cell function in AIDS may lead to multiple abnormalities in local immune response to cutaneous herpesvirus infections and may be responsible for the atypical morphology and a prolonged course. PMID: 2715411 [PubMed - indexed for MEDLINE] 4285. Arthritis Rheum. 1989 Apr;32(4):506-7. Articular presentation of herpes zoster eruption. Leventhal LJ, Bomalaski JS. PMID: 2706034 [PubMed - indexed for MEDLINE] 4286. Nippon Hifuka Gakkai Zasshi. 1989 Apr;99(4):443-7. [HLA-DR antigen expression on peripheral T cell subsets in pityriasis rosea Gibert, herpes zoster, and psoriasis] [Article in Japanese] Aikawa Y, Yoshiike T, Ogawa H. Using 2 color fluorescein activated cytometric analysis, HLA-DR antigen expression in T cell subsets was studied in pityriasis rosea (PR) and compared to the results from herpes zoster (HZ) of viral origin and psoriasis (Ps). In HZ and PR, HLA-DR was significantly expressed on the T cell surface (Leu-4+ cells). Among the T cell subsets, HLA-DR antigen was predominantly expressed on suppressor/cytotoxic cells (Leu-2a+) in HZ. In contrast, it was predominantly expressed on helper cells (Leu-3a+) in PR. However, activated T cell antigen (Tac) was not significantly expressed on T cells (Leu-4+) in either HZ or in PR. This HLA-DR antigen expression of T cell subsets was depressed to the normal level in the recovery phases of HZ and PR. PMID: 2614989 [PubMed - indexed for MEDLINE] 4287. Nippon Hifuka Gakkai Zasshi. 1989 Apr;99(4):457-61. [A case of herpes zoster duplex with generalized eruption--study of the pathogenesis of the eruptions] [Article in Japanese] Yoshida M, Hondo R. A 77-year-old man who developed herpes zoster duplex with generalized eruptions is presented. Three strains of varicella-zoster virus (VZV) were isolated from 2 skin lesions of herpes zoster and one of the generalized eruptions. For strain differentiation, these 3 strains were investigated by restriction endonuclease analysis of the viral DNA. The 3 strains were identical, suggested that a single strain of VZV had been residing in a latent form in multiple spinal ganglions of this patient. We speculate that this strain of VZV in remote ganglions was reactivated by the operation of gastric cancer as a trigger, and, as a result, the 2 skin lesions of herpes zoster appeared, followed by development of generalized eruptions due to virus propagation from zoster lesions. PMID: 2559215 [PubMed - indexed for MEDLINE] 4288. Hosp Pract (Off Ed). 1989 Mar 30;24(3A):21-2, 27, 31-2. Questions and controversies about varicella-zoster infections. Bialecki C, Feder HM Jr. University of Connecticut School of Medicine, Farmington. PMID: 2538487 [PubMed - indexed for MEDLINE] 4289. BMJ. 1989 Mar 25;298(6676):832. Antiviral treatment and postherpetic neuralgia. Klenerman P, Peto TE, Luzzi GA, Juel-Jensen BE. PMCID: PMC1836058 PMID: 2496880 [PubMed - indexed for MEDLINE] 4290. Practitioner. 1989 Mar 22;233(1465):398-403. Shingles in general practice. Peto T. Patients over 50 with simple shingles should be offered topical idoxuridine or intravenous acyclovir to reduce the risk of post-herpetic neuralgia. For younger patients, specific treatment with high dose intravenous acyclovir is needed only for complications or in immunosuppressed patients. PMID: 2594625 [PubMed - indexed for MEDLINE] 4291. Am J Ophthalmol. 1989 Mar 15;107(3):257-61. Penetrating keratoplasty for herpes zoster keratopathy. Reed JW, Joyner SJ, Knauer WJ 3rd. Department of Ophthalmology, Bowman Gray School of Medicine, Wake Forest University Medical Center, Winston-Salem, NC 27103. We reviewed retrospectively the records of 12 patients with herpes zoster keratopathy who had undergone penetrating keratoplasty. Preoperatively, seven patients (58%) had noninflamed eyes with visually significant corneal scarring or edema. Five patients (42%) had progressive neurotrophic corneal ulceration, and four of those had corneal perforation. Tarsorrhaphies were placed in ten patients and appeared to be beneficial in preventing postoperative breakdown of the corneal surface. At an average follow-up time of 36 months, ten of the 12 grafts (83%) remained clear, with nine patients (75%) having a visual acuity of 20/80 or better. PMID: 2646934 [PubMed - indexed for MEDLINE] 4292. N Z Med J. 1989 Mar 8;102(863):93-5. Oral acyclovir in the treatment of herpes zoster in general practice. Morton P, Thomson AN. Wellcome New Zealand Ltd, Auckland. A double-blind, randomised trial evaluated the efficacy of oral acyclovir, 800 mg 5 times daily for 7 days, in acute herpes zoster and postherpetic neuralgia. Forty patients aged 16 years or over, presenting to their general practitioners within 3 days of rash onset, received acyclovir, while 43 patients received placebo. Acyclovir reduced the extent and duration of the rash, the spread of the rash to adjacent dermatomes and the incidence of disseminated lesions. It shortened the period of new lesion formation and reduced the incidence of ulceration. The weekly prevalence of pain was reduced on acyclovir by the fourth week, with a reduction in the monthly prevalence of chronic pain in the second and third months and a reduction in associated local neurological symptoms between months 3-6. Total analgesic use in the first 4 weeks was reduced by acyclovir, but during follow up there was no difference in the prevalence of analgesic use between groups. There were slightly fewer medical events on acyclovir in the second week, but the frequency was the same in each group for the rest of the 6 months. Biochemical and haematological tests showed no adverse effects of treatment. PMID: 2648213 [PubMed - indexed for MEDLINE] 4293. J Am Acad Dermatol. 1989 Mar;20(3):523-4. Corticosteroids and postherpetic neuralgia. [No authors listed] Comment on: J Am Acad Dermatol. 1988 Mar;18(3):605-10. PMID: 2918127 [PubMed - indexed for MEDLINE] 4294. Hum Pathol. 1989 Mar;20(3):292-5. Bulbar encephalitis complicating trigeminal zoster in the acquired immune deficiency syndrome. Rosenblum MK. Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021. A 30-year-old homosexual man with the acquired immune deficiency syndrome and a recent history of zoster involving the mandibular division of the right trigeminal nerve was found at autopsy to have a predominantly demyelinating lesion restricted to the ipsilateral spinal trigeminal tract and nucleus. Cowdry A inclusions were readily apparent in the nuclei of numerous glia and isolated neurons, and inclusion-bearing cells were immunoreactive with an antiserum to the varicella zoster virus (VZV). This represents the first demonstration that zoster-associated trigeminal encephalitis is the result of brainstem invasion by VZV. The restricted topography of this lesion implicates axonal transport in its pathogenesis. PMID: 2722178 [PubMed - indexed for MEDLINE] 4295. Laryngorhinootologie. 1989 Mar;68(3):141-3. [Therapy of facial paralysis in herpes zoster oticus with acyclovir] [Article in German] Schrader B, Laskawi R, Schröder M, Chilla R, Brauneis J. HNO-Klinik des Zentralkrankenhauses, Bremen. In the present study patients suffering from facial nerve palsy caused by a herpes zoster oticus were treated with aciclovir. After therapy all patients could be controlled via clinical grading system and electromyographic observations. Aciclovir therapy did not yield any results superior to those obtained with other forms of therapy presented in the literature. PMID: 2712973 [PubMed - indexed for MEDLINE] 4296. Cutis. 1989 Mar;43(3):262-3. Herpes zoster infection with trigeminal and facial nerve involvement. Waterman G, Epstein JD, Fenske NA. Division of Dermatology, University of South Florida, Tampa. In most cases, herpes zoster (shingles) infections are benign and self-limited, requiring no treatment. However, if patients are elderly or immuno-compromised, they are at increased risk of complications such as visceral dissemination, cranial and nerve palsies, ophthalmic zoster, and postherpetic neuralgia. We present a case of herpes zoster infection complicated by both motor and sensory involvement in an elderly man. PMID: 2707055 [PubMed - indexed for MEDLINE] 4297. J R Soc Med. 1989 Mar;82(3):145-6. Severe herpes zoster infection in the United Kingdom: experience in a regional infectious disease unit. Bannister P, Crosse B. Department of Geriatric Medicine, Bristol Royal Infirmary, Bristol. Seventy-three cases of severe herpes zoster infection admitted to a regional infectious disease unit over a 3-year period were reviewed. Complications were common. Elderly patients were in the majority (55%), were hospitalized for longer and accounted for 78% of all complications. Acyclovir therapy was used in 44 cases with a reduction in both the duration of hospital stay and complication rate. PMCID: PMC1292038 PMID: 2704012 [PubMed - indexed for MEDLINE] 4298. Anesth Prog. 1989 Mar-Apr;36(2):35-40. Herpes zoster management. Katz JA, Phero JC, McDonald JS, Green DB. PMCID: PMC2148633 PMID: 2690678 [PubMed - indexed for MEDLINE] 4299. Tissue Antigens. 1989 Mar;33(3):415-7. HLA-antigens in renal transplanted patients with varicella-zoster infection. Forsberg B, Johnson U. Department of Medicine, Malmö General Hospital, Sweden. The frequency of the HLA B 40 antigen was significantly higher among renal transplanted patients with herpes zoster infection than in controls. The presence of HLA B 40 may be related to impaired immune response in transplanted and immunosuppressed carriers. PMID: 2662473 [PubMed - indexed for MEDLINE] 4300. Bone Marrow Transplant. 1989 Mar;4(2):191-4. Varicella-zoster virus infections after autologous bone marrow transplantation in children. Wacker P, Hartmann O, Benhamou E, Salloum E, Lemerle J. Department of Pediatrics, Institut Gustave-Roussy, Villejuif, France. We report a retrospective analysis of children who underwent autologous bone marrow transplantation (ABMT) and subsequently developed a varicella-zoster virus (VZV) infection. Among 236 patients transplanted between January 1979 and December 1987, 54 (23%) aged 2 to 18.5 years (mean 7.2) developed 60 VZV infections (25%); there were 10 cases of chicken-pox in 10 patients, 43 zoster infections in 41 patients and seven disseminated zoster infections in seven patients. Eighty-seven percent of VZV infections occurred within the first 6 months after bone marrow transplantation, with a mean interval of 89 days. No significant risk factors for the development of zoster infections were identified. The incidence of VZV infections following ABMT was similar to that observed after allogeneic bone marrow transplant but the onset was earlier after ABMT (3 vs 5 months) and there were fewer complications (2 vs 18%). Acyclovir and/or adenine arabinoside were administered to 46 patients. One child who had had chicken-pox died of interstitial pneumonitis due to VZV despite antiviral therapy. No other symptomatic visceral dissemination was observed. PMID: 2650789 [PubMed - indexed for MEDLINE] 4301. Postgrad Med. 1989 Mar;85(4):369-70, 375. Dermatologic symptoms without signs. Seeking the cause of itching, pain, and burning. Wooldridge WE. A patient may seek medical help because of dermatologic itching, pain, or burning that is unaccompanied by visible lesions. Although referral to a dermatologist may be necessary, the primary care physician is at times able to manage such patients if he or she is aware of some of the common causative diseases, including preeruptive herpes zoster, polyneuritis, and aquagenic pruritus. PMID: 2648364 [PubMed - indexed for MEDLINE] 4302. Nurse Pract. 1989 Mar;14(3):30, 35-6, 38 passim. Herpes zoster and postherpetic neuralgia: the need for early intervention in the elderly. LeFort SM. Memorial University of Newfoundland, St. John's, Canada. Herpes zoster is an acute nervous system infection that commonly affects the elderly. Because the causative agent is a virus, herpes zoster is often treated symptomatically in the primary care setting. While this approach is acceptable for immunocompetent patients less than 50 years of age, it can leave older patients at greater risk of developing painful and debilitating complications such as postherpetic neuralgia. There is evidence that appropriate treatment initiated within 48 to 72 hours after the onset of the zoster eruption can decrease healing time, reduce acute pain, decrease ocular complications and may prevent the development of postherpetic neuralgia in this age group. The health care practitioner in a primary care setting is ideally placed to identify elderly clients with herpes zoster in the early stages; to consult with physicians about therapies such as steroids, antiviral agents and sympathetic nerve blocks; to monitor treatment effects; and to provide supportive therapy to those who develop postherpetic neuralgia. PMID: 2648208 [PubMed - indexed for MEDLINE] 4303. Semin Neurol. 1989 Mar;9(1):50-9. The aging neuromuscular system. Baker PC. Hawke's Bay Hospital Board, Napier, New Zealand. PMID: 2547239 [PubMed - indexed for MEDLINE] 4304. Jpn J Med. 1989 Mar-Apr;28(2):219-22. Syndrome of inappropriate secretion of antidiuretic hormone (SIADH) associated with Ramsay Hunt syndrome: report of a case and review of the literature. Kageyama Y, Nakamura M, Sato A, Sato M, Nakayama S, Komatsuzaki O, Fukuda H. Department of Internal Medicine, Tochigi National Hospital, Utsunomiya, Japan. A case of syndrome of inappropriate secretion of antidiuretic hormone (SIADH) associated with Ramsay Hunt syndrome is reported. A 59-year-old man was admitted to our department for treatment of left facial pain that had persisted for three days. A left renal tumor had been diagnosed and a radical nephrectomy had been performed two months earlier. On admission, vesicular lesions were found in the left external auditory canal and ear lobe. Additionally found were left facial nerve palsy and hearing loss. Acyclovir 5 mg/kg, three times per day, was started. Five days after admission, the patient became confused and disorientated. Further investigation revealed hyponatremia 118 mEq/l, low serum osmolality, high urine osmolality, normal renal function, normal adrenal and thyroid hormones, and high plasma vasopressin 30 pg/ml. Although cerebrospinal fluid (CSF) examination revealed a mild elevation in protein and cells, no malignant cells were present and bacterial examinations were negative. Antibodies to varicella-zoster virus (VZV) in both IgG and IgM were present in high titers not only in the serum but also in the CSF. Intravenous hypertonic saline and water restriction were started, and the patient's sensorium was improved in accordance with the increase in serum sodium concentration. These results indicate that the hyponatremia in this case was due to SIADH and that SIADH was caused by an increased release of vasopressin probably because of the infection of VZV in the central nervous system. PMID: 2543853 [PubMed - indexed for MEDLINE] 4305. J Med Virol. 1989 Mar;27(3):224-30. Definition of high-proficiency serological markers for diagnosis of varicella-zoster virus infections by enzyme immunoassay. Echevarría JM, de Ory F, León P, Téllez A. Centro Nacional de Microbiología, Virología e Inmunología Sanitarias, Madrid, Spain. The levels of Varicella-zoster virus (VZV)-specific IgG, IgM, and IgA antibodies produced in 22 cases of varicella, 22 cases of cutaneous zoster, and 12 cases of acute aseptic meningitis due to VZV in the absence of cutaneous lesions, were measured by indirect enzyme immunoassay (EIA) and compared with those observed in a group of 34 age-matched controls. The definition of cutoff titres for each serological marker and combinations of them allowed early diagnosis of infection in 82% of varicella patients and 91% of patients with acute aseptic meningitis lacking cutaneous lesions on a single serum sample, the specificity being over 90%. The system was as sensitive as the demonstration of intrathecally produced IgG antibodies for the early diagnosis of the infection in 22 cases of neurological disease due to VZV. A working protocol for the serological diagnosis of VZV infections, using currently available EIA reagents, is described. PMID: 2542432 [PubMed - indexed for MEDLINE] 4306. J Gen Intern Med. 1989 Mar-Apr;4(2):83-9. Are current therapies useful for the prevention of postherpetic neuralgia? A critical analysis of the literature. Schmader KE, Studenski S. Geriatric Research, Education and Clinical Center (GRECC), Durham Veterans Administration Medical Center, North Carolina. STUDY OBJECTIVE: To determine whether current therapies are useful in preventing postherpetic neuralgia (PHN) by analysis of study designs and pooled results. Design: Meta-analysis of all controlled studies investigating PHN prevention in the immunocompetent host. Articles were identified through MEDLINE, Index Medicus and bibliographic reviews of major texts and review articles. Studies meeting eligibility criteria were independently assessed using explicit methodologic criteria for validity and generalizability in clinical trials. Pooled analysis was also performed where appropriate. MEASUREMENTS AND MAIN RESULTS: Twenty-one investigations met eligibility criteria and primarily addressed the use of antiviral agents and corticosteroids. Among studies with strong designs, no evidence of benefit was found for acyclovir or corticosteroids. Pooled results showed no significant effect of acyclovir on the prevention of PHN (odds ratio 0.81, 95% confidence interval 0.56, 1.11). The strongest studies that found potential efficacy in PHN prevention involved adenosine monophosphate and idoxuridine in dimethyl sulfoxide, but problems with clinical application limit the use of these compounds. Outcome definition, compliance assessment, power estimation, and method of randomization were infrequently addressed aspects of design. CONCLUSION: Currently there is no proven useful therapy for the prevention of PHN. The benefits of acyclovir and corticosteroids are limited but key questions remain regarding these medications. A clear consensus definition of PHN is needed to improve future investigations. PMID: 2540301 [PubMed - indexed for MEDLINE] 4307. Br J Cancer. 1989 Mar;59(3):434-8. The prophylactic role of intravenous and long-term oral acyclovir after allogeneic bone marrow transplantation. Selby PJ, Powles RL, Easton D, Perren TJ, Stolle K, Jameson B, Fiddian AP, Tryhorn Y, Stern H. Institute of Cancer Research, Royal Marsden Hospital, Surrey, UK. Eighty-two patients were randomly allocated to receive intravenous acyclovir 5 mg kg-1 t.d.s. for 23 days followed by oral acyclovir 800 mg 6-hourly for 6 months or matching placebos after allogeneic bone marrow transplantation. Herpes simplex and varicella zoster virus infections were significantly reduced during the period of administration of acyclovir. No reduction in cytomegalovirus infection was demonstrated. The drug was not toxic. PMCID: PMC2247066 PMID: 2539180 [PubMed - indexed for MEDLINE] 4308. J Infect Dis. 1989 Mar;159(3):444-51. IgM and IgG responses to varicella-zoster virus p32/p36 complex after chickenpox and zoster, congenital and subclinical infections, and vaccination. Harper DR, Grose C. Department of Virology, Medical College of St. Bartholomew's Hospital, London, United Kingdom. Varicella-zoster virus (VZV) directs the synthesis of a nonglycosylated polypeptide complex with two prominent species with relative molecular masses of 32,000 and 36,000; the p32/p36 complex is present in both the viral nucleocapsid and the nuclear matrix of the infected cell. We have now further characterized the humoral immune response of VZV-infected humans to this complex and established that it is a major viral antigen. Antibodies to VZV p32/p36 were detected in sera from patients with both primary VZV infection (chickenpox) and VZV reactivation (zoster); the response after zoster was more pronounced. When the IgM and IgG components of the immune response were distinguished, IgM to the viral nucleoproteins was observed following chickenpox and zoster and, to a lesser extent, in recipients of VZV vaccine. An IgM response to VZV p32 also was detected during intrauterine VZV infection and subclinical VZV infection. PMID: 2536788 [PubMed - indexed for MEDLINE] 4309. J Neuroimmunol. 1989 Mar;22(1):69-76. Cimetidine as an immunomodulator in the treatment of herpes zoster. Miller A, Harel D, Laor A, Lahat N. Department of Neurology, Lady Davis Carmel Hospital, Haifa, Israel. As there is evidence of a possible immunoregulatory role for H2-histamine receptor antagonists, we carried out a prospective randomized trial to evaluate the in vivo and in vitro effect of cimetidine, an H2-blocker, in the treatment of herpes zoster infection. Cimetidine treatment shortened the median interval until the first decrease in pain, the median interval until the complete resolution of pain and promoted faster complete healing of skin lesions than symptomatic treatment. The immunological trends observed in vitro support an important role for histamine in the induction of immunosuppression, as measured by the response to the mitogen phytohemagglutinin. This effect of histamine was antagonized by cimetidine. PMID: 2521868 [PubMed - indexed for MEDLINE] 4310. Klin Monbl Augenheilkd. 1989 Mar;194(3):184-6. [Herpes zoster ophthalmicus with subsequent oculomotor paralysis and homolateral media infarct] [Article in German] Pfeifer B, Kempkes K, Krämer G. Neurologische Universitätsklinik Mainz. Oculomotor palsy is a well-known complication of herpes zoster ophthalmicus (HZO). Combination with homolateral cerebral media infarction and contralateral hemiplegia is very rare. Since the first paper on HZO and cerebral ischemia was published, in 1919, about 70 cases have been described. Zoster infection is thought to encroach from the fifth cranial nerve on to a cerebral artery at the base of the brain. The authors describe a case of HZO seen by them, with oculomotor palsy and ipsilateral media infarction with contralateral hemiplegia and aphasia. A review of the literature is given and etiologic and therapeutic aspects are discussed. PMID: 2470951 [PubMed - indexed for MEDLINE] 4311. J Neuroimmunol. 1989 Mar;22(1):63-8. Sequestration of virus-specific T cells in the cerebrospinal fluid of a patient with varicella zoster viral meningoencephalitis. Duby AD, Weiner HL, Benjamin DS, Seidman JG, Hafler DA. Department of Genetics, Harvard Medical School, Boston, MA 02115. The frequency of virus-specific T cells in the cerebrospinal fluid of a patient with viral infection of the brain and meninges was determined by using a single-T-cell cloning technique where a representative sampling of T cells was cloned from the cerebrospinal fluid of a patient with varicella zoster viral (VZV) meningoencephalitis. That the derived T-cell clones were in fact clonal was shown by demonstrating, on Southern blot analyses, unique rearrangements of the T-cell antigen-receptor beta-chain genes of each clone. Five out of the 15 of the T4+ (CD4), 0/4 of the T8+ (CD8), and 0/1 of the T4+T8+ T-cell clones proliferated to VZV, while no clones proliferated to mumps virus or myelin basic protein. There was no clonal expansion of any VZV-reactive T cell in this patient's cerebrospinal fluid. As VZV meningoencephalitis is thought to be due to the reactivation of a dormant herpes zoster viral infection, it can be regarded as a secondary immune response. The presence of different T-cell receptor beta-chain gene rearrangements in each T-cell clone suggests that the T-cell response was polyclonal. These results demonstrate that a high frequency of polyclonal, T4+ antigen-specific T cells can be found in a naturally occurring, localized, immune response. PMID: 2465314 [PubMed - indexed for MEDLINE] 4312. Med J Aust. 1989 Feb 20;150(4):227-8. Treatment of prodromal shingles. Kowal L. PMID: 2785634 [PubMed - indexed for MEDLINE] 4313. BMJ. 1989 Feb 18;298(6671):431. Lack of effect of acyclovir on postherpetic neuralgia. McKendrick MW, McGill JI, Wood MJ. Department of Medicine and Communicable Diseases, Lodge Moor Hospital, Sheffield. PMCID: PMC1835689 PMID: 2495051 [PubMed - indexed for MEDLINE] 4314. J Laryngol Otol. 1989 Feb;103(2):205-6. Aberrant reinervation of the stapedius muscle following facial palsy. McFerran DJ, Baguley D, Moffat DA. Addenbrooke's Hospital, Cambridge. This case report describes the clinical course of a patient with Ramsay Hunt Syndrome. Partial recovery of the lower motor neuron facial palsy was associated with decreased hearing and a reduction of the middle ear compliance on voluntary contraction of the facial musculature. It is suggested that this is due to misdirection of regenerating nerve fibres, normally destined for facial muscles, to stapedius muscle. PMID: 2926271 [PubMed - indexed for MEDLINE] 4315. Eur J Pediatr. 1989 Feb;148(5):468-9. Neurogenic bladder due to herpes zoster infection in an infant. Gold I, Azizi E, Eshel G. Department of Dermatology, Assaf Harofeh Medical Centre, Sackler School of Medicine, Tel Aviv University, Zerifin, Israel. A case is presented of Herpes zoster (HZ) infection in a 2.5-month-old infant with the added complication of a neurogenic bladder. The patient's mother suffered from varicella during the 18th week of pregnancy. The patient had a typical herpetic rash at the age of 2.5 months, and developed constipation and a neurogenic bladder. While the constipation improved, bladder atonicity led to hydroureters necessitating bilateral ureterostomies. Urinary tract involvement of HZ is well known in adults and is reversible. To our knowledge this is the first report of such a complication of HZ infection in infants. PMID: 2920755 [PubMed - indexed for MEDLINE] 4316. Postgrad Med. 1989 Feb 1;85(2):57, 60, 63. Delayed diagnosis of herpes zoster. Brings HA. Branch Medical Clinic, Marine Corps Air Station, Beaufort, SC 29904. Herpes zoster may cause diagnostic confusion and mimic other diseases during the early stage before development of the characteristic rash. Although the disease is usually self-limited, oral acyclovir (Zovirax) shows promise in reducing the duration and severity of symptoms in uncomplicated cases. PMID: 2915962 [PubMed - indexed for MEDLINE] 4317. Ann Ophthalmol. 1989 Feb;21(2):47-8. Pediatric herpes simplex masquerading as varicella-zoster. Aguirre Vila-Coro A, del Cotero JF, Bonafonte S. University of Texas Health Science Center, Houston, Texas 77030-1697. A three-year-old girl developed a generalized cutaneous Herpes simplex infection and a dendritic corneal ulcer. The clinical appearance of the lesions led to the diagnosis of varicella by a pediatrician and of Herpes zoster corneal ulcer by an ophthalmologist, who prescribed topical adrenocorticosteroids. An enzyme-linked immunosorbent assay and cultures were positive for the Herpes simplex virus. Topical antiviral treatment was applied, and the lesions healed without significant sequelae. PMID: 2785359 [PubMed - indexed for MEDLINE] 4318. Klin Med (Mosk). 1989 Feb;67(2):37-40. [Clinical variants of herpes zoster] [Article in Russian] Andreĭchin MA, Savchak VI. The clinical course of herpes zoster has been analysed in 132 in-patients and a variety of the clinical forms shown which were initially disguised as the internal diseases. In addition to typical variants, the following types of herpes zoster have been found: gangrenous, bullous, hemorrhagic and disseminated. PMID: 2724885 [PubMed - indexed for MEDLINE] 4319. Nippon Rinsho. 1989 Feb;47(2):434-9. [Clinical signs and symptoms and chemotherapy of herpes zoster] [Article in Japanese] Ozawa A. PMID: 2724576 [PubMed - indexed for MEDLINE] 4320. Hautarzt. 1989 Feb;40(2):110-1. [Post-zoster granuloma anulare] [Article in German] Kleber R, Landthaler M, Burg G. Dermatologische Klinik, Ludwig-Maximilians-Universität, München. Five weeks after a herpes zoster infection of the right 6th thoracic segment, a 57-year-old male patient developed papular skin lesions in the same area. Histological examination allowed a diagnosis of granuloma anulare. PMID: 2714986 [PubMed - indexed for MEDLINE] 4321. Nippon Rinsho. 1989 Feb;47(2):395-400. [High risk group of patients with infection of herpes group virus] [Article in Japanese] Masaoka T. PMID: 2657136 [PubMed - indexed for MEDLINE] 4322. Jpn J Med Sci Biol. 1989 Feb;42(1):1-11. Varicella-zoster virus prevalence in Japan: no significant change in a decade. Taylor-Wiedeman J, Yamashita K, Miyamura K, Yamazaki S. Central Virus Diagnostic Laboratory, National Institute of Health, Tokyo. A seroepidemiologic time-comparison study was conducted to evaluate changes in IgG antibody to varicella-zoster virus (VZV) and to determine VZV prevalence in Japan with randomly collected serum samples from two healthy Japanese populations: 1973 (n = 670) vs. 1984 (n = 677). Enzyme-linked immunosorbent assay (ELISA) was found to be superior to the immune adherence hemagglutination test (IAHA) especially for detecting seropositivity in adults. Serologic results showed essentially no significant difference between the 1973 and the 1984 age-specific prevalences; with the exception of a slightly lower prevalence in the 5-year-old age group in 1973 than that in 1984. In general, the age-specific prevalence was lowest in the 1-year-old group (mean 11%) and increased in a linear fashion until age 9 (mean 82.9%); prevalence continued to increase slowly after age 9 and plateaued at 100% for ages greater than or equal to 25-29. PMID: 2550689 [PubMed - indexed for MEDLINE] 4323. Nippon Rinsho. 1989 Feb;47(2):424-8. [Efficacy of live varicella vaccine strain (Oka) in high-risk patients] [Article in Japanese] Eizuru Y, Minamishima Y. PMID: 2542665 [PubMed - indexed for MEDLINE] 4324. Nippon Rinsho. 1989 Feb;47(2):378-83. [Chemotherapy to thymidine kinase producing virus (HSV-1, HSV-2, VZV) infection] [Article in Japanese] Goto H, Shimada K. PMID: 2542661 [PubMed - indexed for MEDLINE] 4325. Nippon Rinsho. 1989 Feb;47(2):356-60. [Diagnosis of varicella-zoster virus infection by immunological method] [Article in Japanese] Sata T, Kurata T. PMID: 2542657 [PubMed - indexed for MEDLINE] 4326. Nippon Rinsho. 1989 Feb;47(2):331-9. [DNA diagnosis and epidemiologic analysis of varicella-zoster virus infection] [Article in Japanese] Hondo R. PMID: 2542653 [PubMed - indexed for MEDLINE] 4327. Am J Infect Control. 1989 Feb;17(1):26-30. Susceptibility of hospital-based health care personnel to varicella-zoster virus infections. McKinney WP, Horowitz MM, Battiola RJ. Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee. Varicella-zoster virus (VZV) transmission poses a major infection risk for health care workers in the hospital environment. Immunologically normal adults who contract varicella have 9 to 25 times the risk of major morbidity or death from infection compared with healthy children. Moreover, varicella infection during pregnancy is associated with a high rate of complications and the risk of the congenital varicella syndrome. To evaluate susceptibility to VZV infection among hospital workers, the employee health service screened 241 personnel for VZV antibody by the indirect fluorescent antibody technique. Overall, 7 (2.9%) of 241 personnel lacked VZV antibody and were therefore presumed susceptible to infection. Susceptibility varied dramatically by age and was significantly higher among persons 35 years of age and younger (7/93 = 7.5%) than among those aged 36 years and older (0/148 = 0%, p = 0.001). Persons 35 years old or younger with a clinical history of chickenpox or herpes zoster were much less likely to lack immunity (3/71 = 4.2%) than those stating they had no history of either (4/11 = 36.4%, p = 0.005). Screening strategies for VZV immunity in hospital employees could be made more efficient by performing serologic tests only on those persons aged 35 years or younger with a negative or uncertain history of the disease. Persons who lack antibody may be considered for preexposure immunization with live attenuated varicella vaccine as an alternative to varicella-zoster immune globulin or enforced absence from patient care after exposure to a VZV-infected patient. PMID: 2538095 [PubMed - indexed for MEDLINE] 4328. J Med Virol. 1989 Feb;27(2):117-9. Titration of IgG antibodies against varicella zoster virus before bone marrow transplantation is not predictive of future zoster. Webster A, Grint P, Brenner MK, Prentice HG, Griffiths PD. Department of Virology, Royal Free Hospital School of Medicine, London, England. Serum antibodies to varicella zoster virus (VZV) were measured in 77 patients about to undergo allogeneic bone marrow transplantation, and in 65 of their donors. Ten patients developed zoster within the first 6 months following transplant. There was no significant difference in the mean pretransplant antibody titre between those patients who did or did not subsequently develop zoster. Likewise, the level of antibody to VZV amongst donors had no effect on the subsequent development of zoster. We conclude that the pretransplant level of antibody to VZV is not predictive of subsequent zoster infection, and would not be helpful in identifying patients for trials of antiviral prophylaxis. These results contrast with those previously found for another herpesvirus, herpes simplex (HSV), where antibody level pretransplant is predictive of future HSV recurrence. PMID: 2537881 [PubMed - indexed for MEDLINE] 4329. Am Fam Physician. 1989 Feb;39(2):89-98. Varicella-zoster virus infections in pregnancy. Fox GN, Strangarity JW. Pennsylvania State University College of Medicine, Hershey. Comment in: Am Fam Physician. 1989 Aug;40(2):55. Varicella-zoster virus can cause a distinct congenital syndrome, a potentially fatal neonatal infection and life-threatening maternal illness. Physicians can reduce morbidity from these conditions by advising nonimmune pregnant women to avoid exposure to chickenpox and herpes zoster and, when indicated, by promptly administering varicella-zoster immune globulin. When prevention fails, acyclovir may be effective therapy. PMID: 2537001 [PubMed - indexed for MEDLINE] 4330. J Infect Dis. 1989 Feb;159(2):331-5. Enhancement of simian varicella virus infection in African green monkeys by recombinant human tumor necrosis factor alpha. Soike KF, Czarniecki CW, Baskin G, Blanchard J, Liggitt D. Delta Regional Primate Research Center, Tulane University, Covington, Louisiana. PMID: 2536783 [PubMed - indexed for MEDLINE] 4331. Hum Pathol. 1989 Feb;20(2):174-9. Transsynaptic spread of varicella zoster virus through the visual system: a mechanism of viral dissemination in the central nervous system. Rostad SW, Olson K, McDougall J, Shaw CM, Alvord EC Jr. Department of Pathology, University of Washington School of Medicine, Seattle 98195. Erratum in: Hum Pathol 1989 Aug;20(8):820. We report a patient with pathologic evidence of anterograde spread of varicella zoster virus (VZV) through the visual system. A 29-year-old homosexual man developed the acquired immunodeficiency syndrome (AIDS) 2 months before the onset of left herpes zoster ophthalmicus. During the next 11 months, the zoster infection progressed to involve the left eye, with resultant keratitis, iritis, retinitis, and eventual blindness. Later, the patient developed bilateral blindness, left hemiparesis, and fatal pneumonia. At autopsy, the brain revealed destruction of the visual system and adjacent structures, with sparing of the remainder of the brain. Glial cells near the areas of necrosis showed Cowdry type A intranuclear inclusions. In situ hybridization with probes to VZV nucleic acid sequences were positive in the necrotic brain and retinal areas. Hybridization with probes to cytomegalovirus, herpes simplex virus type II, human immunodeficiency virus, and Epstein-Barr virus were negative. Electron microscopy revealed characteristic herpes group nucleocapsids. This case provides insight into the mechanisms of virus dissemination and the production of encephalitis. PMID: 2536632 [PubMed - indexed for MEDLINE] 4332. BMJ. 1989 Jan 28;298(6668):253. Lignocaine-prilocaine cream in postherpetic neuralgia. Milligan KA, Atkinson RE, Schofield PA. PMCID: PMC1835553 PMID: 2493878 [PubMed - indexed for MEDLINE] 4333. J Immunol. 1989 Jan 15;142(2):636-41. T lymphocyte cytotoxicity with natural varicella-zoster virus infection and after immunization with live attenuated varicella vaccine. Diaz PS, Smith S, Hunter E, Arvin AM. Department of Pediatrics, Stanford University School of Medicine, CA 94305. Varicella-zoster virus (VZV) specific cytotoxicity was investigated during acute primary VZV infection, in naturally immune subjects and after vaccination with the live attenuated varicella vaccine by using T cell cultures (TCC) generated by stimulating PBMC with VZV Ag and autologous VZV-superinfected lymphoblastoid cell lines as targets. Lysis of VZV-infected lymphoblastoid cell lines was observed by TCC from acutely infected subjects, naturally immune subjects, and recipients of the varicella vaccine. VZV glycoprotein I induced cytotoxic T cells but killing was less efficient than killing by TCC stimulated with VZV Ag. The TCC were primarily CD4+ (mean 86.6%) T lymphocytes with 15.2% of the cells coexpressing Leu-19. TCC were predominantly restricted by HLA class II as demonstrated by lack of any blocking using class I mAb and blocking of 15 to 71% by L243, a mAb to class II. Unrestricted killing as measured by killing of K562 cells occurred in all TCC but was minimally greater than that observed against uninfected autologous targets. Phenotypes of PBMC during acute infection had an initial increase in CD4+ cells and an overall decrease in the percentage of circulating Leu-11+ (CD16). No enhanced K562 killing was demonstrated in PBMC from subjects with acute infection compared to subjects without infection. CD4+ CTL may function as an important primary host response in acute varicella. Immunization with live attenuated varicella vaccine induced VZV-specific, memory CTL responses comparable to those of naturally immune subjects. The demonstration of their persistence long after primary VZV infection may indicate a role for CTL in restriction of viral replication during episodes of VZV reactivation from latency. PMID: 2536059 [PubMed - indexed for MEDLINE] 4334. Int J Cancer. 1989 Jan 15;43(1):67-71. Epstein-Barr virus-infected B cells persist in the circulation of acyclovir-treated virus carriers. Yao QY, Ogan P, Rowe M, Wood M, Rickinson AB. Department of Cancer Studies, University of Birmingham, Medical School, UK. In this study, infectious Epstein-Barr virus (EBV) shedding in the oropharynx and numbers of virus-infected B cells in the blood have been monitored in long-term virus carriers receiving acyclovir (ACV) therapy for herpes zoster. Eleven patients on oral ACV were followed prospectively before, during and for 2 weeks after treatment. As expected, the low levels of EBV shedding in these virus carriers (measured as cord-blood lymphocyte transforming activity in throat washings) were eliminated during the period of ACV treatment and returned at later times. Over the same period, however, the frequency of virus-infected B cells in the blood (measured by spontaneous transformation in limiting dilution assay) remained completely unchanged. Regression assays showed that these same patients had normal levels of EBV-specific cytotoxic T-cell immunity, so that the in vivo persistence of virus-infected B cells could not be ascribed to a defect in T-cell surveillance. We infer that the in vivo half-life of the virus-infected B-cell pool in long-term virus carriers is measured in months rather than days. We further suggest that such persistence requires a novel form of virus:B-cell interaction distinct from the type of "latent" infection displayed by in vitro-transformed cells. PMID: 2536009 [PubMed - indexed for MEDLINE] 4335. Ugeskr Laeger. 1989 Jan 9;151(2):90-2. [Acyclovir in the treatment of facial palsy due to zoster virus] [Article in Danish] Albeck H, Ninn-Pedersen K. The varicella zoster virus (VZV) is the cause of 7-10% of the cases of atraumatic facial palsy. In untreated cases, recovery is only partial. Out of five patients, treatment with acyclovir resulted in complete recovery after three weeks in four in whom treatment was commenced within three days of the onset of the palsy. In one patient in whom treatment was commenced more than four days after the onset of the palsy, only partial recovery had occurred after one year. PMID: 2911904 [PubMed - indexed for MEDLINE] 4336. Nord Med. 1989;104(3):72-5. [Herpes zoster neuralgia--a persistent therapeutic problem] [Article in Swedish] Pöyhiä R, Tigerstedt I. Most patients with acute herpes zoster (AHN) who are younger than 50 yrs recover spontaneously and need no more specific medication than NSAID-analgetics. However, older patients and those treated with immunosuppressive medication are at high risk of developing postherpetic neuralgy (PHN), and may need intensive treatment for severe pain. Unfortunately there is no specific method so far to prevent PHN. In the prevention of PHN some promising results have been gained with antiviral drugs, sympathetic blocks, corticosteroids, psychotropic and anticonvulsive drugs. The earlier any of these treatments is started in AHM, the better results. When PHN has developed, in most cases there is no effective treatment to be offered. In the Pain Clinic of Helsinki University Hospital antidepressive and neuroleptic drugs as well as transcutaneous neurostimulation have been used for PHN treatment. PMID: 2922251 [PubMed - indexed for MEDLINE] 4337. J Neurol. 1989 Jan;236(1):26-8. Demonstration of zoster virus antibodies in cerebrospinal fluid cells. Beuche W, Thomas RS, Felgenhauer K. Department of Neurology, University of Göttingen, Federal Republic of Germany. A method is presented that allows the immunocytochemical detection of varicella zoster virus antigen-binding cerebrospinal fluid cells in zoster ganglionitis. Antigen-binding cells were found only in patients suffering from this disease. The technique is sensitive, specific, inexpensive and relatively fast, and is potentially applicable to other inflammatory central nervous system diseases with immunoglobulin-containing cells (ICC) in CSF. The detection of antigen-binding CSF cells may represent a very early diagnostic test comparable with the early IgM antibodies of the systemic immune response. PMID: 2915223 [PubMed - indexed for MEDLINE] 4338. Vestn Dermatol Venerol. 1989;(8):63-5. [Paraneoplastic gangrenous-bullous herpes zoster] [Article in Russian] Savchak VI. A female patient aged 65 is described. Two years after mastectomy for right-side mammary carcinoma she developed herpes zoster round the cicatrix; this condition anticipated metastases. The patient died of cancerous cachexia in 3 months after gangrenous herpes zoster. PMID: 2816036 [PubMed - indexed for MEDLINE] 4339. Vestn Dermatol Venerol. 1989;(8):62-3. [The generalized form of herpes zoster in a patient with mycosis fungoides] [Article in Russian] Kilinskas SIu. The described case is marked for a dissemination of the skin process, its severity, and manifest intoxication. A considerable reduction of the body reactivity because of mycosis fungoides is responsible for the development of the generalized process; another reason is prolonged intake of corticosteroids and cytostatics for the underlying condition. PMID: 2816035 [PubMed - indexed for MEDLINE] 4340. Przegl Dermatol. 1989 Jan-Mar;76(1):45-9. [Griseofulvin in the treatment of herpes zoster] [Article in Polish] Gwieździński Z, Protas-Drozd F. The authors applied griseofulvin in 46 patients (28 women and 18 men) aged from 21 to 82 years with various forms of zoster. The locations of lesions was different: concerned very often the face and the thorax, rarely the extremities and sometimes the lesions were generalized. The treatment was started in beginning stadium of disease. The total daily oral dose of Griseofulvin-Forte (Medexport/SU were 500 mg (taken in two doses with 2 tablets a 125 mg). A average time of therapy was 10 days. Subjective troubles, pain and burning regressed rapidly and the regression endured. In author's opinion treatment with griseofulvin is efficacious and secure. The time of therapy is very short. The above mentioned method can be recommended to wide, general use. PMID: 2813817 [PubMed - indexed for MEDLINE] 4341. Acta Neurochir Suppl (Wien). 1989;46:65-6. Spinal cord stimulation (SCS) in the treatment of postherpetic pain. Meglio M, Cioni B, Prezioso A, Talamonti G. Istituto di Neurochirurgia, Università Cattolica, Roma, Italy. SCS is considered to be of poor value in treating postherpetic pain. We have retrospectively analyzed the results obtained in 10 patients suffering from postherpetic neuralgia. An epidural electrode was implanted, aiming the tip in a position where stimulation could produce paraesthesiae over the painful area. At the end of the test period 6 out of 10 patients reporting a mean analgesia of 52.5% underwent a permanent implant. At mean follow-up (15 months) all the 6 patients were still reporting a satisfactory pain relief (74% of mean analgesia). These figures remained unchanged at the next follow-ups (max 46 months). The result of SCS in our patients, although positive in only 60% of them, are remarkably stable with time. We therefore recommend a percutaneous test trial of SCS in every case of postherpetic neuralgia resistent to medical treatment. PMID: 2788976 [PubMed - indexed for MEDLINE] 4342. Ann Ophthalmol. 1989 Jan;21(1):34-5. Autoimmune endotheliopathy and chronic herpetic conjunctivitis. Coppeto JR, Stern A, Bisson B. St. Mary's Hospital, Waterbury, Connecticut. A migrating endothelial line of keratic precipitates associated with overlying corneal edema suggests an immune attack on the corneal endothelium. This is seen most commonly in corneal allotransplantation rejection. The etiology of such lines in the absence of this condition is unclear. We document the presence of an intranuclear virus compatible with herpesvirus in this condition. PMID: 2784651 [PubMed - indexed for MEDLINE] 4343. Prof Nurse. 1989 Jan;4(4):186-8. Caring for patients with herpes zoster ophthalmicus. Milbourn S. PMID: 2784213 [PubMed - indexed for MEDLINE] 4344. Blood. 1989 Jan;73(1):38-46. Deoxycoformycin-induced immunosuppression in patients with hairy cell leukemia. Urba WJ, Baseler MW, Kopp WC, Steis RG, Clark JW, Smith JW 2nd, Coggin DL, Longo DL. Program Resources, National Cancer Institute-Frederick Cancer Researh Facility, MD 21701. Immune function in patients with hairy cell leukemia (HCL) was examined serially during treatment with alternating monthly cycles of recombinant interferon alpha-2a and 2'-deoxycoformycin (dCF). At presentation, most patients had normal numbers of T lymphocytes and their cells had normal proliferative responses to mitogens [phytohemagglutinin (PHA) and concanavalin A (Con A)] and alloantigens. Patients had severe monocytopenia, decreased delayed-type hypersensitivity (DTH) reactions, and decreased peripheral blood natural killer (NK) activity. Treatment caused a profound decrease in all lymphocyte subpopulations. T cells were more affected than B cells or NK cells. Numbers of CD4+ and CD8+ lymphocytes decreased to levels less than 200 cells/microliters in all patients during treatment. This decrease in T cell number was associated with a marked decrease in proliferative responsiveness to PHA, Con A, and alloantigens. These abnormalities persisted throughout the 14 months of treatment and have continued for up to 6 months beyond discontinuation of treatment. NK cell activity increased during treatment, but cycled depending on the phase of treatment; highest activities were observed after interferon (IFN)-alpha and lower levels of activity were observed after dCF. DTH responses generally did not improve during therapy. Levels of IgM, IgG, IgA, and IgD did not change during treatment, but IgE levels rose in most patients. All immunosuppressive effects were attributable to dCF since patients receiving IFN-alpha 2a alone did not exhibit these same immunosuppressive effects, and patients receiving dCF alone after IFN failure exhibited similar abnormalities. Despite this severe immunosuppression from dCF, life-threatening opportunistic infections have not been observed in our patient population. Six patients developed localized Herpes zoster infection among 21 patients who had received dCF. Pending the results of long-term follow-up, we recommend that dCF be reserved for patients who have failed splenectomy and IFN therapy. PMID: 2783373 [PubMed - indexed for MEDLINE] 4345. Dermatologica. 1989;179(1):45-6. Granuloma formation in herpes zoster scars. Wright AL, Cotton DW, Winfield DA, Messenger AG. University Department of Dermatology, Royal Hallamshire Hospital, Sheffield, UK. An 82-year-old male with chronic lymphocytic leukaemia developed an erythematous papular eruption over the trunk. Lesions occurred at the site of scars related to a disseminated herpes zoster infection 3 months previously. Biopsy of a lesion showed granuloma formation. The rash resolved spontaneously over 6-8 weeks. PMID: 2767297 [PubMed - indexed for MEDLINE] 4346. J Antimicrob Chemother. 1989 Jan;23(1):3-5. The chemotherapeutic approach to zoster. McKendrick MW. Lodge Moor Hospital, Sheffield, UK. PMID: 2745254 [PubMed - indexed for MEDLINE] 4347. Curr Probl Dermatol. 1989;18:152-7. Reinfection with varicella-zoster virus in immunocompromised patients. Junker K, Avnstorp C, Nielsen CM, Hansen NE. Department of Haematology and Internal Medicine, Gentofte Hospital, Denmark. A small epidemic of varicella/atypical generalized zoster among 6 immunocompromised patients and one previously healthy person is described. The 6 immunocompromised patients suffered from lymphoproliferative diseases in terminal stages treated with chemotherapy and reported varicella in their childhood. They developed a generalized maculopapular rash with hemorrhagic bullae and necroses. The infection passed from one patient to another during a 3-month period in the department. They were placed in adjacent rooms and nursed by the same staff. The most specific diagnostic tool was the detection of varicella-zoster virus antigen from vesicles by ELISA technique. The epidemic was supposed to be caused by exogenous reinfection with varicella-zoster virus, and illustrated that generalized zoster may be even so infectious as varicella and that immunocompromised patients should be protected against reinfection. PMID: 2743800 [PubMed - indexed for MEDLINE] 4348. Jpn J Med. 1989 Jan-Feb;28(1):100-4. Treatment of disseminated herpes zoster in six severely immunocompromised patients: acyclovir and vidarabine. Nagafuchi S, Moriyama K, Takamatsu Y, Hayashi S, Niho Y, Takenaka A, Minagawa H, Mori R. First Department of Internal Medicine, Faculty of Medicine, Kyushu University, Fukuoka, Japan. We treated 6 patients with disseminated herpes zoster (D-H-Z) and in a severely immunocompromised condition. Three were effectively treated with 15 mg/kg/day of acyclovir. Ten mg/kg/day of vidarabine alone was given to two patients, but without positive effects. In two patients, acyclovir was effective in limiting the progression of the lesions. The skin lesions looked like a "stitch" on vesicles, thereby suggesting that the "stitch like appearance" may be a useful marker to identify the resistance to acyclovir treatment. In one patient, acyclovir was given for 58 days, but with limited effectiveness. When vidarabine was given in addition to acyclovir, the lesions dramatically disappeared. These findings suggest that acyclovir is superior to vidarabine for treating D-H-Z and the combination therapy with acyclovir and vidarabine should be considered for prescription for patients with D-H-Z, if acyclovir alone is not completely effective. PMID: 2724639 [PubMed - indexed for MEDLINE] 4349. Z Arztl Fortbild (Jena). 1989;83(3):136-8. [Varicellas and herpes zoster in children with oncologic diseases. 2: Prevention and therapy] [Article in German] Heidl M, Scholz H, Dörffel W, Wutzler P. Institut für Infektionskrankheiten im Kindesalter, Klinikum Berlin-Buch. PMID: 2718521 [PubMed - indexed for MEDLINE] 4350. Z Arztl Fortbild (Jena). 1989;83(3):133-5. [Varicellas and herpes zoster in children with oncologic diseases. 1: Clinical characteristics] [Article in German] Heidl M, Scholz H, Dörffel W, Wutzler P. Institut für Infektionskrankheiten im Kindesalter, Klinikum Berlin-Buch. PMID: 2718520 [PubMed - indexed for MEDLINE] 4351. Rev Esp Anestesiol Reanim. 1989 Jan-Feb;36(1):54-6. [Cardiorespiratory failure caused by delayed dural perforation] [Article in Spanish] Miralles Pardo FS, Carrillo Ruipérez E, Velasco Martínez RJ, Sánchez-Jáuregui E, López Rodríguez F. The epidural administration of drugs is today a common approach to chronic pain therapy. Many patients benefit from this therapeutic modality. However, the more extensively this method is used, the bigger are the number of reported complications. In this case we describe a time-delayed dural tap and a secondary respiratory arrest on a patient with an epidural cervical catheter for treatment of a postherpetic neuralgia. PMID: 2710984 [PubMed - indexed for MEDLINE] 4352. Folia Med Cracov. 1989;30(1-2):71-7. [Effect of Zovirax on the course of Varicella-zoster virus (VZV) infections in children with decreased immune response] [Article in Polish] Czajka H, Kluba-Wojewoda U. In 21 children with weakened immune response++ (18 patients after immunosuppression and/or after radiotherapy because of neoplastic disease, 1 patients with diagnosed hepatitis chronica persistens, 1 patient with streptococcal septicemia and one infant with protein deficiency and severe anemia) Zovirax was applied in treatment of Varicella virus infection. Clinical observation showed a positive effect of Zovirax in treatment of VZV infection which was manifested by a milder course of the infection and disappearance symptoms. Better effects were obtained when the treatment was started in the first 72 hours of infection. PMID: 2701820 [PubMed - indexed for MEDLINE] 4353. Adv Exp Med Biol. 1989;257:289-91. Multiple sclerosis and zoster encephalomyelitis: a probable common etiopathogenesis. Viel R. Department of Neurology General Hospital, Udine, Italy. PMID: 2694821 [PubMed - indexed for MEDLINE] 4354. Eye (Lond). 1989;3 ( Pt 3):313-7. Ocular surgery in ophthalmic zoster. Marsh RJ, Cooper M. Department of Clinical Ophthalmology, Moorfields Eye Hospital, London. Surgical outcome after ophthalmic zoster was analysed with respect to cataract, glaucoma, corneal ulceration and scarring. We used data from the Zoster Clinic and Hospital Activity Analysis (HAA) at Moorfields Eye Hospital and a lipid keratopathy database at the Western Ophthalmic Hospital. Conventional surgery for cataract, glaucoma and corneal scarring gave good results which were probably no different from experience with routine cases, although there was a tendency for prolonged post-operative inflammation. Lateral and central tarsorrhaphy for neuroparalytic ulceration almost invariably led to rapid healing. PMID: 2693137 [PubMed - indexed for MEDLINE] 4355. J Gynecol Obstet Biol Reprod (Paris). 1989;18(5):679-83. [Acyclovir and pregnancy: current aspects] [Article in French] Haddad J, Messer J, Willard D, Ritter J. Service de Néonatologie, CHU Hautepierre, Strasbourg. Acyclovir (ACV), an antiviral nucleoside analog, is active against Herpes simplex viruses (HSV1, HSV2) and varicella virus (VZV). These viruses seems to be prejudicial to the pregnant woman and to the fetus. Yet, ACV is not recommended for use in pregnancy. However in certain cases, this drug has been used. We review in this paper, the pharmacokinetics and transplacental passage of ACV, indications, and whether the benefits of the administration of ACV in pregnancy outweigh the theoretical risks. Peak and trough plasma concentrations of ACV in pregnant women seem to be lower as compared to those of non-pregnant adults but effective. This drug crosses the placenta. Levels of ACV in cord blood ranged from 0.5 to 3 mumol/l. In as much as in vitro inhibitory doses 50 (ID 50) for HSV1, HSV2 and VZV ranged from 0.1 to 3 mumol/l, it is quite likely that levels noted above may be effective for in utero inhibition of viral replication. No adverse effects were noted in newborn exposed in utero to ACV. But one must be careful about the direct effects of this drug on nucleic acid metabolism despite encouraging results on animal fetuses. Based on these findings and from our experience, ACV can be administered in pregnancy in two particular situations: in cases of maternal severe viral infections and in order to inhibit in utero VZV replication. Doses required for pregnant women range from 5 to 15 mg/kg/8 hours given intravenously, and 200 mg of oral Acyclovir 5 times daily. PMID: 2681370 [PubMed - indexed for MEDLINE] 4356. ORL J Otorhinolaryngol Relat Spec. 1989;51(4):251-4. Ramsay-Hunt syndrome in a preschool infant. Bjerkhoel A, Hydén D. Department of Otolaryngology, Jönköping Central Hospital, Sweden. The Ramsay-Hunt syndrome affects mostly adults. The recovery of facial nerve function, according to recent literature, seems better than has been generally accepted. A small number of children with herpes zoster oticus have been reported. We describe a case of Ramsay-Hunt syndrome in a healthy 3 1/2-year-old girl. She still had an obvious facial palsy after 12 months. Three out of 6 reported children with herpes zoster oticus have had a slow recovery of the facial nerve function. This suggests a less favorable prognosis in children than in adults. Although not successful in this case, acyclovir should be tried early in the course of the disease. PMID: 2664634 [PubMed - indexed for MEDLINE] 4357. Graefes Arch Clin Exp Ophthalmol. 1989;227(2):118-22. Topical BVDU plus low-dosage steroids in the treatment of chronic relapsing zoster keratouveitis. A pilot study. Ameye C, Sundmacher R, de Clercq E. Universitäts-Augenklinik, Düsseldorf, Federal Republic of Germany. A therapeutic trial with topical bromovinyldeoxyuridine (BVDU) plus low-dosage steroids was conducted in five patients with chronic zoster keratouveitis, who had previously received topical acyclovir (ACV) and steroids. In all cases, BVDU (plus steroids) was found to be superior to ACV (plus steroids). Yet BVDU was not able to keep the patients from having chronic relapsing varicella-zoster keratouveitis. This can probably be explained by pathophysiological reasons, i.e., the persistence and low-grade multiplication of the varicella-zoster virus in peripheral eye tissues during the chronic carrier stage. It is possible that this chronic carrier status could be obviated by vigorous antiviral treatment during the acute phase of the illness. PMID: 2656415 [PubMed - indexed for MEDLINE] 4358. Clin Dermatol. 1989 Jan-Mar;7(1):49-55. Consequences of varicella-zoster infection: advances in treatment and prevention. Olney L, Meissner C. Anna Jaques Hospital, Newburyport, Massachusetts. PMID: 2647263 [PubMed - indexed for MEDLINE] 4359. Clin Dermatol. 1989 Jan-Mar;7(1):37-48. Herpes zoster. Blumberg EA, Molavi A. Division of Infectious Disease, Hahnemann University School of Medicine, Philadelphia, Pennsylvania. PMID: 2647262 [PubMed - indexed for MEDLINE] 4360. Br J Ophthalmol. 1989 Jan;73(1):19-21. Penetrating keratoplasty for corneal scarring due to herpes zoster ophthalmicus. Soong HK, Schwartz AE, Meyer RF, Sugar A. Department of Ophthalmology, WK Kellogg Eye Center, University of Michigan School of Medicine, Ann Arbor 48105. We retrospectively studied the postoperative results in nine patients with corneal scarring due to herpes zoster ophthalmicus who underwent penetrating keratoplasty. This was a highly selected group that satisfied all of the following criteria: (a) absence of active disease of the ocular surface and eyelids, (b) intraocular pressure under control, and (c) absence of active keratouveitis. Penetrating keratoplasty after herpes zoster ophthalmicus may do well in patients with long preoperative quiescent periods in whom these restrictive preoperative criteria are observed. PMCID: PMC1041634 PMID: 2645929 [PubMed - indexed for MEDLINE] 4361. Clin Exp Dermatol. 1989 Jan;14(1):56-7. Herpes zoster following spinal surgery. Weiss R. Comment in: Clin Exp Dermatol. 1990 Mar;15(2):155-6. The onset of most cases of herpes zoster is usually sudden and unexpected. A precipitating factor is seldom obvious. Depressed cellular immunity or an underlying neoplasm are found in only a small number of patients. The relationship between trauma and reactivation of the varicella-zoster virus is uncertain and most of the published cases follow trivial external injury. PMID: 2641675 [PubMed - indexed for MEDLINE] 4362. CES Odontol. 1989;2(2):114-7. [Stomatological atlas. Viral infection] [Article in Spanish] Peña JC. PMID: 2638864 [PubMed - indexed for MEDLINE] 4363. Bull Soc Belge Ophtalmol. 1989;230:27-32. [Uveitis of viral origin] [Article in French] Vadot E. Most well-defined viral uveitis cases are due to herpes viruses. Thus, HSV and VZV may cause a chronic anterior uveitis, usually with other characteristic signs. Cytomegalovirus causes a necrotic and haemorrhagic retinitis in immunosuppressed patients. Acute retinal necrosis also seems to be caused by members of the herpes virus family. Many cases of intraocular inflammation have been described in association with viral diseases, but this does not necessarily imply the presence of virus in the eye. PMID: 2562202 [PubMed - indexed for MEDLINE] 4364. Pediatrie. 1989;44(8):645-7. [Zona in a 6-month-old infant. Apropos of one case] [Article in French] Loras-Duclaux I, Roy P, Lachaux A, Fournier V, Zerbib C, Hermier M. Service d'hépatogastroentérologie infantile, pavillion S, hôpital Edouard-Herriot, Lyon, France. The authors report an unusual case of zona in a 6-month-old infant whose mother was affected by varicella on the fourth month of pregnancy. The course and outcome were benign. PMID: 2560158 [PubMed - indexed for MEDLINE] 4365. Med Microbiol Immunol. 1989;178(5):255-68. Immunological diagnosis in viral infections of the central nervous system: course of antibody titres against homo- and heterologous viruses. Dennin RH, Herb E. Institut für Medizinische Mikrobiologie, Medizinische Universität zu Lübeck, Federal Republic of Germany. In clinical cases suspected for viral encephalitis or meningoencephalitis, the estimation of virus-specific antibodies especially in liquor requires high sensitivity as well as specificity. With enzyme immunoassays the sensitivity in detecting antibodies has increased compared to e.g., complement fixation tests. This report concerns the determination of virus-specific antibodies with a commercial enzyme-linked immunosorbent assay (ELISA) in paired liquor/serum samples of four patients with encephalitis or meningoencephalitis. Up to six virus-specific antibodies of the IgG and IgM classes have been determined [herpes simplex virus (HSV), varicella-zoster virus (VZV), cytomegalovirus, mumps virus, measles virus, and rubella virus]. Additionally, serum samples from several patients suffering, or recovered from, diseases caused by HSV and VZV without CNS involvement have been included as controls. The results showed that besides the virus-specific antibody development (IgG and IgM) against the leading virus, i.e., principally concerned in the disease manifestation assumed to be primarily causing the disease, virus-specific antibodies of the IgG and IgM class against a heterologous virus (e.g., VZV) could also be measured with substantial titers. "Cross-reacting" antibodies to both HSV and VZV with the ELISA only appeared and were present in cases where the infection mainly affected the CNS: no such immunological "cross-reactivity" was observed in serum of individuals in "clinically silent" stages of both HSV and VZV infections. The same situation with no measurable "cross-reacting" antibodies was found in cases of acute HSV or VZV diseases where the CNS was not involved. These findings have been discussed with respect to the findings of common antigens, especially between HSV and VZV, and with respect to an unspecific stimulation of immunocompetent cells. PMID: 2550755 [PubMed - indexed for MEDLINE] 4366. Curr Probl Dermatol. 1989;18:137-51. Herpesvirus infections in the immunocompromised host. Clinical spectrum, diagnosis, management and prophylaxis. Schuler G, Sepp N. Department of Dermatology, University of Innsbruck, Austria. PMID: 2545413 [PubMed - indexed for MEDLINE] 4367. Med Microbiol Immunol. 1989;178(2):61-7. Comparative restriction endonuclease analysis of varicella-zoster virus clinical isolates. Takayama M, Takayama N, Kameoka Y, Hachimori K, Kaneda K, Minamitani M. National Institute of Health, Japan, Tokyo. The DNAs of 67 isolates of varicella-zoster virus (VZV) obtained from 31 individuals were compared by restriction endonuclease analysis using BamHI, EcoRI, PstI and SmaI. All of the epidemiologically unrelated 26 isolates could be differentiated using SmaI and another one or two enzymes. However, the DNA cleavage profiles of multiple VZV isolates from the same patient and the isolates from a group of patients who were infected with VZV from the same source were found to be identical to each other, as reported previously. No patients were found who were simultaneously infected with different VZV strains. Moreover, VZV showed no change in DNA fragment profiles after serial passages not only through human embryonic lung cells but also through patients. PMID: 2543893 [PubMed - indexed for MEDLINE] 4368. Eur Neurol. 1989;29(3):124-7. Transient intrathecal IgG synthesis in herpes zoster myelitis: 2 case reports. Ceroni M, Mazzarello P, Poloni M, Camana C, Maurelli M, Savoldi F. Clinica Neurologica, Università di Pavia, Italia. Alterations in cerebrospinal fluid in 2 cases of viral myelopathy associated with herpes zoster infection are reported. Viral myelopathy is a rare complication of herpes zoster. Quantitatively there was a slight increase in IgG production and oligoclonal IgG bands were detected by isoelectric focusing. These parameters returned to normal after 1 year suggesting a transient involvement of the central nervous system. PMID: 2543579 [PubMed - indexed for MEDLINE] 4369. Zh Nevropatol Psikhiatr Im S S Korsakova. 1989;89(2):3-7. [Pathogenesis of herpes zoster] [Article in Russian] Smirnov IuK, Shishov AS. Long-term follow-up of 2000 patients with herpes zoster (HZ) in the department of viral neuroinfections as well as special HZ studies provided evidence for comprehensive evaluation of HZ pathogenesis. In addition to peripheral nervous system involvement, HZ is shown to cause systemic disorders typical for neuroviral infections. The principles of adequate pathogenetic therapy are validated. It is believed that relevant pathogenetic studies contribute to the development of general pathology. PMID: 2543167 [PubMed - indexed for MEDLINE] 4370. Int Ophthalmol Clin. 1989 Summer;29(2):98-104. External ocular disease and anterior segment disorders associated with AIDS. Shuler JD, Engstrom RE Jr, Holland GN. AIDS Unit, UCLA Uveitis Center. PMID: 2541098 [PubMed - indexed for MEDLINE] 4371. Int Ophthalmol Clin. 1989 Summer;29(2):108-18. Infections of the retina in AIDS. Culbertson WW. Bascom Palmer Eye Institute, Miami, FL 33101. PMID: 2541096 [PubMed - indexed for MEDLINE] 4372. Klin Monbl Augenheilkd. 1989 Jan;194(1):52-8. [Acute necrotizing retinitis following varicella zoster virus infection] [Article in German] Zierhut M, Thiel HJ, Weidle EG, Vallbracht A. Universität-Augenklinik Tübingen. As far as we know today, acute retinal necrosis is caused by infection with a virus of the herpes group. Reports are occasionally published of retinitis developing before or after herpes zoster dermatitis. The present paper reports the case of a patient who developed a retinitis of the right eye five years after a herpes zoster infection of the ophthalmic nerve. Studies and treatment of VZV retinitis and retinitis before or after zoster retinitis reported in the literature are summarized. The possible mechanisms of generalization (neurogenic or hematogenous) are analyzed. PMID: 2540379 [PubMed - indexed for MEDLINE] 4373. J Virol Methods. 1989 Jan;23(1):13-8. Rapid diagnosis of varicella-zoster virus infection with a monoclonal antibody based direct immunofluorescence technique. Rawlinson WD, Dwyer DE, Gibbons VL, Cunningham AL. Department of Infectious Diseases and Microbiology, Westmead Hospital, Australia. Diagnosis of varicella-zoster virus (VZV) infection in immunocompromised patients is difficult because of the frequent atypical appearance. Accurate and early diagnosis is important to allow rapid commencement of antiviral chemotherapy, with consequent improvement in antiviral efficacy. A monoclonal based direct immunofluorescence antibody technique (VZV IFA) was assessed in parallel with viral culture in 56 patients with suspected VZV infection. A subgroup of 17 patients from this group with classical dermatomal herpes zoster all had positive VZV IFA tests. Only 6 patients (35%) were positive on viral culture. None of the 15 patients with proven herpes simplex virus infection had a positive VZV IFA, nor did any patient with positive VZV viral culture have a negative VZV IFA. The VZV IFA test is a rapid and sensitive technique for detecting infection with VZV. PMID: 2536379 [PubMed - indexed for MEDLINE] 4374. Rinsho Ketsueki. 1989 Jan;30(1):89-93. [Primary macroglobulinemia with severe neutropenia, leading to a rapid development of septic shock] [Article in Japanese] Umeki S, Shibayama T, Izumi K, Sezaki T. A 88-year-old man was admitted because of the left chest pain due to herpes zoster for 1 week. Blood analyses and immunoelectrophoresis revealed anemia, severe neutropenia, rouleaux formation and IgM, lambda-type monoclonal gammopathy. The HE staining and peroxidase-anti-peroxidase staining of biopsy specimens of the cervical lymph node swelling appeared from the fifth hospital day, revealed an increase in atypical lymphocytes bearing IgM, lambda-type immunoglobulin. Then a diagnosis of primary macroglobulinemia was made. Although the patient's clinical findings transiently improved after chemotherapy with prednisolone and vindesine, he died of a septic shock which appeared after klebsiella pneumonia and sepsis. We reported an unusual case of primary macroglobulinemia with severe neutropenia, leading to a rapid development of septic shock after the chemotherapy. PMID: 2497264 [PubMed - indexed for MEDLINE] 4375. Bol Asoc Med P R. 1989 Jan;81(1):24-5. The syndrome of cerebral infarction following herpes zoster ophthalmicus. Joy JL, Colón HF, Vélez-Borrás JR. Delayed contralateral hemiparesis following herpes zoster (HZ) ophthalmicus is an unusual but distinct clinical entity, presumably caused by HZ-induced arteritis with subsequent cerebral infarction. We report a case showing typical clinical and angiographic findings. PMID: 2486902 [PubMed - indexed for MEDLINE] 4376. Ter Arkh. 1989;61(11):147-9. [Modern therapy of herpes zoster] [Article in Russian] Turkot LA, Savchak VI, Andreĭchin MA. PMID: 2483761 [PubMed - indexed for MEDLINE] 4377. Scand J Infect Dis. 1989;21(1):15-8. Isoprinosine does not influence the natural history of herpes zoster or postherpetic neuralgia. Payne CM, Menday AP, Rogers T, Staughton RC. Westminster Hospital, Charing Cross & Westminster Medical School, University of London, Great Britain. In a double-blind randomised trial, 38 elderly patients with acute herpes zoster received either isoprinosine (IP) or placebo. IP neither shortened the acute phase of herpes zoster nor prevented postherpetic neuralgia. Transient asymptomatic hyperuricaemia affected one third of IP treated patients. Shortcomings in study design and misleading interpretation of results are common in previously published clinical trials of herpes zoster and postherpetic neuralgia. Guidelines for future studies are proposed. PMID: 2471260 [PubMed - indexed for MEDLINE] 4378. BMJ. 1988 Dec 24-31;297(6664):1636. Erosive pustular dermatosis of the scalp presenting as herpes zoster. Shall L, Shuttleworth D. Department of Dermatology, University Hospital of Wales, Cardiff. PMCID: PMC1838843 PMID: 3147771 [PubMed - indexed for MEDLINE] 4379. Am J Ophthalmol. 1988 Dec 15;106(6):758-9. Successful treatment of postherpetic neuralgia with capsaicin. Bucci FA Jr, Gabriels CF, Krohel GB. Department of Ophthalmology, Albany Medical College. PMID: 3264116 [PubMed - indexed for MEDLINE] 4380. Can J Ophthalmol. 1988 Dec;23(7):311-4. Infectious crystalline keratopathy. Zabel RW, Mintsioulis G, MacDonald I, Tuft S. Department of Ophthalmology, Ottawa Civic Hospital, Ont. Crystalline deposits developed in the anterior third of the stroma in a 60-year-old woman. The deposits resolved only after aggressive treatment with intravenously given penicillin and topical erythromycin and vancomycin hydrochloride. Review of reported cases indicated that infectious crystalline keratopathy is caused by chronic colonization of the stroma by bacteria, usually streptococci of the viridans group. Local tissue trauma, concomitant use of topical corticosteroids, an intact overlying epithelium and use of a bandage-type soft contact lens are factors in the development of the infection. Patients with crystalline formations in this setting should undergo early lamellar biopsy for histologic examination, culture and sensitivity testing, followed by aggressive therapy with appropriate antibiotics. PMID: 3265890 [PubMed - indexed for MEDLINE] 4381. Ann Ophthalmol. 1988 Dec;20(12):480-2. Use of intravenous acyclovir for treatment of herpes zoster ophthalmicus in patients at risk for AIDS. Seiff SR, Margolis T, Graham SH, O'Donnell JJ. Department of Ophthalmology, San Francisco General Hospital, California. Patients who are homosexual, intravenous drug abusers, or have received multiple blood transfusions are at greater risk to contract the immunosuppressive disorders of acquired immunodeficiency syndrome (AIDS) and AIDS-related complex (ARC). These persons also have a greater chance of developing serious neurologic complications after an episode of Herpes zoster. We present two cases which emphasize the serious complications of Herpes zoster ophthalmicus in such patients. Since systemically administered acyclovir may shorten the disease course and reduce the complications of Herpes zoster in immunocompromised individuals, the authors favor treatment of all such patients who have Herpes zoster ophthalmicus with a seven-day course of high-dose (30 mg/kg/day) intravenous acyclovir. To minimize serious neurologic complications in such patients, treatment should be instituted immediately before the results of human immunodeficiency virus (HIV) testing are known. PMID: 3265292 [PubMed - indexed for MEDLINE] 4382. Am J Med. 1988 Dec;85(6):885-6. Successful combination therapy with acyclovir and vidarabine for disseminated varicella zoster virus infection with retinal involvement in a patient with B-cell lymphoma and adult T-cell leukemia. Moriyama K, Asano Y, Fujimoto K, Okamura T, Shibuya T, Harada M, Niho Y. First Department of Internal Medicine, Faculty of Medicine, Kyushu University, Fukuoka, Japan. PMID: 3264113 [PubMed - indexed for MEDLINE] 4383. Cutis. 1988 Dec;42(6):523-4. Herpes zoster and facial palsy. Feldman SR, Ford MJ, Briggaman RA. Department of Dermatology, North Carolina Memorial Hospital, University of North Carolina, Chapel Hill 27514. A case of facial palsy associated with herpes zoster is presented. A good response was obtained using treatment with acyclovir and prednisone. PMID: 3229142 [PubMed - indexed for MEDLINE] 4384. Z Gesamte Inn Med. 1988 Dec 1;43(23):677-80. [5-(2-bromovinyl)-2'-deoxyuridine therapy of herpes zoster diseases in patients with malignant primary diseases] [Article in German] Wutzler P, Wutke K, Bärwolff D, Reefschläger J. Institut für Medizinische Mikrobiologie, der Medizinischen Akademie Erfurt, DDR. BVDU [(E)-5-(2-bromovinyl)-2'-deoxyuridine] has proved effective in the treatment of varicella-zoster virus diseases in patients with malignancies. In 13 out of 20 patients a prompt cessation of new vesicle formation accompanied by rapid resolution of fever, crusting and complete epithelialisation of cutaneous lesions were noted. Only in few cases a prolonged recovery from the severe zoster occurred. When starting the treatment later than 48 hours after the onset of initial rash the dissemination of epithelial lesions could not be prevented. BVDU was well tolerated. Laboratory abnormalities were observed only in some cases and did not result in interruption of treatment. PMID: 2854331 [PubMed - indexed for MEDLINE] 4385. Ophthalmic Surg. 1988 Dec;19(12):876-84. Management of viral retinitis. Schulman JA, Peyman GA. Department of Ophthalmology, Louisiana State University Medical Center, Shreveport. Cytomegalovirus, herpes simplex, and herpes zoster are responsible for the majority of cases of viral retinitis. Herpes zoster also has been strongly incriminated as a causal agent in acute retinal necrosis. Effective chemotherapy exists for retinitis caused by herpes simplex and herpes zoster, along with acute retinal necrosis. Conventional antiviral therapy and immunomodulators are ineffective in the treatment of cytomegalovirus retinitis in patients with acquired immune deficiency disorder. Ganciclovir, a new antiviral agent, has significantly reduced visual morbidity in these patients. Recurrence of the infection is not uncommon while patients are on the drug or when the agent is discontinued, because ganciclovir is virostatic and does not stop viral replication in the retina. The inability to control this viral retinitis using presently available chemotherapy indicates a need to examine other therapeutic modalities. PMID: 2852786 [PubMed - indexed for MEDLINE] 4386. J Virol Methods. 1988 Dec;22(2-3):255-71. The use of colloidal gold immunoelectron microscopy to diagnose varicella-zoster virus (VZV) infections by rapid discrimination between VZV, HSV-1 and HSV-2. Vreeswijk J, Folkers E, Wagenaar F, Kapsenberg JG. Central Veterinary Institute, Department of Virology, Lelystad, The Netherlands. Colloidal gold immunoelectron microscopy was used to diagnose rapidly 53 cases clinically suspected of varicella-zoster virus (VZV) infection and one special case selected from another study on typical herpes simplex virus (HSV) infections. The viruses were identified and subsequently typed within 2.5 h by a direct labelling test for VZV, and within 3.5 h by an indirect labelling test with monoclonal antibodies against HSV type 1 and type 2. The protein A purified IgG fraction of human anti-VZV immunoglobulins was adsorbed to colloidal gold particles, and the specificity of the gold-labelled antibodies was tested with several human and animal herpesviruses. Viral envelopes did not crossreact in the direct labelling test. However, an indirect labelling procedure revealed that a small fraction of the anti-VZV antibodies crossreacted with the cores of herpes simplex virus and pseudorabies virus (Aujeszky disease virus). Virus-infected cellular material taken from typical herpetic lesions was used directly without virus propagation for virus typing. All cases (N = 54) were analyzed without knowing the clinical description of the results of cytopathologic examination (Tzanck smear) and viral culture. Forty-four cases were identified as VZV; however, 5 of the supposed VZV infections were proved to be HSV infections. Although the viral culture of the one HSV case was HSV- and VZV-negative, colloidal gold labelling identified the case as VZV infection. In 16 cases virus immunoglobulin complexes were detected by using gold-tagged antibodies against human immunoglobulins. Immunoglobulins on the viral envelopes did not interfere with virus typing by immunogold labelling. PMID: 2851604 [PubMed - indexed for MEDLINE] 4387. Drug Ther Bull. 1988 Nov 28;26(24):93-4. Oral acyclovir for herpes zoster. [No authors listed] Erratum in: Drug Ther Bull 1989 Jan 9;27(1):4. PMID: 3060343 [PubMed - indexed for MEDLINE] 4388. JAMA. 1988 Nov 18;260(19):2879-82. Continuous varicella-zoster infection associated with acyclovir resistance in a child with AIDS. Pahwa S, Biron K, Lim W, Swenson P, Kaplan MH, Sadick N, Pahwa R. Department of Pediatrics, North Shore University Hospital, Manhasset, NY 11030. Acyclovir has become the treatment of choice for varicella-zoster virus (VZV) infections in immunocompromised individuals. This article describes a 4-year-old girl congenitally infected with human immunodeficiency virus who developed a continuous cutaneous infection with VZV that persisted over a 14-month period until her death. Initial episodes of varicella and zoster were responsive to acyclovir treatment; however, subsequent recurrences necessitated administration of multiple courses of acyclovir. Lesions became markedly hyperkeratotic, slow healing, and persistent despite acyclovir therapy. Numerous attempts to isolate virus from the lesions yielded only one isolate late in the course of therapy. This virus clearly demonstrated acyclovir resistance in vitro. Bizarre manifestations of VZV infection could present both diagnostic and therapeutic dilemmas. Prolonged acyclovir treatment of highly immunocompromised patients with acquired immunodeficiency syndrome and severe VZV may lead to the appearance of resistant virus. PMID: 3184352 [PubMed - indexed for MEDLINE] 4389. Ann Ophthalmol. 1988 Nov;20(11):431-5, 438. Zoster-related bilateral acute retinal necrosis syndrome as presenting sign in AIDS. Chess J, Marcus DM. Albert Einstein College of Medicine, Bronx, New York. The acute retinal necrosis (ARN) syndrome has recently been associated with intraocular infections with one or more members of the herpesvirus family. There have been 14 cases in the literature linking ARN with a preceding or subsequent herpetic dermatitis. We report the development of bilateral ARN (BARN) after unilateral Herpes zoster ophthalmicus as the presenting sign of acquired immunodeficiency syndrome (AIDS) in a previously healthy man. The development of BARN after diffuse Herpes simplex dermatitis in AIDS patients is also discussed. These cases further illustrate the central role of the herpes-virus family in the etiology of ARN and alert the clinician to a new presenting sign for AIDS. PMID: 3266067 [PubMed - indexed for MEDLINE] 4390. Anesth Analg. 1988 Nov;67(11):1105-8. Continuous subpleural-paravertebral block in acute thoracic herpes zoster. Johnson LR, Rocco AG, Ferrante FM. Pain Treatment Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115. PMID: 3189902 [PubMed - indexed for MEDLINE] 4391. Rofo. 1988 Nov;149(5):550-1. Varicella-zoster angiitis with inflammatory and angiomatous angiographic signs. Kutluk K, Schumacher M, Müller-Lantzsch N. Section of Neuroradiology, University of Freiburg, FRG. PMID: 2848294 [PubMed - indexed for MEDLINE] 4392. Hosp Pract (Off Ed). 1988 Oct 30;23(10A):16. Local-anesthetic analgesia--'no humbug'. Stadtner DA. PMID: 3141434 [PubMed - indexed for MEDLINE] 4393. Cancer. 1988 Oct 15;62(8):1641-6. Risk factors for varicella zoster disseminated infection among adult cancer patients with localized zoster. Rusthoven JJ, Ahlgren P, Elhakim T, Pinfold P, Stewart L, Feld R. Princess Margaret Hospital, Ontario Cancer Institute, Toronto, Canada. Varicella zoster (VZ) infection can be a highly morbid and potentially fatal disease among immunocompromised patients; 811 episodes of VZ infection among adult cancer patients seen at the Princess Margaret Hospital from 1970 to 1980, were identified. Seven hundred twelve patients with first episodes of localized VZ infection (zoster) were analyzed for potential risk factors for dissemination. Significant risk factors after univariate analysis included the diagnosis of Hodgkin's disease, decreasing age, chemotherapy within 6 months of VZ infection, and extensive tumor at initial tumor diagnosis. Complete tumor remission at the time of infection, previous radiotherapy, and breast or gynecologic cancer were associated with reduced risk in this analysis. After multivariate analysis the following factors were independently associated with increased risk: Hodgkin's disease (P less than 0.001), non-Hodgkin's lymphoma (P = 0.016), and head and neck cancer (P = 0.043). Complete tumor remission and previous radiotherapy were again related to a reduced risk of infection. This study identifies risk factors that define specific subgroups of adult cancer patients with zoster infections who are at increased risk for VZ dissemination. These factors may be useful in prospectively defining high-risk groups in the design of antiviral therapy trials and may have a role in deciding which cancer patients with zoster will benefit most from receiving antiviral therapy to prevent dissemination. PMID: 3167779 [PubMed - indexed for MEDLINE] 4394. J R Coll Gen Pract. 1988 Oct;38(315):470-1. Erosive pustular dermatosis of the scalp following zoster ophthalmicus. Grattan CE. PMCID: PMC1711726 PMID: 3267192 [PubMed - indexed for MEDLINE] 4395. Rev Med Suisse Romande. 1988 Oct;108(10):889-92. [Current treatment of acute ophthalmic herpes zoster (or, vive la différence!)] [Article in French] Büchi ER, Piguet B, Fitting P, Herbort CP. PMID: 3264614 [PubMed - indexed for MEDLINE] 4396. Ned Tijdschr Geneeskd. 1988 Oct 1;132(40):1861-3. [Minor complaints in family practice; herpes zoster] [Article in Dutch] [No authors listed] PMID: 3263578 [PubMed - indexed for MEDLINE] 4397. Br J Clin Pract. 1988 Oct;42(10):412-4. The prevention of postherpetic neuralgia: a retrospective view of patients treated in the acute phase of herpes zoster. Rutgers MJ, Dirksen R. PMID: 3255420 [PubMed - indexed for MEDLINE] 4398. Rev Med Chir Soc Med Nat Iasi. 1988 Oct-Dec;92(4):733. [Herpes zoster and its stomatologic aspects] [Article in Romanian] Domnişoru L, Ilin Z. PMID: 3253925 [PubMed - indexed for MEDLINE] 4399. Am J Clin Hypn. 1988 Oct;31(2):107-13. Hypnosis in the management of postherpetic neuralgia: three case studies. Dane JR, Rowlingson JC. PMID: 3228059 [PubMed - indexed for MEDLINE] 4400. Med Trop (Mars). 1988 Oct-Dec;48(4):409-11. [Zona in human immunodeficiency virus (HIV-1) infection in Bangui (Central Africa)] [Article in French] Lesbordes JL, Coulaud X. Médecin des Hôpitaux des Armées, Toulouse, France. In Bangui (Central African Republic) where HIV1 prevalence was 7.8% in 1987, 61 cases of herpes zoster have been studied: 17 "during" AIDS and 44 "isolated" cases. During AIDS, herpes zoster has no prognosis value. When it seems to be "isolated", herpes zoster is closely linked to HIV1: 42 seropositives out of 44 (predictive value of 95%) and it announces the outbreak of AIDS in the 2 years to come. PMID: 3221791 [PubMed - indexed for MEDLINE] 4401. Anaesthesia. 1988 Oct;43(10):901. Benzydamine cream in post-herpetic neuralgia. Coniam SW, Hunton J. PMID: 3202315 [PubMed - indexed for MEDLINE] 4402. Acta Anaesthesiol Scand. 1988 Oct;32(7):593-4. Horner's syndrome after intrapleural anesthesia with bupivacaine for post-herpetic neuralgia. Sihota MK, Holmblad BR. Department of Anesthesiology, University of Illinois College of Medicine, Chicago. We observed the development of Horner's syndrome 25 min after the intrapleural administration of 30 cc of 0.5% bupivacaine to a patient with post-herpetic neuralgia in the thoracic region. The patient reported immediate relief of pain. There was no change in blood pressure or pulse rate, and no discernible level of anesthesia to pinprick was detected. PMID: 3188830 [PubMed - indexed for MEDLINE] 4403. Brain. 1988 Oct;111 ( Pt 5):1187-98. Distant referral of cutaneous sensation (Mitempfindung). Observations on its normal and pathological occurrence. Schott GD. National Hospital for Nervous Diseases, Queen Square, London. Certain normal individuals when scratching a small area of skin often experience simultaneously an additional punctate sensation (Mitempfindung) at a remote site on the body. Four patients are described with acquired Mitempfindungen, the sensation being referred to the region that had been rendered abnormal by damage to the nervous system. The differences between normal and pathological Mitempfindungen and other patterns of cutaneous referral are considered, and mechanisms underlying Mitempfindungen, including the possible role of the spinocervical tract, are discussed. PMID: 3179689 [PubMed - indexed for MEDLINE] 4404. Postgrad Med J. 1988 Oct;64(756):832-3. Post-herpetic abdominal wall herniation. McLoughlin R, Waldron R, Brady MP. PMCID: PMC2429017 PMID: 2978429 [PubMed - indexed for MEDLINE] 4405. J Dermatol. 1988 Oct;15(5):448-50. Viral activity in skin lesions of herpes zoster. Hata S, Sugai T, Asoh S, Asada Y, Nishijima S, Soh Y, Doi A, Baba K. PMID: 2851618 [PubMed - indexed for MEDLINE] 4406. Acta Paediatr Jpn. 1988 Oct;30(5):594-600. Clinical use of Oka live varicella vaccine. Kamiya H, Sakurai M, Ihara T, Ito M, Torigoe S, Ota Y, Kamiya T, Horiuchi K, Asano Y, Baba K, et al. PMID: 2849859 [PubMed - indexed for MEDLINE] 4407. J Infect Dis. 1988 Oct;158(4):780-8. Varicella-zoster virus-specific HLA-restricted cytotoxicity of normal immune adult lymphocytes after in vitro stimulation. Cooper EC, Vujcic LK, Quinnan GV Jr. Division of Virology, Food and Drug Administration, Bethesda, Maryland 20892. Varicella-zoster virus (VZV)-specific cytotoxic T cell responses were studied in 35 presumably immune and two nonimmune adult donors and in two patients with herpes zoster. Peripheral blood lymphocytes (PBLs) were stimulated for five or 12 days with autologous, irradiated, VZV-infected PBLs. Cytotoxicity was measured in a chromium-release assay. Target cells were usually cryopreserved, phytohemagglutinin-stimulated PBLs, either infected with VZV or uninfected. In testing the presumably immune adults, VZV-specific cytotoxicity was observed in 32 (91%) of 35 cases after five days and in 19 (90%) of 21 cases after 12 d of stimulation. Lysis of HLA-matched target cells was significantly greater than that of mismatched, VZV-infected target cells after both intervals. Responses were similar when PBLs from two patients with acute zoster were tested after in vitro stimulation and in one of those two tested without in vitro stimulation. PMID: 2844916 [PubMed - indexed for MEDLINE] 4408. Anesth Analg. 1988 Sep;67(9):897-9. Effect of stellate ganglion block with fentanyl on postherpetic neuralgia with a sympathetic component. Fine PG, Ashburn MA. Department of Anesthesiology, University of Utah Health Sciences Center, Salt Lake City 84132. PMID: 3415003 [PubMed - indexed for MEDLINE] 4409. Neurology. 1988 Sep;38(9):1427-32. Amitriptyline, but not lorazepam, relieves postherpetic neuralgia. Max MB, Schafer SC, Culnane M, Smoller B, Dubner R, Gracely RH. Neurobiology and Anesthesiology Branch, National Institute of Dental Research, Bethesda, MD 20892. In a double-blind, randomized, crossover study, 58 patients with postherpetic neuralgia received 6-week courses of amitriptyline, 12.5 to 150 mg/d; lorazepam, 0.5 to 6 mg/d; or lactose placebo. Doses were titrated to the maximum level tolerated. Patients rated pain in a diary, using lists of verbal descriptors. Forty-seven percent of patients reported moderate or greater relief with amitriptyline, 16% with placebo, and 15% with lorazepam. Mean amitriptyline dose was 65 mg/d. Greater relief was associated with higher amitriptyline doses, up to the maximum dose of 150 mg/d, and with higher serum tricyclic levels. Lorazepam did not relieve pain and was associated with severe depressive reactions in four patients. PMID: 3412591 [PubMed - indexed for MEDLINE] 4410. An Esp Pediatr. 1988 Sep;29(3):257-8. [Infantile herpes zoster generalized after intrauterine transmission caused by varicella] [Article in Spanish] Rodríguez Cimadevilla JC, de la Morena Pardo ML, Prados Bueno R, de Inocencio Arcena J, Chamorro Romero MI, Maroto Alvaro E, García Fernández EJ. Servicio di Pediatría II, Hospital Gregorio Marañón, Madrid. PMID: 3195873 [PubMed - indexed for MEDLINE] 4411. Pain. 1988 Sep;34(3):315-7. Report of Higa et al. Yanagida H, Suwa K. PMID: 3186279 [PubMed - indexed for MEDLINE] 4412. Clin Nucl Med. 1988 Sep;13(9):667-8. Gallium-67 localization in herpetic skin lesion. Acio ER, Balasubramanian N, Vieras F, Smith JJ. Nuclear Medicine Service, Veterans Administration Medical Center, Washington, D.C. 20422. Previous cases of gallium localization in various cutaneous lesions have been reported, including sporotrichosis, acne vulgaris, sarcoid, lymphoma, and exfoliative erythroderma. This is a report of a case of gallium localization in cutaneous lesions of herpes zoster. PMID: 3180617 [PubMed - indexed for MEDLINE] 4413. Pediatr Pol. 1988 Sep;63(9):574-80. [Results of the antiviral treatment of chickenpox and herpes zoster in children with neoplasms] [Article in Polish] Jankowska H, Rybacka-Atamaniuk J, Szczepańska-Putz M, Wojnarowski M. PMID: 3075736 [PubMed - indexed for MEDLINE] 4414. J Virol Methods. 1988 Sep;21(1-4):61-72. Chronic herpes simplex virus and varicella zoster virus infection. Mertens T, Eggers HJ. Virology Institute, University of Cologne, F.R.G. After defining such terms as persistent and chronic infection, latency, recurrence, recrudescence, and exogenous reinfection they are applied to infections with HSV and VZV. Possible factors determining pathogenicity are discussed, and an overview is given of the wide range of illnesses and case reports ascribed to HSV and VZV infections. Various types of infection afford different diagnostic procedures. Besides virus isolation supplemented by viral antigen identification IgG antibody tests (increase in titer) may be useful. IgG subtype and IgA antibody determinations appear to be of limited value. Despite the rather large number of available tests, there are still considerable shortcomings in their ultimate significance as to the patient's disease. Thus, some new experimental approaches are mentioned. PMID: 3053746 [PubMed - indexed for MEDLINE] 4415. J Clin Neuroophthalmol. 1988 Sep;8(3):185-93. Herpes zoster ophthalmoplegia. Report of six cases. Archambault P, Wise JS, Rosen J, Polomeno RC, Auger N. Department of Ophthalmology, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal, Quebec, Canada. Ophthalmoplegia occurs infrequently in herpes zoster ophthalmicus. The third nerve appears to be the most commonly affected and the fourth nerve the least. We describe herein the clinical course of six patients with herpes zoster ophthalmoplegia. Spontaneous recovery occurred in four patients. The pathogenesis and clinical features of this syndrome are described. PMID: 2971683 [PubMed - indexed for MEDLINE] 4416. Neurology. 1988 Sep;38(9):1423-7. CSF somatostatin is elevated in patients with postzoster neuralgia. Unger J, Weindl A, Ochs G, Struppler A. Department of Neurology, Technical University of Munich, Federal Republic of Germany. We evaluated the concentration of the neuropeptide somatostatin (SOM) in the CSF of patients with several neurologic diseases. Since SOM is localized in high concentrations in primary sensory pathways, such as the dorsal root ganglia and dorsal horn of the spinal cord, it might be involved in conditions of chronic pain due to functional alterations of nociceptive neurons, such as postinfectious zoster neuralgia. Our study indicated a marked elevation of SOM in patients suffering from postzoster neuralgia compared with controls. Comparison with other neurologic diseases revealed decreased CSF SOM levels in Parkinson's and Alzheimer's disease, unchanged values in patients with amyotrophic lateral sclerosis, and increased concentrations in patients with brain tumors. In neurodegenerative disorders, SOM levels in CSF seemed to reflect the anatomic distribution as well as a reduction or preservation of the peptide in certain brain areas affected by the disease process. In postzoster patients, postinfectious degeneration of dorsal root ganglia cells might cause deafferentation of dorsal horn neurons and activation of SOM-containing systems with increased release either locally from neurons in the dorsal horn of the spinal cord or from descending fiber projections. The results suggested that SOM may take part in the modulation of nociceptive responses. PMID: 2901053 [PubMed - indexed for MEDLINE] 4417. Nippon Naika Gakkai Zasshi. 1988 Sep;77(9):1355-7. [Viral infections in medicine. 5. EB virus, cytomegalovirus, herpesvirus infections diseases] [Article in Japanese] Osato T. PMID: 2854545 [PubMed - indexed for MEDLINE] 4418. J Clin Microbiol. 1988 Sep;26(9):1623-5. Use of murine monoclonal antibodies for laboratory diagnosis of varicella-zoster virus infection. Gleaves CA, Lee CF, Bustamante CI, Meyers JD. Program in Infectious Diseases, Fred Hutchinson Cancer Research Center, Seattle, Washington. The laboratory diagnosis of varicella-zoster virus (VZV) infection was reevaluated by direct immunofluorescent-antibody staining (DFA) and centrifugation culture with newly available murine monoclonal antibodies. Specimen smears were examined by DFA using monoclonal antibodies to VZV and to herpes simplex virus types 1 and 2. Specimens were also inoculated into shell vials for centrifugation culture and into standard tube cell culture. Of 68 specimens tested from 60 patients, 39 (57%) were positive for VZV by at least one method. DFA was positive in 36 of 39 (92%); centrifugation culture was positive at 24 h in 23 of 39 (59%) and at 48 h in 31 of 39 (79%); and standard culture was positive in 25 of 39 (64%). Twenty-three of the 39 positive specimens (59%) were positive by all three techniques. Forty-three of the 60 patients were considered to have VZV by clinical criteria, and 35 of these 43 (81%) had laboratory confirmation of the diagnosis. These data confirm that DFA is the method of choice for the rapid laboratory confirmation of VZV infection. The centrifugation culture assay can provide an alternative method to DFA for the laboratory diagnosis of VZV infection. PMCID: PMC266683 PMID: 2846644 [PubMed - indexed for MEDLINE] 4419. J Virol Methods. 1988 Sep;21(1-4):305-13. Treatment of persistent active herpesvirus infections. Straus SE. Medical Virology Section, National Institutes of Allergy and Infectious Diseases, Bethesda, Maryland 20892. All human herpesviruses cause chronic infections in which latent virus is periodically reactivated. Persistently active infections are uncommon, however, and occur exclusively in individuals whose immune systems fail to control virus multiplication and spread. This paper summarizes the management of these unusual infections. PMID: 2846620 [PubMed - indexed for MEDLINE] 4420. Nippon Naika Gakkai Zasshi. 1988 Sep;77(9):1358-61. [Viral infections in medicine. Antiviral agents] [Article in Japanese] Matsumoto K. PMID: 2469749 [PubMed - indexed for MEDLINE] 4421. Am J Med. 1988 Aug 29;85(2A):99-101. Prevention of herpes zoster in patients by long-term oral acyclovir after allogeneic bone marrow transplantation. Perren TJ, Powles RL, Easton D, Stolle K, Selby PJ. Department of Medicine, Royal Marsden Hospital, Sutton, Surrey, United Kingdom. Following allogeneic bone marrow transplantation for leukemia, herpes zoster infections that are potentially severe with a high risk of dissemination develop in 30 to 50 percent of patients. Intravenous acyclovir is an effective treatment for established zoster in immunocompromised persons. Oral acyclovir has relatively low bioavailability, which has made the value of this route of administration for the treatment or prophylaxis of herpes zoster infections uncertain. In this trial, 82 patients undergoing allogeneic bone marrow transplantation for leukemia were randomly assigned to receive either intravenous acyclovir for 23 days followed by oral acyclovir for six months, or matched placebos; the random groups were well-matched in all clinical characteristics. During the six-month period of acyclovir/placebo administration, no patient receiving acyclovir developed herpes zoster, whereas six patients receiving placebo did so (p = 0.006). During the six-month follow-up, there were six cases of zoster in the treatment arm of the study and two cases in the placebo arm. Herpes zoster was not restricted to those patients who had positive evidence of antibody before transplant. This study shows that oral acyclovir is capable of preventing zoster infection during its period of administration; once the drug treatment is stopped, infections occur. In selected patients, the use of long-term oral acyclovir may be of value in preventing zoster infections during the time of greatest immunosuppression. PMID: 3044103 [PubMed - indexed for MEDLINE] 4422. Am J Med. 1988 Aug 29;85(2A):96-8. Current therapy of varicella zoster virus infection in immunocompromised patients. A comparison of acyclovir and vidarabine. Shepp DH, Dandliker PS, Meyers JD. Fred Hutchinson Cancer Research Center, Seattle, Washington. Both acyclovir and vidarabine are effective treatment for varicella zoster virus (VZV) infection in immunosuppressed patients. To determine which is preferable, therapy with these two agents was compared in a prospective, randomized trial. A total of 22 immunocompromised patients undergoing treatment for hematologic malignancies and presenting with VZV infection within 72 hours of the onset of rash were randomly assigned to receive intravenous acyclovir or vidarabine; 11 patients were randomly assigned to each treatment group. Acyclovir was significantly more effective than vidarabine in preventing complications of VZV infection, and treatment failures requiring a change to the alternate therapy occurred only among those treated with vidarabine. As compared with vidarabine, acyclovir shortened the median period during which results of viral culture specimens were positive and new lesions formed. Acyclovir also shortened the median interval until the first decrease in pain, the crusting of all lesions, and the complete healing of lesions. Acyclovir is more effective than vidarabine in the treatment of VZV infection in severely immunocompromised patients and should be considered the treatment of choice in such cases. PMID: 3044102 [PubMed - indexed for MEDLINE] 4423. Am J Med. 1988 Aug 29;85(2A):90-3. Reduction of the ocular complications of herpes zoster ophthalmicus by oral acyclovir. Cobo M. Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina 27710. Herpes zoster ophthalmicus (HZO) is a unique form of zoster dermatitis associated with a high rate of ocular complications that tend to be chronic and may cause vision loss. The ocular complications are highly varied, with keratitis and uveitis being more persistent sequellae of HZO. Oral acyclovir treatment of acute HZO reduces the incidence of the more common ocular complications, including keratitis and uveitis. Although patients treated early in the course of this disease experience a greater clinical response, treatment as late as seven days after onset of cutaneous lesions confers a beneficial prophylactic effect with respect to the ocular complications of HZO. PMID: 3044100 [PubMed - indexed for MEDLINE] 4424. Am J Med. 1988 Aug 29;85(2A):84-9. Therapy of herpes zoster with oral acyclovir. Huff JC, Bean B, Balfour HH Jr, Laskin OL, Connor JD, Corey L, Bryson YJ, McGuirt P. University of Colorado School of Medicine, Denver 80262. Oral acyclovir therapy for herpes zoster has been studied in double-blind, placebo-controlled trials of two dosages, 400 mg and 800 mg five times per day for 10 days. Compared with placebo recipients, recipients of the high-dosage acyclovir experienced a significantly shortened period of viral shedding, significantly accelerated time to 50 percent scabbing, significantly accelerated time to 50 percent healing, and after two days of therapy, significantly less frequent formation of new lesions. The duration and severity of acute pain were less in acyclovir recipients, with differences in pain severity achieving statistical significance (p = 0.03) between Days 3 and 10 and correlating with the treatment differences in new lesion formation. In studies of the 400 mg five times per day dose schedule, differences between acyclovir and placebo recipients were not significant. In a six-month follow-up of recipients in the higher dosage study, the acyclovir recipients experienced less post-zoster pain than placebo recipients; differences in the prevalence of pain were most significant for the presence of a persistent pain in the first three months of follow-up. Oral acyclovir at these dosages appears to be free of adverse reactions. In summary, oral acyclovir at a dosage of 800 mg five times per day for 10 days for treatment of acute herpes zoster is superior to 400 mg five times per day and favorably alters the course of the disease. PMID: 3044099 [PubMed - indexed for MEDLINE] 4425. Am J Med. 1988 Aug 29;85(2A):79-83. Efficacy of oral acyclovir treatment of acute herpes zoster. Wood MJ, Ogan PH, McKendrick MW, Care CD, McGill JI, Webb EM. Department of Communicable and Tropical Diseases, East Birmingham Hospital, United Kingdom. Oral acyclovir, 800 mg five times per day for seven days, was compared with placebo in a randomized, double-blind trial conducted at three centers in the United Kingdom. The study group consisted of 364 elderly immunocompetent patients with herpes zoster who were entered within 72 hours of the onset of rash. Acyclovir significantly reduced the times to last new lesion formation (p less than 0.01), loss of vesicles (p less than 0.01), and full crusting (p = 0.03). No significant hastening of rash healing was seen in those who started therapy later than 48 hours after the onset of rash. There was also a significant reduction pain during treatment with acyclovir (p = 0.02). Acyclovir produced no effects on the frequency or severity of post-herpetic neuralgia. No clinically important adverse effects of acyclovir were reported. PMID: 3044098 [PubMed - indexed for MEDLINE] 4426. Am J Med. 1988 Aug 29;85(2A):74-8. Management of varicella zoster infections in immunocompetent hosts. Peterslund NA. Department of Medicine and Infectious Diseases, Marselisborg Hospital, Aarhus, Denmark. Varicella in otherwise healthy children usually requires no antiviral treatment. In severe cases, however, such as are seen in neonates and adults, treatment must be given. Anecdotal evidence suggests the efficacy of intravenous acyclovir in such patients. Herpes zoster in immunocompetent patients may be severe enough to warrant antiviral therapy, particularly in elderly patients. Both idoxuridine and acyclovir have been investigated in placebo-controlled double-blind studies. Due to its low toxicity, ease of administration, and the possibility of systemic administration, acyclovir has largely replaced older antivirals in the management of herpes zoster in the normal host. Recent studies have shown the efficacy of oral acyclovir. In addition, oral acyclovir may prevent the ocular complications of ophthalmic zoster. When acyclovir is given, it should be administered as early as possible, preferably no later than four days after the onset of the rash. The combination of acyclovir and prednisolone for the prevention of post-herpetic neuralgia has not proved effective. PMID: 3044097 [PubMed - indexed for MEDLINE] 4427. Am J Med. 1988 Aug 29;85(2A):68-73. Varicella zoster virus infections in immunocompromised hosts. A review of the natural history and management. Balfour HH Jr. Department of Laboratory Medicine and Pathology, University of Minnesota Health Sciences Center, Minneapolis 55455. Varicella is relatively mild in otherwise normal children, in whom new lesions form for a mean of four days after onset and heal 50 percent of their lesions in eight days. New lesions form in most immunocompromised children for longer than five days and those not treated with antiviral drugs have a 28 percent incidence of pneumonitis and a 7 percent mortality rate. Untreated immunocompromised adults with herpes zoster shed virus for longer (7.0 days) than otherwise normal adults (5.3 days). Herpes zoster is much more likely to disseminate cutaneously in immunocompromised than in immunocompetent hosts. Visceral dissemination, which is a rare event in immunocompetent patients, occurred in 8 percent of prospectively followed untreated immunocompromised hosts with herpes zoster. Acyclovir has been found to be superior to vidarabine for treatment of both chickenpox and herpes zoster. Whether or not steroids should be used to treat herpes zoster remains controversial. Concerns about the use of intravenous acyclovir include the side effects of renal and central nervous system dysfunction and the possibility of emergence of resistant viral strains. None of these concerns has proved to be an impediment to successful treatment of immunocompromised patients. The major future challenge is to find an optimal way to treat varicella zoster virus infections with oral formulations of acyclovir or its congeners. PMID: 3044096 [PubMed - indexed for MEDLINE] 4428. Am J Med. 1988 Aug 29;85(2A):1-2. Antiviral chemotherapy. Lietman PS. Division of Clinical Pharmacology, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205. PMID: 2457312 [PubMed - indexed for MEDLINE] 4429. Epidemiol Infect. 1988 Aug;101(1):187-95. Detection of specific IgM in varicella and herpes zoster by antibody-capture radioimmunoassay. Kangro HO, Ward A, Argent S, Heath RB, Cradock-Watson JE, Ridehalgh MK. Department of Virology, St Bartholomew's Hospital, West Smithfield, London. A simple and sensitive M antibody-capture radioimmunoassay (MACRIA) is described which utilizes crude commercial VZV antigen and a single monoclonal anti-VZV antibody. This was compared to the immunofluorescence (IF) test for IgM antibody and was used to study IgM responses in sera from 261 patients with varicella and 220 patients with herpes zoster. With MACRIA, IgM antibodies were detected in all patients with varicella. The IgM antibodies appeared shortly after onset of rash, reached peak levels between 1 and 4 weeks after onset and then declined to low or undetectable levels in most, though not all, patients after 3 months. IgM antibodies were also detected in 98.2% of patients with herpes zoster, but the levels of IgM were significantly lower than after varicella and there was wider individual variation both in magnitude and duration of the IgM responses, in some cases only lasting 2-3 weeks. Comparison between MACRIA and IF showed good agreement in the detection of IgM antibodies following varicella. Discordant results were obtained with 13% of sera, of which 81% were taken either early or late after onset of rash and contained very low IgM levels. In contrast, 62 (28%) of the 220 sera from patients with zoster gave discordant results in the two tests, all except five being MACRIA-positive but IF-negative. The largest proportion of discordant results were obtained with sera taken more than 3 months after onset of rash, but 18 (29%) contained high IgM levels and were taken during the period of peak IgM responses. The diagnostic applications of the VZV MACRIA are discussed. PMCID: PMC2249341 PMID: 3402547 [PubMed - indexed for MEDLINE] 4430. Neurology. 1988 Aug;38(8):1331. Brainstem infarction following cervical herpes zoster. Snow BJ, Simcock JP. University Geriatric Unit, North Shore Hospital, Auckland, New Zealand. PMID: 3399086 [PubMed - indexed for MEDLINE] 4431. Dig Dis Sci. 1988 Aug;33(8):1050. Gastroparesis and herpes. Eisenberg D. PMID: 3391078 [PubMed - indexed for MEDLINE] 4432. Bull Soc Ophtalmol Fr. 1988 Aug-Sep;88(8-9):1079-81. [Ophthalmic zona in a LAV+ infant] [Article in French] Lagier J, Lods F, Ghenassia G, Szepetowski G, Gillon P. PMID: 3266930 [PubMed - indexed for MEDLINE] 4433. Can J Ophthalmol. 1988 Aug;23(5):249. Contralateral hemiparesis: late complication of herpes zoster ophthalmicus. Mallek D. PMID: 3263177 [PubMed - indexed for MEDLINE] 4434. Hautarzt. 1988 Aug;39(8):514-8. [Acute primary stage of HIV infection and progression to AIDS with Kaposi sarcoma 24 months later] [Article in German] Bratzke B, Orfanos CE. Universitäts-Hautklinik, Klinikum Steglitz, Freien Universität Berlin. The case is reported of a 31-year-old homosexual male who developed distinct maculopapular and papulovesicular exanthema with aphthous-like, painful lesions of the oral mucosa, together with marked general symptoms (fever, diarrhoea, lymphadenopathy). This clinical picture suggested the primary acute phase of an initial HIV infection; during this phase the HIV-ELISA and Western blot test were negative. One year later the patient was found to be HIV-positive, showing oral candidosis, generalized lymphadenopathy, seborrhoeic eczema and zoster infection (L5/S1). A further year later, the patient developed full-blown AIDS with disseminated Kaposi's sarcoma. This observation underlines the acute inflammatory character of the primary phase of HIV infection with initial exanthema and documents the appearance of AIDS-associated Kaposi's sarcoma in a time period of maximally 2 years thereafter. PMID: 3220765 [PubMed - indexed for MEDLINE] 4435. Pain. 1988 Aug;34(2):129-38. Post-herpetic neuralgia: post-mortem analysis of a case. Watson CP, Morshead C, Van der Kooy D, Deck J, Evans RJ. Irene Eleanor Smythe Pain Clinic, Toronto General Hospital, Ont., Canada. The morphological and biochemical substrates of the severe pain in post-herpetic neuralgia (PHN) are unclear. This report is an autopsy study of a 67-year-old male with severe PHN during the last 5 years of his life over the right T7-8 dermatomes. The dorsal horn of the thoracic spinal cord of the affected side was atrophic from T4 to T8, with loss of both myelin and axons. Despite this, only the T8 ganglion was affected by fibrosis and cell loss and only the nerve roots at that level appeared affected. Markers of unmyelinated afferents (substance P), substantia gelatinosa neurons (opiate receptors), glial cells (glial fibrillary acidic protein), and descending spinal projections (dopamine-beta-hydroxylase and serotonin) were not different at affected versus non-affected spinal cord levels. The pain of PHN may result from the uninhibited activity of unmyelinated primary afferents as a result of the loss of myelinated afferent fibers and the possible presence of hypersensitive neurons in the dorsal horn. PMID: 3174152 [PubMed - indexed for MEDLINE] 4436. J Am Dent Assoc. 1988 Aug;117(2):288, 290. Herpes zoster infection. Iacono FR. PMID: 3166473 [PubMed - indexed for MEDLINE] 4437. Am J Med. 1988 Aug;85(2):147-51. Recombinant interferon alpha-2a for treatment of herpes zoster in immunosuppressed patients with cancer. Winston DJ, Eron LJ, Ho M, Pazin G, Kessler H, Pottage JC Jr, Gallagher J, Sartiano G, Ho WG, Champlin RE, et al. Department of Medicine, UCLA Center for the Health Sciences 90024. PURPOSE: Acyclovir and high doses of intramuscular leukocyte interferon have been shown to prevent dissemination of herpes zoster in cancer patients with localized herpes zoster. With the availability of recombinant interferon, we decided to conduct a multicenter, placebo-controlled, double-blind trial of intramuscular recombinant interferon alpha-2a to assess its efficacy and safety in the treatment of localized herpes zoster in immunosuppressed patients with cancer. PATIENTS and METHODS: Immunosuppressed cancer patients with localized herpes zoster were randomly assigned to receive placebo, 36 X 10(6) units of recombinant interferon alpha-2a per day, or 68 X 10(6) units of recombinant interferon alpha-2a per day. Due to frequent adverse effects, the 68 X 10(6) unit dose of interferon was discontinued prior to conclusion of the trial. RESULTS: Dissemination of herpes zoster occurred in 14 of the 24 patients (58 percent) who received placebo but in only four of 24 recipients (17 percent) of 36 X 10(6) units of interferon per day (p = 0.003). Adverse effects (fever, chills, headaches, gastrointestinal irritability, fatigue, and myalgias) were more common or severe in interferon-treated patients. CONCLUSION: These results suggest that interferon modifies the severity of herpes zoster in immunosuppressed patients with cancer but is associated with frequent side effects. PMID: 3041829 [PubMed - indexed for MEDLINE] 4438. Nippon Ganka Gakkai Zasshi. 1988 Aug;92(8):1398-405. [The detection of varicella-zoster virus (VZV) antigen from vitreous humor of 3 cases with Kirisawa-Urayama type uveitis] [Article in Japanese] Usui M, Gotoh H, Shima Y, Takamura K, Kurata T, Sata T. PMID: 2848401 [PubMed - indexed for MEDLINE] 4439. Clin Otolaryngol Allied Sci. 1988 Aug;13(4):289-98. The natural history of facial paralysis in herpes zoster. Devriese PP, Moesker WH. Academic Medical Centre, Department of Facial Research, Amsterdam, The Netherlands. A group of 102 patients with facial palsy caused by herpes zoster was studied in order to determine the course and prognosis without treatment. In most cases, the eruption and the paralysis appeared at the same time. The maximal degree of loss of function was usually reached within 1 week and was clearly related to the age of the patient. Recovery was better when the vesicles preceded complete loss of function. Complete recovery was achieved in about 10% of patients after a complete loss of function and in about 66% after an incomplete loss. PMID: 2846216 [PubMed - indexed for MEDLINE] 4440. J Med Virol. 1988 Aug;25(4):387-98. Serological responses in varicella and zoster assayed by immunoblotting. Harper DR, Kangro HO, Heath RB. Virology Department, St. Bartholomew's Hospital, London, England. Acute and convalescent zoster sera taken from 11 patients with varicella and 12 patients with zoster were assayed using immunoblotting for the presence of IgG- and IgM-class antibodies to proteins present in varicella-zoster virus-infected cells. All patients exhibited a detectable virus-specific response with both antibody classes. The IgG responses involved up to 28 protein bands between 28 and 255 kilodaltons (kDa). The reactivity was particularly strong in the 78-114-kDa region, with additional bands observed with all patients at 32, 35, 66, and 220 kDa. This pattern of reactivity typically developed more slowly and was weaker and more variable in patients with varicella compared to those with zoster. The reactivity of IgM antibodies in immunoblotting was similar after varicella and after zoster. Individual sera showed up to 25 bands, with the major reactivity being directed against the 78-96-kDa region and two bands at 32 and 35 kDa. Some differences were apparent between the primary and anamnestic responses with both IgG and IgM antibodies, but this did not allow reliable discrimination of the two types of infection. PMID: 2844983 [PubMed - indexed for MEDLINE] 4441. Postgrad Med. 1988 Aug;84(2):181-4, 187-90. Mucocutaneous herpetic infections during cancer chemotherapy. Dreizen S, McCredie KB, Bodey GP, Keating MJ. Department of Oral Oncology, University of Texas Dental Branch, Houston 77225. Adults who are given immunosuppressive and myelosuppressive cancer chemotherapy have a heightened risk for development of herpetic infections during treatment. The impact is much greater in patients who are given antineoplastic drugs for leukemia and lymphoma than in those who are given such drugs for carcinoma and sarcoma. In the series reported here, the incidence of herpes simplex infections exceeded that of herpes zoster infections in patients treated for leukemia by a ratio of more than 12:1, compared to slightly more than 2:1 in patients treated for solid tumor. The frequency of herpes simplex and herpes zoster infections during treatment for leukemia was 25%. Corresponding frequencies for patients with lymphoma, carcinoma, and sarcoma were 28%, 8%, and 3%, respectively. PMID: 2840648 [PubMed - indexed for MEDLINE] 4442. N Z Med J. 1988 Jul 13;101(849):461. A new shingles therapy. Acland RH. PMID: 3399188 [PubMed - indexed for MEDLINE] 4443. Ned Tijdschr Geneeskd. 1988 Jul 2;132(27):1235-7. [Minor symptoms in family practice; herpes zoster] [Article in Dutch] Bergink GJ, Gill K. PMID: 2840583 [PubMed - indexed for MEDLINE] 4444. South Med J. 1988 Jul;81(7):929-30. Herpes zoster causing acute urinary retention. Patel BR, Rivner MH. Department of Neurology, Medical College of Georgia, Augusta 30912-2323. PMID: 3393956 [PubMed - indexed for MEDLINE] 4445. Heart Lung. 1988 Jul;17(4):331-4. Transmissible infections in critical care. Gurevich I. Infection Control Section, Winthrop-University Hospital, Mineola, NY 11501. Personnel caring for critically ill patients in emergency or trauma care settings, or in adult and pediatric intensive care units, face considerable risk of acquiring infections from their patients. Obvious infections are less hazardous than obscure, unsuspected, or unreported ones. Although postexposure prophylaxis is available in some cases, it can add its own risks for uninformed persons. Examples of inadvertent but unnecessary exposures, with their consequences, are discussed in this article. Emphasis is on how ethical and considerate behavior toward others, along with clinical awareness, diagnostic clues, and early communication with the infection control service, could have prevented these exposures and might do so in other instances. PMID: 3391786 [PubMed - indexed for MEDLINE] 4446. Arch Dermatol. 1988 Jul;124(7):1011-3. Unusual varicella zoster virus infection in patients with the acquired immunodeficiency syndrome. Alessi E, Cusini M, Zerboni R, Cavicchini S, Uberti-Foppa C, Galli M, Moroni M. PMID: 3389843 [PubMed - indexed for MEDLINE] 4447. Laryngoscope. 1988 Jul;98(7):776-9. Herpes zoster oticus: treatment with intravenous acyclovir. Dickins JR, Smith JT, Graham SS. Ear and Nose-Throat Clinic, P.A., Little Rock, AR 72205-6358. Herpes zoster oticus generally has a poor prognosis, leaving many patients with permanent facial nerve dysfunction. This preliminary report describes results in seven patients treated for zoster; all were given intravenous acyclovir. Patients were infused with 10 mg/kg every 8 hours over a 7-day hospitalization period. Five of the seven patients showed some return of facial function at the time of discharge. At follow-up, 4 patients had achieved a House grade I result, 1 patient a grade II, and 2 patients a grade III. Reasons for the differences in final results are discussed, along with a recommended regimen for treatment. PMID: 3386386 [PubMed - indexed for MEDLINE] 4448. Arch Intern Med. 1988 Jul;148(7):1561-6. Varicella-zoster infection in adult cancer patients. A population study. Rusthoven JJ, Ahlgren P, Elhakim T, Pinfold P, Reid J, Stewart L, Feld R. Toronto-Bayview Regional Cancer Center, Canada. In a retrospective review of varicella-zoster (V-Z) Infections in adult cancer patients, 766 episodes of V-Z Infection were studied among 740 patients seen at a large comprehensive cancer center from 1972 to 1980. The highest risk of infection was present among patients with lymphoma and leukemia. The risk of dissemination of V-Z Infection was significantly associated with the presence of active tumor at the time of Infection. The site of the primary tumor correlated with the site of subsequent zoster Infection among patients with breast cancer, cancer of the respiratory tract, and gynecologic cancer. Pain attributable to V-Z Infection was present in a large majority of episodes. The median time from the completion of therapy to the onset of Infection was seven months for patients receiving radiotherapy and less than one month for those receiving chemotherapy. Various attributes of this study group were compared with those of previously studied cancer and noncancer populations. PMID: 3382302 [PubMed - indexed for MEDLINE] 4449. J Dermatol Surg Oncol. 1988 Jul;14(7):774-8. Zosteriform metastasis: case presentation and review of the literature. Matarasso SL, Rosen T. Department of Dermatology, Baylor College of Medicine, Houston, Texas 77030. In contrast to benign tumors, malignant tumors, by definition, are characterized by the potential of giving rise to metastases. Albeit infrequently, skin metastases do occur, and their clinical appearance varies over a wide morphologic spectrum. We present the case of a 65-year-old male with zosteriform metastasis secondary to bronchogenic adenocarcinoma. A review of cutaneous metastasis is presented with emphasis on dermatomal distribution and possible mechanisms of dissemination. PMID: 3292614 [PubMed - indexed for MEDLINE] 4450. J Infect. 1988 Jul;17(1):57-63. A double-masked, placebo-controlled trial of acyclovir cream in immunocompetent patients with herpes zoster. Mandal BK, Dunbar EM, Ellis ME, Ellis J, Dowd P. Regional Department of Infectious Diseases and Tropical Medicine, Monsall Hospital, Manchester, U.K. Sixty-four patients with herpes zoster were entered into a randomised double-masked, placebo-controlled trial of 5% acyclovir cream applied five times daily for 5 days. Of these patients, 56 were included in the final analysis (26 acyclovir, 30 placebo). Significant and objective differences in either progression of the rash, severity of acute pain or incidence of post-herpetic neuralgia were not observed. Although significantly more rashes involuted in the acyclovir group, this isolated finding cannot be explained. Twenty-two patients (12 acyclovir, 10 placebo) experienced erythema or desquamation or both during treatment with the cream. The similar incidence of skin reactions in both groups suggests that they were related to the cream base rather than the acyclovir. PMID: 3060542 [PubMed - indexed for MEDLINE] 4451. Nippon Jibiinkoka Gakkai Kaiho. 1988 Jul;91(7):1078-84. [Early diagnosis of varicella-zoster virus infection in acute facial paralysis--significance of VZV antigen skin test and CSF examination] [Article in Japanese] Okuno H. PMID: 2846806 [PubMed - indexed for MEDLINE] 4452. Neurology. 1988 Jul;38(7):1150-3. Chronic progressive varicella-zoster virus encephalitis in an AIDS patient. Gilden DH, Murray RS, Wellish M, Kleinschmidt-DeMasters BK, Vafai A. Department of Neurology, Veterans Administration Medical Center, Denver, CO. A patient with AIDS developed chronic, progressive encephalitis. Pathologic changes indicated that the encephalitis was produced primarily by a human herpesvirus. Hybridization of radiolabeled RNA probes transcribed from cloned DNA fragments of varicella-zoster virus (VZV), herpes simplex virus, cytomegalovirus, and the human immunodeficiency virus to DNA extracted from the patient's brain identified VZV as the causative agent. The results suggest that VZV should be considered in the differential diagnosis of chronic encephalitis of unknown etiology, particularly in immunosuppressed patients. PMID: 2838767 [PubMed - indexed for MEDLINE] 4453. N Engl J Med. 1988 Jun 23;318(25):1669-79. Case records of the Massachusetts General Hospital, Weekly clinicopathological exercises. Case 25-1988. Back and abdominal pain followed by disseminated intravascular coagulation in a five-year-old boy with leukemia in remission. [No authors listed] PMID: 3163775 [PubMed - indexed for MEDLINE] 4454. Am J Med. 1988 Jun;84(6):1076-80. Disseminated herpes zoster in patients with human immunodeficiency virus infection. Cohen PR, Beltrani VP, Grossman ME. Department of Dermatology, College of Physicians and Surgeons of Columbia University, New York, New York 10032. Herpes zoster virus infections occur in persons with decreased cellular immunity. A 45-year-old man is described who presented with disseminated herpes zoster as the initial manifestation of his human immunodeficiency virus infection. Disseminated herpes zoster virus infections have been reported in human immunodeficiency virus-seropositive patients. Similar to disseminated herpes zoster virus infections that occur in immunosuppressed patients seronegative for human immunodeficiency virus, an increased morbidity and responsiveness to acyclovir is observed. In contrast, the morphology of the skin lesions and the clinical course have been more severe, and the mortality has been increased. Visceral involvement has not been described. PMID: 3376978 [PubMed - indexed for MEDLINE] 4455. Stroke. 1988 Jun;19(6):784. Radiation-induced cerebral vasculitis revisited. Devinsky O. PMID: 3376172 [PubMed - indexed for MEDLINE] 4456. Ann Intern Med. 1988 Jun;108(6):907. Varicella-zoster virus infection. Sugar SJ. PMID: 3369785 [PubMed - indexed for MEDLINE] 4457. J Korean Med Sci. 1988 Jun;3(2):79-82. Herpes zoster ophthalmicus and delayed contralateral hemiparesis. Sung KB, Kim SH, Kim JH, Chung KC, Kim MH. Department of Neurology, College of Medicine, Hanyang University, Seoul, Korea. Central nervous system is often involved by herpes zoster but it is very rarely seen that contralateral hemiparesis or hemiplegia developed after herpes zoster ophthalmicus. We report a case of herpes zoster ophthalmicus followed by the delayed contralateral hemiparesis. A 33-year-old man developed acute cerebral infarction and resultant right hemiparesis 44 days after herpes zoster ophthalmicus in the left side. Brain CT disclosed hypodense area in the left basal ganglia. Cerebral angiography revealed segmental narrowing of M1 portion of the right middle cerebral artery. PMID: 3267358 [PubMed - indexed for MEDLINE] 4458. Ital J Neurol Sci. 1988 Jun;9(3):265-9. Herpes zoster ophthalmicus and ipsilateral infarction in the territory of the anterior choroidal artery. Kniahynicki C, Castellano AE, Mossuto-Agatiello L. Divisione di Neurologia, Istituto Sanatrix, Venafro. We report a further case of retarded contralateral hemiplegia syndrome after herpes zoster ophthalmicus in which the motor deficit was caused by an ischemic infarction in the territory supplied by the anterior choroidal artery. We discuss the clinical and physiopathogenetic features of the case and consider the computed tomographic and neurological patterns of anterior choroidal infarction. PMID: 3261282 [PubMed - indexed for MEDLINE] 4459. Scott Med J. 1988 Jun;33(3):267-8. Phenytoin monitoring: clinical or scientific? Fulton JD, McGovern EM, McCarron BN, Carlile AK. Department of Geriatric Medicine, Stobhill General Hospital, Glasgow. Phenytoin is an established therapy for post-herpetic neuralgia. In order to maintain serum phenytoin levels in the normal therapeutic range, serum phenytoin monitoring is required. This range may, however, be misleading in certain clinical conditions. We report here a patient with hypoalbuminaemia who developed marked clinical phenytoin toxicity despite maintenance of the serum total phenytoin concentration within the therapeutic range. PMID: 3175605 [PubMed - indexed for MEDLINE] 4460. HNO. 1988 Jun;36(6):234-40. [Herpes zoster cephalicus] [Article in German] Kainz J, Friedrich G. Universitäts-HNO-Klinik Graz. The clinical features of ENT infections induced by the herpes zoster virus are presented. Detailed descriptions of two cases affecting the ear and one affecting the larynx are given, supplemented by photographs. The possible cranial nerve lesions are demonstrated by a review of the literature. An attempt is made to assign the distribution of dermomucosal eruptions and associated sensory and motor dysfunctions to the appropriate neuroanatomical structures. PMID: 3045057 [PubMed - indexed for MEDLINE] 4461. J Neurol Neurosurg Psychiatry. 1988 Jun;51(6):885-6. Abdominal muscle paralysis from herpes zoster. Glantz RH, Ristanovic RK. PMCID: PMC1033171 PMID: 2969958 [PubMed - indexed for MEDLINE] 4462. Nippon Hifuka Gakkai Zasshi. 1988 Jun;98(7):721-30. [Studies on meningitis phenomena in herpes zoster] [Article in Japanese] Higuchi Y, Morishima T. PMID: 2854865 [PubMed - indexed for MEDLINE] 4463. Semin Respir Infect. 1988 Jun;3(2):148-61. Diagnosis of viral pneumonia. Sullivan CJ, Jordan MC. University of Minnesota Medical School, Minneapolis 55455. The diagnosis of viral pneumonia has changed during the past decade from a purely clinical diagnosis to one that is both clinical and laboratory in nature. Viral pneumonias can be divided into two clinical groups: the so-called "atypical" pneumonias in otherwise normal hosts, and viral pneumonitis in the immunocompromised host. Clinical factors such as patient age, immune status, time of year, illness in other family members, community outbreaks, onset, severity, duration of symptoms, and the presence of a rash remain important aids in diagnosing viral causes of both atypical pneumonia and pneumonia in the immunocompromised patient. However, advances in virus culture methodologies and the use of monoclonal antibodies coupled with immunofluorescence and ELISA techniques have markedly enhanced both the sensitivity, specificity, and rapidity of the diagnosis of viral pneumonias. Further advances are expected in the future as nucleic acid hybridization techniques are increasingly applied to both viral cultures and direct analysis of clinical specimens. PMID: 2840725 [PubMed - indexed for MEDLINE] 4464. Transplantation. 1988 Jun;45(6):1057-61. Neurologic complications of liver transplantation. Vogt DP, Lederman RJ, Carey WD, Broughan TA. Department of General Surgery, Cleveland Clinic Foundation, Ohio 44106. Nineteen adult patients underwent 21 orthotopic liver transplants at the Cleveland Clinic between November 1984, and August 1986. Eight of 19 (42%) patients developed seizures. One patient suffered a single seizure, and seven patients had multiple, generalized seizures. Two of these seven patients became comatose after several days of seizure activity. Over several weeks, both of these patients regained consciousness--however, they exhibited a cerebellar-type syndrome, manifested as severe ataxia, weakness, and dysarthria. Both patients have improved, but remain neurologically impaired. Laboratory evaluation included serum electrolytes, magnesium, osmolality, and cyclosporine levels. Neurologic testing consisted of cerebrospinal fluid (CSF) analysis, computed tomographic (CT) scanning, and electroencephalography (EEG). Although the CSF protein was mildly elevated in two patients, all cultures remained sterile. None of the CT scans demonstrated any abnormalities. In five patients, the EEG showed generalized slowing consistent with diffuse encephalopathy. Other factors associated with seizures in transplant patients were analyzed, including fluid retention, hypertension, high-dose steroids, hypomagnesemia, graft dysfunction, and demyelinization. Many of our patients had the first three of these factors, since all but one developed their seizures within the first ten postoperative days. Only one patient had mild hypomagnesemia. Trough cyclosporine levels (whole blood, HPLC) were not in the toxic range (greater than 500 ng/mL). The serum osmolality was elevated in all four patients in whom it was measured, ranging from 309 to 341 mOsm/kg. Only three patients exhibited graft dysfunction--two moderate and one severe. The cause of neurologic toxicity following transplantation is unclear. Although many factors have been implicated, no common denominator has emerged. Several reports have linked cyclosporine with seizures and other neurologic problems, such as the cerebellar-type syndrome exhibited in two of our patients. Future studies should include magnetic resonance (MR) imaging of the head and measuring osmolality and cyclosporine levels in the blood and CSF. PMID: 2837845 [PubMed - indexed for MEDLINE] 4465. Pain. 1988 Jun;33(3):333-40. Post-herpetic neuralgia and topical capsaicin. Watson CP, Evans RJ, Watt VR. Smythe Pain Clinic, Toronto General Hospital, University of Toronto, Ont., Canada. Topical 0.025% capsaicin was used to treat 33 patients with post-herpetic neuralgia (PHN). Thirty-nine percent of those entering the trial achieved at least a good result and 55% were improved or better. Fifty-six percent of the 23 patients completing the study had good or excellent pain relief after 4 weeks. Seventy-eight percent of the 23 noted at least some improvement in pain. Post-capsaicin burning was a common, untoward effect in most patients and in about one-third was so unbearable that the trial was terminated prematurely. This treatment appears to be a useful modality in PHN, particularly in the elderly in whom oral medications are often poorly tolerated; however, it does require supervision. A double-blind, controlled trial is now necessary. PMID: 2458561 [PubMed - indexed for MEDLINE] 4466. Int J Dermatol. 1988 Jun;27(5):336. Treatment of oral postherpetic neuralgia with topical capsaicin. Hawk RJ, Millikan LE. Department of Dermatology, Tulane University School of Medicine, New Orleans, Louisiana. PMID: 2455696 [PubMed - indexed for MEDLINE] 4467. Presse Med. 1988 May 21;17(19):963. [Zona as a predictive element of the infection by human immunodeficiency type 1 virus in Bangui (Central African Republic)] [Article in French] Lesbordes JL, Coulaud X, Georges AJ. PMID: 2898140 [PubMed - indexed for MEDLINE] 4468. Am J Ophthalmol. 1988 May 15;105(5):556-8. Chronic herpes zoster virus keratitis associated with the acquired immunodeficiency syndrome. Engstrom RE, Holland GN. UCLA Uveitis Center, Jules Stein Eye Institute. PMID: 3369522 [PubMed - indexed for MEDLINE] 4469. Br J Cancer. 1988 May;57(5):516-20. Multiple myeloma--a case-control study. Cuzick J, De Stavola B. Department of Mathematics, Statistics and Epidemiology, Imperial Cancer Research Fund, London, UK. A total of 399 patients with multiple myeloma and an equal number of match controls were interviewed about factors possibly related to the causes of their disease. Factors studied included occupation, chemical exposure, radiation exposure, prior diseases, immunizations, chronic infections and markers for defects in immune regulation. A strong risk associated with agriculture/food processing was observed (RR = 1.8, P = 0.002). The risk could not be restricted to those exposed to animals or meat products, or those exposed to pesticides. Significant excesses were also noted for reported exposures to chemicals and gases/fumes, but no specific agent or group of agents could be identified. Cases had fewer tonsillectomies above the age of 10 (P = 0.01). A large excess of shingles (herpes zoster) was observed in cases (P less than 0.001), but most of the excess cases occurred within 10 years of diagnosis, suggesting this was a preclinical manifestation of disease rather than a cause of it. PMCID: PMC2246387 PMID: 3395559 [PubMed - indexed for MEDLINE] 4470. J Am Acad Dermatol. 1988 May;18(5 Pt 1):1135-6. Topical capsaicin for treatment of neuralgia associated with herpes zoster infection. Don PC. PMID: 3385032 [PubMed - indexed for MEDLINE] 4471. J Pediatr. 1988 May;112(5):844-5. Fetal varicella syndrome. Higa K, Dan K, Manabe H. PMID: 3361401 [PubMed - indexed for MEDLINE] 4472. Masui. 1988 May;37(5):586-91. [Transcutaneous electrical nerve stimulation (TENS) for the treatment of segmental abdominal zoster paresis] [Article in Japanese] Kadota Y, Miyawaki T, Yoshimura N. PMID: 3261807 [PubMed - indexed for MEDLINE] 4473. J Assoc Physicians India. 1988 May;36(5):321-2. Zoster-varicella infection in Hodgkin's disease. Pahuja R, Parikh PM, Charak BS, Rawat RS, Gopal R, Saikia TK, Advani SH. PMID: 3182695 [PubMed - indexed for MEDLINE] 4474. An Esp Pediatr. 1988 May;28(5):481-2. [Cervicofacial herpes zoster in a 2-year-old child] [Article in Spanish] del Castillo Martín F, Cañete Díaz A, Muro Brussi M, Fonseca Capdevila E. Servicio de Dermatología, Clínica Infantil La Paz, Madrid. PMID: 3178071 [PubMed - indexed for MEDLINE] 4475. AJNR Am J Neuroradiol. 1988 May-Jun;9(3):609. MR findings in the Ramsay Hunt syndrome. Daniels DL, Czervionke LF, Millen SJ. PMID: 3132840 [PubMed - indexed for MEDLINE] 4476. J Am Acad Dermatol. 1988 May;18(5 Pt 1):1142-3. Peripheral edema and oral acyclovir. Hisler BM, Daneshvar SA, Aronson PJ, Hashimoto K. PMID: 2968376 [PubMed - indexed for MEDLINE] 4477. J Infect Dis. 1988 May;157(5):882-8. Western blot analysis of antibody to varicella-zoster virus. Dubey L, Steinberg SP, LaRussa P, Oh P, Gershon AA. Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York, New York 10032. We used western blot (WB) to compare the IgG response to varicella-zoster virus (VZV) after chickenpox (CP), zoster, and administration of a live attenuated varicella vaccine (LAVV). After CP, 13 of 14 normal children had antibody to glycoprotein (gp) I (99 and 92 kilodaltons [kDa]), 11 had antibody to gpII (133 kDa), and 10 had antibody to gpIII (119 kDa). Bands at 150 and 35 kDa were also seen in 13 and 11 sera, respectively. Bands to gpI, gpII, and p35 were more intense after zoster than CP. After one dose of LAVV, eight of eight normal children had gpI antibody. In leukemic children, gpI antibody appeared in 18 (56%) after one dose and in 25 (89%) after two doses. Upon household exposure, leukemic vaccinees who developed CP were less likely than those protected to have prior gpIII and p35 antibodies. As seen after zoster, WBs after breakthrough CP showed intense responses to VZV antigens. Thus, WB helps distinguish secondary from primary antibody responses to VZV. PMID: 2834466 [PubMed - indexed for MEDLINE] 4478. Laryngol Rhinol Otol (Stuttg). 1988 Apr;67(4):188-90. [Treatment of zoster oticus] [Article in German] Bier H, Bergler W, Keilmann A. Klinik für Hals-Nasen-Ohrenkrankheiten, Klinikums Mannheim, Fakultät für klinische Medizin, Universität Heidelberg. On the basis of aetiology and pathophysiology a rational concept for the treatment of zoster oticus is attempted. The current literature and own experiences favour the simultaneous application of the virostatic acyclovir and glucocorticosteroids. PMID: 3386371 [PubMed - indexed for MEDLINE] 4479. Pain. 1988 Apr;33(1):73-8. Concerning the management of pain associated with herpes zoster and of postherpetic neuralgia. King RB. Department of Neurological Surgery, SUNY Health Science Center, Syracuse 13210. This simple method of achieving substantial pain control in patients with documented herpes zoster and postherpetic neuralgia has been effective in each of the patients in whom it has been used (the most recent 12 cases have been summarized for this report). It has been more effective than narcotic analgesics, oral anti-inflammatory analgesics, sedatives, tranquilizers, TENS, hypnosis and the wide variety of operative measures we have tried in the past. Although it was initially used pragmatically, there is now a reasonable rationale for its effectiveness that can be proposed based on more recent insights into the anatomy and neurophysiology of cutaneous nociceptors and the neuropharmacology of aspirin. In view of the widely held persuasion that the management of pain syndromes associated with herpes zoster (especially severe postherpetic neuralgia) is an unsatisfactory and frustrating venture, it seemed reasonable to report these more favorable clinical observations. PMID: 3380554 [PubMed - indexed for MEDLINE] 4480. Int J Dermatol. 1988 Apr;27(3):193-7. Treatment of herpes zoster. Recombinant alpha interferon versus acyclovir. Duschet P, Schwarz T, Soyer P, Henk A, Hausmaninger H, Gschnait F. Department of Dermatology, Hospital Vienna Lainz, Austria. Sixty-four patients received systemic alpha-interferon (10 million units subcutaneously daily) and 63 received systemic acyclovir (5 mg/kg body weight intravenously thrice daily) in a randomized study of acute herpes zoster. Start of healing, complete healing, development of new skin lesions in the primarily affected and in other dermatomes, and degree and duration of pain were evaluated. Both drugs proved equally clinically efficient without statistically different findings between the two groups; herpes zoster neuralgia was not prevented by either interferon or acyclovir therapy. Minor clinical side effects occurred slightly more frequently during interferon treatment and included fever and nausea. Transient and moderate leukopenia was observed in nearly all patients in the interferon group. PMID: 3286547 [PubMed - indexed for MEDLINE] 4481. Clin Pharmacol Ther. 1988 Apr;43(4):363-71. Association of pain relief with drug side effects in postherpetic neuralgia: a single-dose study of clonidine, codeine, ibuprofen, and placebo. Max MB, Schafer SC, Culnane M, Dubner R, Gracely RH. Neurobiology and Anesthesiology Branch, National Institute of Dental Research, Bethesda, MD 20892. In a randomized, double-blind crossover study, 40 patients with postherpetic neuralgia were given single oral doses of clonidine, 0.2 mg, codeine, 120 mg, ibuprofen, 800 mg, or inert placebo. Pain relief and side effects were recorded for 6 hours. Patients reported significantly more relief after clonidine than after the other three treatments. Codeine and ibuprofen were ineffective. Sedation, dizziness, and other side effects were more frequent after clonidine (74%) or codeine (69%) than after placebo (36%) or ibuprofen (28%). Reported pain relief was greater during trials in which side effects were present. A single, mild side effect was associated with as much additional pain relief as multiple, severe side effects. Clonidine's superiority to codeine, which had a similar incidence of side effects, argues for a specific analgesic effect. In addition, side effects may have contributed to clonidine analgesia, perhaps by suggesting to patients that they had received a potent drug. PMID: 3281774 [PubMed - indexed for MEDLINE] 4482. J Exp Med. 1988 Apr 1;167(4):1313-22. Oligoclonal T lymphocytes in the cerebrospinal fluid of patients with multiple sclerosis. Hafler DA, Duby AD, Lee SJ, Benjamin D, Seidman JG, Weiner HL. Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts. Erratum in: J Exp Med 1988 Jul 1;168(1):459. We have investigated the T cell populations in the cerebrospinal fluid (CSF) of chronic progressive multiple sclerosis (MS) patients. Individual T cells from the CSF and blood were cloned before expansion and their clonotypes were defined by analysis of rearranged T cell receptor beta chain and gamma chain genes. 87 T cell clones from blood and CSF of two patients with chronic progressive MS were examined for common TCR gene rearrangement patterns. In one patient, 18 of 28 CSF-derived T cell clones demonstrated common TCR gene rearrangements indicating oligoclonal T cell populations; in the blood, two patterns were found twice among 26 T cell clones. In another patient, 5 of 27 CSF-derived clones had common TCR gene rearrangement patterns. In contrast, no common beta chain rearrangement pattern was found among 67 T cell clones derived from the blood or CSF of a patient with subacute sclerosing panencephalitis, among 20 clones from the CSF of a patient with herpes zoster meningoencephalitis, or among 66 clones from a normal subject. A subject with atypical, fatal MS of 8-mo duration was also studied and did not have oligoclonal T cells in the CSF or blood. These results demonstrate that distinct oligoclonal T cell populations can be found in the CSF immune compartment of subjects with nonmalignant inflammatory disease and they can create a new avenue for the investigation of the specificity of the T cell response within the central nervous system. PMCID: PMC2188923 PMID: 3258624 [PubMed - indexed for MEDLINE] 4483. J Am Dent Assoc. 1988 Apr;116(4):500-4. Prodromal odontalgia and multiple devitalized teeth caused by a herpes zoster infection of the trigeminal nerve: report of case. Goon WW, Jacobsen PL. Department of Endodontics, University of the Pacific, School of Dentistry, San Francisco 94115-2399. A case of oral herpes zoster infection with prodromal odontalgia is presented. Tooth devitalization, facial scarring, and neuralgia occurred without concurrent local and systemic factors. The cause, pathological features, diagnosis, and management of an oral herpes zoster infection with prodromal odontalgia are discussed. PMID: 3164018 [PubMed - indexed for MEDLINE] 4484. Ann Intern Med. 1988 Apr;108(4):643-4. Herpes zoster, postherpetic neuralgia, and interferon-gamma. Usuki K, Kitamura K, Urabe A, Takaku F. PMID: 3126691 [PubMed - indexed for MEDLINE] 4485. Am J Med. 1988 Apr;84(4):781-3. Factitious dermatosis masquerading as recurrent herpes zoster. Levitz SM, Tan OT. Evans Memorial Department of Clinical Research, University Hospital, Boston, Massachusetts 02118. A 35-year-old nurse's aide presented with monthly episodes, during her menses, of self-induced cutaneous lesions intended to simulate recurrent herpes zoster. Features of the clinical presentation that prompted the correct diagnosis are discussed. PMID: 3041813 [PubMed - indexed for MEDLINE] 4486. Nippon Hifuka Gakkai Zasshi. 1988 Apr;98(5):521-32. [Clinico-pathological studies on herpes zoster (II); Histologic changes in upper dermis at different stages on herpes zoster] [Article in Japanese] Muraki R. PMID: 2853800 [PubMed - indexed for MEDLINE] 4487. Transplantation. 1988 Apr;45(4):737-40. Nonbacterial nonfungal interstitial pneumonitis following autologous bone marrow transplantation in children treated with high-dose chemotherapy without total-body irradiation. Valteau D, Hartmann O, Benhamou E, Caillaud JM, Brugières L, Beaujean F, Patte C, Flamant F, Lemerle J. Département de Pédiatrie, Institut Gustave-Roussy, Villejuif, France. Between February 1979 and May 1986, 165 children were treated with autologous bone marrow transplantation after high-dose chemotherapy without total-body irradiation for a hematologic malignancy or a solid tumor. Nonbacterial nonfungal interstitial pneumonitis was observed in 24 children and was the cause of death in 11 cases. Of the 24 cases of interstitial pneumonitis, 14 were considered to be idiopathic. Cytomegalovirus was the major pathogenic agent detected in the 10 other cases of interstitial pneumonitis (n = 5), followed by Herpes zoster (n = 2), Pneumocystis carinii (n = 1), tumor (n = 1), and adenovirus (n = 1). The only factor found to correlate significantly with the increased rate of interstitial pneumonitis was the use of high-dose 1-3 bis chloroethyl-1 nitrosourea (BCNU) (600 mg/m2), whereas BCNU at a dose of 300 mg/m2 did not affect this rate. These data, when compared with the literature, show a lower incidence of interstitial pneumonitis than in allogeneic transplantations, and an incidence similar to that observed in syngeneic transplantations, although there was no radiation toxicity in this series. PMID: 2833829 [PubMed - indexed for MEDLINE] 4488. Proc Natl Acad Sci U S A. 1988 Apr;85(8):2767-70. Expression of varicella-zoster virus in blood mononuclear cells of patients with postherpetic neuralgia. Vafai A, Wellish M, Gilden DH. Departments of Neurology, University of Colorado School of Medicine, Denver 80262. Postherpetic neuralgia (PHN), the most frequent complication of varicella-zoster virus (VZV) reactivation, is characterized by pain that persists for greater than 1 mo and often for years after zoster rash. To examine whether PHN might be related to reactivation of VZV, blood mononuclear cells of patients with PHN were tested for the presence of VZV DNA and proteins. VZV DNA was detected in the mononuclear cells of one PHN patient. VZV-specific proteins were detected in mononuclear cells of two acute-varicella patients, one acute zoster patient, and six elderly patients with PHN, but these VZV-specific proteins were not detected in three elderly zoster patients without PHN. Furthermore, pulse-chase experiments revealed further processing or degradation of VZV-specific proteins in the mononuclear cells. These findings strongly suggest that persistence, reactivation, and expression of VZV may result in PHN. PMCID: PMC280080 PMID: 2833752 [PubMed - indexed for MEDLINE] 4489. Hosp Pract (Off Ed). 1988 Mar 30;23(3A):113-4, 116-20. Science, society, and changing viral-host relationships. Weller TH. PMID: 2832426 [PubMed - indexed for MEDLINE] 4490. Schweiz Rundsch Med Prax. 1988 Mar 15;77(11):271-3. [Hepatitis following dextropropoxyphene: a case report] [Article in German] Paganoni R, Reymond JF, Herzog C. PMID: 3375653 [PubMed - indexed for MEDLINE] 4491. N Engl J Med. 1988 Mar 3;318(9):573-5. Hell's fire and varicella-vaccine safety. Plotkin SA. PMID: 3340138 [PubMed - indexed for MEDLINE] 4492. N Engl J Med. 1988 Mar 3;318(9):543-8. The risk of zoster after varicella vaccination in children with leukemia. Lawrence R, Gershon AA, Holzman R, Steinberg SP. Department of Pediatrics, New York University Medical Center, New York. We examined the incidence of zoster in 346 children with underlying acute lymphoblastic leukemia who were immunized with live attenuated varicella vaccine while in remission. We also compared a subset of 84 of these children with a matched group of 84 children with leukemia who had had natural infection with varicella. Of the 346 vaccinated children, 5 (1.45 percent) became infected with zoster after 10,878 months of observation, for an incidence of 0.552 case per 100 person-years. Among the matched pairs of subjects, zoster occurred in 3 (3.6 percent) of the 84 vaccinated subjects during 2936 months of observation--an incidence of 1.23 cases per 100 person-years--and in 11 (13.1 percent) of the subjects with natural infection during 4245 months--an incidence of 3.11 cases of zoster per 100 person-years. Although the incidence of zoster was more than twice as high in the control children as in the vaccinated children (3.11 vs. 1.23 cases per 100 person-years), a Kaplan-Meier product-limit analysis revealed no significant differences in incidence between the two groups. Children from both groups in whom leukemia recurred were more likely to contract zoster than those who did not have a recurrence (7 of 35 vs. 7 of 133, P less than 0.025). Zoster was not a marker for impending relapse. No case of zoster was severe or disseminated. We conclude that the incidence of zoster following immunization with live attenuated varicella vaccine is no greater than that following natural varicella infection. PMID: 2828948 [PubMed - indexed for MEDLINE] 4493. Indian J Pediatr. 1988 Mar-Apr;55(2):301-3. Herpes zoster. Bharija SC, Kanwar AJ, Belhaj MS. PMID: 3403026 [PubMed - indexed for MEDLINE] 4494. J Neurol Neurosurg Psychiatry. 1988 Mar;51(3):425-6. Bell's palsy and HIV infection. Brown MM, Thompson A, Goh BT, Forster GE, Swash M. Department of Neurology, London Hospital, UK. Unilateral infranuclear facial palsy developed in three young homosexual men. All three were positive for antibodies to human immunodeficiency virus (HIV). Two had persistent generalised lymphadenopathy, but the clinical criteria for the acquired immune deficiency syndrome (AIDS) were not fulfilled. There were no features of generalised neuropathy, and no other cause for facial palsy was evident. Recovery was excellent in each patient. PMCID: PMC1032872 PMID: 3361335 [PubMed - indexed for MEDLINE] 4495. J Am Acad Dermatol. 1988 Mar;18(3):584-5. Chronic varicella zoster infection in acquired immunodeficiency syndrome. Janier M, Hillion B, Baccard M, Morinet F, Scieux C, Perol Y, Civatte J. PMID: 3351019 [PubMed - indexed for MEDLINE] 4496. Am Fam Physician. 1988 Mar;37(3):185-92. Neurologic complications of herpes zoster. Bucci FA Jr, Schwartz RA. Albany Medical College of Union University, New York. Encephalitis, contralateral hemiplegia and postherpetic neuralgia are the most serious neurologic sequelae of herpes zoster infections. Encephalitis occurs more frequently in the presence of cutaneous dissemination and cranial nerve lesions. Contralateral hemiplegia following herpes zoster ophthalmicus results from vasculitic and thrombotic lesions. The combination of a tricyclic antidepressant and a phenothiazine is the most effective medical treatment for postherpetic neuralgia. PMID: 3348118 [PubMed - indexed for MEDLINE] 4497. J Am Acad Dermatol. 1988 Mar;18(3):605-10. Do corticosteroids prevent postherpetic neuralgia? A review of the evidence. Post BT, Philbrick JT. Department of Medicine, University of Virginia, School of Medicine, Charlottesville 22908. Comment in: J Am Acad Dermatol. 1989 Mar;20(3):523-4. A short course of corticosteroids is frequently used in herpes zoster to prevent postherpetic neuralgia. To clarify the evidence behind this routine practice, we reviewed the three randomized controlled trials on this subject. Although in all three similar dosages of corticosteroids (40 mg to 60 mg prednisone daily for 2 to 4 weeks) were used, deficiencies in reported clinical characteristics of study subjects, the potential for bias in the ascertainment of pain duration, and the inability to exclude type II error make it impossible to determine whether or not this practice is effective. More research on this subject is needed, with greater attention to good study methodology. PMID: 3280625 [PubMed - indexed for MEDLINE] 4498. Baillieres Clin Obstet Gynaecol. 1988 Mar;2(1):55-71. Infection of the fetus and the newborn: prevention, treatment and related handicap. Rudd P, Peckham C. Congenital infection is uncommon and the cause of only a small proportion of handicap seen in children but some infections may be preventable or even treatable. As an example, the congenital rubella syndrome first described in the 1940s is preventable by use of the vaccine but cases still occur. It is hoped that with the introduction of the measles, mumps, rubella immunization for young children, rubella will become as rare in the UK as it is in the USA. Cytomegalovirus is now a more common cause of handicap than rubella but no vaccine has been developed. Although antiviral drugs are available for herpes simplex virus and vaccinia, infection mortality in the newborn is high, even following the use of these agents; many HSV infections in the newborn arise following primary and asymptomatic maternal infections so that treatment may start late in the course of the illness. The obstetrician needs to understand the natural history as well as possible investigations available for congenital infections. There may be warning signs which require action, such as herpetic lesions in the genital tract of the mother. Less specific abnormalities during pregnancy, such as intra-uterine growth retardation and spontaneous onset of preterm labour, may point to congenital infection. This chapter describes both antenatal and postnatal management of the major congenital infections. We have included recent research data that should influence clinical practice; studies on HSV which suggest that, for women with a history of recurrent infection, routine viral culture of the genital tract at the end of pregnancy is unnecessary; reports from both the USA and the UK that rubella immunization performed inadvertently during early pregnancy has not resulted in the congenital rubella syndrome. The chapter would not have been complete without a discussion of human immunodeficiency virus, of concern to the obstetrician and midwife. There is still much to be learned about the natural history of this infection in both the mother and infant. PMID: 2843313 [PubMed - indexed for MEDLINE] 4499. J Infect. 1988 Mar;16(2):193-7. Severe and recurrent varicella-zoster virus infection in a patient with the acquired immune deficiency syndrome. Acheson DW, Leen CL, Tariq WU, Mandal BK. Regional Department of Infectious Diseases and Tropical Medicine, Monsall Hospital, Manchester, U.K. We report a case of recurrent varicella-zoster virus infection in a patient with severe acquired immune deficiency syndrome in whom the infection has become clinically unresponsive to treatment with acyclovir. PMID: 2832482 [PubMed - indexed for MEDLINE] 4500. Presse Med. 1988 Feb 13;17(5):211-2. [Gastric zoster ulcerations] [Article in French] Durin S, Chapelon C, Ziza JM, Frances C, Malki B, Perreau P, Godeau P. PMID: 2965383 [PubMed - indexed for MEDLINE] 4501. Aesthetic Plast Surg. 1988 Feb;12(1):23-4. Herpes zoster as a complication of a face lift. Bailey MH, McKinney P. Division of Plastic Surgery, St. Michael's Hospital, Toronto, Ontario, Canada. A case of herpes zoster neuritis (shingles) is reported, closely following a face lift with adjunctive dermabrasion and chemical peel. The etiologic relationships are unclear. However, the mental nerve distribution suggests mechanical irritation of the nerve as a possible factor. Management of this complication is conservative. It is suggested that herpes zoster be included in the differential diagnosis of unusual alterations of sensation or persistent pain following procedures for facial aging. PMID: 3376780 [PubMed - indexed for MEDLINE] 4502. Kekkaku. 1988 Feb;63(2):143-8. [A case of Mycobacterium scrofulaceum lung infection associated with giant bullae, leading to development of herpes zoster] [Article in Japanese] Umeki S, Okamoto Y, Hisamoto N, Tanaka Y, Hara Y. PMID: 3373936 [PubMed - indexed for MEDLINE] 4503. Nervenarzt. 1988 Feb;59(2):113-7. [Varicella zoster virus infection of the central nervous system with symptoms resembling cardiac phobia and schizophrenia] [Article in German] Ullmann H, Kühn J. Psychiatrische Klinik, Universität Heidelberg. PMID: 3362259 [PubMed - indexed for MEDLINE] 4504. J Am Acad Dermatol. 1988 Feb;18(2 Pt 2):448-51. Kaposi's sarcoma occurring in a dermatome previously involved by herpes zoster. Niedt GW, Prioleau PG. Department of Pathology, New York Hospital-Cornell Medical Center, NY 10021. A 31-year-old black man with a history of intravenous drug abuse developed a mass in his neck, a biopsy of which revealed Kaposi's sarcoma. The patient underwent radiation therapy, and the mass diminished in size. Approximately 2 months later the patient developed a herpes zoster infection in the left T3 distribution. The vesicular eruption resolved, but postherpetic neuralgia remained. Two months after the herpes zoster infection, the patient developed many small nodules in the area of the prior vesicular eruption. Biopsy revealed these nodules to be Kaposi's sarcoma. At this time no other cutaneous lesions were present. We believe that these nodules represent the occurrence of the Koebner phenomenon in a patient with Kaposi's sarcoma and the acquired immunodeficiency syndrome. PMID: 3343414 [PubMed - indexed for MEDLINE] 4505. Arch Pathol Lab Med. 1988 Feb;112(2):173-7. Varicella-zoster virus leukoencephalitis and cerebral vasculopathy. Morgello S, Block GA, Price RW, Petito CK. Department of Pathology (Neuropathology), New York Hospital, NY 10021. Two patients with varicella-zoster virus leukoencephalitis and acquired immunodeficiency syndrome are described. Neither patient had cutaneous or disseminated varicella-zoster virus infection within the last six months of life. Demyelinated lesions resembling those of progressive multifocal leukoencephalopathy were seen in their brains at autopsy. Numerous cells with Cowdry type A intranuclear inclusions surrounded the lesions; these cells stained positively for varicella-zoster virus with immunohistochemistry and contained herpesvirus nucleocapsids by electron microscopy. Leptomeningeal vessels accompanying the lesions displayed a zoster-induced vasculopathy in one of the two patients. Vascular and parenchymal central nervous system infections with varicella-zoster virus are rare in the absence of cutaneous lesions, and to our knowledge, the presence of both in one patient has not yet been described. PMID: 3337629 [PubMed - indexed for MEDLINE] 4506. J Infect Dis. 1988 Feb;157(2):314-8. Herpes zoster in African patients: a clinical predictor of human immunodeficiency virus infection. Colebunders R, Mann JM, Francis H, Bila K, Izaley L, Ilwaya M, Kakonde N, Quinn TC, Curran JW, Piot P. Project SIDA, Department of Public Health, Kinshasa, Zaire. A recent episode or a history of herpes zoster was found in 30 (11%) of 284 patients hospitalized with human immunodeficiency virus (HIV) infection at Mama Yemo Hospital, Kinshasa, Zaire. Of 146 African patients with a history of herpes zoster who were referred to us by physicians at the Mama Yemo Hospital, 133 (91%) were HIV seropositive. The clinical characteristics of the herpes zoster episodes did not differ between HIV-seropositive and -seronegative individuals, except that 23% of the HIV-seropositive patients experienced recurrences compared with none of the HIV-seronegative patients (P = .05). No patient developed a generalized herpes zoster eruption, and only patients with ophthalmic zoster developed related complications. Patients who experienced severe pain during their herpes zoster attack lost more weight than did those who had only minor pain (P = .0003). PMID: 3335810 [PubMed - indexed for MEDLINE] 4507. Bull Soc Ophtalmol Fr. 1988 Feb;88(2):189-92. [Efficacy of acyclovir by oral route in ophthalmic herpes zoster: preliminary study of 20 cases] [Article in French] Hoang-Xuan T, Thenault JC, Denis J, Thenault S, Frot P, Clay C, Pouliquen Y. PMID: 3265078 [PubMed - indexed for MEDLINE] 4508. Br J Clin Pract. 1988 Feb;42(2):79-82. Lower motor neurone paralysis due to herpes zoster. Bhattacharyya PK, Chakravorty NK. PMID: 3179177 [PubMed - indexed for MEDLINE] 4509. Arch Phys Med Rehabil. 1988 Feb;69(2):132-4. Herpes zoster: a consideration in the differential diagnosis of radiculopathy. Burkman KA, Gaines RW Jr, Kashani SR, Smith RD. Department of PM&R, Rusk Rehabilitation Center, Columbia, MO 65212. Herpes zoster probably occurs more often than generally thought. Since it produces a radicular distribution of pain, it should be included in the differential diagnosis of radiculopathy. A case is presented in which evaluating the radicular low back pain before the characteristic rash appears was misleading. Careful history-taking concerning the exact nature of the pain and sensory changes is needed to differentiate between zoster and radiculopathy, if no rash is evident. PMID: 2963601 [PubMed - indexed for MEDLINE] 4510. J Hosp Infect. 1988 Feb;11 Suppl A:90-5. Prevention of varicella by vaccination. Heath RB. Department of Virology, St. Bartholomew's Hospital, London, UK. PMID: 2896753 [PubMed - indexed for MEDLINE] 4511. J Hosp Infect. 1988 Feb;11 Suppl A:29-36. Herpes virus infections. Snoeck R, Griffiths PD. Virology Department, Royal Free Hospital, London, England. PMID: 2896721 [PubMed - indexed for MEDLINE] 4512. Pain. 1988 Feb;32(2):147-57. Factors influencing the duration of treatment of acute herpetic pain with sympathetic nerve block: importance of severity of herpes zoster assessed by the maximum antibody titers to varicella-zoster virus in otherwise healthy patients. Higa K, Dan K, Manabe H, Noda B. Department of Anesthesiology, School of Medicine, Fukuoka University, Japan. Antibody responses to varicella-zoster virus (VZV) were serially investigated by the complement-fixation test in 72 Japanese of both sexes, suffering from herpes zoster (HZ), but otherwise healthy. Our objective was to elucidate whether there were mutual relationships among severities of skin lesion, maximum antibody titers to VZV, and duration of treatment for acute herpetic pain (AHP). Patients were divided into 3 groups: mild group (n = 26), moderate group (n = 26) and severe group (n = 20), according to the severity of the skin lesions. The 3 groups did not differ significantly with respect to age (P greater than 0.6). All patients were treated with regional sympathetic nerve blocks (SNBs) until pain relief was achieved. The durations of treatment for AHP became significantly longer as HZ increased in severity; the mean log10 durations of treatment (+/- S.E.) for the mild, moderate, and severe groups were 1.383 +/- 0.037, 1.616 +/- 0.055, and 1.888 +/- 0.069 days, respectively (P less than 0.01 for the mild group vs. the moderate group, and P less than 0.001 for the moderate group vs. the severe group). Irrespective of age, the maximum antibody titers closely paralleled the severities of the skin lesion of HZ; the mean maximum log2 antibody titers (+/- S.E.) for the mild, moderate, and severe groups were 5.12 +/- 0.24, 6.73 +/- 0.20, and 8.00 +/- 0.18, respectively (P less than 0.001 for the mild group vs. the moderate group and for the moderate group vs. the severe group).(ABSTRACT TRUNCATED AT 250 WORDS) PMID: 2834685 [PubMed - indexed for MEDLINE] 4513. J Cutan Pathol. 1988 Feb;15(1):49-52. Linear IgA deposition associated with cutaneous varicella-zoster infection: a case report. Blickenstaff RD, Perry HO, Peters MS. Department of Dermatology, Mayo Clinic, Rochester, MN 55905. The homogeneous linear deposition of IgA along the basement membrane zone of uninvolved skin is a distinguishing feature of linear IgA dermatosis in adults and chronic bullous dermatosis of childhood. Although linear IgA deposition may be seen in other cutaneous diseases, to our knowledge, there are no previous reports of a direct association with cutaneous infection. We describe the finding of intense fluorescence, in a linear pattern, of IgA at the basement membrane zone in an elderly man with disseminated cutaneous varicella-zoster infection. PMID: 2832459 [PubMed - indexed for MEDLINE] 4514. W V Med J. 1988 Feb;84(2):18-21. Varicella zoster virus infections. Neely JL. PMID: 2830722 [PubMed - indexed for MEDLINE] 4515. Ann Intern Med. 1988 Feb;108(2):221-37. NIH conference. Varicella-zoster virus infections. Biology, natural history, treatment, and prevention. Straus SE, Ostrove JM, Inchauspé G, Felser JM, Freifeld A, Croen KD, Sawyer MH. National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland. Erratum in: Ann Intern Med 1988 Sep 1;109(5):438-9. During the last 10 years, there have been major advances in the understanding of varicella-zoster virus and the diseases it causes. The molecular biology of the virus is being unraveled with the aid of new molecular technologies. Varicella, usually a benign manifestation of primary infection, and zoster, a result of reactivation of latent virus, can cause considerable morbidity in patients with immune impairment. Antiviral drugs, especially acyclovir, ameliorate severe infections but still have little role in the treatment of most normal patients with varicella or zoster. Varicella can be prevented when necessary by patient isolation and passive prophylaxis with varicella-zoster immune globulin. An experimental live vaccine also prevents varicella, but problems regarding its virulence for immunosuppressed patients and the durability of the protective response are still being addressed. PMID: 2829675 [PubMed - indexed for MEDLINE] 4516. J Infect Dis. 1988 Feb;157(2):392-3. Restriction endonuclease analysis of viral DNA from a patient with bilateral herpes zoster lesions. Takayama M, Takayama N, Hachimori K, Minamitani M. PMID: 2826618 [PubMed - indexed for MEDLINE] 4517. Br Med J (Clin Res Ed). 1988 Jan 23;296(6617):257-61. ABC of dermatology. Viral infections. Buxton PK. Royal Infirmary, Edinburgh. PMCID: PMC2544820 PMID: 2829988 [PubMed - indexed for MEDLINE] 4518. Orv Hetil. 1988 Jan 17;129(3):111-7. [The significance of varicella zoster infections today] [Article in Hungarian] Nyerges G. Erratum in: Orv Hetil 1988 Jun 19;129(25):1343. PMID: 3281090 [PubMed - indexed for MEDLINE] 4519. Klin Wochenschr. 1988 Jan 4;66(1):21-5. Chronic HIV encephalitis--I. Cerebrospinal fluid diagnosis. Lüer W, Poser S, Weber T, Jürgens S, Eichenlaub D, Pohle HD, Felgenhauer K. Neurologische Klinik und Poliklinik, Universität Göttingen. To establish a reliable procedure for the early detection of central nervous system involvement in HIV infection, paired cerebrospinal fluid and serum samples of 59 patients were analysed. Fifteen were HIV antibody positive without clinical symptoms (stage I), 12 had lymphadenopathy syndrome or AIDS-related complex (stage II), and 32 had AIDS (stage III). Intrathecal synthesis of HIV antibodies was determined by a modified ELISA. Antibodies in CSF and serum were evaluated at identical immunoglobulin G levels to correct for the actual blood-CSF-barrier permeability. A CSF/serum quotient above 1.5 is indicative of intrathecal antibody synthesis, which was found in 47% of the patients in stage I, 67% in stage II, and 84% in stage III. These findings indicate an early and frequent invasion of the CNS. PMID: 2830432 [PubMed - indexed for MEDLINE] 4520. Scand J Infect Dis. 1988;20(3):277-82. Herpes zoster in African patients: an early manifestation of HIV infection. Van de Perre P, Bakkers E, Batungwanayo J, Kestelyn P, Lepage P, Nzaramba D, Bogaerts J, Serufilira A, Rouvroy D, Uwimana A, et al. AIDS project, Belgian-Rwandese Medical Cooperation, Kigali, Rwanda. During a 3-month period, 131 cases of herpes zoster were diagnosed in Kigali, Rwanda. There were 46 female and 85 male patients. Mean age was 29 years (range 1-66). An unusually high proportion of patients presented with cranial and sacral nerve localisation of their cutaneous lesions. 55/131 patients (42%) had involvement of more than one dermatome. None of the patients had an underlying condition known to favour herpes zoster. 120/131 (92%) had antibodies to HIV detected by an immunoenzymatic assay (EIA) and indirect immunofluorescence. 92/125 adult patients (74%) had no sign or symptom related to HIV infection other than herpes zoster. This study suggests that herpes zoster in Central Africa is an early and readily detectable manifestation of HIV-induced immunosuppression. PMID: 3406666 [PubMed - indexed for MEDLINE] 4521. Appl Neurophysiol. 1988;51(2-5):164-9. Dorsal root entry zone lesions in the treatment of pain following brachial plexus avulsion, spinal cord injury and herpes zoster. Friedman AH, Bullitt E. Department of Surgery, Duke University Medical Center, Durham, N.C. This paper details the long-term results in patients treated with dorsal root entry zone (DREZ) lesions for the treatment of pain following brachial plexus avulsion, spinal cord injury, and herpes zoster. With our current operative technique, 82% of patients with brachial plexus avulsion injuries were afforded long-term pain relief. Patients with pain confined to dermatomes just below the level of spinal injury also did well with DREZ lesions, although the results were less good in patients with diffuse pain or with sacral pain. The postoperative results in patients with postherpetic pain were disappointing. PMID: 3389792 [PubMed - indexed for MEDLINE] 4522. Virologie. 1988 Jan-Mar;39(1):21-4. [Treatment of cutaneous herpes and herpes zoster with Nivcrisol-D] [Article in French] Giurcăneanu F, Crişan I, Eşanu V, Cioca V, Cajal N. Hôpital Colentina, Service de Dermatologie, Bucarest, Roumanie. The results obtained at the Dermatological service of the Colentina Hospital show that the product NIVCRISOL-D, containing propolis, has a significant therapeutical effect against recurrent herpes and zona zoster. PMID: 3376426 [PubMed - indexed for MEDLINE] 4523. Hematol Oncol. 1988 Jan-Mar;6(1):57-63. Experience with the Portacath. Lambert ME, Chadwick GA, McMahon A, Scarffe JH. Department of Medical Oncology, Christie Hospital, Manchester, U.K. Fifty Portacaths have been inserted in patients undergoing prolonged outpatient chemotherapy, most for haematological disease. Twenty-one are still working at a median duration of 12 months (range 1-27) and a further 15 were functioning normally at the time of the patients death (median survival 6 months). Four functioning Portacaths have been removed, three suspected of causing septicaemia and one believed erroneously to have occluded. Ten have ceased to function and nine of these have been removed. The causes of these failures are nearly all avoidable and are discussed in detail; many occurred early in our experience. With careful attention to detail and with management by trained and interested staff, the Portacath is a safe and reliable device for intermittent vascular access. PMID: 3343028 [PubMed - indexed for MEDLINE] 4524. J Am Acad Dermatol. 1988 Jan;18(1 Pt 2):232-4. Comments on vaccines, August 1987. Wheeler CE Jr. Department of Dermatology, University of North Carolina School of Medicine, North Carolina Memorial Hospital, Chapel Hill 27514. Because of latency and infectious recurrences, eradication of herpes simplex and herpes zoster from the world by vaccines is likely to be much more difficult to accomplish than eradication of smallpox. For some time we may have to settle for control of these diseases rather than their eradication. The live, attenuated varicella vaccine protects immunocompromised and normal persons against clinical chickenpox but it does not completely prevent subsequent infection with natural chickenpox virus or latency. With herpes simplex vaccines we may have to be satisfied with amelioration or control of clinical infections and diminution of latency and recurrent disease. Varicella zoster immune globulin plays a useful role in attenuation of varicella in immunocompromised or special-risk persons exposed to varicella zoster virus. Passive immunization for herpes simplex (herpes simplex immune globulin or other antibody preparations) has been studied very little. Maybe passive immunization will have a place in future therapies, especially for serious herpes simplex virus infections in immunocompromised hosts. PMID: 3339145 [PubMed - indexed for MEDLINE] 4525. J Am Acad Dermatol. 1988 Jan;18(1 Pt 2):204-6. Antiviral treatment in chickenpox and herpes zoster. Huff JC. Department of Dermatology, University of Colorado Health Sciences Center, Denver 80262. Intravenous acyclovir is effective for varicella in adults and immunocompromised children, causing more rapid resolution of the illness and fewer complications. Intravenous acyclovir in immunocompromised patients with herpes zoster decreases new lesion formation, decreases acute pain, halts dissemination of the virus, and lessens visceral complications. Intravenous acyclovir may also be effective in zoster encephalitis. Intravenous vidarabine also has a favorable affect on chickenpox and herpes zoster. Topical acyclovir may benefit herpes zoster in immunosuppressed patients by accelerating cutaneous healing. Oral acyclovir appears to be effective in varicella and zoster in immunocompromised patients. It is also effective in otherwise normal patients, but its effect seems less dramatic and the drug must be given early. Neither acyclovir nor vidarabine has been proven clearly to prevent postherpetic neuralgia. Because varicella zoster virus is less sensitive to acyclovir than is herpes simplex, intravenous doses of 500 mg/m2 or 10 mg/kg every 8 hours or oral doses of 800 mg five times a day are recommended. At these doses adequate hydration and urine flow must be maintained, the mental status of the patient must be monitored, and impaired renal function requires regulation of dosage downward. PMID: 3339143 [PubMed - indexed for MEDLINE] 4526. J Am Acad Dermatol. 1988 Jan;18(1 Pt 2):186-8. Prophylactic and suppressive treatment with acyclovir and the management of herpes in patients with acquired immunodeficiency syndrome. Conant MA. Department of Dermatology, University of California, San Francisco 94117. During 1 year of continuous suppressive therapy for frequent recurrent genital herpes, about 44% of patients taking 400 mg acyclovir twice a day had no recurrences and 4% of patients taking placebo had no recurrences (i.e., fewer patients taking acyclovir had recurrences, and when they did there were fewer recurrences). Toxicity of continuous suppressive acyclovir treatment appears to be minimal, and viral resistance developing to the drug during use of suppressive therapy has not been a problem, although it does occur. Patients with acquired immunodeficiency syndrome with recurrent herpes may be given 400 mg acyclovir five times a day for 5 days or until the eruption clears and then 400 mg three times a day for 1 or 2 months followed by 400 mg twice a day thereafter. Herpes zoster of immunocompromised patients, including patients with acquired immunodeficiency syndrome, may be treated with 800 mg oral acyclovir five or six times a day for 5 to 10 days depending on the response, and they may derive additional benefit from concomitant topical acyclovir. PMID: 3339140 [PubMed - indexed for MEDLINE] 4527. J Am Acad Dermatol. 1988 Jan;18(1 Pt 2):161-238. Antiviral drugs and vaccines for herpes simplex and herpes zoster. Proceedings of a symposium. American Academy of Dermatology forty-fourth annual meeting. December 11, 1985, Las Vegas, NV. [No authors listed] PMID: 3339137 [PubMed - indexed for MEDLINE] 4528. Ann Intern Med. 1988 Jan;108(1):154-5. Thrombotic thrombocytopenic purpura and herpes zoster infection. Satoh K, Takahashi H, Nagai K, Shibata A. PMID: 3337505 [PubMed - indexed for MEDLINE] 4529. Pharmacotherapy. 1988;8(1):52-68. Human infection with herpes zoster: etiology, pathophysiology, diagnosis, clinical course, and treatment. Strommen GL, Pucino F, Tight RR, Beck CL. Department of Pharmacy Practice, College of Pharmacy, North Dakota State University, Fargo 58105. Herpes zoster is a cutaneous vesicular eruption resulting from recrudescence of the chickenpox virus. It is mainly a disease of adults, with a predisposition for the elderly or immunocompromised. Although usually localized, the disease can disseminate to visceral organs. Diagnosis is often made based on the characteristic pattern of the lesion and clinical features. Tzanck smear, viral isolation, seroconversion, antibody titers, and monoclonal antibodies may further aid or confirm the diagnosis. Clinical features of herpes zoster may follow a progression through 3 stages, prodromal, acute, and chronic. The prodromal and acute phases seldom require more than symptomatic management. The chronic pain syndrome, postherpetic neuralgia (PHN), demands a more aggressive approach. Pharmacologic intervention, neuroaugmentation, and/or surgery may prevent or alleviate PHN, but universal response to any of these therapeutic approaches is unlikely. Tricyclic antidepressants remain the first choice in treating this pain syndrome. A trial of antiviral therapy may be warranted in patients with disseminated disease or in immunocompromised patients with localized disease. Of the antiviral agents, acyclovir is considered the drug of choice by most clinicians. PMID: 3287356 [PubMed - indexed for MEDLINE] 4530. Int Ophthalmol Clin. 1988 Spring;28(1):5-13. Indications for corneal transplant surgery. Stanley JA. Department of Ophthalmology, University of California, San Francisco. PMID: 3279006 [PubMed - indexed for MEDLINE] 4531. Am J Dis Child. 1988 Jan;142(1):71-2. Herpes zoster in children with acute lymphocytic leukemia. Novelli VM, Brunell PA, Geiser CF, Narkewicz S, Frierson L. Department of Pediatrics, University of Texas Health Science Center, San Antonio. Herpes zoster (HZ) occurred in 25% (28/88) of a population of children with acute lymphocytic leukemia (ALL) who were seropositive for varicella zoster virus antibody before its onset; 16.5% (33/199) of the total group of children with ALL developed HZ. There were no deaths and only one significant complication, cutaneous disseminated disease, as a result of HZ. The small number of patients studied may have accounted for the failure to find a significant association between the occurrence of HZ and the type of ALL or chemotherapy protocol employed. Although HZ seemed to be more common in those patients who experience relapses of their leukemia, it did not portend a poor outcome for ALL. PMID: 3277389 [PubMed - indexed for MEDLINE] 4532. Clin Exp Neurol. 1988;25:71-84. Effects of topical capsaicin on normal skin and affected dermatomes in herpes zoster. Westerman RA, Roberts RG, Kotzmann RR, Westerman DA, Delaney C, Widdop RE, Carter BE. Department of Physiology, Monash University, Clayton, Vic. Hyperalgesia and allodynia, lasting for months or even years, occurs in the form of post-herpetic neuralgia in approximately 70% of adults previously infected with the varicella herpes zoster virus. The present study aimed at testing the analgesic desensitising actions and reversibility of repeated application of topical capsaicin on disordered polymodal nociceptors and peptidergic sensory fibres mediating warm and pain sensation. Cutaneous nociceptor desensitisation was measured using the Glasgow automated thermal threshold test (Medelec TTT). For normal subjects (n = 69) the mean forearm warm threshold was 0.15 +/- 0.07 degrees C and the cold threshold was 0.14 +/- 0.10 degrees C. A variable degree of partial desensitisation of herpes-affected skin was found in 15 patients with post-herpetic neuralgia before capsaicin treatment where the mean threshold elevation for warm detection was 1.19 degrees C and 0.7 degrees C for cold detection, compared with the corresponding normal skin. In preliminary studies of 15 patients with post-herpetic neuralgia, good pain relief averaging 30% or 77% occurred in the affected dermatome(s) after 3 to 4 weeks of 0.01% or 0.05% capsaicin cream respectively, applied 3-4 times daily. The warm thresholds, after chronic capsaicin treatment, increased between 0.1 and 7.60 degrees C, the average elevation being 3.69 degrees C. By contrast cold thresholds after capsaicin altered inconsistently and by only an average of 0.08 degrees C. The results suggest that elevation of the warm threshold may indicate the desensitisation achieved by capsaicin treatment of skin polymodal nociceptors. Cold detection, being dependent upon A-delta cold fibre function, is unaffected by capsaicin treatment. There was a poor correlation between pain relief and elevation of warm detection in response to capsaicin treatment. Generally, it was found that those patients with less initial desensitisation to warm detection as a consequence of post-herpetic neuralgia experienced better pain relief after capsaicin was applied. The method used permits determination of the minimum effective desensitising dose of capsaicin, enables patient compliance and progress to be monitored and should allow the prediction of patients likely to achieve the best response to treatment. PMID: 3267488 [PubMed - indexed for MEDLINE] 4533. Ophthalmologica. 1988;196(4):185-7. Herpes zoster ophthalmicus complicated by hyphema and hemorrhagic glaucoma. Hayasaka S, Watanabe M, Yamamoto Y, Noda S, Sekimoto M, Setogawa T. Department of Ophthalmology, Shimane Medical University, Izumo, Japan. We treated two patients with herpes zoster ophthalmicus in whom hyphema and hemorrhagic glaucoma occurred. Case 1 complained of facial skin eruption, and was given intravenous acyclovir for 7 days. Hyphema and high intraocular pressure occurred in the left eye 10 days after the onset of the skin eruption. Case 2 had severe pain and blisters on her face, and was given intravenous acyclovir for 7 days. An intracameral hemorrhage and glaucoma developed in the right eye 15 days after the onset of the skin lesion. Intravenous acyclovir may be necessary for longer than 7-day periods if the iridocyclitis remains. PMID: 3262845 [PubMed - indexed for MEDLINE] 4534. Dermatol Monatsschr. 1988;174(8):466-71. [Alternative treatment possibilities of herpetic diseases with low frequency electric currents] [Article in German] Rathkolb O, Ammer K, Hein B, Hein L. PMID: 3262541 [PubMed - indexed for MEDLINE] 4535. Jpn J Ophthalmol. 1988;32(1):64-9. Endogenous uveitis in Chinese--an analysis of 240 cases in a uveitis clinic. Chung YM, Yeh TS, Liu JH. Department of Ophthalmology, National Yang-Ming Medical College, Taipei, Taiwan, Republic of China. A review of 240 consecutive Chinese patients with endogenous uveitis seen over a 3-year period was made in Taiwan. The frequency of major types of uveitis was 110 cases (45.8%) of acute anterior uveitis, 43 cases (17.9%) of Behçet's disease, 22 cases (9.2%) of Harada's disease, 10 cases (4.2%) of peripheral uveitis, 6 cases (2.5%) of virus-induced uveitis and 5 cases (2.1%) of Fuchs' heterochromic cyclitis. Only 1 case (0.4%) of sarcoidosis was found. Of the 110 cases of acute anterior uveitis, 80.9% presented with HLA-B27 antigen. The incidences of types of endogenous uveitis in Chinese differ from those in Caucasians, Japanese and Negro races in the USA. PMID: 3261815 [PubMed - indexed for MEDLINE] 4536. Zh Nevropatol Psikhiatr Im S S Korsakova. 1988;88(2):33-5. [Ocular herpes zoster with contralateral hemiplegia] [Article in Russian] Mikhaĭlenko AA, Osetrov BA. A total of 375 patients with neurologic syndromes of herpes zoster were studied. Ten of them presented, along with the involvement of the first branch of the trigeminal nerve and other cranial nerves, contralateral pyramidal symptomatology. Apart from the typical syndrome of herpes zoster ophthalmicus with contralateral hemiplegia the authors distinguished clinical variants in which contralateral pyramidal symptomatology was associated with acute meningoencephalitis. PMID: 3259770 [PubMed - indexed for MEDLINE] 4537. Nervenarzt. 1988 Jan;59(1):45-7. [Multiple brain infarcts in zoster infection] [Article in German] Karenberg A, Schädlich HJ, Karbe H, Neveling M, Thun F. Universitäts-Nervenklinik, Universität zu Köln. The clinical, CSF, CCT and PET findings in a 14-year-old female patient are reported. CCT and PET investigations demonstrated multiple cerebral infarctions; CSF examinations revealed inflammatory changes. Zoster antibodies were synthesized intrathecally, as detected by an ELISA after adjusting serum and CSF to identical IgG concentrations. Therefore the diagnosis of a cerebral zoster angiitis was made. Diagnostic and therapeutic problems of inflammatory vascular lesions are discussed. PMID: 3258411 [PubMed - indexed for MEDLINE] 4538. Cornea. 1988;7(1):50-6. Corneal complications of herpes zoster ophthalmicus. Prevention and treatment. Cobo LM. Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina 27710. Corneal complications of herpes zoster ophthalmicus include pseudodendritic keratitis, late mucous adherent keratopathy, varied forms of stromal keratitis, and exposure/neurotrophic keratopathy. Prophylactic therapy of acute herpes zoster ophthalmicus with oral acyclovir is of proven benefit in reducing the incidence of early pseudodendritic keratopathy and stromal keratitis but has no evident effect on exposure/neurotrophic keratopathy. Although early pseudodendritic keratitis is due to virus infection of epithelial cells, it is self-limited and does not require topical antiviral therapy. Stromal keratitis and associated epithelial mucous adherent keratopathy are responsive to topical corticosteroids but chronic therapy is often required and may prolong the duration of keratitis and result in cataract or secondary glaucoma. Exposure and neurotrophic keratopathy may respond to topical lubricants and correction of lid abnormalities but severely affected corneas may require tarsorrhaphy or conjunctival flap to maintain corneal integrity. PMID: 3258220 [PubMed - indexed for MEDLINE] 4539. Aust Fam Physician. 1988 Jan;17(1):38. Alive, well and not to be forgotten. Colquhoun JP. PMID: 3257869 [PubMed - indexed for MEDLINE] 4540. Ann Dermatol Venereol. 1988;115(11):1205-7. [Sinus histiocytosis with cutaneous lesions and thoracic herpes zoster] [Article in French] Delisle B, Gilbert M. Service de Dermatologie, Hôpital Saint-François d'Assise, Québec, PQ, Canada. PMID: 3239916 [PubMed - indexed for MEDLINE] 4541. Scand J Infect Dis. 1988;20(6):583-92. Herpes zoster associated encephalitis: clinical findings and acyclovir treatment. Peterslund NA. Department of Medicine and Infectious Diseases, Marselisborg Hospital, Aarhus, Denmark. The clinical course of herpes zoster associated encephalitis (HZAE) with special emphasis on the treatment with acyclovir is described from the experience in 14 own patients and 47 review cases. Immunosuppression and dissemination involved increased risk of HZAE, whereas cranial zoster implied no or only a slightly increased risk. The symptoms were mainly disturbances of mental function and ataxia. Nuchal rigidity was noted in approximately one third of cases. The median duration from dermatomal lesion to HZAE was 15 days in immunosuppressed patients versus 5 days in non-immunosuppressed patients. Abnormal spinal fluid findings included mononuclear pleocytosis, occasionally with low glucose concentration. Protein was elevated in half of the patients. Serum sodium levels were often low. Brain CAT scans were generally normal and EEGs always abnormal. Recurrence of HZAE was noted in 2 patients. Treatment with acyclovir seemed to have a beneficial effect. The results, however, need cautious interpretation due to the heterogenous patient material. Two patients developed signs of HZAE while on treatment with desciclovir but recovered during ongoing therapy. PMID: 3222675 [PubMed - indexed for MEDLINE] 4542. Acta Otolaryngol Suppl. 1988;446:81-4. Studies with electrocochleography and auditory brainstem response in Ramsay Hunt syndrome. Kusakari J, Takeyama M, Kawase T, Takahashi K, Sasaki Y, Takasaka T. Department of Otolaryngology, Tohoku University School of Medicine, Sendai, Japan. Eighteen cases of Ramsay Hunt syndrome were examined with electrocochleography and auditory brainstem response. Hearing was normal in 4 cases, while the other 14 exhibited sensorineural hearing loss ranging from mild to moderate in severity. Although the I-V interwave latency in all cases was within or slightly outside of the normal limits, the N1 latency was significantly prolonged in 8 cases proportionately to the degree of hearing loss at 4 and 8 kHz. The histopathological findings reported so far have indicated that the main lesion in this syndrome is in the internal auditory canal (2, 3, 4, 5). The results obtained in the present study, however, clearly show that the main site responsible for the hearing loss is not in the retrocochlear region, but in the cochlea. The possible mechanism of the cochlear involvement in this syndrome was discussed. PMID: 3166594 [PubMed - indexed for MEDLINE] 4543. Acta Otolaryngol Suppl. 1988;446:42-6. Electrodiagnostic findings in the early stages of Bell's palsy and Ramsay-Hunt's syndrome. Kanzaki J. Department of Otolaryngology, School of Medicine, Keio University, Tokyo, Japan. The incidence of denervation, as determined electrodiagnostically (nerve excitability test and electroneuronography), was analysed during the course of the disease in 150 patients with Bell's palsy and 45 with Ramsay-Hunt's syndrome. Of all 150 patients, 14.2% of those with Bell's palsy and 44% of the patients with Ramsay-Hunt syndrome either showed denervation at the time of the initial examination or developed denervation from neurapraxia within 3 weeks after the onset of paralysis. PMID: 3166587 [PubMed - indexed for MEDLINE] 4544. Acta Otolaryngol Suppl. 1988;446:111-3. Effects of Aciclovir in Ramsay Hunt syndrome. Inamura H, Aoyagi M, Tojima H, Koike Y. Department of Otolaryngology, Yamagata University School of Medicine, Japan. Nine patients with Ramsay Hunt syndrome were treated with Aciclovir and the effects of this treatment were observed for 6 months. The results were excellent in 5 cases, fair in 3, and poor in one case. Otalgia and auricular herpes was improved rapidly after the administration of Aciclovir. No severe side effect was observed in this study. PMID: 3166577 [PubMed - indexed for MEDLINE] 4545. Zhen Ci Yan Jiu. 1988;13(1):6-9, 5. Comments on the technique of the treatment of herpes zoster. [Article in Chinese, English] Serres G. PMID: 3143505 [PubMed - indexed for MEDLINE] 4546. Metab Pediatr Syst Ophthalmol. 1988;11(1-2):43-6. Ten years of experience with human fibroblast interferon in treatment of viral ophthalmic infections. Romano A, Sadan Y. Maurice and Gabriela Goldschleger Eye Institute, Chaim Sheba Medical Center, Tel-Hashomer, Israel. This review of ten years of experience presents the results of clinical use of human beta-interferon (Frone) in viral ocular disease. Two forms of human beta-interferon have been used: (a) Frone cream 20,000 IU/g (Inter-Yeda Ltd.) for local treatment and prevention of HSV-1 periocular skin lesions and for Herpes zoster ophthalmicus. (b) Frone eye drops (500,000-1,000,000 U) for prophylaxis and treatment of adenovirus infections and for prevention of recurrent HSV-1 keratitis. Our results show that Frone cream or drops, applied at an early stage, is: (a) Effective in significantly shortening the course of the disease; (b) Has a drying effect on herpetic skin lesions, and tear secretion in adeno viral disease; (c) Reduces the frequency from 1.2 to 0.04 attacks per year for patients with known biological rhythm of the disease; (d) Prevents subepithelial keratitis in 45% of the study population; (e) Prophylactic treatment of interferon in families reduces the incidence of contamination from 65% to 20%. PMID: 3076609 [PubMed - indexed for MEDLINE] 4547. Zh Nevropatol Psikhiatr Im S S Korsakova. 1988;88(8):51-6. [Encephalitis in the acute period of herpes zoster in children] [Article in Russian] Shishov AS. The data from the author's files and literature are reviewed with respect to the occurrence, clinical characteristics and treatment of encephalitis in children with herpes zoster. A differential-diagnostic table is designed to present the clinical features of this form of encephalitis in different age groups and infantile encephalitis in chickenpox and herpes simplex. PMID: 3057782 [PubMed - indexed for MEDLINE] 4548. AIDS. 1988;2 Suppl 1:S191-3. Treatment of opportunistic viral infections. Crumpacker CS. Division of Infectious Diseases, Beth Israel Hospital, Boston, MA. PMID: 2852503 [PubMed - indexed for MEDLINE] 4549. Acta Otolaryngol Suppl. 1988;456:49-54. Acute profound deafness in Ramsay Hunt syndrome. Two case reports. Hiraide F, Kakoi H, Miyoshi S, Morita M. Department of Otolaryngology, School of Medicine, Jichi Medical School, Tochigi, Japan. Two patients with sudden progressive profound hearing loss resulting from Ramsay Hunt syndrome are reported. Case 1: A 63-year-old woman was admitted to Jichi Medical School Hospital with sudden, progressing deafness of the left ear, vertigo, sore throat, and hoarseness. An otoscopic examination revealed the external ear and the tympanic membrane to be normal. Pure-tone audiometry revealed profound deafness in the left ear. A horizontal nystagmus in the non-affected direction was observed by gaze nystagmus test. An endoscopic examination revealed herpetic vesicles and shallow ulcers on the left side of the pharynx and the larynx. There was complete paralysis of the left recurrent nerve. Hearing acuity of the left ear did not recover at all with steroid hormone therapy. Case 2: A 75-year-old man was referred to the ENT Clinic by a dermatologist for hearing evaluation in Ramsay Hunt syndrome. The man had noticed severe otalgia and sudden progressive deafness of the right ear approximately 2 weeks prior to admission. Physical examination revealed herpetic vesicles and ulcers in the right external ear and lateral neck. Complete paralysis of the right facial nerve was noted. Profound hearing loss in the affected ear was observed by pure-tone audiometry. A gaze nystagmus test revealed a horizontal nystagmus in the non-affected direction. No recovery of the cochlear function was noted following administration of antiviral drug. The pertinent literature is briefly reviewed. PMID: 2852431 [PubMed - indexed for MEDLINE] 4550. Gerontology. 1988;34(5-6):242-9. Detection of antibodies to varicella-zoster virus proteins in sera from the elderly. Vafai A, Mahalingam R, Zerbe G, Wellish M, Gilden DH. Department of Neurology, University of Colorado School of Medicine, Denver. Sera from 40 elderly individuals ranging in age from 60 to 94 years were tested for the presence of antibodies to varicella-zoster virus (VZV)-specific proteins. Sodium dodecylsulfate polyacrylamide gel electrophoresis analysis of lysates of VZV-infected BSC-1 cells labeled with either [35S]methionine or [3H]mannose and immunoprecipitated with human sera revealed the variable presence of VZV-specific antibodies to four VZV glycoproteins (gpI, gpII, gpIII, and gpIV), and three nonglycosylated proteins (155, 140, 32 kilodaltons, kDa). The predominant antibody response in the sera from the elderly was to VZV gpII and the 155-kDa species. In addition, some sera from elderly individuals without an identifiable history of varicella or zoster contained antibodies to VZV proteins, suggesting a possible subclinical infection in these patients. Finally a history of zoster in the elderly was significantly correlated (p = 0.02) with the presence of antibody to gpIV. PMID: 2851500 [PubMed - indexed for MEDLINE] 4551. Arch Otorhinolaryngol. 1988;245(4):230-3. Serology in facial paralysis caused by clinically presumed herpes zoster infection. Njoo FL, Wertheim-van Dillen P, Devriese PP. Faculty of Medicine, University of Amsterdam, The Netherlands. In some cases of peripheral facial palsy due to a clinically suspected varicella zoster virus (VZV) infection, the clinical diagnosis is not supported by serological tests. In a retrospective study, we examined the sera from 63 patients with clinical findings compatible with VZV infection: 57 had paired sera and 6 had single sera. In the paired-sera group, 18 cases were serologically negative initially by complement fixation (CF), while 9 of these cases were actually positive for VZV when CF was combined with ELISA. Moreover, evidence for a recent mumps virus infection was found in 6 patients and 1 patient was diagnosed as having recent mumps and cytomegalo-virus (CMV) infections. In the 6 single sera studied, the ELISA was suggestive of a recent infection with VZV (4 cases) and CMV (1 case). PMID: 2845904 [PubMed - indexed for MEDLINE] 4552. Acta Otolaryngol Suppl. 1988;446:23-6. Viral infection in acute peripheral facial palsy. Investigation in Yamagata Prefecture. Inamura H, Aoyagi M, Tojima H, Koike Y. Department of Otolaryngology, Yamagata University School of Medicine, Japan. We studied viral involvement in Bell's palsy and Ramsay Hunt syndrome. In the CF test, viral infection was confirmed in 2 of 84 patients. Of the 12 patients with Ramsay Hunt syndrome, 5 showed a significantly high titre for varicella zoster and one for rubella. The ELISA test, performed in 60 patients with Bell's palsy, revealed significantly high titres for varicella zoster in 5 patients and for herpes simplex in 4 patients. All 5 patients with Ramsay Hunt syndrome showed significantly high titres for varicella zoster. The ELISA test showed a higher sensitivity than the CF test. The incidence of viral infection in the present study was lower than that in similar investigations. Possible reasons for this are epidemicity or regional differences year from year. PMID: 2844058 [PubMed - indexed for MEDLINE] 4553. Acta Otolaryngol Suppl. 1988;446:17-22. Viral infections in acute peripheral facial paralysis. Nationwide analysis centering on CF. Kukimoto N, Ikeda M, Yamada K, Tanaka M, Tsurumachi M, Tomita H. Department of Otorhinolaryngology, Nihon University School of Medicine, Tokyo, Japan. The degree of participation and regional specificity of virus infection in relation to atraumatic acute peripheral facial palsy was studied, placing particular emphasis on change in the CF titre of varicella zoster virus (VZV), herpes simplex virus (HSV) and adenovirus (adeno). The subjects of the study were 91 patients with Hunt's syndrome and 396 patients with Bell's palsy treated at 17 institutions all over Japan in the period between April 1985 and November 1986. Among the cases of Hunt's syndrome, the positive conversion rate of CF antibody titre of VZV was 81%. In Bell's palsy cases, virus participation was detectable in 8% with VZV, 4% with HSV and 4% with adeno. With regard to the age distribution, Bell's palsy cases with possible virus involvement tended to be observed in younger patients than those without that possibility. As to regional specificity, the incidence of Bell's palsy with possible virus involvement tended to be higher in densely populated areas. With regard to the main cause of acute peripheral facial palsy, virus infection has been implicated, as well as insufficient blood circulation (ischemia). Even in cases of acute peripheral facial palsy, in which herpes zoster oticus is not observed, the participation of varicella zoster virus (VZV) as a cause of paralysis has been pointed out in some cases (zoster sine herpete). Furthermore, it is known that the serum antibody titres of various viruses such as herpes simplex virus (HSV) change significantly in some cases of Bell's palsy (2, 5-13).(ABSTRACT TRUNCATED AT 250 WORDS) PMID: 2844057 [PubMed - indexed for MEDLINE] 4554. Acta Otolaryngol Suppl. 1988;446:10-6. An ELISA study on varicella-zoster virus infection in acute peripheral facial palsy. Tomita H, Tanaka M, Kukimoto N, Ikeda M. Department of Otorhinolaryngology, Nihon University School of Medicine, Tokyo, Japan. ELISA was applied to atraumatic acute peripheral facial palsy for the purpose of examining the usefulness of the method with respect to early diagnosis of varicella-zoster virus (VZV) infection. The material for this study consisted of 287 cases of Bell's palsy, 64 cases of Hunt's syndrome and 12 cases of zoster sine herpete diagnosed by the CF method, obtained from 16 institutions throughout Japan. In view of the results thus obtained, it was provided that cases of specific anti-VZV-IgG antibodies (anti-VZV-IgG) with a titre of 0.6 or more or specific anti-VZV-IgM antibodies (anti-VZV-IgM) with a titre of 0.2 or more were to be regarded as cases of VZV infection. By adopting ELISA, a diagnostic ratio of 94.3% in Hunt's syndrome was achieved. Moreover, possible cases of zoster sine herpete increased further by 28. Furthermore, most of the cases became diagnosable in the second week after onset of the facial palsy. It was therefore presumed that ELISA makes possible diagnosis in the comparatively early stages with only one testing, and that it is a more useful method than CF. PMID: 2844055 [PubMed - indexed for MEDLINE] 4555. Rev Med Suisse Romande. 1988 Jan;108(1):41-5. [Zona and post-zoster pain: therapeutic approach] [Article in French] Uldry PA, Regli F. PMID: 2450394 [PubMed - indexed for MEDLINE] 4556. J Am Acad Dermatol. 1988 Jan;18(1 Pt 2):218-21. New diagnostic tests for herpes simplex and varicella zoster infections. Solomon AR. Department of Dermatology, University of Texas Medical Branch, Galveston 77550. Laboratory tests for herpetic infections can be divided into (1) morphologic, (2) immunomorphologic, (3) serologic, and (4) virologic. Tzanck smears are easy to do, inexpensive, and compare favorably with cultures and immunofluorescence tests for specificity and sensitivity, but they require considerable experience to interpret accurately and they cannot differentiate between herpes type 1, herpes type 2, and varicella zoster infections. Biopsies are useful when clues to a diagnosis are being sought. Peroxidase-antiperoxidase and avidin-biotin tests present technical difficulties but interpretational difficulties are low and the results are available in a few hours. They can distinguish between herpes type 1, herpes type 2, and varicella zoster virus, as can immunofluorescence using monoclonal antibodies. Serologic tests are used primarily to distinguish between primary and recurrent herpes simplex infections. Virus isolation in tissue cultures is the gold standard for identifying herpes simplex virus but it is not 100% specific or 100% sensitive. Restriction endonuclease analysis identifies types and strains of virus by their deoxyribonucleic acid composition and it is very useful in epidemiologic studies. Ability to find virus by whatever method is influenced by the stage of the lesion. As lesions age, less infectivity and antigen result in less sensitivity of the tests. PMID: 2448353 [PubMed - indexed for MEDLINE] 4557. J Am Acad Dermatol. 1988 Jan;18(1 Pt 2):212-8. Promising new antiviral drugs. Bryson YJ. Department of Pediatrics, University of California, School of Medicine, Los Angeles 90024. We now have a basis for a more rational approach to rapid evaluation and development of antiviral drugs by screening for activity in vitro, testing for toxicity and efficacy in animals, and clinical testing in humans. Acyclovir is a prototype of this improved process. Interferon has a beneficial effect against CMV infection in renal transplant patients and has promising results in the treatment of papillomas and rhinovirus infections. It does not seem to be as effective against genital herpes or varicella zoster as acyclovir. Ribavirin is effective against respiratory syncytial virus infections and Lassa fever. Varicella-zoster virus is highly sensitive to bromovinyl deoxyuridine in vitro. Phosphonoformate is effective in herpes simplex in animals but of little clinical benefit topically in human recurrent A2 herpes. Zidovudine may decrease mortality rates and infectious complications in patients with acquired immunodeficiency syndrome. DHPG (9-(1,3-dihydroxy-2-propoxymethyl]guanine is useful in treatment of cytomegalovirus and infection in immunocompromised patients. The prodrug of acyclovir results in high blood levels of acyclovir and shows promise in the treatment of varicella-zoster infections. Many halogenated pyrimidine nucleoside analogs are being developed. Buciclovir is another acyclic guanosine analog effective against herpes simplex virus in vitro. 2'-nor-cyclic guanosine monophosphate has a broad antiviral spectrum of action. Interleukin-2 is being investigated. Combined therapies of two or more antiviral drugs or antiviral drugs and other treatments are being studied. PMID: 2448352 [PubMed - indexed for MEDLINE] 4558. Hosp Pract (Off Ed). 1987 Dec 15;22(12):33-5, 38, 40 passim. Eye pain: ocular and nonocular causes. Kohrman BD, Warfield CA. Harvard Medical School, Boston. PMID: 3119639 [PubMed - indexed for MEDLINE] 4559. Aichi Gakuin Daigaku Shigakkai Shi. 1987 Dec;25(4):513-9. [Two cases of herpes zoster in trigeminal nerve region] [Article in Japanese] Horii M, Takai Y, Suzuki A, Kinoshita Y, Tuji S, Yoshida K, Kakami K, Fukaya M. PMID: 3506803 [PubMed - indexed for MEDLINE] 4560. Postgrad Med J. 1987 Dec;63(746):1087-8. Guillain-Barré syndrome associated with herpes zoster. Hart IK, Kennedy PG. Department of Neurology, Southern General Hospital, Glasgow, UK. A case of Guillain-Barré syndrome following herpes zoster is described. This is a rare association and the possible pathogenesis is discussed. PMCID: PMC2428593 PMID: 3451236 [PubMed - indexed for MEDLINE] 4561. Zh Mikrobiol Epidemiol Immunobiol. 1987 Dec;(12):45-50. [Epidemiology of herpes zoster. The herpes zoster patient as a source of infection with chickenpox] [Article in Russian] Shishov AS, Smirnov IuK. The authors analyse the inpatient findings accumulated from 2,179 observations on herpes zoster cases for 10 years. The clinico-epidemiological characterization of herpes zoster patients as the potential source of chickenpox infection is presented. The clinical data speak for the droplet transfer of the agent (varicella zoster virus) in this infection, which has permitted the formulation of exact practical recommendations of quarantine and isolation measures in the focus of herpes zoster. PMID: 3445730 [PubMed - indexed for MEDLINE] 4562. Ann Ophthalmol. 1987 Dec;19(12):453-6, 460. Acute retrobulbar neuritis complicating herpes zoster ophthalmicus. Tunis SW, Tapert MJ. Department of Ophthalmology, Medical University of South Carolina, Charleston. Acute retrobulbar neuritis occurred 24 days after an episode of Herpes zoster ophthalmicus in an otherwise healthy, 19-year-old man. Profound visual loss with consecutive optic atrophy ensued. Neurologic evaluation was normal and supported the presumptive diagnosis of parainfectious Herpes zoster retrobulbar neuritis. PMID: 3322138 [PubMed - indexed for MEDLINE] 4563. Clin Lab Med. 1987 Dec;7(4):853-68. Treatment of varicella-zoster virus infections. Bean B, Englund JA. Department of Pathology, Michael Reese Hospital, Chicago, Illinois. Effective antiviral therapy is now available for many forms of infection due to varicella-zoster virus. Acyclovir is the most widely prescribed treatment, but the virus is not exquisitely sensitive to this drug, and others are under study. The goals of therapy differ among different kinds of patients and must be considered when designing a treatment program. PMID: 3319369 [PubMed - indexed for MEDLINE] 4564. Arch Ophthalmol. 1987 Dec;105(12):1656-9. Transcorneal extrusion of anterior chamber intraocular lenses. A report of three cases. McKnight GT, Richards SC, Apple DJ, Stanko ML, O'Morchoe DJ, Solomon KD. Department of Ophthalmology, University of Utah Health Sciences Center, Salt Lake City 84132. We examined three cases of transcorneal extrusion of anterior chamber intraocular lenses. In each case a preexisting condition (rheumatoid arthritis, glaucoma, and herpes zoster ophthalmicus, respectively) contributed to corneal necrosis and subsequent extrusion of the pseudophakos. The clinicopathologic correlations of this condition are discussed, as well as some causes of corneal decompensation associated with anterior chamber lenses. We emphasize the need for careful evaluation of patients who have preexisting disease before intraocular lens implantation. PMID: 3318770 [PubMed - indexed for MEDLINE] 4565. Ann Intern Med. 1987 Dec;107(6):859-74. Drugs five years later: acyclovir. Dorsky DI, Crumpacker CS. Department of Medicine, Beth Israel Hospital, Harvard Medical School, Boston, Massachusetts. In the 5 years since its release for clinical use, acyclovir (9-[2-hydroxyethoxymethyl]guanine) has proved to be a safe and effective agent for therapy of herpes simplex and varicella-zoster infections. The drug's availability in topical, oral, and intravenous preparations has allowed its use in a range of clinical situations. Acyclovir must be phosphorylated by viral thymidine kinase in infected cells, where it then acts to inhibit viral DNA replication specifically. Epstein-Barr virus and human cytomegalovirus infections do not seem to respond to acyclovir therapy, although in-vitro effects on these viruses may be seen. Acyclovir is well absorbed and distributed, with cerebrospinal fluid levels 50% that of plasma. Clearance is almost entirely by the renal route, with a half-life of 20 hours in the anuric patient. Acyclovir has an excellent safety profile, its major adverse effect being transient serum creatinine elevations during high-dose intravenous use. Major uses include treatment of primary and recurrent genital herpes and herpes encephalitis and prophyllaxis and therapy of mucocutaneous herpes and varicella-zoster infections in immunocompromised patients. Resistance to acyclovir in herpes simplex virus is rarely encountered and does not seem to be due to long-term chronic suppressive therapy. PMID: 3318610 [PubMed - indexed for MEDLINE] 4566. Uirusu. 1987 Dec;37(2):179-91. [Chemotherapy of varicella-zoster virus infection] [Article in Japanese] Shigeta S, Yokota T. PMID: 2833837 [PubMed - indexed for MEDLINE] 4567. Pol Tyg Lek. 1987 Nov 9;42(45):1429. [The course of encephalitis caused by varicella-zoster virus in patients treated with acyclovir] [Article in Polish] Caban J, Sykut L, Sznajder J. PMID: 3447107 [PubMed - indexed for MEDLINE] 4568. Ann Intern Med. 1987 Nov;107(5):783. Herpes zoster infection in a patient on methotrexate given prednisone to prevent post-herpetic neuralgia. Anderson DJ, Janoff EN. PMID: 3662298 [PubMed - indexed for MEDLINE] 4569. Br J Ophthalmol. 1987 Nov;71(11):806-9. Severe herpes zoster ophthalmicus in young African adults: a marker for HTLV-III seropositivity. Kestelyn P, Stevens AM, Bakkers E, Rouvroy D, Van de Perre P. Centre Hospitalier de Kigali, Rwanda. This report proves the relationship between herpes zoster ophthalmicus and seropositivity for HTLV-III in young and often apparently healthy African patients. The ophthalmologist should screen patients with herpes zoster ophthalmicus for antibodies against HTLV-III in areas where this virus is endemic or if the patient belongs to a known risk group. If the test is positive, the patient should be instructed about the infectious nature of his condition to prevent spread of this sexually transmitted disease. As the rate of corneal involvement and postherpetic neuralgia are very high in these patients, it would be worthwhile to ascertain whether routine use of acyclovir treatment in HTLV-III seropositive patients with herpes zoster has a beneficial effect on these complications. PMCID: PMC1041316 PMID: 3500743 [PubMed - indexed for MEDLINE] 4570. Br J Ophthalmol. 1987 Nov;71(11):805. Herpes zoster ophthalmicus and AIDS. [No authors listed] PMCID: PMC1041315 PMID: 3500742 [PubMed - indexed for MEDLINE] 4571. Gen Dent. 1987 Nov-Dec;35(6):464-5. Herpes zoster. Hager TS, Connor JP. PMID: 3481730 [PubMed - indexed for MEDLINE] 4572. CMAJ. 1987 Nov 1;137(9):788. Herpes zoster in psychogeriatric practice. Hontela S. PMCID: PMC1267343 PMID: 3442766 [PubMed - indexed for MEDLINE] 4573. J Antimicrob Chemother. 1987 Nov;20(5):743-51. Open study of 2-amino-9-(hydroxyethoxymethyl)-9H-purine (desciclovir) in the treatment of herpes zoster. Peterslund NA, Esmann V, Geil JP, Petersen CM, Mogensen CE. Department of Medicine and Infectious Diseases, Marselisborg Hospital, Aarhus, Denmark. An oral pro-drug of acyclovir, 2-amino-9-(2-hydroxyethoxymethyl)-9H-purine (desciclovir) was evaluated in an open study comprising of 20 patients with herpes zoster. The clinical effects were comparable to those obtained with oral and intravenous acyclovir, even with a dosage of only 125 mg thrice daily. There was adequate absorption though considerable individual variation occurred. No effects of concomitant food intake were demonstrated. The finding of possible impaired conversion of desciclovir to acyclovir in one patient was unexplained and deserves attention in future studies. Likewise, more studies are needed to understand the occurrence of transient high peak plasma concentrations of acyclovir. Side-effects other than those already known with the use of acyclovir, namely reversible tubular damage, were not observed. PMID: 3429375 [PubMed - indexed for MEDLINE] 4574. J Virol. 1987 Nov;61(11):3463-9. Varicella-zoster virus-specific cytotoxic T lymphocytes (Tc): detection and frequency analysis of HLA class I-restricted Tc in human peripheral blood. Hickling JK, Borysiewicz LK, Sissons JG. MRC Clinical Immunology Research Group, Royal Postgraduate Medical School, London, United Kingdom. The cytotoxic T-cell (Tc) response to varicella-zoster virus (VZV) is incompletely characterized. We investigated whether VZV-specific Tc restricted by class I products of the major histocompatibility complex can be generated from the peripheral blood of VZV-immune donors. Cell lines were established from peripheral blood lymphocytes (PBL) of seropositive donors by secondary in vitro restimulation. If cell-free VZV was used as the stimulating antigen, the resulting lines were predominantly CD4+ and did not show class I-restricted cytotoxicity; when autologous infected fibroblasts were used for in vitro stimulation, the resultant lines were usually cytotoxic, although in only 4 of 11 subjects tested was this cytotoxicity HLA restricted and virus specific. PBL were also tested for Tc activity without prior restimulation; VZV-specific Tc activity was only demonstrable in the PBL of a subject convalescent following zoster but not from subjects with recent varicella infection or from normal subjects. VZV-specific Tc precursor frequencies were then determined in six selected subjects by limiting-dilution analysis. A measurable frequency was detectable in four of the six seropositive subjects, ranging from 11/10(6) T cells in an asymptomatic carrier, to 63/10(6) T cells in a subject with recent zoster. We conclude that virus-specific major histocompatibility complex class I-restricted Tc precursors may be present in the peripheral blood of normal individuals seropositive for VZV but at a frequency lower than that for other herpesviruses with nonneuronal sites of latency. PMCID: PMC255943 PMID: 2822954 [PubMed - indexed for MEDLINE] 4575. Wiad Lek. 1987 Oct 15;40(20):1417-21. [Encephalitis in herpes zoster] [Article in Polish] Nicpoń K, Ochmański S, Slotała T. PMID: 3445628 [PubMed - indexed for MEDLINE] 4576. Br Med J (Clin Res Ed). 1987 Oct 10;295(6603):926-7. Acyclovir for shingles. Chase AO. PMCID: PMC1247968 PMID: 3119110 [PubMed - indexed for MEDLINE] 4577. Practitioner. 1987 Oct 8;231(1436):1336-40. Trial of ultrasonic therapy for acute herpes zoster. Jones RJ, Silman GM. PMID: 3505029 [PubMed - indexed for MEDLINE] 4578. Lancet. 1987 Oct 3;2(8562):800. Post-herpetic neuralgia. Cooper M. PMID: 2889015 [PubMed - indexed for MEDLINE] 4579. Am Fam Physician. 1987 Oct;36(4):233-5. Herpes zoster as a sign of AIDS-related complex. Wilkerson MG, Jordan WP, Kerkering TM. Medical College of Virginia, Richmond. Herpes zoster has recently been reported in young patients with risk factors for AIDS. In high-risk patients under age 55, herpes may be the first manifestation of AIDS or AIDS-related complex. Dissemination of zoster does not appear to be greatly increased in this group, but corticosteroid therapy should be withheld. PMID: 3673868 [PubMed - indexed for MEDLINE] 4580. Klin Med (Mosk). 1987 Oct;65(10):116-9. [Clinical differentiation of herpetic ganglioneuritis] [Article in Russian] Mikhaĭlenko AA. PMID: 3501503 [PubMed - indexed for MEDLINE] 4581. Br J Ophthalmol. 1987 Oct;71(10):725-8. Ophthalmic zoster: mucous plaque keratitis. Marsh RJ, Cooper M. Department of Clinical Ophthalmology, Moorfields Eye Hospital, London. Data taken from 1221 patients attending the Zoster Clinic of Moorfields Eye Hospital over the past 15 years were used to characterise the clinical appearance and behaviour of zoster mucous plaque keratitis (MPK). The typical greyish branching plaques are usually accompanied by a limbitis, stromal keratitis, or decrease in corneal sensation and are commonly associated with cataract, raised intraocular pressure, or corneal ulceration. MPK may begin at any time within two years of onset of the rash, but when it appears after three months there are more complications. Usually MPK settles within one month if appropriate treatment with topical steroids and acetylcysteine drops is given, but surgical intervention is sometimes required to control glaucoma or neuroparalytic keratitis or to remove cataracts. The results of surgery are surprisingly good. PMCID: PMC1041293 PMID: 3499932 [PubMed - indexed for MEDLINE] 4582. Ann Acad Med Singapore. 1987 Oct;16(4):631-5. Acyclovir in the treatment of herpes simplex virus infection. Cheong WK, Thirumoorthy T. Middle Road Hospital, Singapore. Acyclovir is a highly potent inhibitor of herpes simplex virus types 1 and 2 and varicella zoster virus, and has a remarkably low toxicity for normal host cells. It is now available as an ophthalmic ointment, skin cream and oral and intravenous formulations. Clinical trials in the past few years have shown acyclovir to be clinically useful in the therapy of certain aspects of genital herpes infection. Acyclovir has also been shown to be useful in herpes zoster, especially in immunocompromised patients. A retrospective study on the use of acyclovir was carried out on 14 patients with first episode genital herpes and 3 patients with eczema herpeticum. In patients with genital herpes, relief of symptoms was experienced within three days of treatment and lesions showed healing within five to seven days of treatment. Two out of the three patients with eczema herpeticum showed dramatic response to acyclovir; the lesions healed completely after six days of treatment. PMID: 3446004 [PubMed - indexed for MEDLINE] 4583. Klin Med (Mosk). 1987 Oct;65(10):119-21. [Hyperbaric oxygenation in the complex treatment of patients with herpes zoster] [Article in Russian] Shishov AS, Sibirev AA, Rudometov IuP, Smagulov KZ, Chekal' LV. PMID: 3431038 [PubMed - indexed for MEDLINE] 4584. Drug Intell Clin Pharm. 1987 Oct;21(10):803-5. Effect of cimetidine on herpes zoster infection. Bense L, Marcusson JA, Ramsten T. Department of Lung Medicine, Huddinge University Hospital, Sweden. Cimetidine was administered to two patients for herpes zoster infection. An acute pain-relieving effect was observed. The patients were followed for 11 and 14 months without developing postherpetic neuralgia. Possible mechanisms for prevention of postherpetic neuralgia by cimetidine are discussed. PMID: 3428139 [PubMed - indexed for MEDLINE] 4585. Br J Dermatol. 1987 Oct;117(4):495-501. Oral acyclovir for herpes zoster: a double-blind controlled trial in normal subjects. Wassilew SW, Reimlinger S, Nasemann T, Jones D. University of Hamburg, UKE Hautklinik, FRG. Sixty immunocompetent patients with herpes zoster of various dermatomes were treated 5 times a day for 5 days with either acyclovir at a dose of 400 mg or placebo. Acyclovir was shown to reduce significantly the time to full crusting (P = 0.02). There were also trends in favour of acyclovir for time to first dry vesicle and time to first day without macules or papules, but these were not statistically significant. There were no differences between the groups in the occurrence of adverse events or postherpetic neuralgia. PMID: 3314973 [PubMed - indexed for MEDLINE] 4586. J Virol. 1987 Oct;61(10):2951-5. Successful infection of the common marmoset (Callithrix jacchus) with human varicella-zoster virus. Provost PJ, Keller PM, Banker FS, Keech BJ, Klein HJ, Lowe RS, Morton DH, Phelps AH, McAleer WJ, Ellis RW. The common marmoset, Callithrix jacchus, can be infected with human varicella-zoster virus (VZV), both wild-type strain KMcC and attenuated vaccine strain Oka/Merck. Infection was accomplished with either whole-cell-associated or cell extract VZV by combined oral-nasal-conjunctival application and was characterized by substantial and persistent anti-VZV antibody responses. The infectivity of VZV for marmosets was destroyed by treatment of inocula with heat or UV light. Diluted inocula with as few as 40 PFU/ml were infectious for marmosets. The lungs were demonstrated to be a major site of viral replication; both the presence of viral antigens and signs of pneumonia were demonstrated in lung tissues. Four serial passages of VZV KMcC were carried out in C. jacchus by a process of in vitro isolation and culturing of VZV from infected lung tissue and reapplication of the cultured isolates to fresh animals. The isolated viruses were identified as VZV both serologically and by restriction endonuclease analyses. The C. jacchus infectivity model should prove useful for determining the efficacy of subunit and live recombinant VZV vaccines as well as for the study of zoster. PMCID: PMC255866 PMID: 3041014 [PubMed - indexed for MEDLINE] 4587. Minerva Med. 1987 Sep 30;78(18):1404-5. [Herpes zoster] [Article in Italian] Stagnaro-Neri M, Stagnaro S. Ospedale di Sestri Levante, Genova. PMID: 2821453 [PubMed - indexed for MEDLINE] 4588. Lancet. 1987 Sep 5;2(8558):576. Prednisolone does not prevent post-herpetic neuralgia. Finn R. PMID: 2887875 [PubMed - indexed for MEDLINE] 4589. Arch Esp Urol. 1987 Sep;40(7):480-4. [Urinary retention caused by herpes zoster. Urodynamic follow-up] [Article in Spanish] Broseta E, Martínez Agulló E, Domínguez C, Giménez Edo M, Jiménez Cruz JF. PMID: 3688992 [PubMed - indexed for MEDLINE] 4590. Rev Infect Dis. 1987 Sep-Oct;9(5):1020-5. Infectious disease rounds: headache, diminished mentation, and leg pain. [No authors listed] PMID: 3685758 [PubMed - indexed for MEDLINE] 4591. J Neurol Sci. 1987 Sep;80(2-3):343-9. The prevalence of locally-synthesized virus antibodies in various forms of multiple sclerosis. Schädlich HJ, Karbe H, Felgenhauer K. Neurologic University Clinic, Cologne, F.R.G. In 125 patients with multiple sclerosis, intrathecally synthesized antibodies against measles, rubella and zoster viruses were determined with an ELISA. 70% of patients with chronic progressive disease synthesized measles antibodies in comparison to 50% with a relapsing course. Women suffering from chronic progressive multiple sclerosis exhibited zoster antibodies 3 times as frequent as the other patients. These data indicate that relapsing and chronic progressive forms of multiple sclerosis exhibit different antiviral responses within the central nervous system which remain stable during the course of the disease. PMID: 3681338 [PubMed - indexed for MEDLINE] 4592. J Laryngol Otol. 1987 Sep;101(9):975-7. Superior orbital fissure syndrome in trigemino-facial zoster. Gupta D, Vishwakarma SK. A case of trigemino-facial zoster presenting as Superior Orbital Fissure Syndrome is reported. Geniculate ganglion involvement was limited to the vestibular branch of the cochleo-vestibular nerve, without any hearing impairment or facial palsy. This case clearly illustrates that herpes zoster cranialis is a polyneuropathy of multifocal asynchronous viral activity and can present in numerous forms. PMID: 3668384 [PubMed - indexed for MEDLINE] 4593. Int J Epidemiol. 1987 Sep;16(3):484-5. Herpes zoster and multiple sclerosis. De Keyser J. PMID: 3667053 [PubMed - indexed for MEDLINE] 4594. Anesthesiology. 1987 Sep;67(3):441-2. Prevention of postherpetic neuralgia. Bauman J. PMID: 3631618 [PubMed - indexed for MEDLINE] 4595. Showa Shigakkai Zasshi. 1987 Sep;7(2):213-7. [A case of herpes zoster treated with acyclovir] [Article in Japanese] Osawa K, Kakuta S, Tone K, Tokuoka T, Kimura Y, Nagumo M. PMID: 3505091 [PubMed - indexed for MEDLINE] 4596. Neurology. 1987 Sep;37(9):1537-8. Infantile herpes zoster ophthalmicus and acute hemiparesis following intrauterine chickenpox. Leis AA, Butler IJ. A 17-month-old boy developed herpes zoster ophthalmicus (HZO) and delayed contralateral hemiparesis following intrauterine varicella exposure. CT demonstrated multiple areas of hypodensity in the left basal ganglia, and angiography showed occlusion of left lenticulostriate arteries. As in most adults with HZO and delayed hemiparesis, this infant had a self-limiting course with excellent recovery. PMID: 3498130 [PubMed - indexed for MEDLINE] 4597. J Infect Dis. 1987 Sep;156(3):430-5. Antibodies to the three major glycoproteins of varicella-zoster virus: search for the relevant host immune response. Brunell PA, Novelli VM, Keller PM, Ellis RW. Clinical manifestations of chickenpox have occurred in individuals known to have seroconverted after vaccination against varicella. To determine whether these "breakthroughs" might be due to the absence of specific antibodies, we tested sera from vaccinees before or at the time of exposure to varicella for antibodies to the three major glycoproteins of varicella-zoster virus (VZV). Protection could not be correlated with the presence or level of any of these antibodies. Levels of antibodies to glycoproteins before onset of zoster were similar to those in sera of individuals who had had varicella previously and did not develop varicella after household exposure. Thus, protection against infections with VZV cannot be explained by the presence of specific antibodies to glycoproteins. PMID: 3039010 [PubMed - indexed for MEDLINE] 4598. Semin Respir Infect. 1987 Sep;2(3):177-83. Pneumonia in the immunocompromised child. Hughes WT. Department of Child Health Sciences, St Jude Children's Research Hospital, Memphis, TN 38101. Certain types and causes of pneumonia are unique to the immunocompromised host. The most frequent causes are cytomegalovirus, Pneumocystis carinii, varicella zoster virus, Candida species and Aspergillus species. Lymphoid interstitial pneumonia has recently been recognized in children with the acquired immunodeficiency syndrome. With the exception of varicella-zoster pneumonitis, an invasive procedure, such as open lung biopsy, is required to establish a definitive diagnosis. Infrequent causes of pneumonitis in immunocompromised children include Toxoplasma gondii; Cryptosporidium; Herpes simplex; adenovirus, gram-negative bacillary infections (Pseudomonas aeruginosa, Klebsiella pneumoniae, Escherichia coli, Legionella pneumophilia); Nocardia spp; zygomycetes, and Cryptococcus neoformans. The discovery of any of the aforementioned pneumonias suggests the patient may have a serious underlying immunodeficiency. PMID: 2825316 [PubMed - indexed for MEDLINE] 4599. J Med Virol. 1987 Sep;23(1):23-30. Cell-mediated immunity to varicella-zoster virus infection in strain 2 guinea pigs. Jenski L, Myers MG. Division of Hematology, Children's Hospital Research Foundation, Cincinnati, Ohio 45229-2899. Young adult male strain 2 guinea pigs were inoculated intramuscularly with varicella-zoster virus (VZV) cultured in fetal guinea pig tissue cultures. Lymphocyte proliferation and interleukin 2 secretion in response to viral antigen challenge in vitro were measured at weekly intervals for 2 months and periodically thereafter. VZV-specific immunity was apparent 2 weeks after infection, peaking after 2 weeks (lymphoproliferation) or 1-2 months (interleukin 2 secretion). Diminished but significant anamnestic responses were detected as late as 30 months after infection. PMID: 2824676 [PubMed - indexed for MEDLINE] 4600. Hosp Pract (Off Ed). 1987 Aug 15;22(8):223, 228-32. Evaluating and treating the patient with neck pain. Gilbert R, Warfield CA. PMID: 3114276 [PubMed - indexed for MEDLINE] 4601. Ugeskr Laeger. 1987 Aug 3;149(32):2138-9. [Cimetidine in herpes zoster. A double-blind study in general practice] [Article in Danish] Brint-Nielsen P, Christiansen LV, Damsbo N, Nørrelund N. PMID: 3329788 [PubMed - indexed for MEDLINE] 4602. Aust Fam Physician. 1987 Aug;16(8):1133, 1137-40. Herpes zoster in general practice. Trollor J. PMID: 3675350 [PubMed - indexed for MEDLINE] 4603. Hinyokika Kiyo. 1987 Aug;33(8):1266-71. [Urinary retention secondary to herpes zoster] [Article in Japanese] Tanikawa K, Kawamura N, Baba S. Department of Urology, Faculty of Medicine, Tokai University. We present a case of urinary retention and constipation secondary to Herpes zoster in the distribution of the second and third sacral dermatomes in a 68-year-old woman. Vesical irritability was not observed. Cystometry revealed a flaccid type bladder. Cell count of spinal fluid increased but clinical symptoms and physical findings of myelitis were not observed. A Foley catheter was left indwelling for five days due to urinary retention. After removal of the catheter, bladder paresis gradually improved. Skin eruption and disturbance of urination completely improved about three weeks later. Forty-seven cases of bladder involvement secondary to Herpes zoster including our case have been reported in the Japanese literature. PMID: 3321960 [PubMed - indexed for MEDLINE] 4604. Can J Neurol Sci. 1987 Aug;14(3):312-4. Herpes zoster ophthalmicus with delayed cerebral infarction and meningoencephalitis. Freedman MS, Macdonald RD. Department of Neurology, Wellesley Hospital, Toronto, Ontario, Canada. Herpes zoster ophthalmicus can be complicated by a delayed ipsilateral cerebral angiitis which may cause infarction and a smoldering meningoencephalitis. We describe such a case treated successfully with steroids and acyclovir. It is important to consider the diagnosis of this disorder early since therapeutic intervention may prevent an otherwise high morbidity and mortality. Steroids may have to be continued for some time after clinical resolution, using the ESR as a guideline for decreasing dosages. PMID: 3311326 [PubMed - indexed for MEDLINE] 4605. J Neurol. 1987 Aug;234(6):437-9. Guillain-Barré syndrome after varicella-zoster infection. Report of two cases. Sanders EA, Peters AC, Gratana JW, Hughes RA. Department of Neurology, United Medical School, Guy's Hospital, London, England. Two patients developed Guillain-Barré syndrome after varicella-zoster infection; a 4-year-old boy after chickenpox and a 74-year-old man after shingles. Both had decreased CD8-positive lymphocytes in the blood during the course of their illness. These cases and others reported in the literature suggest that varicella-zoster infection is a significant but rare trigger factor of Guillain-Barré syndrome. An alteration in the balance of helper and suppressor lymphocytes may be an important pathogenetic mechanism. PMID: 3309194 [PubMed - indexed for MEDLINE] 4606. Klin Monbl Augenheilkd. 1987 Aug;191(2):95-105. [Eye involvement in AIDS] [Article in German] Fabricius EM, Jäger H, Lander T, Prantl F, Högel B, Greite JH. Augenabteilung des Städtischen Akademischen Lehrkrankenhauses München-Harlaching. Between 1984 and 1987 (over two-and-a-half years) 30 hospitalized patients with HIV infections of different degrees of severity were ophthalmologically examined. Ocular involvement was found in 17 patients (approx. 57%). In 16 of these 17 patients with pathologic ophthalmologic findings (approx. 94%), AIDS was already fully developed. Ocular involvement is therefore a sign of poor prognosis. Fourteen patients had a microvascular retinal syndrome and four patients had infectious (chorio-)retinitis (causative organisms: cytomegalovirus in three cases, Cryptococcus neoformans in one). Further findings included sicca syndrome with superficial punctate keratitis in two cases, keratitis in one patient with generalized mucocutaneous candidiasis, Kaposi's sarcoma of the eyelids in two cases, Kaposi's sarcoma of the conjunctiva in one case, papilledema with cryptococcal meningitis in one case, and atypical hordeolum in one case. Morphologic and pathogenetic aspects of the ophthalmologic findings, their importance and course in AIDS patients, and therapeutic problems are discussed. PMID: 2822996 [PubMed - indexed for MEDLINE] 4607. An Esp Pediatr. 1987 Aug;27(2):89-93. [Pediatric kidney transplants and herpesvirus infections] [Article in Spanish] Reyes Martín A, Luque de Pablos A, Canals Badía MJ, Morales Sanjosé MD, Niembro de Rasche E. Hospital Provincial de Madrid. Twenty seven children were followed up prospectively after renal transplant for evidence of infection and illness due to cytomegalovirus (CMV), Epstein-Barr virus (EBV) and varicella zoster virus (VZV). Virus shedding and serological status were tested at transplant day, biweekly for two months, monthly for six months and trimestrialy thereafter. Determinations were done by complement fixation test. CMV isolation was established by microscopic examination of urinary cultures. Primary infections were objetivated in 27 cases (18 CMV, 1 EBV, 8 VZV) and reinfection in 3 (2 CMV, 1 VZV). Irreversible allograft rejection related to infection was disclosed in 2 patients (1 primary CMV infection, 1 VZV reinfection). Renal function impairment occurred only with CMV (6 primary and 1 secondary infections). One patient died with CMV over infection. PMID: 2821861 [PubMed - indexed for MEDLINE] 4608. Minerva Med. 1987 Jul 31;78(14):1029-30. [Cluster headache appearing after Ramsey Hunt syndrome and antigens of the HLA system. Description of a case] [Article in Italian] Giacovazzo M, Martelletti P. PMID: 3601146 [PubMed - indexed for MEDLINE] 4609. Br Med J (Clin Res Ed). 1987 Jul 25;295(6592):270-1. Herpes zoster of second and third segments causing ipsilateral Horner's syndrome. Vernon SA. PMCID: PMC1247111 PMID: 3115408 [PubMed - indexed for MEDLINE] 4610. Lancet. 1987 Jul 18;2(8551):126-9. Prednisolone does not prevent post-herpetic neuralgia. Esmann V, Geil JP, Kroon S, Fogh H, Peterslund NA, Petersen CS, Ronne-Rasmussen JO, Danielsen L. In a randomised, double-blind, controlled study of the effect of prednisolone on the development of post-herpetic neuralgia 78 patients with herpes zoster whose pain and exanthema had been present for less than 96 h were given 800 mg acyclovir five times daily for 7 days and prednisolone in a total dose of 575 mg, starting with 40 mg daily in the first week and tapering off over the next 2 weeks. 18 (23%) of the patients had post-herpetic neuralgia at 6 months after the acute zoster, 9 (24.3%) having received prednisolone and 9 (22.5%) placebo. The 95% CI for the difference between the placebo and prednisolone groups in the proportion of patients having pain at 6 months was minus 17% to plus 20%. Prednisolone, however, relieved pain for the first 3 days. The 1-2 week interval between admission and reappearance of pain and development of triggered pain seems to be the time needed to establish neuralgia. Once established, the type and intensity of pain remained largely unaltered. PMID: 2885599 [PubMed - indexed for MEDLINE] 4611. Klin Med (Mosk). 1987 Jul;65(7):100-4. [Herpes zoster in patients with hematologic diseases] [Article in Russian] Bogomolov BP, Bakhur EG. PMID: 3669563 [PubMed - indexed for MEDLINE] 4612. G Ital Dermatol Venereol. 1987 Jul-Aug;122(7-8):397-402. [Possibility of therapy in post-zoster neuralgia] [Article in Italian] Clausi-Schettini C. PMID: 3666800 [PubMed - indexed for MEDLINE] 4613. J Am Acad Dermatol. 1987 Jul;17(1):93-6. Treatment of chronic postherpetic neuralgia with topical capsaicin. A preliminary study. Bernstein JE, Bickers DR, Dahl MV, Roshal JY. Continuing pain following herpes zoster is common in patients 60 years of age or older. Current treatments are generally unsatisfactory. The endogenous neuropeptide substance P is an important chemomediator of nociceptive impulses from the periphery to the central nervous system and has been demonstrated in high levels in sensory nerves supplying sites of chronic inflammation. In an attempt to alleviate the pain of 14 patients with postherpetic neuralgia, capsaicin (trans-8-methyl-N-vanillyl-6-nonenamide), known to deplete substance P, was applied topically to painful areas of skin for 4 weeks. Of the 12 patients completing this preliminary study, 9 (75%) experienced substantial relief of their pain. The only adverse reaction was an intermittent, localized burning sensation experienced by one patient with application of capsaicin. Although these results are preliminary, they suggest that topical application of capsaicin may provide a useful approach for alleviating postherpetic neuralgia and other syndromes characterized by severe localized pain. PMID: 3611458 [PubMed - indexed for MEDLINE] 4614. J Ophthalmic Nurs Technol. 1987 Jul-Aug;6(4):151-5. Nursing grand rounds: herpes zoster ophthalmicus. Pederson KM, Nulty G. PMID: 3497280 [PubMed - indexed for MEDLINE] 4615. Neurology. 1987 Jul;37(7):1264-5. Herpes zoster ophthalmicus and delayed ipsilateral intracerebral hemorrhage. Mossuto-Agatiello L, Iovine C, Kniahynicki C. PMID: 3496558 [PubMed - indexed for MEDLINE] 4616. Nippon Hifuka Gakkai Zasshi. 1987 Jul;97(8):931-6. [Immunological studies on natural killer-cell activity in herpes zoster] [Article in Japanese] Nagai T. PMID: 3430791 [PubMed - indexed for MEDLINE] 4617. Dent Update. 1987 Jul-Aug;14(6):255-6, 258-60. Herpes zoster and post-herpetic neuralgia: diagnosis and management. Watts PG. PMID: 3332642 [PubMed - indexed for MEDLINE] 4618. Zhonghua Yan Ke Za Zhi. 1987 Jul;23(4):212-4. [Herpes zoster ophthalmicus] [Article in Chinese] Song XW. PMID: 3127162 [PubMed - indexed for MEDLINE] 4619. AJNR Am J Neuroradiol. 1987 Jul-Aug;8(4):615-9. Mycotic aneurysm in angiitis associated with herpes zoster ophthalmicus. O'Donohue JM, Enzmann DR. Varicella zoster (VZ) is an unusual cause of CNS angiitis, usually occurring in older patients and immunocompromised hosts. The infection most commonly presents as herpes zoster ophthalmicus with contralateral hemiplegia. Mycotic aneurysm formation associated with VZ angiitis is rare. We report two cases of VZ angiitis with mycotic aneurysm formation (both aneurysms eventually ruptured) and one case of probable VZ angiitis with distal carotid occlusion and cerebral infarction. The CT and angiographic appearances, clinical course, and histopathology are presented. PMID: 3113199 [PubMed - indexed for MEDLINE] 4620. HNO. 1987 Jul;35(7):310-3. [Acute viral infections in association with idiopathic peripheral facial paralysis] [Article in German] Mang WL, Bonkowsky VM. The possible association of some viral infections with the onset of Bell's palsy was examined in a study of 29 patients. The results were compared with a sex- and age-matched control group. The number of probable recent viral infections, as judged by a fourfold increase in antibody titers or the presence of specific IgM antibodies, differed statistically from that found in the control group. In seven patients with Bell's palsy the enzyme-linked-immunosorbent assay (ELISA) indicated an acute viral infection (herpes simplex 4; varicella zoster 2; cytomegalovirus 1). All these infections were due to viruses belonging to the herpesvirus group. Clinical evidence of herpesvirus infection was found in three cases (Herpetic eruption). The aetiological relationship between the virological findings and Bell's palsy is discussed. Reactivated herpes simplex virus and transient demyelination of the facial nerve could be one cause of an idiopathic facial palsy. PMID: 3040643 [PubMed - indexed for MEDLINE] 4621. Pediatr Infect Dis J. 1987 Jul;6(7):644-7. Magnetic resonance imaging of the brain in childhood herpesvirus infections. Bale JF Jr, Andersen RD, Grose C. We used magnetic resonance imaging (MRI) to evaluate nine children with neurologic disorders caused by infections with members of the herpesvirus family. MRI studies were abnormal in eight children and demonstrated a wide range of central nervous system lesions, including cystic encephalomalacia, ventricular enlargement, cerebral atrophy and focal parenchymal lesions. When compared with conventional computed tomographic scanning, MRI was more sensitive in detecting abnormalities of white matter and in defining the extent of parenchymal lesions. These studies indicate that MRI scans are highly useful in children with herpesvirus infections involving the central nervous system. PMID: 3039447 [PubMed - indexed for MEDLINE] 4622. Rev Chir Oncol Radiol O R L Oftalmol Stomatol Ser Oftalmol. 1987 Jul-Sep;31(3):221-4. [Zona ophthalmica of superacute evolution in a patient with cortisone immunodepression] [Article in Romanian] Săninoiu M. PMID: 2962245 [PubMed - indexed for MEDLINE] 4623. Riv Neurol. 1987 Jul-Aug;57(4):274-6. Segmental abdominal zoster paresis. Jandolo B, Biolcati G, Montanari U, Pietrangeli A, Fazio M. Istituto Regina Elena per lo Studio e la Cura dei Tumori, Servizio di Neurologia, Roma. A case of uncommon feature of herpes zoster, a segmental abdominal paresis, is described. The importance of searching a motor defect in the thoracoabdominal segments and the utility of the electromyographic examination are stressed. PMID: 2961042 [PubMed - indexed for MEDLINE] 4624. Klin Oczna. 1987 Jul;89(7):307-8. [Isoprinosine in the treatment of virus diseases of the visual system] [Article in Polish] Debicka A. PMID: 2447324 [PubMed - indexed for MEDLINE] 4625. J Am Acad Dermatol. 1987 Jul;17(1):64-9. Comparison of detection of varicella-zoster virus by the Tzanck smear, direct immunofluorescence with a monoclonal antibody, and virus isolation. Sadick NS, Swenson PD, Kaufman RL, Kaplan MH. A study comparing direct immunofluorescence assay using a new monoclonal antibody specific for a varicella-zoster virus glycoprotein complex, the Tzanck smear, and virus isolation for detection of varicella-zoster virus in 56 patients with clinically apparent herpes zoster is presented. Of 47 patients with clinical herpes zoster and with cultures negative for herpes simplex virus, 30 (64%) had positive Tzanck smears, direct immunofluorescence assay results were positive in 26 (55%), and cultures were positive in only 12 (26%). Both direct immunofluorescence assay and the Tzanck smear were found to be superior to culture technics; however, direct immunofluorescence assay was found to have greater specificity. PMID: 2440920 [PubMed - indexed for MEDLINE] 4626. Br Med J (Clin Res Ed). 1987 Jun 6;294(6585):1463. Herpes zoster of second and third segments causing ipsilateral Horner's syndrome. Wimalaratna HS, Capildeo R, Lee HY. PMCID: PMC1246615 PMID: 3111588 [PubMed - indexed for MEDLINE] 4627. Masui. 1987 Jun;36(6):971-5. [Treatment with total spinal block of severe herpetic neuralgia accompanying median and ulnar nerve palsy] [Article in Japanese] Yamashiro H, Hirano K. PMID: 3656663 [PubMed - indexed for MEDLINE] 4628. J Neurol. 1987 Jun;234(5):308-14. Cerebrospinal fluid immunoglobulins and virus-specific antibodies in disorders affecting the facial nerve. Weber T, Jürgens S, Lüer W. Sixty-two patients with acute idiopathic peripheral facial nerve palsy (AIPFP) and 31 patients with lymphocytic meningoradiculitis (Garin-Bujadoux or Bannwarth's syndrome) are described. Results of cerebrospinal fluid (CSF) analysis, including the measurement of immunoglobulins (Ig) G, A, and M, indicate that pleocytosis and/or disturbance of the blood-CSF barrier (BCB) and/or local immunoglobulin synthesis within the central nervous system (CNS) do occur in about 25% of patients with AIPFP. The commonest finding is a slight to moderate breakdown of BCB function without evidence of intrathecal immunoglobulin synthesis. In only about 10% of patients, further support for an inflammatory process within the CNS is found by intrathecal synthesis of oligoclonal IgG and/or localized synthesis of IgG and/or IgA. The majority of cases (75%) do not show any signs of an inflammatory process within the CNS. In contrast, lymphocytic meningopolyradiculitis (LMR) has a characteristic CSF profile with early impairment of BCB permeability as well as with rapid and predominant intrathecal IgM synthesis, which helps to distinguish monosymptomatic LMR from AIPFP. By applying a sensitive enzyme-linked immunosorbent assay to identical concentrations of IgG in serum and CSF, evidence of intrathecal synthesis of virus-specific antibodies was found only in 2 of 13 patients with AIPFP. In contrast, all 4 patients with herpes zoster oticus and peripheral facial palsy (Ramsay Hunt syndrome) showed an intrathecal IgG synthesis to varicella zoster virus lasting for up to 4 months after onset of disease. PMID: 3612202 [PubMed - indexed for MEDLINE] 4629. Ann Neurol. 1987 Jun;21(6):559-63. Postherpetic gustatory flushing and sweating. Drummond PD, Boyce GM, Lance JW. An 11-year-old girl who had suffered right facial herpes zoster at the age of 6 years was left with anesthetic scars in the distribution of the third division of the trigeminal nerve. Since then, certain tastes provoked flushing and sweating localized to the scarred areas, lasting for 10 to 15 minutes after a latency of a few seconds. The response was evoked most readily from the ipsilateral posterior section of the tongue and was virtually abolished by local administration of anesthesia to the tongue. It remained unaltered after blockade of the sphenopalatine and stellate ganglia but was diminished by blockade of the mandibular nerve. Thermoregulatory sweating and flushing were diminished in the scarred areas. Patchy destruction of sympathetic fibers, which are known to accompany peripheral trigeminal nerve branches, and reinnervation of the affected areas by parasympathetic fibers that normally mediate salivation may explain the phenomenon. It is thus analogous to the gustatory flushing and sweating that may follow damage to the auriculotemporal nerve in the region of the parotid gland (Frey's syndrome). PMID: 3606044 [PubMed - indexed for MEDLINE] 4630. J Am Acad Dermatol. 1987 Jun;16(6):1261-3. Granuloma formation in herpes zoster scars. Fischer G, Jaworski R. PMID: 3597868 [PubMed - indexed for MEDLINE] 4631. Chemioterapia. 1987 Jun;6(2 Suppl):663-4. Treatment of herpes virus ocular pathology with acyclovir. Gorgone G, Cavallaro N, Spina F. Department of Ophthamology, University of Catania, Italy. PMID: 3509940 [PubMed - indexed for MEDLINE] 4632. J Indian Dent Assoc. 1987 Jun-Sep;59(6,7,8,9):170-2. Herpes zoster of facial structures. Bhatia B, Bhatia KK, Aparna. PMID: 3509565 [PubMed - indexed for MEDLINE] 4633. Chemioterapia. 1987 Jun;6(2 Suppl):748-50. Varicella-zoster infection in patients with neoplastic diseases. Panagos G, Boukis H, Coutsouradis T, Voskaridou E, Papadakou M, Flevaris C. 2nd Department of Medicine, A. Anargiri Cancer Hospital, N. Kifisia, Greece. PMID: 3509539 [PubMed - indexed for MEDLINE] 4634. Ophthalmology. 1987 Jun;94(6):602-6. Association of varicella zoster dermatitis with acute retinal necrosis syndrome. Browning DJ, Blumenkranz MS, Culbertson WW, Clarkson JD, Tardif Y, Gourdeau A, Minturn J. The authors report seven patients in whom the acute retinal necrosis (ARN) syndrome developed shortly after cutaneous varicella zoster infection. The length of time between the skin infection and ARN varied from 5 days to 3 months. Both eyes were affected in one of seven cases. The ophthalmic branch of cranial nerve V ipsilateral to an affected eye was involved by the zoster dermatitis in only two of the seven cases. The association lends further support to the proposal that herpes zoster virus is a major cause of ARN. A history of recent zoster dermatitis should be sought in patients with ARN. PMID: 3498140 [PubMed - indexed for MEDLINE] 4635. Klin Med (Mosk). 1987 Jun;65(6):128-9. [A case of contralateral hemisyndrome in the ophthalmic form of herpes zoster] [Article in Russian] Shishov AS, Smirnov IuK, Rusakova IuP. PMID: 3498090 [PubMed - indexed for MEDLINE] 4636. Chemioterapia. 1987 Jun;6(2 Suppl):671-3. Recent developments in the management of herpes zoster (shingles). Wood MJ, McKendrick M, McGill JI. Department of Communicable & Tropical Diseases, Birmingham Hospital, England. PMID: 3334658 [PubMed - indexed for MEDLINE] 4637. Infect Dis Clin North Am. 1987 Jun;1(2):367-82. The management of varicella and zoster infections. Straus SE. Medical Virology Section, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland. The varicella-zoster virus causes chickenpox and shingles. Antiviral drugs like acyclovir ameliorate certain severe forms of these infections, particularly as they present in immunodeficient patients. Varicella-zoster immune globulin prevents chickenpox, but a more desirable and effective strategy entails administration of a live-attenuated vaccine. PMID: 3332795 [PubMed - indexed for MEDLINE] 4638. Semin Respir Infect. 1987 Jun;2(2):84-94. Varicella zoster and herpes simplex virus pneumonias. Feldman S, Stokes DC. Division of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, TN 38101. Varicella zoster (VZV) and herpes simplex (HSV) viruses commonly cause self-limited infection of the skin and mucous membranes. However, certain groups of subjects, including neonates, cancer patients, organ and bone marrow transplant recipients and those with congenital or acquired deficiencies of cell mediated immunity, are at increased risk for dissemination of either virus to the lungs and/or other viscera. The highest risk for VZV pneumonitis is in bone marrow transplant recipients, 44%, and in children with acute leukemia, 32%. The mortality from this complication of VZV infection in the preantiviral era was at least 25%. Except for neonates, dissemination and mortality rates for HSV infections are less than for VZV infections in the high risk groups. Cell-mediated immunity has a major role in both recovery from primary infection and modulation of latent infection, but antiherpes antibodies also have an important role in moderating the extent and severity of infection. Both viruses cause a patchy nodular pneumonia with scattered necrotic and hemorrhagic foci. Physical examination is often misleading and rapid progression of pneumonia can occur within hours. Intravenous acyclovir, administered early in the course of HSV and VZV infection at dosages of 250 mg/m2 and 500 mg/m2 every eight hours, respectively, has nearly eliminated the risk of severe symptomatic pneumonitis. Treatment of established pneumonitis with acyclovir at these doses has also reduced the mortality of herpesvirus pneumonias. PMID: 3321272 [PubMed - indexed for MEDLINE] 4639. Minn Med. 1987 Jun;70(6):333-5. Response of immunocompromised patients with acute herpes zoster to intravenous acyclovir. McMonigal KA, Balfour HH Jr, Bean B. PMID: 3037291 [PubMed - indexed for MEDLINE] 4640. Am J Ophthalmol. 1987 May 15;103(5):711-2. Treatment of neurotrophic ulcers with conjunctival flaps. Lugo M, Arentsen JJ. PMID: 3495182 [PubMed - indexed for MEDLINE] 4641. Fortschr Med. 1987 May 10;105(14):280-2. [Acyclovir in acute herpes zoster. Effect of early intravenous treatment on pain intensity and the course of pain] [Article in German] Christe W, Kölmel HW. PMID: 3596449 [PubMed - indexed for MEDLINE] 4642. Med Clin (Barc). 1987 May 9;88(18):741. [Generalized herpes zoster and infection by the human immunodeficiency virus] [Article in Spanish] Fonseca Capdevila E, Almagro Sánchez M. PMID: 3613717 [PubMed - indexed for MEDLINE] 4643. Schweiz Med Wochenschr. 1987 May 2;117(18):669-75. [Common infections in immunocompromised patients] [Article in German] Malinverni R. Immunocompromised patients are at increased risk for life-threatening as well as non life-threatening infectious complications. In contrast to the acutely granulocytopenic patient, the infectious syndromes occurring in other immunocompromised hosts are easily detected clinically. From a precise knowledge of the underlying specific host defense abnormality it is possible to predict the spectrum of the most likely causative organisms and the course of the infection. In the case of a defect in cell-mediated host defense, the variety of potential pathogens is wide and includes characteristically intracellular microorganisms. A defect in humoral immunity places patients at increased risk for infection due to encapsulated, extracellular organisms. Patients with qualitative defects of polymorphonuclear leukocyte defense are particularly susceptible to S. aureus infections. The lack of integrity of anatomical barriers (skin, mucous membranes) may lead to increased risk of localized or invasive infections by the colonizing microbial flora. Virtually every decision on antimicrobial therapy must be based upon careful evaluation of the integrity of all these host defense mechanisms. These relationships are illustrated by discussion of four infectious diseases: urinary tract infections, Candida mucositis, Varicella-Zoster virus infections and fever in the asplenic patient. PMID: 3589624 [PubMed - indexed for MEDLINE] 4644. Laryngol Rhinol Otol (Stuttg). 1987 May;66(5):290-1. [Treatment of herpes zoster] [Article in German] Wilmes E. PMID: 3613783 [PubMed - indexed for MEDLINE] 4645. J Am Podiatr Med Assoc. 1987 May;77(5):249-51. An unusual manifestation of herpes zoster. Marsh NS, Black JR. PMID: 3585757 [PubMed - indexed for MEDLINE] 4646. Indian J Ophthalmol. 1987 May-Jun;35(3):160-1. Herpes zoster maxillaries--a case report. Tandon MP, Verma SK. PMID: 3507414 [PubMed - indexed for MEDLINE] 4647. Br J Ophthalmol. 1987 May;71(5):353-8. Natural history of herpes zoster ophthalmicus: predictors of postherpetic neuralgia and ocular involvement. Harding SP, Lipton JR, Wells JC. Seventy-one patients presenting with acute herpes zoster ophthalmicus were followed up for six months for a prospective analysis of the natural history of the disease. Acute and chronic ocular complications, nasociliary nerve involvement, age, sex, rash, and pain were assessed, and the results are presented. Acute pain was measured by a visual analogue scale. Postherpetic neuralgia (PHN) was more likely in patients over 80 and in those who scored their pain highly at presentation. Duration of rash was longer in patients who developed PHN. No other associations between the parameters studied were found. Nasociliary nerve involvement was associated with subsequent ocular disease. PMCID: PMC1041165 PMID: 3495293 [PubMed - indexed for MEDLINE] 4648. J Infect Dis. 1987 May;155(5):959-67. Aseptic meningitis due to varicella-zoster virus: serum antibody levels and local synthesis of specific IgG, IgM, and IgA. Echevarría JM, Martínez-Martín P, Téllez A, de Ory F, Rapún JL, Bernal A, Estévez E, Nájera R. We used an indirect enzyme immunoassay to describe the evolution of serum levels and the intrathecal production of IgG, IgA, and IgM antibodies to varicella-zoster virus (VZV) in eight patients with a syndrome of acute aseptic meningitis (AAM) and evidence of intrathecal production of VZV-specific IgG antibodies. Four of the eight patients showed no cutaneous zoster while hospitalized. Our results suggested an etiologic relation between VZV and AAM in all cases. Furthermore, we observed some differences in the pattern of evolution of antibodies in serum and cerebrospinal fluid in relation to the presence or absence of cutaneous lesions in our patients. These differences could reflect different pathogenic mechanisms in the spread of VZV to the central nervous system and in the production of the AAM syndrome. PMID: 3031175 [PubMed - indexed for MEDLINE] 4649. Masui. 1987 May;36(5):771-7. [Factors influencing the prognosis of herpetic pain--statistical analysis of cases with acute herpes zoster] [Article in Japanese] Shiotani M. PMID: 2443732 [PubMed - indexed for MEDLINE] 4650. Ned Tijdschr Geneeskd. 1987 Apr 25;131(17):721-5. [Facial nerve paralysis] [Article in Dutch] Devriese PP. PMID: 3587388 [PubMed - indexed for MEDLINE] 4651. Br Med J (Clin Res Ed). 1987 Apr 11;294(6577):974. Oral acyclovir in acute herpes zoster. Juel-Jensen BE. PMCID: PMC1246034 PMID: 3107684 [PubMed - indexed for MEDLINE] 4652. Med Monatsschr Pharm. 1987 Apr;10(4):100-2. [Herpes zoster (shingles)] [Article in German] Cremer H. PMID: 3587110 [PubMed - indexed for MEDLINE] 4653. Nippon Ika Daigaku Zasshi. 1987 Apr;54(2):153-61. [Delayed hypersensitivity response in patients with herpes zoster] [Article in Japanese] Yajima J. PMID: 3584405 [PubMed - indexed for MEDLINE] 4654. J Am Acad Dermatol. 1987 Apr;16(4):883-4. Herpes zoster incidence in younger age groups. Funaki B, Elpern DJ. PMID: 3571553 [PubMed - indexed for MEDLINE] 4655. Am J Med. 1987 Apr;82(4):861-3. Herpes zoster and zosteriform herpes simplex virus infections in immunocompetent adults. [No authors listed] PMID: 3565445 [PubMed - indexed for MEDLINE] 4656. Clin Pediatr (Phila). 1987 Apr;26(4):177-80. Sporadic congenital Caffey's disease. Marshall GS, Edwards KM, Wadlington WB. Caffey's disease is an inflammatory skeletal disorder of infancy manifested clinically by fever, soft-tissue swelling, and constitutional signs with radiographic evidence of periosteal new bone formation. Although prevalent between 1940 and 1960, nonfamilial cases have become extraordinarily rare. The authors report the sporadic occurrence of congenital Caffey's disease in a premature infant and note an interesting association with maternal herpes zoster early during gestation. The etiology of this mysterious disease is likely to remain elusive as new cases become scarce. PMID: 3549106 [PubMed - indexed for MEDLINE] 4657. SAAD Dig. 1987 Apr;6(10):216-21. Update on antiviral drugs. Acyclovir in dental practice. Cawson RA. PMID: 3473693 [PubMed - indexed for MEDLINE] 4658. J Dermatol. 1987 Apr;14(2):126-31. Rabbit zosteriform eruption induced by intra-arterial inoculation of herpes simplex virus, type 1. Matsubara M, Kishimoto S, Yasuno H, Sotomatsu S, Yoshioka A, Tanaka A, Ueda K, Ohashi M. PMID: 3038980 [PubMed - indexed for MEDLINE] 4659. Virus Res. 1987 Apr;7(2):117-29. Varicella-zoster virus infection of human mononuclear cells. Gilden DH, Hayward AR, Krupp J, Hunter-Laszlo M, Huff JC, Vafai A. Varicella-zoster virus (VZV) DNA was detected in mononuclear cells (MNC) of 7 humans with acute zoster 1-23 days after the onset of skin lesions. To further study the interaction of VZV with human MNC, cells obtained from seropositive normal donors were infected with VZV and analyzed for the presence of viral DNA and proteins. VZV-DNA was detected in T, B, and OKM 1 (monocyte-macrophage) positive cells, and virus-specific proteins were demonstrated by indirect immunofluorescence and immunoprecipitation. Hybridization studies revealed that VZV-DNA did not replicate in human MNC. PMID: 3035815 [PubMed - indexed for MEDLINE] 4660. J Infect Dis. 1987 Apr;155(4):633-40. Molecular epidemiology of live, attenuated varicella virus vaccine in children with leukemia and in normal adults. Gelb LD, Dohner DE, Gershon AA, Steinberg SP, Waner JL, Takahashi M, Dennehy PH, Brown AE. Restriction endonuclease analysis of varicella-zoster virus (VZV) DNA has been used in unraveling the complex epidemiology of VZV infections in individuals immunized with a live, attenuated varicella virus vaccine. Early rashes appearing within the first six weeks after vaccination are invariably due to vaccine virus. True breakthrough infections with wild-type VZV also occur in vaccinees. Five cases of zoster have been seen in leukemic children vaccinated while in remission. One case appeared 22 months after vaccination in the same general area as the inoculation. The virus isolated was vaccine derived. A second case of zoster appeared in a dermatome unrelated to the sites of vaccination approximately 19 months after apparently natural varicella. This virus was wild type. Vaccine virus can therefore establish latency and can later reactivate as herpes zoster. PMID: 3029239 [PubMed - indexed for MEDLINE] 4661. Cutis. 1987 Apr;39(4):352-3. Capsaicin in the treatment of dermatologic disease. Bernstein JE. Capsaicin cream is the first of a class of neuropeptide active agents to be introduced into dermatologic therapy. Capsaicin's effects appear primarily related to its ability to deplete the neuropeptide substance P from local sensory terminals in the skin. The use of capsaicin cream in the treatment of postherpetic neuralgia and psoriasis is discussed. I believe that capsaicin and other neuropeptide active agents may become important therapeutic modalities for the dermatologist in the near future. PMID: 2438089 [PubMed - indexed for MEDLINE] 4662. Lancet. 1987 Mar 28;1(8535):728-31. Risk of AIDS after herpes zoster. Melbye M, Grossman RJ, Goedert JJ, Eyster ME, Biggar RJ. In a closed internal medicine practice for homosexual men in Central Manhattan herpes zoster developed in 112 men between 1980 and mid-1986. In these patients the incidence of acquired immunodeficiency syndrome (AIDS) was high: Kaplan-Meier survival analysis indicated cumulative incidences of AIDS of 22.8% within 2 years after herpes zoster, 45.5% within 4 years, and an estimated 72.8% after 6 years. Severity of zoster (relative risk, RR = 4.6), degree of pain (RR = 3.4), and zoster of the cranial or cervical dermatomes (RR = 2.2) were all associated with a poor outcome. Oral thrush, oral hairy leucoplakia, amoebiasis, and superficial (tinea) fungal infections also indicated an increased risk of AIDS among zoster patients. Oral thrush and oral hairy leucoplakia manifestations were diagnosed an average of 1.2 and 1.1 years, respectively, after the diagnosis of herpes zoster; thus zoster is an early indicator of an impaired immunity. Herpes zoster can be used as a predictor of AIDS and in AIDS risk groups should be regarded as a poor prognostic sign. PMID: 2882139 [PubMed - indexed for MEDLINE] 4663. Med Clin (Barc). 1987 Mar 21;88(11):476-7. [Meningoencephalitis and ocular herpes zoster] [Article in Spanish] [No authors listed] PMID: 3494892 [PubMed - indexed for MEDLINE] 4664. Med Clin (Barc). 1987 Mar 14;88(10):432-3. [Hypoglycorrhachia in varicella zoster meningoencephalitis] [Article in Spanish] Pujadas R, Fernández-Monrás F, Sort MD, Jané J. PMID: 3573843 [PubMed - indexed for MEDLINE] 4665. Br Med J (Clin Res Ed). 1987 Mar 14;294(6573):704. Oral acyclovir in acute herpes zoster. Marsh RJ, Cooper M. PMCID: PMC1245759 PMID: 3105699 [PubMed - indexed for MEDLINE] 4666. Dtsch Med Wochenschr. 1987 Mar 6;112(10):407-8. [Pain intensity and outcome in acute herpes zoster under acyclovir therapy] [Article in German] Christe W, Kölmel HW. PMID: 3816588 [PubMed - indexed for MEDLINE] 4667. Wien Klin Wochenschr. 1987 Mar 6;99(5):149-53. [Physical treatment of herpetic diseases. Report of a pilot study with low-frequency electrotherapy] [Article in German] Hein L, Ammer K, Rathkolb O, Krcevsky N. Standard methods employed in physiotherapy are seldom applied to florid herpes zoster since they bring little benefit. Initial experience with electrotherapy for herpes is reported. Pulsed galvanic current at a frequency of 30 hertz was applied to the region of the affected segmental nerve. In two centres (Vienna and Maribor) treatment was carried out on 32 patients with herpes zoster (recovery in Vienna after a mean duration of treatment of 6.3 days; in Maribor recovery after 20 days of treatment) and 18 patients with herpes simplex (recovery after 5 or 6.5 days respectively) were treated. Follow up of all patients treated in Vienna showed that only one patient out of the zoster group developed post-herpetic neuralgia. Three patients with herpes simplex had a relapse of the disease, but it was less severe than before treatment. The better results in Vienna were explained by the use of strictly monopolar wave forms and the fact that treatment was applied every day, while in Maribor patients received no treatment over a weekend. PMID: 3495073 [PubMed - indexed for MEDLINE] 4668. Am J Med. 1987 Mar;82(3):560-2. Rapid response to acyclovir in herpes zoster-associated encephalitis. Johns DR, Gress DR. A previously healthy patient became acutely encephalopathic, with complete disorientation and amnesia, several days after the onset of thoracic herpes zoster. She had transiently abnormal electroencephalographic results, abnormalities on radionuclide brain scanning, and cerebrospinal fluid pleocytosis. There was no evidence of a toxic/metabolic encephalopathy except for a mildly elevated ammonia level. Intravenously administered acyclovir (30 mg/kg per day) induced a dramatic response, with complete resolution of the encephalopathy within 72 hours and normalization of the electroencephalographic results. The scant clinical experience with the successful use of acyclovir in the treatment of herpes zoster-associated encephalitis is reviewed. PMID: 3826110 [PubMed - indexed for MEDLINE] 4669. Postgrad Med. 1987 Mar;81(4):321-2. Postherpetic neuralgia. Prevention and treatment. Diamond S. PMID: 3822967 [PubMed - indexed for MEDLINE] 4670. Dig Dis Sci. 1987 Mar;32(3):318-22. Transient gastroparesis associated with cutaneous herpes zoster. Kebede D, Barthel JS, Singh A. We report a patient who developed delayed gastric emptying with vomiting and weight loss simultaneously with herpes zoster in the sixth right thoracic dermatome. Sequential radionuclide solid egg meal gastric emptying studies were used to document gastroparesis, the response to metoclopramide and its transient nature. We present a possible explanation for this phenomenon within the context of the known pathophysiology of varicella-zoster infection. PMID: 3816485 [PubMed - indexed for MEDLINE] 4671. Yale J Biol Med. 1987 Mar-Apr;60(2):159-67. Latent herpesvirus infections of neurons in guinea pigs and humans. Tenser RB, Hyman RW. Latent herpes simplex virus (HSV) infection of the trigeminal ganglion of guinea pigs and latent varicella-zoster virus (VZV) infection of the trigeminal ganglion of humans were studied by in situ nucleic acid hybridization. Guinea pig trigeminal ganglia were removed during the period of viral latency (four to five weeks after corneal inoculation of HSV), and human ganglia were removed at autopsy. Radiolabeled HSV and VZV DNAs were used to probe ganglion tissue sections for viral-specified RNA. Hybridization detected only over neurons was present in 46 percent of ganglia from 22 latently infected guinea pigs and from 33 percent of ganglia from 10 human subjects. These results support the conclusion that some viral transcription occurred during HSV and VZV latency. PMCID: PMC2590332 PMID: 3495074 [PubMed - indexed for MEDLINE] 4672. Am Fam Physician. 1987 Mar;35(3):121-8. Herpes zoster ophthalmicus. Bucci FA Jr, Savia PV Jr, Mauriello JA Jr. The incidence and severity of herpes zoster ophthalmicus have increased because of the growing number of immunocompromised patients. Uveitis and keratitis are the most common inflammatory complications. Corneal exposure from scarring and contraction of the upper lid may require reconstructive plastic surgery. Preliminary studies of oral acyclovir, specifically targeted at preventing ocular complications, are encouraging. PMID: 3493673 [PubMed - indexed for MEDLINE] 4673. J Oral Maxillofac Surg. 1987 Mar;45(3):264-6. Spontaneous tooth exfoliation and osteonecrosis following a herpes zoster infection of the fifth cranial nerve. Mostofi R, Marchmont-Robinson H, Freije S. Spontaneous exfoliation of teeth and osteonecrosis of the alveolar bone are rare complications of HZ infection that usually follow the acute phase of infection. Awareness of osteonecrosis associated with secondary HZ infection is important for early detection and treatment of the condition to prevent further complications, particularly in high-risk patients. PMID: 3469368 [PubMed - indexed for MEDLINE] 4674. Infection. 1987 Mar-Apr;15(2):93-8. Serologic detection of active infections with human herpes viruses (CMV, EBV, HSV, VZV): diagnostic potential of IgA class and IgG subclass-specific antibodies. Doerr HW, Rentschler M, Scheifler G. In 175 sera from healthy persons as well as those suffering from primary or secondary herpes virus infections/reactivations, serum antibodies were assessed by an indirect ELISA in the immunoglobulin classes A, G and M and the subclasses G1-4, using carrier-fixed antigens (CMV, VZV, HSV) and monoclonal tracer antibodies. In a similar way EBV-specific antibodies were tested by an indirect IFT. Only IgG1 antibodies were detectable in nearly all persons. Virus-specific IgA and IgG3 may support conventional serological methods (IgM, IgG) indicating recent infection/reactivation with VZV, EBV and possibly CMV. Furthermore, differentiation of primary and secondary CMV and VZV infection was possible in some cases, when IgG3 was detectable before IgG1 in subsequent blood specimens. Recurrent herpes lesions could not be diagnosed serologically. PMID: 3036714 [PubMed - indexed for MEDLINE] 4675. Nippon Shishubyo Gakkai Kaishi. 1987 Mar;29(1):233-43. [The gingival findings of herpes zoster] [Article in Japanese] Fukai K, Otaki K, Hasegawa A, Ishikawa K. PMID: 2851628 [PubMed - indexed for MEDLINE] 4676. Rev Hosp Clin Fac Med Sao Paulo. 1987 Mar-Apr;42(2):55-8. [Vaccine against varicella-zoster] [Article in Portuguese] Nicodemo AC, Nicodemo EL, Amato Neto V. PMID: 2831610 [PubMed - indexed for MEDLINE] 4677. J UOEH. 1987 Mar 1;9(1):45-51. [Usefulness of nerve block therapy in patients with herpetic pain] [Article in Japanese] Tsubaki T, Fukui J, Tanaka T, Ogata M, Nakamura S. A retrospective study was performed on 230 patients with Herpes zoster. Among these patients, 156 patients (67.8%) were over 50 years old. Ninety-four percent of the patients who received the nerve block therapy within a month from the onset became ultimately free from pain while only seventy-nine percent of the patients upon whom this therapy was started after 2 months or more were relieved of pain. It was suggested that the earlier the therapy and the younger the patients, the more easily herpetic pain could be controlled. In conclusion, it became apparent that early treatment of Herpes zoster with nerve block therapy, is extremely important for prevention of post-herpetic neuralgia. PMID: 2437634 [PubMed - indexed for MEDLINE] 4678. Wiad Lek. 1987 Feb 15;40(4):278-81. [Use of acyclovir in the treatment of herpes zoster with severe clinical course] [Article in Polish] Domański P, Wańkowicz Z, Knapp J. PMID: 3617750 [PubMed - indexed for MEDLINE] 4679. J Immunol. 1987 Feb 15;138(4):1229-33. Analysis of immune function in herpes zoster patients: demonstration and characterization of suppressor cells. Cauda R, Grossi CE, Whitley RJ, Tilden AB. We sought to identify imbalances of immune regulatory cells that might contribute to the depression of cell-mediated immunity that occurs during an episode of herpes zoster. Peripheral blood mononuclear cells (PBMC) were obtained from patients with herpes zoster during the acute (less than 7 days after disease onset) and convalescent (more than 10 days after disease onset) phases of illness and from healthy seropositive donors. The PBMC were analyzed for: lymphoproliferative responses to varicella-zoster virus (VZV) antigens, Leu-3 (helper/inducer):Leu-2 (cytotoxic/suppressor) ratios, and percentages of suppressor cells as defined by coexpression of the Leu-2 and OKM1 antigens. Significantly depressed proliferative responses of VZV antigens and Leu-3:Leu-2 ratios, and increased percentages of Leu-2+ OKM1+ suppressor cells were observed in PBMC of acute phase herpes zoster patients as compared with the PBMC of convalescent patients or healthy donors. These differences were also observed in individual patients sequentially studied during both phases of disease. Cryopreserved acute phase PBMC suppressed the proliferative response of autologous convalescent phase PBMC to VZV antigens, but not to herpes simplex virus (HSV) antigens. The acute phase PBMC suppressor cell was radiation sensitive and was identified as a Leu-2+ cell by fluorescence-activated cell sorting. Thus, depression of cell-mediated immunity during the acute phase of herpes zoster was associated with a relative increase of lymphocytes expressing a suppressor cell phenotype and the activation of a radiosensitive Leu-2+ suppressor cell with some degree of antigen specificity. PMID: 3027175 [PubMed - indexed for MEDLINE] 4680. Med Clin (Barc). 1987 Feb 14;88(6):249-51. [Treatment of herpes infections with acyclovir] [Article in Spanish] Rello J. PMID: 3031392 [PubMed - indexed for MEDLINE] 4681. Postgrad Med J. 1987 Feb;63(736):85-9. Herpes zoster and its neurological complications. Chang CM, Woo E, Yu YL, Huang CY, Chin D. Department of Medicine, Queen Mary Hospital, University of Hong Kong. Ninety-three Chinese patients with cutaneous herpes zoster were seen during a 4-year period. Thoracic zoster occurred most commonly, followed by ophthalmic, cervical and lumbosacral zoster. Neurological complications were present in eleven patients (11.8%), the commonest being Ramsay-Hunt syndrome and segmental limb paresis. The clinical picture, pathogenesis, treatment and outcome of segmental limb paresis, myelitis and delayed contralateral hemiparesis following zoster ophthalmicus are discussed. Nine immunocompromised patients received intravenous adenine arabinoside (vidarabine) or acycloguanosine (acyclovir), and no cutaneous or visceral spread occurred in these patients. PMCID: PMC2428244 PMID: 3671248 [PubMed - indexed for MEDLINE] 4682. Ann Ophthalmol. 1987 Feb;19(2):77-8. Optic neuropathy and central retinal artery occlusion in a case of herpes zoster ophthalmicus. Scharf Y, Kraus E, Zonis S. In this case report the authors present a patient in whom loss of vision developed in the left eye in the early stage of herpes zoster ophthalmicus. He suffered from optic neuropathy followed by central retinal artery occlusion. Ophthalmologists should be aware of this rare and early complication of herpes zoster. PMID: 3566029 [PubMed - indexed for MEDLINE] 4683. Br J Ophthalmol. 1987 Feb;71(2):118-25. The enigma of herpes stromal disease. McGill J. Herpes stromal disease is due to direct damage as a result of viral replication, virally induced immune mechanisms, or a combination of the two. Viral replication may have a major initiating role in the production of herpes simplex and herpes zoster induced stromal disease, and steroids may initially be harmful in their treatment. On topical antiviral drugs alone, in patients who never previously had had topical steroids, 14 of 15 cases of herpes simplex induced disciform keratitis responded favourably in an average of 44 days of treatment. This compared with one out of 14 responding if steroids had previously been used, 13 of 14 requiring topical steroids and an average 112 days' treatment. In herpes zoster stromal disease cases 78% had epithelial involvement, 54 of 57 responded to topical antivirals alone without the use of steroids, 2% recurred, and treatment averaged a total of 62 days. If steroids were used alone or in combination with antivirals, there was a 50% recurrence rate and 200 day total treatment duration. PMCID: PMC1041102 PMID: 3548807 [PubMed - indexed for MEDLINE] 4684. Transplant Proc. 1987 Feb;19(1 Pt 3):2190-3. Effectiveness of oral acyclovir prophylaxis in renal transplant recipients. Stoffel M, Squifflet JP, Pirson Y, Lamy M, Alexandre GP. PMID: 3547919 [PubMed - indexed for MEDLINE] 4685. Kansenshogaku Zasshi. 1987 Feb;61(2):134-9. [Herpes zoster in patients with systemic lupus erythematosus] [Article in Japanese] Kusaba T, Iwahashi T, Hayashida I, Nagasawa K, Hachimine K, Mayumi T. PMID: 3039018 [PubMed - indexed for MEDLINE] 4686. Ital J Neurol Sci. 1987 Feb;8(1):67-70. Zoster sine herpete causing encephalomyelitis. Mancardi GL, Melioli G, Traverso F, Tabaton M, Farinelli M, Terragna A. The case of a patient with encephalomyelitis and laboratory signs of a central nervous system herpes zoster infection without cutaneous lesions is reported. The diagnosis was supported by the serological evidence of intrathecal synthesis of specific antibodies against Varicella-zoster virus (VZV). PMID: 3032844 [PubMed - indexed for MEDLINE] 4687. Infect Control. 1987 Feb;8(2):48. Medical students and community physicians also susceptible to varicella-zoster virus. Murray DL. Erratum in: Infect Control 1987 Aug;8(8):305. PMID: 3030950 [PubMed - indexed for MEDLINE] 4688. Transplant Proc. 1987 Feb;19(1 Pt 3):2142-9. Viral infections in kidney transplant patients immunosuppressed with cyclosporine. Takahashi K, Yagisawa T, Teraoka S, Toma H, Agishi T, Ota K, Kobayashi S. PMID: 3029916 [PubMed - indexed for MEDLINE] 4689. Obstet Gynecol. 1987 Feb;69(2):214-22. Varicella-zoster virus infections during pregnancy: hypothesis concerning the mechanisms of congenital malformations. Higa K, Dan K, Manabe H. An analysis of the data on 52 infants whose mothers had contracted varicella during pregnancy revealed that 27 had congenital malformations ascribed to the maternal varicella infections, while another 25 developed herpes zoster in the early postnatal period. Most of the mothers whose infants had congenital malformations had contracted varicella within the first 20 weeks of gestation, whereas most of the mothers whose infants developed herpes zoster had varicella after 21 weeks of gestation. The clinical features of the various congenital malformations and dysfunctions after maternal varicella were diverse; however, there were peculiar segmental manifestations of anomalies of the skin, the peripheral nervous, the autonomic nervous, and the musculoskeletal systems, all of which receive common innervations from the same levels of the spinal cord. Most other dysfunctions may be ascribed to an encephalitis. Therefore, the mechanism of congenital malformations caused by varicella-zoster virus seems to be due not to fetal varicella but to the development of herpes zoster in utero and to an encephalitis associated with herpes zoster. At least one infant had congenital malformations that were due to maternal herpes zoster infection. PMID: 3027637 [PubMed - indexed for MEDLINE] 4690. J Antimicrob Chemother. 1987 Feb;19(2):255-62. Efficacy of acyclovir combined with immunopotentiating agents in the treatment of varicella-zoster. Tanphaichitra D, Srimuang S. In-vitro and in-vivo evaluation of cellular immune reactions (T-cell subset, E-rosette formation, 2,4-dinitrochlorobenzene, were made in patients with varicella-zoster infection (VZ) and with other intracellular infections. The data demonstrated depressed cellular immunity including a decrease in the number of T-helper cells and a fall in the T-helper/T-suppressor lymphocyte subset ratio to less than 0.7. Three groups of patients with VZ infections were randomly assigned to three regimens: nine patients were given acyclovir alone for five days; ten patients received acyclovir for five days and isoprinosine for ten days; and twelve patients acyclovir for five days and levamisole twice weekly for three weeks. In patients with VZ infections treated with acyclovir and either levamisole or isoprinosine cellular immunity improved faster, while VZ infections in those treated with levamisole healed more rapidly. One patient treated with acyclovir alone had recurrent VZ infection and required a further course of therapy. PMID: 2437095 [PubMed - indexed for MEDLINE] 4691. N Engl J Med. 1987 Jan 15;316(3):166-7. High frequency of herpes zoster in young hemophiliacs. Verroust F, Lemay D, Laurian Y. PMID: 3796690 [PubMed - indexed for MEDLINE] 4692. Pediatr Infect Dis J. 1987 Jan;6(1):84. Acyclovir treatment in a case of facial paralysis caused by herpes zoster. Ivarsson S, Andréasson L, Ahlfors K. PMID: 3822626 [PubMed - indexed for MEDLINE] 4693. J Ky Med Assoc. 1987 Jan;85(1):15-7. Nerve blocks utilizing 0.5% bupivacaine in the treatment of post-herpetic neuralgia. Ackerman WE. PMID: 3819583 [PubMed - indexed for MEDLINE] 4694. Postgrad Med. 1987 Jan;81(1):229-31, 233, 236. Medical complications of herpes zoster in immunocompetent patients. Murray BJ. The vast majority of the more than 300,000 annual cases of herpes zoster in the United States occur among healthy, immunocompetent persons. Most patients recover from reactivated varicella-zoster infection, but some experience complications. The most common of these is postherpetic neuralgia, but other neurologic as well as ocular and dermatologic complications can occur as well. Zoster during pregnancy is not of serious concern. Ongoing trials of antiviral agents are aimed at resolving the infection quickly and decreasing the incidence and severity of postherpetic neuralgia. PMID: 3809038 [PubMed - indexed for MEDLINE] 4695. Anesthesiology. 1987 Jan;66(1):73-6. No prophylactic effect of early sympathetic blockade on postherpetic neuralgia. Yanagida H, Suwa K, Corssen G. PMID: 3800039 [PubMed - indexed for MEDLINE] 4696. J Assoc Pediatr Oncol Nurses. 1987;4(1-2):23-9. Herpes-zoster infections in children with Hodgkin's disease. Hammond E. PMID: 3694499 [PubMed - indexed for MEDLINE] 4697. Eye (Lond). 1987;1 ( Pt 3):413-21. The epidemiology of herpes zoster. Cooper M. Moorfields Eye Hospital, London. The epidemiology of Zoster is analysed by means of data acquired from the Zoster Clinic at Moorfields and the RCGP Research Unit. It complements and extends previous surveys, using much larger and consistent data, showing the effects of age, sex and season. The behaviour in the population as a whole and the pathogenesis are discussed; a model is proposed to explain the characteristics of some of the data, particularly the effects of age and non-specific stresses. PMID: 3653445 [PubMed - indexed for MEDLINE] 4698. Vestn Dermatol Venerol. 1987;(6):41-3. [Generalized forms of herpes in lymphocytic leukemia] [Article in Russian] Raznatovskiĭ IM, Mikheev GN, Iastrebov VV, Ugriumova LF, Kolb ZK. PMID: 3630363 [PubMed - indexed for MEDLINE] 4699. Retina. 1987 Spring;7(1):9-13. Presumed varicella zoster retinitis in immunocompromised patients. Jabs DA, Schachat AP, Liss R, Knox DL, Michels RG. The acute retinal necrosis (ARN) syndrome is a morphologically defined necrotizing retinitis, occurring in apparently otherwise healthy patients. It has been shown that the varicella zoster virus is at least one cause of the ARN syndrome; treatment with acyclovir has proven to be effective for the infectious component of ARN. We report three immunocompromised patients who developed cutaneous herpes zoster and a necrotizing retinitis that was morphologically similar to the ARN syndrome. All three patients responded promptly to treatment with acyclovir, an agent highly effective against varicella zoster and herpes simplex viruses, but ineffective in the treatment of cytomegalovirus. While cytomegalovirus retinitis is more common in immunocompromised patients, these patients may occasionally develop an ARN-like retinitis, presumably as a result of the varicella zoster virus, which responds to treatment with acyclovir. PMID: 3602608 [PubMed - indexed for MEDLINE] 4700. Ter Arkh. 1987;59(4):136-7. [Herpes zoster--an unusual complication of gold therapy] [Article in Russian] Murav'ev IuV, Tsurko VV, Sigidin IaA. The authors observed the development of herpes zoster in 2 rheumatoid arthritic patients against a background of chrysanol therapy. Such a complication should be regarded as an indication for aurum drug cancellation. The study provided an opportunity for specifying some aspects in the mechanism of action and indicated a possible immunodepressive effect. PMID: 3589991 [PubMed - indexed for MEDLINE] 4701. Curr Eye Res. 1987 Jan;6(1):231-5. Acyclovir (Zovirax) ophthalmic ointment: a review of clinical tolerance. Grant DM. Twenty nine published clinical trials with acyclovir (ACV) ophthalmic ointment in the treatment of herpes simplex virus (HSV) corneal disease have been reviewed in which ACV has been demonstrated to be effective in the treatment of simple dendritic ulcers, geographic ulcers, deep corneal HSV infections and ocular disease associated with herpes zoster (VZV) infection affecting the ophthalmic division of the trigeminal nerve. 998 patients were studied. The most commonly occurring adverse reactions were superficial punctate keratopathy (in 9.8% of patients) and burning or stinging on application of the ointment (4%). ACV ophthalmic ointment was first licensed for the treatment of HSV infections of the eye in September 1981. Spontaneous reports of adverse reactions to ACV ophthalmic ointment to both the UK Committee on Safety of Medicines and the Wellcome Group Adverse Reactions Reporting Centre total 43 cases. These include conjunctivitis, inflammation and pain in the treated eye. In this time it is estimated that there have been approximately one million exposures to the ointment. Thus in general use, tolerance to ACV treatment has been extremely good, and clinical trial data demonstrate that it compares favourably with alternative therapies for HSV corneal disease. PMID: 3549163 [PubMed - indexed for MEDLINE] 4702. J Infect. 1987 Jan;14(1):1-5. Herpes zoster and the immunocompromised. Mandal BK. PMID: 3546510 [PubMed - indexed for MEDLINE] 4703. Bull Soc Belge Ophtalmol. 1987;224:9-14. The management of herpes zoster ophthalmicus. Collum LM, Hillery M, McDermott M, Benedict-Smith A, Hope-Ross M, Mullaney P, Kinsella F, Hickey-Dwyer M. PMID: 3509911 [PubMed - indexed for MEDLINE] 4704. Przegl Epidemiol. 1987;41(4):369-75. [Clinical evaluation of herpes zoster in old age] [Article in Polish] Obodowska-Zysk W. PMID: 3502188 [PubMed - indexed for MEDLINE] 4705. Arch Dermatol Res. 1987;279(6):374-8. Reduction of the number of immunocompetent cells in the acute stage of herpes zoster. Baadsgaard O, Lindskov R, Geisler C. Department of Dermatology, Gentofte Hospital, Copenhagen. Circulating and in situ mononuclear cell subsets were phenotypically characterized during both the acute and convalescent phase of herpes zoster infections in 14 patients. In peripheral blood a significant reduction in the absolute number of Leu 4+ T cells, Leu 2a+ suppressor/cytotoxic T cells, Leu 3a+ helper/inducer T cells, Leu 7+ killer cells, and B1+ B cells were found during the acute stage compared to convalescents and normal controls. In contrast no change in the absolute number of MO2+ monocytes was seen in the acute stage of the disease. During convalescence a return to normal values in the lymphocyte subsets and killer cells was seen within 1-2 months after the initial disease presentation. In skin biopsy specimens from 4 of the 14 patients with active herpes zoster lesions the cellular infiltrate consisted of T cells (Leu 4+) the majority being helper/inducer T cells (Leu 3a+). Most of the cells expressed HLA-DR (Ia) antigens and were according to this in an activated state. The observed changes in effector and regulatory cell numbers may have implications for the acquisition of Varicella-zoster virus infections, the immune deficiency state associated with the disease, and/or the immune response to resolve the infection. PMID: 3499870 [PubMed - indexed for MEDLINE] 4706. Clin Exp Neurol. 1987;23:219-24. Herpes zoster arteritis: pathological findings. Mackenzie RA, Ryan P, Karnes WE, Okazaki H. Concord Hospital, New South Wales. This paper describes the pathological findings in two cases of delayed contralateral hemiparesis following herpes zoster arteritis. Both died of cerebral haemorrhage and a necrotizing angiitis was found involving the major vessels of the ipsilateral cerebral hemisphere. No feature of granulomatous arteritis or of encephalitis was found. It is likely that the virus spreads along intracranial branches of the ophthalmic nerve supplying the major arteries and causes the inflammatory reaction by direct invasion of vascular muscle. PMID: 3499267 [PubMed - indexed for MEDLINE] 4707. Fortschr Ophthalmol. 1987;84(3):252-4. [Therapy of bacterial infections in varicella-zoster kerato-uveitis] [Article in German] Bialasiewicz AA, Jahn GJ. PMID: 3497859 [PubMed - indexed for MEDLINE] 4708. Curr Eye Res. 1987 Jan;6(1):195-9. Observations on the natural history of herpes zoster ophthalmicus. Cobo M, Foulks GN, Liesegang T, Lass J, Sutphin J, Wilhelmus K, Jones DB. We have studied certain aspects of the natural history of acute herpes zoster ophthalmicus in placebo-treated patients followed prospectively over one year as part of a therapeutic drug trial. Observations on the incidence of ocular complications relating to the efficacy of oral acyclovir in this disease have been previously published. This report provides supplemental observations on the natural history of frequently observed ocular complications of zoster ophthalmicus: corneal hypesthesia, episcleritis, dendritiform keratopathy, stromal keratitis, anterior uveitis, and post herpetic neuralgia. These ocular complications of zoster typically present within the first two weeks of the diagnosis. This report characterizes the onset of corneal hypesthesia, episcleritis, dendritiform keratopathy, stromal keratitis, and anterior uveitis as well as interrelationships amongst these sequellae of herpes zoster ophthalmicus. Post-herpetic neuralgia occurs in 52% of patients and persists beyond a year in 22% of those affected. PMID: 3493883 [PubMed - indexed for MEDLINE] 4709. Haematol Blood Transfus. 1987;30:182-7. Special aspects of supportive therapy in childhood acute leukemias. Ritter J, Voigt D, Hoese G, Schellong G. PMID: 3476355 [PubMed - indexed for MEDLINE] 4710. Duodecim. 1987;103(23-24):1494. [Management of herpes zoster] [Article in Finnish] Hänninen P. PMID: 3455386 [PubMed - indexed for MEDLINE] 4711. Duodecim. 1987;103(11):714-7. [Varicella zoster encephalitis and its treatment] [Article in Finnish] Savola J, Vehviläinen O, Jussila A. PMID: 3454325 [PubMed - indexed for MEDLINE] 4712. Duodecim. 1987;103(18):1099-1101. [Varicella-zoster encephalitis and its treatment] [Article in Finnish] Suhonen R, Hannuksela M, Karvonen J, Reunala T. PMID: 3450503 [PubMed - indexed for MEDLINE] 4713. Akush Ginekol (Sofiia). 1987;26(6):84-6. [A rare case of a complication in ovarian cancer] [Article in Bulgarian] Simeonova L, Simeonov S. PMID: 3442315 [PubMed - indexed for MEDLINE] 4714. Med Pregl. 1987;40(5-6):217-20. [Herpes zoster in lymphoproliferative diseases] [Article in Croatian] Svilar V, Cvetić L. PMID: 3441234 [PubMed - indexed for MEDLINE] 4715. Zh Nevropatol Psikhiatr Im S S Korsakova. 1987;87(10):1455-7. [Differential diagnosis of paralytic poliomyelitis and paralytic herpes zoster in a child with a congenital immunologic deficiency state] [Article in Russian] Smirnov IuK. A child aged 4 years and 10 months with congenital immunodeficient status (agammaglobulinemia) developed an acute viral disease combined with torpid arm paralysis, which is considered as paralytic zoster. This disorder is differentiated from the spinal form of poliomyelitis. PMID: 3425044 [PubMed - indexed for MEDLINE] 4716. Infection. 1987;15 Suppl 1:S9-13. Oral acyclovir for acute herpes zoster infections in immune-competent adults. Wood MJ, McKendrick MW, McGill JI. Previous studies have shown that intravenous acyclovir does modify rash development, reduce viral shedding and alleviate acute pain in herpes zoster. To assess the clinical efficacy of an oral dosage regimen with 800 mg acyclovir five times daily, double-blind, placebo-controlled studies were carried out at three centres within the U.K., using a common protocol. According to inclusion criteria (immune competent patients over 60 years of age with a clinical diagnosis of herpes zoster with rash of no more than 72 h duration, no previous systemic antiviral treatment, no history of renal insufficiency) 205 patients were recruited after they had given their informed consent. Patients were randomly assigned to receive either two 400 mg tablets acyclovir (41 men, 59 women) or matching placebo (46 men, 59 women) five times daily for seven days. Treatment was predominantly domiciliary based. According to clinical assessment and pain score acyclovir recipients showed a significant benefit in terms of reduction in rash progression if treatment was started within 48 h of the onset of rash, and alleviation of pain during the acute phase of herpes zoster. Overall, the number of patients developing extradermal lesions was significantly lower in the acyclovir group than in the placebo group (p = 0.02). However, there were no significant differences in rash progression and pain response in patients with herpes zoster affecting the ophthalmic division of the trigeminal nerve in patients who received acyclovir (n = 21) compared to those who received placebo (n = 32). 12 acyclovir and 13 placebo recipients reported symptoms, predominantly gastrointestinal in nature, possibly or probably related to therapy.(ABSTRACT TRUNCATED AT 250 WORDS) PMID: 3298071 [PubMed - indexed for MEDLINE] 4717. Clin Exp Neurol. 1987;24:169-74. Herpes zoster arteritis. Clinical and angiographic features. Herkes GK, Storey CE, Joffe R, Mackenzie RA. Department of Neurology, Royal North Shore Hospital, NSW. Herpes zoster ophthalmicus is a common condition, and has now been widely recognised as associated with the delayed onset of neurological events, associated with angiographic evidence of arteritis. The time lag between the zoster and subsequent neurological symptoms, along with the age of the patients, often leads to a missed diagnosis. As more cases are recognised, the pathogenic mechanisms will be better characterised and treatment may become more effective. PMID: 3268343 [PubMed - indexed for MEDLINE] 4718. Arch Odonto Estomatol. 1987 Jan-Feb;3(1):45-8. [Herpes zoster with bilateral involvement of the oral mucosa] [Article in Spanish] Bullón Fernández P, Camacho Martínez F. PMID: 3136734 [PubMed - indexed for MEDLINE] 4719. Cornea. 1987;6(4):283-5. Secondary bacterial keratitis in herpes zoster ophthalmicus. Lyon DB, Newman SA. Department of Ophthalmology, University of Virginia School of Medicine, Charlottesville 22903. We report a case of an unusual complication of herpes zoster ophthalmicus, secondary bacterial keratitis. Compared with previously reported cases, ours is unique in its early occurrence in the course of zoster and the lack of predisposing factors such as steroid use, contact lens use, or prior corneal disease or surgery. The opportunistic pathogen Branhamella cattarhalis responded well to medical therapy. We feel that bacterial superinfection must always be a concern in patients with herpes zoster keratitis, even early in their often prolonged chronic disease. PMID: 3121255 [PubMed - indexed for MEDLINE] 4720. Pediatrician. 1987;14 Suppl 1:15-7. Differential diagnosis of unusual skin diseases in infants. Honda M. There are a number of relatively unique clinical skin diseases that may develop on the buttocks of infants. These include iatrogenic skin diseases caused by external medicine; skin tumors caused by methylrosaniline chloride (Pyoktanin); atrophy of the skin due to steroidal liniments; nevus and tumor diseases, such as nevoxanthoendothelioma and Letterer-Siwe disease. Finally, there is chronic granulomatous disease. These unusual cases are reviewed and their differential diagnoses discussed. PMID: 3110751 [PubMed - indexed for MEDLINE] 4721. Infection. 1987;15 Suppl 1:S32-3. Management of viral infections in AIDS patients. Drucker JL, King DH. Viral infections, predominantly those of the herpes virus family, account for up to 16% of all clinically significant infections in AIDS patients. Acyclovir has provided successful treatment in AIDS patients suffering from severe herpes simplex and herpes zoster virus infections. Preliminary results are presented on newly developed acyclovir analogues. Desciclovir, an oral prodrug of acyclovir which is metabolized to acyclovir in vivo, allows treatment of virus infections per os, where high serum levels are needed, e.g. in Epstein-Barr virus infections. BW B759U, another analogue of acyclovir, has been used for the treatment of life-threatening or sight-threatening cytomegalovirus infections in AIDS patients. More than 80% of the patients treated for retinitis experienced stabilization or clinical improvement. Antiviral efficacy was demonstrated in 73% of the patients. Azidothymidine, a nucleoside analogue of thymidine, has been developed specifically to treat the HIV infection. Its antiviral activity is based on inhibition of reverse transcriptase. Phase I studies have demonstrated that azidothymidine is well tolerated. Its ability to cross the blood brain barrier makes it an attractive candidate for treatment of HIV. Trials to determine efficacy are in progress. PMID: 3036716 [PubMed - indexed for MEDLINE] 4722. Laryngol Rhinol Otol (Stuttg). 1987 Jan;66(1):41-4. [Therapy of herpes simplex and varicella zoster infections in the ENT area] [Article in German] Elies W, Hermes H, Schlöndorff G. The article reports on 41 patients having infections induced by Herpes simplex and Herpes zoster virus. Systemic intravenous administration of acyclovir results in a very rapid reduction of pain and mucosal changes in herpetic stomatitis. In cutaneous lesions of the trigeminal nerve branches induced by Herpes zoster virus there is also a very rapid reduction of pain and efflurescence after 3 days. In 16 patients suffering from Ramsay Hunt syndrome, also known as Herpes zoster oticus, lesions of the facial nerve function were present. 8 Patients demonstrated cochleovestibular signs and symptoms, 2 had flat inner ear hearing loss of 40 dB, 1 reduced unilateral caloric response. Treatment was effected by intravenous administration of acyclovir and simultaneous classical symptomatic therapy consisting of intravenously administered dextrane, cortisone and antiinflammatory drugs. Symptomatic therapy is necessary because acyclovir stops the replication of viruses but does not influence the disturbed nerve function. In 2 cases with a damage of more than 90% of the facial nerve fibres, endaural decompression of the geniculate ganglion was performed. Cochleovestibular deficits improved to normal during one week and all facial lesions within 8 months. Drug-related side effects were seen in one patient who had an exanthema. PMID: 3031395 [PubMed - indexed for MEDLINE] 4723. Pediatr Infect Dis J. 1987 Jan;6(1):56-8. Oral therapy with acyclovir in infants and children. Arvin AM. PMID: 3029659 [PubMed - indexed for MEDLINE] 4724. J Med Virol. 1987 Jan;21(1):57-66. Detection of varicella-zoster virus in lymphocytes by DNA hybridization. Vonsover A, Leventon-Kriss S, Langer A, Smetana Z, Zaizov R, Potaznick D, Cohen IJ, Gotlieb-Stematsky T. The availability of cloned varicella-zoster virus (VZV) DNA probes allows rapid detection of viral-specific DNA by "dot-blot" hybridization in lymphocytes or in lesion aspirates. Thirty-six blood specimens were obtained from 25 patients with suspected varicella or zoster. VZV-specific DNA was demonstrated in 15 lymphocyte preparations of nine patients with varicella and in one with disseminated zoster out of five patients with zoster. VZV-specific DNA was detected prior to rise in antibodies, indicating early viremia in these patients. Virus isolation from lesions and serological tests confirmed VZV infections. VZV-specific DNA was detected in lymphocytes of three patients out of six with active herpetic lesions, whereas it was not detected in lymphocyte specimens from two patients with undiagnosed rash or four with lymphoproliferative diseases, who did not present varicella or zoster, or from 18 healthy controls. No signal was obtained in herpes simplex virus (HSV)-infected and -uninfected cell lines. The hybridization assay proved that specific and viral or cellular DNAs other than VZV did not cross-hybridize with the probe. The sensitivity limit of detection was 4-15 pg of homologous DNA, and the assay was accomplished within 72-96 hr. These results point to the possible rapid diagnosis of VZV infection in patients suspected of varicella or generalized zoster. In addition, simultaneous infection with both VZV and HSV seems to occur in some patients. PMID: 3025357 [PubMed - indexed for MEDLINE] 4725. Viral Immunol. 1987;1(2):145-52. T-cell imbalances and NK activity in varicella-zoster virus infections. Cauda R, Prasthofer EF, Tilden AB, Whitley RJ, Grossi CE. Clinica Malattie Infettive, Universita Cattolica S. Cuore, Roma, Italy. Samples of peripheral blood lymphocytes (PBMC) were serially obtained from 30 patients with herpes zoster (HZ) and 10 patients with chickenpox (CP). Cells were assayed for NK-cell function and for the expression of surface membrane antigens which identify T-cell and NK-cell subsets. During the acute phase of disease (less than 7 days from onset), PBMC from patients with HZ had low proportions of T-helper (CD 4+) cells and a large number of T-suppressor (CD 8+) cells, resulting in a low T-helper/T-suppressor ratio. There was an increased percentage of nonspecific suppressor cells (GD 8+-CD 11+ cells) and increased expression of HLA-DR determinants on both CD 8+ and CD 4+ cells. The NK activity was depressed with no concomitant decrease in NK cells (CD 16+ or Leu 7+ cells). In the early convalescing phase of disease (8-14 days), there was a significant increase in CD 16+ cells and increased expression of HLA-DR on these cells, correlating with increased NK activity. In the late recovery phase (greater than 14 days), NK activity and levels of T-cell subpopulations were normal with the exception of increased CD 4+ cells and, consequently, of the helper/suppressor ratios. In the acute phase of CP (less than 7 days), the T-cell imbalances were similar to those encountered with HZ patients.(ABSTRACT TRUNCATED AT 250 WORDS) PMID: 2978454 [PubMed - indexed for MEDLINE] 4726. Arch Dermatol Res. 1987;279 Suppl:S52-4. Cutaneous pseudolymphoma at the site of prior herpes zoster eruption. Wolff HH, Wendt V, Winzer M. Clinic of Dermatology and Venereology, Medical University of Lübeck, Federal Republic of Germany. A 55-year old woman with a history of herpes zoster in the dermatome supplied by the mandibular branch of the trigeminal nerve developed cutaneous red papules and umbilicated nodules within the same segment. The clinical and histological diagnosis was pseudolymphoma. The lesions showed a polymorphous infiltrate without germinal center formation. Immunologic phenotyping with monoclonal antibodies revealed the predominance of helper T cells and distinct compartmentalization of B and T cells. The lesions healed up within 7 weeks. The development of pseudolymphomas at the site of previous herpes zoster eruptions seems to be extremely rare. PMID: 2959212 [PubMed - indexed for MEDLINE] 4727. Acta Virol. 1987 Jan;31(1):19-24. Varicella-zoster virus IgM antibody fraction separated by minicolumn gel filtration in serodiagnosis of acute infection. Kovác J, Zachar V, Reichel M, Necas S. Gel filtration through Sephadex G-200 or Ultrogel AcA 34 minicolumns was applied to isolate IgM antibodies from sera of patients with varicella and herpes zoster (HZ). Serum samples were stained with Sudan III and Evan's Blue in order to monitor the separation process visually when running several columns at the same time. The presence of specific IgM antibodies was demonstrated by enzyme linked immunosorbent assay (ELISA). Rapid separation of stained sera by diffusion chromatography on minicolumns with successive determination of specific IgM antibodies in ELISA proved suitable for serological diagnosis of varicella, whereas the significance of IgM-specific antibody response in HZ seems uncertain. PMID: 2883853 [PubMed - indexed for MEDLINE] 4728. Arch Virol. 1987;93(1-2):1-12. Genome variation among varicella-zoster virus isolates derived from different individuals and from the same individuals. Hondo R, Yogo Y, Kurata T, Aoyama Y. We have used 12 restriction enzymes to analyse the DNA of 24 clinical isolates of VZV derived from 12 patients in order to compare isolates derived from different individuals and derived serially from the same individual. As reported previously, only a small proportion of the isolates differed with respect to the presence or absence of restriction sites. However, we found that the size of DNA fragments generated from all the isolates derived from different patients varied in any of four regions, one of which was first recognized in this study. In one case, where multiple isolates recovered from the same individual were analysed, each was distinguished from the others not only by differences in the variable regions but also by the presence or absence of a restriction site in a nonvariable region. This suggests that multiple strains of VZV can be present in the same human host. PMID: 2880576 [PubMed - indexed for MEDLINE] 4729. Ann Fr Anesth Reanim. 1987;6(6):523-4. [Zona after spinal anesthesia: coincidence or consequence?] [Article in French] Junke E, Boussard N, Pertek JP, Coissard A, Helmer J. Département d'Anesthésie-Réanimation, CHU de Nancy-Brabois, Vandoeuvre-lès-Nancy. A case is reported of a herpes zoster infection occurring a few days after spinal anaesthesia in a man with severe cardiac disease who had undergone transurethral endoscopic resection of a prostatic epithelioma. The question as to whether there was a relationship between the two events had to be asked, all the more so as the rash seemed to be centered on the puncture wound. Others factors involved may have been the effect of anaesthesia on the body's defence mechanisms, the use of prophylactic antibiotics and the neoplasm. PMID: 2450493 [PubMed - indexed for MEDLINE] 4730. Arch Dermatol Res. 1987;279(4):283-4. Rosette-formation in herpes simplex and herpes zoster lesions as demonstrated in Tzanck smears. Nieboer C, Beljaards R, van der Veen JP. Free University Hospital, Department of Dermatology, Amsterdam, The Netherlands. PMID: 2445307 [PubMed - indexed for MEDLINE] 4731. Annu Rev Med. 1987;38:51-9. Interferon for the treatment of infections. Ho M. Interferon, both natural and recombinant, has been shown in controlled clinical studies to be effective against herpes simplex virus infections, herpes zoster, the common cold caused by rhinoviruses, and some papilloma virus infections. In some cases, it is in competition with other antivirals, and in others its precise clinical indication is still unclear. Thus, further work and developments are required before interferon becomes a clinically recognized antiviral agent. PMID: 2437854 [PubMed - indexed for MEDLINE] 4732. Presse Med. 1986 Dec 20;15(45):2255. [Peripheral neurogenic bladder due to perineal zona] [Article in French] Amarenco G, Savatovsky I, Amarenco P, Goudal H. PMID: 2949262 [PubMed - indexed for MEDLINE] 4733. Hosp Pract (Off Ed). 1986 Dec 15;21(12):16, 21. Xylocaine treatment for acute herpes zoster. Stadtner DA. PMID: 3098751 [PubMed - indexed for MEDLINE] 4734. Br Med J (Clin Res Ed). 1986 Dec 13;293(6561):1536-7. Effectiveness of intravenous acyclovir in immunocompetent patient with herpes zoster encephalitis. Whyte MK, Ind PW. PMCID: PMC1342310 PMID: 3099946 [PubMed - indexed for MEDLINE] 4735. Br Med J (Clin Res Ed). 1986 Dec 13;293(6561):1529-32. Oral acyclovir in acute herpes zoster. McKendrick MW, McGill JI, White JE, Wood MJ. Oral acyclovir at a dose of 800 mg five times daily for seven days was compared with placebo in a randomised double blind trial conducted at three centres in the United Kingdom. The study group comprised 205 elderly immune competent patients suffering from herpes zoster who were entered within 72 hours of the onset of rash. Acyclovir significantly reduced the times to arrest of new lesion formation (p = 0.005), loss of vesicles (p less than 0.001), and full crusting (p = 0.02) in those patients entered within 48 hours of the onset of rash. In addition, there was a significant reduction in pain during treatment with acyclovir as compared with placebo (p = 0.008). Of the patients with severe pain on entry, 40% (10/25) of those treated with acyclovir had no or only mild pain at the end of treatment, whereas in the placebo group all had residual moderate or severe pain (p less than 0.001). No clinically important adverse effects of acyclovir were reported. Oral acyclovir may modify acute herpes zoster and reduce pain. PMCID: PMC1342307 PMID: 3099943 [PubMed - indexed for MEDLINE] 4736. Br Med J (Clin Res Ed). 1986 Dec 13;293(6561):1523. Acyclovir update. Jeffries DJ. PMCID: PMC1342302 PMID: 3099939 [PubMed - indexed for MEDLINE] 4737. Ital J Neurol Sci. 1986 Dec;7(6):617-22. Herpes zoster myelitis: nervous system complications. Boiardi A, Ferrante P, Porta E, Sghirlanzoni A, Bussone G. Transverse myelitis after a zoster viral infection is an exceptional occurrence. In this case we documented an antibody activity against varicella zoster (V-Z) in the cerebrospinal fluid in association with Coxsackie A enterovirus. The clinical course was atypical because of a second episode of myelitis 2 years after the first episode of neurologic viral complications. The positive outcome of therapy with Acyclovir is noteworthy. This case was retrieved in a review of neurologic complications observed in the last few years in patient affected by zoster in our hospital. PMID: 3804716 [PubMed - indexed for MEDLINE] 4738. Arch Dermatol. 1986 Dec;122(12):1357-8. Metastatic transitional cell carcinoma mimicking zoster sine herpete. Jaworsky C, Bergfeld WF. PMID: 3789766 [PubMed - indexed for MEDLINE] 4739. Am J Dis Child. 1986 Dec;140(12):1213-4. Prognosis of herpes zoster in healthy children. Garty BZ, Danon YL, Nitzan M, Ingber A. PMID: 3776930 [PubMed - indexed for MEDLINE] 4740. J Rheumatol. 1986 Dec;13(6):1190-1. Herpes zoster: serological study and cranial giant cell arteritis. Barrier JH, de Haldat du Lys F, Billaudel S, Peltier D, Ponge T. PMID: 3560114 [PubMed - indexed for MEDLINE] 4741. Ann Neurol. 1986 Dec;20(6):651-64. Acute herpetic and postherpetic neuralgia: clinical review and current management. Portenoy RK, Duma C, Foley KM. The pain of acute herpes zoster (HZ) may be severe, but it is usually transitory. A minority of patients, with the elderly at particular risk, go on to develop persistent, severe, often disabling pain called postherpetic neuralgia. Though the clinical features of these conditions are well known, the pathology of PHN is poorly described and the pathogenesis of the pain in both remains conjectural. During the past 60 years, an extraordinary number of pharmacological, anesthetic, and surgical therapies have been applied in an attempt to ameliorate the symptoms of acute herpes zoster, enhance its healing, prevent its transition to postherpetic neuralgia, and treat the pain of those with this complication. Relatively few treatments have been studied in a controlled manner, and fully reliable, safe, and effective therapeutic approaches for preventing and treating postherpetic neuralgia have not yet been found. This review summarizes current information on the epidemiology, clinical features, and pathology of herpes zoster and postherpetic neuralgia, and critically examines the accumulated experience with the various treatments. Guidelines for management are suggested. PMID: 3545049 [PubMed - indexed for MEDLINE] 4742. Klin Monbl Augenheilkd. 1986 Dec;189(6):486-90. [Complications following temporary occlusion of the nasolacrimal duct with tissue adhesive (Histoacryl)] [Article in German] Köhler U. This paper presents 4 cases in which the punctum had been temporarily occluded with tissue adhesive, still showing toxic tissue reaction years later. Abscess, dacryocystitis, dacryocystitis with dacryolithiasis, dacryocellulitis and polyposis were found. In the light of these findings and the relevant literature-especially with regard to late injuries-it is not advisable to use tissue adhesive, at least not for the purpose of punctal occlusion. PMID: 3494156 [PubMed - indexed for MEDLINE] 4743. Acta Neurol Scand. 1986 Dec;74(6):460-6. Herpes zoster ophthalmicus with cerebral angiitis and reduced cerebral blood flow. Gjerstad L, Nyberg-Hansen R, Bjørland O, Nakstad P, Russell D, Rootwelt K. Two patients with herpes zoster ophthalmicus (HZO) who experienced a delayed contralateral hemiparesis, the so-called crossed zoster syndrome, are described. Particular emphasis is paid to the cerebral blood flow (CBF) findings studied with the Xenon-133 inhalation technique using single photon emission computed tomography (SPECT). In a 40-year-old female with right-sided hemiparesis, angiography showed multiple segmental narrowings of the intracerebral arteries. Cerebral computer tomography (CT) scans were normal. The CBF studied 11 months after the HZO showed a generalized reduction of flow which, however, was more pronounced in the left hemisphere. On re-examination 8 months later both the mean hemispheric flow and regional CBF (rCBF) had increased to normal values. In a 66-year-old male with dysphasia and right-sided hemiparesis, cerebral CT scans demonstrated two small deep left-sided infarcts. CBF examination showed a generalized reduction of flow in the left hemisphere. The flow was slightly increased on re-examination 12 months later. These findings suggest that the Xenon-133 inhalation method represents a useful way to demonstrate the CBF pattern in this group of patients. PMID: 3493617 [PubMed - indexed for MEDLINE] 4744. Biken J. 1986 Dec;29(3-4):91-7. Antibody responses to early antigens of varicella-zoster virus (VZV) during varicella and zoster. Namazue J, Kato T, Yamanishi K, Takahashi M, Asano Y, Muraki R. The antibody responses to membrane and early antigens and thymidine kinase of varicella-zoster virus (VZV) were studied in sera during both varicella and zoster by a test with fluorescent antibody to membrane antigen (FAMA), staining the biochemically transformed cells by the immunofluorescent technique and neutralization of virus-specific thymidine kinase activity, respectively. Similar increases in FAMA antibody titers were demonstrated in sera from patients with varicella and zoster. IgM was detected in both groups, but appeared earlier during varicella than during zoster. Furthermore, the antibody titers to early antigens and virus-specific thymidine kinase were higher in patients with zoster than in those with varicella. These data suggest that different types of antibody responses occur during varicella and zoster. PMID: 3039973 [PubMed - indexed for MEDLINE] 4745. Cutis. 1986 Dec;38(6):363-5. Response of varicella zoster virus and herpes zoster to silver sulfadiazine. Montes LF, Muchinik G, Fox CL Jr. The addition of silver sulfadiazine to cultures of varicella zoster virus resulted in inactivation of the viral infectivity. At a concentration of 10 micrograms/ml or higher the virus was inactivated after thirty minutes exposure at 37 degrees C. Forty-two patients with herpes zoster were treated topically with 1 percent silver sulfadiazine cream applied four times a day. All patients experienced complete drying of vesicles, marked reduction erythema and edema, and striking elimination of pain and burning sensation within twenty-four to seventy-two hours. The sooner the treatment began after the onset of symptoms, the more dramatic was the response. Postherpetic neuralgia was either mild or did not occur. Signs of local, systemic, or laboratory-documented toxicity were not observed. PMID: 3026736 [PubMed - indexed for MEDLINE] 4746. Int Ophthalmol. 1986 Dec;9(4):247-51. Isolation of the human T-cell leukemia/lymphotropic virus type III from aqueous humor in two patients with perivasculitis of the retinal vessels. Kestelyn P, Van de Perre P, Sprecher-Goldberger S. The human T-cell leukemia/lymphotropic virus type III (HTLV-III) has been isolated from aqueous humor in two patients with perivasculitis of the peripheral retinal vessels, an AIDS-related ocular manifestation. Both patients had antibodies to HTLV-III and although they presented with herpes zoster ophthalmicus, they did not present other symptoms known to be associated with HTLV-III infection. The isolation of HTLV-III from aqueous humor in these two patients with retinal perivasculitis suggests that the virus itself may play a role in the etiology of this ocular sign. The presence of infectious HTLV-III in the anterior chamber further emphasises the necessity to discard corneas from HTLV-III infected donors. PMID: 2432026 [PubMed - indexed for MEDLINE] 4747. Hosp Pract (Off Ed). 1986 Nov 30;21(11A):81, 84-6, 92-3. Managing the pain of herpes zoster. Sandrock NJ, Warfield CA. PMID: 3097040 [PubMed - indexed for MEDLINE] 4748. Br Med J (Clin Res Ed). 1986 Nov 22;293(6558):1349-51. Thirty one years of herpes zoster in a rural practice. Wilson JB. The principal finding in this study of 151 cases of herpes zoster in a rural practice was the predominance of patients who had a lesion on the right side. This supports the proposition that the site of occurrence may be determined by repeated trauma. The decline in the frequency of attacks in older men was significant. Studying these cases and published reports has elucidated some of the problems of the occurrence and distribution of herpes zoster in the body, which still await definition. Others may be encouraged to carry these studies further. PMCID: PMC1342060 PMID: 3098346 [PubMed - indexed for MEDLINE] 4749. Orv Hetil. 1986 Nov 16;127(46):2805-7. [Otic zoster (Hunt syndrome)] [Article in Hungarian] Karg E, Kishonti J, Kosaras B. PMID: 3796978 [PubMed - indexed for MEDLINE] 4750. Wiad Lek. 1986 Nov 15;39(22):1532-4. [Cryotherapy of herpes zoster] [Article in Polish] Kudejko J, Tyszlukiewicz D, Przyszlak-Szabała M. PMID: 3554766 [PubMed - indexed for MEDLINE] 4751. Ugeskr Laeger. 1986 Nov 3;148(45):2916-8. [The Marstock method. A method for measuring sensitivity and pain thresholds] [Article in Danish] Fogh H, Bisgaard H, Kristensen JK. PMID: 3787833 [PubMed - indexed for MEDLINE] 4752. Ophthalmology. 1986 Nov;93(11):1418-22. Acute retinal necrosis syndrome following herpes zoster dermatitis. Yeo JH, Pepose JS, Stewart JA, Sternberg P Jr, Liss RA. The acute retinal necrosis (ARN) syndrome has been recently linked to intraocular infection with one or more members of the herpesvirus family. The authors report two cases of ARN following herpes zoster skin eruptions, and one case following ipsilateral facial nerve palsy (Ramsay Hunt syndrome). Evaluation of serial serum antibody titers against cytomegalovirus (CMV), herpes simplex virus (HSV) (types 1 and 2), and varicella zoster (VZ) virus revealed diagnostic changes for VZ virus alone following the retinitis. Immune precipitation of radiolabeled VZ proteins by these sera followed by gel fractionation yielded radioimmune precipitation profiles characteristic of a recent zoster reactivation. These cases further implicate a central role for VZ virus infection in the etiology of the ARN syndrome. PMID: 3808602 [PubMed - indexed for MEDLINE] 4753. J Am Acad Dermatol. 1986 Nov;15(5 Pt 1):1049-50. Granuloma annulare arising after herpes zoster. Shideler SJ, Richards M. PMID: 3782519 [PubMed - indexed for MEDLINE] 4754. Postgrad Med. 1986 Nov 1;80(6):211-3, 216. Neurogenic bladder from occult herpes zoster. Rothrock JF, Walicke PA, Swenson MR. Active infection with herpes zoster may cause acute urinary retention, especially when it involves sacral dermatomes. Although frank retention usually develops days to weeks after eruption of the typical rash, bladder incompetence infrequently develops first, raising concern over other, more ominous etiologies. In the case presented, rash appearance was delayed until six weeks after the initial onset of urinary retention, a much longer interval than previously reported. Occult herpes zoster infection should be considered in patients presenting with an acute neurogenic bladder of obscure cause. PMID: 3774661 [PubMed - indexed for MEDLINE] 4755. Geriatrics. 1986 Nov;41(11):67-9, 74-7, 80. Management of common infections in the elderly outpatient. Nagami P. Bacteriuria is not thought to cause progressive renal damage in the asymptomatic adult. Therefore, in the elderly patient with relapsing asymptomatic bacteriuria, further antibiotic therapy may be withheld, and the patient instructed to return in the event of symptomatic exacerbations. Postherpetic neuralgia is particularly frequent and severe in the elderly, occurring in 25 to 40% of patients over age 60 with herpes zoster. When the patient is seen within the first week, a 3-week regimen of oral corticosteroid therapy may shorten the duration of neuralgia. PMID: 3770484 [PubMed - indexed for MEDLINE] 4756. Geriatrics. 1986 Nov;41(11):34-6, 41-3, 47-8. Postherpetic neuralgia: a workable treatment plan. Portenoy RK. Management of established postherpetic neuralgia should proceed on several fronts simultaneously and may include pain-oriented treatments that are pharmacologic, neuroaugmentative, anesthetic, physiatric, psychological, and surgical. Many patients develop a pattern of abnormal illness behavior, manifesting loss of interest in work or avocations, social withdrawal, and disturbance of family roles. Improvement in these impairments must be a goal that is as important as amelioration of the pain itself. PMID: 3770482 [PubMed - indexed for MEDLINE] 4757. Indian J Pediatr. 1986 Nov-Dec;53(6):817-9. Lacrimal canalicular obstruction following herpes zoster ophthalmicus. Panda A, Vasisht S, Patnaik NK. PMID: 3493218 [PubMed - indexed for MEDLINE] 4758. Klin Padiatr. 1986 Nov-Dec;198(6):471-5. [Herpesvirus infections in children with acute lymphatic leukemia] [Article in German] Färber I, Sauerbrei G, Wutzler P, Weinmann G. 33 children with acute lymphatic leukemia and 33 healthy controls were longitudinally studied for herpesvirus infections. Active herpes simplex-virus, varicella-zoster virus and cytomegalovirus (CMV) infections were more frequent in patients than in controls. CMV and Epstein-Barr virus infections were often inapparent or associated with infections of the upper respiratory tract. Analysis of serological datas revealed a coincidence of active CVM infection and lethal course of the leukemia. This may be a result of the immunodeficiency in leukemia patients caused by disease and therapy. An additional influence of the immunosuppressive effect of active CMV infections on the course of the disease is discussed. PMID: 3027445 [PubMed - indexed for MEDLINE] 4759. J Clin Pathol. 1986 Nov;39(11):1254-8. Importance of anticomplement immunofluorescence antibody titration for diagnosing varicella-zoster virus infection in Bell's palsy. Shigeta S, Baba M, Ogata M, Nozaki H, Okuaki A, Nakamura S. Anticomplement Immunofluorescence was used for antibody titration against varicella-zoster virus (VZV) in 43 patients with peripheral facial palsy. Nine of 31 patients (29%) with Bell's palsy and eight of 12 patients (75%) with Ramsey-Hunt syndrome had anticomplement immunofluorescence antibody titres of greater than or equal to 1/10. On the other hand, none of 14 patients with herpes simplex virus (HSV) infection and 51 healthy adults showed anticomplement immunofluorescence antibody titres of greater than or equal to 1/10. The anticomplement immunofluorescence antibody titre in two patients with Ramsey-Hunt syndrome increased later and decreased sooner than the indirect immunofluorescence antibody titre, becoming undetectable at 66 and 104 days, respectively, after onset of the disease. There was no cross reaction between anti-VZV and anti-HSV antibodies in the patients who showed a positive antibody rise for VZV. As the acute stage of VZV infection is obscure in the patients with peripheral facial palsy without herpes the screening of anticomplement immunofluorescence antibody to VZV at titres greater than or equal to 1/10 may be useful for the diagnosis of VZV infection in patients with peripheral facial palsy. PMCID: PMC1140774 PMID: 3025268 [PubMed - indexed for MEDLINE] 4760. Am J Med. 1986 Nov;81(5):775-8. Herpes zoster and zosteriform herpes simplex virus infections in immunocompetent adults. Kalman CM, Laskin OL. Among 111 immunocompetent patients referred to a general hospital setting with the clinical diagnosis of herpes zoster, viral cultures were obtained from 47 patients. Six of these patients (13 percent) had herpes simplex virus isolated, with four of the six infections involving the facial distribution, and the other two involving the T4 (breast) distribution. Excluding those in whom herpes simplex virus was isolated, the mean age (+/- SD) of the remaining 105 patients was 50 +/- 19 years. Thirty-two percent of the patients were at least 65 years old; however, 39 percent were younger than 40 years of age. Thus, herpes zoster frequently occurs in young, immunocompetent adults. Also, since zosteriform rashes may be caused by herpes simplex virus, viral cultures of lesions are useful to differentiate infections caused by herpes simplex virus from those due to varicella-zoster virus. The need to distinguish between these two viruses may be important with the advent of antiviral drugs and for use of the proper epidemiologic isolation procedures. PMID: 3022586 [PubMed - indexed for MEDLINE] 4761. Am J Public Health. 1986 Nov;76(11):1362-3. Varicella-zoster dilemma: common sense in medical education. Murray DL, Cleveland RP, Keefe C. PMCID: PMC1646741 PMID: 3021007 [PubMed - indexed for MEDLINE] 4762. Med Clin (Barc). 1986 Oct 18;87(12):522. [Meningoencephalitis and paralysis of the 3d pair of cranial nerves as a complication of herpes zoster in an immunocompetent patient] [Article in Spanish] Domínguez A, González J, Olascoaga B, Peña JM. PMID: 3491265 [PubMed - indexed for MEDLINE] 4763. Am J Ophthalmol. 1986 Oct 15;102(4):531-2. Oral acyclovir in the treatment of acute herpes zoster ophthalmicus. Büchi ER, Herbort CP, Ruffieux C. PMID: 3532807 [PubMed - indexed for MEDLINE] 4764. Am J Ophthalmol. 1986 Oct 15;102(4):532-3. A new fundus finding in patients with zoster ophthalmicus. Amano Y, Ohashi Y, Haruta Y, Kinoshita S, Tano Y, Manabe R. PMID: 3490181 [PubMed - indexed for MEDLINE] 4765. Hosp Pract (Off Ed). 1986 Oct 15;21(10):92C-92K, 92O-92P, 92S passim. Pain and its management. Lasagna L. PMID: 3093498 [PubMed - indexed for MEDLINE] 4766. Ital J Neurol Sci. 1986 Oct;7(5):541-3. Lumbosacral herpes zoster myelitis. Schoenhuber R, Bortolotti P, Panzetti P, Guerzoni MC, Colombo A. We present a case of herpes zoster (HZ) with some uncommon features, namely lumbar localization and muscle weakness with a distribution different from the site of cutaneous eruptions and sensory deficits. Spread of HZ virus from sensory ganglion to anterior horn cells seems the only possible explanation of these clinical features. Urinary retention and CSF data confirm the hypothesis of HZ myelitis. PMID: 3804709 [PubMed - indexed for MEDLINE] 4767. Aust Fam Physician. 1986 Oct;15(10):1343-4. Herpes zoster. Newton-John H, Murtagh J. PMID: 3778348 [PubMed - indexed for MEDLINE] 4768. Am J Dermatopathol. 1986 Oct;8(5):456-8. Giant cells in lesions of varicella and herpes zoster. King DF, King LA. PMID: 3777382 [PubMed - indexed for MEDLINE] 4769. Pediatrics. 1986 Oct;78(4 Pt 2):723-7. Population-based studies of varicella complications. Guess HA, Broughton DD, Melton LJ 3rd, Kurland LT. Population-based data on varicella complications are presented using information both from national sample surveys of hospitalizations and physician office visits and from reviews of medical records for all cases occurring within one community (Olmsted County, Minnesota) during a specified period. Acute cerebellar ataxia is the most common neurologic complication of varicella and occurs about once in 4,000 varicella cases among children younger than 15 years of age. Among adults, varicella pneumonia is the most common complication and results in hospitalization about once in every 400 varicella cases. Overall, varicella accounts for approximately 4,000 hospitalizations and 364,000 physician office visits annually in the United States and represents an important continuing source of childhood and adult morbidity. PMID: 3763290 [PubMed - indexed for MEDLINE] 4770. J Med Virol. 1986 Oct;20(2):127-34. Comparative trial of acyclovir and vidarabine in disseminated varicella-zoster virus infections in immunocompromised patients. Vildé JL, Bricaire F, Leport C, Renaudie M, Brun-Vézinet F. A comparative assessment of vidarabine and acyclovir in the treatment of varicella and disseminated zoster in immunosuppressed patients was undertaken. Thirty-eight immunosuppressed patients with varicella (N = 18) or disseminated zoster (N = 20) were treated intravenously with 10 mg/kg/day of vidarabine or 30 mg/kg/day of acyclovir for 5 days according to a preestablished code within each diagnosis group--varicella and disseminated zoster. Two deaths, although not directly related to VZV infection, were observed in the vidarabine-treated varicella group. The times to cessation of formation of new lesions and to the disappearance of fever were similar for vidarabine and acyclovir in each group. In the varicella group, VZV was isolated on day 5 in four out of five vidarabine patients versus one out of five acyclovir patients. No severe adverse effects were observed with either drug. Neutropenia present in patients of both drug groups was transitory and most often related to previous cytolytic chemotherapy. These data suggest that either vidarabine or acyclovir could be used in the treatment of severe VZV infections in immunosuppressed patients, although a larger number of patients would be required for definitive conclusion. Because of the large amount of solute required for vidarabine administration, acyclovir may be preferred when the risk of cardiorespiratory failure is high. PMID: 3534140 [PubMed - indexed for MEDLINE] 4771. Bull Soc Ophtalmol Fr. 1986 Oct;86(10):1239-40. [The ophthalmic zona-ipsilateral cerebral ischemia syndrome] [Article in French] Bec P, Camuzet F, Maillard P, Mathis A, Arne JL. PMID: 3495359 [PubMed - indexed for MEDLINE] 4772. Aust N Z J Surg. 1986 Oct;56(10):807-8. Segmental abdominal herpes zoster paresis. Tjandra J, Mansel RE. A case of segmental abdominal paresis due to thoraco-abdominal herpes zoster in a 63 year old man is reported. This is caused by peripheral motor paresis. It has a good prognosis with spontaneous resolution. PMID: 3464246 [PubMed - indexed for MEDLINE] 4773. Otolaryngol Head Neck Surg. 1986 Oct;95(3 Pt 1):292-7. Ramsay Hunt facial paralysis: clinical analyses of 185 patients. Robillard RB, Hilsinger RL Jr, Adour KK. In a prospective study of 1507 patients, evaluated consecutively for facial palsy in the Cranial Nerve Research Clinic at the Kaiser Permanente Medical Center, Oakland, California, between 1966 and 1976, 185 cases (12%) were diagnosed as Ramsay Hunt syndrome. In 46 cases (25%), the diagnosis of herpes zoster was confirmed by acute and convalescent serum titers for varicella-zoster virus. In 139 cases (75%), viral titers were not performed and the diagnosis was based on the characteristic clinical presentation of the Ramsay Hunt syndrome. The data were subjected to multivariate analysis evaluating age, sex, race, signs, and symptoms at onset, severity of paralysis, associated medical problems with concomitant neurologic deficits, and response to therapy. These were compared with data of 1202 patients with Bell's (herpes simplex) palsy. The facial palsy of Ramsay Hunt syndrome was found to be more severe, to cause late neural denervation, and to have a less favorable recovery profile than Bell's (herpes simplex) facial palsy. Prognostic factors and treatment recommendations are discussed. PMID: 3108776 [PubMed - indexed for MEDLINE] 4774. Neurosurgery. 1986 Oct;19(4):599-603. Reactivation of herpesvirus in neurosurgical patients. Nabors MW, Francis CK, Kobrine AI. The authors are presenting seven patients who had operations between July 1984 and July 1985 and who developed herpes infections postoperatively. Four of the patients developed their infections in a dermatomal distribution that correlated with the nerve roots manipulated at operation. A spectrum of localized herpes reactivation is demonstrated in this series. The use of corticosteroids and other associated variables are discussed. Like reactivation of herpes simplex after trigeminal nerve operation, we believe reactivation of herpes simplex and herpes zoster can occur in operation of the cervical, thoracic, or lumbosacral spine. PMID: 3024061 [PubMed - indexed for MEDLINE] 4775. J Med Virol. 1986 Oct;20(2):151-63. Binding and internalization of herpes simplex virus-antibody complexes by polymorphonuclear leukocytes. Smith JW, Jachimowicz JR, Bingham EL. We studied the interactions between rabbit polymorphonuclear leukocytes (PMN) and the RE strain of herpes simplex virus type 1 (HSV-1) to determine better the role of inflammatory cells in herpetic stromal keratitis. PMN were found to be nonpermissive for HSV replication and were unable to bind virus in the absence of antibody. However, PMN did bind and internalize HSV-antibody complexes in vitro as was demonstrated visually by electron microscopic studies and quantitatively by measurement of activity associated with radiolabeled HSV-antibody complexes. Virus used for immune complex formation was labeled with either 125Iodine or 35S-methionine. In some experiments, anti-HSV IgG used for immune complex formation was labeled with 125Iodine before incubation with virus. Use of all three radiolabeling approaches resulted in the same general pattern of binding, indicating a requirement for both antibody and virus for interaction with PMN. The activity associated with PMN was increased by preincubation with complement. The results suggest an active role for PMN in controlling HSV infection through their ability to bind and ingest virus-antibody complexes. PMID: 3021898 [PubMed - indexed for MEDLINE] 4776. Pediatrics. 1986 Oct;78(4 Pt 2):757-62. Live attenuated varicella vaccine use in immunocompromised children and adults. Gershon AA, Steinberg SP, Gelb L. Live attenuated varicella vaccine has been administered to 307 children with leukemia in remission and to 86 healthy adults. The vaccine was well tolerated and immunogenic. The major side effect in leukemic children receiving maintenance chemotherapy was development of a vaccine-associated rash. Vaccinees in whom a rash developed were potentially somewhat infectious to others about 1 month after immunization. Vaccination was not associated with an increase in the incidence of herpes zoster or in relapse of leukemia. Vaccination provided excellent protection against severe varicella. It was associated with a significant decrease in the attack rate of chickenpox following an intimate exposure to varicella-zoster virus, conferring about 80% protection in leukemic children. The cases of breakthrough varicella that occurred were mild. Thus, the vaccine may either prevent or modify varicella in high-risk individuals. It may also have use for prevention of nosocomial varicella. PMID: 3020495 [PubMed - indexed for MEDLINE] 4777. Pediatrics. 1986 Oct;78(4 Pt 2):748-56. Varicella vaccine studies in healthy children and adults. Arbeter AM, Starr SE, Plotkin SA. Immunization of normal children and adults with Oka strain live varicella vaccine from several manufacturers has been studied in our laboratory and elsewhere. This paper summarizes clinical trials designed to obtain information on minimum dose immunogenicity pre- and postexposure prophylaxis, immunization of various age groups, and booster immunizations for seropositive individuals. These studies documented a 94% to 100% seroconversion rate with 95% to 100% persistence of antibodies at 3 to 4 years. Protective efficacy was more than 90%, and the vaccine was successful in preventing varicella when a high dose was given postexposure. Clinical reactions were limited to temperature elevations and minor papulovesicular rashes that occurred in 5% to 10% of vaccinees. Herpes zoster has been absent in vaccinated healthy individuals. PMID: 3020494 [PubMed - indexed for MEDLINE] 4778. Pediatrics. 1986 Oct;78(4 Pt 2):736-41. Clinical overview of varicella vaccine: development and early studies. Takahashi M. A live varicella vaccine was developed in 1973 and has been used effectively and safely in normal as well as high-risk children. Some precautions are necessary for use in the high-risk children. PMID: 3020493 [PubMed - indexed for MEDLINE] 4779. Am J Nurs. 1986 Oct;86(10):1138-41. Aging skin. Berliner H. PMID: 2945435 [PubMed - indexed for MEDLINE] 4780. Pharmacol Res Commun. 1986 Oct;18(10):991-6. Griseofulvin-methisoprinol combination in the treatment of herpes zoster. Castelli M, Zanca A, Giubertoni G, Zanca A, Bertolini A. A total of 57 herpes zoster patients (28 men and 28 women) were randomly assigned to one of the following four treatments: griseofulvin, 125 mg four times daily; methisoprinol, 1 g four times daily; griseofulvin plus methisoprinol (dosage schedules as above); placebo, four times daily. Griseofulvin had no effect at all, methisoprinol both significantly accelerated drying of vesicles and reduced pain, and the combination of griseofulvin and methisoprinol turned out to be significantly more effective in reducing pain than methisoprinol alone. The present results suggest a new effective treatment for herpes zoster disease. PMID: 2433701 [PubMed - indexed for MEDLINE] 4781. Br Dent J. 1986 Sep 20;161(6):217-8. Oral herpes zoster with contralateral skin involvement. Hill PA, Lamey PJ. PMID: 3463341 [PubMed - indexed for MEDLINE] 4782. Lancet. 1986 Sep 20;2(8508):694-5. Viral origin of hairy leukoplakia. Friedman-Kien AE. PMID: 2876171 [PubMed - indexed for MEDLINE] 4783. Arch Otolaryngol Head Neck Surg. 1986 Sep;112(9):925-8. Electrocochleography and brain-stem potentials in Ramsay Hunt syndrome. Abramovich S, Prasher DK. Audiometric investigations and electrophysiologic recordings of cochlear and brain-stem auditory evoked potentials (BAEPs) were performed in 13 patients to elucidate further the type of hearing disorders in Ramsay Hunt syndrome. Transtympanic electrocochleography showed no enhancement of summating potential and did not suggest secondary endolymphatic hydrops. The recording of BAEPs was clearly abnormal in several of the 13 patients. The striking feature of the abnormalities in these patients was the prolongation of the latencies of waves III and V with the preservation of wave I, which clearly suggests retrocochlear involvement. In all the patients tested, abnormalities of the BAEPs were present only on the affected side. It is possible, on the basis of BAEP findings, to suggest that in Ramsay Hunt syndrome both cochlear and retrocochlear involvement may occur. PMID: 3741657 [PubMed - indexed for MEDLINE] 4784. J Infect. 1986 Sep;13(2):159-62. Renal failure in the course of reactivation of varicella-zoster virus infection in a renal transplant recipient. Bourbigot B, Quillien MC, Airiau J, Hardy E, Guiserix J, Leroy JP, Cledes J, Chastel C. Renal failure developed in a 20-year-old female renal transplant recipient in the course of reactivation of varicella-zoster virus infection. The patient was treated with acyclovir and immunosuppression was continued. The year later renal function in the transplanted kidney was satisfactory. PMID: 3531351 [PubMed - indexed for MEDLINE] 4785. J Infect Dis. 1986 Sep;154(3):430-6. 2'-Fluoro-5-iodoarabinosylcytosine, a new potent antiviral agent: efficacy in immunosuppressed individuals with herpes zoster. Leyland-Jones B, Donnelly H, Groshen S, Myskowski P, Donner AL, Fanucchi M, Fox J. 2'-Fluoro-5-iodoarabinosylcytosine (FIAC) has potent antiviral activity in vivo against herpes simplex virus types 1 and 2 and cytomegalovirus. For examination of the clinical efficacy of FIAC, a randomized, double-blind study of FIAC versus adenine arabinoside (ara-A) was conducted in 34 immunosuppressed individuals with varicella-zoster virus infections. The median time to the appearance of the last new lesion was shorter in patients who received FIAC relative to those who received ara-A (two versus five days, respectively; P less than .001) FIAC also reduced pain and accelerated initial crusting within 72 hr in a significantly greater proportion of patients when compared with ara-A (P = .004 and P = .0009, respectively). FIAC caused few toxic reactions (mild nausea and transient elevation in activity of serum aspartate aminotransferase). Thus FIAC is therapeutically superior to ara-A for the treatment of varicella-zoster virus infections in immunosuppressed subjects. PMID: 3525694 [PubMed - indexed for MEDLINE] 4786. Cancer. 1986 Sep 1;58(5):1047-54. Pulmonary complications occurring after allogeneic bone marrow transplantation. A study of 130 consecutive transplanted patients. Cordonnier C, Bernaudin JF, Bierling P, Huet Y, Vernant JP. This report deals with 81 pulmonary episodes occurring in 130 consecutive patients who underwent allogeneic bone marrow transplantation for hematologic malignancy in the same unit over a 5-year period. These episodes observed in 69/130 patients (53%) were mostly of infectious origin, and were investigated by bronchoalveolar lavage (BAL). The main causes of pneumonia were: cytomegalovirus (CMV) (n = 25), bacterial pneumonia (n = 17), invasive aspergillosis (n = 11) and pulmonary hemorrhage (n = 9). The overall mortality due to or associated with pneumonia was 26/130 (20%). Graft-versus-host disease clearly increased the incidence of infectious pneumonia and the mortality due to or associated with pneumonia. Granulocyte transfusions did not influence the incidence of CMV pneumonitis. The main causes and risk factors for pneumonia are discussed. The role of BAL as a noninvasive procedure is stressed. PMID: 3524798 [PubMed - indexed for MEDLINE] 4787. Cancer Treat Rep. 1986 Sep;70(9):1117-20. Association of severe and fatal infections and treatment with pentostatin. O'Dwyer PJ, Spiers AS, Marsoni S. Pentostatin (dCF), an inhibitor of adenosine deaminase, has shown activity in the treatment of several lymphoid malignancies, even in the earliest phase I trials. An analysis of the first 300 patients treated in such trials shows a high incidence of severe infection (8%) during the relatively brief period of treatment. Of 24 patients in whom infection was diagnosed, 17 had no evidence of myelosuppression. The causative organisms included viruses, fungi, and bacteria of both high and low pathogenicity. Two-thirds of the infections were fatal. It is suggested that dCF may cause a syndrome similar to severe combined immunodeficiency during the course of treatment. Patients treated with dCF who show evidence of infection, even in the absence of neutropenia, should receive vigorous and rapid diagnostic evaluation to establish the cause of their infection, and aggressive treatment of suspected organisms. PMID: 3488805 [PubMed - indexed for MEDLINE] 4788. Zhonghua Kou Qiang Ke Za Zhi. 1986 Sep;21(5):305-6. [Herpes zoster of the trigeminal nerve] [Article in Chinese] Liu YJ. PMID: 3472835 [PubMed - indexed for MEDLINE] 4789. Nippon Rinsho. 1986 Sep;44(9):2028-35. [Pathology of herpesvirus infections] [Article in Japanese] Kurata T, Sata T. PMID: 3025475 [PubMed - indexed for MEDLINE] 4790. Scand J Immunol. 1986 Sep;24(3):261-71. Production of specific antibodies by cerebrospinal fluid lymphocytes in patients with herpes zoster, mumps meningitis and herpes simplex virus encephalitis. Forsberg P, Kam-Hansen S, Frydén A. We applied a new method consisting of short-term culture (18 h) of lymphocytes from cerebrospinal fluid (CSF-L) and peripheral blood (PBL) in viral antigen-coated ELISA plates and subsequent measurement of IgG and IgM antibodies bound to antigen. Utilizing mumps virus, herpes simplex virus (HSV), varicella zoster virus (VZV), and measles virus as antigens, we demonstrated production by CSF-L of antibodies against the aetiological agent only in all patients with mumps meningitis and HSV encephalitis and also in all patients with herpes zoster without central nervous system (CNS) symptoms. This might be considered as direct evidence that specific antibodies are produced within the CNS in inflammatory nervous system diseases. CSF-L usually produced higher amounts of antibodies than the corresponding number of PBL. In comparison with concentrations of free antibodies determined in parallel, our method had higher specificity and sensitivity and gave more precise information about the antibody response in infections of the nervous system. PMID: 3018917 [PubMed - indexed for MEDLINE] 4791. J Gen Virol. 1986 Sep;67 ( Pt 9):1817-29. Analysis of varicella-zoster virus DNAs of clinical isolates by endonuclease HpaI. Hayakawa Y, Yamamoto T, Yamanishi K, Takahashi M. The DNAs of 20 strains of varicella-zoster virus (VZV) isolated from epidemiologically unrelated individuals, and of 15 strains isolated from vesicles of vaccinees with varicella or zoster after vaccination, were compared by restriction enzyme cleavage using HpaI. Differences were found in the sizes of the HpaI-F, -G and -K fragments of the wild strains. The gel migration patterns of the HpaI-F and -G fragments, but not of the HpaI-K fragment, were polymorphic in the different strains isolated from the vaccinees. The effects of serial passages in vitro and in humans on the genome stability of VZV were investigated by HpaI analysis. The DNA profiles of the HpaI-K fragments from six isolates recovered from room-mates infected in a single outbreak were identical, but the mobilities of their HpaI-F and -G fragments varied. The DNA profiles of the Oka vaccine virus after 10 and 85 passages in human embryo cells differed only in the HpaI-F fragment. The profiles of these fragments in DNA derived from two isolates obtained at different times from a vaccinee with varicella followed by zoster were compared with those of the Oka (parental) and Oka (vaccine) strains, and identical results were obtained for the two viruses. In addition, the same DNA profiles of HpaI fragments were obtained from three sequential isolates from one person and also from two isolates from another with varicella and zoster. Thus, it was concluded that: three variable fragments (HpaI-K, -F and -G) were not changed in the DNAs of isolates derived from the same patient; HpaI-K was stable both on passage in vitro and after human transmission in the case of the same outbreak, but was different among all wild-type strains isolated in epidemiologically unrelated outbreaks; HpaI-F was very unstable both on passage in vitro and in human infections by either vaccine or wild-type strains; HpaI-G was not influenced by passage in vitro but varied among wild-type strains. Using physical maps of VZV DNA established by others, three variable regions on the viral genome were identified. One was located near the 0.16 coordinate, which is covered by HpaI-K (variable region I, VRI). Another was represented by HpaI-F (VRII), the most unstable fragment, and mapped at about the 0.35 coordinate. The third was VRIII near the right terminus, covered by HpaI-G. PMID: 3018125 [PubMed - indexed for MEDLINE] 4792. Semin Respir Infect. 1986 Sep;1(3):193-201. Viral pneumonia in the immunocompromised patient. Shanley JD, Jordan MC. Section of Infectious Diseases, University of Minnesota School of Medicine, Minneapolis. PMID: 2825314 [PubMed - indexed for MEDLINE] 4793. Urologe A. 1986 Sep;25(5):286-7. [Urinary retention in herpes zoster] [Article in German] Persson C, Melchior H. We report on 4 cases of transient neurogenic dysfunction of the urinary bladder caused by herpes zoster. All patients noticed a slow urinary stream leading to complete urinary retention and loss of sensation following the vesicular stage of herpes zoster, necessitating the insertion of a suprapubic tube. Urodynamic evaluations revealed a detrusor acontractility, cystoscopic findings included a unilateral cystitis. Symptoms and residual urine spontaneously disappeared after 2 to 3 weeks. The cause is a sacral meningo-radiculitis with herpes zoster virus leading to a transient neuromotoric paralysis of the urinary bladder. PMID: 2431531 [PubMed - indexed for MEDLINE] 4794. Dtsch Med Wochenschr. 1986 Aug 22;111(34):1303. [Herpes zoster in early gastric carcinoma] [Article in German] Ebker E. PMID: 3017672 [PubMed - indexed for MEDLINE] 4795. J Immunol. 1986 Aug 15;137(4):1346-51. Immunity to varicella-zoster viral glycoproteins, gp I (gp 90/58) and gp III (gp 118), and to a nonglycosylated protein, p 170. Arvin AM, Kinney-Thomas E, Shriver K, Grose C, Koropchak CM, Scranton E, Wittek AE, Diaz PS. Humoral and cellular immunity against two major glycoproteins (gp) of varicella-zoster virus (VZV), gp I (gp 90/58) and gp III (gp 118), and against a nonglycosylated phosphoprotein (p 170) was demonstrated in human subjects. Primary VZV infection was accompanied by the development of IgG to gp I (mean titer 1:200), gp III (mean titer 1:132), and p 170 (mean titer 1:331). Increased IgG antibody production to each of the VZV proteins occurred during recurrent VZV infection with mean titers to gp I of 1:29512, to gp III of 1:15848, and to p 170 of 1:15848. Persistent high titers to gp III (mean titer 1:891) and to p 170 (mean titer 1:2238) were observed in 75% and 88% of VZV-immune subjects, respectively. T lymphocytes which proliferated on stimulation with gp I, gp III, and p 170 developed with primary VZV infection. VZV-immune subjects had mean transformation indices of 4.2 +/- 0.70 SE to gp I, 4.7 +/- 1 SE to gp III, and 3 +/- 0.39 SE to p 170. Among individual subjects, humoral and cellular immunity was not always detected to all three of the VZV proteins. Resolution of primary VZV infection and maintenance of VZV latency did not require a host response to each of these major viral proteins. PMID: 3016094 [PubMed - indexed for MEDLINE] 4796. Rinsho Shinkeigaku. 1986 Aug;26(8):797-800. [A case of sarcoidosis accompanied by herpes zoster encephalitis] [Article in Japanese] Kobayashi H, Ota K, Yamane K, Kabayashi I, Maruyama S. PMID: 3802672 [PubMed - indexed for MEDLINE] 4797. Vrach Delo. 1986 Aug;(8):114-6. [Nervous system lesions in herpes zoster] [Article in Russian] Rudenko AE, Lushchin IuK, Muravskaia LV, Novikova OV. PMID: 3776146 [PubMed - indexed for MEDLINE] 4798. J Otolaryngol. 1986 Aug;15(4):224-7. Head and neck pain in the elderly. MacRae DL. Pain in the head and neck region is a common symptom in elderly people, with degenerative disease and neoplasms being the most frequent causes. Pain of neuralgic, orbital and vascular origin requires a multidisciplinary approach. Adequate suppression of pain by appropriate medical or surgical methods is of paramount importance to the patient's well-being even when the underlying disease cannot be cured. PMID: 3747016 [PubMed - indexed for MEDLINE] 4799. South Med J. 1986 Aug;79(8):1026-8. Trigeminal herpes zoster causing mandibular osteonecrosis and spontaneous tooth exfoliation. Manz HJ, Canter HG, Melton J. We have described a 60-year-old woman with polymyalgia rheumatica treated initially with prednisone but ultimately with azathioprine and cyclophosphamide. Herpes zoster infection along the mandibular division of the right trigeminal nerve ensued with spontaneous exfoliation of two teeth. She subsequently died. Medical practitioners need to be made aware of this rare complication of a common disease. PMID: 3738577 [PubMed - indexed for MEDLINE] 4800. Postgrad Med. 1986 Aug;80(2):241-9. Blistering diseases in children. How to recognize and treat the most common. Weston WL. The most common blistering diseases encountered in children are impetigo, burns, acute dermatitis, friction blisters, viral blisters, insect bite reactions, and linear IgA dermatosis. Diagnosis should be based on specific clinical manifestations and, when necessary, results of a Tzanck test or skin biopsy. A search for an intact blister is always warranted when erosions, oozing, or crusts are noted. PMID: 3737496 [PubMed - indexed for MEDLINE] 4801. Arch Ophthalmol. 1986 Aug;104(8):1176-7. Abnormal spatial localization in patients with herpes zoster ophthalmicus. Evidence for the presence of proprioceptive information. Campos EC, Chiesi C, Bolzani R. Patients with herpes zoster of the ophthalmic branch of the trigeminal nerve and normal ocular motility were examined. They were asked to point to targets without the sight of their own hand. Significant errors were found on the affected side. Proprioceptive information of the extraocular muscles is assumed to travel in the trigeminal nerve, and these results thus suggest the existence of peripheral afferent signals influencing eye-hand coordination. PMID: 3488730 [PubMed - indexed for MEDLINE] 4802. Laryngoscope. 1986 Aug;96(8):870-7. The relationship of the herpesvirus family to sudden hearing loss: a prospective clinical study and literature review. Wilson WR. The herpesvirus family is associated with sudden hearing loss syndrome and the evidence includes clinical findings (HV-Z), temporal bone studies (CMV and HV-Z), and serologic studies. The data presented demonstrate that herpes infections, in association with sudden viral hearing loss, occur as part of a multiple viral infection in 70% of instances. This feature is unique to the herpesvirus infections when compared to other neurotropic viral agents. The study also demonstrates that the variables of viral hearing loss, such as degree of hearing loss, percentage of recovery, or the incidence of vertigo are unaffected by the presence of herpesvirus infection. Mechanisms for inner ear injury may be influenced by temporary alterations in cellular immunity secondary to simultaneous viral infections as well as the native virulence of the infecting herpesvirus. PMID: 3016434 [PubMed - indexed for MEDLINE] 4803. Contact Dermatitis. 1986 Aug;15(2):114-5. Contact allergy to antiviral agents. Angelini G, Vena GA, Meneghini CL. PMID: 2946523 [PubMed - indexed for MEDLINE] 4804. Arch Neurol. 1986 Aug;43(8):836-40. Postherpetic neuralgia. A review. Watson PN, Evans RJ. Postherpetic pain persisting one month or longer occurs in 9% to 14% of patients with herpes zoster, diminishing with time. The incidence and duration are directly related to age. The pathologic features have been described but the pathogenesis of postherpetic neuralgia is unknown. Treatment remains difficult. It is reasonable to hope for a reduction in pain from severe to mild in two of three cases. There is evidence to support the use of low doses of tricyclic antidepressants, especially amitriptyline hydrochloride, with gradual small increments, and also the use of phenothiazines. Corticosteroids may exert a preventive effect when used in the acute phase. There is some support for the use of local physical modalities. Neurosurgical procedures are a possibility in failed medical cases. Controlled studies of newer approaches are necessary. PMID: 2873807 [PubMed - indexed for MEDLINE] 4805. Med J Aust. 1986 Jul 7;145(1):60. Herpes zoster and corticosteroid therapy. Mills K. PMID: 3724640 [PubMed - indexed for MEDLINE] 4806. Dtsch Med Wochenschr. 1986 Jul 4;111(27):1068-73. [Neurologic manifestations in acquired immunodeficiency syndrome (AIDS)] [Article in German] Kesselring J. PMID: 3013565 [PubMed - indexed for MEDLINE] 4807. Masui. 1986 Jul;35(7):1099-106. [Results of nerve block treatment in 1,000 patients with zoster-related pain] [Article in Japanese] Noda B, Dan K, Higa K, Manabe H. PMID: 3773256 [PubMed - indexed for MEDLINE] 4808. Rinsho Shinkeigaku. 1986 Jul;26(7):689-92. [A case report of myoclonus following herpes zoster infection] [Article in Japanese] Matsumoto Y, Tsuchiya I, Kayanuma K, Uono M. PMID: 3769315 [PubMed - indexed for MEDLINE] 4809. Neurochirurgia (Stuttg). 1986 Jul;29(4):109-10. [Partial vertical nucleotomy as a modification of tractotomy of the trigeminal nerve] [Article in German] Grunert V, Witzmann A, Grunert P. The authors report on partial vertical nucleotomy, a modification of tractotomy of the quintothalamic tract. In 1979 eight patients underwent this procedure. Three of them showed a recurrence of pain from genuine trigeminal neuralgia. Three patients had symptomatic trigeminal neuralgia, one patient atypical neuralgia of the face without organic cause, whereas in one case the neuralgia occurred subsequent to a herpes zoster. At the time of examination all patients were free from pain. PMID: 3748261 [PubMed - indexed for MEDLINE] 4810. J Neurol Neurosurg Psychiatry. 1986 Jul;49(7):824-6. Auditory dysfunction in Ramsay Hunt syndrome. Iragui VJ. A 48-year-old woman with a Ramsay Hunt syndrome due to herpes zoster had a hearing deficit. Brainstem auditory evoked potentials (BAEPs) localised the site of dysfunction to the ipsilateral eighth nerve. Clinical improvement was associated with improvement of the BAEP. Conventional audiological studies and BAEPs provided no evidence of involvement of the cochlea or the brainstem. In Ramsay Hunt syndrome, BAEPs may help to localise the site of involvement within the auditory pathway and follow the course of the disease. PMCID: PMC1028909 PMID: 3746312 [PubMed - indexed for MEDLINE] 4811. J Laryngol Otol. 1986 Jul;100(7):839-41. Herpes zoster of the larynx after intubational trauma. Wackym PA, Gray GF Jr, Avant GR. Multiple or prolonged endotracheal intubations may result in laryngeal trauma. This case illustrates that recrudescence of latent varicella-zoster virus as herpes zoster of the larynx, with subsequent laryngeal paralysis, can complicate intubation. Consequently, physicians should strive to minimize laryngeal injury in this setting. It is advised that careful laryngeal examination follow extubation. PMID: 3734605 [PubMed - indexed for MEDLINE] 4812. Pediatr Infect Dis. 1986 Jul-Aug;5(4):482-3. Almost simultaneous occurrence of varicella and zoster in an otherwise healthy child. Mietens C. PMID: 3725660 [PubMed - indexed for MEDLINE] 4813. Clin Chem. 1986 Jul;32(7):1347-9. Lactate dehydrogenase inhibition by immunoglobulin G in human serum. Maekawa M, Sudo K, Iwahara K, Kanno T. Low lactate dehydrogenase (LD; EC 1.1.1.27) activity and an abnormal LD pattern in electrophoretograms of LD isoenzymes in the sera of two patients were caused by inhibition of LD by immunoglobulin G. One of these showed inhibitor activity in the serum upon direct analysis, while the other showed activity only after the immunoglobulin was stripped from the LD. As judged from the LD isoenzyme patterns in serum, the LD inhibitor appeared to act against M subunits. However, quantification of binding affinities to each isolated isoenzyme showed that the LD inhibitor had a stronger effect on LD isoenzymes 2 and 3 (H3M1 and H2M2, respectively). PMID: 3719944 [PubMed - indexed for MEDLINE] 4814. Int J Dermatol. 1986 Jul-Aug;25(6):369-71. A rapid immunoperoxidase technique to distinguish herpetic types. Ganderup G, Newburger AE, Barr RJ, Riley RJ. The United States is experiencing an epidemic of herpetic infections. Rapid specific diagnosis of herpes simplex types and herpes zoster is important epidemiologically and also for individual cases since treatment as well as prognosis for recurrence or dissemination varies with virus type. We report a rapid test for the diagnosis and differentiation of these infections. This test uses scrapings from viral vesicles. It employs standard immunoperoxidase techniques and takes 2 hours to perform at 37C. Smears from 13 patients with clinical and/or culture confirmation of viral type were tested. Eleven of eleven who had fresh smears (vesicles present less than 5 days) had positive staining for the viral type expected clinically. Two patients with vesicles 5 days or older showed nonspecific staining. PMID: 3531043 [PubMed - indexed for MEDLINE] 4815. Dent Clin North Am. 1986 Jul;30(3):421-46. Treatment of common orofacial conditions. Glass BJ, Kuhel RF, Langlais RP. The conditions discussed in this article are those most likely to cause a patient to seek emergency care, primarily for pain. All the characteristics given for the conditions to aid in the diagnosis do not necessarily need to be present and other characteristics not mentioned may in fact be present. A complete differential diagnosis, especially of more obscure lesions, was also not attempted. An attempt was made to provide the practitioner with enough information to develop a working diagnosis from which to alleviate the patient's discomfort. A definitive diagnosis may not be available in an emergency setting. However, it must be emphasized that the final responsibility of the dentist is to make a definitive diagnosis at a later time if one cannot be made when emergency treatment is sought. Alleviating pain without dealing with the underlying cause may be more detrimental to the patient's health in the long run, as palliative therapy may mask a more severe condition. PMID: 3522291 [PubMed - indexed for MEDLINE] 4816. Klin Monbl Augenheilkd. 1986 Jul;189(1):46-7. [Bandage lenses in neuroparalytic keratitis] [Article in German] Annen D. The successful treatment of two cases of neuroparalytic keratitis with bandage lenses is described. The possible pathogenesis of epithelial damage and our experience with the problems of fitting soft contact lenses on anesthetic corneas are discussed. PMID: 3489859 [PubMed - indexed for MEDLINE] 4817. Acta Pathol Microbiol Immunol Scand A. 1986 Jul;94(4):263-9. Herpes zoster ophthalmicus and the mesencephalic nucleus. A neuropathological study. Reske-Nielsen E, Oster S, Pedersen B. The ganglion Gasseri and the brainstem were examined in three old patients with herpes zoster without predisposing diseases with special reference to the mesencephalic trigeminal nucleus. The primary lesions in the semilunar ganglion vary with the length of the course. Secondary changes in the brainstem were as expected from pons to the second cervical segment of the cord. Besides, we observed degeneration, inflammation and glial nodules in the mesencephalic trigeminal nucleus in two patients. According to Brodal this nucleus presumably corresponds to the semilunar and spinal ganglia. As herpes zoster virus is prone to attack the sensory nuclei our findings support this hypothesis. PMID: 3489349 [PubMed - indexed for MEDLINE] 4818. Neurology. 1986 Jul;36(7):1011. Small-vessel angiitis without angiographic signs of arteritis. Bahar S, Tolun R, Gürsoy G. PMID: 3487045 [PubMed - indexed for MEDLINE] 4819. Clin Exp Immunol. 1986 Jul;65(1):182-9. Interleukin 2 enhances natural killing of varicella-zoster virus-infected targets. Ito M, Bandyopadhyay S, Matsumoto-Kobayashi M, Clark SC, Miller D, Starr SE. Preincubation of peripheral blood non-adherent mononuclear cells with purified or recombinant interleukin 2 (IL-2) significantly enhanced natural killer (NK) activity against uninfected and varicella-zoster virus (VZV)-infected targets, while antibody-dependent cellular cytotoxicity (ADCC) against VZV-infected targets was not increased. Preincubation of effector cells with IL-2 had no effect on conjugate formation, but lysis of both targets was increased in single cell assays. IL-2-enhanced NK against VZV-infected targets was independent of gamma-interferon (gamma-IFN) production. PMCID: PMC1542273 PMID: 3098472 [PubMed - indexed for MEDLINE] 4820. J Med Virol. 1986 Jul;19(3):277-86. Nucleic acid hybridization for detection of herpes viruses in clinical specimens. Schuster V, Matz B, Wiegand H, Polack A, Corsten B, Neumann-Haefelin D. A diagnostic hybridization assay for detecting varicella zoster virus (VZV), herpes simplex virus (HSV), and Epstein-Barr virus (EBV) in different clinical specimens was developed using cloned viral DNAs as probes. All probes detected at least 5 pg of homologous DNA and did not cross-react with other viral or cellular DNA. Results of cell culture, serology, and DNA assay were highly concordant. Using a simple standardized protocol for preparation of specimens, hybridization, and washing procedures, this sensitive and specific assay appears to be useful for screening clinical specimens and may be helpful in confirming the serological diagnosis of HSV encephalitis and persistent EBV infections or EBV-associated diseases. PMID: 3016169 [PubMed - indexed for MEDLINE] 4821. Diagn Microbiol Infect Dis. 1986 Jul;5(2):113-26. Varicella-zoster-specific immune responses in acute herpes zoster during a placebo-controlled trial of oral acyclovir therapy. Mitchell CD, Gehrz RC, Balfour HH Jr. During a placebo-controlled trial of oral acyclovir therapy for acute zoster in immunocompetent patients, we examined the blastogenic response of peripheral blood mononuclear cells and antibody titers in both placebo and acyclovir recipients to determine whether the drug affected the cell-mediated or humoral immune responses. Proliferative responses to mitogens and two dilutions of varicella-zoster virus antigen were not inhibited when fresh peripheral blood mononuclear cells were simultaneously tested in autologous sera collected before and on day 7 of a 10-day course of 2 g/day of oral acyclovir (plasma drug levels averaged 4.6 microM). Using cryopreserved cells from study days 0, 3, 7, 14, and 30, thawed and tested simultaneously, there was no significant difference at the p less than or equal to 0.05 level between the net proliferative responses at each time point for the two groups. On day 14, however, the proliferative response of the acyclovir group was approximately 50% lower than that of the placebo group. Geometric mean antibody titer rises to varicella-zoster virus were also lower among drug recipients but not significantly so. Although this dose of acyclovir did not have a statistically significant effect on lymphocyte proliferative responses to varicella-zoster virus antigen or antibody titers, the lower values in drug recipients may be a reflection of the ability of acyclovir to terminate viral replication, thus reducing the patient's antigenic burden. PMID: 3013495 [PubMed - indexed for MEDLINE] 4822. J Infect Dis. 1986 Jul;154(1):190. Herpes zoster and the classification of HTLV-III/LAV-related diseases. Deresinski SC. PMID: 3011924 [PubMed - indexed for MEDLINE] 4823. Postgrad Med. 1986 Jul;80(1):109-10, 113-4, 117-20. Antiviral therapy. New drugs and their uses. Bean B. PMID: 2425347 [PubMed - indexed for MEDLINE] 4824. N Engl J Med. 1986 Jun 12;314(24):1582-3. Disseminated herpes zoster or varicella following herpes zoster: restriction-endonuclease digestion analysis. Embil JA, McFarlane ES, Embree JE. PMID: 3012337 [PubMed - indexed for MEDLINE] 4825. N Engl J Med. 1986 Jun 12;314(24):1542-6. Intrauterine infection with varicella-zoster virus after maternal varicella. Paryani SG, Arvin AM. We investigated the consequences of maternal infection with varicella-zoster virus in a prospective study of 43 pregnancies complicated by varicella and 14 pregnancies complicated by herpes zoster. Nine of 43 pregnant women with varicella had associated morbidity--pneumonia (4 women), death (1), premature labor (4 of 42), premature delivery (2 of 42), and herpes zoster (1). Intrauterine varicella infection was identified on the basis of clinical evidence (anomalies characteristic of the congenital varicella syndrome, acute varicella at birth, or herpes zoster in infancy) or immunologic evidence (IgM antibody to varicella-zoster in the neonatal period, persistent IgG antibody to varicella-zoster at one to two years of age, or in vitro lymphocyte proliferation in response to varicella-zoster virus antigen). The congenital varicella syndrome occurred in 1 of 11 infants of women with first-trimester varicella. Immunologic evidence of intrauterine varicella infection was present in 7 of 33 infants tested; 4 of these infants were asymptomatic. According to clinical or immunologic criteria, 8 of 33 infants had evidence of intrauterine varicella infection. These observations show that varicella during pregnancy was associated with maternal morbidity and evidence of fetal infection, but that herpes zoster was not. PMID: 3012334 [PubMed - indexed for MEDLINE] 4826. G Clin Med. 1986 Jun;67(3):173-5. [Varicella-zoster virus infections in pregnancy] [Article in Italian] Lisi B. PMID: 3792725 [PubMed - indexed for MEDLINE] 4827. Aust Fam Physician. 1986 Jun;15(6):810. An awful earful. [No authors listed] PMID: 3753335 [PubMed - indexed for MEDLINE] 4828. Klin Med (Mosk). 1986 Jun;64(6):138-40. [Acute myopericarditis in herpes zoster] [Article in Russian] Novikov IuI, Kotliarova LA. PMID: 3747427 [PubMed - indexed for MEDLINE] 4829. Z Hautkr. 1986 Jun 1;61(11):773-8. [Value of glucocorticoid treatment in herpes zoster] [Article in German] Wassilew SW, Lilie M. 48 patients suffering from severe acute zoster pain were treated with methylprednisolone 1 mg/kg body weight daily, if bed rest and analgetics had not been effective. The pain completely vanished in 33.3% of the patients; only 20.9% still suffered from unaltered pain. This therapy proved only to be effective if it was applied during the first 5 to 10 days after the appearance of the first lesions. There was no exacerbation observed in any patient. 66.6% of the patients developed postherpetic neuralgia accompanied by rather low pains, as 61.8% of the patients did not need analgetics. PMID: 3739396 [PubMed - indexed for MEDLINE] 4830. Ophthalmology. 1986 Jun;93(6):763-70. Oral acyclovir in the treatment of acute herpes zoster ophthalmicus. Cobo LM, Foulks GN, Liesegang T, Lass J, Sutphin JE, Wilhelmus K, Jones DB, Chapman S, Segreti AC, King DH. Seventy-one nonimmunocompromised patients with herpes zoster ophthalmicus, presenting within seven days of onset of characteristic skin eruption, were enrolled in a prospective, longitudinal, randomized, double-masked, placebo-controlled trial with oral acyclovir. In a previous interim report we noted more prompt resolution of dermatomal signs and symptoms with acyclovir treatment. There was also a reduction of viral shedding in acyclovir-treated patients coupled with a trend to greater rate of microdissemination of the virus in placebo-treated patients (Cobo LM, et al. Ophthalmology 1985; 92:1574-83). While further substantiating these findings, we report that a ten-day course of treatment with oral acyclovir (600 mg, five times a day) is well-tolerated and significantly reduces the incidence and severity of the most common complications of herpes zoster ophthalmicus: dendritiform keratopathy, stromal keratitis, and uveitis. While this acyclovir treatment regimen reduces the zoster-related pain during the acute phase of the disease, especially in patients treated within 72 hours of onset of skin lesions, it has no evident effect on either incidence, severity, or duration of post-herpetic neuralgia in the patients studied. PMID: 3488532 [PubMed - indexed for MEDLINE] 4831. Minerva Stomatol. 1986 Jun;35(6):589-94. [Case of herpes zoster of Gasser's ganglion. Etiopathogenic and clinical considerations] [Article in Italian] Parascandolo S, Grulliero A, Tortora P, Rusciano A, Bianco R. PMID: 3462473 [PubMed - indexed for MEDLINE] 4832. J Am Acad Dermatol. 1986 Jun;14(6):1023-8. Herpes zoster: a possible early clinical sign for development of acquired immunodeficiency syndrome in high-risk individuals. Friedman-Kien AE, Lafleur FL, Gendler E, Hennessey NP, Montagna R, Halbert S, Rubinstein P, Krasinski K, Zang E, Poiesz B. Zoster is uncommon before the age of 50 years in immunologically normal individuals, but it occurs with increased frequency in people who are immunosuppressed. A retrospective review of 300 patients with acquired immunodeficiency syndrome associated with Kaposi's sarcoma, revealed that 8% had prior zoster, a rate that is sevenfold greater than historic controls of the same age. We prospectively examined forty-eight patients, with no known immunodeficiency or signs of AIDS or AIDS related complex (ARC), who presented with zoster localized to the thoracic region. Forty-one patients had known risk factors for AIDS and thirty-five had antibody to the AIDS-associated virus (AAV) at the time of presentation. One seropositive subject had no known risk factors. Absolute lymphocyte counts, lymphocyte OKT4/OKT8 ratios, and lymphocyte mitogen responses were all depressed in subjects with antibody to AAV when compared with seronegative individuals. Seven of thirty-three AAV antibody-positive subjects, who could be followed longitudinally, developed AIDS from 1 to 28 months (mean = 13) after zoster. One antibody-negative subject seroconverted to become AAV seropositive 16 months after zoster and developed Kaposi's sarcoma 1 month later. These eight subjects had persistently low lymphocyte OKT4/OKT8 ratios and elevated beta-2 microglobulin. In patients at risk for AIDS, the occurrence of zoster may be one sign that heralds the marked depression of cellular immunity associated with AIDS or ARC. PMID: 3013955 [PubMed - indexed for MEDLINE] 4833. Fortschr Neurol Psychiatr. 1986 Jun;54(6):73-81. [Neurological complications and therapy in herpesvirus diseases] [Article in German] Bleistein J, Tackmann W. An overview on the diversity of neurologic complications of infections with different human herpes virus strains is given. Encephalitis, meningoencephalitis and the Guillain-Barré-syndrome are of major importance. Affection of single cranial nerves and mononeuropathies occur in a lesser frequency, while myelitis and isolated disturbances of the autonomic nervous system are rare complications. Therapeutically the application of acyclovir in herpes simplex and varicella zoster virus infections has given encouraging outlooks, whereas no convincing results exist with respect to cytomegalovirus and Epstein-Barr virus infections. PMID: 3013738 [PubMed - indexed for MEDLINE] 4834. Br J Ophthalmol. 1986 Jun;70(6):431-4. Development of an immunofluorescence test for the serodiagnosis of herpes zoster ophthalmicus. Walpita P, Darougar S, Marsh RJ, Cooper M. An indirect immunofluorescence test has been developed and evaluated for the serodiagnosis of herpes zoster ophthalmicus (HZO) by the detection of antivaricella zoster virus (VZV) antibody. The results show that, in patients with HZO, anti-VZV IgG antibody titre usually rises rapidly after onset. One hundred and seven of the 134 sera (80%) from patients with a clinical diagnosis of HZO had an anti-VZV IgG titre of greater than or equal to 256, and IgM antibody at a level of 1 in 8 was present in six of them. In comparison only two of the 216 sera (1%) from patients with a clinical diagnosis of ocular infections other than those caused by VZV had such IgG titres. It was concluded that, on the basis of results of a single sample of serum, it is possible to make a provisional diagnosis of HZO with a high degree of confidence. PMCID: PMC1041035 PMID: 3013281 [PubMed - indexed for MEDLINE] 4835. Transplantation. 1986 Jun;41(6):719-24. Cellular immunity to vaccinations and herpesvirus infections after bone marrow transplantation. Gratama JW, Verdonck LF, van der Linden JA, van Heugten JG, Kreeft HA, D'Amaro J, Zwaan FE, de Gast GC. The cellular immune response to herpesviruses was studied in 46 recipients of marrow grafts (23 autologous, 23 allogeneic). That study was performed in vitro by evaluating the degree of lymphocyte proliferative responses to herpes simplex virus (HSV), cytomegalovirus (CMV), and varicella zoster virus (VZV). No primary infections with any of those viruses were noted after bone marrow transplantation (BMT). The incidence of active infection in seropositive patients was significantly lower after autologous BMT than after allogeneic BMT (HSV, 2/22 vs. 11/22 patients, respectively, P = 0.007; CMV, 4/12 vs. 9/10 patients, respectively, P = 0.02; VZV, 3/23 vs. 11/23 patients, respectively, P = 0.02). After autologous BMT, the restoration of cellular immunity to the three viruses occurred at a clearly faster rate than after allogeneic BMT. That pattern may have contributed to the low incidence of active infections with those viruses after autologous BMT. Recipients of allogeneic marrow from donors with a positive lymphocyte proliferation test to HSV had a significantly increased incidence of active HSV infection post-BMT (8/9 patients) than those who received marrow from donors with a negative test (3/13 patients; P = 0.008). Acute or chronic graft-versus-host disease (GVHD) decreased the cellular immune response to the three herpes viruses, but not significantly. Our program of vaccinations with diphtheria and tetanus toxoids started in the fourth month post BMT. Chronic GVHD patients who were vaccinated had a clearly impaired cellular immune response to both toxoids as compared with those without chronic GVHD. PMID: 3012833 [PubMed - indexed for MEDLINE] 4836. Infect Control. 1986 Jun;7(6):312-6. Hospital experience with varicella-zoster virus. Krasinski K, Holzman RS, LaCouture R, Florman A. Varicella-zoster virus (VZV), one of the most common highly communicable agents of disease, stimulates aggressive infection control measures. In a 1-year period, at one hospital, at least 93 inpatients (82 adult patients, 11 pediatric patients) and 2 hospital staff with active varicella-zoster infections served as potential sources of nosocomial infection. Six incidents of exposure to the virus that occurred without the protection of standard infection control precautions were investigated by the infection control surveillance team. One hundred fifty-six patients and 353 hospital staff were exposed. Fifty-one patients had no history of varicella-zoster infection, but only five were susceptible by serologic testing. One hundred one staff members had no history of varicella-zoster, but only 11 were susceptible by serologic testing. These exposures resulted in three secondary varicella-zoster infections, six courses of varicella-zoster immune globulin prophylaxis and furlough of 13 staff members. Epidemiologic investigation consumed approximately 356 hours of staff time, and management of exposed persons cost approximately $41,500. Prospective knowledge of the immune status of health care workers would vastly decrease the time and effort required to control hospital VZV exposures. PMID: 3011693 [PubMed - indexed for MEDLINE] 4837. J Immunol. 1986 Jun 1;136(11):4243-8. Demonstration of NK cell-mediated lysis of varicella-zoster virus (VZV)-infected cells: characterization of the effector cells. Tilden AB, Cauda R, Grossi CE, Balch CM, Lakeman AD, Whitley RJ. Infection with varicella-zoster virus (VZV) rendered RAJI cells more susceptible to lysis by non-adherent blood lymphocytes. At an effector to target ratio of 80:1 the mean percentage of 51Cr release of VZV-infected RAJI cells was 41 +/- 12%, whereas that of uninfected RAJI cells was 15 +/- 6%. The increased susceptibility to lysis was associated with increased effector to target conjugate formation in immunofluorescence binding assays. The effector cells cytotoxic for VZV-infected RAJI cells were predominantly Leu-11a+ Leu-4- granular lymphocytes as demonstrated by fluorescence-activated cell sorting. The effector cell active against VZV-infected RAJI cells appeared similar to those active against herpes simplex virus (HSV)-infected cells, because in cold target competition experiments the lysis of 51Cr-labeled VZV-infected RAJI cells was efficiently inhibited by either unlabeled VZV-infected RAJI cells (mean 71% inhibition, 2:1 ratio unlabeled to labeled target) or HSV-infected RAJI cells (mean 69% inhibition) but not by uninfected RAJI cells (mean 10% inhibition). In contrast, competition experiments revealed donor heterogeneity in the overlap between effector cells for VZV- or HSV-infected RAJI vs K-562 cells. PMID: 3009620 [PubMed - indexed for MEDLINE] 4838. Klin Med (Mosk). 1986 Jun;64(6):50-4. [Drug hypersensitivity and infectious allergy in the clinical picture of herpes zoster] [Article in Russian] Smirnov IuK, Shishov AS, Rudometov IuP, Kupriianova LV. PMID: 2943932 [PubMed - indexed for MEDLINE] 4839. J Clin Neuroophthalmol. 1986 Jun;6(2):113-5. Herpes zoster maxillaris with delayed occipital infarction. Powers JM. A case of occipital infarction following herpes zoster involving the maxillary division of the trigeminal nerve is presented. Herpes zoster ophthalmicus is followed occasionally by an angiitis and cerebral infarction, usually manifest as a hemiplegia. Cerebral angiitis has not been reported previously following herpes zoster involving the maxillary or mandibular divisions. Patients with herpes zoster involving any trigeminal division may be at risk for delayed stroke. The distribution of rash and angiitis in this case supports the hypothesis that the virus extends directly to the large vessels adjacent to the gasserian ganglion, instead of being transmitted along intracranial nerves. PMID: 2942567 [PubMed - indexed for MEDLINE] 4840. Int J Dermatol. 1986 Jun;25(5):273-9. Interferons in the treatment of skin disease. Ringenberg QS, Anderson PC. PMID: 2424849 [PubMed - indexed for MEDLINE] 4841. Br Med J (Clin Res Ed). 1986 May 31;292(6533):1428. Relief of acute pain in herpes zoster ophthalmicus by stellate ganglion block. Harding SP, Lipton JR, Wells JC, Campbell JA. PMCID: PMC1340431 PMID: 3087456 [PubMed - indexed for MEDLINE] 4842. N Engl J Med. 1986 May 29;314(22):1456. Inversion of T-cell subsets before herpes zoster infection. Neumeyer DA, Hirsch MS. PMID: 2939348 [PubMed - indexed for MEDLINE] 4843. Am J Dis Child. 1986 May;140(5):477-8. Prognosis of herpes zoster in healthy children. Wurzel CL, Kahan J, Heitler M, Rubin LG. Previous investigators have suggested that herpes zoster may be the presenting sign of a malignancy. However, no data have been available concerning the prognosis of herpes zoster in normal children. To assess outcome and prognosis for healthy children with a diagnosis of herpes zoster, we collected and reviewed 22 cases of herpes zoster from 90 pediatric practices in our community. In all cases, the illness was of short duration and resolved completely. Patients were followed up by their pediatricians for a mean of 4.2 years, and in no case did malignancy manifest subsequent to the zoster infection. We conclude that herpes zoster is a relatively benign infection in children and, given the period of follow-up, the onset of zoster does not appear to herald the occurrence of malignancy in this population. PMID: 3962944 [PubMed - indexed for MEDLINE] 4844. Hautarzt. 1986 May;37(5):259-62. [Virostatics in dermatology] [Article in German] Wassilew SW. Many antiviral substances are known, but only a few are clinically effective in certain disease resulting from herpes virus infections. Early diagnosis is essential. Antiviral chemotherapy is discussed in respect to herpes infections in immunocompetent patients, and in patients with primary genital herpes, eczema herpeticum, genital and gluteal recurrent herpes and herpes zoster. PMID: 3733445 [PubMed - indexed for MEDLINE] 4845. Aust Fam Physician. 1986 May;15(5):554-6. Postherpetic neuralgia. Armstrong PJ, Murphy TM. PMID: 3729805 [PubMed - indexed for MEDLINE] 4846. Antimicrob Agents Chemother. 1986 May;29(5):933-5. Vidarabine-associated encephalopathy and myoclonus. Vilter RW. A 24-year-old man with disseminated herpes zoster, which occurred 9 months after bone marrow transplantation for chronic myeloid leukemia, developed encephalopathy and immobilizing myoclonus after 7 days of vidarabine treatment (10 mg/kg of body weight per day). Only mild hepatic dysfunction was a risk factor for a toxic reaction. After the vidarabine therapy was stopped, the symptoms worsened until treatment with hydration, large doses of chlordiazepoxide, and protective care gave symptomatic relief. PMCID: PMC284185 PMID: 3729352 [PubMed - indexed for MEDLINE] 4847. Klin Padiatr. 1986 May-Jun;198(3):281-4. [Specific immunoglobulin and acyclovir in the prevention and treatment of varicella zoster infections in children with neoplastic diseases] [Article in German] Lakomek M, Tillmann W, Schrewe H, Prindull G. Immunocompromised children with acute leukemias and solid tumors are at high risk of fatal varicella infection. Reviewing a total of 242 patients at risk we have found that zoster immune plasma from reconvalescent patients (ZIP) and commercially available specific varicella/zoster immune globulin (VZIG) both prevent fatal disease. In addition, Acyclovir was effective against VZV-infections in this group of patients. We summarize our present policy of prophylaxis and treatment of immunocompromised children with neoplastic disease who have been exposed to VZV. PMID: 3723992 [PubMed - indexed for MEDLINE] 4848. Br J Dermatol. 1986 May;114(5):575-82. Recurrent viral infections in patients with past or present atopic dermatitis. Rystedt I, Strannegard IL, Strannegard O. Histories of recurrent infections were obtained from 955 adults with past or present atopic dermatitis (AD) and from 199 controls. Patients who had previously been hospitalized in childhood because of severe AD had a significantly higher incidence of recurrent (greater than 5 episodes per year) cold sores and upper respiratory tract infections as well as a higher incidence of herpes zoster, than non-atopic controls. Patients with milder AD in childhood (never hospitalized) had lower incidence of these diseases, but as regards cold sores, the frequency of recurrent infections was still significantly higher than that of the controls. AD patients with past or present respiratory allergy had a slight but not statistically significant increased incidence of recurrent infections, as compared to AD patients without concomitant respiratory allergy. The factors predisposing to frequent infections appeared to be those related to severity of the atopic condition, i.e. ongoing AD, need for hospitalization in childhood and extent of dermatitis. The increased susceptibility to recurrent viral infections in AD patients is most probably related to dysfunctioning cell-mediated immunity. PMID: 3718847 [PubMed - indexed for MEDLINE] 4849. J Am Acad Dermatol. 1986 May;14(5 Pt 1):764-70. Granuloma annulare arising in herpes zoster scars. Report of two cases and review of the literature. Friedman SJ, Fox BJ, Albert HL. We present two patients who developed granuloma annulare in the scars from previous herpes zoster. The development of granuloma annulare in herpes zoster scars may represent an atypical delayed hypersensitivity immune reaction to herpes zoster/varicella virus antigen(s) or a tissue antigen altered by the virus. PMID: 3711380 [PubMed - indexed for MEDLINE] 4850. Pain. 1986 May;25(2):165-70. Iontophoresis of vincristine versus saline in post-herpetic neuralgia. A controlled trial. Layman PR, Argyras E, Glynn CJ. Twenty patients with post-herpetic neuralgia (median duration 28.5 months) were randomly allocated to receive transdermal iontophoresis of either vincristine or saline. Although significant improvement in pain by word score and visual analogue scale (P = 0.05) was reported by 6 out of 10 of the vincristine group, none of the patients considered themselves 'cured.' There was no significant change in the saline group. No adverse haematological or neurological side effects were seen, but skin irritation and painless electrical burns were common in both groups. The dramatic relief of pain in patients with post-herpetic neuralgia of 3 months or less reported elsewhere was not seen in our group who had pain of a longer duration. This present trial does not confirm the value of vincristine iontophoresis in the treatment of post-herpetic neuralgia of over 6 months duration. PMID: 3523393 [PubMed - indexed for MEDLINE] 4851. Nervenarzt. 1986 May;57(5):298-301. [Optic neuritis caused by herpes zoster ophthalmicus. Case report and review of the literature] [Article in German] Schlegel U, Tackmann W, Cordt A. PMID: 3487740 [PubMed - indexed for MEDLINE] 4852. J Endod. 1986 May;12(5):210-3. Herpes zoster revisited: implicated in root resorption. Solomon CS, Coffiner MO, Chalfin HE. PMID: 3459806 [PubMed - indexed for MEDLINE] 4853. Ophthalmology. 1986 May;93(5):559-69. Varicella zoster virus is a cause of the acute retinal necrosis syndrome. Culbertson WW, Blumenkranz MS, Pepose JS, Stewart JA, Curtin VT. We studied two blind eyes enucleated during the active phase of the acute retinal necrosis syndrome. Both eyes showed similar histopathologic findings of necrotizing retinitis, retinal arteritis, and optic neuropathy. A virus morphologically consistent with a herpes group virus was found on electron microscopy and immunocytopathologic stains showed this virus to be varicella zoster in both cases. Varicella zoster virus was cultured from the vitreous of one of the eyes. We conclude that varicella zoster virus retinal infection is a cause of the acute retinal necrosis syndrome. PMID: 3014414 [PubMed - indexed for MEDLINE] 4854. J Clin Microbiol. 1986 May;23(5):978-9. Sensitivity of different assay systems for immunoglobulin M responses to varicella-zoster virus in reactivated infections (zoster). Schmidt NJ, Arvin AM. An immunoglobulin M response to varicella-zoster virus was detected in 70% of zoster patients by solid-phase radioimmunoassay, in 52% by indirect immunofluorescence, in 48% by neutralization on sucrose density gradient fractions, and in 27% by an antibody class capture enzyme immunoassay. The patients showed marked variations in their varicella-zoster virus immunoglobulin M responses detectable in the different assays. PMCID: PMC268768 PMID: 3011851 [PubMed - indexed for MEDLINE] 4855. Am J Obstet Gynecol. 1986 May;154(5):1116-7. Excretion of varicella-herpes zoster virus in breast milk. Frederick IB, White RJ, Braddock SW. Two cases involving breast-feeding and varicella-herpes zoster virus infection are presented. The possibility of viral excretion in the breast milk and its effects on continued breast-feeding are discussed. In neither case was the virus isolated from the breast milk. PMID: 3010724 [PubMed - indexed for MEDLINE] 4856. J Infect Dis. 1986 May;153(5):840-7. Clinical and subclinical reactivations of varicella-zoster virus in immunocompromised patients. Ljungman P, Lönnqvist B, Gahrton G, Ringdén O, Sundqvist VA, Wahren B. The frequencies of reactivated disease due to varicella-zoster virus (VZV) in immunocompromised patients were determined by enzyme-linked immunosorbent assay for antibody and also by the lymphocyte proliferation response to VZV antigen. Subclinical reactivations were as common as classical herpes zoster in all patient groups. Among bone marrow transplant (BMT) recipients, 36% developed herpes zoster and 26%, a subclinical reactivation. The corresponding frequencies for patients with leukemia during induction therapy were 5% and 10%; in renal transplant recipients, 0% and 26%; and in patients with seminoma, 0% and 6%, respectively. Subclinical reactivation of VZV thus appears to be a common finding in severely immunocompromised patients. A regained lymphocyte proliferation response to VZV antigen is a sensitive indicator of subclinical reactivation of VZV in BMT recipients. None of 19 BMT recipients with subclinical disease due to VZV later developed clinical reactivation of VZV. Acyclovir given as prophylaxis against infection with herpes simplex virus reduced the number of clinical and subclinical reactivations of VZV during treatment in BMT recipients, but not thereafter. PMID: 3009635 [PubMed - indexed for MEDLINE] 4857. Pain. 1986 May;25(2):149-64. Herpes zoster and postherpetic neuralgia. Loeser JD. PMID: 2873549 [PubMed - indexed for MEDLINE] 4858. Am J Clin Pathol. 1986 Apr;85(4):522-6. Varicella-zoster infection with pleural involvement. A cytologic and ultrastructural study of a case. Charles RE, Katz RL, Ordóñez NG, MacKay B. Cytologic evidence of herpes viral infection within cells from body cavity effusions is extremely uncommon. The authors report the case of a 57-year-old woman who was treated with chemotherapy and irradiation for malignant lymphoma and subsequently developed disseminated varicella-zoster infection with pleural involvement. Cytologic examination of pleural fluid revealed cytopathic changes caused by the varicella-zoster virus, which were confirmed by electron microscopy and viral culture of the effusion. The cytologic and ultrastructural features of the virus-infected cells are described, and the pathogenesis of the effusion and sequence of events in varicella-zoster virus-cell interaction are discussed. PMID: 3953509 [PubMed - indexed for MEDLINE] 4859. J Am Geriatr Soc. 1986 Apr;34(4):309-12. Herpes zoster ophthalmicus and granulomatous angiitis. An ill-appreciated cause of stroke. Verghese A, Sugar AM. The syndrome of granulomatous angiitis related to varicella zoster virus infection often manifests as herpes zoster ophthalmicus followed by contralateral hemiplegia. Forty-five cases have been reported to date, and the authors' experience with two additional cases seen in a one-year period is described. Given the frequency of both stroke and herpes zoster ophthalmicus in an aging population, the authors postulate that granulomatous angiitis is underdiagnosed. There is need for increased awareness of this disease by the non-neurologist. Diagnostic and therapeutic considerations are reviewed. PMID: 3485127 [PubMed - indexed for MEDLINE] 4860. Postgrad Med. 1986 Apr;79(5):150-54, 159-67. Acute exanthems in children. Clues to differential diagnosis of viral disease. Bligard CA, Millikan LE. The numerous viral skin diseases that affect children present a diagnostic challenge to the clinician. Most of these diseases may be conveniently grouped according to the clinical appearance of the exanthem as maculopapular, petechial, papular, or vesicular. In some situations, viral infection may be difficult to differentiate clinically from nonviral disease; thus, extensive laboratory evaluation is sometimes necessary to pinpoint the virus involved. Nonviral disease should be considered in the differential diagnosis of a patient with skin eruptions, especially of the maculopapular type. Common nonviral causes include Kawasaki disease, toxic shock syndrome, and drug reactions. PMID: 3008138 [PubMed - indexed for MEDLINE] 4861. Ann Intern Med. 1986 Apr;104(4):496-500. Long-term seropositivity for human T-lymphotropic virus type III in homosexual men without the acquired immunodeficiency syndrome: development of immunologic and clinical abnormalities. A longitudinal study. Melbye M, Biggar RJ, Ebbesen P, Neuland C, Goedert JJ, Faber V, Lorenzen I, Skinhøj P, Gallo RC, Blattner WA. The long-term effects of seropositivity for human T-lymphotropic virus type III (HTLV-III) on T-lymphocyte subsets and health status were evaluated in longitudinal studies of 250 initially healthy homosexual men. The relative risk of having an inverted T-lymphocyte helper-to-suppressor ratio rose from 14.3-fold among short-term seropositive subjects (less than 19 months) to 46.9-fold among long-term seropositive subjects (greater than 29 months) in comparison with the risk among seronegative subjects. Overall, 91.7% of long-term seropositive men had inverted ratios, compared with 12.9% of seronegative men. None of the seropositive men who developed an inverted ratio later reestablished a normal ratio. Both decreased T-helper cell number and percentage (p = 0.003) and increased T-suppressor cell number and percentage (p = 0.03) were significantly correlated with duration of seropositivity. Among seropositive persons, lymphadenopathy was a highly significant short-term as well as long-term consequence, whereas diarrhea, oral thrush, and herpes zoster were correlated with long-term seropositivity. Overall, 50% of long-term seropositive men compared with 16% of seronegative men developed at least one of five clinical symptoms (p less than 0.003). We conclude that a high proportion of persons infected with HTLV-III will develop measurable immunologic and clinical abnormalities. PMID: 3006568 [PubMed - indexed for MEDLINE] 4862. Masui. 1986 Apr;35(4):605-9. [Enkephalin metabolism in human serum; serum Leu-enkephalin concentration in patients with acute and chronic pain] [Article in Japanese] Machi T, Hazato T, Katayama T. PMID: 2943909 [PubMed - indexed for MEDLINE] 4863. Bol Asoc Med P R. 1986 Apr;78(4):142-5. Varicella and herpes zoster infections in immunocompromised host: prevention and treatment. Ramírez Palacios RM, Sánchez J, Bermúdez RH, Ramírez Ronda CH. PMID: 2424477 [PubMed - indexed for MEDLINE] 4864. Int J Dermatol. 1986 Apr;25(3):169-70. The Tzanck smear. Viable and valuable in the diagnosis of herpes simplex, zoster, and varicella. Solomon AR. PMID: 2422130 [PubMed - indexed for MEDLINE] 4865. Med J Aust. 1986 Mar 31;144(7):375, 378-80. Should we treat herpes zoster with corticosteroid agents? Dickinson JA. Herpes zoster is a common disease which is frequently followed by severe long-term pain--post-herpetic neuralgia. The arrival of new antiviral agents, not yet widely available, may lead to the neglect of the older, effective and inexpensive method of treatment with systemic corticosteroid agents. Evidence for the value of corticosteroid therapy is strong, while published data discouraging its use is weak. Consequently, the administration of these agents should be the standard treatment for painful acute zoster. PMID: 3959952 [PubMed - indexed for MEDLINE] 4866. Lancet. 1986 Mar 29;1(8483):744. Varicella zoster in the newborn. Trompeter RS, Bradley JM, Griffiths PD. PMID: 2870256 [PubMed - indexed for MEDLINE] 4867. Br Dent J. 1986 Mar 22;160(6):189. Bilateral shingles. Cousin GC, Ferguson MM. PMID: 3456780 [PubMed - indexed for MEDLINE] 4868. Lancet. 1986 Mar 22;1(8482):682. Unusual shingles and chickenpox. Dawson TA, Scott KW. PMID: 2869372 [PubMed - indexed for MEDLINE] 4869. Lancet. 1986 Mar 15;1(8481):581-3. Isolation of retroviruses from two patients with "common variable" hypogammaglobulinaemia. Webster AD, Dalgleish AG, Malkovsky M, Beattie R, Patterson S, Asherson GL, North M, Weiss RA. Retroviruses related to human T-lymphotropic virus III/lymphadenopathy-associated virus (HTLV-III/LAV) have been isolated from peripheral-blood mononuclear cells of two patients with "common variable" hypogammaglobulinaemia who were being treated with intravenous gammaglobulin. One has had three different opportunistic infections. In both patients hypogammaglobulinaemia developed within 6 years of a longlasting undiagnosed viral-like illness in adolescence, and it is suggested that the virus causing that illness also gave rise to the hypogammaglobulinaemia. However, iatrogenic infection from intravenous gammaglobulin cannot be ruled out. PMID: 2869303 [PubMed - indexed for MEDLINE] 4870. Anesth Analg. 1986 Mar;65(3):309-11. Herpes zoster and reflex sympathetic dystrophy. Grosslight KR, Rowlingson JC, Boaden RW. PMID: 3954095 [PubMed - indexed for MEDLINE] 4871. J Laryngol Otol. 1986 Mar;100(3):337-40. The use of acyclovir in Ramsay Hunt syndrome. Stafford FW, Welch AR. Acyclovir is a specific anti-viral agent which has been used in the treatment of the Ramsay Hunt Syndrome with encouraging results. To our knowledge, no previous study has been published utilizing this treatment. A discussion is also undertaken of the underlying pathology and prognosis of the Ramsay Hunt Syndrome, with a summary of those cases in which Acyclovir was prescribed. PMID: 3950504 [PubMed - indexed for MEDLINE] 4872. J Tradit Chin Med. 1986 Mar;6(1):17-8. Observation of the efficacy of Ampelopsis brevipedunculata Trautv. in the treatment of herpes zoster. Sun X, Guan YX, Luo XL, Yu YA, Gao HZ. PMID: 3736094 [PubMed - indexed for MEDLINE] 4873. Gan No Rinsho. 1986 Mar;32(3):287-92. [Treatment of oral carcinoma in elderly patients--case reports and associated problems] [Article in Japanese] Kato I, Osaki T, Ohno A, Nakao K, Tomita Y, Umazume M, Yoneda K. Three very elderly patients (more than 90 years old) suffering from oral carcinoma are reported with a discussion concerning complications of treatment and safety of surgery. In all cases, pretreatment with chemotherapy and/or chemo- and radiotherapy could be uncomplicatedly followed by surgery to excise the primary lesion done neck dissection. In one case, however, surgery after potent therapy with PLM, 5-FU and irradiation for the recurrence at the primary site was complicated by any severe consequences. Based on the clinical course of the patients, surgical treatment seems to be rather beneficial in very elderly cancer victims with the aim of avoiding complications caused by the usual conservative therapies. PMID: 3712768 [PubMed - indexed for MEDLINE] 4874. Monatsschr Kinderheilkd. 1986 Mar;134(3):118-21. [Varicella and herpes zoster] [Article in German] Spiess H. The identity of the virus for herpes zoster and chickenpox has long been guessed by pediatricians and eventually proven in 1958. The patients are infectious 2 days before the rash appears until 7 days later. Specific antibodies are found 2 days after the rash appeared. Varicella induce life long immunity which can weaken in old age or during immuno suppressive therapy, so that reactivation of the virus, most likely located in the spinal ganglia, causes the clinical symptoms of herpes zoster. About 7% of women in child-bearing age have no antibodies against the virus. Varicella during pregnancy may induce abortion or especially during the first 3 months severe embryopathies with organic lesions. Therefore young women who have not had the illness should be tested along with the test for rubella-antibodies, and subsequently vaccinated, at least 3 months before any planned pregnancy. The rather expensive varicella vaccination is justified in immunodeficient patients without varicella-antibodies, or in patients under immunosuppressive therapy without varicella-antibodies (minimal requirements of 1200 lymphocytes, interruption of cytostatics one week before and until 1 week after the vaccination, no irradiation for 3 months), or in women planning pregnancy, personnel caring for pregnant women or personnel who has no antibodies in intensive-care units for hematological-onkological patients. PMID: 3702883 [PubMed - indexed for MEDLINE] 4875. Hautarzt. 1986 Mar;37(3):152-5. [Acyclovir-corticosteroid therapy in herpes zoster] [Article in German] Söltz-Szöts J. Thirty patients between 60 and 86 years of age (average 73.6 years) [8, 9, 11] with high risk of having the disease for an extraordinarily long time or of developing neuritis were treated for 5 days with 4-5 mg acyclovir per kilogram body weight. They were not immunocompromised and received the drug intravenously at 8-h intervals. Of this group, 20 patients received daily 40-80 mg methylprednisolone simultaneously. All patients were hospitalized because of extensive, hemorrhagic lesions, which in 8 cases were necrotizing. The primary site of the disease was the head in 13 patients (43.3%), the neck or trunk in 15 (50%) and the extremities in 2 (6.7%). In addition, 8 (26.7%) showed generalized lesions. The duration of the disease could be reduced by one-third by acyclovir treatment, as compared with reference groups, and the methylprednisolone group had even better results. Individual pain was more promptly resolved by the combined treatment than by acyclovir alone. No persistent neuritis was observed in the methylprednisolone-acyclovir group, but occurred in two out of ten patients who had received acyclovir alone. No side effects were reported. The antiviral effect of acyclovir obviously reduces the risk of possible generalization during corticosteroid treatment to negligible amounts. Because of the possible selection of resistant strains, acyclovir should usually only be given to high-risk zoster patients beyond the age of 60. Administration must be initiated in the early phase of the disease, since no effect can be expected after viral shedding has been terminated. PMID: 3700103 [PubMed - indexed for MEDLINE] 4876. Monatsschr Kinderheilkd. 1986 Mar;134(3):122-9. [Antiviral chemotherapy] [Article in German] Eggers HJ. After a discussion of the principles of antiviral chemotherapy, treatment and chemoprophylaxis of the following virus infections are reviewed in detail: the various manifestations of herpes simplex virus infections, varicella-zoster, cytomegalovirus infections, Epstein-Barr virus infections, laryngeal papillomas, and influenza A. Special reference is made to the treatment of immunocompromized patients. Acycloguanosine (acyclovir) has been found particularly useful in the treatment of herpes simplex virus and varicella zoster virus infections in immunocompromized patients and for herpesencephalitis. Varicella-zoster can also be treated effectively with bromovinyldeoxyuridine (BVDU). Toxicity of the currently used antiviral drugs is discussed as well as the problem of drug resistance. PMID: 3010086 [PubMed - indexed for MEDLINE] 4877. Arch Dermatol. 1986 Mar;122(3):282-5. A comparison of the Tzanck smear and viral isolation in varicella and herpes zoster. Solomon AR, Rasmussen JE, Weiss JS. We compared the usefulness of the Tzanck smear to viral culture in patients with varicella and herpes zoster. All 11 patients with early lesions of varicella had a positive Tzanck preparation, while only seven (64%) of 11 had a positive culture. Twelve (80%) of 15 patients with zoster had a positive Tzanck preparation, while only nine (60%) of 15 had a positive culture. The predominance of the Tzanck yield over the culture is probably due to the increased difficulty in isolation of the varicella zoster virus. These results suggest that the Tzanck preparation is a valuable tool in the diagnosis of patients with varicella and zoster and offers a much more immediate answer than does viral culture, which often takes one to two weeks. These results contrast with those of our previous study of the Tzanck preparation and herpes simplex, in which the viral culture was more accurate than the Tzanck preparation. PMID: 3006599 [PubMed - indexed for MEDLINE] 4878. J Pediatr. 1986 Mar;108(3):372-7. Increased incidence of herpes zoster in normal children infected with varicella zoster virus during infancy: community-based follow-up study. Baba K, Yabuuchi H, Takahashi M, Ogra PL. We surveyed outbreaks of varicella zoster virus (VZV) and herpes zoster virus, involving 31 outbreaks of chicken pox, in a semiclosed institution in Osaka Japan during the 34 years between 1949 and 1984. Eight hundred forty-nine infants and children who had had clinical varicella during the first 4 years of life and those who had resided in the institution at least 12 to 144 months after the onset of varicella were included in the study. Nine cases of zoster were observed among children who had acquired varicella during the first year of life, but there was no case of zoster in those who had acquired varicella after 1 year of age. In 61,800 person-months of observation, the overall incidence rate of zoster was calculated as 0.15 per 1000 person-months for the population at risk. The incidence rate in children infected with VZV when younger than 2 months was 1.0 per 1000 person-months during the first decade of life. This rate was significantly (P less than 0.005) greater than that (0.19 per 1000 person-months) in children who had varicella when they were 2 to 11 months of age. These observations suggest that zoster occurs at a significantly shorter interval if VZV infection is acquired during infancy. More than 85% of subjects with prior infection were intimately reexposed to epidemic varicella during their residency in the institution, before having zoster. Epidemic reexposure to varicella during follow-up resulted in enhancement of preexisting immunologic reactivity, but did not prevent subsequent zoster in the population studied. PMID: 3005536 [PubMed - indexed for MEDLINE] 4879. J Infect Dis. 1986 Mar;153(3):605-8. Varicella-Zoster virus does not become more resistant to acyclovir during therapy. Cole NL, Balfour HH Jr. PMID: 3005428 [PubMed - indexed for MEDLINE] 4880. Ann Allergy. 1986 Mar;56(3):206, 241-3. Intravenous gammaglobulin treatment of profound herpes varicella zoster associated thrombocytopenia. DiTuro WJ, Goldsmith PM, Frenkel LD, Jadeja NG, Dennis TR. PMID: 2420239 [PubMed - indexed for MEDLINE] 4881. Am J Ophthalmol. 1986 Feb 15;101(2):153-5. Herpes zoster ophthalmicus in patients at risk for the acquired immune deficiency syndrome (AIDS). Sandor EV, Millman A, Croxson TS, Mildvan D. In a prospective investigation of 54 consecutive cases of herpes zoster ophthalmicus, conducted over a two-year period, immunologic evaluations included enumeration of T lymphocyte subsets and serum immunoglobulin levels. Herpes zoster ophthalmicus occurred with frequent ocular complications in a subgroup of adults distinguishable by their young age, the presence of AIDS-risk factors, alterations in T-cell subpopulations, and polyclonal increases of serum gammaglobulin. Over the study duration, 21% (three of 14) of the AIDS-risk subgroup patients have developed AIDS with a 14% (two of 14) mortality. Herpes zoster ophthalmicus in AIDS-risk group members appeared to be an early clinical marker for the immune deficiency induced by AIDS retroviral infection. PMID: 3484904 [PubMed - indexed for MEDLINE] 4882. Ann Neurol. 1986 Feb;19(2):182-8. Progressive encephalitis three months after resolution of cutaneous zoster in a patient with AIDS. Ryder JW, Croen K, Kleinschmidt-DeMasters BK, Ostrove JM, Straus SE, Cohn DL. A 37-year-old homosexual man with the acquired immune deficiency syndrome (AIDS) developed progressive, ultimately fatal, neurological deficits 12 weeks after a course of cutaneous zoster. Premortem radiological procedures and cerebrospinal fluid analyses were nondiagnostic. At postmortem examination, several opportunistic infections associated with AIDS were recognized. Throughout the brain, necrotic and demyelinative lesions were present, suggestive of progressive multifocal leukoencephalopathy. However, light microscopical examination showed numerous Cowdry type A intranuclear inclusions in astrocytes, oligodendrocytes, and neurons near the periphery of the lesions. Herpes zoster encephalomyelitis was diagnosed and confirmed by electron microscopy, peroxidase-antiperoxidase staining, and by Southern blot analysis of DNA extracted from brain tissue. This case provides insight into the pathogenesis of zoster-associated encephalomyelitis and suggests another agent to be considered in the differential diagnosis of encephalopathy in patients with AIDS and other disorders of immunological impairment. PMID: 3963760 [PubMed - indexed for MEDLINE] 4883. J Hand Surg Br. 1986 Feb;11(1):115-6. Shingles following axillary nerve block. A case report. Percival NJ. Axillary nerve blocks are now frequently used for emergency and elective upper limb surgery. The method gives reliable anaesthesia with few complications. A case is described in which a patient developed Herpes Zoster following an Axillary Nerve Block, a hitherto unreported complication. PMID: 3958530 [PubMed - indexed for MEDLINE] 4884. Hawaii Med J. 1986 Feb;45(2):37-9. The patterns of herpesvirus infection in a multiracial population Kauai County, Hawaii, 1981-1985. Brinkworth S, Elpern DJ. PMID: 3957653 [PubMed - indexed for MEDLINE] 4885. Am J Med Sci. 1986 Feb;291(2):115-8. SIADH during disseminated Herpes varicella-zoster infections: relationship to vidarabine therapy. Semel JD, McNerney JJ Jr. Three patients with the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) during the course of disseminated Herpes Varicella-Zoster (HVZ) virus infections are reported. In one patient and two previously reported patients, SIADH occurred at or shortly after admission, prior to antiviral drug therapy. In two patients and one previously reported patient, SIADH began or hyponatremia worsened after vidarabine therapy was begun. Therefore, SIADH may occur during the course of untreated, disseminated HVZ infection. However, the relatively high fluid volume required to dilute vidarabine may play a role in the development of the clinical and laboratory manifestations of SIADH, in patients receiving the drug. Physicians should avoid excess fluid intake and monitor serum sodium carefully when caring for patients with disseminated HVZ infections. Doses of vidarabine greater than 10 mg/kg/day may increase the likelihood of SIADH. Acyclovir therapy was not associated with worsening of hypotonic hyponatremia in our patients. PMID: 3946467 [PubMed - indexed for MEDLINE] 4886. Nihon Kyobu Shikkan Gakkai Zasshi. 1986 Feb;24(2):195-9. [Two cases of primary varicella pneumonia] [Article in Japanese] Aizawa H, Ohsaki Y, Sakai E, Ikeda Y, Kuwajima T, Onodera S. PMID: 3735830 [PubMed - indexed for MEDLINE] 4887. J Assoc Physicians India. 1986 Feb;34(2):161. Unusual cases of herpes zoster involving cranial nerves. Bhattacharya SK, Sundar S. PMID: 3711014 [PubMed - indexed for MEDLINE] 4888. Neurol Clin. 1986 Feb;4(1):265-83. CNS diseases associated with varicella zoster virus and herpes simplex virus infection. Pathogenesis and current therapy. Barnes DW, Whitley RJ. In recent years, herpes simplex virus has been recognized as an important CNS pathogen in neonates and adults. The recent development of effective antiviral therapy has substantially reduced the excessive morbidity and mortality associated with these infections. For neonatal herpes simplex infections, the current drug of choice is vidarabine. The results of ongoing clinical trials comparing vidarabine with acyclovir in neonatal herpes may lead to a change in the recommended therapy. In the adult, the therapy of choice for herpes simplex encephalitis is acyclovir. Although effective, the present therapies for herpes simplex infections of the CNS leave much room for improvement. In addition to the development of more effective antiviral drugs and less invasive diagnostic techniques, prevention of these often devastating infections will be important in reducing morbidity and mortality. The CNS diseases associated with varicella and herpes zoster may have a different pathogenesis. The implication for therapy in these diseases favors nonspecific supportive therapy in the varicella-associated syndromes. The few anecdotal reports of the use of vidarabine and acyclovir in herpes zoster encephalitis and the histopathologic evidence suggesting viral invasion of the CNS in many cases of zoster-associated neurologic syndromes makes the use of specific antiviral therapy in zoster encephalomyelitis more rational. However, appropriate therapeutic recommendations will have to be based on controlled clinical trials that have not yet been performed. PMID: 3523204 [PubMed - indexed for MEDLINE] 4889. Klin Monbl Augenheilkd. 1986 Feb;188(2):97-100. [Total lid replacement by an autologous and homologous combination graft in emergencies] [Article in German] Neubauer H. Report on 3 cases with total loss of a lid which required an "emergency lid" in order to protect the cornea. In all cases the tarsus was replaced by a strip of dura mater, the eye-lid skin by a free retroauricular graft. In all 3 cases the attempt was made to mobilize the levator and other adjacent tissue and fix them to the tarsus replacement. In one case the upper palpebral and bulbar conjunctiva was also replaced by 2 flaps of lip mucosa. In this case the lower half of the tarsal zone was rejected; however, the situation was mastered by tarsoconjunctival shifting of the lower lid with a free lid skin graft from the other eye. All "emergency lids" resulted in lid closure which protected the cornea sufficiently. The 2 patients in whom the upper lid was replaced had active lid movement of 3 to 4 mm. PMID: 3520123 [PubMed - indexed for MEDLINE] 4890. South Med J. 1986 Feb;79(2):256-7. Recurrent varicella-zoster infection after acyclovir therapy in immunocompromised patients. Oblon DJ, Elfenbein GJ, Rand K, Weiner RS. Varicella-zoster virus (VZV) infection is a late complication of bone marrow transplantation in almost half of the long-term survivors. We have reported the clinical relapse of VZV infection in two marrow transplant recipients treated with standard regimens of acyclovir, a new antiviral agent with activity against VZV. Since most VZV infections occur after discharge from a transplant center, primary care physicians must be alert to the possibility of relapse of VZV infection after acyclovir therapy. PMID: 3511542 [PubMed - indexed for MEDLINE] 4891. Rinsho Shinkeigaku. 1986 Feb;26(2):133-6. [Herpes zoster ophthalmicus with delayed ipsilateral cerebellar ataxia] [Article in Japanese] Yamamoto T, Inoue N, Tsuji S, Murai Y, Tsukamoto Y. PMID: 3486079 [PubMed - indexed for MEDLINE] 4892. Lancet. 1986 Feb 1;1(8475):273-4. Shingles clusters. Palmer SR, Tillett H. PMID: 2868283 [PubMed - indexed for MEDLINE] 4893. N Engl J Med. 1986 Jan 23;314(4):208-12. Treatment of varicella-zoster virus infection in severely immunocompromised patients. A randomized comparison of acyclovir and vidarabine. Shepp DH, Dandliker PS, Meyers JD. In a prospective, randomized trial, we compared intravenous acyclovir and vidarabine in the treatment of varicella-zoster virus infection in severely immunocompromised patients who presented within 72 hours of onset of the infection. Eleven patients were treated in each group. Cutaneous dissemination of infection occurred in none of the 10 acyclovir recipients and in 5 of the 10 vidarabine recipients who had presented with localized dermatomal disease (P = 0.016). As compared with vidarabine, acyclovir treatment shortened the median periods during which cultures were positive for the virus (four vs. seven days, P = 0.004) and new lesions formed (three vs. six days, P = 0.03). Acyclovir also shortened the median interval until the first decrease in pain (4 vs. 7 days, P = 0.005), the pustulation of all lesions (4 vs. 7 days, P = 0.0004), the crusting of all lesions (7 vs. 17 days, P = 0.0003), and the complete healing of lesions (17 vs. 28 days, P = 0.003). In addition, acyclovir reduced the incidence of fever (two vs. eight patients, P = 0.015). We conclude that acyclovir is better than vidarabine for the treatment of varicella-zoster infection in immunocompromised patients. PMID: 3001523 [PubMed - indexed for MEDLINE] 4894. Lancet. 1986 Jan 18;1(8473):160. Varicella-zoster: reactivation or reinfection? Pallett AP, Nicholls MW. PMID: 2867379 [PubMed - indexed for MEDLINE] 4895. JAMA. 1986 Jan 17;255(3):387-8. Acyclovir therapy for herpes zoster: advantages and adverse effects. Balfour HH Jr. PMID: 3941520 [PubMed - indexed for MEDLINE] 4896. JAMA. 1986 Jan 17;255(3):385-6. Vesicular eruption. A local complication of concentrated acyclovir infusions. Sylvester RK, Ogden WB, Draxler CA, Lewis FB. PMID: 3510331 [PubMed - indexed for MEDLINE] 4897. Minerva Med. 1986 Jan 14;77(1-2):47-50. [Drug therapy of so-called postherpetic neuralgia, the only valid alternative. Clinical experience in 43 treated cases] [Article in Italian] Bianchetti L. The efficacy of tricyclic antidepressants in association with neuroleptics having been demonstrated in patients suffering from so-called tardive post-herpetic neuralgia, 43 patients were given this treatment either alone or in association with transcutaneous nerve stimulation (TENS). Of the 33 patients given drug treatment alone, 25 found relief from pain in 3-18 months, 5 produced a partial result and in 3 the treatment failed. The results obtained suggest that this is the most effective treatment as long as it is continuous and given for at least 3-6 months. The use of TENS produced no benefit. PMID: 2868434 [PubMed - indexed for MEDLINE] 4898. Wien Klin Wochenschr. 1986 Jan 10;98(1):20-4. [Experiences with acyclovir in herpes virus infections] [Article in German] Fortelny A, Heinz R, Waldner R, Baumgartner G, Lutz D. 46 patients suffering from various malignancies (17 non Hodgkin lymphomas, 12 Hodgkin's diseases, 11 acute leukaemias, 4 myelomas, 2 carcinomas), 6 patients with haematological disorders such as ITP, SAA, myeloproliferative disease, LAS and 3 patients without preexisting disease were treated with acyclovir for herpes virus infection diagnosed by clinical means. All but 7 patients had been given intensive treatment with various cytostatic agents and/or irradiation. Most patients were treated with 1500 mg acyclovir daily for 5 to 13 days. Dosage was adjusted according to renal function and clinical response in the remaining 10 cases. 11 patients received intravenous immunoglobulins in addition. Side effects were negligible (local irritation, minimal rise in serum creatinine levels in 5 patients). All patients responded to treatment; 6 patients complained of severe neuralgia lasting for more than one month; 5 patients relapsed. PMID: 3006362 [PubMed - indexed for MEDLINE] 4899. Ugeskr Laeger. 1986 Jan 6;148(2):66-8. [Postherpes neuralgia. Optimal treatment of pain in acute herpes zoster is essential] [Article in Danish] Andersen S. PMID: 3952825 [PubMed - indexed for MEDLINE] 4900. Nervenarzt. 1986 Jan;57(1):14-8. [Specific antibody activity as a marker of pathogen-stimulated immune response in the central nervous system. Exemplified by syphilis and zoster diseases] [Article in German] Prange HW, Ritter G. Under normal conditions the portion of any antigen specific IgG of total IgG is identical in serum and CSF. This thesis was investigated in 51 patients who were found to have seropositive syphilis without CNS involvement. For this purpose a special index (ITpA-index) was used, based on the ratio of specific IgG per total IgG of CSF to specific IgG per total IgG of serum. This index has a value of 1 (0.5-2), if there is no antibody synthesis in the CNS, as confirmed on the 51 seropositive control patients. In patients with syphilitic CNS involvement the index rose above 2 (3-430), due to local antibody synthesis in the CNS. When there is an ITpA-index below 2.0 in patients with seropositive syphilis who show any CNS symptoms whatsoever, it can be presumed that the actual CNS disease is not a consequence of the former syphilitic infection, but is caused by a condition other than syphilis. In 6 patients with reactive syphilis tests, moderate CSF pleocytosis and increased CSF total IgG, the ITpA-index was below 0.5. Among these 6 patients the inflammatory CNS process was non-syphilitic. The principle of the ITpA-index is applicable to other bacterial or viral CNS diseases insofar as a local humoral immune response takes place. This could be demonstrated in cases of herpes zoster. PMID: 3960215 [PubMed - indexed for MEDLINE] 4901. Clin Exp Immunol. 1986 Jan;63(1):179-87. Human lymphocyte, monocyte and polymorphonuclear leucocyte mediated antibody-dependent cellular cytotoxicity against varicella-zoster virus-infected targets. Ihara T, Ito M, Starr SE. The ability of lymphocytes, monocytes and polymorphonuclear leucocytes (PMN) to mediate antibody-dependent cellular cytotoxicity (ADCC) against varicella-zoster virus (VZV) infected fibroblasts was tested in 51Cr release and single-cell assays. Lymphocytes had the greatest lytic activity, monocytes were intermediate in activity and PMN were the least active. Lymphocyte-mediated ADCC was complete by as early as 4 h, while maximal monocyte and PMN-mediated ADCC required 18 h. In single-cell assays, monocytes formed conjugates with both uninfected and VZV-infected targets, but did not cause lysis. PMN failed to bind or lyse either target. Few lymphocytes formed conjugates with uninfected targets, while a higher percentage bound to VZV-infected targets and caused lysis. In the presence of human antibodies to VZV conjugate formation and lysis of VZV-infected targets was significantly increased with each of the effector-cell populations. Lymphocytes had the highest lytic activity in single-cell assays as well as in 51Cr release assays, and were responsible for most of the ADCC detected in adult peripheral blood against VZV-infected targets. PMCID: PMC1577353 PMID: 3955882 [PubMed - indexed for MEDLINE] 4902. J Am Osteopath Assoc. 1986 Jan;86(1):34-6. Epidural phenol in the treatment of postherpetic neuralgia. Neuendorf TL. PMID: 3949557 [PubMed - indexed for MEDLINE] 4903. Int J Dermatol. 1986 Jan-Feb;25(1):58-9. Dermatologic dyspnea. O'Doherty CJ, Savin JA. PMID: 3949433 [PubMed - indexed for MEDLINE] 4904. Zentralbl Gynakol. 1986;108(21):1273-81. [New aspects of therapy with standard immunoglobulin preparations] [Article in German] Briese V. Both, in vitro and in vivo studies have shown that intravenous immunoglobulin administration in high doses is of usefulness in the therapy of bacterial infections because of synergistic effects with antibiotics. Unmodified, polyvalent immunoglobulin for intravenous administration is actually used for therapy in patients with severe generalized infections, in patients with autoimmune diseases such as idiopathic thrombocytopenic purpura (ITP). ITP patients were treated with IgG i.v. 400 mg/kg KG. One can hope for practical purposes that IgG preparations administrated prophylactically decrease infectious complications in myelosuppressive phases during aggressive tumor therapy. PMID: 3811676 [PubMed - indexed for MEDLINE] 4905. Vestn Dermatol Venerol. 1986;(9):54-5. [Keloid scars as a sequel of herpes zoster] [Article in Russian] Manikhas MG, Egorova MA, Orlova EV. PMID: 3799054 [PubMed - indexed for MEDLINE] 4906. Adv Exp Med Biol. 1986;195 Pt B:689-92. 2-5A synthetase activities in herpes virus infection and after interferon treatment. Mejer J, Justesen J, Ernst P. PMID: 3766247 [PubMed - indexed for MEDLINE] 4907. J Tongji Med Univ. 1986;6(2):109-11. The efficacy of long-dan-xie-gan-tang in the treatment of herpes zoster: a clinical trial and animal experimental data. Shen LL, Wu HS, Wang XY. PMID: 3746978 [PubMed - indexed for MEDLINE] 4908. Neoplasma. 1986;33(3):355-9. Ph1-positive acute leukemia in a patient with Hodgkin's disease treated by irradiation and chemotherapy. Yavorkovsky LL, Yavorkovsky LI, Bondare DK. A case of acute undifferentiated leukemia with a Ph1-chromosome and a typical translocation t(9;22) is reported in a 54-year-old female with Hodgkin's disease. The interval from diagnosis of Hodgkin's disease to the development of acute leukemia was 19 months. Treatment of Hodgkin's disease consisted of combined cytotoxic therapy including irradiation and chemotherapy. Detection of Ph1-chromosome in undifferentiated blasts supports the suggestion of leukemogenic chromosomal aberration within uncommitted hemopoietic cells. PMID: 3736721 [PubMed - indexed for MEDLINE] 4909. J R Coll Gen Pract. 1986 Jan;36(282):24-8. Postherpetic neuralgia. Robinson PN, Fletcher N. PMCID: PMC1960355 PMID: 3701690 [PubMed - indexed for MEDLINE] 4910. Clin Neuropharmacol. 1986;9(6):533-41. Treatment of postherpetic neuralgia. Watson PN, Evans RJ. PMID: 3542206 [PubMed - indexed for MEDLINE] 4911. Vestn Dermatol Venerol. 1986;(1):56-7. [A case of generalized herpes zoster in a patient with reticulosarcomatosis] [Article in Russian] Nemkaeva RM, Unzhakov VP, Kuz'min IK. PMID: 3515801 [PubMed - indexed for MEDLINE] 4912. Curr Probl Dermatol. 1986;15:111-6. Applications of laser light of low power density. Experimental and clinical investigations. Brunner R, Haina D, Landthaler M, Waidelich W, Braun-Falco O. PMID: 3512177 [PubMed - indexed for MEDLINE] 4913. J Med Virol. 1986 Jan;18(1):11-20. Oral bromovinyldeoxyuridine therapy for herpes simplex and varicella-zoster virus infections in severely immunosuppressed patients: a preliminary clinical trial. Tricot G, De Clercq E, Boogaerts MA, Verwilghen RL. Twenty-five patients with haematological diseases were treated orally with the highly potent and selective anti-herpes agent, bromovinyldeoxyuridine (BVDU), in a dosage of 7.5 mg/kg/day (divided over three or four doses a day) for 5 days for an intercurrent mucocutaneous herpesvirus infection. Of these 25 patients, 8 were severely granulocytopenic at the time of the viral infection, and 12 recently had undergone bone-marrow transplantation; 5 were under cytotoxic therapy for a lymphoproliferative disorder; 13 had herpes simplex virus type 1 (HSV-1); 1 had herpes simplex virus type 2 (HSV-2); and 11 had varicella-zoster virus (VZV) infection. In all but two patients, BVDU arrested progression of the HSV or VZV infection within 1-2 days after treatment was started. One of the two patients who failed to respond to BVDU had an HSV-2 infection. The other had an HSV-1 infection, which was highly sensitive to BVDU in vitro; BVDU may have failed in this patient because of incomplete drug intake or profuse diarrhoea, or both. The results of this preliminary uncontrolled clinical trial suggest that BVDU may be an effective and safe drug for the oral treatment of HSV-1 and VZV infections in severely immunosuppressed patients. PMID: 3511181 [PubMed - indexed for MEDLINE] 4914. Int Ophthalmol Clin. 1986 Winter;26(4):29-48. Peripheral corneal infections. Taylor PB, Tabbara KF. PMID: 3492477 [PubMed - indexed for MEDLINE] 4915. Agents Actions Suppl. 1986;19:321-9. Pyrazolone drugs in outpatient pain treatment. Baar HA. Even today, pyrazolone drugs still play an essential role in outpatient pain treatment. Their applications and limitations are discussed from the point of view of the general practitioner treating outpatients. PMID: 3489360 [PubMed - indexed for MEDLINE] 4916. An Otorrinolaringol Ibero Am. 1986;13(2):185-93. [The crocodile tear syndrome. Apropos of a case] [Article in Spanish] De la Fuente Arjona L. PMID: 3487989 [PubMed - indexed for MEDLINE] 4917. Clin Exp Immunol. 1986 Jan;63(1):141-6. Cellular interactions in the lysis of varicella-zoster virus infected human fibroblasts. Hayward AR, Herberger M, Lazslo M. The in vitro lysis of varicella-zoster virus (VZV) infected human fibroblasts by blood mononuclear cells (MNC) is inhibited by cyclosporin A, whether or not the effector and target cells chare HLA A or B antigens. Interleukin 2 (IL-2) reversed the inhibition by cyclosporin A (CyA) and also induced a further increase in target cell lysis by MNC in the absence of CyA. MNC depleted of OKM-1+ or Leu-11+ cells showed reduced lysis of VZV infected fibroblasts and this reduction was not overcome by adding IL-2. Depletion of monocytes from the MNC effectors reduced target cell lysis and this effect was reversed by adding Interleukin 1 (IL-1). The results indicate that NK cells contribute to the lysis of VZV infected cells and suggest that IL-2 release by T cells, as a result of HLA matching or antigen representation, may amplify this mechanism. PMCID: PMC1577337 PMID: 3485481 [PubMed - indexed for MEDLINE] 4918. Arch Otorhinolaryngol Suppl. 1986;2:146-59. [The larynx, the trachea] [Article in German] [No authors listed] PMID: 3469945 [PubMed - indexed for MEDLINE] 4919. J Oral Med. 1986 Jan-Mar;41(1):25-8. Facial herpes zoster. Description and therapeutic update. Kinni ME, Wedell DW. PMID: 3457111 [PubMed - indexed for MEDLINE] 4920. Pediatrics. 1986 Jan;77(1):53-6. Risk of herpes zoster in children with leukemia: varicella vaccine compared with history of chickenpox. Brunell PA, Taylor-Wiedeman J, Geiser CF, Frierson L, Lydick E. A study was undertaken to determine whether children immunized with live varicella vaccine are at greater risk of acquiring herpes zoster than children who have had varicella. Children with acute lymphocytic leukemia who had had varicella were compared with those who received live varicella vaccine. During the period of observation, 15 of 73 children who had varicella acquired herpes zoster and none of the 34 children who had been vaccinated. If the time of observation was adjusted for and the vaccinees who failed to have a sustained antibody response or who acquired chickenpox were removed, the risk of herpes zoster was still less in vaccinees (P = .0075). Because herpes zoster is common in children with acute lymphocytic leukemia, differences in the two groups could be discerned more readily than if normal children were compared. There is no reason to suspect that recipients of live varicella vaccine would be more likely to acquire herpes zoster than children who get varicella. PMID: 3455669 [PubMed - indexed for MEDLINE] 4921. Adv Pediatr Infect Dis. 1986;1:99-115. Varicella zoster infections of the fetus, neonate, and immunocompromised child. Feldman S. Division of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, Tennessee. PMID: 3331278 [PubMed - indexed for MEDLINE] 4922. J Med. 1986;17(3-4):267-70. Connection between varicella and herpes zoster. Jako GJ, Jako RA. PMID: 3295093 [PubMed - indexed for MEDLINE] 4923. Indian J Ophthalmol. 1986;34:107-8. Autoserum therapy and zoster keratitis. Satsangi SK, Verma S, Singh YP, Pandey DJ, Bist HK, Choudhary RM. PMID: 3155040 [PubMed - indexed for MEDLINE] 4924. Indian J Ophthalmol. 1986;34:101-3. A clinical study of acyclovir in herpes zoster ophthalmicus. Matalia P. PMID: 3155038 [PubMed - indexed for MEDLINE] 4925. Pediatr Hematol Oncol. 1986;3(3):267-71. Short-time and low-dose intravenous acyclovir therapy in varicella zoster infections with malignant disease in children receiving combined chemotherapy. Sarialioğlu F, Buyukpamukcu M, Cevik N, Kutluk MT, Akyol H, Kansu E. Department of Paediatric Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey. The effects of low-dose and short-time acyclovir therapy in 14 children with malignant disease of ages 4-18 years who had developed varicella zoster virus infections while receiving aggressive chemo-/+radiotherapy are reported. Ten of them had chickenpox and 4 herpes zoster. Acyclovir 5 mg/kg was infused IV every 12 h in 9 patients and every 8 h in 5 patients for a median of 4 days' duration. We resumed the primary therapy when the patients' lesions had dried out and became crusted and new lesions had not reappeared. The period of initiation of the acyclovir therapy to the resumption of oncological treatment was 8.4 +/- 2.7 days for chickenpox and 12.0 +/- 3.4 days for herpes zoster patients. After restarting the oncological therapy, no adverse effects of acyclovir or complication of infection were observed. The efficiency of early, short-term, and relatively low dose acyclovir therapy is discussed and compared to the results in the relevant literature. PMID: 3153239 [PubMed - indexed for MEDLINE] 4926. Year Immunol. 1986;2:267-78. The role of T cell immunity in infection with the herpes group viruses. Finberg R, Hom R. PMID: 3033947 [PubMed - indexed for MEDLINE] 4927. Czech Med. 1986;9(4):203-5. Acyclovir in the treatment of infection due to herpes viruses. Zicha J, Stafová J, Vacek V. Intravenous infusions of acyclovir were administered to 15 patients suffering from herpes simplex or varicella-zoster infections. The therapeutic effect of the drug consisted in rapid cessation of progression of the disease and in considerable shortening of duration of clinical symptoms. There were no adverse reaction in our groups of patients. There were no relapses after the treatment with acyclovir had been stopped. From what has been stated above, we take acyclovir for a highly efficient and safe drug for therapy of HSV and VZV infections. PMID: 3028734 [PubMed - indexed for MEDLINE] 4928. Adv Exp Med Biol. 1986;202:95-118. Herpesvirus infections in the immunocompromised host: diagnosis and management. Whitley RJ. PMID: 3024455 [PubMed - indexed for MEDLINE] 4929. Int J Cell Cloning. 1986;4 Suppl 1:155-73. Therapeutic use of newer antiviral agents. Sacks SL. PMID: 3018100 [PubMed - indexed for MEDLINE] 4930. Auris Nasus Larynx. 1986;13(1):11-34. Vestibular neuronitis--serum and CSF virus antibody titer. Matsuo T. The cerebrospinal fluid (CSF) findings of patients with vestibular neuronitis were virologically evaluated and discussed in contrast to those of herpes zoster. CSF samples obtained from seven patients with vestibular neuronitis, aged 28 to 55 years, were examined. The results were as follows: The CSF protein level in the vestibular neuronitis showed the peculiar change; i.e. its level was normal at the onset period of vertigo, but it rose to abnormal levels mostly in the period of two weeks, while the cell count remained normal throughout all phases of our study. Herpes simplex virus (HSV) type 1 IgG antibody titers measured by indirect immunofluorescent antibody technique (IF) in paired sera rose in one of the seven cases of vestibular neuronitis, but the antibody titers of the same virus in the CSF were not detected. HSV type 1 IgG antibody titers measured by IF in the CSF were detected in two of seven cases of vestibular neuronitis, but not significant. The ratio of EB virus (EBV) capsid antigen IgG antibody titers in CSF to that in serum ranged from 1:160 to 1:80 in vestibular neuronitis. There was no direct available evidence that vestibular neuronitis caused a break in blood-CSF barrier, an increase in IgG synthesis in the central nervous system or active infection with HSV, varicella zoster virus (VZV), or EBV. In this paper, we summarized the recent information on studies of the CSF and a latent herpes virus infection in order to give perspective to the pathogenesis of vestibular neuronitis. PMID: 3017280 [PubMed - indexed for MEDLINE] 4931. Arch Virol. 1986;88(3-4):265-77. Inoculation of guinea pigs with varicella-zoster virus via the respiratory route. Walz-Cicconi MA, Rose RM, Dammin GJ, Weller TH. Guinea pigs were inoculated by the respiratory route with wild-type (Cyr) or vaccine (Oka) strain varicella zoster virus (VZV). Wild-type cell-free virus obtained by sonication produced neutralizing antibody responses in steroid-treated animals when given via the intratracheal route, and induced neutralizing antibody as well as a pneumonitis in normal animals when given via the intrabronchial (i.b.) route. A humoral response also followed i.b. instillation of cell-associated wild-type or vaccine strain VZV. Prior i.b. administration of thioglycollate or exposure to hyperoxia altered the number and function of pulmonary macrophages, respectively, but viral susceptibility of the guinea pigs was not enhanced. Both strains of VZV could be isolated from bronchial washings up to 48 hours after i.b. instillation of cell-associated virus, but neither strain was isolated thereafter from cultures of bronchial washings or explanted lung tissues. PMID: 3010908 [PubMed - indexed for MEDLINE] 4932. Nippon Hifuka Gakkai Zasshi. 1986 Jan;96(1):1-7. [Clinico-pathological studies on herpes zoster; [I]. Changes in antibody titers on herpes zoster] [Article in Japanese] Muraki R. PMID: 3009931 [PubMed - indexed for MEDLINE] 4933. Adv Nephrol Necker Hosp. 1986;15:353-78. Viral infections in renal transplant recipients: an evolutionary problem. Charpentier B. PMID: 3006452 [PubMed - indexed for MEDLINE] 4934. Ann Neurol. 1986 Jan;19(1):7-14. Thrombotic cerebral vasculopathy associated with herpes zoster. Eidelberg D, Sotrel A, Horoupian DS, Neumann PE, Pumarola-Sune T, Price RW. We describe the clinical, radiographic, and pathological findings in 3 patients with large-vessel cerebral vasculopathy following herpes zoster. Two of the patients were studied at postmortem examination, and a brain biopsy was performed in the third. Each of the 3 patients suffered thrombotic occlusions of large vessels without notable inflammatory or granulomatous changes following trigeminal or segmental herpes zoster infection. In the 2 autopsied patients, varicella-zoster virus (VZV) antigens were detected by immunoperoxidase staining within the media of the affected cerebral arteries. Little or no inflammation was associated with the foci of the VZV antigens. These studies provide evidence that the vasculopathy following herpes zoster may result from direct VZV infection of the artery and the in situ thrombosis can develop within the infected vessels in the absence of clear inflammatory vasculitis. PMID: 3004319 [PubMed - indexed for MEDLINE] 4935. Acta Derm Venereol. 1986;66(2):127-33. Diagnostic value of Tzanck smear in herpetic and non-herpetic vesicular and bullous skin disorders in pediatric practice. Oranje AP, Folkers E, Choufoer-Habova J, Duivenvoorden JN. The diagnostic value of the Tzanck smear was investigated in 76 patients of a pediatric hospital population suffering from vesicular, erosive or bullous skin disorders. Examination took place by two investigators together (AB), besides the smears were examined by two others (C and D) double blind. Sensitivity for patients with clinical herpetic infections was greater than 80%, specificity for those without herpetic infections was greater than 90%. These figures are higher than expected from literature. Reliability was also high; between the three investigators no significant differences were found. The Tzanck smear is simple, inexpensive, easy to perform and rapid; it does not require a specialized laboratory, but experience and correct technique of sampling is required. PMID: 2424235 [PubMed - indexed for MEDLINE] 4936. Graefes Arch Clin Exp Ophthalmol. 1986;224(3):313-6. Sectorial corneal infiltrates and pannus in herpes zoster ophthalmicus. Mondino BJ, Farley MK, Aizuss DH. We report four patients with herpes zoster ophthalmicus who developed a dense pannus limited to a sector of the superior cornea that advanced to the central region of the cornea. The pannus appeared to develop in response to peripheral infiltrates in a subepithelial or anterior stromal location and not in association with disciform corneal edema, interstitial keratitis, or scleritis. The corneal pannus developed insidiously as a late complication without associated ulceration and with little or no anterior uveitis or conjunctival reaction. Additionally, all four patients developed anterior and mid-stromal infiltrates in a punctate or incomplete ring configuration at the leading border of the pannus that threatened the visual axis. In the three patients that were treated with topical corticosteroids, the infiltrates resolved with preservation of visual acuity. The other patient developed central scarring with a permanent reduction in vision. Patients with infiltrates and pannus in a sector of the cornea should be followed carefully and treated with topical corticosteroids when infiltrates appear to prevent progression to the central cornea. PMID: 2423418 [PubMed - indexed for MEDLINE] 4937. Lancet. 1985 Dec 21-28;2(8469-70):1433-4. Clusters of shingles. [No authors listed] PMID: 2867432 [PubMed - indexed for MEDLINE] 4938. Nurs Times. 1985 Dec 18-31;81(51):22-4. Herpes zoster ophthalmicus. Fox J. PMID: 3878963 [PubMed - indexed for MEDLINE] 4939. N Engl J Med. 1985 Dec 12;313(24):1504-10. Patients at risk for AIDS-related opportunistic infections. Clinical manifestations and impaired gamma interferon production. Murray HW, Hillman JK, Rubin BY, Kelly CD, Jacobs JL, Tyler LW, Donelly DM, Carriero SM, Godbold JH, Roberts RB. We studied 81 men (79 homosexuals and 2 drug abusers) with persistent lymphadenopathy to determine whether those at risk for AIDS-related opportunistic infections could be identified prospectively. (Sixty-nine of 76 [91 per cent] had antibodies to human T-cell lymphotropic virus Type III [HTLV-III], and 76 of 79 [96 per cent] had abnormal T4/T8 cell ratios.) During the follow-up period (mean +/- S.E.M., 12.9 +/- 0.5 months; range, 8 to 19), infections developed in none of 38 patients with lymphadenopathy alone and in only 1 of 15 (7 per cent) with antecedent herpes zoster infection; however, 13 of 28 (46 per cent) with lymphadenopathy accompanied by constitutional symptoms or oral candidiasis or both had opportunistic infections within the follow-up period. Among the results of various T-cell assays, only antigen-stimulated lymphocyte proliferation and gamma interferon generation, which were absent or barely measurable in those in whom AIDS ultimately developed, were of prognostic value. T cells from 15 patients, 11 of whom had constitutional symptoms or thrush, failed to generate antigen-induced gamma interferon; infections developed in 10 of these 15 (67 per cent) within a mean of 8.2 months. These results suggest that patients with AIDS-related complex who are at risk for opportunistic infections within a year can be identified by correlating clinical manifestations with antigen-stimulated T-cell responses--in particular, with the production of gamma interferon. PMID: 3934537 [PubMed - indexed for MEDLINE] 4940. J Infect Dis. 1985 Dec;152(6):1172-81. Infection with varicella-zoster virus after marrow transplantation. Locksley RM, Flournoy N, Sullivan KM, Meyers JD. Infection with varicella-zoster virus (VZV) occurred in 231 (16.6%) of 1,394 patients undergoing marrow transplantation in Seattle, Washington, between 1969 and 1982. The probability of VZV infection was 30% by one year after transplant. Eighty percent of infections occurred within the first nine months after transplant, and of these cases 45% had cutaneous or visceral dissemination. Twenty-three deaths were associated with VZV infection, all within the initial nine months after transplant. Postherpetic neuralgia, scarring, and bacterial superinfection were also significantly more frequent among patients with VZV in the first nine months after transplant (32%) than among patients with later infection (19%; P less than .05). By multivariate analysis, allogeneic transplant, acute or chronic graft-vs.-host disease, patient age between 10 and 29 years, diagnosis other than chronic myelogenous leukemia, and posttransplant use of antithymocyte globulin were each risk factors for VZV infection. Among infected patients, the only significant risk factor for VZV dissemination or death was acute graft-vs.-host disease (P less than .03 and P less than .0002, respectively. PMID: 3905982 [PubMed - indexed for MEDLINE] 4941. Pain. 1985 Dec;23(4):381-6. Treatment of post-herpetic neuralgia. A review of 77 consecutive cases. Milligan NS, Nash TP. The treatment of 77 consecutive cases of post-herpetic neuralgia is reviewed. Stellate blockade proved helpful in 75% of patients with pain of less than 1 year's duration; 40% became virtually pain free. Drug treatment and electrical counterirritation methods gave improvement in 60% of cases but only 15% became pain free. Stellate block carried out after 1 year of pain proved helpful in only 44% of patients, and only 22% became pain free. Stellate blockade carried out within 1 year of the onset of symptoms would appear to be one of the treatments of choice for post-herpetic neuralgia. It would be of interest to see the results of a controlled randomised trial. PMID: 3878959 [PubMed - indexed for MEDLINE] 4942. Quintessenz. 1985 Dec;36(12):2385-9. [Herpes virus diseases in mouth, lip and facial regions] [Article in German] Mastalier O. PMID: 3869704 [PubMed - indexed for MEDLINE] 4943. Nippon Hifuka Gakkai Zasshi. 1985 Dec;95(14):1519-22. [A case of reticulate hyperpigmentation distributed in zosteriform fashion] [Article in Japanese] Yoshida M, Tezuka T. PMID: 3831437 [PubMed - indexed for MEDLINE] 4944. Aust N Z J Med. 1985 Dec;15(6):712-6. Paralysis in herpes zoster. Rosenfeld T, Price MA. Herpes zoster is a relatively common disease which affects predominantly the middle-aged and elderly. The segmentally distributed cutaneous eruption, sensory changes, and pain make up the well known zoster syndrome. Motor loss is another aspect of this syndrome which is less well known but occurs in a significant number of cases, and is probably far more frequent than is recognised because the weakness is readily obscured by pain. Four cases of herpes zoster with motor involvement are described. Two cases had zoster paresis affecting the arm and hand, and one of these had, in limb, and one case had urinary retention owing to an atonic bladder. These cases serve to illustrate many of the clinical features of the zoster syndrome with motor involvement. The significant functional implications of unrecognised motor deficit, particularly in the elderly, are a prominent feature and highlight the importance of early accurate diagnosis and management. The pathogenesis and clinical features of this syndrome are discussed in the literature review. PMID: 3010924 [PubMed - indexed for MEDLINE] 4945. J Neurol Sci. 1985 Dec;71(2-3):291-9. Cerebrospinal fluid virus antibodies. A diagnostic indicator for multiple sclerosis? Felgenhauer K, Schädlich HJ, Nekic M, Ackermann R. Specific antibody activities (antibody per weight unit IgG) of serum and CSF against a broad variety of viruses were compared in multiple sclerosis and certain inflammatory diseases of the central nervous system, e.g. neurosyphilis, as well as herpes simplex and zoster encephalitis. No "unspecific" antiviral activities within the CSF compartment were found in the non-MS diseases. The most frequent antibodies locally produced were directed against measles, rubella and zoster antigens. A diagnostic test with these three viruses would give positive results in about 80% of patients with MS. This finding is not as frequent as the oligoclonal pattern of the CSF gamma-globulins but would have a considerably greater diagnostic significance. PMID: 3003256 [PubMed - indexed for MEDLINE] 4946. J Neurol Neurosurg Psychiatry. 1985 Dec;48(12):1193-207. Treatment of peripheral neuropathies. Hallett M, Tandon D, Berardelli A. There are three general approaches to treatment of peripheral neuropathy. First, an attempt should be made to reverse the pathophysiological process if its nature can be elucidated. Second, nerve metabolism can be stimulated and regeneration encouraged. Third, even if the neuropathy itself cannot be improved, symptomatic therapy can be employed. This review outlines the options available for each approach. PMCID: PMC1028602 PMID: 3003254 [PubMed - indexed for MEDLINE] 4947. J Infect Dis. 1985 Dec;152(6):1349. Determination of infection and immunity to varicella-zoster virus with an enzyme-linked immunosorbent assay. Sirpenski SP, Brennan T, Mayo DR. PMID: 2999261 [PubMed - indexed for MEDLINE] 4948. Pain. 1985 Dec;23(4):387-94. A comparative trial of amitriptyline and zimelidine in post-herpetic neuralgia. Watson CP, Evans RJ. Serotoninergic pathways are believed to be important in pain mechanisms. Accordingly, we studied the action of zimelidine, a very highly serotoninergic antidepressant, in relieving the pain of post-herpetic neuralgia. Fifteen patients received zimelidine and amitriptyline in that order in an open-label cross-over study. Only one patient with zimelidine obtained a good result, whereas 8 patients on amitriptyline amitriptyline has a pain-relieving action, at least in post-herpetic neuralgia, which is not primarily linked with its serotoninergic effects and which is also independent of its effects on depression. PMID: 2935772 [PubMed - indexed for MEDLINE] 4949. Am Rev Respir Dis. 1985 Dec;132(6):1366-7. Respiratory muscle dysfunction after herpes zoster. Passerini L, Cosio MG, Newman SL. We report an unusual neurologic complication of herpes zoster. After thoracic herpes zoster, our patient complained of severe shortness of breath as a result of myoclonus of the abdominal muscles as documented by electromyography. The myoclonus resulted in repetitive interruption of expiratory air flow, resulting in shortness of breath and a staccato speech. This case demonstrates the need to evaluate the function of all the respiratory muscles in a patient complaining of dyspnea. PMID: 2934014 [PubMed - indexed for MEDLINE] 4950. J Virol Methods. 1985 Dec;12(3-4):199-208. Lymphocyte proliferation and IgG production with herpesvirus antigens in solid phase. Ljungman P, Wahren B, Sundqvist VA. A technique for simultaneous specific lymphocyte proliferation and IgG production with herpesvirus antigens in solid phase was developed. The cell mediated immune response was highly specific. Stronger cellular responses were found after stimulation with nucleocapsid antigens than with membrane antigens. Varicella-zoster virus (VZV) and herpes simplex virus (HSV) specific antibody production in vitro were found in almost 100% of seropositive individuals, while cytomegalovirus (CMV) antibody production was detectable in 70%. A higher specific IgG production was found after stimulation with CMV and VZV membrane antigens than with CMV nucleocapsid and VZV cell antigens. No differences in IgG production were found with the two types of HSV antigens. A method for viral IgG subclass determination in vitro was also developed. These methods may be used for monitoring immunosuppressed patients for immunological responsiveness to herpesvirus infections. PMID: 2422193 [PubMed - indexed for MEDLINE] 4951. Med Clin (Barc). 1985 Nov 23;85(17):715-26. [A 47-year-old male, hemophiliac, with fever, cough and dyspnea (clinicopathologic conference)] [Article in Spanish] Coca A, Egido R. PMID: 3003469 [PubMed - indexed for MEDLINE] 4952. N Engl J Med. 1985 Nov 21;313(21):1327-30. Herpesvirus infections of pregnancy. Part II: Herpes simplex virus and varicella-zoster virus infections. Stagno S, Whitley RJ. PMID: 3903503 [PubMed - indexed for MEDLINE] 4953. Lancet. 1985 Nov 16;2(8464):1108-11. An outbreak of shingles? Palmer SR, Caul EO, Donald DE, Kwantes W, Tillett H. 7 of 101 staff within one department of a large office complex had shingles, as diagnosed by a general practitioner, within a three-month period. This incidence was significantly greater than that in the remaining workforce. Varicella-zoster-specific IgM antibody was detected in all 4 cases from whom early convalescent serum samples were obtained but in none of 22 controls. Within the index department there was evidence of clustering in time and by work area. A case/control study showed that a recent preceeding illness might have been a risk factor for shingles in the outbreak cases, but not for sporadic cases in other departments of the same office complex. This outbreak suggests that shingles can be provoked by reexposure to varicella-zoster virus. PMID: 2865576 [PubMed - indexed for MEDLINE] 4954. Lancet. 1985 Nov 16;2(8464):1105-6. Outbreaks of shingles. [No authors listed] PMID: 2865573 [PubMed - indexed for MEDLINE] 4955. Acta Paediatr Scand. 1985 Nov;74(6):979-81. Herpes zoster in a 2-week-old premature infant with possible congenital varicella encephalitis. Bennet R, Forsgren M, Herin P. This report concerns a case of neonatal herpes zoster associated with maternal gestational varicella. The child developed skin lesions at 18 days of age virologically confirmed to be varicella-zoster. The baby also had encephalitis and aspiration probably due to bulbar paralysis. Multiple small necrotic areas were found in the thalamus at post-mortem examination. PMID: 4090975 [PubMed - indexed for MEDLINE] 4956. Anaesthesia. 1985 Nov;40(11):1133-4. Post-herpetic neuralgia. Alexander JI. PMID: 4073436 [PubMed - indexed for MEDLINE] 4957. Am J Otol. 1985 Nov;Suppl:80-7. Evoked serial electromyography in the evaluation of the paralyzed face. Silverstein H, McDaniel AB, Hyman SM. Serial evoked electromyography (EEMG) is a reliable, objective, repeatable test of facial nerve function. It is very important in the initial patient evaluation in determining percent degeneration of the facial nerve. A response of 0-20% will usually result in incomplete return of facial function while responses of 60% or better will usually result in normal function. With viral facial paralysis (Bell's palsy, herpes zoster oticus), serial EEMG after several weeks has little value in predicting the final percent recovery of facial function. If there is no EEMG response, the diagnosis of viral facial paralysis is questionable and serial tests should be done until facial function begins to return. If there is no return of facial function or EEMG responses, the diagnosis is probably a tumor and the nerve should be explored. When surgical manipulation of the facial nerve has resulted in partial facial weakness, EEMG helps predict the degree of recovery of facial function. EEMG results of 60% or better will result in normal facial function while EEMG results of 25% or less will result in incomplete return of facial function. Serial testing is not necessary in this group of patients. After transection and repair of the facial nerve, serial EEMG is of value in showing continuity of the repair. Lack of improvement in EEMG over 5-12 months and no return of facial function indicates poor prognosis. PMID: 4073249 [PubMed - indexed for MEDLINE] 4958. Lijec Vjesn. 1985 Nov-Dec;107(11-12):506-10. [Topical administration of human leukocyte interferon in patients with herpes zoster] [Article in Croatian] Aglić V, Smerdel S, Delimar N, Jusić D, Soos E. PMID: 3908864 [PubMed - indexed for MEDLINE] 4959. Ophthalmology. 1985 Nov;92(11):1542-9. Necrotizing scleritis. A clinico-pathologic study of 41 cases. Rao NA, Marak GE, Hidayat AA. Scleritis is not a single clinical or pathologic entity. It has several distinct forms. A clinico-pathologic study of 41 cases of necrotizing scleritis suggests that these different histopathologic forms of disease may reflect different mechanisms of immunopathogenesis. These cases were divided into three main groups: (1) scleral inflammations associated with various systemic autoimmune diseases, including 11 cases of rheumatoid arthritis, three cases of Wegener's granulomatosis, one case of polychondritis, and one case of Goodpasture's syndrome; (2) infectious scleritis, consisting of four cases of herpes zoster ophthalmicus and two cases of pseudomonas scleritis; and (3) idiopathic scleritis, without evidence of systematic disorder, consisting of 19 cases. The first group exhibited predominantly necrosis of the sclera surrounded by granulomatous inflammation and vasculitis. None of these cases showed lymphoid follicles, or healing attempts manifested by proliferation of fibroblasts and blood vessels at the site of inflammation. The idiopathic group revealed few small foci of scleral necrosis and mainly non-granulomatous inflammation. In addition, there was evidence of proliferation of granulation tissue and lymphoid follicles in this group of eyes. PMID: 3878485 [PubMed - indexed for MEDLINE] 4960. Ophthalmology. 1985 Nov;92(11):1574-83. Oral acyclovir in the therapy of acute herpes zoster ophthalmicus. An interim report. Cobo LM, Foulks GN, Liesegang T, Lass J, Sutphin J, Wilhelmus K, Jones DB, Chapman S, Segreti A. A prospective, randomized, double-masked, placebo-controlled clinical trial was conducted to study the effects of oral acyclovir on 55 patients with acute herpes zoster ophthalmicus. Treatment with oral acyclovir resulted in more prompt resolution of signs and symptoms, particularly in patients treated within 72 hours after onset of skin rash (P less than 0.05), and shortened the duration of viral shedding (P = 0.02). Vesicular skin lesions involving other dermatomes (microdissemination) occurred in five (19%) placebo-treated patients but in no acyclovir-treated patients (P = 0.03). Interim analysis of this longitudinal study suggests that the incidence and severity of secondary ocular inflammatory disease was reduced by acyclovir. Prolonged observation of these patients is ongoing to determine if oral acyclovir reduces post-herpes zoster neuralgia or the late ocular complications of ophthalmic zoster. PMID: 3001610 [PubMed - indexed for MEDLINE] 4961. J Infect Dis. 1985 Nov;152(5):859-62. Live attenuated varicella vaccine. Gershon AA. PMID: 2995509 [PubMed - indexed for MEDLINE] 4962. J Clin Oncol. 1985 Nov;3(11):1490-4. Allogeneic marrow transplantation in the treatment of MOPP-resistant Hodgkin's disease. Appelbaum FR, Sullivan KM, Thomas ED, Buckner CD, Clift RA, Deeg HJ, Neiman PE, Sanders JE, Stewart P, Storb R. Eight patients with disseminated Hodgkin's disease resistant to MOPP (mechlorethamine, vincristine, procarbazine, and prednisone) chemotherapy were treated with high-dose chemoradiotherapy and marrow transplantation from an HLA-identical sibling. Two patients remain alive in unmaintained complete remission (CR) at 38 and 39 months after transplant. In the other six patients, reasons for failure included relapse of lymphoma (two patients), or death due to complications of the transplant procedure, including Legionnaire's disease, disseminated zoster, graft-v-host disease, and aspiration pneumonia secondary to severe mucositis. These results demonstrate that some patients with MOPP-resistant Hodgkin's disease can obtain prolonged CR following intensive chemoradiotherapy and allogeneic marrow transplantation. PMID: 2414410 [PubMed - indexed for MEDLINE] 4963. Clin Ter. 1985 Oct 31;115(2):79-82. [Use of acyclovir in zoster encephalitis] [Article in Italian] Traverso F, Romagnoli P, Bacigalupo F. PMID: 3907941 [PubMed - indexed for MEDLINE] 4964. Ugeskr Laeger. 1985 Oct 21;147(43):3401-3. [Herpes zoster in general practice] [Article in Danish] Christensen P, Nørrelund N. PMID: 4071778 [PubMed - indexed for MEDLINE] 4965. JAMA. 1985 Oct 11;254(14):1905. False hope on drug availability. Klapp D, Bean S. PMID: 4046116 [PubMed - indexed for MEDLINE] 4966. J Rheumatol. 1985 Oct;12(5):967-70. Chlorambucil in the treatment of intractable Uveitis associated with juvenile chronic arthritis. Palmer RG, Kanski JJ, Ansell BM. The response to prolonged low dose chlorambucil for chronic active uveitis in 6 patients with juvenile chronic arthritis and one patient with juvenile ankylosing spondylitis is described. Only 2 patients were judged to have had longterm benefit from treatment in both eyes and one had a transient benefit in one eye. Drug induced adverse effects occurred in 3 patients. PMID: 4087273 [PubMed - indexed for MEDLINE] 4967. Int J Dermatol. 1985 Oct;24(8):539. Tinea in a site of healed herpes zoster (isoloci response?) Wolf R, Wolf D. PMID: 4066096 [PubMed - indexed for MEDLINE] 4968. J Am Acad Dermatol. 1985 Oct;13(4):590-6. Topical acyclovir treatment of herpes zoster in immunocompromised patients. Levin MJ, Zaia JA, Hershey BJ, Davis LG, Robinson GV, Segreti AC. Topical acyclovir favorably influences the healing of localized herpes zoster in immunocompromised patients. This therapy, or placebo, was applied to forty-three patients in a random access, double-blind trial, four times daily for 10 days, beginning within 72 hours after the onset of skin lesions. The mean time to pustulation is decreased from 12.4 to 6.7 days and the mean time to crusting is decreased from 16.0 to 11.4 days (p = 0.038 and 0.086, respectively) by topical treatment. The mean time to 50% healing is decreased from 24.5 to 15.2 days and the mean time to 100% healing is decreased from 34.9 to 25.8 days (p = 0.023 and 0.033, respectively). Favorable effects in treated patients are not associated with a more rapid decline in lesion virus titer, but do accrue without any toxicity. PMID: 3908504 [PubMed - indexed for MEDLINE] 4969. Am J Infect Control. 1985 Oct;13(5):199-209. Infectious complications of neoplastic disease. Polsky B, Armstrong D. Progress has been made in the diagnosis and treatment of infection in patients with neoplastic disease. Among the advances is the appreciation that certain opportunistic infections occur in association with particular host immune defects and epidemiologic factors. Such immune defects are seen secondary to or as a consequence of treatment for the patient's basic disease. Improved methods such as serology, open lung biopsy, and fiberoptic bronchoscopy have allowed for earlier diagnosis and treatment of opportunistic infections. The development of empiric antibiotic regimens, particularly aminoglycosides and the antipseudomonal penicillins, have improved the outcome in the febrile neutropenic patient. The benefits of protective environments have been challenged; prophylactic antibiotics and various forms of immunotherapy are of interest but remain investigational. PMID: 3877475 [PubMed - indexed for MEDLINE] 4970. Neurology. 1985 Oct;35(10):1531-2. Herpes zoster ophthalmicus with ipsilateral cerebellar infarction. Filloux F, Townsend J. PMID: 3875808 [PubMed - indexed for MEDLINE] 4971. Pediatrics. 1985 Oct;76(4):512-7. Epidemiology of herpes zoster in children and adolescents: a population-based study. Guess HA, Broughton DD, Melton LJ 3rd, Kurland LT. Medical records were reviewed for all 173 cases of herpes zoster diagnosed among residents of Rochester, Minnesota, less than 20 years of age during the period 1960 through 1981. The incidence of zoster increased with age from 20 cases per 100,000 person-years in those residents less than five years of age to 63 cases per 100,000 person-years in those aged 15 to 19. Morbidity was less than has been described in adults, as only two patients required hospitalization and no postherpetic neuralgia or other late complications were diagnosed. The single case of subsequent cancer found in 1,288 person-years of follow-up was not significantly different from the number expected based on cancer incidence in the general Rochester population. The incidence of childhood zoster in patients with acute lymphocytic leukemia was 122 times higher than in children without an underlying malignancy. Chickenpox in the first year of life was found to be a risk factor for childhood zoster, with a relative risk between 2.8 and 20.9. Neither chickenpox in the second year of life nor recent vaccinations were found to be risk factors for childhood zoster. PMID: 3863086 [PubMed - indexed for MEDLINE] 4972. Indian J Dermatol. 1985 Oct;30(4):25-8. Herpes zoster: multicentric. Chattopadhyay SP, Arora PN, Chakraborty BN. PMID: 3038738 [PubMed - indexed for MEDLINE] 4973. J Clin Microbiol. 1985 Oct;22(4):505-9. Virus-specific polymeric immunoglobulin A antibodies in serum from patients with rubella, measles, varicella, and herpes zoster virus infections. Negro Ponzi A, Merlino C, Angeretti A, Penna R. More than 85% of the immunoglobulin A (IgA) antibodies in normal adult serum are monomeric (m-IgA). By contrast, virus-specific IgA is mainly polymeric (p-IgA) in sera from patients with rubella, measles, and varicella. Specific m-IgA antibodies only reach quantitative significance in late convalescence. In patients with herpes zoster, on the other hand, a varying response was observed: in three of six sera, specific IgA was absent or at a very low titer, whereas in the remaining three cases, a high titer of both p-IgA and m-IgA was noted. These results suggest that in the initial response to rubella, measles, and varicella-zoster viruses, specific IgA first appears as p-IgA and only later becomes, or is replaced by, m-IgA. PMCID: PMC268455 PMID: 3001129 [PubMed - indexed for MEDLINE] 4974. Am J Infect Control. 1985 Oct;13(5):193-8. An algorithm for the control of nosocomial varicella-zoster virus infection. Weitekamp MR, Schan P, Aber RC. Inadvertent or uncontrolled introduction of varicella-zoster virus into the hospital environment occurs commonly and must be investigated in a systematic and efficient manner to minimize secondary spread to patients (particularly the immunocompromised) or hospital personnel. On the basis of a review of the literature and our practical experience with 11 such exposures to varicella-zoster virus during a 2-year period, we have developed a working algorithm for such investigations. Index cases most often are children, resident physicians, students, young nurses, and ancillary personnel, or adult patients with herpes zoster. A negative or uncertain past history of this infection is an unreliable predictor of susceptibility among the exposed and should be confirmed by serology tests or delayed hypersensitivity skin testing. An incubation-contagion timetable, coupled with a stratification of risk among the exposed, permits a prioritized response in dealing with an introduction of varicella-zoster virus. The preemployment screening of all hospital workers for susceptibility to varicella-zoster virus should be considered as a practical and cost effective policy. PMID: 2998229 [PubMed - indexed for MEDLINE] 4975. Br Med Bull. 1985 Oct;41(4):357-60. Skin infections. Brigden D. PMID: 2413950 [PubMed - indexed for MEDLINE] 4976. Br Med Bull. 1985 Oct;41(4):351-6. Viral keratitis. McGill J, Scott GM. PMID: 2413949 [PubMed - indexed for MEDLINE] 4977. Life Sci. 1985 Sep 30;37(13):1213-20. Intrathecal administration of beta-endorphin and dynorphin-(1-13) for the treatment of intractable pain. Wen HL, Mehal ZD, Ong BH, Ho WK, Wen DY. Seven cases of chronic pain were treated by intrathecal administration of 30 micrograms of beta-endorphin and dynorphin-(1-13). Compared with saline, both peptides were able to suppress pain for periods up to 4.5 and 7 hours on the average, respectively. No significant side reactions were noticed during the entire investigation. PMID: 2864619 [PubMed - indexed for MEDLINE] 4978. Wiad Lek. 1985 Sep 1;38(17):1204-7. [Clinical course of herpes zoster in elderly patients] [Article in Polish] Ellert-Zygadłowska J, Trocha H, Lemańska M, Witczak-Malinowska K, Gajda A. PMID: 4090492 [PubMed - indexed for MEDLINE] 4979. Acta Stomatol Belg. 1985 Sep;82(3):183-8. [Alveolar bone necrosis as a complication of herpes zoster infection] [Article in Dutch] De Biscop J, Wackens G. PMID: 3866489 [PubMed - indexed for MEDLINE] 4980. Southeast Asian J Trop Med Public Health. 1985 Sep;16(3):414-20. Susceptibility to varicella-zoster virus in Thai children and young adults. Kositanont U, Wasi C, Oonsombat P, Suvatte V, Thongcharoen P. During 1982-1983, susceptibility to varicella-zoster virus (VZV) in 224 Thai subjects at high risk for varicella infection was studied. The immune adherence hemagglutination (IAHA) and VZ skin test were carried out to determine VZV immunity in immunocompromised children and young adults. The history of varicella and herpes zoster from each subject was recorded. The mean +/- SD age in children and young adults were 7.3 +/- 2.8 and 19.6 +/- 1.2. Negative IAHA test was found in 74.2% of 62 children and 35.2% of 162 young adults. The increase in immune individuals was demonstrated with advancing age. Response to VZ skin test showed positive results in 79 of 162 (48.8%) young adults. The seronegativity was related to the negative VZ skin test (p less than 0.001, X2 test). Regardless of antibody detection or VZ skin test, 47 of 162 (29%) young adults were susceptible. According to the positive history of varicella and of herpes zoster obtained from 95 young adults, 80% had developed varicella during 1 to 10 years of age and 8.8% had positive history of herpes zoster. The findings suggest that the IAHA and VZ skin test should be used together for assessing VZ immunity. Varicella vaccination is highly recommended for susceptible persons who may develop severe illness. PMID: 3006266 [PubMed - indexed for MEDLINE] 4981. Clin Pharm. 1985 Sep-Oct;4(5):539-54. Treatment of infectious complications of acquired immunodeficiency syndrome. Furio MM, Wordell CJ. The infectious complications of the acquired immunodeficiency syndrome (AIDS) are discussed, and the conventional and nonconventional therapies used for these infections are reviewed. The infections most commonly encountered in patients with AIDS are Pneumocystis carinii pneumonia (58%), Candida esophagitis (31%), toxoplasmosis (21%), cytomegalovirus infections (15%), and herpes-simplex virus infections (12%). Pneumocystis carinii pneumonia is the most common life-threatening process in these patients. Trimethoprim-sulfamethoxazole (TMP-SMZ) is considered the drug of choice for its treatment. Oral candidiasis often indicates the progression to AIDS in the high-risk populations of homosexual or bisexual men, intravenous drug abusers, and individuals with hemophilia. Nystatin suspension is commonly used to treat oral candidiasis, while Candida esophagitis demands systemic therapy with ketoconazole. Toxoplasmosis most commonly manifests itself in patients with AIDS as a cerebral mass lesion. The recommended therapy includes sulfadiazine and pyrimethamine. AIDS patients frequently experience protozoal invasion of the intestinal tract with Giardia lamblia, Isospora belli, and Cryptosporidium muris. Various drugs have been tried for these infections, including quinacrine hydrochloride, metronidazole, TMP-SMZ, and spiramycin. Cytomegalovirus (CMV) infections commonly involve the lungs, gastrointestinal tract, eyes, brain, and nervous system. Attempts to treat these disseminated CMV infections with antiviral agents, including acyclovir, have not been successful. However, acyclovir has been found beneficial in the treatment of herpes-simplex virus infections. Multiple infectious complications may occur in patients with AIDS as a result of the cellular-immune deficiency associated with this disease. Until more research is done with AIDS patients, therapy must be based on the data available from the treatment of these infections in immunosuppressed patients without AIDS. PMID: 2996829 [PubMed - indexed for MEDLINE] 4982. JAMA. 1985 Aug 16;254(7):912. Herpes zoster: adenosine monophosphate for the prevention of post-neuralgia. Sklar SH, Alexander EJ, Blue WT, Bodian CA. PMID: 4021022 [PubMed - indexed for MEDLINE] 4983. Practitioner. 1985 Aug;229(1406):747-9. A treatment of herpes zoster. Fothergill WT, Ninaber V, Thick GC. PMID: 4034486 [PubMed - indexed for MEDLINE] 4984. J Trop Med Hyg. 1985 Aug;88(4):261-4. Herpes zoster in children following malaria. Cook IF. Herpes zoster is uncommon in normal children in the 0-9 year age group. However, its incidence is markedly increased in those who are immunosuppressed. Six Papua New Guinean children under 9 years of age developed herpes zoster following an episode of malaria, due to Plasmodium falciparum or Plasmodium vivax which was treated with chloroquine. The reactivation of the varicella-zoster virus in these patients may reflect transient depression of cell-mediated immunity by these malaria parasites, possibly augmented by the chloroquine used in their treatment. PMID: 3910848 [PubMed - indexed for MEDLINE] 4985. Z Hautkr. 1985 Aug 1;60(15):1237-40. [Generalized zoster in 2 girls responding well to therapy with intravenous acyclovir] [Article in German] Ingber A, Ianiv J, Grünwald Z, Bialowons M, Garti B. PMID: 3876660 [PubMed - indexed for MEDLINE] 4986. Cancer. 1985 Aug 1;56(3):642-8. The incidence of herpes zoster in patients with Hodgkin's disease. An analysis of prognostic factors. Guinee VF, Guido JJ, Pfalzgraf KA, Giacco GG, Lagarde C, Durand M, van der Velden JW, Löwenberg B, Jereb B, Bretsky S, et al. The incidence of zoster in 717 patients with Hodgkin's disease was determined by a retrospective chart review. All patients had been treated and followed in one of six cancer centers. Prognostic factors that might predict the subsequent incidence of zoster were examined by univariate and multivariate analytic techniques. Intensity of treatment was a key factor in the incidence of zoster. Thirty-six months after initiation of treatment, patients receiving chemotherapy-radiation-chemotherapy had twice the attack rate (27.3%) of those receiving radiation alone (11.5%). The pediatric age group had a significantly higher attack rate (26.6%) than did adults (18.7%). Stage, histology, and laparotomy did not influence the incidence of zoster. PMID: 3873986 [PubMed - indexed for MEDLINE] 4987. Shikai Tenbo. 1985 Aug;Spec No:81-4. [Diagnosis and management of pain. Pain in the maxillofacial area caused by various reasons] [Article in Japanese] Ono T. PMID: 3868123 [PubMed - indexed for MEDLINE] 4988. Dent Update. 1985 Aug;12(7):429-30, 432-4, 436. The tongue: 3. Infections and mucosal atrophy. Lamey PJ, Lewis MA. PMID: 3864695 [PubMed - indexed for MEDLINE] 4989. J Clin Gastroenterol. 1985 Aug;7(4):309-13. Ogilvie's syndrome associated with herpes zoster infection. Caccese WJ, Bronzo RL, Wadler G, McKinley MJ. Acute colonic pseudo-obstruction that occurs in the setting of an underlying medical condition is known as Ogilvie's syndrome. The etiology of Ogilvie's syndrome is unknown, and associated medical illnesses are varied and often extra-abdominal. While herpes zoster infection has been reported to cause constipation and hypomotility, the association with massive colonic distention has not so far been described. We present a patient with Ogilvie's syndrome in the setting of herpes zoster infection. There was no evidence of other active illnesses, and the patient has continued to do well since the resolution of the zoster. We believe that this is the first reported association of Ogilvie's syndrome and herpes zoster infection. PMID: 3840187 [PubMed - indexed for MEDLINE] 4990. J Infect Dis. 1985 Aug;152(2):280-5. Human monoclonal antibodies neutralizing varicella-zoster virus. Foung SK, Perkins S, Koropchak C, Fishwild DM, Wittek AE, Engleman EG, Grumet FC, Arvin AM. Hybridomas secreting human monoclonal antibodies to varicella-zoster virus were produced by fusing B cells of a patient recovering from acute varicella infection with a human-mouse cell line. Two hybrid lines have continued to secrete IgG1, one with kappa and the other with lambda chains, for at least 12 months. Each antibody neutralizes virus infectivity between 1-5 micrograms of partially purified immunoglobulin/ml, each shows a different pattern of immunofluorescent staining of virus-infected cells, and one identifies three viral proteins with molecular weights of 60,000, 95,000, and 97,000. PMID: 2993433 [PubMed - indexed for MEDLINE] 4991. J Gen Virol. 1985 Aug;66 ( Pt 8):1795-9. Affinity-purified varicella-zoster virus glycoprotein gp1/gp3 stimulates the production of neutralizing antibody. Wroblewska Z, Gilden D, Green M, Devlin M, Vafai A. Varicella-zoster virus glycoprotein gp1/gp3 was purified by affinity chromatography using anti-gp1/gp3 monoclonal antibody 19.1 linked to CNBr-activated Sepharose CL-4B. Rabbits immunized with purified glycoprotein gp1/gp3 developed mono-specific neutralizing antibody. PMID: 2991442 [PubMed - indexed for MEDLINE] 4992. J Gen Virol. 1985 Aug;66 ( Pt 8):1785-93. Antibody response to varicella-zoster virus surface glycoproteins in chickenpox and shingles. Larkin M, Heckels JE, Ogilvie MM. Varicella-zoster virus (VZV)-infected cell surface proteins were investigated using extrinsic radiolabelling of the cell surface, immunoprecipitation of detergent-solubilized extract of the same cell surface and fractionation of the immunoprecipitates using SDS-PAGE. Glycosylated proteins were identified by their affinity for Ricinus communis lectin. Six glycoproteins with apparent mol. wt. of 170K, 105K, 93K, 81K, 53K and 45K were identified. The 170K glycoprotein was shown to be disulphide-linked since under reducing conditions for SDS-PAGE it was cleaved to a protein of 63K mol. wt. The IgG responses to these glycoproteins during various clinical circumstances are described. In acute sera from all chickenpox patients and in the majority of acute shingles sera, antibodies reactive with glycoproteins could not be detected. In chickenpox convalescence, antibodies reactive with glycoproteins of mol. wt. 170K, 105K, 53K and 45K were identified, whilst during zoster convalescence antibodies to all six were prominent. Antibodies to the disulphide-linked glycoprotein persisted for many years following both the primary disease and its reactivation. Disseminated zoster was associated with significantly low levels of antibodies to these surface glycoproteins. PMID: 2991441 [PubMed - indexed for MEDLINE] 4993. Virology. 1985 Aug;145(1):62-71. Varicella-zoster virus envelope glycoproteins: biochemical characterization and identification in clinical material. Edson CM, Hosler BA, Poodry CA, Schooley RT, Waters DJ, Thorley-Lawson DA. Varicella-zoster virus (VZV)-infected human foreskin fibroblasts synthesize viral glycoproteins of 125,000 (gp125), 118,000 (gp118), 92,000 (gp92), 63,000 (gp63), 59,000 (gp59), and 47,000 (gp47) Da. In biochemical studies, all of these VZV glycoproteins were shown to contain asparagine-linked (N-linked) oligosaccharide chains and, except for gp125 and gp47, to be sialoglycoproteins. Experiments with endo-beta-N-acetylglucosaminidase H (endo H) demonstrated that gp92 contained only complex type (endo H-resistant) N-linked glycosyl chains, while the other mature glycoproteins contained both high-mannose (endo H-sensitive) and complex-type oligosaccharides. Monoclonal antibodies recognizing multiple glycoproteins, gp63/gp125 or gp92/gp59/gp47, neutralized virus infection, suggesting the glycoproteins were important components of the virus envelope. This was confirmed for gp92/gp59/gp47 by immunoelectron microscopy, which revealed dense staining localized exclusively to the virion envelope and to the plasma membrane of virus-producer cells. The mature forms of all of these glycoproteins were also present in viral material isolated from vesicles of varicella and zoster patients, indicating that in infected individuals the viral glycoproteins are synthesized and processed in a manner similar to that in tissue culture cells. PMID: 2990103 [PubMed - indexed for MEDLINE] 4994. Antimicrob Agents Chemother. 1985 Aug;28(2):265-73. High-pressure liquid chromatographic methods for determining arabinosyladenine-5'-monophosphate, arabinosyladenine, and arabinosylhypoxanthine in plasma and urine. McCann WP, Hall LM, Siler W, Barton N, Whitley RJ. New high-pressure liquid chromatographic methods for determining concentrations of arabinosyladenine (Ara-A), its 5'-monophosphate (Ara-AMP), and arabinosylhypoxanthine (Ara-H) in plasma and urine are presented. A fluorescence detector is used for Ara-A and Ara-AMP, which are first converted to highly fluorescent derivatives with chloroacetaldehyde. This increases sensitivity greatly over previous methods. The sensitivities of the methods (in micrograms per milliliter) are as follows: in plasma, Ara-AMP, 0.002; Ara-A, 0.0015; and Ara-H, 0.35; and in urine, 9 times these values, respectively. Drug concentration data are also presented, which were obtained after doses of Ara-AMP were given intramuscularly to two patients treated with this drug for severe herpes zoster. One patient was given 13 mg of Ara-AMP per kg of body weight once daily, and the other was given 6.5 mg/kg twice daily. Peak Ara-AMP and Ara-A levels in plasma occurred within 1 h after the doses, and neither exceeded 2 micrograms/ml. Ara-AMP and Ara-A concentrations in plasma fell to less than 0.01 micrograms/ml in both patients by 4 to 6 h after the doses. Peak Ara-H concentrations in plasma occurred within 1 to 2 h after doses and were 21 micrograms/ml in patient 1 and 2. The highest concentration of Ara-AMP in urine was 0.09 micrograms/ml. The highest Ara-A concentration in urine was 62 micrograms/ml, and the highest Ara-H concentration in urine was 1,080 micrograms/ml. An interfering substance of unknown nature, cochromatographing with Ara-H, was encountered sporadically in urine samples. An algorithm based on differential spectrophotometry to identify and correct for this problem is described. Estimates of the renal clearances of Ara-AMP, Ara-A, and Ara-H are also given. PMCID: PMC180230 PMID: 2423028 [PubMed - indexed for MEDLINE] 4995. Pediatr Infect Dis. 1985 Jul-Aug;4(4):413. Contagiousness of zoster in a day care setting. Riegle L, Cooperstock M. PMID: 4022807 [PubMed - indexed for MEDLINE] 4996. Mykosen. 1985 Jul;28(7):332-5. [Generalized follicular pustular candidiasis following herpes zoster] [Article in German] Ginter G, Kresbach H. PMID: 3897855 [PubMed - indexed for MEDLINE] 4997. Cancer Res. 1985 Jul;45(7):2943-50. Selectivity--key to chemotherapy: presidential address. Elion GB. PMID: 3891079 [PubMed - indexed for MEDLINE] 4998. J Indian Dent Assoc. 1985 Jul;57(7):267-71. Herpes zoster of the trigeminal nerve with dental involvement. Sofat JR, Greval RS, Minocha YC. PMID: 3869151 [PubMed - indexed for MEDLINE] 4999. Infirm Fr. 1985 Jul;(267):23-5. [Zona] [Article in French] Harlay A. PMID: 3850067 [PubMed - indexed for MEDLINE] 5000. Drug Intell Clin Pharm. 1985 Jul-Aug;19(7-8):518-24. Evaluation of oral acyclovir therapy. Fletcher C, Bean B. Acyclovir is a specific antiviral agent. The triphosphate form inhibits viral DNA replication by competing for incorporation into the replicating DNA chain or by inhibiting viral DNA polymerase. Cells not infected with herpesvirus are generally unaffected. Oral acyclovir inhibits most herpes simplex virus types 1 and 2, and varicella-zoster virus at concentrations used clinically. Oral acyclovir has an average plasma half-life of three hours and is eliminated primarily by renal mechanisms. Peak plasma concentrations occur 1.5 to 2.5 hours after administration and the oral bioavailability is 15 to 30 percent. Acyclovir distributes into most body tissues, including vesicular fluid and the central nervous system. Oral acyclovir is effective treatment of initial and recurrent genital herpes and can suppress frequently recurring genital herpes in both immunocompetent and immunocompromised patients. It is also effective for acute herpes zoster in the immunocompetent and possibly immunocompromised patient. No role is established in either Epstein-Barr virus or cytomegalovirus infections. Oral acyclovir appears to be effective and relatively safe, nontoxic therapy when administered in doses of 1-4 g/d. Oral acyclovir represents a major therapeutic advance in the treatment of herpesvirus infections. PMID: 2992899 [PubMed - indexed for MEDLINE] 5001. J Infect Dis. 1985 Jul;152(1):230. The significance of specific IgA antibodies in the serum in the early diagnosis of zoster. Tovi F, Hadar T, Sidi J, Sarov B, Sarov I. PMID: 2989386 [PubMed - indexed for MEDLINE] 5002. Harefuah. 1985 Jun 16;108(12):598-601. [Neurological complications in herpes zoster and possible mechanisms] [Article in Hebrew] Miller A, Gross B, Tourezkite T. PMID: 3905541 [PubMed - indexed for MEDLINE] 5003. J Rheumatol. 1985 Jun;12(3):625. Herpes zoster and cranial giant cell arteritis. Mussini JM, Ponge T, Barrier J, Mussini-Montpellier J, Grolleau JY. PMID: 4045865 [PubMed - indexed for MEDLINE] 5004. Rev Clin Esp. 1985 Jun;177(1):29-30. [Motor disorders of the extremities in herpes zoster. Presentation of 4 cases] [Article in Spanish] Kulisevsky Bojarski J, Peiró Grasa A, Illa Sendra L, Escartín Siquier AE, Pradas Orozco J, Grau Veciana JM. PMID: 4035035 [PubMed - indexed for MEDLINE] 5005. Semin Oncol. 1985 Jun;12(2):180-91. Prevention of infectious complications in acute lymphoblastic leukemia. Hughes WT, Feldman S, Gigliotti F, Shenep J, Sixbey J. PMID: 3925557 [PubMed - indexed for MEDLINE] 5006. Pediatrics. 1985 Jun;75(6):1127-31. Nephrotic syndrome associated with varicella infection. Lin CY, Hsu HC, Hung HY. A 4-year-old boy developed nephrotic syndrome following varicella infection. Serologic studies during the early phase of the disease demonstrated a decrease in serum C3, C4, and properdin factor B. Renal biopsy revealed an acute proliferative glomerulonephritis with deposition of immunoglobulins A (IgA) and M, C3, C1q, and varicella virus antigen in the glomerulus, suggesting an immune complex deposition. Ultrastructurally, this suggested a postinfectious immune complex glomerulonephritis. These phenomena suggested that varicella virus antigen antibody complexes were deposited in the glomerulus and activated the classic and alternative pathway of complements, leading to an immune complex glomerulonephritis. During the nephrotic phase, an increase in OKT8 cells and decrease of the OKT4 cells were demonstrated. Two months later, this alteration returned to normal as the renal disease was in remission. This change of lymphocyte subsets during varicella infection may play a role in the pathogenesis of nephrotic syndrome. PMID: 3873641 [PubMed - indexed for MEDLINE] 5007. Acta Stomatol Belg. 1985 Jun;82(2):131-41. [Zona of the facial nerve] [Article in French] Peiffer R, Cesteleyn L, Peiffer A. PMID: 3861085 [PubMed - indexed for MEDLINE] 5008. Klin Monbl Augenheilkd. 1985 Jun;186(6):421-3. [Therapy of herpetic diseases of the anterior eye segment] [Article in German] Sundmacher R. Clinico-virologic investigations and the availability of the new antiviral drug Acyclovir have changed our therapeutic approach to deep herpetic diseases. Treatment of the symptoms alone with steroids should now be avoided. Basic treatment should consist of optimal dosages of Acyclovir. However, additional steroid therapy is still necessary. Significant progress in the treatment of dendritic keratitis is to be expected as soon as high-titer interferon preparations become commercially available. Treatment of dendritic keratitis with a combination of a modern antiviral drug and high-titer interferon will reduce the average time the corneal epithelium takes to heal from the present 6 days to 3 days. While considerable progress has been made in the treatment of herpes, no more than a step in the right direction has been taken with herpes zoster varicellosus virus, owing to its greater resistance to Acyclovir. PMID: 2413240 [PubMed - indexed for MEDLINE] 5009. Clin Ter. 1985 May 31;113(4):315-22. [Drug therapy in auricular pathology] [Article in Italian] Tripodi D, Rotolo A, Rossi M. PMID: 4017509 [PubMed - indexed for MEDLINE] 5010. Can Med Assoc J. 1985 May 15;132(10):1112. Vidarabine therapy for herpes zoster. Diosy A. PMCID: PMC1345928 PMID: 3995428 [PubMed - indexed for MEDLINE] 5011. Lancet. 1985 May 11;1(8437):1103. Acyclovir in herpes zoster oticus. Hall SJ, Kerr AG. PMID: 2860316 [PubMed - indexed for MEDLINE] 5012. J Assoc Physicians India. 1985 May;33(5):373-4. Varicella--zoster involving multiple cranial nerves with meningo-encephalitis. Mathur SL, Bhandari R, Banerjee K, Mathur A, Kothari D, Mathur M. PMID: 4044508 [PubMed - indexed for MEDLINE] 5013. Vestn Dermatol Venerol. 1985 May;(5):54-6. [Herpes zoster and chickenpox] [Article in Russian] Kogan AI. PMID: 4036295 [PubMed - indexed for MEDLINE] 5014. Rev Clin Esp. 1985 May;176(8):429. [Acute polyradiculoneuritis and herpes zoster] [Article in Spanish] Pérez García C, Antón Aranda E, Tiberio López G, Martínez Ibáñez F. PMID: 4023329 [PubMed - indexed for MEDLINE] 5015. Arch Dermatol. 1985 May;121(5):588-9. A case of herpes zoster involving a skin graft. Ramos-Caro FA, Jackson DB. PMID: 3888121 [PubMed - indexed for MEDLINE] 5016. Orv Hetil. 1985 Apr 21;126(16):1001-2. [Difficulty of the etiological diagnosis of viral nervous system diseases: double virus infection] [Article in Hungarian] [No authors listed] PMID: 4000663 [PubMed - indexed for MEDLINE] 5017. Rev Prat. 1985 Apr 11;35(21):1223-30. [Pains of deafferentiation] [Article in French] Laurent B. PMID: 2988103 [PubMed - indexed for MEDLINE] 5018. Tex Hosp. 1985 May;40(12):10. Persons contract varicella following exposures to herpes zoster. Lister J. PMID: 10272569 [PubMed - indexed for MEDLINE] 5019. J R Coll Physicians Lond. 1985 Apr;19(2):96-8. Cimetidine in the treatment of herpes zoster. Levy DW, Banerjee AK, Glenny HP. PMID: 3889322 [PubMed - indexed for MEDLINE] 5020. J Neurol Neurosurg Psychiatry. 1985 Apr;48(4):338-41. Contralateral hemiparesis following herpes zoster ophthalmicus. Gasperetti C, Song SK. A case of herpes zoster ophthalmicus was followed, after a latent period of four weeks, by contralateral hemiparesis. An attempt is made to clarify the anatomical relationships involved in the pathogenesis of postherpetic cerebral complications. Detailed presentation of neuropathological findings in this case may provide evidence of vasculitis in the syndrome, with better understanding of the pathological anatomy. PMCID: PMC1028298 PMID: 3873518 [PubMed - indexed for MEDLINE] 5021. Am Rev Respir Dis. 1985 Apr;131(4):662-5. A case of invasive penicilliosis in Hong Kong with immunologic evaluation. So SY, Chau PY, Jones BM, Wu PC, Pun KK, Lam WK, Lawton JW. A 53-yr-old Chinese sailor developed prolonged pyrexia with unresolved lobar pneumonia, cervical lymphadenopathy, generalized subcutaneous abscesses, and pericardial effusion. Penicillium marneffei was isolated from pericardial fluid and subcutaneous pus and was demonstrated on histologic sections of lymph nodes and lung tissue. The penicilliosis was treated successfully with amphotericin B, ketoconazole, and 5-fluorocytosine. Subsequently, he also developed other T-lymphocyte-related opportunistic infections such as disseminated cutaneous herpes zoster and chronic osteomyelitis of sternum caused by Salmonella typhimurium. He was also a chronic carrier of cytomegalovirus. Further investigations showed that he had persistent depression of T-lymphocyte function and enhancement of B-lymphocyte activity, the cause of which was undetermined. PMID: 3873195 [PubMed - indexed for MEDLINE] 5022. Compend Contin Educ Dent. 1985 Apr;6(4):298-308. Clinical virology of the head and neck. Eversole R. PMID: 3858049 [PubMed - indexed for MEDLINE] 5023. Ala J Med Sci. 1985 Apr;22(2):193-207. Therapy for human herpesvirus infections. A perspective. Whitley RJ. PMID: 2988359 [PubMed - indexed for MEDLINE] 5024. Semin Hematol. 1985 Apr;22(2):81-114. Lymphocyte markers and infectious diseases. Blumberg RS, Schooley RT. PMID: 2988132 [PubMed - indexed for MEDLINE] 5025. JAMA. 1985 Mar 22-29;253(12):1722-3. Zoster after exposure to varicella-zoster virus. Morens DM. PMID: 2983129 [PubMed - indexed for MEDLINE] 5026. Science. 1985 Mar 15;227(4692):1296-303. Antiviral chemotherapy and chemoprophylaxis. Dolin R. Antiviral compounds have been developed for use in chemoprophylaxis and chemotherapy of a variety of infections in humans, including those caused by influenza viruses, respiratory syncytial virus, and herpesviruses. The efficacy of several of these compounds has been demonstrated in rigorously controlled trials. Advances in molecular virology have led to the identification of biochemically defined, virus-specific functions that serve as appropriate targets for the future development of antiviral compounds. Clinical investigators and practicing physicians are now confronting questions previously raised with the use of antibacterial antibiotics. These questions concern appropriate routes of administration for antiviral compounds, optimal dosage regimens, risks of long-term prophylaxis, and the emergence of resistant organisms. PMID: 2983421 [PubMed - indexed for MEDLINE] 5027. JAMA. 1985 Mar 8;253(10):1444-5. Adenosine monophosphate for the treatment of varicella zoster infections: a large dose of caution. Sherlock CH, Corey L. PMID: 3968776 [PubMed - indexed for MEDLINE] 5028. JAMA. 1985 Mar 8;253(10):1427-30. Herpes zoster. The treatment and prevention of neuralgia with adenosine monophosphate. Sklar SH, Blue WT, Alexander EJ, Bodian CA. Thirty-two adults were enrolled in a randomized, placebo-controlled double-blind trial of intramuscular injections of gel-sustained adenosine monophosphate (AMP) given three times a week for up to four weeks for acute herpes zoster. Adenosine monophosphate moderately reduced the pain soon after the start of treatment, decreased desquamation time, and promoted faster healing of the skin than placebo treatment. Adenosine monophosphate treatment reduced virus shedding and cleared the virus faster than in placebo-treated subjects. At the end of the initial four-week treatment period, 88% of AMP-treated patients were pain free, as opposed to only 43% in the placebo group. After four weeks, all patients who had not recovered from pain started receiving AMP treatment without breaking the code. All these patients recovered from pain within three weeks after initiation of treatment. No recurrence of pain or lesions was experienced from three to 18 months after the end of treatment. Adenosine monophosphate, a natural cellular metabolite, showed no side effects or toxicity during and after the treatment. PMID: 3968773 [PubMed - indexed for MEDLINE] 5029. Masui. 1985 Mar;34(3):339-42. [Treatment of herpes zoster] [Article in Japanese] Kato Y, Kato Y, Amagasa S, Tada T, Ono T, Ichiyanagi K. PMID: 4021079 [PubMed - indexed for MEDLINE] 5030. Nippon Ronen Igakkai Zasshi. 1985 Mar;22(2):110-5. [Vasculitis as a cause of cerebrovascular disease among the elderly] [Article in Japanese] Ogata J. PMID: 4010036 [PubMed - indexed for MEDLINE] 5031. Med Clin North Am. 1985 Mar;69(2):399-413. Viral meningitis. Ratzan KR. Viral meningitis is part of the aseptic meningitis syndrome but must be distinguished from bacterial meningitis on the basis of a careful examination of the CSF and sound clinical judgment. Enteroviruses probably account for the bulk of cases of aseptic meningitis that occur in the United States and which are reported to the Centers for Disease Control each year. The seasonal pattern in the incidence of aseptic meningitis is largely due to the seasonal variation of enteroviral infections. Early on, the CSF in patients with viral meningitis frequently contains a predominance of polymorphonuclear leukocytes and may even have a low glucose level. The presence of neutrophils in the initial CSF sample is especially common in patients with enteroviral infections. A CSF glucose level lower than 50 per cent of a simultaneously drawn blood glucose determination is not uncommon in patients with viral meningitis due to mumps, LCM, and herpes simplex. In a patient with a predominance of polymorphonuclear leukocytes in the initial CSF specimen and in whom a viral infection is suspected, antibiotics may be withheld if a spinal tap is repeated within 12 hours. A shift from polymorphonuclear leukocytes to mononuclear cells makes viral meningitis the likely diagnosis. Both herpes simplex and varicella-zoster may infect the meninges by means of spread from cervical and dorsal root ganglia in a retrograde fashion much the way they spread in an antegrade fashion to the skin. HSV-2 is more likely to cause the clinical syndrome of viral meningitis, while HSV-1 is more likely to cause a meningoencephalitis with serious brain dysfunction. The identification of a specific viral agent in body fluids, especially the CSF, in a patient with aseptic meningitis is of more than academic interest, since it can shorten duration of hospital stay and eliminate unnecessary antimicrobial therapy. The diagnosis of enteroviral infections depends upon the isolation of a virus from CSF, stool, or throat plus a fourfold antibody response in the serum to the viral isolate. The 60-odd serotypes of enterovirus, each with different antigenic determinants, preclude serologic testing alone as a useful diagnostic test to identify the patient infected with coxsackievirus or echovirus. For infections, due to herpes simplex, varicella-zoster, LCM, and arboviruses, a serologic test alone can be useful.(ABSTRACT TRUNCATED AT 400 WORDS) PMID: 3990441 [PubMed - indexed for MEDLINE] 5032. Clin Pharm. 1985 Mar-Apr;4(2):170-6. Nontraditional analgesics for the management of postherpetic neuralgia. Thompson M, Bones M. The pathogenesis and clinical manifestations of herpes zoster and postherpetic neuralgia and the use of nontraditional analgesics in the management of postherpetic neuralgia are reviewed. Herpes zoster represents the reactivation in an immunocompromised host of dormant varicella-zoster virus (Herpesvirus varicellae) contracted during a previous episode of chickenpox. Fever, neuralgia, and paresthesia occur four to five days before skin lesions develop. Acute herpes zoster pain usually does not last more than two weeks after all skin lesions have healed. Postherpetic neuralgia is defined as pain that persists in the affected dermatomes after the disappearance of all skin crusts. The neuralgia can vary from "lightninglike" stabbing pain to constant, burning pain with hyperesthesia; it can persist for years and is often refractory to traditional analgesic therapy. A number of nontraditional analgesic agents have been used in the management of postherpetic neuralgia. Tricyclic antidepressants, especially amitriptyline, have been used alone and in combination with phenothiazines or anticonvulsants (carbamazepine, phenytoin, valproate sodium), with good results. The effectiveness of phenothiazines or anticonvulsants as sole therapeutic agents has not been demonstrated. Although the intralesional administration of corticosteroids appears to be beneficial, considerable fear about the potential for these agents to precipitate widespread viral dissemination exists. Positive results have been reported with levodopa, amantadine, and interferon, but the role of these agents in the prevention of postherpetic neuralgia remains unclear. Nontraditional analgesic agents are useful in the management of postherpetic neuralgia, but patients must be selected and monitored appropriately. A tricyclic antidepressant (especially amitriptyline) is a reasonable first choice. PMID: 3987215 [PubMed - indexed for MEDLINE] 5033. Ann Intern Med. 1985 Mar;102(3):421. Acyclovir and disseminated varicella zoster and encephalitis. Ehrensaft DV, Safani MM. PMID: 3970498 [PubMed - indexed for MEDLINE] 5034. Ophthalmology. 1985 Mar;92(3):316-24. Corneal complications from herpes zoster ophthalmicus. Liesegang TJ. Of 94 patients with acute herpes zoster ophthalmicus who were seen during a six-year period, 61 had corneal involvement. The corneal complications in the order of chronological clinical occurrence were punctate epithelial keratitis in 51%, early pseudodendrites in 51%, anterior stromal infiltrates in 41%, sclerokeratitis in 1%, kerato-uveitis/endothelitis in 34%, serpiginous ulceration in 7%, delayed corneal mucous plaques in 13%, disciform keratitis in 10%, neurotrophic keratitis in 25%, and exposure keratitis in 11%. Some of the earlier lesions seemed to result from viral infection, whereas later lesions resulted from limbal vasculitis, an immunologic mechanism to soluble viral antigen, a delayed hypersensitivity reaction, or damage to nerves and tissues. An elucidation of the lesions awaits better viral and immunologic detection techniques and further histopathologic study. Modern topical and systemic antiviral therapy, corticosteroids, and surgery have a role in treatment. PMID: 3873048 [PubMed - indexed for MEDLINE] 5035. Neurology. 1985 Mar;35(3):444. Trigeminovascular neurons and the arteritis complicating herpes zoster ophthalmicus. Moskowitz MA, Henrikson BM. PMID: 3871925 [PubMed - indexed for MEDLINE] 5036. Neurology. 1985 Mar;35(3):442-4. Angiography in herpes zoster ophthalmicus and delayed contralateral hemiparesis. Tabbaa M, Selhorst JB. PMID: 3871924 [PubMed - indexed for MEDLINE] 5037. Med Sestra. 1985 Mar;44(3):39-43. [Herpes zoster (shingles)] [Article in Russian] Malkova EV, Malkov GF. PMID: 3846735 [PubMed - indexed for MEDLINE] 5038. Geriatr Nurs. 1985 Mar-Apr;6(2):74-8. Understanding herpes zoster and relieving its discomfort. Hallal JC. PMID: 3844359 [PubMed - indexed for MEDLINE] 5039. Med Clin North Am. 1985 Mar;69(2):415-29. Acute viral encephalitis. Ho DD, Hirsch MS. Clinical manifestations of acute viral encephalitis are described, differential diagnoses are outlined, and a diagnostic approach is recommended. Encephalitic syndromes caused by arboviruses, herpesviruses, enteroviruses, and parainfectious processes are discussed. PMID: 2985888 [PubMed - indexed for MEDLINE] 5040. Transplantation. 1985 Mar;39(3):279-81. Prophylactic oral acyclovir after renal transplantation. Pettersson E, Hovi T, Ahonen J, Fiddian AP, Salmela K, Höckerstedt K, Eklund B, von Willebrand E, Häyry P. In a double-blind, controlled study 35 herpes simplex virus (HSV) antibody-positive patients were randomized to receive oral acyclovir 200 mg X 4 daily or placebo for 28 days following renal transplantation. The incidence of herpes virus infection was compared in both groups by weekly virus demonstration/isolation testing from throat swabs and urine, and by serum antibody demonstration. None of the 18 patients allocated to acyclovir showed any signs of HSV or varicella zoster virus (VZV) infection during the trial period, whereas 9 of 17 receiving placebo had signs of HSV (P less than 0.001) and 2 of VZV (P less than 0.05) infection. Because of systemic as well as local symptoms of infection in five of the placebo patients, the trial was interrupted and treatment with oral acyclovir instituted. All of them responded well with rapid disappearance of all symptoms. Cytomegalovirus (CMV) was isolated from the urine of two patients in both groups during the trial period; a significant antibody rise was seen later in three of them. There was no evidence of drug-related toxicity during the study. PMID: 2983461 [PubMed - indexed for MEDLINE] 5041. Med J Aust. 1985 Feb 18;142(4):283-4. Herpes zoster and cimetidine. [No authors listed] PMID: 3974481 [PubMed - indexed for MEDLINE] 5042. Br Med J (Clin Res Ed). 1985 Feb 16;290(6467):509-11. Long term effects of exposure to viral infections in utero. Fine PE, Adelstein AM, Snowman J, Clarkson JA, Evans SM. An analysis was conducted of the major findings of a long term follow up study of 3076 subjects who were exposed to viral infections in utero and who at the time of analysis were up to 40 years of age. Mortality and morbidity were compared with those in a control population matched for sex and date and area of birth. An excess of cancers (16 cases against seven) appeared to be clustered among those exposed to herpes viruses (varicella or cytomegalovirus). There was evidence of an increased risk of diabetes among those exposed to mumps during the first trimester (four cases among 128 subjects against none in 148 controls). The most surprising finding was a decrease of diseases of the skin and subcutaneous tissue and of the nervous system among subjects exposed to antenatal varicella zoster infection. The mechanism for the association may include production of fetal anti-idiotype antibodies in response to transplacentally acquired maternal autoantibodies. PMCID: PMC1418004 PMID: 3918651 [PubMed - indexed for MEDLINE] 5043. Can Med Assoc J. 1985 Feb 15;132(4):392-5. Neurotoxic effects during vidarabine therapy for herpes zoster. Burdge DR, Chow AW, Sacks SL. Two cases of neurotoxic effects resulting from therapy with vidarabine are described. Both patients were undergoing treatment for cutaneously disseminated herpes zoster complicating therapy for solid malignant tumours. Both had normal renal function. The serum levels of hepatic enzymes were normal in one patient and slightly elevated in the other. Neurotoxicity was first manifested in both patients by the development of intention tremors that progressed to gross tremors. Obtundation, coma and death ensued in one patient and pain syndromes in the other. Vidarabine-induced neurotoxic effects, which may occur in the absence of hepatic or renal dysfunction or treatment with another drug, may be mild initially but may progress rapidly to more serious, even life-threatening, conditions. Presentation of neurotoxic effects should be considered an indication for withdrawal of vidarabine. PMCID: PMC1345827 PMID: 3971255 [PubMed - indexed for MEDLINE] 5044. Clin Ter. 1985 Feb 15;112(3):203-16. [Nosology, clinical aspects and therapy of herpes zoster] [Article in Italian] Gottwald W. PMID: 3896619 [PubMed - indexed for MEDLINE] 5045. Fortschr Med. 1985 Feb 14;103(6):130-2. [Therapy of recurrent herpes infections with oral acyclovir] [Article in German] Nolting S. PMID: 3988215 [PubMed - indexed for MEDLINE] 5046. N Z Med J. 1985 Feb 13;98(772):70. Cimetidine and herpes zoster. Pryor WJ. PMID: 3856143 [PubMed - indexed for MEDLINE] 5047. Emerg Med Serv. 1985 Mar-Apr;14(2):48. Chickenpox, shingles and EMS. West KH. PMID: 10269642 [PubMed - indexed for MEDLINE] 5048. Med Clin (Barc). 1985 Feb 2;84(4):138-42. [Clinical features and application of enzyme immunoassay in a herpes zoster meningitis series] [Article in Spanish] Martínez Martín P, Estévez Guerra E, Grande Pérez J, Valenzuela Conthe MP, Rapun Pac JL, García Saiz A, Echevarría Mayo JM. PMID: 2984486 [PubMed - indexed for MEDLINE] 5049. J Assoc Physicians India. 1985 Feb;33(2):185. Pre-eruption herpes zoster myelitis. Yeolekar ME, Banavali S, Menon PS. PMID: 3997768 [PubMed - indexed for MEDLINE] 5050. Acta Neurol (Napoli). 1985 Feb;7(1):32-4. Brachial monoparesis following herpes zoster. Verma AK, Maheshwari MC. PMID: 3993457 [PubMed - indexed for MEDLINE] 5051. Postgrad Med J. 1985 Feb;61(712):145-6. A case of herpes zoster associated encephalitis with rapid response to acyclovir. Cheesbrough JS, Finch RG, Ward MJ. A case of herpes zoster encephalitis which responded very rapidly to acyclovir is presented. The differential serum: cerebrospinal fluid antibody response was followed and its value in making the diagnosis is discussed. The penetration of acyclovir into the cerebrospinal fluid was measured, and found to be in agreement with predicted values. PMCID: PMC2418175 PMID: 3983042 [PubMed - indexed for MEDLINE] 5052. N C Med J. 1985 Feb;46(2):83-4. Successful therapy of postherpetic neuralgia of the trigeminal nerve. Grosshandler S, Gray W. PMID: 3920535 [PubMed - indexed for MEDLINE] 5053. J Neurol Neurosurg Psychiatry. 1985 Feb;48(2):122-7. Herpes zoster ophthalmicus followed by contralateral hemiparesis: report of two cases and review of literature. Reshef E, Greenberg SB, Jankovic J. Two patients with herpes zoster ophthalmicus and contralateral hemiparesis are described, and their findings compared with 49 patients previously reported. These patients presented with delayed contralateral hemiparesis approximately seven weeks after the onset of herpes zoster ophthalmicus. Most patients had evidence of infarction of the ipsilateral middle cerebral artery by angiography or by CT scan. Cerebrospinal fluid pleocytosis and elevated protein commonly were found. Twenty per cent of the reported patients died, but they were older than the patients who survived and predisposed to have diffuse CNS lesions. The pathogenesis of this syndrome is thought to be due to direct viral invasion of the blood vessel wall with resulting angiitis. Further studies need to be performed to clarify the role of specific antiviral therapy or anti-inflammatory agents in treating this complication of herpes zoster. PMCID: PMC1028210 PMID: 3884741 [PubMed - indexed for MEDLINE] 5054. J Infect Dis. 1985 Feb;151(2):362-5. Adverse effects of high-dose intravenous acyclovir in ambulatory patients with acute herpes zoster. Bean B, Aeppli D. PMID: 3881542 [PubMed - indexed for MEDLINE] 5055. Soins. 1985 Feb;(447):33-4. [Zona] [Article in French] Reinert P. PMID: 3846363 [PubMed - indexed for MEDLINE] 5056. RN. 1985 Feb;48(2):52-62. Easing the discomfort of herpes zoster. Hallal JC. PMID: 3844277 [PubMed - indexed for MEDLINE] 5057. Aust N Z J Med. 1985 Feb;15(1):43-4. A case of herpes zoster associated encephalitis treated with acyclovir. Bowman RV, Lythall DA, de Wytt CN. The case of a 67 year old male who developed severe encephalitis associated with herpes zoster ophthalmicus is described. Encephalitis occurred in the absence of cutaneous dissemination and recovery followed treatment with Acyclovir. PMID: 2988489 [PubMed - indexed for MEDLINE] 5058. Zentralbl Bakteriol Mikrobiol Hyg B. 1985 Feb;180(2-3):107-20. [Prevention and therapy of herpesvirus infections] [Article in German] Abb J. The group of the human-pathogenic herpesviruses comprises five subgroups: Herpes simplex virus type 1 (HSV-1), Herpes simplex virus type 2 (HSV-2), varicella zoster virus (VZV), cytomegalovirus (CMV), and Epstein-Barr virus (EBV). Primary infection with these ubiquitous herpesviruses usually occurs in childhood or during adolescence and frequently remains inapparent. However, it can also give rise to a variety of clinical pictures. Important clinical manifestations of herpesvirus infections are mucocutaneous lesions (HSV-1, HSV-2, VZV) self-limited, lymphoproliferative diseases (CMV, EBV) and congenital malformations (CMV). Primary infection with herpesviruses leads to a persistent infection of the host. This clinically silent condition of latency can be interrupted and may cause pathological symptoms to recur by reactivation of latent herpesviruses. A classical example of the clinical manifestation of herpesvirus reactivation is herpes zoster following an overcome varicella disease. The mechanism of herpesvirus reactivation has not yet been fully clarified. Reactivation of herpesviruses might be attributable to a weakening of the cellular immunodefence. For the control of viral infections mainly two cellular effector systems are responsible: unspecific, cytotoxic, natural killer (NK) cells and specific cytotoxic thymus-dependent (T) lymphocytes. The functional impairment of these cytotoxic active cells my cause herpesvirus reactivation in immunodeficient or immunosuppressed persons. Interference with the immunological control function may also contribute to the genesis of herpesvirus-associated tumours. Such an association between herpesviruses and human tumours is assumed to exist especially in the case of EBV. The frequently life-endangering severity of local or disseminated herpesvirus infections calls for suitable measures ensuring efficient prophylaxis and therapy. However, the possibilities of a specific immunoprophylaxis (vaccine, special immunoglobulins) against herpesvirus infections are still rather limited. The development of antiviral substances has greatly benefited from the introduction of new agents (Acyclovir) and the production of sufficient quantities of interferon (IFN) preparations during the last few years. Impressive results were obtained with the nucleoside-related substance Acyclovir in the prevention and therapy of primary or reactivated HSV-1 or HSV-2 infections. The use of Acyclovir as prophylactic agent produced the effect that recipients of bone-marrow transplants were no longer afflicted by HSV-1 infections.(ABSTRACT TRUNCATED AT 400 WORDS) PMID: 2986378 [PubMed - indexed for MEDLINE] 5059. Internist (Berl). 1985 Feb;26(2):68-72. [Latent persistent infection caused by herpes simplex and varicella zoster virus] [Article in German] Schneweis KE. PMID: 2984134 [PubMed - indexed for MEDLINE] 5060. J Pediatr. 1985 Feb;106(2):259-61. Herpes zoster following varicella vaccine in a child with acute lymphocytic leukemia. Williams DL, Gershon AA, Gelb LD, Spraker MK, Steinberg S, Ragab AH. PMID: 2982006 [PubMed - indexed for MEDLINE] 5061. JAMA. 1985 Jan 25;253(4):511. Fulminant varicella hepatitis following bone marrow transplantation. Morishita K, Kodo H, Asano S, Fujii H, Miwa S. PMID: 2982045 [PubMed - indexed for MEDLINE] 5062. Br Med J (Clin Res Ed). 1985 Jan 19;290(6463):177-8. Clinical use of acyclovir. Jeffries DJ. PMCID: PMC1417918 PMID: 3917742 [PubMed - indexed for MEDLINE] 5063. Pol Tyg Lek. 1985 Jan 14;40(2):45-6. [Results of treatment of herpes simplex and herpes zoster with isoprinosine] [Article in Polish] Polubiec A, Kołakowska-Polubiec K, Stepka K. PMID: 2579368 [PubMed - indexed for MEDLINE] 5064. Med J Aust. 1985 Jan 7;142(1):78. Cimetidine for herpes zoster. Fitzhenry J. PMID: 3965888 [PubMed - indexed for MEDLINE] 5065. Eur Neurol. 1985;24(5):314-8. Fisher's syndrome following trigeminal herpes zoster. Uematsu D, Satoh T, Tanahashi N, Koto A, Gotoh F. A case of Fisher's syndrome associated with trigeminal herpes zoster is reported for the first time. Retrograde propagation of the virus to the brainstem through the trigeminal root was thought to be the most probable pathogenic mechanism. We provide additional evidence suggesting that the focus of Fisher's syndrome is in the brainstem. PMID: 4054180 [PubMed - indexed for MEDLINE] 5066. Med Pregl. 1985;38(1-2):45-7. [Generalized varicelliform herpes zoster] [Article in Croatian] Madle-Samardzija N, Tesin S, Milovanov A. PMID: 4033555 [PubMed - indexed for MEDLINE] 5067. Minerva Anestesiol. 1985 Jan-Feb;51(1-2):45-50. [Treatment of pain in acute herpes zoster and post-herpetic neuritis] [Article in Italian] Bassino P, Bandini M, Dal Tio R. PMID: 4022404 [PubMed - indexed for MEDLINE] 5068. Rev Neurol (Paris). 1985;141(3):234-6. [Zoster myelitis. Immunological study and treatment with acyclovir] [Article in French] Mas JL, Lapresle J. A case of thoracic herpes zoster in a 52 year old man was succeeded by myelopathy. Intrathecal synthesis of varicella-zoster antibodies was demonstrated. Myelopathy rapidly improved upon treatment with acyclovir. PMID: 4001711 [PubMed - indexed for MEDLINE] 5069. Eur J Pediatr. 1985 Jan;143(3):198-202. Oral BVDU treatment of varicella and zoster in children with cancer. Benoit Y, Laureys G, Delbeke MJ, De Clercq E. In the period June 1980-April 1983, 21 children with malignant disease were admitted because of an intercurrent varicella or zoster infection. They were treated with the new antiviral drug BVDU [(E)-5-(2-bromovinyl)-2'-deoxyuridine]. The drug was administered orally at a dose of 15 mg/kg per day for 5 days. All our patients responded promptly to BVDU treatment and recovered completely from their varicella or zoster infections without complications. No toxic side-effects due to the drug were observed. PMID: 3987714 [PubMed - indexed for MEDLINE] 5070. Z Hautkr. 1985 Jan;60(1-2):204, 207-10. [Passive immunotherapy in herpes zoster. A pilot study with intravenous hyperimmune globulin] [Article in German] Kaufmann R. While passive immunisation with hyperimmune globulin proved beneficial for the prevention of varicella infections in immuno-compromised patients, there has been no reliable evidence for such preparations to be effective with the treatment of or prophylaxis against zoster complications. This may be partly due to the minor significance of the humoral immune response in herpes zoster as well as to insufficient bioavailability of the preparation when administered intramuscularly. In an openly and prospectively conducted study, a recently available varicella-zoster hyperimmune globulin was intravenously given to an unselected group of 20 in-patients suffering from herpes zoster. There have not been observed any side effects. If therapy was started within the first week of manifestation of the disease (15 test persons), the patients showed rapid and uncomplicated healing. PMID: 3984430 [PubMed - indexed for MEDLINE] 5071. J Pediatr. 1985 Jan;106(1):71-3. Tooth exfoliation and osteonecrosis of the maxilla after trigeminal herpes zoster. Garty BZ, Dinari G, Sarnat H, Cohen S, Nitzan M. PMID: 3965684 [PubMed - indexed for MEDLINE] 5072. Scand J Infect Dis Suppl. 1985;47:80-4. The treatment of herpes zoster infections. Peterslund NA. A review of the many past and present therapeutic attempts in herpes zoster is given. Serious candidates are interferon, idoxuridine, adenine arabinoside, and acyclovir. Cumbersome administration and risk of side effects make acyclovir today's choice. The treatment with acyclovir has been improved by the availability of an oral formulation. The development of a well-absorbed prodrug, 6-deoxyacyclovir may in the future replace conventional acyclovir tablets in non-emergency cases. PMID: 3912976 [PubMed - indexed for MEDLINE] 5073. Scand J Infect Dis Suppl. 1985;47:76-9. Oral acyclovir in herpes zoster. McKendrick MW. Zoster is a common disease that may be associated with severe and protracted pain. Antiviral therapy with acyclovir intravenously has been shown to modify the course of the disease and reduce pain during the acute phase. The results of two studies using doses of 400 mg and 800 mg of acyclovir orally are outlined. The data suggest a significant benefit of the higher dose treatment on the course of the illness and the pain. PMID: 3912975 [PubMed - indexed for MEDLINE] 5074. Scand J Infect Dis Suppl. 1985;47:145-8. Acyclovir and renal transplantation. Pettersson E, Eklund B, Höckerstedt K, Salmela K, Ahonen J. The efficacy of oral acyclovir to prevent reactivation of herpes simplex virus (HSV) in seropositive renal allograft recipients was tested in a double-blind placebo controlled study. None of the 18 patients allocated to acyclovir showed any signs of HSV infection. In contrast, 11/17 on placebo (p less than 0.001), had signs of HSV or varicella zoster virus (VZV) infection--in 5 patients severe enough to interrupt the trial and initiate treatment with oral acyclovir. Soon after cessation of the trial, HSV was isolated from the throats of 6 patients on acyclovir, and 1 developed shingles 3 months later. Oral acyclovir prophylaxis thus effectively protected the patients from reactivation of HSV and VZV while they were receiving the drug, but could not prevent disease once off the drug. Treatment with acyclovir brought rapid relief of both local and general symptoms in all patients. No adverse reactions were seen. As a consequence of these experiences our goal in subsequent transplant patients has been either early therapeutic intervention with oral acyclovir whenever signs of HSV or VZV infection have been noted, or prophylactic remedy in patients at particular risk to develop troublesome herpetic lesions after renal transplantation. PMID: 3912970 [PubMed - indexed for MEDLINE] 5075. Ariz Med. 1985 Jan;42(1):16-9. Treatment of pain due to herpes zoster infections. Borowsky S, Shetter AG. PMID: 3883956 [PubMed - indexed for MEDLINE] 5076. West J Med. 1985 Jan;142(1):117-8. Treatment of herpes zoster with corticosteroids--fact or faith? Levinson W, Shaw JC. PMCID: PMC1305968 PMID: 3883657 [PubMed - indexed for MEDLINE] 5077. Scand J Infect Dis Suppl. 1985;47:85-8. Herpes zoster ocular infection. McGill J. A retrospective analysis of 171 patients with herpes zoster ocular infection has been carried out to determine the effect of treatment with either topical acyclovir, topical steroids, or a combination of both. Acyclovir was superior to steroids and to the combination. Treatment with topical acyclovir was on average 54 days compared with 200 days with steroids, and recurrences were 6% with acyclovir compared with 50% with steroids. PMID: 3879378 [PubMed - indexed for MEDLINE] 5078. Cornea. 1985-1986;4(1):14-8. Bacterial infection of a neurotrophic cornea in an immunocompromised subject. Webb RM, Duke MA. The following is a case report of a 61-year-old woman with a 10-year history of pemphigus vulgaris, successfully treated with steroids and cytotoxic agents. The patient developed severe herpes zoster ophthalmicus, complicated by a staph-indolent corneal ulcer. This case illustrates several of the many unfortunate ophthalmological complications that may develop in the immunocompromised patient. PMID: 3879210 [PubMed - indexed for MEDLINE] 5079. Am J Pediatr Hematol Oncol. 1985 Spring;7(1):9-14. Spontaneous remission of Burkitt's lymphoma associated with herpes zoster infection. McClain K, Warkentin P, Kay N. A 12-year-old white female with recurrent Burkitt's lymphoma had a spontaneous remission associated with a localized herpes zoster infection. The remission lasted nearly 2 months before the tumor recurred in the central nervous system. LDH isoenzyme determinations done on an earlier ovarian tumor and serum at time of bone marrow relapse showed different predominant LDH isoenzyme patterns. These data might be interpreted as showing that different malignant cell clones were responsible for ovarian and bone marrow relapses. Studies to elucidate the mechanism of spontaneous remission at the time of zoster infection demonstrated serum factor(s) which stimulated normal B lymphocytes. PMID: 3876039 [PubMed - indexed for MEDLINE] 5080. Ter Arkh. 1985;57(5):127-30. [Clinical course of herpes zoster in middle-aged and elderly persons] [Article in Russian] Bogomolov BP, Bakhur EG. The clinical progress of herpes zoster (HZ) was studied in 216 patients under 60 years and in elderly and senile persons. A clear relationship was revealed between the gravity of the clinical progress of HZ and the patients' age. The number of patients with grave HZ patterns and with HZ of medium gravity was found to be increasing in elderly and senile persons. It was also established that HZ took a graver course in patients aggravated with concomitant pathology. The concomitant diseases are demonstrated to have a multifactorial aggravating effect on the progress of HZ. PMID: 3875159 [PubMed - indexed for MEDLINE] 5081. Zh Nevropatol Psikhiatr Im S S Korsakova. 1985;85(2):180-4. [Immunologic characteristics of the pathogenesis of herpes zoster] [Article in Russian] Seletskaia TA, Shishov AS, Sysoeva KR. Patients suffering from herpes zoster were subjected to immunological studies including the determination of the levels of the main immunoglobulin classes (IgA, IgM, IgG) in 102 subjects and the blast transformation test (19 subjects). Sufficiently tense humoral immunity and low reserve potentialities of cell-mediated immunity were discovered. Based on the data obtained the authors point to the necessity of using immunocorrecting agents, particularly levamisole, in combined therapy of herpes zoster. PMID: 3872543 [PubMed - indexed for MEDLINE] 5082. Ann Ophthalmol. 1985 Jan;17(1):46-51. Acute phthisis bulbi and external ophthalmoplegia in herpes zoster ophthalmicus. Amanat LA, Cant JS, Green FD. A patient developed acute phthisis bulbi and external ophthalmoplegia with herpes zoster ophthalmicus (HZO). The clinical course and ocular complications of HZO are described briefly and the cause of phthisis bulbi and external ophthalmoplegia in zoster ophthalmicus is discussed. It is suggested that the acute hypotonia in HZO is due to an ischemic necrosis of the ciliary body, resulting from an occlusive vasculitis which may also be responsible for the external ophthalmolplegia. PMID: 3872092 [PubMed - indexed for MEDLINE] 5083. Int Ophthalmol Clin. 1985 Spring;25(1):77-96. Herpes zoster ophthalmicus. Liesegang TJ. PMID: 3871748 [PubMed - indexed for MEDLINE] 5084. Ter Arkh. 1985;57(5):105-7. [Use of cytosar (cytosine arabinoside) in the control of herpetic complications in patients with acute leukemia and lymphogranulomatosis] [Article in Russian] Berliner GB, Mendeleev IM, Polezhaev IuN, Arkavina EA, Miasnikov AA. The authors report the use of the cytostatic drug cytosar in the control of herpetic complications in patients with acute leukemia and lymphogranulomatosis. A distinct effect was obtained as a result of intravenous drip of cytosar in a dose of 0.03-0.05 g for 2 days. It is desirable that cytosar therapy may be instituted within the first days of the development of herpetic infection. PMID: 3860998 [PubMed - indexed for MEDLINE] 5085. Dtsch Z Mund Kiefer Gesichtschir. 1985 Jan-Feb;9(1):38-42. [Apical osteitis and herpes zoster in the 3rd branch of the trigeminal nerve. A case history] [Article in German] Rixecker H, Tetsch P. PMID: 3858038 [PubMed - indexed for MEDLINE] 5086. Appl Neurophysiol. 1985;48(1-6):277-80. A method for bulbospinal trigeminal nucleotomy in the treatment of facial deafferentation pain. Siqueira JM. Many types of facial pain are difficult to treat, such as postherpetic, posttraumatic, or pain following denervation procedures used in the treatment of trigeminal neuralgia (anesthesia dolorosa), all of which involve deafferentation of the spinal trigeminal nucleus. PMID: 3837649 [PubMed - indexed for MEDLINE] 5087. Rev Chir Oncol Radiol O R L Oftalmol Stomatol Ser Oftalmol. 1985 Jan-Mar;29(1):45-7. [Therapeutic problems in zona ophthalmica] [Article in Romanian] Leibovici M, Nemoianu V. PMID: 3159051 [PubMed - indexed for MEDLINE] 5088. Rev Med Interna Neurol Psihiatr Neurochir Dermatovenerol Neurol Psihiatr Neurochir. 1985 Jan-Mar;30(1):25-9. [Clinical and physiopathological aspects of a case of recurrent polyradiculoneuritis zoster] [Article in Romanian] Truşcă E, Grubneac A, Stoica I. PMID: 3158051 [PubMed - indexed for MEDLINE] 5089. Postgrad Med J. 1985;61 Suppl 4:7-14. Clinical and pathogenetic aspects of varicella-zoster. Plotkin SA. In this review article the pathogenetic mechanisms of infection with the varicella-zoster virus (VZV) and its short- and long-term clinical consequences are discussed. It is concluded that the impact of VZV is severe enough to seriously consider widespread immunization against it. PMID: 3014481 [PubMed - indexed for MEDLINE] 5090. Postgrad Med J. 1985;61 Suppl 4:61-7. Clinical experience with Oka live varicella vaccine in Japan. Takahashi M, Kamiya H, Baba K, Asano Y, Ozaki T, Horiuchi K. A live varicella vaccine (Oka strain) has been developed and used since 1974 in normal and diseased children, particularly those at high risk. Children with acute leukaemia were usually vaccinated while in remission when showing a normal cell-mediated immunity as assessed with phytohaemagglutinin (PHA) or other reagents, and during suspension of all anticancer therapy, except 6-mercaptopurine from 1 week before to 1 week after vaccination. While clinical reactions were observed in only 40 out of 263 (15.2%) of these patients, they were noted in 30 out of 72 (41.7%) children immunized without suspension of chemotherapy. Symptoms were mostly mild; only a few cases of the latter group with T-cell leukaemia or malignant lymphoma developed severe symptoms. An immune response was observed in most vaccinees, but some (11%) developed clinical symptoms after exposure to natural varicella due to immunodepression caused by continuing anticancer chemotherapy. In these cases, revaccination seems advisable. The incidence and severity of zoster in vaccinated acute leukaemic children were less than in those with natural infection. Satisfactory immune responses with few concomitant clinical reactions were observed in approximately 1,500 vaccinees having nonmalignant diseases and in about 4,000 normal children. A 7-10-year follow-up study revealed that the vaccine had conferred solid immunity on the children. These results indicate that live varicella vaccine of the Oka strain is useful in preventing varicella in high-risk as well as in normal children. PMID: 3014479 [PubMed - indexed for MEDLINE] 5091. Postgrad Med J. 1985;61 Suppl 4:23-30. Management of varicella-zoster contact and infection in pregnancy using a standardized varicella-zoster ELISA test. Enders G. An ongoing 5-year prospective study of the outcome of contact with varicella-zoster virus (VZV) and infection in pregnant women has made use of a standardized VZV enzyme-linked immunosorbent assay for the determination of immune status and as a guide for therapeutic management. Out of of a total of 778 such cases investigated to date in the Federal Republic of Germany, 93.1% have been shown to be VZV immune, whereas 6.9% were seronegative and, therefore, susceptible to infection. Those of the latter group who received zoster hyperimmunoglobulin (ZIG) between 24-96 hours after varicella contact remained symptom-free, while women receiving ZIG from the 3rd-10th day after contact developed a modified varicella. For the prevention of varicella, ZIG with known titres should be administered at doses of 0.2-0.4 ml/kg. It is also recommended for the newborn when maternal infection occurs within 4 days before until 2-4 days after delivery. The prevention and attenuation of varicella in pregnancy is justified since the outcomes may include spontaneous abortion in early pregnancy, the congenital varicella syndrome, and severe neonatal disease with a rather high mortality around term. PMID: 3014475 [PubMed - indexed for MEDLINE] 5092. Postgrad Med J. 1985;61 Suppl 4:155-62. The future of varicella vaccine. Plotkin SA, Arbetter AA, Starr SE. Based on conservative figures, an estimated 60 million varicella-zoster cases occur annually worldwide, highlighting the global significance of this disease. The development of a viable varicella vaccine, therefore, raises important questions as to the indications for its use in normal children, normal seropositive and seronegative adults, and immunocompromised patients. A review of the available data addresses the potential future role of the varicella vaccine in these groups. PMID: 3014474 [PubMed - indexed for MEDLINE] 5093. Postgrad Med J. 1985;61 Suppl 4:147-50. Stimulation of specific immune response to varicella antigens in the elderly with varicella vaccine. Duchateau J, Vrijens R, Nicaise J, D'Hondt E, Bogearts H, Andre FE. Ageing is associated with several immune defects that probably lead to the increased incidence of zoster observed after the 5th decade. In a double-blind study to assess an eventual stimulation of the specific immune response against the varicella-zoster virus by vaccination, either the Oka-strain live varicella vaccine or a placebo was administered to 30 healthy volunteers over 70 years of age, after a 4-week pretreatment period with either zinc acetate as an immunostimulant or a placebo. Specific skin delayed hypersensitivity and antibody levels measured by the fluorescent antibody to membrane antigen method were recorded at the start of the pretreatment period, just before vaccination, and two weeks or one month after vaccination. Initially decreased delayed-type responses to varicella antigens were observed when compared with reported values for younger subjects despite normal levels of skin reactivity to common bacterial antigens (Multitest). The varicella-specific responses were markedly boosted in the 3 groups by repeated skin testing. As a result, the effects of zinc pretreatment and vaccination were masked. On the other hand, treatment with zinc acetate was shown to increase tuberculin delayed reactions. Preexisting specific antibody titres were elevated and no significant changes occurred in the 3 study groups. The data suggest that it is not the potential for an immune response that is decreased in the elderly but rather the speed of the response. This might be the defect responsible for the increased incidence of zoster in this age group. PMID: 3014473 [PubMed - indexed for MEDLINE] 5094. Postgrad Med J. 1985;61 Suppl 4:137-41. Delayed hypersensitivity skin test to detect susceptibility to varicella and zoster. Berger R, Luescher D, Just M, D'Hondt E, Bogaert H. A crude varicella skin-test antigen corresponding to an inactivated partly-purified high-titre varicella Oka-strain vaccine was prepared at Smith Kline-RIT. It was used for a delayed hypersensitivity skin test in 60 healthy adults for determination of their immune status. The findings were analysed according to the presence or absence of humoral antibodies to varicella-zoster virus (VZV), and of a specific cell-mediated immune (CMI) response as measured by the VZV-specific lymphocyte transformation test. The immune status to varicella could be determined in all subjects provided that the amount of antigenic material in the skin-test antigen was sufficiently high. The 2 tests for the CMI response, the delayed hypersensitivity skin test and the lymphocyte transformation test, gave concordant results in both seropositive and seronegative individuals. The inactivated skin-test antigen cannot replace vaccination with the live varicella vaccine since it is unable to induce seroconversion in seronegatives or an antibody booster response in seropositives. Furthermore, seropositive and seronegative subjects showing a negative response to the varicella-zoster-specific lymphocyte transformation test remained negative 2 weeks after the injection of the skin-test antigen. PMID: 3014471 [PubMed - indexed for MEDLINE] 5095. Postgrad Med J. 1985;61 Suppl 4:103-6. Varicella vaccine in children with chronic renal insufficiency. Broyer M, Boudailliez B. This study reports the antibody response and clinical follow-up of uraemic children awaiting kidney transplantation after administration of the Oka-strain varicella vaccine (Varilirix). Seroconversion was observed in 20 out of 23 patients found to be seronegative when tested by the fluorescent antibody to membrane antigen technique, and an antibody booster response was observed in 41 out of 47 seropositive patients. Mild clinical varicella occurred in 5 vaccinated patients and herpes zoster in 3 initially seropositive ones. Nevertheless, a dramatic decrease in the incidence of both varicella and herpes zoster was observed in a series of 330 consecutive transplantations after the introduction of the varicella vaccine. PMID: 3014466 [PubMed - indexed for MEDLINE] 5096. Scand J Urol Nephrol Suppl. 1985;92:41-4. Clinical experiences with phosphonoformate (foscarnet) treatment of viral diseases following renal transplantation. Ahlmén J, Wijnween AC, Brynger H, Lycke E. The effect of the antiviral drug phosphonoformate (Foscarnet) was studied in 32 patients following renal transplantation. Viral diagnosis was verified in 29 of 33 episodes of suspected clinical virosis. The clinical effect of Foscarnet was good in 12 of 14 primary cytomegalovirus infections. In 5 of 7 varicella-zoster virus, in 4 of 6 secondary cytomegalovirus and in 2 herpes simplex virus (type 1; type 2) infections the effect of the treatment was clinically judged as good. The beneficial effect could in these patients be overestimated as the natural courses of the viral infections were unknown. No clinical side effects of Foscarnet were found. Clinically unimportant changes in s-calcium were noted in 6 patients. The dosage of Foscarnet was increased during the study. At present an initial bolus dose followed by 14 days of parenteral infusions can be recommended. PMID: 3008316 [PubMed - indexed for MEDLINE] 5097. Scand J Infect Dis Suppl. 1985;47:44-50. Herpesvirus infection in man. Zachariae H. Herpesviruses which affect man are herpes simplex virus type 1 and type 2, varicella-zoster virus, cytomegalovirus and Epstein-Barr virus. The review deals with the more common clinical manifestations of human herpesvirus infections, which occur ubiquitously in all populations throughout the world. Primary infections most commonly occur in childhood. It is a characteristic feature of herpesvirus that they generally remain in a latent form after clearance of the primary infection. The overall majority of clinical problems are related to activated latent infections, viz. recurrent lesions of herpes simplex, herpes zoster with remaining neuralgia in older patients, and in particular herpesvirus infections and reactivation in immunodeficient individuals. Herpes infection during pregnancy may result in severe generalised infection of the newborn. A possible relationship between herpesvirus and cancer, especially between herpesvirus type 2 and cervical cancer and between Epstein-Barr virus and Burkitt's lymphoma are of major interest today. PMID: 3006233 [PubMed - indexed for MEDLINE] 5098. Scand J Infect Dis Suppl. 1985;47:165-73. Present and future of acyclovir. Yeo JM, Fiddian AP. Acyclovir is now established as an effective and well tolerated therapeutic agent for the management of at least the more common infections of the herpes virus group. Evaluation of the drug nevertheless continues, primarily to verify its value in those infections caused by cytomegalovirus (CMV) and Epstein-Barr virus (EBV). Furthermore with the development of analogues of acyclovir with better absorption profiles or enhanced anti-viral activity the future for this area of anti-viral therapy looks optimistic. PMID: 3006231 [PubMed - indexed for MEDLINE] 5099. Scand J Infect Dis Suppl. 1985;47:121-7. Herpesvirus infections in the immunocompromised patient. Skinhøj P. The herpes group viral infections in the T cell immunocompromised host may be seen as a disturbance of a delicate balance between the host and well adapted commensals. The clinical aspect of this disturbance is highly variable but may cause the destruction of the host due to widespread organ damage or prolonged debilitating illnesses. An important aspect is the immunosuppressive effect of the infections themselves leading to a number of superinfections, often with unusual pathogens, difficult to treat. Further problems arise from the potential onchogenic effect of some of these viruses such as EBV induced lymphomas. On the threshold to the era of effective antiviral chemotherapy, two major problems are still present: identification of the precise immunological mechanisms controlling the latency/reactivation of the different viruses and the establishment of reliable methods for rapid diagnosis, crucial for the treatment of patients with atypical clinical presentation and atypical serological responses. PMID: 3006227 [PubMed - indexed for MEDLINE] 5100. Antiviral Res. 1985;Suppl 1:35-44. Therapy of varicella-zoster virus infection--mechanism of action of (E)-5-(2-bromovinyl)-2'-deoxyuridine. Shigeta S, Yokota T, De Clercq E. PMID: 3002264 [PubMed - indexed for MEDLINE] 5101. Antiviral Res. 1985;Suppl 1:241-50. Treatment and prevention of virus infections in immunosuppressed patients. Lietman PS, Saral R. PMID: 3002259 [PubMed - indexed for MEDLINE] 5102. Ann Dermatol Venereol. 1985;112(3):265-6. [Large necrotic ulcerations caused by varicella-zona virus in an immunosuppressed patient] [Article in French] Prigent F, Ferrier E, Dontenwille MN, Mathieu A, Restout S, Pérol Y, Civatte J. PMID: 2998258 [PubMed - indexed for MEDLINE] 5103. Eur Arch Psychiatry Neurol Sci. 1985;234(6):404-7. Hemichorea associated with varicella-zoster reinfection and endocarditis. A case report. Hammann KP, Henkel B, Erbel R, Krämer G. A 20-year-old woman developed transient right-sided hemichoreatic movements after household exposure to varicella-zoster. Some days before the appearance of involuntary movements a vesicular rash had occurred. About 6 months later an elevated IgG serum titer against varicella virus was found and two-dimensional echocardiography showed signs of an endocarditis. During the following 2 months the IgG value returned to within the normal range and the choreatic movements disappeared almost totally. The possibility is discussed that endocarditis had been caused and maintained by serum antibodies to varicella-zoster virus which cross-reacted with valvular tissue. Embolization to the region of the left striatum and/or postinfectious encephalitis in this region are assumed to be the most plausible causes of the transient hemichorea. PMID: 2992991 [PubMed - indexed for MEDLINE] 5104. Trans Ophthalmol Soc U K. 1985;104 ( Pt 3):243-7. Ocular disease in immunosuppressed patients. Sarkies NJ, Blach RK. New therapies and diseases causing immunosuppression have provoked new and devastating ocular diseases. The possible reasons for the vulnerability of the retina to opportunistic infections are discussed. The clinical patterns of disease caused by common opportunistic agents are described, and current treatment available is reviewed. PMID: 2992127 [PubMed - indexed for MEDLINE] 5105. Bull World Health Organ. 1985;63(2):185-201 contd. Prevention and control of herpesvirus diseases. Part 1. Clinical and laboratory diagnosis and chemotherapy. A WHO meeting. [No authors listed] PMCID: PMC2536392 PMID: 2990748 [PubMed - indexed for MEDLINE] 5106. Eur Neurol. 1985;24(4):225-8. Delayed contralateral hemiplegia following herpes zoster ophthalmicus: should antiviral therapy be used? Booss J, Haak BB, Leroy RF. We review clinical virological studies in the syndrome of delayed contralateral hemiplegia following herpes zoster ophthalmicus. Virus could not be isolated from the cerebrospinal fluid (CSF) of the present case, nor was antiviral antibody found in the CSF. There appear to have been no reports of successful virus isolation from the CSF although there are reports of antibody in the spinal fluid. Thus the evidence for ongoing viral replication in the central nervous system is marginal. It is suggested that the sensitive antibody assay against membrane antigens (FAMA) be used in the future as a guide to antiviral therapy. PMID: 2988963 [PubMed - indexed for MEDLINE] 5107. Acta Derm Venereol Suppl (Stockh). 1985;114:121-4. Viral infections in atopic dermatitis. Strannegård O, Strannegård IL, Rystedt I. In a study of almost 1000 patients with past or present atopic dermatitis (AD) it was found that histories of recurrent (greater than 5 episodes/year) cold sores and upper respiratory infections, as well as histories of zoster were significantly more common in AD patients than in non-atopic controls. Serological studies revealed that AD patients have clearly elevated titers of antibodies against Epstein-Barr virus. These findings suggest that the increased susceptibility to viral infections in AD is due to immune dysfunction rather than to cutaneous alterations which are associated with the disease. The mechanisms underlying the increased susceptibility to infections may be related to immunological aberrations that are secondary to a basic abnormality in the fatty acid or cyclic AMP metabolism. PMID: 2988250 [PubMed - indexed for MEDLINE] 5108. Isr J Med Sci. 1985 Jan;21(1):27-31. Intravenous acyclovir for herpesvirus in immunocompromised patients. Dan M, Michaeli D, Siegman-Igra Y. Severe herpesvirus infections in 18 immunocompromised patients (25 episodes) were treated with i.v. acyclovir. Six patients had 13 episodes of mucocutaneous herpes simplex infections, eight children had varicella, three patients had generalized zoster, and one patient had cytomegalovirus pneumonia. No patient died from infections. In 18 episodes treatment with acyclovir produced a beneficial effect, in 5 episodes acyclovir was probably beneficial, and in 2 patients the effect could not be evaluated. No serious side effects could be definitely attributed to acyclovir administration. These data support the previous experience that i.v. acyclovir may be useful in the treatment of herpesvirus infections in immunocompromised patients. PMID: 2982763 [PubMed - indexed for MEDLINE] 5109. Br Med Bull. 1985 Jan;41(1):46-9. Opportunistic viral infections. Burns WH, Saral R. PMID: 2982446 [PubMed - indexed for MEDLINE] 5110. Transplantation. 1985 Jan;39(1):21-3. Late-onset interstitial pneumonia following allogeneic bone marrow transplantation. Wingard JR, Santos GW, Saral R. Although most episodes of interstitial pneumonia (IP) following allogeneic bone marrow transplantation occur during the second or third month, occasional cases occur later. The records of 139 patients transplanted for leukemia over 6 years were reviewed in this study to examine cases of IP occurring beyond 100 days following marrow transplantation. Ten episodes of IP occurred among the 67 patients who survived 100 days (an actuarial probability of 18%). All cases occurred within the first year. An infectious cause was established in 80%. The case fatality rate was 60%. Although most infectious cases of IP occurring before 100 days are caused by cytomegalovirus, the late-onset cases in this study were caused by a heterogeneous group of pathogens, some of which were amenable to specific therapies. Thus, an aggressive approach to establishing a specific diagnosis should be made in cases of IP occurring more than 100 days after marrow transplantation. PMID: 2981443 [PubMed - indexed for MEDLINE] 5111. J Infect Dis. 1985 Jan;151(1):106-13. Varicella-zoster virus infection of strain 2 guinea pigs. Myers MG, Stanberry LR, Edmond BJ. Weanling strain 2 guinea pigs are susceptible to infection with varicella-zoster virus cultured in embryonic guinea pig tissue. Animals inoculated by an intramuscular route develop mononuclear cell viremia that may persist for as long as three weeks. During the period of viremia, virus may be recovered from the nasopharynx and a variety of tissues. In addition, virus may be recovered from neural tissues in the absence of viremia, although infectious virus has not been cultivated from neural tissues after the 23rd day. The strain 2 guinea pig should provide an animal model to study the pathophysiology of infections caused by varicella-zoster virus. PMID: 2981274 [PubMed - indexed for MEDLINE] 5112. Kansenshogaku Zasshi. 1985 Jan;59(1):57-61. [A case of herpes zoster with a dramatic response to cimetidine] [Article in Japanese] Shibuya T, Etoh H. PMID: 2860189 [PubMed - indexed for MEDLINE] 5113. Scand J Infect Dis Suppl. 1985;47:128-36. Treatment of herpesvirus infections in the immunocompromised host. Meyers JD. Major advances have been made in the treatment of herpesvirus infections in the compromised host. Acyclovir is clearly effective in the treatment of HSV infection, and preferable to vidarabine for this purpose. Additional information about the optimal use of acyclovir for treatment or prophylaxis and about the ultimate significance of the phenomena of acyclovir resistance and possible suppression of the specific immune response are needed. The major challenge at this time is the rapid clinical or virologic diagnosis of HSV infection, especially the rarer manifestations such as HSV pneumonia or encephalitis, so that effective therapy can be initiated. The serious manifestations of VZV infection (e.g. cutaneous and visceral dissemination) can also be controlled with either vidarabine or acyclovir, although definition of the agent of choice is still lacking. More information is needed to define the relative efficacy of acyclovir compared with vidarabine, and also to define better treatment regimens for the prevention of post-herpetic neuralgia which remains a major source of morbidity. Use of either oral or topical acyclovir and anti-inflammatory agents in combined regimens is being studied. Interferon, although effective, has little present role in view of the availability of both acyclovir and vidarabine, although it is of interest as a model of an agent that can be administered to outpatients or used in synergistic regimens. The challenge for treatment of CMV is the development of an agent which is effective in vivo. Several promising agents are on the horizon, but much initial work must be done before their effectiveness will become apparent.(ABSTRACT TRUNCATED AT 250 WORDS) PMID: 2419973 [PubMed - indexed for MEDLINE] 5114. Int J Tissue React. 1985;7(6):449-57. The modulation of cutaneous inflammatory reactions by peptide-containing sensory nerves. Jancsó G, Obál F Jr, Tóth-Kása I, Katona M, Husz S. In the present experiments the role of unmyelinated sensory fibres in the mechanism of cutaneous inflammatory reactions under normal and pathological conditions has been studied in man and animals. Dye leakage responses to histamine, serotonin, compound 48/80, bradykinin and substance P were significantly reduced, while neurogenic inflammation was completely abolished in rats treated neonatally with capsaicin, as studied quantitatively by the Evans blue technique. Neurogenic inflammation could also be elicited by mustard oil in normally innervated human skin, but not in skin areas affected by herpes zoster or in a patient suffering from congenital analgesia. Repeated topical treatment of the skin with capsaicin (local desensitization) abolished the neurogenic inflammatory response for several days. Chemical pain sensitivity was strongly reduced, and thresholds for warmth and heat pain sensations were significantly elevated. Local capsaicin desensitization of the skin prevented whealing, flare and itch in patients with acquired cold and heat urticaria. The findings indicate that peptide-containing sensory nerves are involved in the mediation of chemogenic and heat pain, and possibly itch, and are responsible for initiation of the neurogenic inflammatory response. The results also provide direct evidence of the involvement of these particular sensory nerves in the modulation of the permeability-increasing effects of putative mediators of acute inflammatory reactions. It is concluded that, through modulation of cutaneous vascular reactions, peptidergic sensory nerves may play a hitherto unrecognized role in the pathomechanism of certain diseases of human skin. PMID: 2417973 [PubMed - indexed for MEDLINE] 5115. Am J Ophthalmol. 1984 Dec 15;98(6):825-7. Skin test with varicella-zoster virus antigen for ophthalmic herpes zoster. Pepose JS. PMID: 6095668 [PubMed - indexed for MEDLINE] 5116. N Z Med J. 1984 Dec 12;97(769):852-4. Antiviral drugs today. Goldwater PN. PMID: 6392956 [PubMed - indexed for MEDLINE] 5117. Med J Aust. 1984 Dec 8-22;141(12-13):903. Herpes zoster and cimetidine. Arnot RS. PMID: 6503811 [PubMed - indexed for MEDLINE] 5118. Med J Zambia. 1984 Dec;18(4):14-5. Herpes zoster with pulmonary tuberculosis: a report of 4 cases. Verma RC, Hira SK. PMID: 6600052 [PubMed - indexed for MEDLINE] 5119. Neurosurgery. 1984 Dec;15(6):969-70. Dorsal root entry zone lesions for the treatment of postherpetic neuralgia. Friedman AH, Nashold BS Jr. These investigators attempted to diminish postherpetic neuralgia in 17 patients by making dorsal root entry zone (DREZ) lesions. They describe the clinical syndrome of pain after herpes zoster, the incidence of which increases with age, and discuss its pathology. They briefly review the medical and surgical treatment of postherpetic neuralgia. The results and complications of the DREZ procedure are reported. PMID: 6514174 [PubMed - indexed for MEDLINE] 5120. Neurosurgery. 1984 Dec;15(6):928-32. Deafferentation pain after posterior rhizotomy, trauma to a limb, and herpes zoster. Sweet WH. After incisional or alcoholic destruction of trigeminal posterior rootlets, constant dysesthesias of major degree referred to some part of the markedly denervated zone develop in 5 to 15% of the patients. The full severity may not appear for weeks or months. There is no allodynia or hyperpathia of the denervated zone. Bulbar trigeminal tractotomy with sparing of touch sensation produces severe dysesthesias in a tiny percentage of the patients, as does selective destruction of pain fibers by radiofrequency heating or glycerol. Spinal posterior rhizotomy elicits in less than 4% a lasting dysesthesia entirely different in temporal sequence, locus, and type of pain: (a) it tends to be maximal early after operation and to improve, (b) the spontaneous pain is accompanied by severe allodynia, and (c) the pain is usually referred beyond the margins of the insentient (rhizotomized) zone and may even be referred to the corresponding area on the opposite side. Sindou's "selective posterior rhizotomy," i.e., cutting of the small fiber lateral component of each rootlet as it enters the cord, has not given rise to dysesthesias. These do occur briefly in 50% of the cases following spinal ganglionectomy, the sensations being referred to the dermatomal segment of the ganglion in question. The secondary afferent neurons in the mesencephalic, principal, oral, and interpolar nuclei for the trigeminal posterior roots have no counterpart in the spinal cord for the spinal posterior roots. We suggest that the explanation for the fact that neither trigeminal neuralgia nor trigeminal anesthesia dolorosa have a spinal clinical counterpart is related to the as yet unexplained special functions of the elaborate trigeminal secondary afferent neuronal apparatus.(ABSTRACT TRUNCATED AT 250 WORDS) PMID: 6514166 [PubMed - indexed for MEDLINE] 5121. J Neurol Neurosurg Psychiatry. 1984 Dec;47(12):1351-4. Vidarabine encephalopathy. Cullis PA, Cushing R. Vidarabine (adenine arabinoside, ara-a) has been found to be useful in the treatment of various viral infections. Its adverse neurological effects include tremor and encephalopathy. Two cases of vidarabine encephalopathy are reported and the five other cases in the literature are reviewed. The clinical features of the tremor and encephalopathy are discussed. PMCID: PMC1028148 PMID: 6512557 [PubMed - indexed for MEDLINE] 5122. J Antimicrob Chemother. 1984 Dec;14(6):661-5. Oral acyclovir in herpes zoster. McKendrick MW, Care C, Burke C, Hickmott E, McKendrick GD. Forty-one patients with herpes zoster were treated with acyclovir or placebo at a dosage of 400 mg five times a day by mouth for five days in a double-blind randomized domiciliary study. Acyclovir was shown to reduce the days of new lesion formation within the effected dermatome after day 0 (P = 0.049). No other statistical difference was demonstrated between the two groups although the trends for new lesion formation outside the dermatome, full crusting, involution and diminution of acute pain all favoured acyclovir. PMID: 6394572 [PubMed - indexed for MEDLINE] 5123. Arq Neuropsiquiatr. 1984 Dec;42(4):402-7. [Ocular herpes zoster and delayed cerebrovascular accident: report of a case] [Article in Portuguese] Guerreiro CA, Guerreiro MM. A sixty-nine year old man suffered a stroke fourteen weeks after the onset of right herpes zoster ophthalmicus (HZO). Hemispheric infarction was documented by a computed tomography which showed a small hypodense zone in the right internal capsula; after contrast there was enhancement of this hypodense area. Cerebral angiography and cerebral-spinal fluid were not done. Despite of a diagnosis of probability the authors report the case and review the literature. A long latency between the HZO and onset of neurological deficit is stressed. New antiviral agents may prevent the ictus. PMID: 6336029 [PubMed - indexed for MEDLINE] 5124. Br J Ophthalmol. 1984 Dec;68(12):904-5. Acyclovir and steroids in herpes zoster keratouveitis. Marsh RJ, Cooper M. PMCID: PMC1040507 PMID: 6334535 [PubMed - indexed for MEDLINE] 5125. Am J Dermatopathol. 1984 Dec;6(6):561-5. Leukocytoclastic vasculitis associated with cutaneous infection by herpesvirus. Cohen C, Trapuckd S. Two patients with leukocytoclastic vasculitis of dermal vessels and evidence of infection by herpesvirus in the overlying epidermis showed, by conventional microscopy, viral inclusions in endothelial cells and in dermal fibroblasts adjacent to them and, by electron microscopy, viral inclusions in endothelial cells and pericytes of involved vessels. It is speculative whether viral involvement of the latter structures was the result of direct spread of the virus along dermal nerves, from the overlying intraepidermal viral vesicles, or from hematogenous dissemination of the virus. PMID: 6098188 [PubMed - indexed for MEDLINE] 5126. Isr J Med Sci. 1984 Dec;20(12):1189-92. Herpes zoster encephalitis: isolation of virus from cerebrospinal fluid. Ophir O, Siegman-Igra Y, Vardinon N, Liron M. Two elderly female patients developed symptoms and signs of encephalitis, coincident with a cutaneous zoster eruption ("shingles"). One recovered slowly with mild residual motor dysfunction, and the other died. Varicella-zoster virus was isolated from the cerebrospinal fluid of the two patients. Review of the literature revealed only eight previously described patients in whom herpes zoster virus was isolated from the cerebrospinal fluid. PMID: 6097567 [PubMed - indexed for MEDLINE] 5127. J Gen Virol. 1984 Dec;65 ( Pt 12):2141-7. Investigation of varicella-zoster virus-infected cell proteins that elicit antibody production during primary varicella using the immune transfer method. Palumbo PE, Arvin AM, Koropchak CM, Wittek AE. The varicella-zoster virus-infected cell proteins (VZV-ICPs) against which IgG, IgM and IgA antibodies were made in the course of primary varicella-zoster virus (VZV) infection were analysed by the immune transfer method. IgG antibodies were made against one or more of 18 VZV-ICPs by patients with varicella. IgM antibodies were produced which reacted with 21 VZV-ICPs. The spectrum of IgG antibody production during the first week after the onset of infection was limited to an average of three VZV-ICPs while IgM antibodies which reacted with an average of seven VZV-ICPs were detectable in the acute phase of varicella. Equivalent VZV IgG or IgM antibody titres by radioimmunoassay did not correlate with a similar pattern of antibody specificity for VZV-ICPs by immune transfer. A detectable immune response to all VZV-ICPs was not required for the recovery of individual patients from primary VZV infection. PMID: 6096492 [PubMed - indexed for MEDLINE] 5128. Ann Intern Med. 1984 Dec;101(6):852-8. Whither immunization against viral infections? Hilleman MR. Economic and social considerations with respect to the infectious diseases demand increased application of preventive measures. Vaccines provide high benefit at low cost and low risk. Past vaccines have emphasized use of live attenuated, or killed whole, or fractionated organisms. Future vaccines will involve recombinant and synthetic antigens, with emphasis on control of many different infections with single polyvalent vaccines directed against individual epitopes rather than complex antigens. Heightened interest in preventive medicine is evident among physicians, aided by the activities of the World Health Organization and governments, and individual academic and public health initiatives. An overview of the past, present, and future with respect to technological possibilities and other practical considerations for vaccines is presented. PMID: 6093664 [PubMed - indexed for MEDLINE] 5129. N Engl J Med. 1984 Nov 22;311(21):1362-4. Endonuclease analysis of viral DNA from varicella and subsequent zoster infections in the same patient. Straus SE, Reinhold W, Smith HA, Ruyechan WT, Henderson DK, Blaese RM, Hay J. PMID: 6092956 [PubMed - indexed for MEDLINE] 5130. Pol Tyg Lek. 1984 Nov 5;39(45):1485-7. [Use of acyclovir in varicella-zoster virus infection with severe clinical course in a patient with glomerulonephritis treated with immunosuppressive drugs] [Article in Polish] Panasiuk E, Przybylska W, Kałczak M, Wańkowicz Z. PMID: 6514628 [PubMed - indexed for MEDLINE] 5131. Pediatr Infect Dis. 1984 Nov-Dec;3(6):505-9. Varicella: clinical manifestations, epidemiology and health impact in children. Preblud SR, Orenstein WA, Bart KJ. PMID: 6514591 [PubMed - indexed for MEDLINE] 5132. J R Coll Gen Pract. 1984 Nov;34(268):627-8. Ultrasound therapy for herpes zoster pain. Walker E. PMCID: PMC1960050 PMID: 6502574 [PubMed - indexed for MEDLINE] 5133. G Ital Dermatol Venereol. 1984 Nov-Dec;119(6):XXIII-VII. [Rifamycin SV in the treatment of herpes zoster. Results of a multicenter clinical investigation] [Article in Italian] Bruni L, Califano A, De Angelis G, Montagnani A, Pisani M, Pezzarossa G, Pozzo G, Reali D, Rebora A, Zanca A. PMID: 6397429 [PubMed - indexed for MEDLINE] 5134. Clin Exp Dermatol. 1984 Nov;9(6):557-63. ACTH versus prednisone and placebo in herpes zoster treatment. Clemmensen OJ, Andersen KE. PMID: 6388918 [PubMed - indexed for MEDLINE] 5135. J Infect Dis. 1984 Nov;150(5):707-13. Characteristics of autoantibodies to human interferon in a patient with varicella-zoster disease. Pozzetto B, Mogensen KE, Tovey MG, Gresser I. A patient with varicella-zoster disease was found to have antibodies to human interferon. These antibodies included all IgG subclasses, showed a high combined affinity (average dissociation constant, 10(-11)M), and were present in serum at a concentration of 10(-9)M. The antibodies neutralized the activity of a series of human alpha-interferons prepared from recombinant DNA as well as that of naturally occurring mixtures of alpha-type interferon prepared by viral stimulation of human cells. Examination of the patient's lymphoid cells revealed normal production of interferon and normal expression of interferon receptors. Interferon from the patient's cells was neutralized by her serum. The neutralizing capacity of this serum was analyzed with regard to levels of interferon previously detected in patients with varicella-zoster infections. PMID: 6238105 [PubMed - indexed for MEDLINE] 5136. J Am Geriatr Soc. 1984 Nov;32(11):789-93. Zoster in the elderly: clinical, immunologic and therapeutic considerations. Harnisch JP. Herpes zoster is common in the elderly. Persons over the age of 50 years have an attack rate double that of patients less than 50 years old. In the very aged, this rate nearly doubles again. The loss of cell-mediated immunity for the VZ virus appears to be the primary factor in the disruption of the dynamic containment process responsible for VZ virus latency within the sensory ganglion. Humoral immunity may play a role in the maintenance of latency, but the degree is unproven, except in the case of dissemination where loss of detectable antibodies seems to correlate with extradermatomal dissemination. Severe forms of the disease and its complications, e.g., postherpetic neuralgia, are likely among the elderly. Direct immunofluorescent staining or cytologic examination is useful for early diagnosis, and serologic changes can document the confusing clinical entity of zoster sine herpete. PMID: 6094642 [PubMed - indexed for MEDLINE] 5137. J Am Acad Dermatol. 1984 Nov;11(5 Pt 2):1000-6. Pruritus, cutaneous pain, and eccrine gland and sweating disorders. Tuckett RP, Denman ST, Chapman CR, Gilchrest BA, Kraning KK, Sato K. PMID: 6094620 [PubMed - indexed for MEDLINE] 5138. Can Med Assoc J. 1984 Nov 1;131(9):1045-6. Acyclovir for intravenous use. Committee on Infectious Diseases and Immunization, Canadian Paediatric Society. [No authors listed] PMCID: PMC1483800 PMID: 6093977 [PubMed - indexed for MEDLINE] 5139. Lancet. 1984 Oct 20;2(8408):925. Oral acyclovir for herpes zoster. McKendrick MW, McGill JI, Bell AM, Hickmott E, Burke C. PMID: 6148641 [PubMed - indexed for MEDLINE] 5140. Fortschr Med. 1984 Oct 4;102(37):932-4. [Therapeutic experiences with the immunostimulator inosine pranobex] [Article in German] Darlath W, Wybran J. The reason for giving substances with immunostimulatory properties is to restore or normalize immune functions. Since various human pathogenic viruses can induce immunodepression, the administration of immunostimulants offers a possibility for therapeutic intervention in the immune system. This could be demonstrated. Various virus infections can effectively be influenced by the synthetic immunostimulating agent Inosine Pranobex. PMID: 6209193 [PubMed - indexed for MEDLINE] 5141. Am J Otol. 1984 Oct;5(6):499-502. Current medical treatment for facial palsy. Adour KK, Hetzler DG. Medical treatment for facial palsy includes an accurate diagnosis and reliable estimate of prognosis as well as appropriate medication. Cranial polyneuritis (Bell's palsy and Ramsay Hunt syndrome), the most common cause of facial palsy, is an inflammatory, autoimmune, demyelinating disease best treated by parenteral steroids without surgical intervention. The antiviral agent acyclovir is now being tested as an adjunct to or replacement for steroid therapy. Trauma, the second most common cause of facial palsy, is often treated with steroids, but no controlled study has ever been performed. However, animal experiments clearly demonstrate that steroid treatment of a compressed facial nerve accelerates repair of the mechanical injury and decreases time of recovery. Acute otitis media with facial palsy is best treated with myringotomy, appropriate antibiotics, and steroid therapy. The use of steroids with antibiotics improves the resolution of middle ear exudate fourfold, compared with the use of antibiotics alone. Other treatment modes in selected cases are discussed. Physiotherapy in the form of electrical stimulation of the facial muscles is not advised. PMID: 6517137 [PubMed - indexed for MEDLINE] 5142. Vestn Dermatol Venerol. 1984 Oct;(10):59-61. [Generalized form of herpes zoster] [Article in Russian] Korsunskaia IM, Kotov AA, Anton'ev AA. PMID: 6516576 [PubMed - indexed for MEDLINE] 5143. Aust Fam Physician. 1984 Oct;13(10):770-1. Developing a hypothesis. A question about herpes zoster. Dickinson JA. PMID: 6508646 [PubMed - indexed for MEDLINE] 5144. Lijec Vjesn. 1984 Oct;106(10):414-7. [Clinical and epidemiologic characteristics of herpes zoster in patients treated at the Clinic during a 5-year period] [Article in Croatian] Puntarić V. PMID: 6503593 [PubMed - indexed for MEDLINE] 5145. J Clin Microbiol. 1984 Oct;20(4):696-700. Use of bone marrow fibroblasts to prepare targets for an HLA restricted-cytotoxicity assay system. Bowden RA, McGavren L, Hayward AR, Levin MJ. Methods are described for obtaining and growing fibroblasts from bone marrow for use as virus-infected targets. Fibroblasts obtained at the time of routine marrow examination were maintained through 12 to 18 passages as confluent monolayers. Bone marrow fibroblasts could be infected with varicella-zoster virus, and these infected cells were suitable targets for a 51Cr-release cytotoxicity assay. Since these virus-infected cells retain their HLA-A and -B antigens, they are readily available to study the immune cells which mediate virus-specific cytotoxicity. PMCID: PMC271414 PMID: 6490855 [PubMed - indexed for MEDLINE] 5146. Kansenshogaku Zasshi. 1984 Oct;58(10):1033-7. [Clinical study on dermatomyositis-polymyositis complicated with herpes zoster] [Article in Japanese] Nagaoka S, Ishigatsubo Y, Chiba J, Kato K, Narita M, Sakamoto H, Tani K, Ito A, Okubo T. PMID: 6442317 [PubMed - indexed for MEDLINE] 5147. J Tenn Med Assoc. 1984 Oct;77(10):575-8. Management of post-herpetic neuralgia. Parris WC. PMID: 6389985 [PubMed - indexed for MEDLINE] 5148. Antiviral Res. 1984 Oct;4(5):281-91. Efficacy of bromovinyldeoxyuridine in the treatment of herpes simplex virus and varicella-zoster virus eye infections. Maudgal PC, De Clercq E, Missotten L. As has been established in rabbits, (E)-5-(2-bromovinyl)-2'-deoxyuridine (BVDU) is superior to 5-iodo-2'-deoxyuridine (IDU) in the topical treatment of epithelial HSV-1 (herpes simplex virus type 1) keratitis, and superior to 5-trifluoromethyl-2'-deoxyuridine (TFT) in the topical treatment of deep stromal HSV-1 keratitis and HSV-1 uveitis. BVDU 0.1% eye drops have also proven efficacious in the treatment of patients with dendritic corneal ulcers, geographic corneal ulcers and stromal keratitis, and combined treatment of BVDU 0.1% eye drops with oral BVDU at 375 mg/day for 5 days led to a prompt healing of keratouveitis and skin lesions in patients with ophthalmic herpes zoster. PMID: 6335020 [PubMed - indexed for MEDLINE] 5149. Z Hautkr. 1984 Oct 1;59(19):1303-8, 1311. [Motor function loss in zoster neuritis versus encephalitis--clinical case and review of literature] [Article in German] Kempkes K, Hillert-Kempkes US, Pfeifer B. Motor lesions following herpes zoster are quite common. Hemiparesis, paraparesis, pareses of the facial and other cranial nerves as well as segmental pareses can be observed. We report on a patient suffering from zoster ophthalmicus complicated by paresis of the third cranial nerve. As a cause, a partial brain stem-encephalitis was diagnosed. The patient recovered after antiviral treatment (Aciclovir, Inosiplex). PMID: 6209868 [PubMed - indexed for MEDLINE] 5150. Clin Haematol. 1984 Oct;13(3):645-60. Herpes virus infections: clinical manifestations and therapeutic strategies in immunocompromised patients. Saral R, Burns WH, Prentice HG. Herpesvirus infections are a major cause of morbidity and mortality in immunosuppressed patients. Bone marrow and organ transplant recipients are model patient populations for studying the natural history of herpesvirus infections because the infections occur predictably after transplantation. Herpes simplex virus infections occur within the first month after transplantation and may cause severe mucocutaneous disease. Cytomegalovirus infections occur one to three months after transplantation and are the major viral cause of morbidity and mortality. Varicella-zoster virus infections occur four to five months after transplantation and rarely cause life-threatening infection. Further studies of Epstein-Barr virus are necessary to determine its significance as a pathogen. The development of new antiviral agents has introduced effective therapeutic approaches for herpes simplex virus infections and varicella-zoster virus infections. Efforts to treat or prevent cytomegalovirus infections in transplant recipients have had limited success. However, new therapeutic strategies may lead to therapies which may reduce the severity of these infections and lead to increased survival in bone marrow transplant and organ transplant recipients. PMID: 6094062 [PubMed - indexed for MEDLINE] 5151. J Clin Pathol. 1984 Oct;37(10):1140-3. Serum beta 2-microglobulin and C reactive protein concentrations in viral infections. Cooper EH, Forbes MA, Hambling MH. Serum beta 2-microglobulin concentrations were assayed in a number of virus diseases. Infectious mononucleosis, cytomegalovirus, and influenza A were associated with pronounced increases in serum beta 2-microglobulin concentration. Smaller increases, with values generally less than 4 mg/l, were noted in other viral infections. Apart from in acute influenza A, the C reactive protein and beta 2-microglobulin responses were not associated. PMCID: PMC498955 PMID: 6092437 [PubMed - indexed for MEDLINE] 5152. Clin Exp Immunol. 1984 Oct;58(1):217-22. Antibody-dependent cell-mediated cytotoxicity to Varicella zoster. Babbage J, Sigfusson A, Souhami RL. Antibody-dependent cell-mediated cytotoxicity (ADCC) against Varicella zoster (VZ) infected fibroblasts is described. ADCC requires antibody to VZ and is greater with heavily infected targets. It is not dependent on the immune status of the effector cells. The effector cells responsible for ADCC are present in sheep red cell (E) positive and E-fractions of peripheral blood, and in the G10 non-adherent population. The ADCC activity is present in microexudate non-adherent cells and in the adherent population to a lesser extent. The technique provides a means to study host defence against VZ infection in immune compromised individuals. PMCID: PMC1576969 PMID: 6090042 [PubMed - indexed for MEDLINE] 5153. Lancet. 1984 Sep 22;2(8404):677-82. Antiviral therapy. Varicella-zoster virus infections, herpes labialis and mucocutaneous herpes, and cytomegalovirus infections. Nicholson KG. PMID: 6147701 [PubMed - indexed for MEDLINE] 5154. Ugeskr Laeger. 1984 Sep 19;146(38):2888-92. [Acyclovir (Zovirax). A new antiviral agent against herpes infections] [Article in Danish] Kroon S, Petersen CS, Krebs HJ. PMID: 6515916 [PubMed - indexed for MEDLINE] 5155. Lancet. 1984 Sep 8;2(8402):575. Oral acyclovir for herpes zoster. Finn R, Smith MA. PMID: 6147619 [PubMed - indexed for MEDLINE] 5156. Lakartidningen. 1984 Sep 5;81(36):3132. [Cimetidine effective in herpes zoster] [Article in Swedish] Björklund O, Strandberg L. PMID: 6482593 [PubMed - indexed for MEDLINE] 5157. J Am Acad Dermatol. 1984 Sep;11(3):480-2. Herpes zoster and occult malignancy. Fueyo MA, Lookingbill DP. Herpes zoster and malignancy have both been associated with conditions of immune suppression. It has been well documented that herpes zoster occurs more frequently in patients with a previously diagnosed malignancy, especially lymphoma. To determine whether there is an increased frequency of malignancy subsequent to the diagnosis of herpes zoster, we studied fifty outpatients with herpes zoster and compared them with fifty control patients with psoriasis. In a follow-up period ranging from 24 to 68 months, one individual in the herpes zoster group developed a subsequent malignancy, in comparison to none in the control population and to 1.5 cancer cases expected in the general population. These results support the view that herpes zoster is not a marker for an occult malignancy. PMID: 6480952 [PubMed - indexed for MEDLINE] 5158. Med J Aust. 1984 Sep 1;141(5):320. Treatment of herpes zoster. [No authors listed] PMID: 6472173 [PubMed - indexed for MEDLINE] 5159. Hosp Pract (Off Ed). 1984 Sep;19(9):67-9, 72, 74-6 passim. Diagnosis of eyelid and periorbital abnormalities. Meltzer MA. PMID: 6432825 [PubMed - indexed for MEDLINE] 5160. Infection. 1984 Sep-Oct;12(5):338-41. Limited value of acyclovir in the treatment of uncomplicated herpes zoster: a placebo-controlled study. van den Broek PJ, van der Meer JW, Mulder JD, Versteeg J, Mattie H. The effect of intravenous acyclovir (at a dosage of 30 mg/kg per day for five days) on uncomplicated herpes zoster was investigated in 51 patients in a double-blind study. Although existing herpes zoster lesions tended to heal more rapidly and new lesions ceased to appear somewhat earlier in the acyclovir group, these differences were not statistically significant. During treatment, patients on acyclovir had significantly lower pain scores than placebo-treated patients. At follow-up, however, there was no difference between the two groups. Complications of herpes zoster occurred only in the placebo groups (generalization in two and keratitis in two cases). With the possible exception of trigeminal zoster or severe pain, acyclovir seems to offer little benefit for immunocompetent patients with herpes zoster. PMID: 6392105 [PubMed - indexed for MEDLINE] 5161. Med Radiol (Mosk). 1984 Sep;29(9):66-74. [Complications of radiotherapy and chemoradiotherapy of lymphogranulomatosis] [Article in Russian] Kholin AV. PMID: 6384718 [PubMed - indexed for MEDLINE] 5162. J Dermatol Surg Oncol. 1984 Sep;10(9):718-20. Cutaneous metastatic squamous-cell carcinoma in zosteriform distribution. Buecker JW, Ratz JL. A renal transplant patient on immunosuppressives with a history of multiple premalignant and malignant skin tumors developed cutaneous metastatic squamous-cell carcinoma in a typical zosteriform distribution on the right arm and chest. This distribution of a squamous-cell carcinoma is unique to the English literature and serves to emphasize the necessity for frequent follow-up and aggressive treatment in this high-risk population. PMID: 6384303 [PubMed - indexed for MEDLINE] 5163. South Med J. 1984 Sep;77(9):1149-56. Herpes zoster: epidemiology, clinical features, and management. Reuler JB, Chang MK. Herpes zoster is a commonly encountered infectious disease primarily affecting the elderly and immunosuppressed. The natural history and complications of the disease and the principles of management are often not appreciated by clinicians in a variety of disciplines who may see the patient during the acute phase. Recent literature has furthered our understanding of the virology of herpes zoster and the roles of corticosteroid and antiviral therapy. We review the clinical features, diagnostic principles, and management controversies of herpes zoster. PMID: 6207596 [PubMed - indexed for MEDLINE] 5164. Biken J. 1984 Sep;27(2-3):99-102. Immunization of acute leukemic children with a live varicella vaccine (Oka strain). Kamiya H, Kato T, Isaji M, Torigoe S, Oitani K, Ito M, Ihara T, Sakurai M, Takahashi M. A total of 52 acute leukemic children have been safely and effectively vaccinated with live varicella (Oka strain) vaccine given under close clinical and immunological observation. The incidence of zoster in the vaccinated children group was slightly less than that in the group that had experienced natural varicella. PMID: 6100066 [PubMed - indexed for MEDLINE] 5165. Biken J. 1984 Sep;27(2-3):43-9. A live varicella vaccine in a pediatric community. Yabuuchi H, Baba K, Tsuda N, Okada S, Nose O, Seino Y, Tomita K, Ha K, Mimaki T, Ogawa M, et al. A total of 663 children with various underlying diseases were immunized with a live varicella vaccine at the vaccine clinic of Osaka University Hospital during a period of seven years from October, 1975. Clinical reactions after vaccination occurred in 32.4% (24/74) of the children with malignancies and in 0.3% (2/591) of those in other groups. Vaccine-induced immunity was detected for more than 6 years, by FAMA (fluorescent antibody to membrane antigen) and IAHA (immune adherence hemagglutination) tests, and a skin-test for varicella-zoster virus (VZV). During an observation period of more than 7 years, clinical varicella developed in 12 children, 8 of whom were in the group with malignancies. Zoster occurred in only 4 (9.1%) of 44 vaccinees with acute leukemia, this incidence being significantly less (p less than 0.05) than that (21.6%, 8/37) in un-vaccinated leukemic children. PMID: 6100057 [PubMed - indexed for MEDLINE] 5166. Biken J. 1984 Sep;27(2-3):103-9. Evaluation of varicella vaccine in childhood leukemia. Observation over 6 years. Oka T, Iseki K, Oka R, Sakuma S, Yoshioka H, Takahashi M. Since 1977, we have used a live attenuated varicella vaccine to immunize 10 children with acute leukemia. 8 patients had no adverse clinical reaction but 2 patients developed mild fever and papulovesicular rash after vaccination. All 9 tested children became seropositive after the vaccination. Also in all 3 children who were observed for more than 4 years, persistence of neutralizing antibody was detected. Most of the recipients were prevented from developing symptoms of varicella in spite of contact exposure. Two patients developed varicella when they were in severe immunosuppressive states but their symptoms were mild. None of the children developed herpes-zoster during the 6 year follow-up period. The results suggest that the varicella vaccine is effective in children with acute leukemia, and that long-term effectiveness can be expected. PMID: 6100045 [PubMed - indexed for MEDLINE] 5167. Cutis. 1984 Sep;34(3):278-81. Treatment of varicella-zoster pneumonia with transfer factor. Winkelmann RK, DeRemee RA, Ritts RE Jr. A 29-year-old woman with a long history of immunoreactive disease--thrombocytopenic purpura, bullous pemphigoid, nephropathy, and hemolytic anemia--contracted generalized herpes zoster and varicella pneumonia. Respiratory failure requiring assisted respiration accompanied progressive chest findings. She recovered rapidly simultaneous with the administration of transfer factor from a healing herpes zoster patient. We believe that this therapy should be attempted in similar desperate circumstances. PMID: 6092003 [PubMed - indexed for MEDLINE] 5168. Mol Pharmacol. 1984 Sep;26(2):376-80. Comparative inhibition of DNA polymerases from varicella zoster virus (TK+ and TK-) strains by (E)-5-(2-bromovinyl)-2'-deoxyuridine 5'-triphosphate. Yokota T, Konno K, Shigeta S, De Clercq E. The inhibitory effect of (E)-5-(2-bromovinyl)-2'-deoxyuridine (BVDU) 5'-triphosphate on varicella zoster virus (VZV) DNA polymerase was studied using the parent strain (TK+-VZV) and the mutant strain (TK--VZV). The mutant strain was deficient in thymidine kinase (TK)-inducing activity and resistant to BVDU. In the absence of BVDU, TK--VZV and TK+-VZV induced an equivalent level of viral DNA polymerase activity in human embryo fibroblasts. In the presence of 5 microM BVDU, TK--VZV still induced viral DNA polymerase activity, whereas TK+-VZV failed to do so. BVDU 5'-triphosphate (BVDUTP) was considerably more inhibitory to the TK+- and TK--VZV DNA polymerases than to the cellular DNA polymerases. There were no significant differences in the affinity for dTTP as substrate and the sensitivity to BVDUTP as inhibitor between the TK+- and TK--VZV DNA polymerases. The Km value for dTTP and the Ki value for BVDUTP of the VZV DNA polymerases were 1.43 microM and 0.55 microM, respectively. The inhibitory effect of BVDUTP to VZV DNA polymerase was competitive with respect to the natural substrate. PMID: 6090888 [PubMed - indexed for MEDLINE] 5169. J Gen Virol. 1984 Sep;65 ( Pt 9):1477-86. Pathogenesis of zosteriform spread of herpes simplex virus in the mouse. Blyth WA, Harbour DA, Hill TJ. Zosteriform spread of herpes simplex virus (HSV) infection occurs after primary inoculation of the skin of both outbred and inbred mice. With HSV type 1 strain SC16 few outbred animals died if they were inoculated when 8 weeks old whereas up to 50% of animals died if inoculated when 4 weeks old. However, at either age, zosteriform spread of infection occurred in almost all animals as it did when 4-week-old outbred animals were inoculated with the avirulent strain KOS. Thus, control of zosteriform spread must act by different mechanisms from those controlling the encephalitis which leads to death. During replication in the epidermis virus enters axons and could first be found in sensory ganglia 2 days after inoculation of the skin. Thereafter, it was found in the nerve roots and in skin within the same dermatome but remote from the site of inoculation. When sensory nerves to this latter area were cut during the 4 days after primary inoculation lesions developing as a result of zosteriform spread were either completely inhibited or, with later section, decreased in incidence. Mortality was not affected by such nerve section. Latent infection must be established in neurons serving areas of skin remote from the inoculation site since with HSV-1 strain SC16, recrudescent lesions on the pinna could be induced by stripping the skin of the ear when the original inoculation had been in the skin of the neck. Such recrudescent disease was not demonstrated in animals infected with HSV-1 strain KOS even though this virus efficiently established latent infection in sensory ganglia. PMID: 6088680 [PubMed - indexed for MEDLINE] 5170. Chest. 1984 Sep;86(3 Suppl):6S-9S. Cell-mediated immunity and pregnancy. Lederman MM. PMID: 6088180 [PubMed - indexed for MEDLINE] 5171. JAMA. 1984 Aug 24-31;252(8):1012. Hemiparesis and Bell's palsy following brachial plexus herpes zoster. Economou PG. PMID: 6748204 [PubMed - indexed for MEDLINE] 5172. Can Med Assoc J. 1984 Aug 15;131(4):279. Treatment of herpes zoster with cimetidine. Shandera R. PMCID: PMC1483442 PMID: 6744172 [PubMed - indexed for MEDLINE] 5173. Ugeskr Laeger. 1984 Aug 13;146(33):2487-8. [Herpes zoster in infants] [Article in Danish] Siersted HC, Pfeiffer P, Trommer B. PMID: 6515860 [PubMed - indexed for MEDLINE] 5174. Med J Aust. 1984 Aug 4;141(3):200. Herpes zoster in the S3 dermatome. Fitzhenry J. PMID: 6749045 [PubMed - indexed for MEDLINE] 5175. N Engl J Med. 1984 Aug 2;311(5):329-30. Varicella and herpes zoster. [No authors listed] PMID: 6738644 [PubMed - indexed for MEDLINE] 5176. Klin Med (Mosk). 1984 Aug;62(8):130-2. [Clinical aspects of herpes infection] [Article in Russian] Shul'tsev GP. PMID: 6492703 [PubMed - indexed for MEDLINE] 5177. Cutis. 1984 Aug;34(2):177-9. Granuloma annulare in herpes zoster scars. Packer RH, Fields JP, King LE Jr. We have described a patient in whom GA developed at the site of remotely healed herpes zoster scars. This case represents another example of GA occurring in traumatized or injured skin and provides further evidence for the existence of the isomorphic response in the pathogenesis of this common disorder. PMID: 6478880 [PubMed - indexed for MEDLINE] 5178. Mil Med. 1984 Aug;149(8):479-81. Esophageal stricture following esophagitis in a patient with herpes zoster: case report. Kroneke K, Cuadrado R. PMID: 6433236 [PubMed - indexed for MEDLINE] 5179. J Antimicrob Chemother. 1984 Aug;14(2):185-9. Oral and intravenous acyclovir are equally effective in herpes zoster. Peterslund NA, Esmann V, Ipsen J, Christensen KD, Petersen CM. In a double-blind randomised trial 40 patients above 60 years old with acute herpes zoster received either 5 mg/kg acyclovir three times daily intravenously or 400 mg acyclovir five times daily orally for five days. Identical results were obtained with respect to duration of pain and rate of healing. Twenty per cent of orally administered acyclovir was absorbed and gave satisfactory concentrations of acyclovir in the vesicular fluid. PMID: 6389470 [PubMed - indexed for MEDLINE] 5180. Onkologie. 1984 Aug;7(4):210-2. [Improved clinical course of herpes zoster in immunosuppressed patients treated with fibroblast interferon] [Article in German] Heidemann E, Dietz K, Obert HJ, Wilms K. In a randomized study with patients suffering from herpes zoster spread of eruptions was inhibited and segmental pain was reduced rapidly by continuous infusion of daily 0.5 X 10(6) IE fibroblast interferon/kg body weight for 3-5 days. Postherpetic neuralgia was observed more rarely and interferon healing of eruptions was accelerated by interferon compared to the controls. PMID: 6384863 [PubMed - indexed for MEDLINE] 5181. J Antimicrob Chemother. 1984 Aug;14 Suppl A:57-74. Treatment of human herpesvirus infections with special reference to encephalitis. Whitley RJ. PMID: 6092319 [PubMed - indexed for MEDLINE] 5182. J Am Acad Dermatol. 1984 Aug;11(2 Pt 1):165-91. The varicella-zoster virus: systemic and ocular features. Liesegang TJ. Although the varicella-zoster virus infections are usually benign skin diseases, they can have serious systemic manifestations and complications. This article reviews the current concepts concerning the anatomy and physiology of the virus and the epidemiology, pathogenesis, pathology, immunology, and laboratory diagnosis of these infections. The information gained in these areas has improved our knowledge of the disease, permitted the detection of susceptible patients, allowed the earlier use of new antiviral treatment, and provided a background for the use of active and passive immunization. The clinical features and consequences of both varicella and herpes zoster are described. The prevention and treatment are underscored, especially with regard to the newer systemic antiviral therapy. Herpes zoster ophthalmicus is specifically detailed because of its frequency and because of serious ocular and systemic implications for both the dermatologist and the ophthalmologist. The nerve innervation of the eye and ocular adnexa as it pertains to herpes zoster ophthalmicus is outlined, and a description is given of the multiple ocular complications for the dermatologist. Data on the role of antiviral agents and of topical and systemic corticosteroids in herpes zoster ophthalmicus are presented. Postherpetic neuralgia, probably the most difficult management problem of herpes zoster ophthalmicus, is addressed from a descriptive, preventive, and treatment view. PMID: 6090512 [PubMed - indexed for MEDLINE] 5183. Immun Infekt. 1984 Aug;12(4):187-91. [Antiviral therapy of immunocompromised patients] [Article in German] Eggers HJ. For immunocompromised patients virus infections represent a definite risk, particularly infections with measles virus and viruses of the herpes group (primary infections or reactivations). Vidarabine, acyclovir and bromovinyldeoxyuridine are therapeutically active against varicella, zoster, and herpes simplex, provided they are administered early in the course of disease. For zoster at least, the efficacy of interferon has been documented in controlled studies. No convincing therapy is so far available for the severe cytomegalovirus infections. Interferons obtained with DNA recombinant techniques are of significant promise in the near future. PMID: 6090308 [PubMed - indexed for MEDLINE] 5184. Am J Ophthalmol. 1984 Jul 15;98(1):7-10. Skin test with varicella-zoster virus antigen for ophthalmic herpes zoster. Tanaka Y, Harino S, Danjo S, Hara J, Yamanishi K, Takahashi M. We assessed delayed dermal hypersensitivity to varicella-zoster virus by a varicella skin test in 12 patients (nine women and three men ranging in age from 27 to 85 years) with ophthalmic herpes zoster during the acute stage and in a group of 27 healthy controls (15 women and 12 men ranging in age from 18 to 58 years). Of the 27 healthy individuals, 25 had positive skin test reactions whereas only one of the 12 patients with ophthalmic herpes zoster had a positive skin test reaction within two weeks after the onset of the eruption, suggesting that cellular immunity to varicella-zoster virus antigens is impaired in the development of ophthalmic herpes zoster. Our study also showed that the varicella skin test is a convenient way to diagnose ophthalmic herpes zoster during the acute stage of the disease. PMID: 6331167 [PubMed - indexed for MEDLINE] 5185. Postgrad Med. 1984 Jul;76(1):95-7, 100-2, 105. Facial nerve paralysis. 2. 'All that palsies is not Bell's'. Olsen KD. Management of the patient with facial nerve paralysis challenges the diagnostic skills and clinical judgment of the attending physician. The clinician should not assume that all facial paralysis is Bell's palsy; the disease possibilities are broad and fascinating. Therapeutic options are still being evaluated, debated, and assessed. Appropriate management of the patient with facial nerve paralysis requires a complete history and precise examination. PMID: 6739387 [PubMed - indexed for MEDLINE] 5186. Arch Ophthalmol. 1984 Jul;102(7):1027-9. Herpes zoster ophthalmicus and acquired immune deficiency syndrome. Cole EL, Meisler DM, Calabrese LH, Holland GN, Mondino BJ, Conant MA. Acquired immune deficiency syndrome (AIDS) is a recently recognized disease characterized by abnormalities in cell-mediated immunity that predispose affected persons to severe opportunistic infections and unusual malignant neoplasms. We describe four cases of herpes zoster ophthalmicus in four previously healthy homosexual men. Two had signs and symptoms consistent with AIDS, and two had signs and symptoms of a lymphadenopathic syndrome associated with AIDS. We suggest that underlying AIDS be considered in young, healthy persons with herpes zoster ophthalmicus and no known cause of immunosuppression. PMID: 6611148 [PubMed - indexed for MEDLINE] 5187. Geriatrics. 1984 Jul;39(7):79-80, 85-7, 91 passim. Herpes zoster: protecting older patients' vision. Lass JH. PMID: 6610604 [PubMed - indexed for MEDLINE] 5188. Pediatr Med Chir. 1984 Jul-Aug;6(4):573-4. [Herpes zoster in a 12-month-old girl subsequent to intrauterine exposure to the varicella-zoster virus] [Article in Italian] Della Porta G, Pullini A, Pascucci T. A few cases have been recorded in which zoster was presumably due to reactivation of V-Z virus acquired during the intrauterine life. In our patient, a 12-month-old infant, the mother had chickenpox during her seventh month of pregnancy. PMID: 6543465 [PubMed - indexed for MEDLINE] 5189. Int J Dermatol. 1984 Jul-Aug;23(6):404-7. Cutaneous angiosarcoma in a site of healed herpes zoster. Hudson CP, Hanno R, Callen JP. A 57-year-old woman presented with an erythematous plaque of the left postauricular area that was diagnosed as metastatic carcinoma on clinical and histologic bases. It was revealed that herpes zoster had been diagnosed in the same dermatomal distribution 10 years previously. The lesion recurred 2 years after irradiation, and angiosarcoma was diagnosed. Recent evidence linking viral infection and vascular tumors is examined as it might apply to the pathogenesis of angiosarcoma. Repeat biopsy, reticulum stain, and electronmicroscopic examination of a lesion of the head and neck region that histologically suggests metastatic carcinoma are recommended if no primary malignancy is discovered. PMID: 6541210 [PubMed - indexed for MEDLINE] 5190. Pediatr Infect Dis. 1984 Jul-Aug;3(4):345-8. The use of acyclovir in children. Bryson YJ. Acyclovir represents a significant advance in the treatment of herpes simplex and varicella zoster virus infections and appears to be safe and well-tolerated. Physicians now have several drugs to choose from in the treatment of these infections. Hopefully there will be other antiviral chemotherapeutic agents that will be effective for therapy of cytomegalovirus and Epstein-Barr virus infections. Coincident with the development of antivirals, continued progress in the area of rapid viral diagnosis is critical for early institution of therapy. Direct diagnosis of HSV or VZV from clinical specimens or lesions using monoclonal antibodies, enzyme-linked immunoassays or DNA probes are promising techniques for the future. Investigation into improved rapid diagnosis for neonatal and maternal HSV infections and HSV encephalitis should further improve outcome with antiviral therapy. PMID: 6540867 [PubMed - indexed for MEDLINE] 5191. Eur J Cancer Clin Oncol. 1984 Jul;20(7):871-2. Therapy of Herpes zoster infections. Hirsch MS. PMID: 6540187 [PubMed - indexed for MEDLINE] 5192. Vestn Dermatol Venerol. 1984 Jul;(7):43-5. [Use of the Soviet antiviral preparation methisazone in herpes zoster] [Article in Russian] Beliaev NV, Anton'ev AA, Korsunskaia IM. PMID: 6475278 [PubMed - indexed for MEDLINE] 5193. Rev Otoneuroophtalmol. 1984 Jul-Dec;56(4-5):487-90. [Electrooculographic study of ocular motility changes in ophthalmic zona] [Article in French] Gorgone G, Tomarchio S, Dal Bello A. PMID: 6335772 [PubMed - indexed for MEDLINE] 5194. Rev Otoneuroophtalmol. 1984 Jul-Dec;56(4-5):315-21. [Ophthalmic zona and motor involvement] [Article in French] Lauvin R, Maugendre D, Darcel F, Sabouraud O. PMID: 6335770 [PubMed - indexed for MEDLINE] 5195. J Virol. 1984 Jul;51(1):110-6. Human polymorphonuclear leukocyte-mediated cytotoxicity against varicella-zoster virus-infected fibroblasts. Ihara T, Starr SE, Ito M, Douglas SD, Arbeter AM. Polymorphonuclear leukocytes (PMN) were studied for their ability to mediate cytotoxicity against varicella-zoster virus (VZV)-infected and uninfected human fibroblasts in 51Cr release assays. PMN were capable of mediating antibody-dependent cellular cytotoxicity (ADCC) against VZV-infected targets. Maximal ADCC was obtained with effector-to-target ratios of 100:1 and 18 h of incubation. Percent 51Cr release for 26 normal adults was 14.1 +/- 0.6 (mean +/- standard error) in the presence of pooled human seropositive sera (final dilution, 1:100) and 0.5 +/- 0.6 in the presence of pooled human seronegative sera. Addition of phorbol myristate acetate (PMA) enhanced PMN-mediated cytotoxicity against VZV-infected and uninfected targets. PMA-stimulated cytotoxicity was optimal with PMA concentrations of 200 ng/ml and effector-to-target ratios of 10:1, and antibody was not required; killing was detected as early as 3 h after incubation and was maximal after 18 h. Highly purified PMN were capable of mediating both ADCC and PMA-stimulated lysis. Catalase completely inhibited PMA-stimulated PMN cytotoxicity, but had no effect on PMN-mediated ADCC. PMN from patients with chronic granulomatous disease were capable of mediating ADCC, but not PMA-stimulated killing, against VZV-infected targets. Thus, PMN could kill VZV-infected targets by two different mechanisms: ADCC, which required antibody but not hydrogen peroxide (H2O2), and PMA-stimulated cytotoxicity, which required H2O2 but not antibody. PMCID: PMC254407 PMID: 6328030 [PubMed - indexed for MEDLINE] 5196. Zhonghua Yan Ke Za Zhi. 1984 Jul;20(4):211-3. [Observation on the effect of cyclocytidine in herpes zoster of the eye] [Article in Chinese] Ni RZ. PMID: 6210182 [PubMed - indexed for MEDLINE] 5197. J Invest Dermatol. 1984 Jul;83(1 Suppl):116s-120s. Advances in antiviral therapy. Chou S. Recent developments have increased the options for treatment of viral infections. Vidarabine, an agent originally released for herpes simplex encephalitis, has more recently been shown to be of benefit in neonatal herpes simplex infection and in varicella-zoster infections in immunocompromised hosts. The introduction of acyclovir represents a major advance in antiviral therapy because of its low host toxicity and marked selectivity for herpes simplex and varicella-zoster viruses. Extensive controlled clinical trials demonstrate efficacy in the treatment of infections caused by these viruses in the immunocompromised host and in genital herpes simplex infections in normal hosts. The use of recombinant DNA technology has increased the purity, variety, and availability of interferons for clinical trial. Earlier experience with natural buffy coat-derived alpha interferon showed efficacy in the treatment of varicella-zoster infections in the immunocompromised host, as well as prophylaxis of herpes virus infections in high-risk populations. These results have to be confirmed using the newer interferon preparations. Under development are a variety of new drugs with broadened viral spectrum and improved pharmacokinetic properties. These include nucleoside analogues and novel interferons with modified amino acid sequences. One or more of these agents, used singly or in combination, may prove useful in the more difficult therapeutic problems, such as cytomegalovirus and hepatitis B infections. PMID: 6203990 [PubMed - indexed for MEDLINE] 5198. Rev Otoneuroophtalmol. 1984 Jul-Dec;56(4-5):379-88. [A case of facial contracture in acute polyradiculopathy with electromyographic myokymia and permanent activity. Regressive development] [Article in French] Bastard J, Blanguernon R, Goas JY, Dorval JC, Masse R. PMID: 6099603 [PubMed - indexed for MEDLINE] 5199. Pediatr Dermatol. 1984 Jul;2(1):64-70. Advances in antiviral therapy: acyclovir. Chadwick EG, Shulman ST. Acyclovir [9-(2-hydroxyethoxymethyl)guanine] is a newly licensed acyclic nucleoside analog that is active in vitro and in vivo against herpes simplex virus (HSV) and varicella zoster virus (VZV). This agent is available in the United States in topical and intravenous forms, and the oral preparation is currently being evaluated in clinical trials. The precise therapeutic role for acyclovir in patients with herpesvirus infections is still evolving. This article reviews the current status of this exciting new antiviral agent. PMID: 6095238 [PubMed - indexed for MEDLINE] 5200. Pediatr Infect Dis. 1984 Jul-Aug;3(4):358-68. Ocular viral infections. Matoba A. The ocular manifestations of viral infection vary greatly. Involvement of the anterior segment is generally mild and self-limited, except in cases of congenital infection which are often associated with significant alteration of ocular structures or in cases of childhood infection with herpes simplex virus or varicella-zoster virus, in which prolonged inflammation may lead to corneal thinning or perforation, glaucoma and cataract formation. Involvement of the posterior structures is potentially sight-threatening. Retinal or optic nerve involvement should be suspected in any patient who complains of acute onset of blurred vision in the absence of anterior segment inflammation or opacities in the ocular media. Fortunately retinal viral infection is rare in immunocompetent hosts. Optic neuropathy may occur as an isolated sign but is more often associated with more generalized involvement of the central nervous system. While specific therapy is not always available, early diagnosis of ocular viral disease should aid in the amelioration of acute symptoms and prevention of long term complications. PMID: 6089128 [PubMed - indexed for MEDLINE] 5201. J Infect Dis. 1984 Jul;150(1):149-54. Detection of varicella-zoster viral antigens in clinical specimens by solid-phase enzyme immunoassay. Ziegler T. Forty-two vesicular specimens from patients with a clinical diagnosis of varicella-zoster virus (VZV) infection were tested in a four-layer solid-phase enzyme immunoassay (EIA) for VZV antigens. Guinea pig and rabbit immunoglobulins to purified VZV nucleocapsids and a commercially obtained conjugate were used as immunoreagents. Thirty-nine specimens were positive by EIA, and the results were verified by a confirmatory test with normal guinea pig immunoglobulins as a first layer. None of 20 specimens reacted in a similar EIA for herpes simplex virus (HSV) antigens. One of 60 specimens from which HSV had veen isolated gave a weak positive reaction in the VZV assay; no reaction was detected after further dilution of the specimen. Of 24 specimens from which VZV isolation was attempted, virus was isolated from eight, but 21 were shown to contain VZV antigen by EIA. Thus this EIA enables a rapid and specific diagnosis of VZV infections. PMID: 6086769 [PubMed - indexed for MEDLINE] 5202. J Clin Microbiol. 1984 Jul;20(1):94-8. Virus-specific immunoglobulin G subclasses in herpes simplex and varicella-zoster virus infections. Sundqvist VA, Linde A, Wahren B. The subclass specificities of antiviral immunoglobulin G (IgG) produced in response to herpes simplex and varicella-zoster virus infections were investigated. IgG1 and IgG3 with anti-herpes simplex virus activity were seen in patients with primary and reactivated disease, as well as in healthy seropositive subjects and in immunoglobulin preparations. IgG4 was occasionally seen alone or together with IgG1 and IgG3 in patients. In varicella, IgG3-specific antiviral antibodies were predominant, whereas in zoster, IgG1 was the dominant subclass. PMCID: PMC271254 PMID: 6086711 [PubMed - indexed for MEDLINE] 5203. Med J Aust. 1984 Jun 23;140(13):804. Herpes zoster in the S3 dermatome. Spence GC. PMID: 6727765 [PubMed - indexed for MEDLINE] 5204. Presse Med. 1984 Jun 16;13(25):1551-4. [Delayed contralateral hemiplegia complicating ophthalmic herpes zoster] [Article in French] Thevenet JP, Clavelou P, Devoize JL, Tournilhac M. Contralateral hemiplegia may develop a few weeks after the onset of an ophthalmic herpes zoster. This complication, which is not part of the herpetic encephalopathy, generally coexists with lesions of arteritis demonstrable by arteriography, affecting in most cases the proximal segments of the middle and anterior cerebral arteries and resulting in infarcts. The pathophysiology of these lesions is uncertain, but the vessels appear to be invaded by contiguity. PMID: 6234538 [PubMed - indexed for MEDLINE] 5205. Med J Aust. 1984 Jun 9;140(12):715-20. Antiviral chemotherapy. White DO. Progress in antiviral chemotherapy has taken place as a logical strategy for the design of antiviral agents has emerged. The second-generation nucleoside analogues, led by acyclovir, have proved their worth against herpesviruses and should now become a standard part of medical practice. Meanwhile, recombinant DNA technology has lowered the cost of interferons to the point at which the several human subtypes of these naturally occurring hormones can be subjected individually to controlled clinical trials against the viral diseases in the treatment of which they show promise. Yet, optimism about the future of antiviral chemotherapy must be tempered by the observation that most of the agents discussed in this review are described more accurately as promising rather than proven, and several of these have not yet been released in Australia at the time of writing. PMID: 6203021 [PubMed - indexed for MEDLINE] 5206. J Am Acad Dermatol. 1984 Jun;10(6):1074. Cimetidine and herpes zoster. Wagner RF Jr. PMID: 6736334 [PubMed - indexed for MEDLINE] 5207. J Neurosurg. 1984 Jun;60(6):1258-62. Dorsal root entry zone lesions for the treatment of post-herpetic neuralgia. Friedman AH, Nashold BS Jr, Ovelmen-Levitt J. Post-herpetic pain was treated in 12 patients using dorsal root entry zone ( DREZ ) lesions. All patients had failed to receive adequate pain relief from conservative therapy consisting of transcutaneous nerve stimulation, carbamazepine, and/or amitriptyline. Dorsal root entry zone lesions were made to include the involved dermatomes plus one-half of the dermatomes above and below the painful areas. Eight patients reported good pain relief with follow-up periods ranging from 6 to 21 months. A ninth patient obtained satisfactory pain relief, but the superior 1 cm of the original painful area was not included in the distribution of the DREZ lesions. Patients whose lesions were performed using a thermally controlled lesion probe suffered no significant postoperative neurological deficit. Dorsal root entry zone lesions appeared to be a satisfactory treatment for post-herpetic neuralgia in patients who have failed to respond to more conservative modes of therapy. PMID: 6726370 [PubMed - indexed for MEDLINE] 5208. Arch Dermatol. 1984 Jun;120(6):747-50. Chronic neuralgia incidence following local anesthetic therapy for herpes zoster. Riopelle JM, Naraghi M, Grush KP. We treated 72 patients, referred to a pain clinic for acute herpes zoster neuralgia, with local anesthetics administered by nerve block and infiltration. Only those patients with severe pain initially proved to be at risk for the development of chronic postherpetic neuralgia (defined as pain in the involved dermatomes lasting at least six months). Although local anesthetic injections effectively relieved the acute pain of active herpes zoster, they did not prevent the development of chronic postherpetic neuralgia. PMID: 6721540 [PubMed - indexed for MEDLINE] 5209. Ann Intern Med. 1984 Jun;100(6):920. Severe but reversible neurotoxicity from acyclovir. Cohen SM, Minkove JA, Zebley JW 3rd, Mulholland JH. PMID: 6721312 [PubMed - indexed for MEDLINE] 5210. J Assoc Physicians India. 1984 Jun;32(6):535. Unusual cases of herpes zoster involving cranial nerves. Bhattacharya SK, Sunder S. PMID: 6511737 [PubMed - indexed for MEDLINE] 5211. Rinsho Shinkeigaku. 1984 Jun;24(6):581-5. [A case of segmental zoster paresis] [Article in Japanese] Honda H, Mano Y, Takayanagi T. PMID: 6499332 [PubMed - indexed for MEDLINE] 5212. Isr J Med Sci. 1984 Jun;20(6):547-8. Disseminated herpes zoster and hypernephroma: chance incidence or first reported case? Cohen N, Weissgarten J, Pik A, Modai D. PMID: 6469577 [PubMed - indexed for MEDLINE] 5213. Transplantation. 1984 Jun;37(6):571-4. Acyclovir treatment of varicella-zoster virus infection in the compromised host. Meyers JD, Wade JC, Shepp DH, Newton B. Forty marrow transplant patients were treated with acyclovir for varicella-zoster virus infection. Median duration of virus positivity and of new lesion formation was 2.1 and 2.2 days, and pustulation , crusting, and healing occurred at medians of 3.5, 8, and 28 days, respectively. Acute pain ceased at a median of 7 days, though seven patients had later recurrence of pain and eight had pain that persisted for more than 28 days. Three patients had recurrence of infection within 4 days after the end of treatment and were successfully treated in each case with a second course of acyclovir. Side effects were minimal. These data compare favorably with published data both from the treatment of normal persons with acyclovir and treatment of normal persons with acyclovir and treatment of immunocompromised patients with vidarabine, and they indicate that acyclovir is safe and effective for the treatment of varicella-zoster virus infection in the severely immunocompromised host. PMID: 6328703 [PubMed - indexed for MEDLINE] 5214. Ann Intern Med. 1984 Jun;100(6):866-80. Latent herpesviruses of humans. Jordan MC, Jordan GW, Stevens JG, Miller G. The herpesviruses that infect humans characteristically establish a latent infection that may be reactivated later. The consequences of reactivation range from asymptomatic shedding to severe disseminated infection. Varicella-zoster and herpes simplex viruses are both highly neurotropic, establishing nonreplicating infections in sensory ganglia. Latent herpes simplex virus is known to reside in neurons, and the virus-cell interactions involved have been defined to an extent. Cytomegalovirus and Epstein-Barr virus interact with peripheral blood leukocytes. Latent cytomegalovirus infection of human leukocytes has not been proved, although studies in a murine model have implicated B lymphocytes as a repository of latent virus. Epstein-Barr virus is known to persist in a non-replicating state as extrachromosomal DNA in B lymphocytes and to cause "immortalization" of the infected cell; persistence of the viral genome in epithelial cells may also result in malignant transformation, such as nasopharyngeal carcinoma. PMID: 6326635 [PubMed - indexed for MEDLINE] 5215. Antiviral Res. 1984 Jun;4(3):99-117. Acyclovir: an update of the clinical applications of this antiherpes agent. Fiddian AP, Brigden D, Yeo JM, Hickmott EA. This paper reviews the clinical evaluation of acyclovir in the treatment of herpes-virus infections, predominantly those due to herpes simplex and varicella-zoster viruses. Intravenous, oral and topical acyclovir have been reported to be effective in the therapy of a wide variety of established herpes simplex virus infections and the systemic drug has been shown to be capable of suppressing reactivation of that virus. Although acyclovir has less activity against varicella-zoster virus, infections caused by this agent are also susceptible to intravenous and possibly oral therapy. Clinical efficacy against Epstein-Barr virus and cytomegalovirus infections has not been demonstrated but several studies are currently in progress. Limited evidence of in vivo activity against hepatitis B virus also requires further evaluation. Continued studies on tolerance of the drug in clinical use has confirmed the early promise of this selective antiviral, whilst initial concern about the development of widespread resistance has not been borne out in practice. PMID: 6089659 [PubMed - indexed for MEDLINE] 5216. J Clin Microbiol. 1984 Jun;19(6):880-3. Factors influencing quantitative isolation of varicella-zoster virus. Levin MJ, Leventhal S, Masters HA. Optimal conditions are described for the recovery of cell culture-derived varicella-zoster virus (VZV). Of the cells tested, human embryonic lung fibroblasts were the most sensitive. Storage and handling procedures were examined to determine the stability of VZV in viral transport medium. When the initial VZV titer was high (2 X 10(4) PFU/ml) 40% of the VZV survived room temperature for 24 h and 75% of the VZV remained viable for this long at 4 degrees C. Recovery was 5- to 10-fold less at lower initial VZV titers (less than 2 X 10(3) PFU/ml). Other factors which influenced VZV recovery included freezing at -20 degrees C, the use of cotton or calcium alginate swabs, and filtration to remove bacterial contaminants. The tissue culture methods described were used in a reconstruction experiment to demonstrate that VZV could be recovered from a laboratory coat or human skin (0.1 to 0.3% of input VZV) or from a stethoscope (19% of input VZV) as late as 30 min after inoculation. During a clinical trial using optimal VZV recovery procedures, 76% of the patients with herpes zoster yielded VZV when first cultured, and 60% remained culture positive for an additional 48 h. PMCID: PMC271203 PMID: 6088572 [PubMed - indexed for MEDLINE] 5217. CDA J. 1984 Jun;12(6):27-31. Herpes viruses and the human race. Beierle JW. PMID: 6088092 [PubMed - indexed for MEDLINE] 5218. Pol Tyg Lek. 1984 May 21;39(21):701-3. [Herpes zoster in children treated for Hodgkin's disease] [Article in Polish] Armata J, Balwierz W, Rytlewska M. PMID: 6483673 [PubMed - indexed for MEDLINE] 5219. Can Med Assoc J. 1984 May 1;130(9):1109. Course of herpes zoster. Tyrrell DL. PMCID: PMC1876021 PMID: 6713324 [PubMed - indexed for MEDLINE] 5220. Arthritis Rheum. 1984 May;27(5):481-8. Total lymphoid irradiation therapy in refractory rheumatoid arthritis. Fifteen- to forty-month followup. Brahn E, Helfgott SM, Belli JA, Anderson RJ, Reinherz EL, Schlossman SF, Austen KF, Trentham DE. Twelve patients with refractory rheumatoid arthritis were treated with total lymphoid irradiation (TLI) to a total cumulative dose of 3,000 rads. Post-TLI morbidity/mortality included 8 patients with xerostomia, 4 with weight loss of greater than 10 kg, 3 with loss of 4 or more teeth, 3 with herpes zoster, 4 with bacterial infection that was fatal in 2, 3 with hypothyroidism, 1 with cutaneous vasculitis, and death from myocardial infarction in 1 patient and cardiorespiratory arrest in another. Ten of the patients were reevaluated 15-40 months (mean +/- SE, 30 +/- 2) after completion of TLI, and significant improvement was noted in several disease parameters including number of swollen joints, duration of morning stiffness, and 50-foot walking time. Blood lymphopenia and a decrease in helper T cells (T4) were also noted. These data suggest that changes in immunoregulation induced by TLI can produce longlasting alterations in rheumatoid arthritis, although adverse effects may limit its efficacy. PMID: 6609705 [PubMed - indexed for MEDLINE] 5221. Taiwan Yi Xue Hui Za Zhi. 1984 May;83(5):491-8. [Adult-onset Still's disease complicated with bone marrow anomalies and herpes zoster] [Article in Chinese] Yang BY, Chang JG, Liao ST, Wei CF, Siauw CP, Chen PH. PMID: 6590781 [PubMed - indexed for MEDLINE] 5222. Neurol Clin. 1984 May;2(2):215-40. Herpes simplex and herpes zoster. Nervous system involvement. Tenser RB. Mainly discussed are neurologic complications of two neurotropic herpesviruses: herpes simplex viruses types 1 and 2 and varicella-zoster virus. Briefly discussed are cytomegalovirus and Epstein-Barr virus. Treatment of immunosuppressed and nonimmunosuppressed patients is reviewed. PMID: 6503937 [PubMed - indexed for MEDLINE] 5223. Arch Fr Pediatr. 1984 May;41(5):345-7. [Acute encephalitis in zoster infection] [Article in French] Billard C, Goudeau A, Santini JJ, Boudeux J, Lebon P. A case of herpes zoster acute meningo-encephalitis is reported. It is characterized by a profuse intra-cerebral hemorrhage on CT scan and a favorable outcome after treatment with acyclovir. The serological basis for the diagnosis, the mechanism of the encephalitis (viral invasion or immuno-allergic type of reaction), and the origin of the hemorrhagic lesion are discussed. The effectiveness of acyclovir in treating the extention of the infection to the nervous system in patients suffering from varicella-zoster is also discussed. PMID: 6466035 [PubMed - indexed for MEDLINE] 5224. N Y State J Med. 1984 May;84(5):245-51. Vesicular rash and bilateral pulmonary infiltrates in a 67-year-old woman with Hodgkin's disease. [No authors listed] PMID: 6377143 [PubMed - indexed for MEDLINE] 5225. N Y State J Med. 1984 May;84(5):241-4. Viral infections in immunosuppressed patients. Hirschman SZ. PMID: 6330629 [PubMed - indexed for MEDLINE] 5226. J Clin Microbiol. 1984 May;19(5):606-9. Antibody class capture assays for varicella-zoster virus. Forghani B, Myoraku CK, Dupuis KW, Schmidt NJ. Pooled monoclonal antibodies to varicella-zoster virus (VZV) were used as "detector" antibodies in a four-phase enzyme immunofluorescence assay for determination of immunoglobulin M (IgM), IgA, and IgG antibodies to VZV. Polyclonal antisera specific for heavy chains of human IgM, IgA, and IgG were employed as "capture" antibodies on the solid phase. The antibody class capture assay (ACCA) for VZV IgM antibody detected high titers of virus-specific IgM in all patients with varicella and in 5 of 10 zoster patients. VZV IgM antibody was not detected in patients with primary herpes simplex virus infections or in other individuals without active VZV infection, with one exception, a patient with encephalitis who had other serological findings compatible with a reactivated VZV infection. VZV-specific IgA and IgG antibody titers demonstrable by ACCA were compared with those measured by solid-phase indirect enzyme immunofluorescence assay (EIFA). VZV IgA antibody titers detected in patients with varicella and zoster were variable and could not be considered to be reliable markers of active VZV infection. IgA antibody titers detected by ACCA tended to be higher than those demonstrated by solid-phase indirect EIFA in varicella and zoster patients. VZV IgG antibody titers detected by ACCA in patients with varicella, and to a lesser extent in zoster patients, were as high as or higher than those demonstrated by solid-phase indirect EIFA. However, ACCA was totally insensitive in detecting VZV IgG antibody in individuals with past infections with VZV and would not be a suitable approach for determination of immunity status to VZV. PMCID: PMC271140 PMID: 6330163 [PubMed - indexed for MEDLINE] 5227. J Infect Dis. 1984 May;149(5):741-9. Molecular dissection of the humoral immune response to individual varicella-zoster viral proteins during chickenpox, quiescence, reinfection, and reactivation. Weigle KA, Grose C. The sequence of antibody formation to molecularly defined varicella-zoster virus (VZV) proteins was examined during the course of chickenpox, quiescence, and subsequent VZV reactivation and reinfection. The first antibodies produced after primary VZV infection were to two virion envelope glycoproteins, gp66 and gp118 , and the nucleocapsid protein p155 . Within one to two months, antibodies to a greater array of viral proteins and glycoproteins were observed. Antibodies to the immunodominant viral proteins ( gp66 , gp118 , and p155 ) persisted for years after varicella and were, therefore, excellent markers of prior VZV infection. Subclinical VZV reinfection also was associated with transient rises in levels of the same polypeptide-specific antibodies as during primary disease. The immunoglobulin response to zoster appeared more rapidly than that to chickenpox or reinfection and was to the broadest complement of viral proteins, including the distinctive VZV polypeptide p32. These radioimmune-precipitation profiles could be subdivided into six different patterns characteristic of the following clinical states: acute- and convalescent-phase chickenpox, quiescence, acute- and convalescent-phase zoster, and postzoster quiescence. PMID: 6327848 [PubMed - indexed for MEDLINE] 5228. J Virol. 1984 May;50(2):615-8. Physical maps of varicella-zoster virus DNA derived with 11 restriction enzymes. Mishra L, Dohner DE, Wellinghoff WJ, Gelb LD. Varicella-zoster virus DNA was digested with 11 restriction endonucleases, and the resulting fragments were separated on agarose gels. Terminal fragments were identified by lambda exonuclease digestion. Physical maps were then constructed using a combination of double restriction enzyme digestion and hybridization to cloned BamHI fragments to place the remaining fragments in order. PMCID: PMC255684 PMID: 6323760 [PubMed - indexed for MEDLINE] 5229. Pediatr Infect Dis. 1984 May-Jun;3(3 Suppl):S34-6. Prevention and treatment of varicella-zoster virus infection. Gershon AA. PMID: 6204323 [PubMed - indexed for MEDLINE] 5230. Ugeskr Laeger. 1984 Apr 30;146(18):1345-7. [Oculomotor paralysis in ophthalmic herpes zoster] [Article in Danish] Johnsen T, Ahrendt N. PMID: 6333745 [PubMed - indexed for MEDLINE] 5231. Med J Aust. 1984 Apr 28;140(9):567. Herpes zoster: an unusual case. Curry M. PMID: 6708909 [PubMed - indexed for MEDLINE] 5232. N Engl J Med. 1984 Apr 26;310(17):1118-9. Herpes zoster ophthalmicus in patients at risk for AIDS. Sandor E, Croxson TS, Millman A, Mildvan D. PMID: 6608691 [PubMed - indexed for MEDLINE] 5233. N Engl J Med. 1984 Apr 12;310(15):987-8. Acyclovir for varicella zoster infection. Fanelli C, Sattler FR. PMID: 6366564 [PubMed - indexed for MEDLINE] 5234. Presse Med. 1984 Apr 7;13(15):943. [Herpes zoster gastritis associated with Hodgkin's disease] [Article in French] Roussignol B, Maechel H, Morlans E, Kazi M, Royneau L. PMID: 6231636 [PubMed - indexed for MEDLINE] 5235. Schweiz Rundsch Med Prax. 1984 Apr 3;73(14):455-61. [Clinico-pathological conference: necrotizing angiitis of leptomeningeal vessels and fatal brainstem hemorrhage following ocular herpes zoster] [Article in German] Probst A, Wüthrich R, Vögtli J. PMID: 6144156 [PubMed - indexed for MEDLINE] 5236. Eur J Clin Microbiol. 1984 Apr;3(2):158-9. Antibody response of patas monkeys to experimental infection with Delta herpesvirus. Achilli G, Sarasini A, Gerna G, Iltis JP, Madden DL. PMID: 6723641 [PubMed - indexed for MEDLINE] 5237. Geriatrics. 1984 Apr;39(4):108, 113-4. A common agent explains a case of idiopathic lupus. Dickstein ES. PMID: 6706115 [PubMed - indexed for MEDLINE] 5238. Am J Clin Pathol. 1984 Apr;81(4):529-32. Giant cell granulomatous angiitis of the central nervous system in a patient with leukemia and cutaneous herpes zoster. Ojeda VJ, Peters DM, Spagnolo DV. Pontine infarcts associated with granulomatous (giant cell) arteritis were the terminal events in a 71-year-old man treated for chronic myeloid leukemia with intermittent Busulphan therapy during the previous ten years. The final admission was precipitated by a severe episode of herpes-zoster infection of the scalp. Since 1950 there have been 25 papers in the English language medical literature describing 36 cases of granulomatous angiitis of the central nervous system (CNS). Seven cases, including this report, were associated with lymphoid malignancies, and five had cutaneous herpes-zoster as well. Virus-like particles were detected in the affected vessels in three patients and in the nearby glial cells of a further case. PMID: 6702756 [PubMed - indexed for MEDLINE] 5239. Oral Surg Oral Med Oral Pathol. 1984 Apr;57(4):388-9. An unusual oral complication of herpes zoster infection. Smith S, Ross JW, Scully C. This paper describes a complication of herpes zoster infection of the orofacial region involving a 15-year-old girl who, following herpes zoster of the right mandibular division of the trigeminal nerve at the age of 7 years, suffered abnormal development of the permanent teeth in this quadrant. PMID: 6584833 [PubMed - indexed for MEDLINE] 5240. Riv Neurobiol. 1984 Apr-Sep;30(2-3):336-42. [Bannwarth syndrome. Observation apropos of 1 case] [Article in Italian] Marotta P, Sozzi G. PMID: 6544485 [PubMed - indexed for MEDLINE] 5241. Eur J Cancer Clin Oncol. 1984 Apr;20(4):471-6. Oral (E)-5-(2-bromovinyl)-2'-deoxyuridine treatment of severe herpes zoster in cancer patients. Wildiers J, De Clercq E. BVDU [(E)-5-(2-bromovinyl)-2'-deoxyuridine] is a highly potent and selective anti-herpes drug. It is particularly active against Varicella zoster virus, as demonstrated in cell culture and animals (monkeys). BVDU has been administered orally, at a dose of 7.5 mg/kg/day for 5 days, to 20 patients with severe localised or disseminated Herpes zoster. All patients had a malignant disorder for which they had been given intensive chemo- or radiotherapy. Upon BVDU treatment a rapid cessation of the acute Herpes zoster episode was noted in all but one patient. In the majority of patients progression of the infection was arrested within 1 day of starting treatment. No toxic side-effects could be attributed to the drug at the dosage used. PMID: 6539202 [PubMed - indexed for MEDLINE] 5242. Nowotwory. 1984 Apr-Jun;34(2):181-8. [Preliminary evaluation of acyclovir treatment of patients with herpes zoster at the Chemotherapy Clinic, Institute of Oncology, in Warsaw] [Article in Polish] Rubach M, Zborzil J. PMID: 6494000 [PubMed - indexed for MEDLINE] 5243. Semin Hematol. 1984 Apr;21(2):101-8. The early complications of bone marrow transplantation. Champlin RE, Gale RP. PMID: 6377500 [PubMed - indexed for MEDLINE] 5244. Klin Med (Mosk). 1984 Apr;62(4):28-34. [Chronic viral infections] [Article in Russian] Boriskon IuS, Bogomolova NN. PMID: 6376937 [PubMed - indexed for MEDLINE] 5245. Transplantation. 1984 Apr;37(4):366-8. Fatal central nervous system infection with varicella-zoster virus in renal transplant recipients. Peterson LR, Ferguson RM. Three renal transplant patients with culture-positive central nervous system infections resulting from varicella-zoster virus died of the virus infection. No finding predicting a poor outcome in these patients could be identified. Varicella-zoster infection in transplant recipients is a potentially fatal disease, and upon diagnosis should it be treated by (1) reduction in immunosuppression, and (2) initiation of either vidarabine or acyclovir as specific antiviral therapy. PMID: 6369667 [PubMed - indexed for MEDLINE] 5246. Diagn Microbiol Infect Dis. 1984 Apr;2(2):157-60. Diagnosis of herpesvirus infections: correlation of Tzanck preparations with viral isolation. Motyl MR, Bottone EJ, Janda JM. Evaluation of Giemsa-stained smears of scrapings from the base of vesicles or ulcers ( Tzanck preparation) for the presence of multinucleated giant cells and/or intracellular inclusions were diagnostic for herpesvirus in 18 of 21 cases (86%) of culturally proved herpesvirus infections. Smears from four patients with varicella-zoster infection also revealed cytologic alterations characteristic of herpesvirus. PMID: 6201317 [PubMed - indexed for MEDLINE] 5247. Clin Dermatol. 1984 Apr-Jun;2(2):117-32. Acyclovir: new era in antiviral chemotherapy. Keeney RE, Wilson SJ. PMID: 6100713 [PubMed - indexed for MEDLINE] 5248. Lancet. 1984 Mar 31;1(8379):702-5. Cancer, warts, and sunshine in renal transplant patients. A case-control study. Boyle J, MacKie RM, Briggs JD, Junor BJ, Aitchison TC. 94 renal transplant patients were examined for the presence of cutaneous malignancies, actinic keratoses, warts, and cutaneous fungal infection, and a history was taken of infection with herpes simplex and herpes zoster. Each patient had a control matched for age, sex, and sun exposure. Of the 17 patients with high exposure to sunshine (more than 3 months in a tropical or subtropical climate or more than 5 years in an outdoor occupation), 2 had squamous cell carcinoma and 7 actinic keratoses. These lesions did not occur in the other renal transplant patients or the control group. The immunosuppressive effect of ultraviolet radiation in the sunburn spectrum (290-320 nm) in man and animals may be related to the increased incidence of cutaneous malignancy, actinic keratoses, and warts. Transplant patients should be under regular surveillance for the early detection and treatment of premalignant cutaneous lesions, and they should receive advice on avoiding sun exposure. PMID: 6143041 [PubMed - indexed for MEDLINE] 5249. Am J Med. 1984 Mar 30;76(3A):124-7. Varicella zoster antibody titers after the administration of intravenous immune serum globulin or varicella zoster immune globulin. Paryani SG, Arvin AM, Koropchak CM, Wittek AE, Amylon MD, Dobkin MB, Budinger MD. Varicella is a serious infection in the immunocompromised patient. Prophylaxis with varicella zoster immune globulin is known to decrease the incidence of severe varicella infection. The titers of antibody to varicella zoster virus were compared in patients who received either varicella zoster immune globulin or intravenous immune globulin, 4 ml or 6 ml/kg per dose. The titers of antibody to varicella zoster virus were comparable in each group. PMID: 6324585 [PubMed - indexed for MEDLINE] 5250. Minerva Med. 1984 Mar 10;75(9-10):457-62. [Use of high-dose lysozyme in the treatment of herpes zoster and flat warts] [Article in Italian] Cavicchini S. Lysozyme is a natural enzyme with antiviral, antibacterial and immunomodulating+ action. This drug has several dermatological applications particularly in the therapy of some viral skin diseases as herpes zoster, viral warts and aphthous stomatitis. In this work the Author has valued the efficacy of high dosage lysozyme in the treatment of 30 patients with herpes zoster infection and in 10 patients affected with viral plane warts. The good results obtained in this clinical trial confirm those reported in previous papers and denote the usefulness of this therapy. PMID: 6369176 [PubMed - indexed for MEDLINE] 5251. Med J Aust. 1984 Mar 3;140(5):310. Unusual herpes zoster. Heise G. PMID: 6700479 [PubMed - indexed for MEDLINE] 5252. Physiotherapy. 1984 Mar;70(3):96-7. Ultrasound for post-herpetic neuralgia. A study to investigate the results of treatment. Payne C. PMID: 6718571 [PubMed - indexed for MEDLINE] 5253. Physiotherapy. 1984 Mar;70(3):94-6. Treatment of acute herpes zoster using ultrasonic therapy. Report on a series of twelve patients. Jones RJ. PMID: 6718570 [PubMed - indexed for MEDLINE] 5254. J Infect Dis. 1984 Mar;149(3):478. Acyclovir administered perorally in immunocompromised children with varicella-zoster infections. Novelli VM, Marshall WC, Yeo J, McKendrick GD. PMID: 6715905 [PubMed - indexed for MEDLINE] 5255. Am J Vet Res. 1984 Mar;45(3):523-30. Pathologic changes of experimental simian varicella (Delta herpesvirus) infection in African green monkeys (Cercopithecus aethiops). Roberts ED, Baskin GB, Soike K, Gibson SV. Gross and microscopic lesions of experimental simian varicella (Delta herpesvirus) infection in African green monkeys (Cercopithecus aethiops) are described. In stratified squamous epithelium, such as the epidermis, tongue, and esophagus, focal areas of epidermal hyperplasia, ballooning degeneration, and blood-filled vesicle formation with ulceration were apparent. Most visceral organs were involved, and the changes included necrosis, hemorrhage, and characteristic intranuclear eosinophilic inclusions in a variety of cells. A generalized vascular involvement was present with intranuclear inclusions in the endothelial and smooth muscle cells in various organs. The nervous system was normal on gross and microscopic examination. Virus titer and serum transferase values were correlated with the clinical signs of infection. PMID: 6711981 [PubMed - indexed for MEDLINE] 5256. Ann Intern Med. 1984 Mar;100(3):462. Herpes zoster and the acquired immunodeficiency syndrome. Cone LA, Schiffman MA. PMID: 6696374 [PubMed - indexed for MEDLINE] 5257. Helv Paediatr Acta. 1984 Mar;39(1):63-70. Varicella and herpes zoster in immunosuppressed children: preliminary results of treatment with intravenous immunoglobulin. Sulliger JM, Imbach P, Barandun S, Gugler E, Hirt A, Lüthy A, Rossi E, Tönz O, Wagner HP. Seven immunosuppressed children with varicella and two with herpes zoster were treated with large intravenous doses of polyvalent, intact immunoglobulin (IgG i.v.). In all patients the treatment was effective for controlling fever and skin lesions and for preventing progression and complications, even if this therapy was started late and/or if the patient was severely lymphopenic . More IgG was needed to control disseminated than less advanced varicella. No untoward effects of IgG therapy were observed. The preliminary results suggest that in future trials i.v. IgG should be used for comparison with antiviral agents. PMID: 6609911 [PubMed - indexed for MEDLINE] 5258. Ann Neurol. 1984 Mar;15(3):311-2. Angiographic changes in intracranial arteritis of ophthalmic herpes zoster. Fryer DG, Crane R, Margolis MT. PMID: 6609681 [PubMed - indexed for MEDLINE] 5259. Klin Monbl Augenheilkd. 1984 Mar;184(3):163-7. [Corneal endotheliitis. Definition and clinical classification] [Article in German] Sundmacher R. Corneal endotheliitis in the narrower sense is the term applied to immune reactions directed against the endothelial cells themselves. Virus antigens, histocompatibility antigens and autoantigens in the cell membrane represent the target for immune attack. The most significant clinical sign of endotheliitis is a strict correlation between the area of endothelial damage and the area of the (immune) precipitates. PMID: 6374261 [PubMed - indexed for MEDLINE] 5260. J Am Acad Dermatol. 1984 Mar;10(3):486-90. "Recurrent herpes zoster": an unproved entity? Heskel NS, Hanifin JM. Physicians sometimes misdiagnose recurrent zosteriform herpes simplex virus (HSV) skin infections as "zoster" or "recurrent zoster." Misdiagnosis can lead to inappropriate therapy with potentially harmful consequences, particularly in patients with ophthalmitis or immunosuppression, in which early institution of the correct antiviral therapy may be crucial. We report three patients who were originally misdiagnosed to have recurrent herpes zoster skin infections before we cultured HSV from their vesicles. We suggest: (1) that most recurrent zosteriform eruptions are caused by HSV; (2) that "recurrent zoster" has yet to be documented; and (3) that the diagnosis of "recurrent zoster" be reserved for those patients who have laboratory confirmation of recurrent varicella zoster (VZ). Viral culture or examination of vesicle contents by indirect immunofluorescent technic can provide definitive diagnosis of the etiology of a zosteriform eruption. PMID: 6327783 [PubMed - indexed for MEDLINE] 5261. Am J Med. 1984 Mar;76(3):464-78. Herpes virus infections in patients with neoplastic disease. Diagnosis and therapy. Wong KK, Hirsch MS. Herpes viruses are among the most common and troublesome opportunistic pathogens infecting patients with neoplastic diseases. The recent development of partially effective and relatively nontoxic antiviral agents offers promise for the prophylaxis or therapy of these infections in high-risk groups. Vidarabine and acyclovir have shown efficacy in several herpes virus infections and are now licensed in the United States. Alpha interferon may also be useful in the prophylaxis or early therapy of certain herpes virus infections. Newer antiviral agents and combination therapies are under study. Early and rapid diagnosis of such infections is critical to the development of effective therapy. PMID: 6199972 [PubMed - indexed for MEDLINE] 5262. Dtsch Z Mund Kiefer Gesichtschir. 1984 Mar-Apr;8(2):90-2. [Clinical picture of viral infections in the oral cavity] [Article in German] Haneke E. PMID: 6098398 [PubMed - indexed for MEDLINE] 5263. Biken J. 1984 Mar;27(1):23-9. A simplified immunofluorescence technique for antibody to varicella-zoster membrane antigen (FAMA). Baba K, Yoshida M, Tawa A, Yabuuchi H, Maeda K, Takahashi M. Indirect fluorescent antibody to varicella-zoster membrane antigens (FAMA) was measured by a new technique. The procedure gives rapid, sensitive and accurate results and is suitable for use in diagnosis or screening of susceptibility to varicella-zoster virus (VZV) infection. The test procedure was simplified by using Terasaki tissue culture plates for the reaction and for direct observation by fluorescence microscopy. Preparations of VZV-infected Vero cells stored in liquid nitrogen could be used as antigen in this FAMA-test. PMID: 6091617 [PubMed - indexed for MEDLINE] 5264. Lancet. 1984 Feb 18;1(8373):404-5. Production of specific antibodies by CSF lymphocytes in patients with herpes zoster. Forsberg P, Frydén A, Kam-Hansen S. PMID: 6141474 [PubMed - indexed for MEDLINE] 5265. N Engl J Med. 1984 Feb 2;310(5):318-9. Cimetidine for herpes zoster. Mavligit GM, Talpaz M. PMID: 6690956 [PubMed - indexed for MEDLINE] 5266. West J Med. 1984 Feb;140(2):292. Other treatments for herpes zoster neuralgia. [No authors listed] PMCID: PMC1021634 PMID: 6730483 [PubMed - indexed for MEDLINE] 5267. Klin Med (Mosk). 1984 Feb;62(2):111-4. [Generalized form of herpes zoster] [Article in Russian] Bakhur VT, Shkatova KS, Korovina AF, Aleksandrova NG. PMID: 6708430 [PubMed - indexed for MEDLINE] 5268. Gastrointest Endosc. 1984 Feb;30(1):26-7. Shingles esophagitis: endoscopic diagnosis in two patients. Gill RA, Gebhard RL, Dozeman RL, Sumner HW. PMID: 6706086 [PubMed - indexed for MEDLINE] 5269. Arch Dermatol. 1984 Feb;120(2):261-2. Eccrine duct involvement by herpes zoster. Rinder HM, Murphy GF. PMID: 6696483 [PubMed - indexed for MEDLINE] 5270. Arch Neurol. 1984 Feb;41(2):137. Myelopathy after herpes zoster. Cullis PA. PMID: 6691809 [PubMed - indexed for MEDLINE] 5271. Scand J Haematol. 1984 Feb;32(2):130-4. Effectiveness of pentostatin (2'-deoxycoformycin) in refractory lymphoid neoplasms. Spiers AS, Ruckdeschel JC, Horton J. Pentostatin (2'-deoxycoformycin, DCF) was administered to 17 patients with a variety of lymphoid neoplasms, both T- and B-cell, that were refractory to conventional treatments. Several responses and 2 complete remissions occurred. Toxic effects were less severe than previously described: this may be attributable to relatively low doses of DCF or to precautions taken to prevent tumour lysis syndrome. DCF appears valuable as a second-line treatment in non-Hodgkin's lymphomas and as initial treatment in T-cell chronic lymphocytic leukaemia and mycosis fungoides. Although myelosuppression is mild, immunosuppression and superinfection are potential hazards of treatment with DCF. The ocular toxicity of DCF, previously described as conjunctivitis, appears to be a keratitis of moderate severity which requires further study. PMID: 6608139 [PubMed - indexed for MEDLINE] 5272. N C Med J. 1984 Feb;45(2):137. Herpes zoster ophthalmicus. Friewald MJ. PMID: 6608057 [PubMed - indexed for MEDLINE] 5273. Arch Ophthalmol. 1984 Feb;102(2):195. Benign intracranial tumors and zoster ophthalmicus. Naumann GO, Procher G. PMID: 6607725 [PubMed - indexed for MEDLINE] 5274. Am J Infect Control. 1984 Feb;12(1):2-5. Herpes zoster causing varicella (chickenpox) in hospital employees: cost of a casual attitude. Hyams PJ, Stuewe MC, Heitzer V. Varicella is a benign exanthematous disease of childhood, with adult infection usually occurring in the immunocompromised patient. Hospital employees may be exposed to the varicella virus through contact with patients having either varicella or herpes zoster. Two nurses developed varicella 11 and 15 days after contact with a patient with disseminated herpes zoster. Twenty-five susceptible employees were excluded from work. The cost to the hospital for this paid leave was $10,941. Additional nurses were hired to staff the 189 uncovered supplementary nursing shifts; the accrued cost was $8,093. Ninety patients were exposed. There were no secondary cases in either employees or patients. Nosocomial varicella in hospital employees can be both costly to the hospital and disruptive of patient care. Measures to prevent such an occurrence are discussed. PMID: 6561002 [PubMed - indexed for MEDLINE] 5275. Gan To Kagaku Ryoho. 1984 Feb;11(2):221-6. [Interferon in skin diseases] [Article in Japanese] Niimura M. In the dermatological field, interferon is used in clinical trials for viral skin diseases and for malignant skin tumors such as malignant melanoma. In regard to viral diseases, clinical trials have shown promising results in viral warts, herpes simplex and herpes zoster. In the double-blind trial, patients with bilateral common warts of the extremities were treated at weekly intervals with intralesional injections of either human fibroblast interferon or placebo. More than 81% of the interferon-treated extremities were either cured by or responded effectively to the therapy, while only 17% of the placebo responded. Although our data has confirmed that interferon is effective in the treatment of common warts diseases, the method of application and repeated injections indicate that this therapy may not be helpful in routine cases but only in selected patients in whom other therapy has failed. However, development of new delivery systems or modification of dosages may increase the value of interferon therapy for warts disease. Interferon seems also effective for herpes zoster. But herpes zoster usually regresses spontaneously within three weeks, therefore, it is not easy to define efficacy of interferon in this disease. Therefore, we need to examine the effect of interferon on herpes zoster both in placebo controlled and double-blind trials involving patients with immunocompromised diseases. PMID: 6364993 [PubMed - indexed for MEDLINE] 5276. Monatsschr Kinderheilkd. 1984 Feb;132(2):105-9. [Acyclovir therapy in varicella/zoster diseases in immunocompromised children with cancer] [Article in German] Kuhn N, Landbeck G. 21 patients, aged 1 to 15 years, who developed manifest varicella/zoster-virus infection while on chemotherapy for malignant disease were treated with acyclovir. Drug dosage was 10 mg/kg every eight hours for 5 days as a one hour infusion. The clinical course of the infection in all patients was mild. 1 to 4 (median 2,2) days after beginning of acyclovir therapy the formation of new lesions stopped. Within 4 to 8 (median 5,9) days all vesicles were scabbed . In 13 patients with fever in the beginning the temperature fell within 2 to 6 (median 2,6) days of treatment. The development of visceral involvement was not observed during or after acyclovir therapy. Acyclovir was well tolerated. Tests of the hematopoietic, liver and renal functions before and after acyclovir therapy revealed no adverse effects of the drug. Also the immunologic response seemed not to be impaired. With one exception, all patients investigated had antibodies against varicella/zoster-virus after recovery. In order to prevent varicella infection after household exposure two immunocompetent patients were treated prophylactically with acyclovir tablets (400 mg 5 times a day for 5 days). Both children did not exhibit manifest varicella/zoster infection, but five weeks later they had antibodies against varicella/zoster-virus (KBR 1:10, resp. KBR 1:20). PMID: 6328285 [PubMed - indexed for MEDLINE] 5277. Am J Infect Control. 1984 Feb;12(1):34-63. CDC guidelines for the prevention and control of nosocomial infections. Guideline for infection control in hospital personnel. Williams WW. PMID: 6322620 [PubMed - indexed for MEDLINE] 5278. J Infect Dis. 1984 Feb;149(2):137-42. Clinical reinfection with varicella-zoster virus. Gershon AA, Steinberg SP, Gelb L. Eight patients became clinically reinfected with varicella-zoster virus despite the presence of specific antibody in the blood three days to six months before the onset of illness. One patient had had varicella previously; a second had been immunized with live, attenuated varicella vaccine 10 months earlier. While it was suspected that these patients experienced a reactivation of latent virus that caused atypical disseminated zoster rather than varicella, detailed study of the vaccinated child suggests that this was not the case; by restriction-endonuclease techniques, this vaccinee was shown to have been infected with wild-type varicella-zoster virus despite the presence of specific antibody and cellular immunity to the virus. All cases clinically resembled chickenpox. Thus, not only subclinical varicella (manifested by a rise in antibody titer after close exposure) but also clinical reinfection with the virus can occur. Clinical reinfection probably develops more frequently in immunocompromised than in immunocompetent individuals. Reinfections are usually mild. PMID: 6321605 [PubMed - indexed for MEDLINE] 5279. Br J Dermatol. 1984 Feb;110(2):151-4. Mechanisms of pustule formation in cutaneous bacterial and viral infections: alterations of neutrophil membrane surface receptors. Imaizumi S, Iwatsuki K, Yamada M, Tagami H. Changes in membrane surface receptors have been demonstrated by rosetting methods in polymorphonuclear leukocytes obtained from the pustules of different infectious dermatoses. There was a distinct difference in numbers of receptors in neutrophils from bacterial and viral pustules, i.e., C3b receptors were decreased on neutrophils from both bacterial and viral pustules, whereas IgG-Fc receptors were decreased only in neutrophils from viral pustules. The difference appears to be due to variations in the defence mechanisms against the invading micro-organisms. PMID: 6230096 [PubMed - indexed for MEDLINE] 5280. Ugeskr Laeger. 1984 Jan 16;146(3):193. [Herpes zoster ophthalmicus with retrobulbar atrophy] [Article in Danish] Schmidt P. PMID: 6608169 [PubMed - indexed for MEDLINE] 5281. Lancet. 1984 Jan 14;1(8368):103-4. Shingles in seven homosexuals. Rowland Payne CM, Farthing C, Byrom N, Staughton RC. PMID: 6140400 [PubMed - indexed for MEDLINE] 5282. Rev Laryngol Otol Rhinol (Bord). 1984;105(1):63-5. [Various etiologic rarities in facial paralysis in the child and in the adult] [Article in French] Coll J. PMID: 6729283 [PubMed - indexed for MEDLINE] 5283. Kekkaku. 1984 Jan;59(1):39-63. [Clinico-immunological factors relating to the onset of tuberculosis] [Article in Japanese] Mikami R. PMID: 6716753 [PubMed - indexed for MEDLINE] 5284. J Neurol. 1984;231(2):96-8. Herpes zoster ophthalmicus with contralateral hemiplegia and normal pressure hydrocephalus. Inoue N, Shiraishi S, Tsuda T, Yamato T, Murai Y, Tsukamoto Y, Nakata H. A case of herpes zoster ophthalmicus complicated by contralateral hemiplegia and normal pressure hydrocephalus is presented. The hydrocephalus is considered to be caused by recurrent haemorrhage from extensive cerebral arteritis. PMID: 6610727 [PubMed - indexed for MEDLINE] 5285. Int Ophthalmol Clin. 1984 Summer;24(2):39-48. Herpes zoster. Olson RJ. PMID: 6609904 [PubMed - indexed for MEDLINE] 5286. J R Coll Physicians Lond. 1984 Jan;18(1):51-5. Cytotoxic chemotherapy and viral infections: the role of acyclovir. Anderson H, Sutton RN, Scarffe JH. PMID: 6584619 [PubMed - indexed for MEDLINE] 5287. Nuovi Ann Ig Microbiol. 1984 Jan-Feb;35(1):79-83. [Antiviral action of a 40% solution of 5-iodo-2'-deoxyuridine] [Article in Italian] Simonetti N, Strippoli V, Scalzo M. PMID: 6536923 [PubMed - indexed for MEDLINE] 5288. Indian J Dermatol. 1984 Jan;29(1):31-4. Relation of herpes zoster with lepromatous leprosy (report of two cases). Shafique M, Singa AK, Prakash AP. PMID: 6526431 [PubMed - indexed for MEDLINE] 5289. Cleve Clin Q. 1984 Winter;51(4):667-9. Leukemia cutis presenting as a chronic herpes zoster ulceration. Mikesell JF, Bailin PL, Bergfeld WF. PMID: 6525762 [PubMed - indexed for MEDLINE] 5290. Ter Arkh. 1984;56(8):138-40. [Diagnostic difficulties in herpes zoster] [Article in Russian] Bogomolov BP, Bakhur EG. The authors have analysed the clinical and laboratory findings in 170 patients with herpes zoster (HZ). Of these, 21 patients (12.3%) had been erroneously diagnosed before the appearance of herpetic eruption as having other diseases (erysipelas, renal colic, acute pancreatitis, acute abdomen, and so forth). The authors point to the difficulties encountered in making the diagnosis at the initial disease period with emphasis on the great importance for early diagnosis of HZ of the analysis of the clinical findings, prodromal period and hemogram data. PMID: 6495196 [PubMed - indexed for MEDLINE] 5291. Sante Publique (Bucur). 1984;27(2):99-114. Herpes zoster and herpes simplex--public health matter; chelatotherapy in these acute neuroviroses. Dinu R, Dinu I. PMID: 6441289 [PubMed - indexed for MEDLINE] 5292. Med Oncol Tumor Pharmacother. 1984;1(2):87-96. The clinical application of fibroblast interferon--an overview. Billiau A. Preclinical as well as clinical studies with fibroblast interferon (IFN) are still lagging behind on those with leukocyte interferon. Its side-effects seem to be less pronounced than those of human IFN-alpha, yet it may be slightly pyrogenic after intravenous injection. Pyrogenicity of current impure preparations might for the larger part be due to impurities. Higher doses of HuIFN-beta than of HuIFN-alpha are required to obtain measurable blood titers by intramuscular injections. Since there is concern about this being due to destruction of the interferon before it has reached its target organ(s), most current clinical studies use either local (e.g. intratumoral) treatment or intravenous infusions. A study of topical treatment for acute rhinovirus infection has indicated that there is very little if any chance for fibroblast interferon to be a clinically useful substance to prevent or cure common cold. In herpetic dendritic keratitis eye drops of fibroblast interferon may be useful as such or in combination with debridement. Topical treatment of warts (multiple intralesional injections) has been shown to yield a high success rate, especially in the case of verrucae vulgares, but less so in the case of verrucae planae juveniles. Studies on condyloma accuminatum are not so far advanced as to permit a documented conclusion. Topical (intralesional) treatment of neoplastic diseases has been investigated, especially in Japan, to demonstrate that fibroblast interferon does have an antineoplastic effect in vivo. While there seems to be little doubt that local delivery does indeed cause tumor nodules to regress, the question is whether this procedure can offer a true clinical benefit to the patient. Systemic (intravenous) administration for chronic hepatitis B has been investigated further: given alone or in combination with adenine-arabinoside, fibroblast interferon seems to be able to reduce the level of viral activity. Whether this will lead to a generally accepted treatment of chronic active hepatitis is difficult to say at this moment. In treating herpes zoster in cancer patients, results have been obtained which are comparable to those found for leukocyte interferon. The practical significance of this finding must be seen in the perspective of recent developments in the chemotherapy of herpes zoster. In breast cancer patients given intramuscular injections, metastases in the skin, but not in other organs, showed alterations suggestive of an effect on tumor progression. Yet there was no true clinical benefit for the patient. In other tumors, e.g. head and neck epithelioma, no effect was seen.(ABSTRACT TRUNCATED AT 400 WORDS) PMID: 6400034 [PubMed - indexed for MEDLINE] 5293. J Int Med Res. 1984;12(4):255-60. Herpes zoster treatments: results of a clinical trial relative to the use of rifamycin SV versus neuramide. Bruni L, Tagliapietra G, Innocenti P. The authors describe a controlled clinical study in which rifamycin SV 250 mg intramuscularly and topical b.i.d. was compared to intramuscular neuramide b.i.d. plus, where necessary, other drugs (antibiotics, polivitamins, analgesics, etc.) for the treatment of two groups of thirty randomly selected patients suffering from herpes zoster. In all patients the symptoms were controlled by both treatments but statistical tests revealed that rifamycin SV was able to heal pain (p less than 0.05), vesicles, crusts and burning sensation (p less than 0.1) faster than neuramide. Furthermore, by the seventh day of therapy, the authors found that rifamycin SV reduced the intensity of both pain and erythema (p less than 0.01 for pain; p less than 0.05 for erythema) more than neuramide. PMID: 6381169 [PubMed - indexed for MEDLINE] 5294. Clin Neuropharmacol. 1984;7(1):51-82. Anticonvulsant drugs and chronic pain. Swerdlow M. PMID: 6367974 [PubMed - indexed for MEDLINE] 5295. Geriatrics. 1984 Jan;39(1):56-61, 64-6. Corneal disease: an approach to primary care. Schlichtemeier WR. PMID: 6360796 [PubMed - indexed for MEDLINE] 5296. Acta Clin Belg. 1984;39(3):159-62. [A rare complication of ophthalmic zona: spreading cerebral arteritis] [Article in French] André C, Bury J, Fillet G, Moonen G. PMID: 6333129 [PubMed - indexed for MEDLINE] 5297. Trans Ophthalmol Soc N Z. 1984;36:57-8. Pain relief in herpes ophthalmicus. Fernando LC, Talbot AN. PMID: 6332404 [PubMed - indexed for MEDLINE] 5298. Sov Med. 1984;(4):121-2. [Enzymatic profile of peripheral blood leukocytes in herpes zoster] [Article in Russian] Il'inskiĭ IuA, Dvurechenskaia GS, Dzhordzhadze NS, Markova EA. PMID: 6330911 [PubMed - indexed for MEDLINE] 5299. Annu Rev Med. 1984;35:279-91. Acyclovir and other chemotherapy for herpes group viral infections. Balfour HH Jr. The recent profusion of antiviral research has resulted in significant advances toward prevention and treatment of herpes group virus infections. The most promising new agent is acyclovir, which is available in topical, intravenous, and oral formulations. Results of clinical trials of acyclovir for prevention and treatment of herpes simplex, varicella-zoster virus, cytomegalovirus, and Epstein-Barr virus infections are discussed, and the potential problem of antiviral resistance considered. Vidarabine therapy is reviewed briefly, and future new drugs with activity against herpesviruses are mentioned. PMID: 6326661 [PubMed - indexed for MEDLINE] 5300. Adv Intern Med. 1984;29:25-58. The five human herpesviruses: infection, prevention, and treatment. Galasso GJ, Myers MW. PMID: 6324554 [PubMed - indexed for MEDLINE] 5301. Br J Clin Pract. 1984 Jan;38(1):21-4. Steroidstoss therapy in the treatment of herpes zoster. Sutton G. PMID: 6322830 [PubMed - indexed for MEDLINE] 5302. Prog Med Virol. 1984;29:166-96. Varicella-zoster virus infection in pregnancy. Enders G. PMID: 6322232 [PubMed - indexed for MEDLINE] 5303. J Med Virol. 1984;13(1):53-61. Detection of varicella-zoster virus by dot-blot hybridization using a molecularly cloned viral DNA probe. Seidlin M, Takiff HE, Smith HA, Hay J, Straus SE. Varicella-zoster virus (VZV) infection can be definitively diagnosed by isolation of virus in cell culture, a process that usually takes 7-14 days. In order to facilitate the more rapid detection of this virus, we developed a technique for hybridization of DNA from clinical specimens using an in vitro-labeled mixture of cloned fragments of VZV DNA as a probe. The assay can be completed in 36-48 hr and can be successfully carried out in the range of 10 pg to 10 ng of viral DNA. In analyses of 38 specimens from patients with a clinical diagnosis of VZV infection, the results of viral isolation and this assay were highly concordant. The sensitivity of standard cell culture for detection of VZV was 58%, whereas the sensitivity of the assay was 76%, not significantly different (P = 0.14). The specificity of cell culture was 100%, whereas that of the assay was 94% (P = 0.49). The technique appears to be sensitive, specific, and useful for analyses of tissues and body fluids. PMID: 6319586 [PubMed - indexed for MEDLINE] 5304. J Med Virol. 1984;13(1):1-12. Class-specific antibody responses to early and late antigens of varicella and herpes simplex viruses. Schmidt NJ, Gallo D. Antibody responses to early antigens of varicella-zoster virus (VZV), simian varicella virus, and herpes simplex virus types 1 and 2 (HSV-1 and HSV-2) were studied in primary, secondary, and latent infections. IgG antibody responses to the early antigens occurred in primary and secondary VZV and HSV infections, and antibodies to early antigens were also demonstrable in healthy individuals with latent VZV and HSV infections, indicating that the presence of antibodies to early antigens cannot be taken as evidence of active infection with the viruses. Patients with current VZV or HSV infections showed heterotypic IgG antibody responses to early antigens of VZV and HSV to the same extent as to late antigens. In all groups of patients, IgG antibody titers to early antigens were similar to those against the corresponding late antigens, and no difference was seen in the reactivity of early antigens produced with four different blocking agents (cytosine arabinoside, bromodeoxyuridine, trisodium phosphonoformate, and cycloheximide). Antibodies of the IgM and IgA classes reacted with both early and late antigens of HSV, but only with late antigens of VZV and simian varicella virus, suggesting that these antibodies may be directed against late proteins that are expressed to a greater extent in HSV-infected cells treated with blocking agents than they are expressed in treated VZV-infected cells. Homologous IgM antibody responses occurred in both primary and secondary VZV infections, but only in primary HSV infections. Heterotypic IgM responses to HSV-2 antigen were noted in a few VZV patients who did not have demonstrable IgG antibody to HSV, suggesting that even in patients without prior experience with HSV, a VZV infection may stimulate the production of IgM antibodies that react with antigens that are shared by VZV and HSV-2. IgA antibodies to late antigens of VZV and HSV were demonstrable in latent, as well as active, infections with these viruses. PMID: 6319583 [PubMed - indexed for MEDLINE] 5305. Am J Dis Child. 1984 Jan;138(1):56-9. Varicella-zoster antibody titers in children with leukemia and lymphoma. Relationship of titer to varicella-zoster infection. Hutter JJ Jr, Minnich LL, Ray CG. Serum varicella-zoster (VZ) antibody titers were determined by a simple, indirect immunofluorescent antibody technique in 50 children with leukemia or non-Hodgkin's lymphoma. Sixteen children had initial antibody titers that were not detectable at a serum dilution of 1:8 and were considered to be susceptible to varicella. Thirty-one patients had initial serum VZ antibody titers of 1:16 or greater, while three had levels of 1:8. The serum antibody titer was 1:8 or greater in 16 children with a history of varicella. Seven episodes of localized herpes zoster were observed in children whose VZ titer was 1:8 or greater prior to onset. Two nonfatal infections with primary varicella developed in children with leukemia in remission whose initial titers were less than 1:8 and were associated with a convalescent rise in VZ antibody to levels greater than 1:16. Three susceptible children received zoster immune plasma or zoster immune globulin for varicella exposure, causing a transient rise in serum VZ titer. The assessment of serum VZ titer by this immunofluorescent antibody technique combined with the prior varicella history is useful in defining the population of children with leukemia and non-Hodgkin's lymphoma who are susceptible to primary varicella. PMID: 6318551 [PubMed - indexed for MEDLINE] 5306. Ann N Y Acad Sci. 1984;437:559-62. A longitudinal study of cellular immunity in male homosexuals in London. Pinching AJ, Weber J, Rogers LA, Jeffries DJ, Harris JR. PMID: 6242008 [PubMed - indexed for MEDLINE] 5307. Ann Med Interne (Paris). 1984;135(8):662-8. [Cutaneous paraneoplastic syndromes] [Article in French] Barrière H. The authors list the really significant paraneoplastic cutaneous syndromes: acanthosis nigricans, paraneoplastic acrokeratosis, acquired ichthyosis (and eventually the "explosive" onset of seborrheic warts) and a special type of desquamative circinate erythema (erythema gyratum repens). The possible paraneoplastic character of other conditions is also discussed: dermatomyositis, necrosing vasculitis, autoimmune bullous conditions and pruritus "sine materia". PMID: 6241441 [PubMed - indexed for MEDLINE] 5308. Acta Biomed Ateneo Parmense. 1984;55(5-6):269-71. [Sacral herpes zoster: a cause of urination and defecation disorders] [Article in Italian] Bassissi P, Benoldi D, Alinovi A. A case of sacral herpes zoster associated with alteration of urination and defecation is presented. The pathogenetic mechanisms of these unusual complications are discussed. PMID: 6241410 [PubMed - indexed for MEDLINE] 5309. Henry Ford Hosp Med J. 1984;32(2):116-22. Prospects for the medical use of interferon in 1984. Postic B, Arroyo JC. PMID: 6210270 [PubMed - indexed for MEDLINE] 5310. Acta Derm Venereol. 1984;64(4):275-80. Naturally occurring T lymphocytotoxic antibody in viral and related skin diseases. Hosokawa H, Horio S, Takiuchi Y, Maruyama N, Asada Y. The naturally occurring T lymphocytotoxic antibodies in patients with viral and related skin diseases were investigated and compared with those of systemic lupus erythematosus (SLE). The incidences of T lymphocytotoxic antibodies in exanthema suspected of viral infection, infectious mononucleosis, rubella and pityriasis rosea were 28%, 44%, 8% and 28% respectively. Sera from patients with herpes zoster and erythema infectiosum did not show positivity. Incidence in SLE sera as positive control was 82%. The T lymphocytotoxic antibodies detected in skin diseases were similar in nature to those of SLE patients, but were transient and lower in titer than those of SLE. PMID: 6209882 [PubMed - indexed for MEDLINE] 5311. Clin Exp Neurol. 1984;20:129-40. Segmental motor paralysis in herpes zoster. Rice JP. Herpes zoster infection may be complicated by motor involvement, the most common example of this being facial palsy in the Ramsay Hunt syndrome. Segmental lower motor neurone weakness is an uncommon disorder which does occur in the limbs, such paralysis usually occurring in the same segments as the dermatomes involved, or in those immediately contiguous. Nine cases of limb weakness are described, the weakness often being severe and accompanied by wasting and segmental reflex impairment. Long tract signs were absent. The cervical region was affected more commonly than the lumbosacral area. The prognosis for recovery was usually good. The condition reflects anterior horn cell or anterior nerve root involvement by the herpes zoster virus at the same or adjacent segmental levels as the sensory lesion. PMID: 6096053 [PubMed - indexed for MEDLINE] 5312. Diagn Immunol. 1984;2(3):137-42. Serologic study by enzyme-linked immunosorbent assay of the IgM antibody response in the patas monkey following experimental simian varicella virus infection. Iltis JP, Achilli G, Madden DL, Sever JL. The time course of IgM and IgG antibody appearance in sera following experimental simian varicella virus infection in the patas monkey was studied. Serum IgM and IgG antibody to Delta herpes virus (DHV) were measured by a double indirect and indirect ELISA test, respectively. IgM antibody was detected 5-8 days postinfection (p.i.) and IgG antibody was present 10-14 days p.i., which was 5-7 days after IgM. Viremia preceded detectable IgM antibody by 2 days. Sucrose gradient separation of serum IgM and IgG was carried out to determine whether IgG competed significantly with IgM. Results of these studies indicated that competition by IgG with IgM antibody did not occur except when IgM had declined to a low level some 40 days p.i. Comparison of the double indirect ELISA test with a double indirect immunofluorescent antibody test for detection of IgM antibody to DHV antigen indicated the ELISA test was more sensitive. PMID: 6094088 [PubMed - indexed for MEDLINE] 5313. Probl Med Wieku Rozwoj. 1984;13:176-84. [Interferon] [Article in Polish] Smogorzewska E. Twenty five years ago Isaas and Lindenmann discovered that virus-infected cells may release a protein capable of reacting with normal cells and render them resistant to infection by a variety of viruses. That protein, a major mediator of viral interference was called interferon. Three main types of interferon have been identified and originally designated as fibroblast, leukocyte and immune interferon. According to the newly adopted nomenclature (as defined by the International Committee on Interfern Nomenclature) these interferons are now called beta, alpha and gamma interferon, respectively. The use of interferon as a therapeutic agent for tumor-bearing patients has gained considerable interest after reports demonstrated potent enhancing effects of interferon on the immunologic system. Thus, besides its direct effect on tumor cell multiplication, interferon may influence the host-tumor relationship by activating cells with potential antitumor activity such as natural-killer (NK) cells, killer (K) cells or macrophages. Interferon can also modify the metabolism of molecules involved in immunologic functions, such as antigen receptors, histocompatibility antigens or receptors for Fc fragment of immunologlobulins. Systematic clinical trials with interferon have been greatly expanded over the last three or four years. At this time the data support a cautious optimism for the therapeutic value of interferon in both viral and neoplastic diseases. PMID: 6085167 [PubMed - indexed for MEDLINE] 5314. Wiad Lek. 1983 Dec 15;36(24):2019-23. [Skin changes and symptoms in Hodgkin's disease] [Article in Polish] Gabryś K, Medraś E, Wołowiec D, Miklaszewska M. PMID: 6675313 [PubMed - indexed for MEDLINE] 5315. Can Med Assoc J. 1983 Dec 15;129(12):1284-5. Herpes zoster: treatment with cimetidine. Hayne ST, Mercer JB. The active phase of herpes zoster can be predicted from the length of time it takes for all the vesicles to erupt. A case is reported in which cimetidine therapy appeared to reduce the expected length of the active phase from 35 days or longer to 10 days. PMCID: PMC1875716 PMID: 6652595 [PubMed - indexed for MEDLINE] 5316. N Engl J Med. 1983 Dec 8;309(23):1434-40. Varicella and herpes zoster. Changing concepts of the natural history, control, and importance of a not-so-benign virus. Weller TH. New knowledge of the relationship between the varicella-zoster virus and its host suggests a heretofore unappreciated dynamic pattern. Molecular finger-printing has demonstrated a degree of heterogeneity between different strains of virus. It is probable that exogenous reinfection with different strains and endogenous reactivation are commonplace events, although usually asymptomatic. The lability of the endogenous interaction inversely parallels the responsiveness of the cell-mediated immune system--a major factor in viral containment by the human host. Thus, the therapeutic use of immunosuppressive or cytotoxic substances increases the morbidity and mortality associated with varicella-zoster. Promising new approaches to the prevention and treatment of the virus should alter the balance in favor of the host. PMID: 6195526 [PubMed - indexed for MEDLINE] 5317. Pain. 1983 Dec;17(4):361-8. Acupuncture compared with placebo in post-herpetic pain. Lewith GT, Field J, Machin D. A single blind randomised controlled study of auricular and body acupuncture compared with placebo (mock transcutaneous nerve stimulation) was performed in 62 patients with post-herpetic neuralgia. There was no difference in the amount of pain relief recorded in the two groups during or after treatment; 7 patients in the placebo group and 7 patients in the acupuncture group experienced significant improvement in their pain at the end of treatment. This suggests that acupuncture is of little value as an analgesic therapy for post-herpetic neuralgia. However the study method and the use of a mock transcutaneous nerve stimulator as a placebo may be of value when assessing the effects of acupuncture in other conditions. PMID: 6664681 [PubMed - indexed for MEDLINE] 5318. Ann Intern Med. 1983 Dec;99(6):882-3. Acyclovir and neurologic manifestations. Auwerx J, Knockaert D, Hofkens P. PMID: 6651045 [PubMed - indexed for MEDLINE] 5319. Am Fam Physician. 1983 Dec;28(6):138-44. Herpes zoster. Yardley DE, Schwartz RA, Adams HG. Herpes zoster ("shingles") is usually a benign, self-limited disease. However, it can be debilitating or even fatal. The potentially serious complications of ocular involvement or postherpetic neuralgia and the confusing therapeutic regimens that are often advocated make this a complicated subject. Dissemination is more common in immunosuppressed and elderly febrile patients, and the complications are more serious. Herpes zoster patients may benefit from treatment with vidarabine, currently the only antiviral agent approved for use in this disease. Corticosteroids may be helpful in selected patients. PMID: 6650330 [PubMed - indexed for MEDLINE] 5320. Eur J Clin Microbiol. 1983 Dec;2(6):581-7. Rapid and direct detection of herpes simplex virus and varicella-zoster virus antigens in clinical specimens by staphylococcal reagent and membrane filtration. Dishon T, Mogensen SC. Herpes simplex virus was detected rapidly and directly in 31 and varicella-zoster virus in two of 50 clinical specimens using specific antisera, stabilized staphylococci rich in protein A and membrane filtration. Microscopical examination of the cells retained on the filter membrane revealed attached staphylococci only on cells harbouring viral antigens but not on non-infected cells or cells from healthy donors. Infected cells treated with negative control sera and stabilized staphylococci and subsequently subjected to membrane filtration were also devoid of the marker. It was also possible to detect herpes simplex virus antigens in three specimens which were culture negative. Similar results were obtained with staphylococci specifically sensitized with anti-herpes simplex rabbit serum. No interfering, non-specific background of unattached staphylococci was observed on the filter membrane. The results were confirmed by the direct immunofluorescent test. The method is sensitive, specific, and provides results within 3 h. It could be employed for the rapid screening of populations at risk, e.g. pregnant women, medical personnel, and societies with a growing incidence of genital herpes. Since no special, expensive equipment is required, the method is also suitable for modestly equipped clinical laboratories. PMID: 6321167 [PubMed - indexed for MEDLINE] 5321. Pediatr Clin North Am. 1983 Dec;30(6):1123-44. Ocular findings in pediatric systemic disease. Richard JM, Friendly DS. The many diseases and disorders that frequently have ophthalmologic implications in the pediatric age group are discussed. PMID: 6316240 [PubMed - indexed for MEDLINE] 5322. N Engl J Med. 1983 Dec 1;309(22):1362-8. Varicella and herpes zoster. Changing concepts of the natural history, control, and importance of a not-so-benign virus. Weller TH. PMID: 6314138 [PubMed - indexed for MEDLINE] 5323. Orv Hetil. 1983 Nov 27;124(48):2913-8. [Intravenous acyclovir (ACV, Zovirax) therapy of varicella zoster infections in immunologically endangered patients] [Article in Hungarian] Kerpel-Fronius S, Nyerges G, Mészner Z, Eckhardt S, Walker E, Bridgen D. PMID: 6657237 [PubMed - indexed for MEDLINE] 5324. Lancet. 1983 Nov 26;2(8361):1223-5. DNA mapping of paired varicella-zoster virus isolates from patients with shingles. Pichini B, Ecker JR, Grose C, Hyman RW. Varicella-zoster virus (VZV) was isolated from two separate sites in each of three patients with shingles (herpes zoster). The DNAs of the six VZV isolates were compared by high-resolution restriction endonuclease analysis with HindIII, KpnI, and HpaI. DNA cleavage patterns for each pair of VZV isolates were indistinguishable. These studies suggest that clinical shingles is the manifestation of a single VZV strain that becomes reactivated and causes both a viraemia and a dermatomal exanthem. PMID: 6139571 [PubMed - indexed for MEDLINE] 5325. MMW Munch Med Wochenschr. 1983 Nov 18;125(46):1067-70. [Infections caused by viruses of the herpesvirus group. Possibilities of rapid diagnosis] [Article in German] Schneweis KE. PMID: 6316132 [PubMed - indexed for MEDLINE] 5326. N Engl J Med. 1983 Nov 17;309(20):1254-5. Acyclovir for immunocompromised patients with herpes zoster. [No authors listed] PMID: 6633579 [PubMed - indexed for MEDLINE] 5327. Med Clin (Barc). 1983 Nov 12;81(15):693. [Cutaneous hyperpigmentation and vidarabine] [Article in Spanish] Cirera L, Palou J, Estapé J. PMID: 6656419 [PubMed - indexed for MEDLINE] 5328. Aust Fam Physician. 1983 Nov;12(11):800-1. The many faces of herpes zoster. [No authors listed] PMID: 6667191 [PubMed - indexed for MEDLINE] 5329. Rev Med Suisse Romande. 1983 Nov;103(11):997-9. [Treatment of zona] [Article in French] Lasserre B. PMID: 6665385 [PubMed - indexed for MEDLINE] 5330. Klin Med (Mosk). 1983 Nov;61(11):116-21. [Viral infections in hemoblastoses] [Article in Russian] Loginskiĭ VE, Doroshenko LG. PMID: 6664044 [PubMed - indexed for MEDLINE] 5331. West J Med. 1983 Nov;139(5):718-20. Clinical aspects of herpes zoster. Glaser RB. PMCID: PMC1010991 PMID: 6606904 [PubMed - indexed for MEDLINE] 5332. Ann Neurol. 1983 Nov;14(5):591-2. Intracerebral hemorrhage with herpes zoster ophthalmicus. Elble RJ. PMID: 6606388 [PubMed - indexed for MEDLINE] 5333. Ann Neurol. 1983 Nov;14(5):543-53. Herpes zoster ophthalmicus and delayed contralateral hemiparesis caused by cerebral angiitis: diagnosis and management approaches. Hilt DC, Buchholz D, Krumholz A, Weiss H, Wolinsky JS. Four patients with herpes zoster ophthalmicus and delayed contralateral hemiparesis are described, and their findings are compared with those in patients previously reported in the English language literature. The current patients evidenced multifocal ipsilateral cerebral angiitis by angiography and multifocal infarcts in the distribution of the ipsilateral middle cerebral artery by computed tomographic scanning. Cerebrospinal fluid showed mononuclear pleocytosis, positive oligoclonal bands, and an elevated immunoglobulin G index. Two patients were treated with corticosteroids and acyclovir, and 1 with corticosteroids alone, all without apparent response. Necrotizing angiitis ipsilateral to the herpes zoster ophthalmicus was demonstrated postmortem in 1 patient with multifocal cerebral infarction and progressive leukoencephalopathy. Neither herpes varicella zoster immunocytochemical reactivity nor viral inclusions were seen. The leukoencephalopathy associated with herpes varicella zoster either may be caused by cerebral angiitis or, as previously reported, may be a temporally remote manifestation of persistent herpes varicella zoster infection. The cerebral angiitis associated with herpes varicella zoster is histologically similar to granulomatous angiitis, and both may be related to herpes varicella zoster infection of the cerebral vasculature. PMID: 6606387 [PubMed - indexed for MEDLINE] 5334. Br J Ophthalmol. 1983 Nov;67(11):751-4. Endothelial cell loss in herpes zoster keratouveitis. Reijo A, Antti V, Jukka M. Fourteen patients were followed up with slit-lamp, noncontact, and wide-field specular microscopical examination for anterior segment changes during unilateral attacks of keratouveitis due to varicella zoster virus (VZV). Ten patients had severe keratouveitis. Their affected eyes presented nonreflecting endothelial changes in different phases of the disease. The first non-reflecting changes suggesting virus endothelitis were observed at the onset of keratouveitis. These changes later recurred for several months. When the corneal oedema had subsided, the mean endothelial cell density of the affected eyes was on average 15.3% lower (p less than 0.01) than in the healthy fellow eyes. During early uveitis transient high intraocular pressure (IOP) developed in 5 patients. Patients with severe disease and an episode of high IOP had a 20.2% lower cell count in the diseased than in the healthy fellow eye. During the follow-up interstitial keratitis developed in 2 cases and focal iris atrophy in another 2. Four patients presented with mild keratouveitis. The posterior cornea and endothelial cell density in this group remained unchanged. PMCID: PMC1040193 PMID: 6605764 [PubMed - indexed for MEDLINE] 5335. Neurology. 1983 Nov;33(11):1428-32. Herpes zoster ophthalmicus and delayed ipsilateral cerebral infarction. Bourdette DN, Rosenberg NL, Yatsu FM. We studied five patients who had acute cerebral infarctions 5 weeks to 6 months after herpes zoster ophthalmicus (HZO). All had infarcts of the cerebral hemisphere ipsilateral to the HZO, and one also had a cerebellar infarct. Cerebral arteriography in one patient disclosed narrowing of the middle cerebral artery, occlusion of the anterior cerebral artery ipsilateral to the HZO and narrowing of the opposite anterior cerebral artery. In another case, arteriography revealed occlusion of the distal internal carotid artery on the side of the HZO. PMID: 6605495 [PubMed - indexed for MEDLINE] 5336. J Antimicrob Chemother. 1983 Nov;12(5):489-96. Subjective response to lysine in the therapy of herpes simplex. Walsh DE, Griffith RS, Behforooz A. To test the effect of lysine supplementation on herpes infection, 1543 subjects were surveyed by questionnaire after a six-month trial period. The study included subjects with cold sores, canker sores, and genital herpes. Of these, 54% had been diagnosed and treated by a physician. The results showed that the average dosage used was 936 mg of lysine daily. Eighty-four per cent of those surveyed said that lysine supplementation prevented recurrence or decreased the frequency of herpes infection. Whereas 79% described their symptoms as severe or intolerable without lysine, only 8% used these terms when taking lysine. Without lysine, 90% indicated that healing took six to 15 days, but with lysine 83% stated that lesions healed in five days or less. Overall, 88% considered supplemental lysine an effective form of treatment for herpes infection. PMID: 6423612 [PubMed - indexed for MEDLINE] 5337. Br J Ophthalmol. 1983 Nov;67(11):746-50. A comparison of topical acyclovir with steroids in the treatment of herpes zoster keratouveitis. McGill J, Chapman C. Topical acyclovir has been compared with topical steroids in a coded controlled trial of the treatment of keratouveitis caused by herpes zoster in 40 patients. Topical acyclovir was significantly superior to topical steroids in terms of treatment duration (75 days to 280 days), with no recurrences after the patients were weaned off treatment; there was a 63% recurrence rate in the steroid group. Corneal epithelial disease resolved significantly quicker in the acyclovir treated group. If recurrences occurred in the steroid group, other parts of the eye not initially affected were also involved. Treatment of such recurrences was more difficult than treatment of the initial attack. PMCID: PMC1040192 PMID: 6357273 [PubMed - indexed for MEDLINE] 5338. Blood. 1983 Nov;62(5):941-64. Allogenic bone marrow transplantation: current status and future directions. O'Reilly RJ. PMID: 6354307 [PubMed - indexed for MEDLINE] 5339. Haematologica. 1983 Nov-Dec;68(6):812-6. An open trial with acyclovir for the treatment of viral infections in marrow graft recipients. Van Lint MT, Frassoni F, Melioli G, Marmont A, Lombardi A, Bacigalupo A. PMID: 6321303 [PubMed - indexed for MEDLINE] 5340. Isr J Med Sci. 1983 Nov;19(11):959-62. Human fibroblast interferon in treatment of viral diseases of the skin and mucous membranes. Isacsohn M, Berson B, Sternberg I, Morag A. The therapeutic effect of human fibroblast interferon (HFIF) was studied in 33 patients. Seven had ophthalmic lesions (three due to adenovirus Type 8, four to herpes simplex virus, and one to herpes zoster) and were treated with HFIF. In the four patients with herpes simplex keratitis, HFIF was given in addition to standard therapy or together with other antiviral agents. Ten other patients, 8 with herpes simplex or herpes zoster skin or mucous membrane lesions, were treated with HFIF. HFIF was incorporated into an ointment as well as into a solution for subconjunctival infections. Although the number of cases was small, our results showed that HFIF was effective in shortening the course of the disease. PMID: 6319325 [PubMed - indexed for MEDLINE] 5341. J Clin Microbiol. 1983 Nov;18(5):1146-9. Serum immunoglobulin A antibody to varicella-zoster virus in subjects with primary varicella and herpes zoster infections and in immune subjects. Wittek AE, Arvin AM, Koropchak CM. Immunoglobulin A (IgA) antibodies to varicella-zoster virus (VZV) were measured in sera from subjects with acute varicella and herpes zoster, VZV-immune subjects remote from infection, and recipients of a live attenuated varicella vaccine, using a solid-phase radioimmunoassay. Primary infection with VZV was associated with early production of IgA antibodies. Among 36 subjects with varicella tested 1 to 5 days after onset, 22 had detectable IgA, and all of the negative sera were obtained before day 3 of the varicella exanthem. VZV IgA was detected in one of three sera obtained more than 60 days after onset of the illness. Four of five sera obtained from subjects within 1 week of the onset of herpes zoster had measurable levels of IgA. Between 1 and 4 weeks after onset of zoster, all 10 subjects tested had detectable IgA to VZV. VZV IgA was detected as late as 63 days after the onset of herpes zoster. Of 10 vaccine recipients, 5 developed VZV IgA which was detected as early as 4 weeks and persisted for as long as 16 weeks after vaccination. VZV IgA was not detected in sera from 42 children who had no detectable IgG antibody to VZV. VZV IgA was found on only 3 of 23 sera from adults who had varicella more than 20 years before. PMCID: PMC272858 PMID: 6315766 [PubMed - indexed for MEDLINE] 5342. Drugs. 1983 Nov;26(5):378-438. Acyclovir. A review of its pharmacodynamic properties and therapeutic efficacy. Richards DM, Carmine AA, Brogden RN, Heel RC, Speight TM, Avery GS. Acyclovir (aciclovir) is a nucleoside analogue antiviral drug related to cytarabine, idoxuridine, trifluridine and vidarabine. In common with these earlier antivirals, acyclovir is active against some members of the herpesvirus group of DNA viruses. The efficacy of topical acyclovir has been convincingly demonstrated in ocular herpetic keratitis, and in initial and primary initial genital herpes infection, but little or no clinical benefit was seen when non-primary initial genital infections were assessed separately. Acyclovir ointment demonstrated little benefit in recurrent genital herpes but topical acyclovir cream decreased the course of the infection by 1 to 2 days. Orally and intravenously administered acyclovir were beneficial in initial genital herpes infections, and oral therapy shortened the duration of recurrent infections by 1 to 2 days but did not ameliorate pain. In non-immunocompromised patients with recurrent herpes simplex labialis, generally little clinical benefit was seen with the use of topical acyclovir ointment even when therapy was initiated during the prodromal phase, while topical acyclovir cream effected small but significant improvements in the clinical but not the symptomological course of the disease. However, in immunocompromised patients, both intravenous and topical acyclovir shortened the clinical course of herpes simplex virus infections occurring mainly on the lips, oral mucosa and face, and prophylaxis with either oral or intravenous acyclovir suppressed the appearance of recurrent lesions from latent virus for the period of drug administration, but acyclovir did not eradicate latent herpesviruses. In non-immunocompromised patients, intravenous acyclovir was shown to decrease the acute pain of zoster, especially in the elderly, but postherpetic neuralgia was not ameliorated. When immunocompromised patients were studied, intravenous acyclovir inhibited the progression of zoster infections and shortened the healing time and duration of viral shedding in patients with cutaneous disseminated zoster. However, acute and post-herpetic pain were not significantly affected. Well designed controlled studies are underway to establish the efficacy of acyclovir in herpes simplex encephalitis and cytomegalovirus infections in immunocompromised patients, infections due to Epstein-Barr virus, and neonatal herpesvirus infections. Despite some aspects of the drug's use which require further clarification, acyclovir will make a major impact on the treatment of herpesviral infections. Barring unexpected findings with wider clinical use, it will become the agent of choice in several conditions. PMID: 6315332 [PubMed - indexed for MEDLINE] 5343. N Engl J Med. 1983 Oct 20;309(16):963-70. Drug therapy. Treatment of herpesvirus infections. Hirsch MS, Schooley RT. PMID: 6194435 [PubMed - indexed for MEDLINE] 5344. Lancet. 1983 Oct 8;2(8354):814-6. Varicella-zoster virus RNA in human trigeminal ganglia. Hyman RW, Ecker JR, Tenser RB. The technique of in situ hybridisation was used to examine human trigeminal ganglia for the presence of varicella-zoster virus (VZV) RNA. The ganglia were removed from fresh cadavers of individuals without a history of current or recent herpes zoster. Of the various types of cell in the ganglia, only the neurons appeared positive for VZV RNA. 0 to 0.3% of neurons were positive for VZV RNA. PMID: 6137648 [PubMed - indexed for MEDLINE] 5345. Arch Neurol. 1983 Oct;40(10):637-42. Microorganisms as antineoplastic agents in CNS tumors. Kapp JP. In two patients, malignant tumors unexpectedly regressed following infections. I reviewed the extensive body of literature, both experimental and clinical, concerning the antineoplastic potential of bacteria and viruses. Substantial evidence exists to indicate that microorganisms may, by growing in or near tumors, completely or partially inhibit tumor growth, or alternatively may have no effect at all. In fact, oncolysis may occur only when a specific organism infects a specific tumor. PMID: 6688521 [PubMed - indexed for MEDLINE] 5346. J Assoc Physicians India. 1983 Oct;31(10):669-71. Two unusual cases of herpes zoster involving cranial nerves. Baruah MC, Lal S, Padiyar NV. PMID: 6671938 [PubMed - indexed for MEDLINE] 5347. J Assoc Physicians India. 1983 Oct;31(10):617-8. Interesting new findings regarding the age old shingles. Sainani GS, Deshpande DV. PMID: 6671929 [PubMed - indexed for MEDLINE] 5348. Indian J Dermatol. 1983 Oct;28(4):173-4. Ophthalmic zoster in infancy. A case report. Bharija SC, Kanwar AJ, Singh G. PMID: 6608489 [PubMed - indexed for MEDLINE] 5349. Isr J Med Sci. 1983 Oct;19(10):874-5. Rapid viral diagnosis: a review. Gershon AA. PMID: 6363344 [PubMed - indexed for MEDLINE] 5350. Rev Ig Bacteriol Virusol Parazitol Epidemiol Pneumoftiziol Pneumoftiziol. 1983 Oct-Dec;32(4):361-5. [Herpes zoster varicellosus in a case of silicotuberculosis] [Article in Romanian] Ispas TL, Căruntu V, Dumitrescu V. PMID: 6320342 [PubMed - indexed for MEDLINE] 5351. J Infect Dis. 1983 Oct;148(4):630-8. Common expression of varicella-zoster viral glycoprotein antigens in vitro and in chickenpox and zoster vesicles. Weigle KA, Grose C. Human cells infected with varicella-zoster virus (VZV) produce at least three major virus-specific, immunogenic glycoproteins: gp118, gp98, and gp62. Since glycoproteins gp98 and gp62 were found to be prominent constituents of the infected cell membrane, a murine monoclonal antibody (clone 3B3) that reacted avidly with this glycoprotein complex was selected as a probe for detection of VZV replication in laboratory and clinical settings. Cultured cells of human, simian, and caviid origin, when infected with wild-type isolates as well as laboratory and vaccine strains of VZV all expressed these viral glycoproteins. The monoclonal antibody immunostained the basal and malpighian epithelial layers of a zoster vesicle biopsy specimen and also reacted with all specimens of vesicular cells obtained from epidemiologically unrelated patients with chickenpox and zoster. Thus, these studies demonstrate that the VZV-specific glycoprotein complex gp98/gp62 is highly conserved, abundantly expressed, and easily detected with a monoclonal antibody probe. PMID: 6313814 [PubMed - indexed for MEDLINE] 5352. Minn Med. 1983 Oct;66(10):623-5. Varicella-zoster infections. Advances in the prevention and treatment. Bean B, Balfour HH Jr. PMID: 6196611 [PubMed - indexed for MEDLINE] 5353. Vestn Dermatol Venerol. 1983 Sep;(9):57-9. [Treatment of herpes zoster with methisazone] [Article in Russian] Sergeev SIa, Milevskaia SG, Oksenov BS, Levitskaia NS, Labzovskaia NP. PMID: 6649872 [PubMed - indexed for MEDLINE] 5354. J Infect Dis. 1983 Sep;148(3):607. Immunoglobulin levels in serum and cerebrospinal fluid in certain viral infections of the central nervous system. Prasad R. It is seriously debated whether the presence of immunoglobulins in CSF is due to local production, diffusion of proteins through the blood-brain barrier, or both. Tourtellotte et al [1] strongly suggest that in both healthy and diseased individuals, immunoglobulins are synthesized extravascularly and subsequently diffuse into the CSF. Cohen and Bannister [2] demonstrated that lymphocytes from the CSF of patients with multiple sclerosis could produce IgA and IgG in vitro. Although such evidence suggests the likelihood of local production of immunoglobulins, others believe that elevated protein levels in CSF are due to migration of immunoglobulins from serum to CSF because of damage to the blood-brain barrier [3]. Thus, the elevated IgG level in CSF could be an expression of such an impaired blood-brain barrier. A further implication of this hypothesis is that the more the function of this barrier is impaired, the more extensive is the transudation. This includes the migration of large molecules such as IgM during the inflammatory state, a condition which increases not only the number of theoretical filters but also the size of the pores. IgG levels in CSF and serum were elevated in all five infections studied except viral encephalitis, in which this value remained normal. The serum IgA level was elevated in all five lesions, but the IgA level in CSF was elevated only in viral encephalitis, Guillain-Barré syndrome, and meningeal carcinomatosis.(ABSTRACT TRUNCATED AT 250 WORDS) PMID: 6619581 [PubMed - indexed for MEDLINE] 5355. Arch Dermatol. 1983 Sep;119(9):788-9. Cutaneous sarcoid granuloma formation in herpes zoster scars. Bisaccia E, Scarborough DA, Carr RD. PMID: 6614968 [PubMed - indexed for MEDLINE] 5356. South Med J. 1983 Sep;76(9):1189-92. Thymic hyperplasia in a case of Hodgkin's disease. Grissom JR, Durant JR, Whitley RJ, Flint A. PMID: 6604334 [PubMed - indexed for MEDLINE] 5357. Rev Med Interne. 1983 Sep;4(3):289-93. [Efficacy and tolerability of acyclovir in immunosuppressed patients with herpes simplex, herpes zoster or cutaneomucous chicken-pox. Multicenter trial apropos of 50 cases] [Article in French] Dellamonica P, Bernard E, Chichmanian RM. A multicenter trial of Acyclovir was carried out in 50 immunodepressed patients. The dose used was 15 mg/kg/day for 5 days in herpes simplex and 30 mg/kg/day for 10 days in herpes zoster and chicken pox by three one-hourly intravenous infusion per day. Acyclovir had a clear cut effect in 42 cases, a partial effect in 1 case, no effect in 1 case, and its action could not be assessed in 6 cases. The cutaneous and mucous membrane lesions were stabilised after an average of two days' treatment, and regression was observed from the third day. Of the 21 cases of zoster, 15 were cured without sequellae and 5 with post-zoster pain. The treatment failed in one patient. Of the 21 cases of cutaneous and/or mucous membrane herpes simplex, 20 satisfactory and 1 partial result were obtained. The outcomes of the 2 cases of chicken pox were favourable. There were three relapses after the end of therapy (2 herpes simplex, 1 zoster) but their outcomes were favourable after a second course of Acyclovir. In 20 cases it was possible to maintain the immuno-suppressive therapy. General tolerance was satisfactory. PMID: 6364284 [PubMed - indexed for MEDLINE] 5358. Ophthalmic Surg. 1983 Sep;14(9):763-5. Cicatricial ectropion secondary to herpes zoster. Nasr AM, Beyer-Machule CK, Yeatts RP. We present three patients with cicatricial ectropion of the upper and lower lids secondary to herpes zoster. Surgical release of the lid traction, excision of scars, and full thickness skin grafting were performed with satisfactory results. PMID: 6358990 [PubMed - indexed for MEDLINE] 5359. J Antimicrob Chemother. 1983 Sep;12 Suppl B:45-9. A review of acyclovir treatment of ocular herpes zoster and skin infections. McGill J, Chapman C, Copplestone A, Maharasingam M. Intravenous acyclovir had a significant effect on the resolution of the skin rash in patients with acute zoster, but the 5-day course of therapy was not, in itself, sufficient to treat coexisting ocular involvement. In an open study, topical acyclovir was found to control herpes zoster kerato-uveitis, without recurrences and in a shorter time than if steroids alone were used. The use of steroids in combination with acyclovir led to prolonged treatment and high recurrence rates. A comparative trial of topical acyclovir versus steroids in the treatment of acute herpes zoster kerato-uveitis showed significant differences in favour of acyclovir in terms of the time to resolution of corneal epithelial disease, total treatment duration and the numbers of patients having a recurrence of infection. The reductions in treatment duration and recurrence rate would be expected to result in a reduced incidence of ocular damage and visual loss in acyclovir treated patients. PMID: 6355050 [PubMed - indexed for MEDLINE] 5360. J Antimicrob Chemother. 1983 Sep;12 Suppl B:123-7. Acyclovir in shingles. Bean B, Aeppli D, Balfour HH Jr. Acyclovir given intravenously in either low dose (5 mg/kg every 8 h) or high dose (500 mg/m2 every 8 h) significantly reduced pain and accelerated skin healing in acute herpes zoster occurring in otherwise healthy adults. The higher dose also significantly reduced the duration of viral shedding. No significant effect on post-herpetic neuralgia could be demonstrated, although the higher dose showed a promising trend. No adverse effects were associated with the lower dose, but acyclovir at 500 mg/m2 resulted in nausea, vomiting and transiently elevated serum creatinine in a substantial number of patients. PMID: 6355047 [PubMed - indexed for MEDLINE] 5361. Br J Clin Pract. 1983 Sep;37(9):304-6. Prevention of post-herpetic neuralgia by amantadine hydrochloride (Symmetrel). Galbraith AW. PMID: 6354236 [PubMed - indexed for MEDLINE] 5362. Ariz Med. 1983 Sep;40(9):616-20. Acyclovir. Wood D. PMID: 6314944 [PubMed - indexed for MEDLINE] 5363. J Reprod Med. 1983 Sep;28(9):600-3. Pregnancy complicated by herpes zoster. A report of two cases and literature review. Eyal A, Friedman M, Peretz BA, Paldi E. Herpes zoster during pregnancy is rare, with only 13 reported cases. Although the prognosis is usually favorable, the disease can be associated with congenital malformations. We treated two pregnant women with herpes zoster at 25 and 31 weeks of gestation. The disease was diagnosed clinically and confirmed by serology and virus isolation. Both women delivered normal infants with normal development. PMID: 6313918 [PubMed - indexed for MEDLINE] 5364. J Antimicrob Chemother. 1983 Sep;12 Suppl B:195-9. The present and future for acyclovir. Brigden D, Keeney RE, King DH. PMID: 6313599 [PubMed - indexed for MEDLINE] 5365. J Antimicrob Chemother. 1983 Sep;12 Suppl B:169-79. Acyclovir therapy of varicella-zoster virus infections in immunocompromised patients. Balfour HH Jr, McMonigal KA, Bean B. In a randomized, placebo-controlled, double-blind trial of intravenous acyclovir in the treatment of varicella zoster virus (VZV) infections, 8 of 20 immunocompromised children with varicella received acyclovir (500 mg/m2/dose three times daily for 7 days). There was no significant difference in skin healing between the acyclovir and placebo groups although there was a significant reduction in the incidence of development of pulmonary involvement during acyclovir treatment. Nineteen out of 34 patients received vidarabine (10 mg/kg/day for 5 days). Vidarabine significantly shortened the duration of new vesicle formation. Both drugs significantly reduced the incidence of visceral varicella, the most serious complication of VZV infection. An open trial also concluded that early treatment of varicella in these patients is essential. Of the 94 patients with zoster infection, 52 received acyclovir (500 mg/m2/dose infused over one hour three times daily for 7 days). Acyclovir recipients healed more rapidly, had fewer days of pain and shorter duration of viral shedding compared with placebo patients. The most important finding was that acyclovir significantly protected against progression of zoster as defined by development or progression of cutaneous dissemination and development of visceral zoster. Vidarabine seemed to be equally effective in this respect. The likelihood of cutaneous dissemination is related to the nature of the underlying condition. The in vitro sensitivity of VZV isolates from patients with second episode VZV infection during the trial did not change appreciably which suggests that VZV does not become resistant to acyclovir during therapy. PMID: 6313596 [PubMed - indexed for MEDLINE] 5366. Med Clin North Am. 1983 Sep;67(5):973-90. Ocular viral infections. Pavan-Langston D. The most important viral organisms involving the eye are the DNA viruses herpes simplex, varicella-zoster, cytomegalovirus, adenovirus, and vaccinia virus. All of these agents except CMV may cause acute epithelial infection, sterile trophic ulceration due to basement membrane damage, deep corneal stromal immune reaction, and iritis. Although there are three excellent antiviral drugs commercially available, only HSV and vaccinia virus are highly sensitive to therapy with these antimetabolites; varicella-zoster virus and CMV are equivocally responsive and adenovirus has not been shown to be susceptible to these agents. In selected situations, topical or systemic corticosteroids are useful for managing any associated immune reactions in the eyes, but patients on these drugs should be monitored carefully both for superinfections and for interference with tissue healing that might ultimately threaten the integrity of the globe. PMID: 6312219 [PubMed - indexed for MEDLINE] 5367. Med Clin North Am. 1983 Sep;67(5):1075-92. Viral infections in immunocompromised patients. Wong DT, Ogra PL. PMID: 6312214 [PubMed - indexed for MEDLINE] 5368. Drug Intell Clin Pharm. 1983 Sep;17(9):623-8. The clinical use of intravenous acyclovir. Hopefl AW. Acyclovir (acycloguanosine) is a new antiviral compound with activity against certain herpes viruses. Acyclovir is phosphorylated preferentially in virus-infected cells into its active form, acyclovir triphosphate, an inhibitor of viral-induced DNA polymerase. Acyclovir, which possesses an acyclic carbohydrate moiety, also causes premature DNA chain termination. Acyclovir has shown clinical activity against herpes simplex virus (HSV) types 1 and 2 and varicella zoster virus (VZV), but its usefulness in cytomegalovirus, Epstein-Barr virus, and chronic hepatitis B infections requires further study. In randomized clinical trials of infections caused by HSV and VZV, intravenous acyclovir has been shown to shorten the duration of viral shedding and lesion pain and hasten the resolution of skin lesions, with minimal toxicity. PMID: 6311503 [PubMed - indexed for MEDLINE] 5369. JAMA. 1983 Aug 19;250(7):936-7. Herpes zoster infection and use of oral anticoagulants. A potentially dangerous association. Blumenkopf B, Lockhart WS Jr. PMID: 6864976 [PubMed - indexed for MEDLINE] 5370. Arthritis Rheum. 1983 Aug;26(8):937-46. Sustained improvement of intractable rheumatoid arthritis after total lymphoid irradiation. Field EH, Strober S, Hoppe RT, Calin A, Engleman EG, Kotzin BL, Tanay AS, Calin HJ, Terrell CP, Kaplan HS. Total lymphoid irradiation (TLI) was administered to 11 patients who had intractable rheumatoid arthritis that was unresponsive to conventional medical therapy, including aspirin, multiple nonsteroidal antiinflammatory drugs, gold salts, and D-penicillamine. Total lymphoid irradiation was given as an alternative to cytotoxic drugs such as azathioprine and cyclophosphamide. After radiotherapy, 9 of the 11 patients showed a marked improvement in clinical disease activity as measured by morning stiffness, joint tenderness, joint swelling, and overall functional abilities. The mean improvement of disease activity in all patients ranged from 40-70 percent and has persisted throughout a 13-28 month followup period. This improvement permitted the mean daily steroid dose to be reduced by 54%. Complications included severe fatigue and other constitutional symptoms during radiotherapy, development of Felty's syndrome in 1 patient, and an exacerbation of rheumatoid lung disease in another. After therapy, all patients exhibited a profound T lymphocytopenia, and a reversal in their T suppressor/cytotoxic cell to helper cell ratio. The proliferative responses of peripheral blood mononuclear cells to phytohemagglutinin, concanavalin A, and allogeneic leukocytes (mixed leukocyte reaction) were markedly reduced, as was in vitro immunoglobulin synthesis after stimulation with pokeweed mitogen. Alterations in T cell numbers and function persisted during the entire followup period, except that the mixed leukocyte reaction showed a tendency to return to normal values. PMID: 6882488 [PubMed - indexed for MEDLINE] 5371. Am J Dis Child. 1983 Aug;137(8):801-2. Herpes zoster in normal and immunocompromised children. Latif R, Shope TC. PMID: 6869342 [PubMed - indexed for MEDLINE] 5372. Singapore Med J. 1983 Aug;24(4):218-20. Herpes zoster in patients with systemic lupus erythematosus. Wang F, Chua CT, Bosco J. PMID: 6648552 [PubMed - indexed for MEDLINE] 5373. Vestn Dermatol Venerol. 1983 Aug;(8):36-7. [6 cases of recurring herpes zoster] [Article in Russian] Korsunskaia IM, Anton'ev AA, Fokin MA. PMID: 6637068 [PubMed - indexed for MEDLINE] 5374. J Neurol Neurosurg Psychiatry. 1983 Aug;46(8):786-7. Hemispheric infarction after herpes zoster ophthalmicus. Menkes DB, Bishara SN, Corbett AJ. PMCID: PMC1027536 PMID: 6604135 [PubMed - indexed for MEDLINE] 5375. N C Med J. 1983 Aug;44(8):500-1. Shingles. Heald PW, Burton CS, Callaway JL. PMID: 6579360 [PubMed - indexed for MEDLINE] 5376. Ann Intern Med. 1983 Aug;99(2):151-8. National case-control study of Kaposi's sarcoma and Pneumocystis carinii pneumonia in homosexual men: Part 2. Laboratory results. Rogers MF, Morens DM, Stewart JA, Kaminski RM, Spira TJ, Feorino PM, Larsen SA, Francis DP, Wilson M, Kaufman L. The Centers for Disease Control conducted a case-control study to investigate an outbreak of Kaposi's sarcoma and Pneumocystis carinii pneumonia in homosexual men. The occurrence of these diseases was found to be associated with certain aspects of lifestyle, including a greater number of male sex partners per year, exposure to feces during sex, history of syphilis and non-B hepatitis, treatment for enteric parasites, and use of various illicit substances. Laboratory studies reflected both this lifestyle and the probable underlying cause of the Kaposi's sarcoma and P. carinii pneumonia--cellular immune deficiency. Patients were found to have lymphopenia, specifically a deficiency of the T-helper subpopulation, resulting in a reversal of the T-helper to T-suppressor ratio. Levels of IgG and IgA were increased. When compared with controls, patients were also found to have significantly higher titers of antibody to Epstein-Barr virus and cytomegalovirus, a higher prevalence of antibody to hepatitis A virus and Treponema pallidum, a lower prevalence of antibody to varicella zoster virus, and a higher frequency of isolation of cytomegalovirus. PMID: 6309049 [PubMed - indexed for MEDLINE] 5377. J Med Microbiol. 1983 Aug;16(3):303-8. Virological course of herpes zoster in otherwise normal hosts. Cevenini R, Donati M, Rumpianesi F, Moroni A, Tosti A, Patrizi A, Varotti C, Negosanti M. The virological course of herpes zoster infection in 42 otherwise normal hosts was studied by virus isolation and antibody titration. Varicella-zoster virus (VZV) was isolated from vesicle fluid from all three patients examined on the first day of the vesicular eruption and from five out of six examined on the second day. The isolation rate fell to one out of six patients on the seventh day of illness and VZV was not isolated from patients at a later stage of the illness. IgG antibodies were detected by IFAMA and ELISA, in sera from all the patients by the end of the first week of illness; IgG antibody titres were highest during the second and the third weeks. IgM antibodies to VZV were detected in sera from six of the 42 patients with herpes zoster after fractionation by ion-exchange chromatography. PMID: 6308258 [PubMed - indexed for MEDLINE] 5378. Ned Tijdschr Geneeskd. 1983 Jul 2;127(27):1191-4. [A 5-year-old girl with generalized herpes zoster] [Article in Dutch] Hoekstra GR. PMID: 6888585 [PubMed - indexed for MEDLINE] 5379. Arch Neurol. 1983 Jul;40(7):445-6. Myelopathy after herpes zoster. Muder RR, Lumish RM, Corsello GR. A 73-year-old woman with a remote history of carcinoma of the ovary had herpes zoster involving several lumbosacral dermatomes. There subsequently developed a progressive myelopathy with normal myelographic findings and CSF pleocytosis. Vidarabine (15 mg/kg/day) was given for ten days. No further progression occurred. The syndrome of progressive myelopathy following herpes zoster is rare; direct viral invasion of the cord with subsequent necrosis appears to be the pathogenic mechanism. Antiviral therapy may have halted progression, but it did not lead to recovery of function. PMID: 6860184 [PubMed - indexed for MEDLINE] 5380. Pathologica. 1983 Jul-Aug;75(1038):557-63. [Virus-associated hematophagocytic syndrome observed in 2 cases of fatal varicella-zoster infections] [Article in Italian] Bontempini L, Doglioni C, Brandi G, Alloi I, Colombari R. PMID: 6669414 [PubMed - indexed for MEDLINE] 5381. Aust Fam Physician. 1983 Jul;12(7):500. Herpes zoster (shingles). Murtagh JE. PMID: 6639484 [PubMed - indexed for MEDLINE] 5382. Harefuah. 1983 Jul;105(1-2):11-3. [Idiopathic hypoparathyroidism in the elderly] [Article in Hebrew] Sirkis I, Okun G, Leventhal H, Strauss Z. PMID: 6629178 [PubMed - indexed for MEDLINE] 5383. Rinsho Shinkeigaku. 1983 Jul;23(7):613-6. [Case of herpes zoster ophthalmicus with contralateral hemiplegia and normal pressure hydrocephalus] [Article in Japanese] Tsuda T, Inoue N, Shiraishi S, Yamato T, Tsukamoto Y. PMID: 6607150 [PubMed - indexed for MEDLINE] 5384. Ann Neurol. 1983 Jul;14(1):84-5. Herpes zoster ophthalmicus with contralateral hemiplegia: identification of cause. Doyle PW, Gibson G, Dolman CL. A patient with herpes zoster ophthalmicus developed hemiparesis that at first responded to steroids but, when these were reduced, culminated in massive cerebral infarction and death. The cause was an extensive necrotizing arteritis of large and small cerebral arteries. Herpes-like virions were identified in smooth muscle cells of the middle cerebral artery. PMID: 6604495 [PubMed - indexed for MEDLINE] 5385. Quintessenz. 1983 Jul;34(7):1407-13. [Therapy of viral oral mucosal diseases] [Article in German] Haneke E. PMID: 6583738 [PubMed - indexed for MEDLINE] 5386. Stomatologiia (Mosk). 1983 Jul-Aug;62(4):78-9. [Necrotic form of herpes zoster of the maxillofacial area] [Article in Russian] Poliak GB, Rusak MK, Kaspina AI. PMID: 6578631 [PubMed - indexed for MEDLINE] 5387. Oral Surg Oral Med Oral Pathol. 1983 Jul;56(1):39-46. Alveolar bone necrosis and tooth loss. a rare complication associated with herpes zoster infection of the fifth cranial nerve. Wright WE, Davis ML, Geffen DB, Martin SE, Nelson MJ, Straus SE. Eleven case reports involving herpes zoster infection associated with alveolar bone necrosis and tooth loss were reviewed in order to develop a patient profile for this rare combination of physical findings. The clinical course of a 56-year-old white woman with herpes zoster infection of the fifth cranial nerve and related alveolar bone necrosis, tooth loss, and oroantral fistula development is reported. The etiology and management of herpes zoster infection associated with destructive oral sequelae are discussed. PMID: 6576309 [PubMed - indexed for MEDLINE] 5388. Bol Asoc Med P R. 1983 Jul;75(7):308-10. [Effects of acyclovir on mucocutaneous herpes] [Article in Spanish] Garib JL, Gurrea C, Torres A, Bermúdez RH. PMID: 6335969 [PubMed - indexed for MEDLINE] 5389. Z Geburtshilfe Perinatol. 1983 Jul-Aug;187(4):155-67. [Virus and other infections in pregnancy: diagnosis and prevention. 2] [Article in German] Enders G. The various viral and other microbial infections represent only a small proportion (5-10%) of the noxae which threaten pregnancy and the fetus. However, interest is centered on them because methods of controlling them are now available. These include preventive measures, e.g., active immunization prior to pregnancy for measles, mumps, and rubella; passive prophylaxis with immunoglobulins when the pregnant women comes into contact with, e.g., rubella and varicella, and passive-active prophylaxis with hyperimmunoglobulin and simultaneous active immunization of the newborns from HBsAg and HBeAg-positive resp. anti-HBe-negative mothers and early therapy. The latter is possible for acute herpes simplex and toxoplasmosis infection; it is effective for lues and infections with gonococci, listeriae, beta-hemolytic streptococci, chlamydiae and mycoplasmas. In cases of acute rubella during the first 17 weeks of pregnancy termination of pregnancy must also be considered a prophylactic measure. Laboratory diagnosis today includes, in addition to the conventional tests for antibodies and pathogens, determination of IgG (permanent) and IgM (early) antibodies as well as demonstration of antigens. Depending on the type of pathogen and the diagnostic problem, several types of serologic tests must be combined for rapid determination of the immune status on contact or for detection of acute infections in pregnancy; necessitating in some instances also the isolation of the pathogen. Diagnostic procedures are similar for identifying prenatal and perinatal infection with and without abnormalities in the neonate. Modern laboratory diagnosis is therefore very important for prophylactic and therapeutic measures in pregnancy as well as for further management and supportive care of congenitally infected infants. PMID: 6312703 [PubMed - indexed for MEDLINE] 5390. Tex Med. 1983 Jul;79(7):27-9. What's new: acyclovir for treatment of ocular viral infections. Wilhelmus KR, Jones DB. PMID: 6312627 [PubMed - indexed for MEDLINE] 5391. Am J Clin Pathol. 1983 Jul;80(1):57-60. Treatment of varicella-zoster meningoencephalitis with acyclovir--demonstration of virus in cerebrospinal fluid by electron microscopy. Steele RW, Keeney RE, Bradsher RW, Moses EB, Soloff BL. Disseminated varicella-zoster (V-Z) infection developed in three immunocompromised patients, with direct invasion of the central nervous system by virus. For two of these patients, diagnosis was confirmed by electron microscopic examination of cerebrospinal fluid (CSF) and detection of viral particles. Extensive immunologic evaluation demonstrated impairment of cellular immune function. All were treated with acyclovir at a dose of 1,500 mg/m2/day for 5-7 days. Peak and trough plasma levels of this antiviral agent were monitored during the course of therapy and were shown to be well above V-Z virustatic levels. Clinical response was noted by the third day of therapy. Vesicles and CSF were culture negative at termination of treatment. Administration of this high dose of acyclovir was not associated with hematologic, immunologic, hepatic, renal, or gastrointestinal toxicity as judged by frequent laboratory and clinical evaluation. PMID: 6305186 [PubMed - indexed for MEDLINE] 5392. Geriatrics. 1983 Jul;38(7):91-100. Herpes: a problem in older age groups. Adams HG. PMID: 6303910 [PubMed - indexed for MEDLINE] 5393. Pediatr Pol. 1983 Jul;58(7):591-7. [Isoprinosine in the treatment of herpesvirus infections in children with leukemia and malignant lymphoma] [Article in Polish] Ochocka M, Chmielewska D, Matysiak M. PMID: 6197693 [PubMed - indexed for MEDLINE] 5394. J Antimicrob Chemother. 1983 Jul;12(1):79-87. Effect of low dose acyclovir (5 mg/kg) on virus shedding, interferon and humoral immunity in herpes zoster. Larkin M, Ogilvie MM, McGill JI. In a double-blind randomized trial, virological studies were carried out in non-immunocompromised patients with herpes zoster who received either acyclovir (5 mg/kg) or placebo intravenously three times daily for five days. Mean duration of virus shedding was not significantly different in the two groups and all patients developed high titres of antibody to varicella-zoster virus. Interferon levels in vesicle fluid reached a peak significantly sooner (P less than 0.025) and at a lower level in eight treated patients compared with eight given placebo, corresponding with significantly earlier cessation of vesicle formation in the treated group (P less than 0.05). Pretreatment virus isolates tested for sensitivity to the drug showed ED50 values from 4 +/- 0.7 to 17.5 +/- 1 microM acyclovir. Treatment with a dose of acyclovir greater than 5 mg/kg, but not exceeding 10 mg/kg, is recommended for herpes zoster. PMID: 6194145 [PubMed - indexed for MEDLINE] 5395. Fukushima J Med Sci. 1983 Jul;29(3-4):101-11. A mutant strain of varicella-zoster virus deficient in thymidine kinase-inducing activity. Yokota T, Ogata M, Shigeta S. PMID: 6088377 [PubMed - indexed for MEDLINE] 5396. Orv Hetil. 1983 Jun 26;124(26):1551-3. [Incidence of herpes zoster among patients with Hodgkin's disease] [Article in Hungarian] Stefanits K, Kuhn E, Csere T, Nádor G. PMID: 6888907 [PubMed - indexed for MEDLINE] 5397. Med J Aust. 1983 Jun 25;1(13):597-8. Antiviral drugs today. Harkness JL, Atkinson K. PMID: 6855672 [PubMed - indexed for MEDLINE] 5398. Med J Aust. 1983 Jun 25;1(13):637-8. Acyclovir therapy in patients with malignant disease and disseminated herpes zoster. Ackland SP, Bishop JF, Whiteside MG. Acyclovir is a new antiviral agent which is active in vitro and in vivo against a variety of herpesviruses. Two cases are reported in which intravenous administration of acyclovir arrested the progress of disseminated herpes zoster within 24 to 48 hours after the beginning of therapy. There was no evidence of toxicity. Thus, acyclovir appears to be useful in the therapy of herpes zoster, but this requires evaluation. PMID: 6687918 [PubMed - indexed for MEDLINE] 5399. N Engl J Med. 1983 Jun 16;308(24):1448-53. Acyclovir halts progression of herpes zoster in immunocompromised patients. Balfour HH Jr, Bean B, Laskin OL, Ambinder RF, Meyers JD, Wade JC, Zaia JA, Aeppli D, Kirk LE, Segreti AC, Keeney RE. We conducted a placebo-controlled, double-blind study of acyclovir therapy for acute herpes zoster in immunocompromised patients. Of the 94 patients enrolled in the study, 52 had localized skin lesions at entry, and 42 had disseminated cutaneous zoster. A one-week course of intravenous acyclovir (1500 mg per square meter of body-surface area per day) halted progression of zoster in both groups, as determined by development or progression of cutaneous dissemination, development of visceral zoster, or proportion of cases deemed treatment failures. Significantly fewer patients treated with acyclovir within the first three days after the onset of exanthem had complications of zoster, as compared with patients treated with placebo (P = 0.02 by Fisher's exact test), but acyclovir also stopped progression of zoster in patients treated after three days of rash (P = 0.05 by Fisher's exact test). Acyclovir recipients with disseminated cutaneous zoster had a significantly accelerated rate of clearance of virus from vesicles, as compared with placebo recipients (P = 0.05 by the Breslow test). PMID: 6343861 [PubMed - indexed for MEDLINE] 5400. Fortschr Med. 1983 Jun 9;101(22):1039-41. [Treatment of zoster, post-zoster pain and herpes simplex recidivans in loco with laser light] [Article in German] Landthaler M, Haina D, Waidelich W. Red light of a krypton laser (lambda = 647 nm) was used for treatment of patients suffering from herpes zoster (n = 4), postherpetic neuralgias (n = 8) and herpes simplex recidivans in loco (n = 13). The afflicted skin was irradiated daily for ten days (laserpower 50 mw, exposure time 90 sec). Improvement was observed in 7 out of the 12 patients suffering from herpes zoster and postherpetic neuralgias respectively, and in 8 out of 13 patients afflicted with recurrent herpes simplex. PMID: 6873857 [PubMed - indexed for MEDLINE] 5401. J Neurol Neurosurg Psychiatry. 1983 Jun;46(6):582-3. Meningitis and disseminated cutaneous zoster complicating herpes zoster infection. Karp SJ. PMCID: PMC1027458 PMID: 6875597 [PubMed - indexed for MEDLINE] 5402. Srp Arh Celok Lek. 1983 Jun;111(6):841-51. [Herpes zoster oticus. Case reports] [Article in Serbian] Brkić M, Zecević M, Popović V. PMID: 6665630 [PubMed - indexed for MEDLINE] 5403. Acta Ophthalmol (Copenh). 1983 Jun;61(3):501-9. Herpes zoster ophthalmicus with retrobulbar neuritis. A case report. Schmidt P. In ophthalmic zoster, involvement of the optic nerve is very rare, and most of the published cases have resulted in optic atrophy. This case report presents a woman who developed a severe visual loss in her right eye 4 weeks after the primary attack. Computer tomography and ultrasonic B-scan showed a spindle-shaped thickening of the optic nerve. Eight months later the visual acuity was 2/60 and the optic nerve showed atrophy. The computer tomography was normal, and the Visual Evoked Potential had reduced amplitudes. Earlier reports and pathogenesis are discussed. PMID: 6605018 [PubMed - indexed for MEDLINE] 5404. Arch Intern Med. 1983 Jun;143(6):1270-1. Disseminated varicella-zoster virus infection with the syndrome of inappropriate antidiuretic hormone. Ingraham IE Jr, Estes NA, Bern MM, DeGirolami PC. A patient with non-Hodgkin's lymphoma who was previously treated with chemotherapy and radiotherapy was seen with intestinal pseudoobstruction due to paralytic ileus associated with herpes zoster (varicella zoster) infection. The infection was accompanied by a polydermatomal rash with typical morphologic characteristics, followed by cutaneous dissemination and the syndrome of inappropriate antidiuretic hormone (SIADH), as well as myotomal paresis. The diagnosis was supported by cytology and by culture of the virus from the CSF. The isolation of the virus from the CSF, coupled with abnormalities of the patient's mental status and CSF, indicate that meningoencephalitis occurred and probably accounted for the SIADH. The patient had a spontaneous and complete recovery. To our knowledge, this is the first report of SIADH associated with herpes zoster infection. PMID: 6305297 [PubMed - indexed for MEDLINE] 5405. J Infect Dis. 1983 Jun;147(6):974-81. Infections due to herpesviruses in cardiac transplant recipients: role of the donor heart and immunosuppressive therapy. Preiksaitis JK, Rosno S, Grumet C, Merigan TC. The role of the donor heart and immunosuppressive therapy on infection due to herpesviruses in 74 cardiac transplant recipients (CTRs) was determined. When cellular blood products from donors seronegative for antibody to cytomegalovirus (anti-CMV) were used, all primary CMV infections were attributable to transmission from donor heart. None of eight CTRs negative for anti-CMV before transplant and who received an anti-CMV donor heart and anti-CMV blood products developed CMV infection compared to one (20%) of five who received unscreened blood. A change from high-dosage anti-thymocyte globulin, azothioprine, and prednisone (ATG regimen) to low-dosage anti-thymocyte globulin, cyclosporin A, and prednisone (CsA regimen) significantly decreased the severity and prevalence of lesions due to herpes simplex virus and the duration of CMV shedding in patients with recurrent CMV infection. CTRs with recurrent CMV infection treated with the ATG regimen had significantly more fever, required more parenteral antibiotics, and were more likely to be infected with opportunistic pathogens than were CsA-treated patients. PMID: 6304206 [PubMed - indexed for MEDLINE] 5406. J Clin Pathol. 1983 Jun;36(6):683-92. Problems of infection after bone marrow transplantation. Watson JG. Representatives of 17 bone marrow transplant (BMT) teams met to discuss the problems of infection after BMT. With experience of more than 2200 transplanted patients over the past 10 yr, the changes in the patterns of infection were surprisingly similar. Deaths due purely to bacterial infection have greatly diminished and the major early problems today result from fungi and cytomegalovirus. The role of non-herpes group viruses has only recently received attention. With increasing numbers of survivors, late bacterial infections are assuming importance. The meeting also provided an opportunity to document the measures adopted to prevent infection during BMT and following discharge. PMCID: PMC498351 PMID: 6304151 [PubMed - indexed for MEDLINE] 5407. J Clin Neuroophthalmol. 1983 Jun;3(2):111-4. Herpes zoster ophthalmicus with contralateral hemiparesis. A case report and review of the literature. Chan C, Huffaker G. An 80-year-old man developed right herpes zoster ophthalmicus complicated by contralateral hemiparesis after right cataract extraction. Although herpes zoster ophthalmicus is a frequent occurrence among the elderly, the association with contralateral hemiparesis is probably overlooked by many ophthalmologists. A review of the literature has been made to outline the etiology of this problem and to make diagnosis more likely. The varicella virus probably spreads in a retrograde fashion from the gasserian ganglion toward the cavernous sinus to involve cranial nerves 3, 4, or 6. Involvement of the ipsilateral carotid arterial system by the progressive inflammatory reaction can result in the contralateral hemiparesis. Standard therapy includes topical steroids and topical antibiotics for the ocular and surface lesions. The efficacy of systemic steroids to minimize the hemiparesis is still in question. PMID: 6224810 [PubMed - indexed for MEDLINE] 5408. S Afr Med J. 1983 May 21;63(21):820-1. Pain relief in herpes zoster. Schreuder M. The severity of pain as a symptom of herpes zoster and post-herpetic neuralgia has seldom been emphasized in the literature. In this report on a series of 113 patients, a treatment which gives immediate relief of pain and prevents post-herpetic neuralgia is described. Provided that the steroid solution could be placed accurately in the epidural space adjacent to the affected nerves, the method was 100% successful. Failure to provide relief of pain after the initial effect of the local anaesthetic had worn off was taken as an indication that the epidural injection had been misplaced, and it was repeated. PMID: 6845108 [PubMed - indexed for MEDLINE] 5409. S Afr Med J. 1983 May 7;63(19):735-6. Syndrome of inappropriate antidiuretic hormone secretion in association with herpes zoster of the chest wall. A case report. Maze SS, Klaff LJ, Yach D. The syndrome of inappropriate antidiuretic hormone secretion (SIADH) occurs in a number of diverse medical conditions. We report a case in which SIADH and herpes zoster of the chest wall occurred concurrently. In the absence of other recognized causes we suggest that the two conditions may have been related and speculate on possible mechanisms. PMID: 6845086 [PubMed - indexed for MEDLINE] 5410. Klin Med (Mosk). 1983 May;61(5):36-9. [Herpes zoster and heart disease] [Article in Russian] Bakhur VT. PMID: 6876698 [PubMed - indexed for MEDLINE] 5411. Cutis. 1983 May;31(5):489. Herpes zoster presenting as soft abdominal mass with obstipation. Rexinger EL. PMID: 6851642 [PubMed - indexed for MEDLINE] 5412. Neurology. 1983 May;33(5):648-9. Epidemiologic investigation of the association between herpes zoster and multiple sclerosis. Ragozzino MW, Kurland LT. The apparent association between MS and herpes zoster reported in the literature was investigated in a community-based epidemiologic study. Five hundred ninety residents of Rochester, Minnesota, diagnosed with herpes zoster from 1945 through 1959 were followed 9,389 person-years for onset of MS. No cases were observed, whereas 0.2 case was expected, using Rochester incidence rates for MS. Calculation of the power of this study indicated that approximately 200,000 person-years of follow-up of herpes zoster patients is necessary in order to detect a threefold increase in incidence of MS with 85% probability. Conversely, 48 Rochester residents diagnosed with MS were followed for 860 person-years for subsequent onset of herpes zoster. Three cases were observed, whereas 1.8 cases were expected for a relative risk of 1.7, which is not significantly different from unity. PMID: 6682503 [PubMed - indexed for MEDLINE] 5413. Compr Ther. 1983 May;9(5):33-42. Diagnosis and therapy of common eye infections: bacterial, viral, fungal. Pavan-Langston D. PMID: 6602028 [PubMed - indexed for MEDLINE] 5414. J Infect. 1983 May;6(1 Suppl):31-6. High-dose intravenous acyclovir in the treatment of zoster: a double-blind, placebo-controlled trial. Juel-Jensen BE, Khan JA, Pasvol G. In a randomised, double-blind, controlled trial, 40 patients with zoster of short duration (rash present for less than three days) were given either 10 mg/kg acyclovir (20) or placebo (20) intravenously three times daily for five days. Pain was reduced in the treatment group both in the acute phase and at follow-up, when compared with the placebo group, but this difference did not reach statistically significant levels. Healing of the lesions was also better, but not significantly so, in the acyclovir group. No complications of the disease were seen in the six cases of ophthalmic zoster given acyclovir whereas, of the four cases in the placebo group, two developed seventh cranial nerve palsies and one secondary glaucoma. No evidence of renal or other major toxicity was detected in the acyclovir group, although three patients developed mild thrombophlebitis. We conclude that acyclovir, given by the route and in the dose and frequency as used in this study, is free from major side effects, but is only of marginal benefit in the treatment of zoster. PMID: 6350473 [PubMed - indexed for MEDLINE] 5415. Acta Otolaryngol. 1983 May-Jun;95(5-6):528-31. Peripheral facial palsy and viral replication. Mair IW, Traavik T. Significant levels of specific IgM and/or IgG antibodies against the cytomegalovirus (CMV) have been demonstrated in 64 (73%) of a consecutive series of 88 patients with acute peripheral facial palsy. Herpes varicella-zoster infection was serologically confirmed in 3 other cases. There were no detectable clinical differences between patients with and without immunological response to CMV antigens. The facial palsy and the CMV immunological response are contemporaneous, but these two phenomena need not necessarily be pathogenetically related. PMID: 6308946 [PubMed - indexed for MEDLINE] 5416. Compr Ther. 1983 May;9(5):9-14. Viral infections of infancy. Gershon AA. PMID: 6303679 [PubMed - indexed for MEDLINE] 5417. Przegl Dermatol. 1983 May-Jun;70(3):283-90. [Isoprinosine in the treatment of herpes zoster and herpes recurrens] [Article in Polish] Bowszyc J, Janicka D, Silny W, Neumann E, Stepień B. PMID: 6198697 [PubMed - indexed for MEDLINE] 5418. Pediatriia. 1983 Apr;(4):64-5. [Herpes zoster in a 5-month-old infant, prenatally infected with varicella-zoster virus] [Article in Russian] Shishov AS, Kozlovskaia LP, Smirnov IuK, Kantor GS. PMID: 6603605 [PubMed - indexed for MEDLINE] 5419. Vestn Dermatol Venerol. 1983 Apr;(4):49-51. [Clinical manifestations and therapy of Gasser's ganglion involvement in herpes zoster] [Article in Russian] Korsunskaia IM, Anton'ev AA, Fokin MA. PMID: 6603079 [PubMed - indexed for MEDLINE] 5420. J Gerontol Nurs. 1983 Apr;9(4):221-3, 226, 245. The scourge of the aged: herpes zoster. Truesdell ML. PMID: 6551399 [PubMed - indexed for MEDLINE] 5421. Gan To Kagaku Ryoho. 1983 Apr;10(4 Pt 1):944-52. [The clinical effects of a new antiviral 9-(2-hydroxyethoxymethyl) guanine (aciclovir) against herpes virus infections] [Article in Japanese] Masaoka T, Shibata H, Amaki I, Takeo H, Sakurai K, Ise T, Ohhira M, Tanaka M, Shimoyama M, Ishihara K, Shibata A, Moriyama Y, Arimori S, Nagao T, Yamada K, Ohno R, Kodera Y, Yamada H, Hirota Y, Fujiwara Y, Nakaide Y, Yoshikawa S, Yoshikawa H, Akao Y, Hattori K, Funada H, Yoshida T, Tsujino G, Sako M, Nagai K, Kanamaru A, Fujita S, Tasaka E, Hamada T, Takahashi M. The clinical effects of a new anti-viral 9-(2-hydroxymethoxymethyl) guanine (Aciclovir) against Herpes virus infections have been investigated. The patients had malignant tumours or auto-immune disease complicated by shingles and chicken pox due to Vaicella zoster virus (VZV) (43 cases), Herpes simplex virus (HSV) (10 cases) and 9 cases which were clinically diagnosed as Herpes, though the virus was not confirmed as the causative agent. As a general principle the dosage of Aciclovir was 5 mg/kg, t. i. d. for 5 days by slow intravenous infusion. The clinically effective rate against VZV was 93%, being excellent in 42% and against HSV it was 80%, being excellent in 40% and when the results of the cases of unknown origin were included it was excellent in 40% and the cumulative effective rate was 88%. Concerning the efficacy in reduction of pain, swelling, disappearance of vesicles and new scab formation, the effect was most noticeable after the third day of treatment. Treatment given early in the disease is likely to provide better results. Concerning side effects, one of 62 patients had proteinuria and the other had a drug rash and an abnormal liver function test. It is likely that the combination of treatment and the primary disease had some influence, but the cause/effect relationship to Aciclovir treatment is not clear. PMID: 6347078 [PubMed - indexed for MEDLINE] 5422. J Infect Dis. 1983 Apr;147(4):737-43. Evaluation of varicella-zoster immune globulin: protection of immunosuppressed children after household exposure to varicella. Zaia JA, Levin MJ, Preblud SR, Leszczynski J, Wright GG, Ellis RJ, Curtis AC, Valerio MA, LeGore J. Varicella-zoster immune globulin (VZIG), an immunoglobulin prepared from normal donor plasma selected for high titer of antibody to varicella-zoster virus (VZV), and zoster immune globulin (ZIG), prepared from the plasma of donors convalescing from herpes zoster, were compared in a double-blind, randomized clinical trial to determine their relative efficacy in protecting immunosuppressed children from severe varicella. VZV infection occurred in 49 (60.4%) of 81 recipients of VZIG and in 57 (68.6%) of 83 recipients of ZIG. These rates and the clinical severity of varicella were not significantly different; however, the subclinical infection rate was significantly higher in ZIG recipients (31.3% vs. 16.0%). This difference was accounted for by a subgroup of patients receiving immunosuppressive therapy for nonneoplastic diseases. Doubling the dose of VZIG administered reduced the rate of subclinical infection. These data indicate that VZIG can be used to protect immunosuppressed children from severe chicken pox. PMID: 6341478 [PubMed - indexed for MEDLINE] 5423. Mayo Clin Proc. 1983 Apr;58(4):217-22. Antiviral agents. Hermans PE, Cockerill FR 3rd. Only a few agents with antiviral activity are available for routine clinical use. Amantadine hydrochloride is effective in the prophylaxis of influenza A. In addition, accumulated evidence shows that amantadine has some therapeutic effect when used early in the course of an influenza A infection. Idoxuridine and adenine arabinoside have found application as topical agents in the treatment of herpes simplex keratitis. Adenine arabinoside has also been approved for the treatment of disseminated infections due to herpes zoster and herpes simplex. Acyclovir sodium has been approved as a topical agent in the treatment of limited mucocutaneous herpes simplex viral infections in immunosuppressed patients and of initial episodes of genital herpes simplex infections in patients with normal immunity. Ribavirin, an experimental agent with a wide spectrum of activity in vitro, has not fulfilled expectations in clinical trials. Because of the eradication of smallpox, methisazone has become obsolete as a prophylactic agent in smallpox. PMID: 6339831 [PubMed - indexed for MEDLINE] 5424. Infect Immun. 1983 Apr;40(1):381-8. Monoclonal antibodies against three major glycoproteins of varicella-zoster virus. Grose C, Edwards DP, Friedrichs WE, Weigle KA, McGuire WL. Varicella-zoster virus (VZV) codes for three prominent glycoproteins--gp62, gp98, and gp118--in infected cell cultures. To characterize individually these known immunogens, we first inoculated BALB/c mice with crude VZV extracts, produced hybridoma cultures by Köhler-Milstein cell-fusion technology, and screened culture supernatants by indirect immunofluorescence for reactivity directed against unfixed VZV-infected cells (FAMA assay). Supernatants from five independently derived and subcloned hybridomas with a high VZV-FAMA titer but no reactivity against either uninfected or herpes simplex virus-infected cells were further analyzed by immunoprecipitation of [3H]fucose-labeled and detergent-solubilized VZV antigen preparations. Fractionation of the precipitates by sodium dodecyl sulfate-polyacrylamide gel electrophoresis demonstrated that four monoclonal antibodies reacted with both gp62 and gp98, and one precipitated only gp118. The profiles were unchanged whether performed under reducing or nonreducing conditions. When assayed for neutralizing activity, the secretory product of the single anti-gp118 hybridoma, but not the supernatants from the four anti-gp62/gp98 clones, inhibited VZV plaque formation by greater than 80%. Thus, at least one of the glycosylated antigens detected by the FAMA assay is a determinant which elicits neutralizing activity. PMCID: PMC264858 PMID: 6299963 [PubMed - indexed for MEDLINE] 5425. Rev Chir Oncol Radiol O R L Oftalmol Stomatol Ser Oftalmol. 1983 Apr-Jun;27(2):139-42. [Neurotropic viral infection and optic neuritis (Considerations on diagnosis and treatment)] [Article in Romanian] Cinciu G, Popa DP, Călinescu G. PMID: 6227040 [PubMed - indexed for MEDLINE] 5426. Nippon Naika Gakkai Zasshi. 1983 Mar 10;72(3):327-32. [Case of Hodgkin's disease with cerebral infarction presumably due to cerebral angiitis] [Article in Japanese] Aburatani H, Takahashi T, Kodama T, Sekihara H, Murakami T, Hashimoto Y, Kudo S, Kosaka K, Mori S. PMID: 6864055 [PubMed - indexed for MEDLINE] 5427. ZFA (Stuttgart). 1983 Mar 10;59(7):342-7. [Varicella zoster immunoglobulin. Prophylactic use in risk patients] [Article in German] Geursen RG. PMID: 6303013 [PubMed - indexed for MEDLINE] 5428. N Engl J Med. 1983 Mar 3;308(9):526-7. Vidarabine for herpes zoster. Topiel MS, Simon GL. PMID: 6823274 [PubMed - indexed for MEDLINE] 5429. J Am Acad Dermatol. 1983 Mar;8(3):433-6. Unusual treatments for herpesvirus infections. II. Herpes zoster. Thiers BH. PMID: 6833550 [PubMed - indexed for MEDLINE] 5430. Postgrad Med. 1983 Mar;73(3):297-303. Acyclovir in the treatment of herpesvirus infections. Bean B. PMID: 6681899 [PubMed - indexed for MEDLINE] 5431. Harefuah. 1983 Mar 1;104(5):176-7. [Hemiparesis and convergence spasm associated with herpes zoster] [Article in Hebrew] Bornstein N, Korczyn AD. PMID: 6607195 [PubMed - indexed for MEDLINE] 5432. Arch Pathol Lab Med. 1983 Mar;107(3):126-8. Granulomatous angiitis of the brain with herpes zoster and varicella encephalitis. Blue MC, Rosenblum WI. We studied a case of herpes zoster with varicella encephalitis in which a granulomatous necrotizing vasculitis was present in the optic nerve and brain. The vasculitis was observed even in foci devoid of inflammatory reaction in surrounding tissue, and was therefore interpreted as a primary vasculitis caused by varicella. To our knowledge, this is the first time a granulomatous vasculitis has been described as an integral part of varicella encephalitis, although others have made similar observations in the eye and even in viscera. These findings support the recent suggestion that so-called granulomatous angiitis of the CNS may be caused by the varicella virus. PMID: 6600918 [PubMed - indexed for MEDLINE] 5433. Arch Dermatol. 1983 Mar;119(3):235-6. Ipsilateral deafness and herpes zoster ophthalmicus. Scott MJ Sr, Scott MJ Jr. Three cases of ipsilateral deafness occurred in association with herpes zoster ophthalmicus. Although our review of the literature did not disclose any identical cases, we believe that this complication may not be rare. If vertigo, tinnitus, abnormal auditory sensations, or ear pain occur with herpes zoster of any cranial nerve, an audiogram is indicated immediately to detect possible hearing loss. There is no known satisfactory treatment for sudden deafness due to herpes zoster infection. PMID: 6600599 [PubMed - indexed for MEDLINE] 5434. J Infect. 1983 Mar;6(2):157-61. Intravenous acyclovir in acute herpes zoster infection. McGill J, MacDonald DR, Fall C, McKendrick GD, Copplestone A. In a double-blind, randomised trial, immune-competent adults with acute herpes zoster received either 5 mg/kg acyclovir (17) or placebo (20) intravenously three times daily. Acyclovir significantly improved rash development, as evidenced by reducing the time of new lesion formation and the times to vesicle collapse and full crusting. Pain at the end of treatment and at three months was less in the treated group but the difference was not statistically significant. Ocular involvement was not affected. PMID: 6348177 [PubMed - indexed for MEDLINE] 5435. Med Clin North Am. 1983 Mar;67(2):531-43. Dermatological aspects of aging. Carter DM, Balin AK. PMID: 6338328 [PubMed - indexed for MEDLINE] 5436. Med Clin North Am. 1983 Mar;67(2):273-93. Infectious diseases in the elderly. Berk SL, Smith JK. PMID: 6338316 [PubMed - indexed for MEDLINE] 5437. Am J Med Technol. 1983 Mar;49(3):157-62. Uses of immunofluorescence in diagnostic virology. Gallo D. PMID: 6301279 [PubMed - indexed for MEDLINE] 5438. Medicine (Baltimore). 1983 Mar;62(2):81-97. Herpes zoster-associated encephalitis: clinicopathologic report of 12 cases and review of the literature. Jemsek J, Greenberg SB, Taber L, Harvey D, Gershon A, Couch RB. Herpes-zoster associated encephalitis (HZAE) is an uncommon complication of herpes zoster. Over 8 years, we evaluated 12 patients with this clinical diagnosis. The majority of our patients were elderly, immunosuppressed, and found to have disseminated skin lesions prior to the onset of CNS symptoms. All patients had abnormal EEGs, and CSF pleocytosis was found in most. In the seven patients who were tested, specific antibody to the varicella-zoster membrane antigen (FAMA) was detected in spinal fluid during the course of the illness. Although three patients died during the period of active infection, the virus could not be definitively implicated as the cause of death. These HZAE patients could not be distinguished from our other herpes zoster patients on the basis of age, initially involved dermatome, or mortality rate. However, among herpes zoster patients who survived, duration of hospitalization was significantly longer in those with a diagnosis of HZAE. All surviving HZAE patients had a slow but eventual return to their prior cognitive status. PMID: 6298562 [PubMed - indexed for MEDLINE] 5439. JAMA. 1983 Feb 18;249(7):922-3. Varicella zoster and staphylococcal toxic shock syndrome in a young man. Jacobson JA, Burke JP, Benowitz BA, Clark PV. PMID: 6218314 [PubMed - indexed for MEDLINE] 5440. Schweiz Rundsch Med Prax. 1983 Feb 8;72(6):194-7. [Temporal arteritis with the appearance of zoster-like skin necroses] [Article in German] Panizzon R, Stieger M, Haubensak T, Leu HJ. PMID: 6835938 [PubMed - indexed for MEDLINE] 5441. Acta Pathol Microbiol Immunol Scand C. 1983 Feb;91(1):69-75. Characterization of classes of intrathecally synthesized antibodies by imprint immunofixation of electrophoretically separated sera and cerebrospinal fluids. Vartdal F, Vandvik B. The use of imprint immunofixation (IIF) method to identify IgG, IgA and IgM classes of microbial antibodies in electrophoretically separated sera and cerebrospinal fluids (CSF) is described. The method was applied to the analysis of intrathecal antibody responses in mumps meningitis, subacute sclerosing panencephalitis (SSPE), neurosyphilis and multiple sclerosis (MS). Intrathecally synthesized mumps virus-specific IgG, IgA and IgM antibodies were demonstrated in the CSF of patients with mumps meningitis. The intrathecally synthesized IgG and IgM antibodies displayed oligoclonal characteristics, while the IgA antibodies appeared to be mainly polyclonal. The intrathecal measles antibody responses in SSPE appeared to be confined to IgG antibodies. In neurosyphilis, the intrathecal treponemal antibody response was predominantly of the IgG class, but IgA antibodies were demonstrated in two of nine patients. Intrathecally synthesized IgG antibodies to measles and/or varicella-zoster viruses were demonstrated in 17 of 18 patients with MS; IgA or IgM antibodies to these viruses were not detected. PMID: 6869017 [PubMed - indexed for MEDLINE] 5442. Ann Neurol. 1983 Feb;13(2):217-8. Herpes zoster and central retinal artery occlusion. Hall S, Carlin L, Roach ES, McLean WT Jr. PMID: 6830188 [PubMed - indexed for MEDLINE] 5443. Arthritis Rheum. 1983 Feb;26(2):236-7. Acute monarticular arthritis in association with herpes zoster. Devereaux MD, Hazelton RA. PMID: 6824520 [PubMed - indexed for MEDLINE] 5444. Geriatrics. 1983 Feb;38(2):105-6, 111-3, 116. Infections and the nervous system in the elderly. Roeltgen DP. PMID: 6822339 [PubMed - indexed for MEDLINE] 5445. Shikai Tenbo. 1983 Feb;61(2):207-13. [Illustrated guide to the diagnosis of oral diseases. 2] [Article in Japanese] Enomoto S. PMID: 6588573 [PubMed - indexed for MEDLINE] 5446. Arch Fr Pediatr. 1983 Feb;40(2):95-9. [Varicella-zoster virus infections in the immunosuppressed child. Treatment with Acyclovir and controls] [Article in French] Peyramond D, Denoyel GA, Philip T, Souillet G, Philippe N, Bertrand JL, Bertoye A. Sixty minutes intravenous infusions of Acyclovir were given at 5 to 10 mg/kg 3 times daily for 6 to 11 days in 20 immunodeficient children with varicella (9 cases) and herpes zoster (11 cases) in a controlled open study. Twelve patients had a life-threatening illness. All patients who received therapy before the first 4 days had a more rapid cessation of new vesicles formation and more rapid scarring. Fourteen controlled children had accelerated clearance of viral antigens from vesicles. In 19 cases, virus was no longer isolated after the 3rd day. Eighteen patients recovered within 6 to 10 days. No relapse of varicella zoster virus infections had been observed 1 to 18 months after the end of treatment. Two children with varicellous interstitial pneumonia died 8 and 32 days after the end of treatment. In 3 cases, zoster pains reappeared 8 days after Acyclovir therapy was stopped. The drug was well-tolerated, but control of renal functions is necessary. PMID: 6347116 [PubMed - indexed for MEDLINE] 5447. J Clin Microbiol. 1983 Feb;17(2):280-7. Rapid diagnosis of varicella-zoster virus infection by detection of viral deoxythymidine kinase in serum and vesicle fluid. Källander CF, Gronowitz JS, Olding-Stenkvist E. A sensitive enzyme assay utilizing [125I]iododeoxyuridine as the substrate and CTP as the phosphate donor in combination with isozyme-specific antisera was used for direct detection and typing of herpesvirus deoxythymidine kinase (dTk) in clinical specimens. An investigation of 16 coded vesicle fluid specimens, taken in connection with varicella-zoster virus (VZV) and herpes simplex virus infections, revealed viral dTk activity in 14 samples. All positive samples except one were taken within 5 days after the onset of illness. Serological typing of the dTk activities easily established whether the vesicles were caused by VZV, herpes simplex virus type 1, or herpes simplex virus type 2. The results were obtainable within 5 h and were in agreement with the results achieved by immunofluorescence tests or by virus isolation when positive. Acute- and convalescent-phase sera from patients with VZV infections were analyzed with regard to dTk isozyme composition. All sera collected within 5 days after the onset of varicella were found to contain elevated levels of dTk activity. By the use of isozyme-specific antisera and gel electrophoresis, it was possible to show the presence of both cellular and VZV dTk's. Among the 13 acute-phase sera from zoster patients, only 2 were found to be VZV dTk positive. Convalescent sera, in most cases collected 15 days or more after the onset of illness, were also found to be devoid of VZV dTk. The relevance of the results and the possible use of these methods for viral diagnostics are discussed. PMCID: PMC272623 PMID: 6339548 [PubMed - indexed for MEDLINE] 5448. Acta Pathol Microbiol Immunol Scand B. 1983 Feb;91(1):83-8. Rapid detection of herpes simplex virus and varicella-zoster virus in clinical specimens by the use of Staphylococcus aureus rich in protein A. Mogensen SC, Dishon T. Herpes simplex virus (HSV) type 1 and type 2 and varicella-zoster virus (VZV) were detected in cytospin preparations from clinical material by using specific antisera and Staphylococcus aureus, Cowan 1 strain, rich in protein A (SRA). Virus was isolated in tissue culture from 22 of the 30 specimens submitted for examination. Eighteen isolates showed cytopathic effect characteristic of HSV infection and 4 of VZV. In the cytospin preparations of the same samples HSV was detected in 15, two contained too few cells to allow a reliable diagnosis and one sample was negative when the SRA reagent was used. In the cytospin preparations of 2 of the 8 samples, which did not show cytopathic effect on isolation in tissue culture, HSV was detected by the SRA. This points to the possible presence of inactive virus in the specimens. All 4 cases of VZV infection were diagnosed correctly with the staphylococcal reagent. No reaction was observed between VZV antigens and rabbit anti-HSV sera. Cells in which viral infection was detected by specific antisera and SRA did not show staphylococcal adherence to their surface after interaction with normal rabbit or normal human serum. Similarly, cells from healthy donors, treated with positive and negative sera were found negative. The method is easy to perform and results can be obtained within three hours from the time specimens are received at the laboratory. Its use offers a rapid diagnosis in suspected cases of herpetic infections in which early therapy is recommended. PMID: 6306990 [PubMed - indexed for MEDLINE] 5449. J Dermatol. 1983 Feb;10(1):13-6. Cell-mediated immunity to varicella-zoster virus demonstrated by lymphocyte transformation in herpes zoster. Hata S. PMID: 6306084 [PubMed - indexed for MEDLINE] 5450. Lancet. 1983 Jan 29;1(8318):243-4. Impaired renal function after bolus injections of acyclovir. Peterslund NA, Black FT, Tauris P. PMID: 6130275 [PubMed - indexed for MEDLINE] 5451. Tidsskr Nor Laegeforen. 1983 Jan 20;103(2):147-8. [Treatment of herpes zoster] [Article in Norwegian] Kolflaath J, Holmboe J. PMID: 6845307 [PubMed - indexed for MEDLINE] 5452. Arch Psychiatr Nervenkr. 1983;233(2):103-10. Combined recordings of compound nerve action potentials and spinal cord evoked potentials in differential diagnosis of spinal root lesions. Stöhr M, Buettner UW, Wiethölter H, Riffel B. Three cases are presented to demonstrate the diagnostic value of sensory neurography in combination with somatosensory evoked potentials in the diagnosis of proximally located neuropathy and its differentiation to centrally located demyelinating processes. Simultaneous recording of cortical and spinal evoked potentials, as well as peripheral nerve action potentials, revealed in two cases (herpes zoster, Guillain-Barré syndrome) a site of lesion at the spinal roots suggesting radiculitis and in one case (tick bite) a site of lesion central to the source of lumbar evoked potentials suggesting myelitis. In all cases almost complete recovery of sensory conduction velocities suggests a complete repair myelination not previously described. PMID: 6882180 [PubMed - indexed for MEDLINE] 5453. Neurol Neurochir Pol. 1983 Jan-Feb;17(1):25-31. [Fluorescence method of evaluation of the lysosomes of the lymphoid cells of the cerebrospinal fluid in meningitis and meningism] [Article in Polish] Kucharska-Demczuk K. The fluorescence method of Blume et al. was found to be useful for identification and morphological evaluation of lysosomes in cerebrospinal fluid cells. The investigations were carried out in 49 patients with viral and bacterial meningitis or meningismus. It was demonstrated that the CSF cells in most patients with purulent meningitis contained no fluorescent granules in an early stage of the disease before introduction of antibacterial therapy. These granules were found in CSF cells in cases of leptospirosis, viral meningitis and meningismus of various aetiology in acute stage of the disease and even in convalescence, and in purulent meningitis in convalescence. In bacterial meningitis large lysosomal granules were observed, and in viral meningitis these granules were small. The method visualizes easily bacteria (meningococci and pneumococci) in the cerebrospinal fluid. PMID: 6877497 [PubMed - indexed for MEDLINE] 5454. J Chronic Dis. 1983;36(7):501-5. Herpes zoster and diabetes mellitus: an epidemiological investigation. Ragozzino MW, Melton LJ, Kurland LT. Five hundred and ninety Rochester, Minnesota, residents were initially diagnosed with herpes zoster in the period 1945-59. Fifteen had diabetes mellitus before the onset of herpes. The expected number was 15.7. The entire herpes zoster cohort was followed subsequently for nearly 9400 person-years and 33 new cases of diabetes mellitus developed while the expected number was 30.6. The clinical spectrum of herpes zoster in individuals with diabetes mellitus was not different from that of zoster patients from the general population. We conclude that herpes zoster is not a risk factor for diabetes mellitus and that diabetes mellitus is not a risk factor for herpes zoster. PMID: 6874881 [PubMed - indexed for MEDLINE] 5455. Intensive Care Med. 1983;9(3):105-7. Viruses and intensive care. Jeffries DJ. PMID: 6863719 [PubMed - indexed for MEDLINE] 5456. Zh Nevropatol Psikhiatr Im S S Korsakova. 1983;83(2):213-8. [Serous meningitis in patients with herpes zoster] [Article in Russian] Shishov AS, Smirnov IuK, Karmysheva VIa, Mal'tseva NN. CSF was studied in 110 patients with herpes zoster. The whole complex of symptoms helped to diagnose serous meningitis in 62% of cases and so-called "asymptomatic meningitis" in 18% of cases. CSF cells were characterized by lymphocyte transformation and the presence of antigen to Varicella zoster virus determined by the fluorescent antibody method. Specific antibodies titer appeared to be at zero or minimal level. The disease pathogenesis is discussed. PMID: 6858479 [PubMed - indexed for MEDLINE] 5457. Ann Otolaryngol Chir Cervicofac. 1983;100(2):135-43. [Idiopathic and zoster vestibular neuritis. Course and prognosis] [Article in French] François M, Vacher S, Freyss G, Frachet B, Pialoux P. 112 cases of vestibular neuritis were studied. 77% were relatively pure lesions, whilst in 23% of cases there were more extensive lesions with abnormalities of the saccadic oculomotor system and BERA abnormalities. Spontaneous nystagmus disappeared in 2 to 3 months in general. In 54% of cases there was complete recovery of absolute reflex activity within normal limits on the affected side. There was restoration of normal difference of reflectivity in 22%. In 13% there was normal absolute reflex activity, normal hypovalence and normal directional preponderance. Age appeared to influence the course of directional preponderance and the extent of lesions on the course of hypovalence. Early mobilisation of the patient is of primordial importance. PMID: 6847070 [PubMed - indexed for MEDLINE] 5458. Hautarzt. 1983 Jan;34(1):1-5. [Possibilities and limits of chemotherapy of diseases caused by herpes simplex and varicella-zoster virus] [Article in German] Wassilew SW. The available antiviral chemotherapeutic agents for the treatment of herpes simplex type 1 and 2 and varicella zoster virus infections are discussed in respect of their mechanism of action, clinical effects, and side effects. Although effective under experimental conditions most of the antiherpetic drugs need further evaluation of clinical efficacy in controlled trials. It is possible to reduce initial herpetic pain mainly in patients with zoster by topical application of 5% 5-iodo-2'-deoxyuridine solved in dimethylsulphoxide when treatment starts within the first 3 days of blister eruption. The postzosteric neuralgia is not influenced. A shortening of pain seems also possible in primary herpes simplex virus type 2 infection. For recurrent herpes simplex there is no proven effect on duration or frequency of recurrences with available antiherpetic drugs. The indication for antiviral chemotherapy is limited not only by the unpredictable, mainly self-limited, course of herpes simplex and zoster but also by the possible side effects of chemotherapeutic agents. Severe and life-threatening herpes disease, e.g., in immunosuppressed patients or newborns, can be defeated with vidarabin applied i.v. and, in the near future, with acyclovir. PMID: 6841073 [PubMed - indexed for MEDLINE] 5459. Clin Exp Dermatol. 1983 Jan;8(1):27-31. Impairment of axon reflex vasodilatation after herpes zoster. Jancsó G, Husz S, Simon N. PMID: 6839534 [PubMed - indexed for MEDLINE] 5460. Cancer. 1983 Jan 1;51(1):30-3. Diffuse thymic hyperplasia following chemotherapy for nodular sclerosing Hodgkin's disease. An immunologic rebound phenomenon? Shin MS, Ho KJ. Diffuse thymic hyperplasia following chemotherapy for nodular sclerosing Hodgkin's disease is reported in an 18-year-old woman. The patient's course was complicated by drug-induced pulmonary fibrosis and disseminated herpes zoster. Subsequently she developed genuine diffuse thymic hyperplasia with disappearance of herpes zoster and apparently complete remission of Hodgkin's disease. We stress that restoration of the host immune system, particularly the cell-mediated immunity, is essential for successful control of Hodgkin's disease and the thymic hyperplasia is most likely a favorable sign for it, which should not be confused with recurrence of Hodgkin's disease. PMID: 6821803 [PubMed - indexed for MEDLINE] 5461. Semin Perinatol. 1983 Jan;7(1):47-56. Fetal and neonatal varicella-zoster infections. Brunell PA. Maternal varicella during pregnancy may have a variety of effects on the fetus and newborn infant. Infection early in pregnancy may result in fetal malformations. Zoster early in life appears to be a sequela of maternal infection at any period during pregnancy. Infants may escape disease, may have mild varicella, or fatal illness following maternal varicella just prior to delivery. The outcome appears to be related to the onset of maternal and newborn illness relative to delivery. A variety of management options are available to the physician. Choices will be dictated by weighing the risks of VZV infection in a particular situation with the risks and benefits of other proposed intervention. In many cases, recommendations must be made on the basis of very limited data. It is hoped that additional information will lead to a more rational approach to VZV infection of the fetus and newborn. PMID: 6682573 [PubMed - indexed for MEDLINE] 5462. Arch Immunol Ther Exp (Warsz). 1983;31(5):655-61. Clinical studies on the effectiveness of Wratizolin in the treatment of some dermatoses. Szarmach H, Wroński A, Laudańska H, Niczyporuk W. Clinical studies on therapeutic effectiveness of ITCL applied as 2-3% ointment, 2% cream and 2-3% lotion were carried out. The study material included 96 patients at the age of 9-80. Of this group, 19 patients were with herpes zoster, 16 with herpes simplex, 29 with eczema complicated by secondary bacterial infection, 30 with palm and foot pustulosis, 1 patient with actinic cheilitis and 1 with varicella. The results obtained have revealed that the preparation is particularly effective in the treatment of dermatoses induced by herpes zoster and herpes simplex virus. PMID: 6675573 [PubMed - indexed for MEDLINE] 5463. Arch Immunol Ther Exp (Warsz). 1983;31(5):649-54. Studies on the therapeutic effect of Wratizolin in selected dermatoses. Michałowski R, Olejnicka Z, Kozak S, Urban J. Clinical investigations of ITCL drug ("Polfa") were carried out on 50 patients (15 women, 16 men, 19 children, at the age of 4-80). ITCL has been successful in non-specific inflammations accompanying some virus dermatoses (zoster, herpes simplex), in streptococcal pyoderma (impetigo, ecthyma), and in some allergic dermatoses (disseminated eczema and atopic dermatitis). Encouraging results were obtained with ITCL in the treatment of psoriasis. It seems that the further attempts with this should be continued in psoriasis. The capillaroscopic examinations in 6 patients revealed ITCL to have vasoconstrictive effect on the nail wall cutis capillaries 6 h after its application. This may be associated with the anti-inflammatory effect of the drug. PMID: 6675572 [PubMed - indexed for MEDLINE] 5464. Arch Immunol Ther Exp (Warsz). 1983;31(5):645-8. Results of Wratizolin treatment of selected skin diseases with particular reference to those of viral etiology. Wasik F, Gasior-Chrzan B, Woytoń A, Cisło M, Dabrowska-Widera J. A newly synthetized compound, p-chlorophenylamide of 3-methyl-5-benzoylaminoisothiazole-4-carboxylic acid (ITCL) was used for local treatment in 68 patients with the following skin diseases: herpes simplex, herpes zoster, eczema complicated by bacterial infection, aphthae of the mucosa. In all cases examined, a good tolerance of the drug, rapid subsidence of pathologic symptoms, mainly of inflammation, pain and edema could be seen. The drug was found to reduce markedly the duration of the disease, particularly in the case of herpes simplex and aphthae. PMID: 6675571 [PubMed - indexed for MEDLINE] 5465. Arch Immunol Ther Exp (Warsz). 1983;31(5):641-4. Wratizolin ITCL in the treatment of herpes simplex and recurrent and zoster. Moskalewska K, Dabrowska H, Rózański J, Grzywa Z. Herpes simplex and zoster are frequent skin diseases of viral origin and the mechanism of their development as well as their course are not yet fully known. Fully effective methods of treating these diseases are not known. The authors evaluated the results of the externally applied ITCL preparation in the form of a 2% cream. A group of 92 patients was treated, 64 with herpes simplex or recurrent, 16 with zoster, 9 with purulent skin lesions and 3 with verruca plana. Very good results, that is earlier regression of lesions with inhibition of further dissemination, were obtained in 83% of patients with herpes, in over half of the cases of zoster, and in nearly all cases with purulent skin lesions. In most cases the tolerance of the drug was good. PMID: 6675570 [PubMed - indexed for MEDLINE] 5466. Med Pregl. 1983;36(9-10):405-7. [Personal experience in the use of Ditamin in the treatment of herpes zoster] [Article in Croatian] Krstić A, Ilić-Krstić B. PMID: 6674725 [PubMed - indexed for MEDLINE] 5467. Zh Nevropatol Psikhiatr Im S S Korsakova. 1983;83(10):1467-71. [Clinical picture and treatment of herpes zoster in children] [Article in Russian] Shishov AS, Smirnov IuK, Kulikova VA. The symptoms and the course of herpes zoster are analyzed in 85 children aged 5 months to 15 years. Many systems of the body were shown to be involved in the process of the disease which is characteristic of neuroviral infections. The authors postulate the etiologic unity of chicken pox and herpes zoster as two clinical forms of the same epidemic process. The questions of treatment are outlined. PMID: 6659778 [PubMed - indexed for MEDLINE] 5468. Neth J Med. 1983;26(10):301-3. Occurrence of herpes zoster varicella infections after completion of treatment for Hodgkin's disease. De Pauw BE, Janssen JT, Vaissier P, Haanen C. PMID: 6656975 [PubMed - indexed for MEDLINE] 5469. Int Anesthesiol Clin. 1983 Winter;21(4):79-96. Management of head and neck pain. Burney RG, Moore PA, Duncan GH. PMID: 6642703 [PubMed - indexed for MEDLINE] 5470. Ann Dermatol Venereol. 1983;110(6-7):507-11. [Treatment of herpes zoster] [Article in French] Revuz J, Huraux JM. A critical study of therapeutic trial reports on herpes zoster is presented. It is noteworthy that authors are frequently unaware of the natural history of herpes zoster; therapeutic trials are not always correctly designed; misinterpretation of the data is not unfrequent. Proof of efficacy is missing for several commonly used drugs. Two groups of drug seem promising: -- Modern antiviral nucleoside analogues : Acyclovir, Vidarabine, Bromovinyl-desoxyuridine are probably effective for severe herpes zoster in immunocompromized patients. -Systemic adrenal steroids are effective as a prevention of post-herpetic neuralgia in elderly patients. The real usefulness of these two treatment procedures, as a whole and for individual patient, remains to be established by well-designed controlled trials. Other treatments should be surrended. PMID: 6638780 [PubMed - indexed for MEDLINE] 5471. Fortschr Ophthalmol. 1983;80(2):100-2. [Neuroparalytic keratitis] [Article in German] Turss R, Kolodziej I. PMID: 6604683 [PubMed - indexed for MEDLINE] 5472. Acta Acad Med Wuhan. 1983;3(1):58-9. Moyamoya disease associated with herpes zoster ophthalmicus: a case report with angiographic findings. Mei YW, Hu JD. PMID: 6602958 [PubMed - indexed for MEDLINE] 5473. Am J Otol. 1983 Jan;4(3):269. The facial nerve. May M. PMID: 6600885 [PubMed - indexed for MEDLINE] 5474. Arch Ophthalmol. 1983 Jan;101(1):42-5. Complications of herpes zoster ophthalmicus. Womack LW, Liesegang TJ. Of 86 patients with herpes zoster ophthalmicus seen at the Mayo Clinic, Rochester, Minn, from 1975 to 1980, 61 had some form of ocular involvement. Corneal disease was seen in 47, uveitis in 37, postherpetic neuralgia in 15, scleritis in three, and ocular motor palsies in three. No case of optic nerve or retinal involvement was found. Of serious concern were four patients with neurologic complications, including two with contralateral hemiplegia and two with segmental cerebral arteritis. Because the neurologic complications occur several months after the episode of herpes zoster ophthalmicus, the association is often overlooked and the opportunity to treat with corticosteroids for systemic effect is missed. PMID: 6600391 [PubMed - indexed for MEDLINE] 5475. J La State Med Soc. 1983 Jan;135(1):34-7. Just another case of "shingles"? Morse RH. PMID: 6405001 [PubMed - indexed for MEDLINE] 5476. Br Med J (Clin Res Ed). 1983 Jan 1;286(6358):60. Outbreak of chickenpox from a patient with immunosuppressed herpes zoster in hospital. Juel-Jensen BE. PMCID: PMC1546676 PMID: 6401472 [PubMed - indexed for MEDLINE] 5477. Trans Ophthalmol Soc U K. 1983;103 ( Pt 1):111-4. Acyclovir therapy in herpes zoster infection. A practical guide. McGill J, Chapman C, Mahakasingam M. The effect of acyclovir on the skin rash and herpes zoster keratouveitis has been studied. It has been shown to have a significant effect on both disease processes, and to be superior to topical steroids in the treatment of herpes zoster keratouveitis. Steroids have been found to have an adverse effect with prolonged treatment and frequent recurrences. PMID: 6362108 [PubMed - indexed for MEDLINE] 5478. Schweiz Med Wochenschr Suppl. 1983;14:26-9. Studies in the prophylaxis of herpes infections in severely immunocompromised patients using acyclovir. Prentice HG, Hann IM. That acyclovir is effective therapeutically in herpes simplex virus (HSV) and herpes zoster (VZV) infections in immunocompromised patients has been established [13]. This paper reviews our subsequent studies in prophylaxis of herpes group infections in a high risk group of patients suffering from acute leukaemia. In study 1 we randomised HSV seropositive (greater than or equal to 1:8) patients to receive intravenous acyclovir or placebo. In this stratified study bone marrow transplant (BMT) recipients were completely protected from HSV infections by acyclovir compared with a 50% failure rate for those on placebo. There was significant protection also in the non-BMT group [8]. In study 2 oral acyclovir prophylaxis failed to provide complete protection in BMT recipients despite the achievement of apparently adequate blood levels. In study 1 the secretion of EBV in saliva before and during the trial gave inconclusive results. In each of the first two studies one patient on "active" acyclovir developed a cytomegalovirus (CMV) infection. Thus, at the dosage of drug used, prophylaxis of CMV was unsuccessful suggesting that claims of therapeutic efficacy are unlikely to be supported in controlled trials. Study 3 is current and concerns the pharmacokinetics of an acyclovir prodrug (BW 134U) taken by mouth. This drug is near 100% absorbed and achieves approximately twice the level of active acyclovir in vivo, following conversion by adenosine deaminase (ADA), in normal volunteers. PMID: 6361988 [PubMed - indexed for MEDLINE] 5479. Annu Rev Med. 1983;34:205-17. Dermatologic manifestations of infection in the compromised host. Wolfson JS, Sober AJ, Rubin RH. The skin occupies an important position in the prevention and evaluation of infection in patients who are immunocompromised. The skin can provide a portal of entry for both locally invasive and disseminated infection; and, not infrequently, skin lesions may be the first sign of disseminated infection from other primary sites. The first clinical principle in approaching this problem is that the skin must be protected from trauma, maceration, or alteration in its normal microbial flora. The second principle is that any lesion, no matter how innocuous, should be carefully evaluated in this patient population. Since the gross morphology of the lesion is so frequently modified by the altered inflammatory response of the immunocompromised patient, an aggressive biopsy approach is essential for diagnosis and therapy. PMID: 6344755 [PubMed - indexed for MEDLINE] 5480. Zh Nevropatol Psikhiatr Im S S Korsakova. 1983;83(4):511-5. [Levamisole in the treatment of different forms of herpes zoster] [Article in Russian] Smirnov IuK, Shishov AS, Bagrov FI, Rudometov IuP, Sverdlova LL. Fifty patients with early stages of herpes zoster (23 patients with the ophthalmic form and 27 with other localizations of the lesion) were treated with levamisol, since it was assumed that the disease is caused by the activation of the varicellazoster virus in association with cellular immunodeficiency. The control group consisted of 63 subjects, including 26 with the ophthalmic form. Beneficial results such as faster skin clearance and fewer days of hospitalization suggest that this agent should be recommended for combined treatment of patients suffering from herpes zoster. PMID: 6344521 [PubMed - indexed for MEDLINE] 5481. Adv Virus Res. 1983;28:285-356. Chickenpox virus. Takahashi M. PMID: 6318539 [PubMed - indexed for MEDLINE] 5482. Scand J Infect Dis. 1983;15(4):327-34. Zoster immunoglobulin in varicella prophylaxis. A study among high-risk patients. Hanngren K, Falksveden L, Grandien M, Lidin-Janson G. The efficacy of zoster immunoglobulin (ZIG) in preventing varicella was studied among patients in a high-risk group. 173 non-immune patients were observed after exposure to varicella-zoster (VZ) virus and subsequent administration of ZIG. For 138 patients (80%) no sign of varicella was recorded, 16 patients (9%) had a subclinical infection and 19 patients (11%) developed varicella. 12/19 patients with varicella contracted a very mild disease (less than 20 pocks, negligible fever), 5 got mild or normal disease and 2 children, both with acute lymphatic leukemia, developed more pronounced symptoms. Three patients protected by 0.15 ml ZIG/kg body weight after heavy exposure to VZ virus, were not protected at a second exposure 2 weeks later. In an enlarged study group of high-risk patients where 52 patients receiving ZIG developed varicella, the mean incubation period for 42 patients was 21 days. Leukemic patients were found to have a higher frequency of clinical varicella, more pronounced symptoms and a slightly longer incubation period than other high-risk patients. VZ specific antibody titers were compared for various immunoglobulin preparations and found to be 30 times higher in zoster immunoglobulins than in normal immunoglobulins. PMID: 6318302 [PubMed - indexed for MEDLINE] 5483. Microbiol Immunol. 1983;27(9):767-77. Incomplete growth of varicella-zoster virus in human monocytes. Baba M, Shigeta S. Infection of human peripheral blood monocytes by varicella-zoster virus (VZV) was investigated. When freshly isolated monocytes of young adult volunteers were infected with cell-free VZV and examined by indirect immunofluorescence, specific antigens appeared at 8 hr and the number of antigen-positive cells reached the maximum between 24 and 48 hr postinfection. The proportion of antigen-positive cells to total cells was similar to that of the permissive control (HeLa cells), while very few infectious centers (IC) of monocytes were formed in comparison with the infected control cells. Monocytes isolated from infants and old persons formed a larger number of IC than those of young adults. Electron microscopic study of VZV-infected monocytes from three young adult volunteers demonstrated that the proportion of VZV particle-positive cells to total cells was similar to that of antigen-positive cells, and most of the particles seen in the nuclei were low in density and lacked a central core. These results suggest that the growth of VZV in human adult monocytes is incomplete. This restriction of VZV growth by monocytes may play an important role in defense against VZV infection. PMID: 6316116 [PubMed - indexed for MEDLINE] 5484. Intervirology. 1983;20(2-3):123-8. Detection of varicella-zoster virus-specific IgA antibodies in varicella and zoster patients and in healthy adults of various ages by solid-phase radioimmunoassay. Levy E, Mosovitz B, Friedman M, Sarov I. The varicella-zoster virus(VZV)-specific serum immunoglobulin A(IgA) response was studied in varicella and zoster patients and in healthy adults of various ages by a sensitive solid-phase radioimmunoassay technique. Significant rises in VZV-specific IgA titer were found for both varicella and zoster patients, while VZV-specific IgA was also detected in greater than 90% of healthy adults but at lower titers. No significant decrease in VZV-specific IgA titer with increasing age was found. The role of humoral versus cell-mediated immunity in VZV reactivation is discussed. PMID: 6313543 [PubMed - indexed for MEDLINE] 5485. Proc Eur Dial Transplant Assoc. 1983;19:513-26. Viral infection in the renal transplant patient. Rubin RH, Tolkoff-Rubin NE. With the advances that have occurred over the last two decades in the prevention and treatment of bacterial and fungal infection, viral infection has been recognised as an important problem in renal transplant patients. Four groups of viruses--the herpesviruses, hepatitis viruses, papovaviruses, and adenoviruses - appear to have a particular impact on this patient population, especially the first two of these. The effects of these viruses can be categorised as follows: the production of infectious diseases by the virus itself; the production of an immunosuppressed state that predisposes to opportunistic superinfection; the production of a unique form of allograft injury; and the production of malignancy. It is the recognition of these last three categories of viral effect that has led to a reawakening of interest in these agents in recent years. In particular, the interaction among rejection, innovative forms of immunosuppression, and reactivated viral infection in the pathogenesis of malignant disease, which occurs at a markedly increased rate in this patient population, offers a major frontier of human biology whose importance extends far beyond the renal transplant population. PMID: 6308602 [PubMed - indexed for MEDLINE] 5486. Curr Top Microbiol Immunol. 1983;104:235-45. A sensitive assay for detection of deoxythymidine kinase and its application to herpesvirus diagnosis. Gronowitz JS, Källander CF. PMID: 6307593 [PubMed - indexed for MEDLINE] 5487. Zh Nevropatol Psikhiatr Im S S Korsakova. 1983;83(4):504-11. [Etiotropic and pathogenetic therapy of painful neurologic syndromes of peripheral origin] [Article in Russian] Akimov GA, Lobzin VS, Shapkin VI, Mikhaĭlenko AA. PMID: 6305067 [PubMed - indexed for MEDLINE] 5488. Semin Perinatol. 1983 Jan;7(1):57-63. Laboratory diagnosis of herpesvirus infections. Sever JL, Jacob AJ. PMID: 6302914 [PubMed - indexed for MEDLINE] 5489. Int J Dermatol. 1983 Jan-Feb;22(1):19-21. When is systemic antiviral therapy indicated? Chou S. PMID: 6299984 [PubMed - indexed for MEDLINE] 5490. J Infect Dis. 1983 Jan;147(1):47-56. Zoster in children with cancer: radioimmune precipitation profiles of sera before and after illness. Grose C. Sera collected from children with cancer before and for extended periods after the onset of zoster were analyzed by radioimmune precipitation techniques. The percent recovery of both [3H]fucose- and [35S]methionine-labeled varicella-zoster virus (VZV)-specific antigens increased severalfold immediately after zoster and declined slowly during convalescence; however, within two years serum panels from two patients exhibited serologic evidence of subclinical reactivation of VZV. After electrophoretic fractionation of the immunoprecipitates, the polypeptide profile after zoster closely resembled that described for high titer xenoantisera to VZV and contained at least 16 constituents ranging in molecular weight from 32 to 174,000. In contrast, sera obtained before zoster were easily distinguished because they precipitated poorly, if at all, two major VZV glycoproteins (gp62 and gp98) and several nonglycosylated polypeptides. The emergence of zoster, therefore, was associated with the appearance of previously undetectable antibodies to VZV-specific proteins. PMID: 6296242 [PubMed - indexed for MEDLINE] 5491. J Infect Dis. 1983 Jan;147(1):149-54. Interferon prophylaxis against simian varicella in Erythrocebus patas monkeys. Arvin AM, Martin DP, Gard EA, Merigan TC. Erythrocebus patas monkeys were given placebo or human leukocyte interferon (5 x 10(5) units/kg of body weight per day im) for five days during an epizootic of simian varicella. During the 14 days beginning with the first day of treatment, the attack rate for simian varicella was 14.3% (two of 14) among interferon recipients compared to 70% (nine of 13) among placebo recipients (P less than 0.025). Excluding animals with antibody to simian varicella when the study began, 18% (two) of 11 interferon recipients had symptoms of infection compared to 80% (nine) of 11 placebo recipients (P less than 0.025). The epizootic began in a room housing male animals. The incidence of infection in male placebo recipients was 100% (seven of seven) compared to 14% (one of seven) in male interferon recipients (P less than 0.01). The efficacy of interferon prophylaxis in the simian varicella model supports its continued evaluation for the management of human varicella in high-risk patients. PMID: 6296238 [PubMed - indexed for MEDLINE] 5492. Acta Derm Venereol. 1983;63(6):540-3. Acquired immune deficiency syndrome (AIDS) manifesting as anogenital herpes zoster eruption: demonstration of virus-like particles in lymphocytes. Thune P, Andersson T, Skjørten F. A case of AIDS manifesting as a necrotic, haemorrhagic anogenital herpes zoster and lymphadenopathy, is described. Investigations of T-lymphocyte subsets showed decreased T4 and slight increase of T8. Electronmicroscopy revealed tubuloreticular virus-like structures in lymphocytes. PMID: 6198847 [PubMed - indexed for MEDLINE] 5493. Prog Brain Res. 1983;59:97-103. Interferon in acute and chronic viral infections. Brigden D, Freestone DS. PMID: 6198685 [PubMed - indexed for MEDLINE] 5494. Lab Delo. 1983;(11):53-6. [Cytomorphology of the cerebrospinal fluid in nervous system infections studied with the method of cell sedimentation on slides] [Article in Russian] Smirnov IuK, Podgornaia GV, Shishov AS, Aleshina BG. PMID: 6197582 [PubMed - indexed for MEDLINE] 5495. Ann Dermatol Venereol. 1983;110(6-7):563. [Generalization of zona in a nonimmunosuppressed patient receiving isoprinosine and rifamycin SV] [Article in French] Revuz J, Guillaume JC, Roujeau JC, Perroud AM. PMID: 6195953 [PubMed - indexed for MEDLINE] 5496. J Med Virol. 1983;12(2):149-53. Comparative use of adenine arabinoside and adenine arabinoside monophosphate in varicella and disseminated zoster in immunosuppressed patients. Vilde JL, Bricaire F, Huchon A, Brun-Vezinet F. Adenine arabinoside monophosphate (ARA AMP) was used in ten immunosuppressed patients suffering from varicella or disseminated zoster, and compared to adenine arabinoside (vidarabine) in ten other similar patients. Good results were obtained with both drugs: the fever stopped suddenly in three or four days and no new vesicles were observed after the third day. ARA AMP is more soluble than vidarabine and is thus easier to handle; it could be an effective treatment of severe varicella-zoster virus infections in immunosuppressed patients. PMID: 6194253 [PubMed - indexed for MEDLINE] 5497. Acta Derm Venereol. 1983;63(2):180-1. Herpes zoster in a 6-month-old infant. Helander I, Arstila P, Terho P. PMID: 6189345 [PubMed - indexed for MEDLINE] 5498. N Engl J Med. 1982 Dec 30;307(27):1706-7. Cancer and herpes zoster. Riegelman R. PMID: 7144870 [PubMed - indexed for MEDLINE] 5499. Ugeskr Laeger. 1982 Dec 13;144(50):3750-1. [Gastrointestinal dysfunction in zoster] [Article in Danish] Storm TL. PMID: 7168070 [PubMed - indexed for MEDLINE] 5500. Br J Clin Pract. 1982 Dec;36(11-12):404, 407. Herpes zoster and electrocardiographic changes. Bilimoria S, Hutton WN, Keczkes K. PMID: 7165770 [PubMed - indexed for MEDLINE] 5501. J Hyg (Lond). 1982 Dec;89(3):421-37. Studies of herpes virus latency in the sensory spinal ganglia of rabbits. Tosolini FA, McCarthy K, Baker BF. Experimental latent herpes infection of rabbit dorsal root ganglia (DRG) is reported. The simian herpes virus used was derived from fatal natural infection in owl monkeys and has limited neurotropism in the rabbit. Following intradermal injection of the flank it causes a local lesion followed only by dorsal root ganglionitis; segmental paraesthesia and/or sensory loss going on to clinical recovery. Methods were developed for mapping sensory losses. Virus could be immediately re-isolated from skin or DRG homogenates in the acute (first week) stage but from 8-550 days by DRG organ culture only. Spontaneous recurrence does not occur but reactivation can be provoked. The system provides an improved analogue model for the study of the pathogenesis and symptomatic treatment of herpes zoster. PMCID: PMC2134237 PMID: 7153508 [PubMed - indexed for MEDLINE] 5502. Ann Allergy. 1982 Dec;49(6):326-9. Transfer factor. Massicot JG, Goldstein RA. A workshop on transfer factor, sponsored by the Immunology, Allergic and Immunologic Diseases Program of the National Institute of Allergy and Infectious Diseases, National Institutes of Health, was held in Bethesda, Maryland, on February 25, 1981. The purpose of the meeting was two-fold: (1) to review the state of the art of transfer factor and (2) to suggest future directions for research in this area, specifically in regard to the prophylactic use of transfer factor for varicella-zoster in leukemic children. PMID: 7149349 [PubMed - indexed for MEDLINE] 5503. Int J Oral Surg. 1982 Dec;11(6):364-71. Tooth exfoliation, osteonecrosis of the jaw and neuralgia following herpes zoster of the trigeminal nerve. Schwartz O, Kvorning SA. PMID: 6820009 [PubMed - indexed for MEDLINE] 5504. Hosp Pract (Off Ed). 1982 Dec;17(12):21. Postherpetic neuralgia. Lyles YM. PMID: 6815060 [PubMed - indexed for MEDLINE] 5505. Am J Med. 1982 Dec;73(6):795-801. Herpes zoster in patients with carcinoma of the lung. Feld R, Evans WK, DeBoer G. Herpes zoster was observed in only four of 250 (1.6 percent) patients with small cell carcinoma of the lung, who were treated in a prospective, combined modality therapy trial. Induction chemotherapy in this study consisted of six courses of cyclophosphamide, doxorubicin, and vincristine (CAV), followed by intrathoracic and cranial irradiation. Those with extensive disease also received single doses of upper half-body irradiation. Patients did not receive maintenance chemotherapy (CAV2 protocol). This contrasted with our previous study (CAV1 protocol), which consisted of three courses of the same induction chemotherapy, the same intrathoracic irradiation, but with one year of oral maintenance chemotherapy. During the CAV1 regimen, we observed that herpes zoster developed in 13 of 161 (8.1 percent) patients in association with their therapy. A retrospective analysis of 6,576 patients with lung cancer revealed that herpes zoster developed in 58 (0.9 percent). This complication developed in 10 of 622 (1.6 percent) patients with small cell carcinoma of the lung, as compared to 48 of 5,954 (0.8 percent) patients with non-small cell carcinoma of the lung. The risk of development of herpes zoster in the CAV1 group was significantly greater than the historical group (p = 0.007) and was also greater than the CAV2 group (p = 0.031). However, there was no significant difference between the historical group and the CAV2 group. Attempts to explain the differences in the rate of herpes zoster in our three studies and those in the literature suggest that the duration of therapy, the type of chemotherapy used, and the improving survival rate may be important contributing factors to this complication in patients aggressively treated for small cell carcinoma of the lung. The literature and our own studies suggest that procarbazine is the most likely chemotherapeutic agent predisposing to this complication. PMID: 6293307 [PubMed - indexed for MEDLINE] 5506. Arch Neurol. 1982 Dec;39(12):785. CNS varicella-zoster vasculitis. Vilchez-Padilla JJ, Redon J, Ruiz A, Lopez-Aldeguer J. PMID: 6291496 [PubMed - indexed for MEDLINE] 5507. Nouv Presse Med. 1982 Nov 27;11(48):3547-50. [Adenine arabinoside treatment of varicella and generalized herpes zoster in 43 immunosuppressed patients] [Article in French] Vildé JL, Bricaire F, Huchon A, Dournon E, Brun-Vezinet F, Leport C, Bastin R. Forty-three immunosuppressed patients presenting with varicella or generalized herpes zoster were treated with adenine arabinoside (as monophosphate in 10 patients). All those who received the recommended 5-day course were rapidly cured without relapse; the skin lesions were virus-free after the 5th days of treatment. Five patients with malignant varicella involving several organs and who had only been treated for a few hours died. It is concluded that adenine arabinoside is a useful drug in VZ virus infections, although it has no immediate action. The monophosphate presentation, more soluble and requiring lesser amounts of solvent, is easier to administer and as effective as the ordinary presentation. PMID: 7155866 [PubMed - indexed for MEDLINE] 5508. Z Arztl Fortbild (Jena). 1982 Nov 15;76(22):966-9. [Epidemiology and clinical problems of herpetic eye diseases (retrospective analysis)] [Article in German] Pietruschka G. PMID: 6984990 [PubMed - indexed for MEDLINE] 5509. Hosp Employee Health. 1982 Dec;1(12):162-3. Restricting employees with herpes; who and for how long? Valenti WM. PMID: 10257425 [PubMed - indexed for MEDLINE] 5510. Pol Tyg Lek. 1982 Nov 1;37(41-42):1233-5. [Cytosine arabinoside in the treatment of herpes zoster] [Article in Polish] Głab-Kordecka E. PMID: 7163071 [PubMed - indexed for MEDLINE] 5511. Klin Monbl Augenheilkd. 1982 Nov;181(5):362-3. [Unusual course of malignant lymphoma] [Article in German] Skorpik C, Binder S. PMID: 7162084 [PubMed - indexed for MEDLINE] 5512. Hawaii Med J. 1982 Nov;41(11):420-2. Corticosteroid therapy of zoster: oral vs. sublesional injection. Epstein E. PMID: 7161091 [PubMed - indexed for MEDLINE] 5513. J R Coll Gen Pract. 1982 Nov;32(244):709, 711. Ultrasound therapy for herpes zoster pain. Garrett AS, Garrett M. PMCID: PMC1972818 PMID: 7153972 [PubMed - indexed for MEDLINE] 5514. Srp Arh Celok Lek. 1982 Nov;110(11):1299-304. [Neuro-ophthalmologic manifestations in persons with herpes zoster of the visual organs] [Article in Serbian] Sasić M, Petrović M, Lesić Lj, Drincić V. PMID: 6985234 [PubMed - indexed for MEDLINE] 5515. Ophthalmology. 1982 Nov;89(11):1250-3. Sodium hyaluronate and tissue adhesive in treating corneal perforations. Hirst LW, De Juan E Jr. The injection of sodium hyaluronate through perforation sites prior to tissue adhesive application has extended the current use of this modality to large perforations and perforations in which intraocular tissue is incarcerated. Three clinical cases are described in which the conjoint therapy was used, and four monkey eyes were studied clinically and histopathologically to test for adverse drug interactions. PMID: 6984163 [PubMed - indexed for MEDLINE] 5516. Vestn Dermatol Venerol. 1982 Nov;(11):43-5. [Paraneoplastic lesions of the skin] [Article in Russian] Fedorovskaia RF, Rutshteĭn LG. PMID: 6760590 [PubMed - indexed for MEDLINE] 5517. J Clin Microbiol. 1982 Nov;16(5):878-84. Comparison of the Raji cell line fluorescent antibody to membrane antigen test and the enzyme-linked immunosorbent assay for determination of immunity to varicella-zoster virus. Iltis JP, Castellano GA, Gerber P, Le C, Vujcic LK, Quinnan GV Jr. A prospective study was performed comparing the fluorescent antibody to membrane antigen (FAMA) test and the enzyme-linked immunosorbent assay (ELISA) for identifying susceptibility and seroconversion to varicella-zoster virus (VZV) infection. A total of 75 sera were collected from index cases and from sibling and parent contacts in 10 families. Varicella-zoster virus-infected human diploid embryonic fibroblasts and continuous lymphoblastoid cells (Raji cells) were compared as indicator cells in the FAMA test. Equivalent results were obtained with both types of cell. Results of the FAMA test and the ELISA were identical in two ways. (i) The same 11 individuals were initally defined as susceptible (seronegative), and 9 of them (82%) developed fourfold rises in antibody titers, clinical varicella, or both. (ii) Of 21 immune (seropositive) individuals, 4 developed fourfold antibody rises by FAMA tests, and 3 of these 4 responded by ELISA. Infection was asymptomatic in these individuals. The geometric mean titer by ELISA was significantly higher than by the FAMA test. The results indicated that the ELISA and the FAMA test have similar capacities to define susceptibility to varicella-zoster virus and that subclinical infection with varicella-zoster virus may be common. PMCID: PMC272496 PMID: 6759530 [PubMed - indexed for MEDLINE] 5518. Thorax. 1982 Nov;37(11):870-1. Hemidiaphragmatic paresis after cervical herpes zoster. Derveaux L, Lacquet LM. PMCID: PMC459448 PMID: 6298966 [PubMed - indexed for MEDLINE] 5519. J Virol Methods. 1982 Nov;5(3-4):219-27. Frequency and specificity of varicella zoster virus IgM response. Sundqvist VA. A direct ELISA was developed for determination of IgM antibody to varicella zoster virus (VZV). With this sensitive method VZV IgM antibodies were detected in all patients with a varicella and in 84% with a herpes zoster infection. All but one of 28 renal allograft recipients had previously had varicella. A primary infection was seen in the last patient, and reactivated infections in 11 of the others. The VZV IgM response seems to be specific since patients with a herpes simplex virus (HSV) infection and a heterotypic VZV IgG titer rise did not have detectable VZV IgM. An indirect enzyme-linked immunosorbent assay (ELISA) for detection of IgG antibodies has been used for serodiagnosis of VZV infections and to determine the immune status. After injection of zoster immune globulin, it was possible to measure passively transferred antibodies. PMID: 6296180 [PubMed - indexed for MEDLINE] 5520. Am J Med. 1982 Nov;73(5):769-72. Zoster encephalitis. Isolation of virus and measurement of varicella-zoster-specific antibodies in cerebrospinal fluid. Andiman WA, White-Greenwald M, Tinghitella T. Varicella-zoster virus (VZV) was isolated on two occasions from the cerebrospinal fluid of an elderly woman with encephalomyelitis complicating thoracic zoster. Antibodies to ZV-induced membrane antigen (FAMA) were present in cerebrospinal fluid in a titer of 1:64; serum antibodies were 64-fold higher. Further evidence for local antibody production was derived from simultaneous measurements of immunoglobulin G and albumin in cerebrospinal fluid and serum and calculation of a cerebrospinal fluid-IgG index. PMID: 6291390 [PubMed - indexed for MEDLINE] 5521. ZFA (Stuttgart). 1982 Oct 31;58(30):1679-80. [A new type of treatment for herpes zoster] [Article in German] Wachter K. PMID: 7157955 [PubMed - indexed for MEDLINE] 5522. Br Med J (Clin Res Ed). 1982 Oct 30;285(6350):1223-4. Acyclovir. Timbury MC. PMCID: PMC1499809 PMID: 6289962 [PubMed - indexed for MEDLINE] 5523. Lancet. 1982 Oct 16;2(8303):884. Subsequent risk of rheumatoid arthritis in patients diagnosed with herpes zoster. Ragozzino MW, Kurland LT. PMID: 6126748 [PubMed - indexed for MEDLINE] 5524. N Engl J Med. 1982 Oct 14;307(16):971-5. Early vidarabine therapy to control the complications of herpes zoster in immunosuppressed patients. Whitley RJ, Soong SJ, Dolin R, Betts R, Linnemann C Jr, Alford CA Jr. We conducted a double-blind, placebo-controlled trial to assess the value of vidarabine therapy for the prevention of complications from herpes zoster in immunocompromised patients. Of 121 patients with localized herpes zoster of 72 hours duration or less, 63 received vidarabine and 58 received the placebo. Populations were matched for pertinent characteristics. Therapy accelerated cutaneous healing and decreased the rates of cutaneous dissemination (from 24 per cent [14 patients] to 8 per cent [5 patients]) (P = 0.014); and of zoster-related visceral complications (from 19 per cent [11 patients] to 5 per cent [3 patients]) (P = 0.015). therapy also decreased the total duration of post-herpetic neuralgia (P = 0.047). Patients with lymphoproliferative cancers and those 38 years of age or older were at greatest risk for complications and benefited most from therapy. There was no serious drug toxicity. We conclude that vidarabine therapy, when started within the first three days, is valuable for the reduction of complications related to herpes zoster. PMID: 7110300 [PubMed - indexed for MEDLINE] 5525. Br Med J (Clin Res Ed). 1982 Oct 9;285(6347):1022-3. Outbreak of chickenpox from a patient with immunosuppressed herpes zoster in hospital. Faizallah R, Green HT, Krasner N, Walker RJ. PMCID: PMC1500374 PMID: 6812728 [PubMed - indexed for MEDLINE] 5526. Lancet. 1982 Oct 2;2(8301):763-4. Vasculitis in association with chickenpox treatment in childhood acute lymphoblastic leukemia. Platt MP, Eden OB. PMID: 6125827 [PubMed - indexed for MEDLINE] 5527. Postgrad Med. 1982 Oct;72(4):195-203, 206-7. Viral skin infections: challenges in differential diagnosis and therapy. Millikan LE. PMID: 7122352 [PubMed - indexed for MEDLINE] 5528. Klin Monbl Augenheilkd. 1982 Oct;181(4):261-2. [Further indications for corneal incision] [Article in German] Nagy Z. The results of operations for disjunctio epithelialis corneae following recurrent keratitis herpetica and injury are reported. The operation is indicated in every chronic or recurrent corneal disease where circumstances do not allow keratoplasty to be carried out; the pain can be alleviated by incisio corneae. PMID: 6982999 [PubMed - indexed for MEDLINE] 5529. Cancer Nurs. 1982 Oct;5(5):361-70. Herpes zoster in the immunocompromised patient. Couillard-Getreuer DL. PMID: 6923771 [PubMed - indexed for MEDLINE] 5530. Ir J Med Sci. 1982 Oct;151(10):318-9. Pseudo obstruction of the colon associated with varicella-zoster infection. Walsh TN, Lane D. PMID: 6897397 [PubMed - indexed for MEDLINE] 5531. J Am Optom Assoc. 1982 Oct;53(10):813-4. Herpes zoster dendritic keratitis. Jones WL. PMID: 6815255 [PubMed - indexed for MEDLINE] 5532. Hosp Pract (Off Ed). 1982 Oct;17(10):166, 171, 174 passim. Shingles, dyspnea, and wild irrational behavior. Kandel G, Aberman A. PMID: 6811401 [PubMed - indexed for MEDLINE] 5533. Blood. 1982 Oct;60(4):877-87. Nonrandom chromosome abnormalities in angioimmunoblastic lymphadenopathy. Kaneko Y, Larson RA, Variakojis D, Haren JM, Rowley JD. Cytogenetic and pathologic studies were performed on six patients with angioimmunoblastic lymphadenopathy (AILD). All six had diffuse lymphadenopathy; five had fever, four had weight loss, and four had a diffuse erythematous rash. All patients except one had a polyclonal elevation of immunoglobulin. All patients had diagnostic findings in lymph node (LN) and bone marrow (BM) biopsies. Two patients died of progressive AILD; one patient died after transformation of AILC to immunoblastic sarcoma (IBS); one patient died of gastrointestinal bleeding of unknown cause. The remaining two patients, who have achieved complete remission with intensive chemotherapy, are alive 20 and 8 mo after the diagnosis; one of these had AILD and the other, both AILD and IBS. Despite diagnostic BM biopsy findings, none of the patients had chromosome abnormalities in their BM cells. In studying LN cels of 5 patients, however, we found chromosome abnormalities in each; clonal abnormalities were detected in two, both clonal and nonclonal abnormalities in two, and only nonclonal single-cell abnormalities in one. An extra chromosome 3, seen in four patients, was clonal in two and nonclonal in the two others. Cells with +5, +15, +19, +21, +22 were seen in two patients. All patients had 50% or more normal dividing cells in their LN. The mosaicism of unrelated abnormal cells in their LN. The mosaicism of unrelated abnormal karyotypes that was seen in four patients suggests that this malignant tumor is not necessarily monoclonal in its early stages, but that one clone may be selected and predominate in the late stage. Because nonrandom acquired clonal chromosome abnormalities are a consistent feature of malignancies, our data suggest that AILD may be a malignant disease despite its original description as a benign proliferative process. Therefore, it may require aggressive chemotherapy. PMID: 6180784 [PubMed - indexed for MEDLINE] 5534. Medicine (Baltimore). 1982 Sep;61(5):310-6. Population-based study of herpes zoster and its sequelae. Ragozzino MW, Melton LJ 3rd, Kurland LT, Chu CP, Perry HO. The epidemiology of herpes zoster and its sequelae have been investigated in a community-based study. The incidence rates observed in Rochester, Minnesota, are lower than those determined in practice-based series; and this may reflect some selectivity in practice-based series compared to population-based studies. No significant sex difference or seasonal variation was observed but the incidence did increase markedly with age. An increase in incidence was also observed over the 15-year period studied. The dermatomal distribution of herpes zoster observed in Rochester was quite similar to previous studies, despite their inherent biases in case ascertainment, except for a lower proportion with cranial nerve zoster. Herpes ophthalmicus (V1) appears to affect a slightly different population than zoster of the other dermatomes, with elderly males being more at risk. Also, herpes ophthalmicus is associated with a higher complication rate compared to the other dermatomes primarily due to the fragility of the involved organ. The elderly are also at greatest risk for the most common complication, post-herpetic neuralgia. The rate of PHN is not significantly increased in any particular dermatome but is significantly decreased in lumbar herpes zoster. PMID: 6981045 [PubMed - indexed for MEDLINE] 5535. Hosp Pract (Off Ed). 1982 Sep;17(9):96A-96O. Herpes zoster and postherpetic neuralgia. Stein JM, Warfield CA. PMID: 6809590 [PubMed - indexed for MEDLINE] 5536. Med Clin North Am. 1982 Sep;66(5):1105-18. Herpes zoster: an approach to systemic therapy. Price RW. PMID: 6752600 [PubMed - indexed for MEDLINE] 5537. Biken J. 1982 Sep;25(3):149-56. Deoxythymidine kinases in varicella-zoster virus infected and biochemically transformed cells. Ogino T, Lopetegui P, Yamanishi K. Deoxythymidine kinase (TK) activity induced in varicella-zoster virus (VZV)-infected human embryonic fibroblast (HEF) cells was immunologically distinguishable from that in non infected HEF cells and also from that in herpes simplex virus type 1 (HSV-1) infected HEF cells. The TKs in VZV-biochemically transformed cells were immunologically the same as that induced in VZV-infected human cells and immunologically different from that in Ltk- cells or in HSV-biochemically transformed cells. One peak of TK activity with an Rm value of 0.8-0.9, corresponding to mitochondrial TK, was observed on polyacrylamide gel electrophoresis of Ltk- cell extracts. VZV infected Ltk- cells had two peaks of TK activity with Rm values of 0.45-0.5 (peak I) and 0.8-0.9 (peak II). Peak I and II were concluded to be virus-specific TK and mitochondrial TK, respectively. VZV-biochemically transformed cells had a peak of activity with an Rm value of 0.4-0.5, corresponding to peak I in VZV-infected Ltk- cells; that is VZV-specific TK activity. The present study indicates that VZV has a gene coding for its own TK. PMID: 6299267 [PubMed - indexed for MEDLINE] 5538. Pediatr Infect Dis. 1982 Sep-Oct;1(5):304-7. Interview with Philip A. Brunell: contagion and varicella-zoster virus. Brunell PA. PMID: 6296801 [PubMed - indexed for MEDLINE] 5539. Ther Umsch. 1982 Sep;39(9):675-82. [Herpesvirus infections in immunosuppressed patients] [Article in German] Stalder H. PMID: 6294896 [PubMed - indexed for MEDLINE] 5540. J Infect Dis. 1982 Sep;146(3):443. Serum amyloid A levels in patients with infections due to cytomegalovirus, varicella-zoster virus, and herpes simplex virus. Sarov I, Shainkin-Kestenbaum R, Zimlichman S, Winikoff Y, Chaimovitz C, Pras M. PMID: 6286800 [PubMed - indexed for MEDLINE] 5541. Geriatrics. 1982 Sep;37(9):107-13. The ten major problems of aging skin. Shelley WB, Shelley ED. PMID: 6213448 [PubMed - indexed for MEDLINE] 5542. Blood. 1982 Sep;60(3):714-20. Analysis of late infections after human bone marrow transplantation: role of genotypic nonidentity between marrow donor and recipient and of nonspecific suppressor cells in patients with chronic graft-versus-host disease. Atkinson K, Farewell V, Storb R, Tsoi MS, Sullivan KM, Witherspoon RP, Fefer A, Clift R, Goodell B, Thomas ED. Infections occurring 6 mo or later after bone marrow transplantation for severe aplastic anemia or hematologic malignancy were analyzed in 98 long-term survivors. Varicella-zoster (VZ) infections were analyzed separately from all other infections. The factor predisposing most strongly to late VZ infection was genotypic nonidentity for HLA between marrow donor and recipient. There was a suggestion that chronic graft-versus-host disease (GVHD) associated with the presence of nonspecific suppressor cells also predisposed to late VZ infection, while age less than 10 yr was protective against such infections. Chronic GVHD predisposed to late non-VZ infections, but this was not increased by the presence of nonspecific suppressor cells. HLA nonidentify between patient and marrow donor further increased the risk of late non-VZ infections over and above that due to the presence of chronic GVHD. Receipt of a syngeneic transplant appeared protective for late non-VZ infections. These findings suggest that full genotypic identity for HLA between donor and recipient may be required for optimal immune reconstitution after marrow transplantation and may denote a possible biologic role for nonspecific suppressor T cells in humans. PMID: 6213276 [PubMed - indexed for MEDLINE] 5543. Jpn J Antibiot. 1982 Sep;35(9):2241-8. [Cyclocytidine therapy for the herpes-group virus infection in children. A preliminary study] [Article in Japanese] Meguro H, Araki K, Fujii R, Yonezawa H, Togo T, Hashira S. Cyclocytidine (Cyclo-C) was evaluated as an antiviral chemotherapeutic agent in 10 children with herpes-group virus infections. The diagnoses of the patients were severe cytomegalovirus (CMV) syndrome with pneumonitis in acute leukemia (2), congenital or infantile CMV infections (3), herpes zoster encephalitis in acute leukemia (1), severe nosocomial varicella in compromised patients (2), varicella pneumonia (1) and acute encephalitis due to herpes simplex type-1 (1). Cyclo-C was effective in all the cases with acute infections, although it had no benefit on the course of chronic CMV infection with irreversible damages. However, complete or transient ceasing of viral shedding was obtained in all the 5 cases with CMV infections. From the present small open study, further evaluation of Cyclo-C as an antiviral agent especially in acute CMV infections is warranted. PMID: 6183467 [PubMed - indexed for MEDLINE] 5544. S Afr Med J. 1982 Aug 21;62(9):274-5. Treatment of post-herpetic neuralgia and acute herpetic pain with amitriptyline and perphenazine. Weis O, Sriwatanakul K, Weintraub M. A fixed-ratio combination of amitriptyline and perphenazine was successful in treating 8 of 9 patients suffering from post-herpetic neuralgia. Side-effects were minimal. Summaries of 4 case histories are presented. In addition, 3 patients suffering from severe acute herpetic pain were successfully treated with the same drug combination. PMID: 7112329 [PubMed - indexed for MEDLINE] 5545. N Engl J Med. 1982 Aug 12;307(7):393-7. Risk of cancer after herpes zoster: a population-based study. Ragozzino MW, Melton LJ 3rd, Kurland LT, Chu CP, Perry HO. Herpes zoster has been associated with immune suppression, as has an increased risk of cancer. To determine whether patients with herpes zoster are at increased risk for subsequent cancer, we followed 590 residents of Rochester, Minnesota, for 9389 person-years after the diagnosis of herpes zoster. Subsequent relative cancer risks, overall and by specific site, were determined for the entire cohort and selected subgroups. In addition, relative risks of cancer during various intervals after the diagnosis of herpes zoster were determined. The overall relative risk was 1.1 (95 per cent confidence interval, 0.9 to 1.3). Relative risks of specific cancer sites were not different from unity except for those for colon and bladder tumors in women, both of which were slightly elevated. Patients with disseminated, recurrent, or gangrenous zoster, with postherpetic neuralgia, and with ophthalmic zoster wee not at elevated risk for subsequent cancer. These findings do not support the investigation of patients for occult cancer at the time of diagnosis of herpes zoster or enhanced surveillance for cancer after such a diagnosis. PMID: 6979711 [PubMed - indexed for MEDLINE] 5546. N Engl J Med. 1982 Aug 5;307(6):348-51. Current concepts in neurology: diagnosis and management of facial paralysis. Adour KK. PMID: 7088100 [PubMed - indexed for MEDLINE] 5547. Ugeskr Laeger. 1982 Aug;144(34):2496-7. [Herpes zoster with paresis] [Article in Danish] Boesen F, Christensen JD. PMID: 7179525 [PubMed - indexed for MEDLINE] 5548. Neurology. 1982 Aug;32(8):914-6. Hemispheric infarction after herpes zoster ophthalmicus. [No authors listed] PMID: 6980380 [PubMed - indexed for MEDLINE] 5549. J Clin Microbiol. 1982 Aug;16(2):373-6. Evaluation of the anticomplement immunofluorescence test for detection of antibody to varicella-zoster virus. Preissner CM, Steinberg SP, Gershon AA, Smith TF. The anticomplement immunofluorescence (ACIF) test was compared with complement fixation and fluorescent antibody to membrane antigen procedures for the detection of antibody to varicella-zoster virus. All of 50 sera from pregnant women contained antibody measured by ACIF (titer, greater than or equal to 1:10); only 27 (54%) were positive by complement fixation (P less than 0.01). For 16 paired sera obtained before and after varicella-zoster virus infection and tested by ACIF and fluorescent antibody to membrane antigen, the result agreed in 27 determinations (sensitivity, 94%; specificity, 81%). Of 99 sera submitted for routine determinations of immune status to the virus, 89 showed comparable results for both tests (sensitivity, 92.5%; specificity, 88%). The ACIF test offers a specific and sensitive alternative to the fluorescent antibody to membrane antigen procedure for the detection of antibody to varicella-zoster virus. In addition, the ACIF test is rapid, easy to perform, and uses commercially available reagents. PMCID: PMC272363 PMID: 6288766 [PubMed - indexed for MEDLINE] 5550. Infect Immun. 1982 Aug;37(2):407-12. Experimental infection and immune response of guinea pigs with varicella-zoster virus. Matsunaga Y, Yamanishi K, Takahashi M. An immune response (fluorescent antibody to membrane antigen) was detected in guinea pigs inoculated with varicella-zoster virus (VZV) adapted to guinea pig embryonic cells, including the Oka vaccine strain, even when inoculation was by an external route, i.e., nasal or corneal. Live or UV-inactivated virus having the same virus titer before irradiation was administered to guinea pigs by the corneal route, and antibody induction was detected only with live virus. The transmission of VZV from infected guinea pigs to noninfected ones was suggested by the appearance of antibody in the serum of the latter, who were kept in the same cage. The time course of the appearance of humoral and cellular immune responses in guinea pigs was examined by the fluorescent antibody to membrane antigen test and the skin reaction, with varicella antigen representing delayed-type hypersensitivity. When VZV was injected subcutaneously, skin reaction appeared as early as 4 days after inoculation, which preceded the appearance of detectable antibody by 2 to 6 days. In in vitro studies, the Oka vaccine showed a higher adsorption rate and better growth in guinea pig embryonic cells than did other wild-type strains when assayed by the infectious center assay. These results suggest that a system of VZV adapted to guinea pig cells and guinea pigs provides a good animal experimental model for immunological study of VZV infection. PMCID: PMC347548 PMID: 6288560 [PubMed - indexed for MEDLINE] 5551. Scand J Haematol. 1982 Aug;29(2):168-74. Interferon production, cellular and humoral immunity in splenectomized patients. Lanng Nielsen J, Haahr S. Undetectable levels of circulating interferon were found in 35 splenectomized patients and in 14 controls. In addition, no differences in virus, purified protein derivative (PPD), and phytohaemagglutinin (PHA) induced interferon production were observed between the patients and the controls. Virus induced lymphocyte transformation tended to be reduced after splenectomy, but only the herpes simplex virus (HSV) induced transformation index was significantly reduced in splenectomized patients without residual splenic tissue (P less than 0.05). In contrast, the PHA lymphocyte transformation was unchanged in patients and controls. The number of natural viral antibodies in splenectomized patients did not differ from that of controls. Furthermore, there were no major differences in the magnitude of the titers of the sero-positive cases between the various groups. Thus, splenectomy does not interfere with interferon production in vitro, and as seen from natural viral antibodies, no impairment of humoral immunity was observed. The reduced HSV lymphocyte transformation may indicate an impaired lymphocyte function after splenectomy. PMID: 6182609 [PubMed - indexed for MEDLINE] 5552. Am J Med. 1982 Jul 20;73(1A):320-5. Therapy of acute herpes zoster with acyclovir in the nonimmunocompromised host. Esmann V, Ipsen J, Peterslund NA, Seyer-Hansen K, Schønheyder H, Juhl H. PMID: 7102712 [PubMed - indexed for MEDLINE] 5553. Am J Med. 1982 Jul 20;73(1A):286-9. Use of acyclovir in herpetic ocular infection. McGill J, Tormey P. Acyclovir has veen shown to have potent antiviral activity against both herpes simplex and herpes zoster viruses, especially the former, with low cellular toxicity, preferentially affecting virally infective cells by inhibiting viral DNA synthesis [1,2]. In experimental herpes simplex corneal infection, acyclovir has been found to be effective [3,4] and in early clinical trials it has been found to be at least as good as idoxuridine [5-7]. Acyclovir has also been found to have antiviral activity against the herpes zoster virus in tissue culture [1] and to affect favorably the course of the disease in immunosuppressed patients [8]. This paper describes the use of acyclovir in patients with either herpes simplex or herpes zoster ocular infections. Topical acyclovir has been compared with adenine arabinoside in the treatment of herpes simplex corneal ulceration in a coded clinical trial. The use of acyclovir will also be described in patients with complicated herpes simplex eye disease. Our initial results with topical acyclovir in herpes zoster keratouveitis are also described. PMID: 7102708 [PubMed - indexed for MEDLINE] 5554. Am J Med. 1982 Jul 20;73(1A):271-4. Acyclovir in severe herpes virus infections. van der Meer JW, Versteeg J. Forty-five patients with severe herpes virus infections were treated with acyclovir intravenously for five days. Nine patients had varicella (eight of whom were immuno- or myelocompromised), 23 had herpes zoster (14 compromised patients) and 13 had herpes simplex (nine compromised patients). No patient died from the viral infection and in eight of the patients the beneficial effect of acyclovir was beyond doubt. Six of these patients had herpes simplex infections. In 21 patients acyclovir was probably beneficial, whereas in 16 patients the effect was doubtful or absent. As expected, in patients with established neurologic damage there was no effect. Except for transient elevation in transaminases in one patient and occasional infusion thrombophlebitis, no toxicity of acyclovir was encountered in this series. PMID: 7102706 [PubMed - indexed for MEDLINE] 5555. Am J Med. 1982 Jul 20;73(1A):275-80. Treatment of herpes virus infections in immunocompromised patients with acyclovir by continuous intravenous infusion. Spector SA, Hintz M, Wyborny C, Connor JD, Keeney RE, Liao S. Sixteen immunocompromised patients with herpes virus infections were treated for three to five days with continuously administered intravenous acyclovir. Patients received initial acyclovir infusions over 5 minutes in dosages ranging from 1.5 to 5.0 mg/kg followed by continuously infused acyclovir at 7.2, 14.4, 21.6, 28.8, 36.0, or 43.2 mg/kg per day. The mean serum plateau levels of acyclovir determined by radioimmunoassay ranged from 4.1 microM for the 7.2 mg/kg per day dosage to 36.6 microM for the 43.2 mg/kg per day dose. A mean of 75 percent of acyclovir administered was recovered in the urine of patients treated. Eleven of 13 patients with varicella-zoster virus (VZV) infections had no new vesicle formation after three days of acyclovir treatment and all patients ceased to have new vesicles after five days of therapy. For the nine patients from whom complete viral cultures were available, six ceased to shed virus at three days, and viral shedding ceased by five days in all patients treated with acyclovir. No clinical or laboratory adverse reactions were associated with acyclovir therapy. These data suggest that acyclovir given by continuous intravenous infusion may be useful in the treatment of herpes virus infections in immunocompromised patients. PMID: 6285719 [PubMed - indexed for MEDLINE] 5556. Am J Med. 1982 Jul 20;73(1A):225-8. Acyclovir treatment of herpes simplex virus infections in immunocompromised humans. An overview. Alford CA. As reflected in the preclinical and early clinical data, acyclovir seems destined to have a very useful role in the treatment and/or prophylaxis of herpes virus (HSV) infections in immunosuppressed humans. If the preclinical predictions can be extrapolated to varicella-zoster (V-Z) infections, acyclovir could well also play a meaningful role in therapy of V-Z infections in the immunosuppressed host; however, this conjecture awaits proof of controlled studies in humans. Clearly the usefulness of acyclovir for treatment of V-Z infections should be compared with that of adenine arabinoside (ara-A) to put into proper perspective the relative efficacies of the two drugs for future therapeutic regimens. The need for comparative studies is most important at this early stage of antiviral drug development, to avoid ethical problems that will cloud the knowledge needed to move forward in a positive way. In any event, the development of acyclovir, with its targeted approach, represents a real fundamental advance in antiviral drug development. Together with the development and deployment of ara-A, it should provide the needed impetus for a surge in the creation of new antiviral compounds for tomorrow. PMID: 6285714 [PubMed - indexed for MEDLINE] 5557. Lancet. 1982 Jul 17;2(8290):118-21. Acyclovir therapy for acute herpes zoster. Bean B, Braun C, Balfour HH Jr. 31 adults took part in a randomised, placebo-controlled, double-blind trial of intravenous acyclovir therapy (500 mg/m2 intravenously 3 times daily for 5 days) for acute herpes zoster. Acyclovir reduced pain, decreased erythema, prevented the formation of new lesions, and healed skin faster than did placebo. The duration of viral shedding was also significantly shorter in acyclovir recipients (2 days versus 5 days). However, 6(35%) of 17 acyclovir recipients had recurrence of pain after the drug was discontinued, and acyclovir did not appear to affect post-herpetic neuralgia. Acyclovir therapy was associated with a transient rise in serum creatinine levels, and may have been related to nausea and vomiting. Intravenous acyclovir was effective therapy for acute herpes zoster but the ideal treatment regimen might be a lower daily dose given for a longer period. PMID: 6123837 [PubMed - indexed for MEDLINE] 5558. Riv Neurobiol. 1982 Jul-Dec;28(3-4):328-33. [Ozone in the treatment of herpes zoster] [Article in Italian] Bassi P, Sbrascini S, Mattassi R, D'Angelo F, Franchina A. PMID: 7187109 [PubMed - indexed for MEDLINE] 5559. Strahlentherapie. 1982 Jul;158(7):395-404. [Risk of infection by iatrogenic asplenia--a study about the indication of exploratory laparotomy with splenectomy (LS) in case of Hodgkin's disease] [Article in German] Slanina J, Wannenmacher M, Heidemann S. A retrospective evaluation of the data of all patients with Hodgkin's disease (collective of Freiburg) treated between 1964 and 1977 was made in order to find out if there was an increased risk of infection after a diagnostic laparotomy with splenectomy (LS). Among a total number of 592 patients, 277 had been submitted to LS (since 1969). 185 patients had a total remission, 130 of them after primary LS, 34 after secondary LS, and 21 without any treatment of the spleen. An inquiry conducted by means of a questionnaire showed no differences between the compared groups as to the frequency of not septic infections such as pulmonary tuberculosis, angina tonsillaris, pyodermia, sinusitis, complications in wound healing, urinary tract infections, and infections of the intestine. However, there was a significant increase of unspecific pneumonias and herpes zoster manifestations after (long-term observation) secondary LS. There were no differences regarding the frequency of febrile and not febrile colds, but after LS, the colds had a longer and more severe course.--The analysis of the cause of death in the 277 patients who died showed a lethal septicaemia in seven cases. All these patients had been submitted to LS. In three of these patients, a recurrence was proved or could not be excluded, four presented as total remission with respect to Hodgkin's disease.--These results and the communications of literature permit to conclude that the iatrogenic asplenia represents an additional immunological risk. They suggest a further reduction of the indication for LS, the criteria of which are discussed. PMID: 7135435 [PubMed - indexed for MEDLINE] 5560. Conn Med. 1982 Jul;46(7):373-4. Disseminated herpes zoster and the syndrome of inappropriate antidiuretic hormone. White TM, Hoffman JH, Holmes WH, Huntley RG. PMID: 7116837 [PubMed - indexed for MEDLINE] 5561. Med Clin North Am. 1982 Jul;66(4):807-17. Common viral infections of the skin and their treatment. Smith EB, Raimer SS. PMID: 7098620 [PubMed - indexed for MEDLINE] 5562. Semin Hematol. 1982 Jul;19(3):193-226. Infectious complications in leukemic patients. Bodey GP, Bolivar R, Fainstein V. PMID: 7051289 [PubMed - indexed for MEDLINE] 5563. Psychiatr Neurol Med Psychol (Leipz). 1982 Jul;34(7):429-32. [Cutaneous thermography in cerebral processes] [Article in German] Lauschke HP. PMID: 6982481 [PubMed - indexed for MEDLINE] 5564. Laryngol Rhinol Otol (Stuttg). 1982 Jul;61(7):380-2. [Treatment of Zoster oticus (author's transl)] [Article in German] Helms J. Conservative treatment of zoster oticus seems to be possible by promoting increased activity of the immunological system. The techniques to be applied were described by Mayr, Stickl and coworkers. These researchers used a special preparation of an attenuated virus. A transtemporal decompression of the facial nerve should be performed after Fisch and Esslen when more than 90% of the neurons of the facial nerve are lost. Signs of vestibular and cochlear damage are additional arguments for decompression surgery. A case is described in which one year after the onset of the disease necrosis of the facial nerve at the fundus of the internal auditory meatus and the beginning of the Fallopian canal (canalis facialis Fallopii) was seen and histologically proven. This was repaired by inserting a nerve graft. Motility of the face returned. An earlier decompression operation would most probably have prevented this course of the disease. PMID: 6981042 [PubMed - indexed for MEDLINE] 5565. Czas Stomatol. 1982 Jul-Aug;35(7-8):487-92. [Treatment of herpes zoster using low temperature] [Article in Polish] Hutowska-Lukasiewicz M. PMID: 6964124 [PubMed - indexed for MEDLINE] 5566. Hokkaido Igaku Zasshi. 1982 Jul;57(4):507-10. [Treatment of herpetic and postherpetic pain] [Article in Japanese] Ogawa H. PMID: 6757080 [PubMed - indexed for MEDLINE] 5567. Riv Neurobiol. 1982 Jul-Dec;28(3-4):412-5. [Herpes zoster of the geniculate ganglion (Ramsay-Hunt syndrome). Therapeutic aspects] [Article in Italian] Baldini D, Tomaiuolo S, Lozza M, Pieczuro A, Votta I. PMID: 6195724 [PubMed - indexed for MEDLINE] 5568. N Engl J Med. 1982 Jun 24;306(25):1553. Symptomatic relief in herpes zoster. Tepperman J. PMID: 7078618 [PubMed - indexed for MEDLINE] 5569. Klin Wochenschr. 1982 Jun 15;60(12):625-9. Effect of human fibroblast interferon on natural killer cell activity: stimulation in vitro and inhibition in vivo. Heidemann E, Reichmann U, Wilms K, Treuner J, Niethammer D. This paper describes the influence of human fibroblast interferon (IFN-beta) on the cytotoxic activity of natural killer cells (NK) in vitro and in vivo using the blood of healthy donors and myeloma patients. IFN-beta stimulates NK activity against all target cells tested in vitro in a dose-dependent way up to 250% of pretreatment values. At higher IFN concentrations, stimulation returned to baseline values. Stimulation was most pronounced in the lowest lymphocyte to target cell ratio. 1- to 2-h preincubation of effector cells with IFN was enough to achieve maximal stimulation. The effector cells of IFN-treated myeloma-patients, or patients with herpes zoster, showed a clear reduction of toxicity against all cells tested during the first infusion, as compared to the pretreatment values. PMID: 6180219 [PubMed - indexed for MEDLINE] 5570. Fortschr Med. 1982 Jun 10;100(22):1067-70. [The effect of epicutaneous heparin treatment] [Article in German] Stüttgen G. Former suggestions that local treatment with external heparin could accelerate healing of zoster could be confirmed. The antitoxic and antiphlogistic components of heparin could be proved by long-term pre-treatment with heparin ointment, based on clinical experimental trials of inhibition of the pyrexal reaction and reduction of erythema, weal and heat radiation produced by histamin and bradykinin i.c. The effectiveness of heparin could be presumed more in its character as a linear anionic polyelectrolyte than as effect on the coagulation process. PMID: 7106672 [PubMed - indexed for MEDLINE] 5571. Rinsho Shinkeigaku. 1982 Jun;22(6):514-20. [Three cases herpes zoster myelitis] [Article in Japanese] Kanehisa Y, Hokezu Y, Nagamatsu K. PMID: 7140099 [PubMed - indexed for MEDLINE] 5572. Z Arztl Fortbild (Jena). 1982 Jun 1;76(11):495-6. [Pain caused by herpes zoster] [Article in German] Meffert H. PMID: 7124007 [PubMed - indexed for MEDLINE] 5573. Voen Med Zh. 1982 Jun;(6):54-6. [Clinical and treatment characteristics of herpes zoster] [Article in Russian] Zaĭtsev RZ, Orekhov EG, Shtabtsov VI. PMID: 7113009 [PubMed - indexed for MEDLINE] 5574. Cutis. 1982 Jun;29(6):611-2. Herpes zoster as a cause of neurogenic bladder. Weaver SM, Kelly AP. PMID: 7105835 [PubMed - indexed for MEDLINE] 5575. Arch Neurol. 1982 Jun;39(6):384. Cluster headache after herpes zoster ophthalmicus. Sacquegna T, D'Alessandro R, Cortelli P, de Carolis P, Baldrati A. PMID: 7092621 [PubMed - indexed for MEDLINE] 5576. Pathol Biol (Paris). 1982 Jun;30(6 Pt 2):596-602. [Acyclovir therapy of varicella-zoster virus infections in the immunosuppressed children ] [Article in French] Peyramond D, Denoyel GA, Bertrand JL, Bertoye A. We evaluated Acyclovir therapy in 16 immunodeficient children with varicella (7 cases) and zoster (9 cases) in a controlled open study. infections were serious in 12 patients. Each patient had daily clinical, biological and virological tests. Sixty minutes intra-venous infusions of Acyclovir were given three times a day (5 to 10 mg/kg/8 hours) for 6 ou 11 days. All patients who received therapy before the first four days, ahd a more rapid cessation of new vesicles formation and more rapid scaring, than those with delayed treatment. Ten controlled children had accelerated clearance of viral antigens from vesicles. In 15 cases, virus was not isolated after the third day. Two children with varicellous interstitial pneumonia died, 8 and 25 days after the end of treatment. Fourteen patients recovered in 8 to 10 days. No relapses of varicella-zoster virus infections had been observed 1 to 14 months after therapy. The drug was well-tolerated, but supervising of renal functions is necessary. Acyclovir had a good therapeutic efficacy to treat chickenpox and shingles in the immunocompromised patients. PMID: 6750532 [PubMed - indexed for MEDLINE] 5577. J Clin Pathol. 1982 Jun;35(6):645-9. Determination of specific IGA antibodies to varicella zoster virus by immunoperoxidase assay. Haikin H, Sarov I. An indirect peroxidase technique was developed for determination of IgA antibodies to varicella zoster virus (VZV). The antigen consisted of acetone-fixed trypsinised VZV-infected cells. Rabbit antihuman IgA peroxidase conjugate was used to detect human IgA antibodies bound to viral antigen. In parallel IgG antibodies to VZV were determined by an immunoperoxidase antibody to membrane antigen (IPAMA) technique. Varicella zoster virus IgA antibodies were detected in all five varicella and seven zoster patients. No VZV IgA antibodies (less than 2) were detected in 45 healthy control sera. Neither were they found in paired sera of five patients with herpes simplex infection, five patients with human cytomegalovirus infection and two patients with Epstein-Barr virus infection. Application of immunoperoxidase IgA technique in serodiagnosis of primary and reactivated VZV infections is discussed. PMCID: PMC497742 PMID: 6282941 [PubMed - indexed for MEDLINE] 5578. Med Lett Drugs Ther. 1982 May 28;24(610):51-3. Varicella-zoster immune globulin. [No authors listed] PMID: 7078520 [PubMed - indexed for MEDLINE] 5579. Dtsch Med Wochenschr. 1982 May 28;107(21):822-5. [Zoster encephalitis without rash: report of two cases (author's transl)] [Article in German] Möller A, Ackermann R, Felgenhauer K, Ulm H. Two previously healthy men, aged 54 and 41 years, fell ill with headaches and increased fatiguability, one also with vomiting, the other with fever, transitory visual disturbances and slight weakness of the left hand. Both of them had a stiff neck and clouded consciousness. The EEG had moderate to severe dysrhythmia, predominantly over the temporal area, CSF showed an increased cell count of 1000/3, predominantly lymphocytes, and increased protein. The younger patient also had global aphasia and the computed tomography indicated an area of decreased density in the left temporal region. In the CSF there were locally produced IgG. The clinical findings were similar to those of herpes encephalitis, but were milder and regressed more quickly. Severe months later only a few minor organic behavioural changes were present. Antibody findings in CSF and serum suggest varicella-zoster virus as the causative agent, although in both instances no rash was observed throughout the entire period of observation. PMID: 7075505 [PubMed - indexed for MEDLINE] 5580. Dtsch Med Wochenschr. 1982 May 7;107(18):695-7. [Fibroblast-interferon in the treatment of herpes zoster: a pilot study (author's transl)] [Article in German] Heidemann E, Wilms K, Treuner J, Niethammer D. PMID: 6176414 [PubMed - indexed for MEDLINE] 5581. Otolaryngol Clin North Am. 1982 May;15(2):421-38. Infectious diseases in the geriatric patient. Corcoran JG, Axline SG. PMID: 7088569 [PubMed - indexed for MEDLINE] 5582. Int J Dermatol. 1982 May;21(4):198-202. The risk of photochemotherapy. Stüttgen G. PMID: 7047417 [PubMed - indexed for MEDLINE] 5583. Practitioner. 1982 May;226(1367):901-23. Eyelid problems. Moriarty PA, Collin JR. PMID: 6980409 [PubMed - indexed for MEDLINE] 5584. Practitioner. 1982 May;226(1367):839-44. The infected eye. Falcon MG. PMID: 6980406 [PubMed - indexed for MEDLINE] 5585. Australas Nurses J. 1982 May;11(4):20-1. Vitamin C: the use of megascorbate therapy in general practice. A clinical experience. Goldbaum JS. PMID: 6921985 [PubMed - indexed for MEDLINE] 5586. Yale J Biol Med. 1982 May-Aug;55(3-4):343-50. The functions of a university-based viral diagnostic laboratory: recent experiences at Yale-New Haven Hospital. Andiman WA. PMCID: PMC2596436 PMID: 6295010 [PubMed - indexed for MEDLINE] 5587. Pediatr Infect Dis. 1982 May-Jun;1(3):164-7. IgM to varicella-zoster virus: demonstration in patients with and without clinical zoster. Gershon AA, Steinberg SP, Borkowsky W, Lennette D, Lennette E. Antibody to varicella-zoster (VZ) virus of the IgM type was detected in sera from 50% of persons with clinical zoster, 67% of asymptomatic varicella immunes with a recent intimate exposure to VZ virus and 22 to 40% of varicella immunes with no symptoms of zoster or known exposure to the virus. No VZ IgM was found in newborn sera or in sera from persons susceptible to varicella, demonstrating specificity of the VA IgM assay. Since development of specific IgM is associated with acute infection, these data suggest that reinfection with VA virus occurs and also that antigenic stimulation due to exposure to endogenous VZ virus may occur. We hypothesize that during reactivation of VZ virus, persons with intact VZ cell-mediated immunity (CMI) remain asymptomatic but that those with depressed VZ CMI may develop clinical zoster. These data suggest that there is an unstable relationship between VZ virus and the human host. PMID: 6292875 [PubMed - indexed for MEDLINE] 5588. Otolaryngol Clin North Am. 1982 May;15(2):271-85. Dermatologic problems of the head and neck in the aged. Lynch PJ. PMID: 6211646 [PubMed - indexed for MEDLINE] 5589. JAMA. 1982 Apr 16;247(15):2132-5. Acyclovir treatment of herpes zoster infections. Use in children undergoing bone marrow transplantation. Serota FT, Starr SE, Bryan CK, Koch PA, Plotkin SA, August CS. Three patients in whom herpes zoster infections developed following bone marrow transplantation were treated with acyclovir. The patients experienced pain relief within 24 hours of starting treatment. The progression of their skin lesions halted within 1, 2, and 4 days of therapy, respectively, and healed completely within two weeks of therapy. Pharmacokinetic studies indicated that acyclovir plasma concentration-time profiles approximated biexponential equations. The drug half-lives were 3.91, 3.83, and 3.40 hours, respectively. Acyclovir was not myelotoxic and may be helpful in aborting varicella-zoster virus infections in bone marrow transplant recipients. PMID: 7038177 [PubMed - indexed for MEDLINE] 5590. Br J Urol. 1982 Apr;54(2):166-9. Urinary retention and granulomatous prostatitis following sacral Herpes Zoster infection. A report of 2 cases with a review of the literature. Clason AE, McGeorge A, Garland C, Abel BJ. PMID: 7200822 [PubMed - indexed for MEDLINE] 5591. Vestn Dermatol Venerol. 1982 Apr;(4):42-4. [Acupuncture in combined treatment of disseminated herpes zoster varioliformis] [Article in Russian] Shupen'ko NM, Samosiuk IZ, Krasun LE. PMID: 7090540 [PubMed - indexed for MEDLINE] 5592. Klin Monbl Augenheilkd. 1982 Apr;180(4):271-4. [The corneal endothelium in ophthalmic zoster (author's transl)] [Article in German] Sundmacher R, Müller O. Up till now corneal endothelium changes in ophthalmic zoster have practically escaped general attention. According to our observations, however, a corneal endotheliitis is a regular feature in acute ocular zoster and often occurs as a late complication as well. The authors report on individual controls of the corneal endothelium by means of specular microscopy in six zoster patients who were treated with steroid eye drops. PMID: 6979659 [PubMed - indexed for MEDLINE] 5593. Kansenshogaku Zasshi. 1982 Apr;56(4):272-7. [Herpes zoster and SLE] [Article in Japanese] Ishigatsubo Y, Tani K, Sakamoto H, Abe S, Narita M, Nagaoka S, Kato K, Matsunaga K, Chiba J, Fukushima K, Tani S. PMID: 6813389 [PubMed - indexed for MEDLINE] 5594. Practitioner. 1982 Apr;226(1366):766-8, 770. Herpes zoster in childhood. Hartley WJ, Mandal BK. PMID: 6283515 [PubMed - indexed for MEDLINE] 5595. Am J Epidemiol. 1982 Apr;115(4):569-76. A population study of herpesvirus infections and HLA antigens. Blackwelder WC, Dolin R, Mittal KK, McNamara PM, Payne FJ. In a population-based study of herpesvirus infection and human leukocyte antigen (HLA) phenotype, conducted during the period 1977-1979 in the Framingham Study cohort, HLA-Bw16 was found less often and HLA-Cw2 more often in individuals with histories of herpes labialis than in other individuals. Similarly, both geometric mean antibody titer to herpes simplex type 1 and proportion of individuals with detectable antibody were higher in those without Bw16 and in those with Cw2. No strong association was found between HLA and history of herpes zoster or titer to herpes simplex type 2, varicella-zoster virus or cytomegalovirus. PMID: 6280494 [PubMed - indexed for MEDLINE] 5596. Rev Chir Oncol Radiol O R L Oftalmol Stomatol Ser Oftalmol. 1982 Apr-Jun;26(2):145-8. [Deep neuroparalytic keratitis following ophthalmic zona] [Article in Romanian] Cernea P, Stefănescu A. PMID: 6216514 [PubMed - indexed for MEDLINE] 5597. Acta Urol Belg. 1982 Apr;50(2):259-62. [Indications for bethanechol in acute urinary retention caused by herpes zoster. Case study] [Article in French] Polito M, Muzzonigro G, Laraia G, Iacopini M. PMID: 6126108 [PubMed - indexed for MEDLINE] 5598. Acta Paediatr Scand. 1982 Mar;71(2):269-73. Herpes zoster and varicella in children with Hodgkin's disease. Skovby F, Sullivan MP. Thirty-nine episodes of herpes zoster and varicella in 94 children with Hodgkin's disease were studied to determine the incidence and complications of these infections and their effect on the prognosis of Hodgkin's disease in children under multimodal treatment. Twenty-nine children (31%) developed herpes zoster and seven (7%) had varicella. Three children had herpes zoster on two occasions. All children with varicella had uncomplicated infections. One patient died and three had visceral complications secondary to herpes zoster infections. Disseminated herpes zoster in nine children (10%) was more often associated with recurrent or active Hodgkin's disease and led to more complications than localized herpes zoster. Although varicella-zoster infection does not impair the prognosis of Hodgkin's disease, it is a potentially fatal infection and an affected child deserves vigorous treatment and support. PMID: 7136635 [PubMed - indexed for MEDLINE] 5599. Practitioner. 1982 Mar;226(1365):531-2. Shingles in diabetes mellitus. McCulloch DK, Fraser DM, Duncan LP. PMID: 7088846 [PubMed - indexed for MEDLINE] 5600. J Med Assoc State Ala. 1982 Mar;51(9):43-9. Shingles, herpes, sex and mononucleosis. Clemmons LH. PMID: 7069308 [PubMed - indexed for MEDLINE] 5601. Rinsho Byori. 1982 Mar;30(3):247-53. [Application of indirect immunoperoxidase technique for diagnosis of viral infections (author's transl)] [Article in Japanese] Nakamura Y, Aoki Y. PMID: 7050467 [PubMed - indexed for MEDLINE] 5602. Acta Otorhinolaryngol Ital. 1982 Mar-Apr;2(2):153-62. [Associated auricular zona] [Article in Italian] Fini-Storchi O, Ciampa G, Tardani T. PMID: 6758475 [PubMed - indexed for MEDLINE] 5603. Fukuoka Igaku Zasshi. 1982 Mar;73(3):131-45. [Immunological response of patients with herpes zoster (author's trans)] [Article in Japanese] Higa K. PMID: 6286440 [PubMed - indexed for MEDLINE] 5604. Aust Fam Physician. 1982 Mar;11(3):173-7. Herpes zoster: complications pathogenesis and pathology. The specialist view. MacLeod C, Murphy A. The term herpes zoster is derived from the Greek herpes: to creep and zoster: a belt or girdle. Shingles is from the Latin cingere: to gird, which was corrupted to mean a belt of girdle for the human form. A typical attack of herpes zoster is usually not difficult to recognise, but it is important to be aware of uncommon manifestations and complications. PMID: 6280661 [PubMed - indexed for MEDLINE] 5605. Aust Fam Physician. 1982 Mar;11(3):167-72. Herpes zoster. The gp view. Manzie PP. Herpes zoster is a fascinating disease with many lessons for the general practitioner. This article raises some practical questions about its diagnosis and management. PMID: 6280660 [PubMed - indexed for MEDLINE] 5606. West J Med. 1982 Mar;136(3):227-35. Advances in interferon research - Medical Staff Conference. Creasey AA, Merigan TC. PMCID: PMC1273650 PMID: 6178224 [PubMed - indexed for MEDLINE] 5607. Rev Med Liege. 1982 Feb 1;37(3):82-5. [Vidarabine: an active antiherpetic treatment by parenteral administration] [Article in French] Tjean M, Bury J, Fillet G. PMID: 7079648 [PubMed - indexed for MEDLINE] 5608. J Kans Med Soc. 1982 Feb;83(2):57-8. Herpes zoster: a ten-year experience with cytosine arabinoside treatment. McFarland HR. PMID: 7061912 [PubMed - indexed for MEDLINE] 5609. J Dermatol. 1982 Feb;9(1):59-62. Sympathetic ganglion block therapy for herpes zoster. Toyama N. PMID: 7047608 [PubMed - indexed for MEDLINE] 5610. Am J Dermatopathol. 1982 Feb;4(1):45-8. In memory of Professor Dr. Felix von Bärensprung by Otto Veit. 1865. [No authors listed] PMID: 7044172 [PubMed - indexed for MEDLINE] 5611. Environ Health Perspect. 1982 Feb;43:21-5. Chemotherapy-induced immunosuppression. Rasmussen L, Arvin A. Chemotherapeutic agents are used widely in clinical medicine for the treatment of conditions where diminution of the host immune response is a goal. The clinical use of immunosuppression is indicated for immunologically mediated disease, lymphoproliferative diseases, and prevention of graft rejection. Five categories of agents are useful for these purposes; they are ionizing irradiation, corticosteroids, biological alkylating agents, antilymphocyte sera and antimetabolites. While the specific molecular action of many of these drugs is known, how they affect cellular events in immune responses is less clear. One of the unfortunate sequelae of chemotherapy induced immunosuppression is an increased susceptibility of the host to opportunistic pathogens or malignancies. Specific methods are described for monitoring the various parameters of both humoral and cellular immunity. Studies of immunologic function in lymphoma patients and cardiac transplant patients treated with immunosuppressive drugs have shown specific defects in cell mediated immunity to herpes viruses which may relate to their increased susceptibility to infection by these agents. PMCID: PMC1568884 PMID: 7037385 [PubMed - indexed for MEDLINE] 5612. J Indian Dent Assoc. 1982 Feb;54(2):57-8. Herpes zoster of oral and facial structures (a case report). Tupkari JV, Gururaja Rao TR, Patni VM. PMID: 6985255 [PubMed - indexed for MEDLINE] 5613. Ophthalmology. 1982 Feb;89(2):165-77. The progression of the ocular abnormalities of herpes zoster. Histopathologic observations of nine cases. Hedges TR 3rd, Albert DM. The ocular pathologic findings from nine patients who suffered from herpes zoster ophthalmicus are described. Autopsy material from four patients who died within weeks of the illness and ocular specimens from five patients who required surgery for complications of the disease months to years later demonstrated how the ocular abnormalities caused by zoster may progress in severity with time. The changes ranged from superficial keratitis and mild uveitis to severe granulomatous inflammation of the ciliary body, choroid, and optic nerve within the first several weeks of the disease. In some instances damage secondary to vasculitis predominated, and in others inflammation directly involved ocular tissue. In some chronically affected eyes, granulomatous reaction to Descemet's membrane persisted for years, whereas in others the inflammatory reaction apparently resolved, allowing successful penetrating keratoplasty to be performed in one case. PMID: 6978475 [PubMed - indexed for MEDLINE] 5614. Am J Ophthalmol. 1982 Feb;93(2):254-5. Acute retinal necrosis. Jampol LM. PMID: 6978072 [PubMed - indexed for MEDLINE] 5615. Cutis. 1982 Feb;29(2):167-70, 182. Dermatology: 1981 report. Sauer GC. PMID: 6460596 [PubMed - indexed for MEDLINE] 5616. Geriatrics. 1982 Feb;37(2):67-9, 73, 76. Drugs for pain in the elderly. Pfeiffer RF. Aspirin and acetaminophen are, as a rule, effective and well-tolerated compounds for use in mild pain of various etiologies. The major advantage of acetaminophen is the absence of gastrointestinal irritation. Tricyclic antidepressants, such as amitriptyline, imipramine, doxepin, and amoxapine are often given with good results to patients who manifest pain as a somatization of depression. PMID: 6120120 [PubMed - indexed for MEDLINE] 5617. Nouv Presse Med. 1982 Jan 23;11(3):191-3. [Isoprinosine treatment of herpes zoster. Résults of a control study in 36 subjects (author's transl)] [Article in French] Lesourd B, Laude J, Meunier P, Doumerc S, Moulias R. A double-blind trial comparing isoprinosine with a placebo was conducted in 36 subjects. Improvement of skin lesions was significantly better in the treatment group (p less than or equal to 0.01). Before entering the trial, patients in the treatment group had significantly more severe pain than those in the placebo group (p less than or equal to 0.01), the difference disappeared after treatment. Healing of skin lesions was more rapid in patients treated before the 5th day of the disease (p less than or equal to 0.03). None of the subjects developed post-zoster neuralgia. The clinical effects of the drugs were accompanied by a decrease in serum rosette activity. We consider isoprinosine as an innocuous and effective treatment of herpes zoster. PMID: 6173843 [PubMed - indexed for MEDLINE] 5618. Med Klin Prax. 1982 Jan 15;77(2):44-5, 48. [Rapid diagnosis: temporal arteritis] [Article in German] Bardach H, Gebhart W, Knobler R. PMID: 7070345 [PubMed - indexed for MEDLINE] 5619. Otolaryngol Pol. 1982;36(5-6):291-5. [Conservative and surgical treatment of facial paralysis of viral etiology] [Article in Polish] Pietruski J. PMID: 7182731 [PubMed - indexed for MEDLINE] 5620. Am J Nephrol. 1982;2(2):95-7. Cure of cryptococcemia in an immunocompromised patient with lupus nephritis. Eiser AR, Neff MS, Slifkin RF. The first documented cure of cryptococcosis with cryptococcemia is reported. The patient had systemic lupus erythematosis and had received corticosteroids and immunosuppressive drugs for diffuse proliferative nephritis. She had additional poor prognostic factors including high serum cryptococcal antigen titer, low cerebrospinal leukocyte count, and absence of anticryptococcal antibody. Pulmonary tuberculosis was diagnosed concurrently and subsequently she developed disseminated herpes zoster. During amphotericin B therapy, renal function worsened. Cure of cryptococcosis with cryptococcemia was accomplished despite multiple concurrent infections and transient worsening of renal function. PMID: 7180906 [PubMed - indexed for MEDLINE] 5621. Ann Dermatol Venereol. 1982;109(12):1057-9. [Alveolar necrosis of the maxillary bone following trigeminal zona] [Article in French] Rodrigues JB, Poiares Baptista A, Leitao A, Lopes T. PMID: 7171203 [PubMed - indexed for MEDLINE] 5622. J Assoc Physicians India. 1982 Jan;30(1):57-8. Ramsay Hunt syndrome with zoster meningitis. Khandelwa AV, Sinha LL. PMID: 7169403 [PubMed - indexed for MEDLINE] 5623. Prog Clin Biol Res. 1982;107:397-411. Thermographic evaluation of the benign diseases and reactive changes of the skin. Stüttgen G. White Erythema is combined with an augmentation of heat radiation only if the convection of heat is increased, reflectoric flush phenomenon is detected more reliably by thermography than reflex photometrics. Urticarial exanthema shows an increased heat radiation if the edema derives from the deeper layers of the skin vessels, whereas a cooling effect results from an edema affecting the superficial layers of the skin. Papular lesions with inflammation are characterized by increased heat radiation. Most of the benign skin tumors are not characterized by an increased convection of heat and show approximately the same temperature as the surrounding skin. Diminished heat isolation by atrophy of the subcutaneous fat is followed by an increase of heat radiation by the conduction of heat from the warm inside of the core. The blood storage capacity of the deeper venous plexus and varicose veins of the lower legs maintain a raised skin temperature which can be decreased by pharmacological vasoconstriction of these veins by catecholamines and serotonin. Finally, the pharmacological effectiveness of topically applied drugs can change the blood flow through the skin vessels and alter the heat radiation of the skin surface. PMID: 7167494 [PubMed - indexed for MEDLINE] 5624. Laryngoscope. 1982 Jan;92(1):65-7. Herpes zoster oticus: surgery based upon prognostic indicators and results. May M, Blumenthal F. We studied 28 patients with herpes zoster oticus prospectively over the six-year period between August 1974 and June 1980. We found that the results of measuring tear production, submandibular salivary flow, the response to maximal stimulation, and evoked electromyography gave us sufficient information to group these patients according to prognosis--either unfavorable or favorable--for spontaneous return of facial function. When the test results were 26% or more of normal, 100% of the patients had complete recovery without treatment; when the test results were 25% or less of normal, 69% had incomplete recovery: 19% had fair and 50% had poor recovery. Of the 31% with complete recovery, 4 were operated upon. The natural history of herpes zoster oticus in patients with a poor prognosis was improved if a transmastoid extralabyrinthine subtemporal decompression of the labyrinthine segment of the facial nerve was performed within 10 days of onset of the paralysis. The decision to perform this surgery was based upon the results of the prognostic tests mentioned above. PMID: 7162299 [PubMed - indexed for MEDLINE] 5625. Vestn Otorinolaringol. 1982;(5):76-8. [Herpes zoster of the ear] [Article in Russian] Kondrashkina AG, Podlasaia LI. PMID: 7147574 [PubMed - indexed for MEDLINE] 5626. Rev Laryngol Otol Rhinol (Bord). 1982;103(1):65-7. [Stage IV zona of the ear] [Article in French] Paiva A, Verhulst J, Noyon P, Crovetto M. PMID: 7111930 [PubMed - indexed for MEDLINE] 5627. Postgrad Med J. 1982 Jan;58(675):39-40. Spinal cord haemorrhage following herpes zoster: a possible complication of warfarin therapy. Friedland ML, Wittels EG. Haemorrhage is the most serious and common side-effect of warfarin therapy. Bleeding had commonly been observed in the gastrointestinal and genitourinary tracts as well as in the skin and subcutaneous tissue. Central nervous system bleeding has also been reported and has usually been associated with marked prolongation of the prothrombin time. Spinal cord haemorrhage has been infrequently observed. The patient reported here may represent a previously undescribed complication of herpes zoster infection with haemorrhage in the involved dorsal root ganglia. Possible mechanisms are discussed. PMCID: PMC2426219 PMID: 7088759 [PubMed - indexed for MEDLINE] 5628. J Neurol Neurosurg Psychiatry. 1982 Jan;45(1):94. Herpes zoster myelitis treated with vidarabine. Cullis PA, Gilroy J, Cushing R. PMCID: PMC491276 PMID: 7062080 [PubMed - indexed for MEDLINE] 5629. Clin Neuropharmacol. 1982;5(1):115-29. Pharmacology of antiviral chemotherapeutic agents useful in human viral infections of the nervous system. McKendall RR. Several drugs that have antiviral activity and acceptably low toxicity for systemic use in humans have been discussed in this paper. For ara-A, acycloguanosine, and interferon, there is convincing evidence of effectiveness in limiting certain viral diseases of the nervous system. At this moment use of these drugs cannot be justified for benign, self-limiting, and uncomplicated viral diseases (e.g., localized herpes labialis). However, data from large controlled clinical trials are just beginning to be available and therefore the indications for use of these drugs may change rapidly. It is anticipated that these drugs will have a definite and welcome role in medical therapeutics. PMID: 7046922 [PubMed - indexed for MEDLINE] 5630. Int J Tissue React. 1982;4(1):27-30. The take of skin allograft following necrotizing herpes zoster in chronic lymphatic leukaemia (report of a case). Hauben J, Baruchin AM, Mahler D. A case of herpes zoster involving the lumbar dermatomes is presented, where an unusual necrosis of the whole skin corresponding to the affected dermatomes was observed. Although it is well known that herpes zoster links with malignancies including chronic lymphatic leukaemia, the necrotizing stage of the skin is unfamiliar. In spite of the fact that malignancy contributes to a decreased host resistance, there is evidence suggesting that herpes zoster virus is the cause of skin necrosis. An allograft skin transplantation was performed successfully in the presence of immune deficient status over a period of six months. PMID: 7044962 [PubMed - indexed for MEDLINE] 5631. Am J Otolaryngol. 1982 Jan-Feb;3(1):61-6. Ramsay Hunt syndrome: a cranial polyneuropathy. Aviel A, Marshak G. PMID: 6981355 [PubMed - indexed for MEDLINE] 5632. Clin Prev Dent. 1982 Jan-Feb;4(1):16-8. Herpes. Medansky RS, Handler RS. PMID: 6980079 [PubMed - indexed for MEDLINE] 5633. Appl Neurophysiol. 1982;45(1-2):179-84. Monopolar electrical stimulation of nucleus ventroposteromedialis thalami for postherpetic facial pain. Siegfried J. PMID: 6977319 [PubMed - indexed for MEDLINE] 5634. Ann Rheum Dis. 1982;41 Suppl 1:37-9. Side-effects of azathioprine treatment in rheumatoid arthritis: analysis of 10 years of experience. Speerstra F, Boerbooms AM, van de Putte LB, van Beusekom HJ, Kruijsen MW, Vandenbroucke JP. Our experience with azathioprine in the treatment of rheumatoid arthritis covers ten years, during which 91 rheumatoid patients (66 female and 25 male) received this drug, with a median treatment period of 36 months. Total follow-up experience, during and after treatment, was 399 person years. Twelve patients died. The principal causes of death were malignant neoplasm (six patients) and cardiovascular diseases (three patients). The mortality in our patients was compared to that of the general Dutch population by the Standardised Mortality Ratio (SMR). In the male patient group a significant excess of both total mortality and mortality from malignancy was observed. The female patients showed no differences from the general population. In this follow-up study, no lymphoreticular tumours occurred during or after azathioprine therapy. PMCID: PMC1030293 PMID: 6802081 [PubMed - indexed for MEDLINE] 5635. Dev Biol Stand. 1982;52:221-36. Serodiagnosis of Varicella-Zoster virus infection in pregnancy and standardization of the ELISA IgG and IgM antibody tests. Enders G. It is recognized that varicella virus infection in early pregnancy may cause severe congenital malformation and that varicella virus infection during the last 4 days of gestation until 48 h. after delivery can be dangerous for the child. Maternal Zoster has also been suggested as a cause of some congenital defect, but this association is poorly documented. Sensitive, specific and rapid indirect (ELISA) and direct (ELA) enzyme-linked-immunoassays for detecting Varicella and Herpes simplex virus, IgM-, IgA and IgG antibodies are employed for serodiagnosis of infection in the mother and the newborn and for determining the immunity status in high risk individuals who are exposed to V-Z infection. In the latter situation serological findings may serve as a guide for passive immunisation with Zoster-hyperimmunoglobulin (ZIG). The antibody concentration of the latter can now easily be standardized by the indirect ELISA-IgG-test. For determining the antibody concentration in the patient's sera in the indirect and direct ELISA with the method of Mona (Multiples of normal activity) a standardized test procedure using 2 optimal working dilutions has been established. PMID: 6762304 [PubMed - indexed for MEDLINE] 5636. Fukushima J Med Sci. 1982;28(3-4):93-103. Antibody dependent cellular protection against the cell to cell spread of varicella- zoster virus. Shigeta S, Ito M, Ogata M, Konno K, Suzuki H. PMID: 6313498 [PubMed - indexed for MEDLINE] 5637. Riv Neurobiol. 1982 Jan-Jun;28(1-2):48-58. [Herpes zoster in C3 which paralysis of the homolateral 7th cranial nerve (a frequent combination with is difficult to interpret)] [Article in Italian] Simonetti C, Della Pina D. PMID: 6308747 [PubMed - indexed for MEDLINE] 5638. Dev Biol Stand. 1982;52:391-7. Clinical trial of live attenuated Varicella vaccine in high risk susceptibles--a preliminary report. Gershon AA, Steinberg S, Borkowsky W. PMID: 6299849 [PubMed - indexed for MEDLINE] 5639. Med Microbiol Immunol. 1982;171(2):77-83. Peripheral facial palsy and infections- findings and problems. Mertens T, Thomas JP, Zippel C, Eggers HJ. Eighty-four patients of the Cologne University ENT Clinic with a diagnosis of idiopathic peripheral facial palsy (PEP) were examined - both clinically and virologically. In addition, examinations were carried out on 33 further PFP-patients from different practising physicians (Group B) where the clinical information, however, was much less detailed. In the ENT Clinical Group (84 patients), there was a total of 12 recent virus infections (9 varicella zoster virus, 2 herpes simplex virus, 1 coxsackie B4). Proof of a recent infection depended strongly on the diagnostic prerequisites: if early and paired sera were available a virological diagnosis was possible in 32% of the cases, while in some of the other patients a recent infection could at most be suspected by the serological results. Group B with the 33 unselected patients yielded no virologically significant results. The aetiological relationship between the virological findings and PEP is discussed. PMID: 6292678 [PubMed - indexed for MEDLINE] 5640. Zh Nevropatol Psikhiatr Im S S Korsakova. 1982;82(4):11-6. [Use of stimulation electromyography in the diagnosis of peripheral nervous system lesions in herpes zoster patients] [Article in Russian] Smirnov IuK, Shishov AS. PMID: 6283773 [PubMed - indexed for MEDLINE] 5641. Antimicrob Agents Chemother. 1982 Jan;21(1):33-8. In vitro susceptibility of varicella-zoster virus to E-5-(2-bromovinyl)-2'-deoxyuridine and related compounds. De Clercq E, Descamps J, Ogata M, Shigeta S. The in vitro susceptibility of eight strains of varicella-zoster virus (VZV) to E-5-(2-bromovinyl)-2'-deoxyuridine (BVDU) was examined in human embryonic fibroblasts by the following techniques: inhibition of focus formation by either cell-free VZV (4-day assay) or cell-associated VZV (2-day assay), inhibition of viral antigen formation (2-day assay), and inhibition of viral cytopathogenicity (15-day assay). The 50% inhibitory dose (ID50) of BVDU ranged from 0.001 microgram/ml (2-day assay) to 0.01 microgram/ml (15-day assay). BVDU appeared highly selective in its anti-VZV activity since even at concentrations as high as 100 micrograms/ml, BVDU did not markedly affect the viability of the host cells. The ID50 of BVDU for VZV was comparable to that of IVDU (E-5-(2-iodovinyl)-2'-deoxyuridine). Both drugs inhibited the replication of VZV at a much lower concentration than did other antiviral compounds such as iododeoxyuridine, ethyldeoxyuridine, arabinosylcytosine, arabinosyladenine, phosphonoacetic acid, iododeoxycytidine, and acycloguanosine. BVDU and IVDU were virtually inactive against a thymidine kinase-deficient VZV mutant, suggesting that phosphorylation by the viral enzyme is responsible, at least in part, for the selective anti-VZV activity of the compounds. PMCID: PMC181824 PMID: 6282207 [PubMed - indexed for MEDLINE] 5642. J Med Virol. 1982;9(1):27-36. Further evidence for common antigens in herpes simplex and varicella-zoster viruses. Schmidt NJ. To elucidate the mechanism of heterologous antibody responses to herpes simplex virus (HSV) and varicella-zoster virus (VZV) which occur in some patients with HSV or VZV infections, stronger evidence was sought for the existence of cross-reacting antibodies to these viruses, using antibody absorption procedures. Absorption of sera from initial HSV infections with HSV antigen was found to abolish heterologous antibody titer rises to VZV, as demonstrated in complement fixation, neutralization, and anti-complement immunofluorescence test systems. In most instances, convalescent-phase titers to heterologous VZV were reduced by HSV absorption to levels comparable to those in the acute-phase serum, indicating that cross-reacting antibodies were, in fact, responsible for the heterologous antibody titer rises. Absorption of convalescent-phase sera from HSV or VZV patients with homologous antigen also abolished or greatly diminished immunoprecipitating activity with the heterologous antigen, furnishing additional evidence of the existence of cross-reacting antibodies. Absorption of sera with insolubilized IgG to re-remove rheumatoid factor, which was present in a number of the sera studied, had no effect on either homologous or heterologous antibody titer increases. The demonstration of cross-reacting antibodies to HSV and VZV supports the concept that these two human herpesviruses share common antigen(s). PMID: 6278070 [PubMed - indexed for MEDLINE] 5643. Ann Intern Med. 1982 Jan;96(1):122-3. Herpes zoster in small-cell carcinoma of the lung. Markman M, Abeloff MD. PMID: 6274236 [PubMed - indexed for MEDLINE] 5644. J Med. 1982;13(3):247-51. Studies with electro-acupuncture. Rico RC, Trudnowski RJ. PMID: 6217269 [PubMed - indexed for MEDLINE] 5645. Interferon. 1982;4:177-200. Interferon in ocular viral diseases. Sundmacher R. PMID: 6195112 [PubMed - indexed for MEDLINE] 5646. J Neurol. 1982;228(4):283-7. Ophthalmic herpes zoster with contralateral hemiparesis: a case report. Federico F, Pedone D, Lamberti P, Achille P, Camicia M, Carella A, Ferrari E. Herpes zoster of the ophthalmic division of the left fifth cranial nerve with contralateral hemiparesis was observed in a 30-year-old man. Left carotid angiography showed segmental constrictions consistent with cerebral arteritis, possibly provoked by direct viral infection along the intracranial part of the ophthalmic nerve. An ischaemic lesion revealed by computed tomographic scan was considered secondary to arteritis and responsible for the hemiparesis. The presence of an immune response within the blood-CSF barrier was suggested by an increase of oligoclonal CSF IgG and IgA. PMID: 6188816 [PubMed - indexed for MEDLINE] 5647. Dev Biol Stand. 1982;52:81-6. Cellular immunity in herpesvirus, Thai hemorrhagic fever and other cellular infections with emphasis on isoprinosine. Tanphaichitra D. PMID: 6187617 [PubMed - indexed for MEDLINE] 5648. J Neurol. 1982;227(1):49-53. Granulomatous angiitis of the nervous system: a clinicopathological study of one case. De Reuck J, Crevits L, Sieben G, De Coster W, vander Eecken H. The clinical history is presented of a 69-year-old man with a disease starting with a herpes zoster infection and an acute ascending myelopathy, and ending with an intracerebral hemorrhage. The postmortem examination revealed multiple angiitis lesions, restricted to the central nervous system. In review of the 31 previously described cases there were four other patients in whom the granulomatous angiitis of the nervous system (GANS) was associated with a herpes zoster infection. The relation between both disorders is discussed. PMID: 6176694 [PubMed - indexed for MEDLINE] 5649. Int J Dermatol. 1982 Jan-Feb;21(1):12-8. The human interferon system. Berman B, Frankfort HM. PMID: 6174471 [PubMed - indexed for MEDLINE] 5650. Aktuelle Gerontol. 1982 Jan;12(1):23-5. [Anesthesia dolorosa in the higher ages - example of problems in therapy (author's transl)] [Article in German] Danke F. Chronic forms of facial pain in higher decades of age demonstrate problems of therapy in this period of life. Following herpetic infections and operations in the course of the trigeminal nerve the anesthesia dolorosa is a complication often resistant to therapy. Observations in two patients with typical pain syndrome made clear, that besides common problems of therapy in the higher ages, disorders of communication influence especially every cooperation and every step of therapy, which the patient does. Independent os success in therapy, longtime-care and permanent allocation in the older patient must compensate the deficit of communication. PMID: 6121502 [PubMed - indexed for MEDLINE] 5651. Wien Klin Wochenschr. 1981 Dec 25;93(24):744-6. [Herpes zoster] [Article in German] Fritsch P. This paper summarizes present knowledge on pathogenesis and therapy of herpes zoster. Formerly, zoster was considered a reinfection of a partly immune individual by the varicella-zoster virus localized into a body segment of lowered resistance. Recent epidemiological and virological evidence, however, suggests a different mode of pathogenesis: in the course of varicella, VZV migrates via the sensory nerves to the dorsal root ganglia where it remains in an inactive form. It may be reactivated in response to a local or systemic lowering of the level of host resistance, resulting in painful ganglionitis and, by descension, in the characteristic segmental skin lesions of herpes zoster. Treatment with systemic corticosteroids in the early stages of zoster helps to decrease the frequency and severity of postzosteric neuralgias. Corticosteroids ought to be given at a relatively high dosage and be tapered only slowly in the course of a few weeks. They are particularly useful in older individuals, who constitute a population prone to postzosteric neuralgias. In severe cases of generalized zoster, corticosteroids should not be given to avoid further lowering of host resistance. Recently, antiviral drugs have been developed which combine high effectiveness with very tolerable side effects, namely vidarabine and acyclovir. PMID: 6281992 [PubMed - indexed for MEDLINE] 5652. Laryngol Rhinol Otol (Stuttg). 1981 Dec;60(12):612-4. [The role of zoster oticus as a paraneoplastic syndrome (author's transl)] [Article in German] Hüttenbrink KB, Blättermann A, Deitmer T. The relation between malignant neoplasms and zoster oticus as a paraneoplastic syndrome is discussed based on a bibliographic review and catamnestic evaluations of own patients. 19 patients who had suffered from zoster oticus were included in a follow-up study covering a period up to 13 years after the affection. The symptoms of zoster oticus as described in the literature are reviewed and compared with the findings in our patients. Although there were no indications of neoplasms in our patients a general check-up is recommended in all cases of zoster oticus in accordance with the rules established in internal medicine and dermatology. PMID: 7345296 [PubMed - indexed for MEDLINE] 5653. J Otolaryngol. 1981 Dec;10(6):449-58. Surgery of the facial nerve. Silverstein H. The diagnosis and management of facial nerve disorders are challenging aspects of neurotological practice. In Bell's palsy and Herpes Zoster oticus facial nerve decompression is indicated in approximately 10 per cent of cases within the first three weeks if 90-95 per cent degeneration has occurred. The presence of a dry eye determines whether the lesion is proximal to the geniculate ganglion and a middle fossa approach is necessary. Injury to the facial nerve occurs most commonly as a result of temporal bone fractures, from either blunt trauma or penetrating wounds. Occasionally iatrogenic injury occurs during ear surgery. Injury resulting in immediate and total facial paralysis with degeneration confirmed by appropriate electrical testing requires facial nerve exploration. In the presence of an injury proximal to the geniculate ganglion and hearing preservation, exploration of the nerve via middle fossa approach is indicated. If the hearing is lost then the translabyrinthine approach is appropriate. In the event the entire interosseous segment requires exposure, both mastoid and middle fossa exposures are required. If the traumatized facial nerve has not been divided it is decompressed proximal and distal to the injury site. In the event the nerve is divided, a direct anastomosis is the ideal treatment. Rerouting is necessary to achieve adequate length for the anastomosis. Nerve grafting is done when required. PMID: 7334569 [PubMed - indexed for MEDLINE] 5654. Prim Care. 1981 Dec;8(4):715-31. Herpes zoster: a challenge in management. Frengley JD. Although herpes zoster is not a fatal disease, its legacy of postherpetic neuralgia gives rise to a great deal of misery and distress, especially in elderly patients. Furthermore, in the immunocompromised patient herpes zoster is an important complication. The management of the sequelae of herpes zoster continues to be extremely difficult. Although work on agents to control viral replication holds promise for the future, at present meticulous management of the pain and depression in the early phases and much patience and understanding in the later phases of the condition are necessary. PMID: 6915592 [PubMed - indexed for MEDLINE] 5655. Ned Tijdschr Geneeskd. 1981 Nov 28;125(48):1953-8. [Experiences with intravenously administered acyclovir in severe herpesvirus infections] [Article in Dutch] van der Meer JW, Versteeg J. PMID: 6273756 [PubMed - indexed for MEDLINE] 5656. Lancet. 1981 Nov 28;2(8257):1227-8. Patient with circulating antibodies to alpha-interferon. Mogensen KE, Daubas P, Gresser I, Sereni D, Varet B. PMID: 6171694 [PubMed - indexed for MEDLINE] 5657. N Engl J Med. 1981 Nov 26;305(22):1349. Acyclovir and herpes zoster. von Schulthess GK, Sauter C. PMID: 7290161 [PubMed - indexed for MEDLINE] 5658. N Z Med J. 1981 Nov 25;94(696):384-6. A multicentre trial of Zostrum (5 percent idoxuridine in dimethyl sulphoxide) in herpes zoster. Burton WJ, Gould PW, Hursthouse MW, Sears PJ, Larnder DA, Stringer HC, Turnbull BC. Forty-six patients with herpes zoster were randomised into two groups treated with DMSO alone and 5 percent IDU in DMSO, provided that treatment started within 48 hours of the appearance of a rash. In the IDU group the interval before pain improved was significantly shorter than in the control DMSO group, and significantly fewer new vesicles developed at the three day follow up in the active group compared with the control group. These findings are in agreement with previously published work and confirm the usefulness of Zostrum (5 percent IDU in DMSO) in the treatment of herpes zoster. PMID: 6459547 [PubMed - indexed for MEDLINE] 5659. Z Hautkr. 1981 Nov 15;56(22):1457-66. [Immunostimulative therapy of herpes zoster (three years' experience with inosiplex) (author's transl)] [Article in German] Bunta S, Peris Z. The authors report on their three years' experience in treating 69 patients with herpes zoster of different localization by Inosiplex. The clinical study was carried out in two dermatological centres. Comparison of the results with those of the usual symptomatic treatment leads to the conclusion that the results achieved in the group treated with Inosiplex are significantly better. PMID: 6171939 [PubMed - indexed for MEDLINE] 5660. Br Med J (Clin Res Ed). 1981 Nov 14;283(6302):1298-9. Long-term morbidity of herpes zoster ophthalmicus. Kritzinger EE. PMCID: PMC1507710 PMID: 6794827 [PubMed - indexed for MEDLINE] 5661. Hokkaido Igaku Zasshi. 1981 Nov;56(6):623-6. [Statistical observations on patients with herpes zoster and postherpetic neuralgia (author's transl)] [Article in Japanese] Makise H, Sasaki K, Nishida N, Igarashi O, Kubota M, Goto Y. From 1969 to 1980, 83 patients with herpes zoster and postherpetic neuralgia were referred to our clinic. They consisted of 36 male and 47 female, whose ages ranged from 18 to 91 years. They were tested mainly with stellate ganglion block or epidural block. Patients with postherpetic neuralgia received imipramine 60 mg per day in addition. About half of the patients were relieved of pain or considerably improved after treatment. Other half of the patients somewhat improved excluding those patients whose therapeutic effect could not be assessed. More favourable results were obtained in patients whose treatment was instituted within 2 weeks from onset of herpes zoster than patients over 2 weeks from onset. Duration of treatment was shorter in younger patients (approximately 59 years) than older patients (60 years approximately), but results were same in both age groups. About 10% of the patients had concomitant malignant disease or autoimmune disease. No relationship between the localization of herpes zoster and the site of malignant disease was found. PMID: 7338339 [PubMed - indexed for MEDLINE] 5662. J Neurol Sci. 1981 Nov-Dec;52(2-3):351-7. [Unilateral involvement of IX, X, Xi and XII in cervical zoster. Cranial nerve contribution to vascular pathology] [Article in French] Lapresle J, Faux N. The authors report a case of a cervical zoster (C2 - C4) with unilateral involvement of the IXth, Xth, XIth and XIIth cranial nerves. Angiography failed to opacify the ascending pharyngeal artery on the same side, presumably because of a thrombosis secondary to the zoster infection. As the ascending pharyngeal artery is known to supply the last four cranial nerves, this study should be seen as a further example of the varied cranial nerve involvement which may arise on a vascular basis. PMID: 7310438 [PubMed - indexed for MEDLINE] 5663. Vojnosanit Pregl. 1981 Nov-Dec;38(6):453-6. [Vestibular lesions in herpes zoster oticus] [Article in Serbian] Risavi A, Pilipović S. PMID: 6977234 [PubMed - indexed for MEDLINE] 5664. J Virol. 1981 Nov;40(2):516-25. Structure of varicella-zoster virus DNA. Straus SE, Aulakh HS, Ruyechan WT, Hay J, Casey TA, Vande Woude GF, Owens J, Smith HA. Varicella-zoster virus (VZV) DNA was prepared from nucleocapsids and from enveloped virions of a laboratory strain (Ellen) and directly from the vesicle fluids of patients with zoster infections. VZV Ellen nucleocapsid DNA was cleaved with 11 different restriction endonucleases and electrophoresed in agarose gels. The restriction profiles of the nucleocapsid DNA were identical to those of the DNA recovered from purified virions, but differed from those of another VZV strain (KM). In vitro-labeled VZV K.M. DNA purified directly from vesicle fluid yielded a distinct restriction pattern which appeared to be unchanged after several tissue culture passages of the isolate from that fluid. Restriction endonuclease analysis (EcoRI or BglII) of VZV DNA revealed the presence of four cleavage fragments with a molar ratio of approximately 0.5. No individual fragments with molar ratios of 0.25 were noted. This observation suggests that the VZV genome may contain one invertible segment. Comparison of the electrophoretic migrations of VZV DNA fragments relative to those of DNAs of known size permitted calculation of the VZV genome size to be 72 X 10(6) to 80 X 10(6) daltons. These results were confirmed by electron microscopy which demonstrated a genome size of about 76 X 10(6) daltons for passaged and unpassaged VZV DNA. Electron microscopy also revealed that some of the DNA molecules recovered from nucleocapsids or directly from vesicle fluids were superhelical circles. PMCID: PMC256654 PMID: 6275100 [PubMed - indexed for MEDLINE] 5665. Transfusion. 1981 Nov-Dec;21(6):732-4. Preparation of varicella-herpes zoster immunoglobulin. Janot C, Stoltz JF, Avenard G, Perrier P, Schooneman F, Streiff F. The efficacy of zoster immunoglobulin in prophylaxis of varicella and herpes zoster is reported by many authors. The screening for zoster's antibodies is performed in the blood donor population and in persons convalescing from herpes zoster. The results show that 25 per cent of blood donors and 83.5 per cent of convalescents, respectively, have CF antibody titer of l6. Varicella zoster immunoglobulin prepared by alcohol fractionation has a fluorescent antibody titer of 1,024 and a CF antibody titer of 512. These results are discussed and compared with those of the literature. PMID: 6274067 [PubMed - indexed for MEDLINE] 5666. J Clin Microbiol. 1981 Nov;14(5):539-43. Comparison of anticomplement immunofluorescence and fluorescent antibody-to-membrane antigen tests for determination of immunity status to varicella-zoster virus and for serodifferentiation of varicella-zoster and herpes simplex virus infections. Gallo D, Schmidt NJ. The anticomplement immunofluorescence (ACIF) test was compared with the fluorescent antibody-to-membrane antigen (FAMA) test for determining varicella-zoster virus antibody levels as a measure of varicella-zoster virus immunity status. The ACIF test was found to be comparable to the FAMA test in sensitivity and could be used for examining sera at low dilutions of 1:2 and 1:4. In addition, the ACIF method proved to be a more economical procedure in terms of antigen required and personnel time necessary to perform the test. Heterologous varicella-zoster virus antibody titer rises were demonstrated by the FAMA test with 10 serum pairs from patients with clinically diagnosed genital herpes simplex virus infection, indicating that the FAMA test is no more suitable than other serological methods for serodifferentiation of those herpes simplex virus and varicella-zoster virus infections in which antibody increases occur to both antigens. PMCID: PMC273984 PMID: 6273453 [PubMed - indexed for MEDLINE] 5667. Ann Neurol. 1981 Nov;10(5):458-64. Angiographic findings in herpes zoster arteritis. MacKenzie RA, Forbes GS, Karnes WE. Four adults patients who experienced an ipsilateral hemispheric deficit 6 to 8 weeks after having developed herpes zoster ophthalmicus were seen during a six-month period. All four patients underwent full-circle angiography, including study of the extracranial arteries in the three older patients. Each examination demonstrated areas of segmental constriction of arteries on the ipsilateral side; two locations that were especially affected were the A2 segment of the pericallosal artery beneath the genu of the corpus callosum and the M4 segment of the middle cerebral artery. The cerebral arteries of the opposite hemisphere and the extracranial vessels did not contain demonstrable abnormalities. Pathological studies suggest that patients with this syndrome may have a necrotizing arteritis of ipsilateral blood vessels; in patients with disseminated zoster, a granulomatous angiitis of cerebral blood vessels has been found. We propose that the pattern of angiographic abnormalities described here is characteristic of herpes zoster arteritis; furthermore, the distribution pattern of the lesions suggests that the virus may spread to these arteries via branches of the ophthalmic division of the trigeminal nerve. PMID: 6118088 [PubMed - indexed for MEDLINE] 5668. Lancet. 1981 Oct 17;2(8251):827-30. Acyclovir in herpes zoster. Peterslund NA, Seyer-Hansen K, Ipsen J, Esmann V, Schonheyder H, Juhl H. PMID: 6116951 [PubMed - indexed for MEDLINE] 5669. ZFA (Stuttgart). 1981 Oct 10;57(28):1894-7. [Differential diagnosis of the lumbo-radicular syndrome--a tabulated review] [Article in German] Plangger C, Fischer J, Twerdy K. PMID: 7293376 [PubMed - indexed for MEDLINE] 5670. JAMA. 1981 Oct 9;246(15):1703-5. Fatal vidarabine toxicity in a patient with normal renal function. Van Etta L, Brown J, Mastri A, Wilson T. PMID: 7277649 [PubMed - indexed for MEDLINE] 5671. Arch Neurol. 1981 Oct;38(10):668. CSF in herpes zoster meningoencephalitis. Reimer LG, Beller LB. PMID: 7295116 [PubMed - indexed for MEDLINE] 5672. J Am Dent Assoc. 1981 Oct;103(4):610. Painful, ulcerated lesions of the palate and facial skin. Correll RW, Wescott WB, Birkholz H. Herpes zoster is an acute viral infection that principally affects the skin. It occasionally may involve the oral region with patients sometimes initially complaining of toothache. Generalized skin involvement by the disease should alert the clinician to the possibility of an underlying malignancy. Dentists should also be aware that the disease is infectious and can be transmitted, especially to susceptible individuals. PMID: 6945347 [PubMed - indexed for MEDLINE] 5673. Indian J Dermatol. 1981 Oct;25(4):17-21. Dermatosis of viral origin in children. Chakravarti SK, Mukherjee KK, Chakraborty MS. PMID: 6273304 [PubMed - indexed for MEDLINE] 5674. Br Med J (Clin Res Ed). 1981 Sep 12;283(6293):698-9. Herpes-zoster myelitis treated successfully with vidarabine. Corston RN, Logsdail S, Godwin-Austen RB. PMCID: PMC1507018 PMID: 6793130 [PubMed - indexed for MEDLINE] 5675. Klin Med (Mosk). 1981 Sep;59(9):66-72. [Disseminated variants of herpes zoster] [Article in Russian] Shishov AS, Umanskiĭ KG. PMID: 7311435 [PubMed - indexed for MEDLINE] 5676. Vestn Dermatol Venerol. 1981 Sep;(9):72-4. [2 cases of a generalized form of herpes zoster] [Article in Russian] Lipets ME, Gavrikov VV, Shibaeva LN, Prokof'eva NM. PMID: 7303889 [PubMed - indexed for MEDLINE] 5677. Ophthalmic Surg. 1981 Sep;12(9):657-60. Combined keratoplasty, cataract extraction, and intraocular lens implantation: experience at the Wilmer Institute. Bruner WE, Stark WJ, Maumenee AE. A review of 12 cases of combined keratoplasty, cataract extraction and IOL implantation performed during the past five years at the Wilmer Institute is presented. The results show 80% of cases with 6/12 (20/40) vision or better with a follow-up of at least six months. All but one of the grafts remained clear. Our current technique for keratoplasty, extracapsular cataract extraction and posterior-chamber IOL implantation is described. This technique has several advantages, including the following: an intact posterior capsule, no anterior vitrectomy, protection of the cornea from the IOL by the iris, and potential for full pupil dilation after surgery. Conservative and highly selective use of the procedure is recommended. PMID: 6763178 [PubMed - indexed for MEDLINE] 5678. Hosp Infect Control. 1981 Sep;8(9):127-8. Chickenpox exposures cost hospital $20,000. Heitzer V. PMID: 10252268 [PubMed - indexed for MEDLINE] 5679. Postgrad Med J. 1981 Aug;57(670):507-8. Encephalitis and polyneuritis complicating varicella zoster infection. Twomey JA, Jefferson D. PMCID: PMC2426124 PMID: 7301699 [PubMed - indexed for MEDLINE] 5680. Am J Ophthalmol. 1981 Aug;92(2):215-20. Herpes simplex type 1 retinitis in an adult with systemic herpes zoster. Partamian LG, Morse PH, Klein HZ. A 72-year-old man developed bullous skin lesions two months before he was discovered to have malignant lymphoma. Herpes zoster virus grew from the skin bullae. He developed encephalitis, keratitis in the left eye, and bilateral retinitis 18 months later. Herpes simplex virus type 1 grew from cultures of the eyelid vesicles and corneal scrapings from the left eye. The patient died two years after the diagnosis of malignant lymphoma. Virus particles believed to be herpes simplex virus were demonstrated on electron microscopy in the necrotic retinal cells. PMID: 7270636 [PubMed - indexed for MEDLINE] 5681. J Am Acad Dermatol. 1981 Aug;5(2):218-9. Intralesional corticosteroids. [No authors listed] PMID: 7263966 [PubMed - indexed for MEDLINE] 5682. Otolaryngol Clin North Am. 1981 Aug;14(3):631-52. Control of pain in the head and neck. Carron H. The patient with head or neck pain should be managed primarily with medication that will adequately prevent, rather than relieve, pain. The terminal patient should receive medication to which he will not develop tolerance and that will permit him to function in his normal environment. Although nerve blocks are not a panacea for all pain syndromes, in carefully selected subjects, chemical interruption of nerve pathways can provide significant relief for chronic pain sufferers. PMID: 7029415 [PubMed - indexed for MEDLINE] 5683. Br J Ophthalmol. 1981 Aug;65(8):542-5. Topical acyclovir in herpes zoster ocular involvement. McGill J. Topical acyclovir has been found in 15 out of 18 patients to control, without recurrences and in an appreciably shorter time than if steroids were used, keratoconjunctivitis induced by herpes zoster. Once steroids were started, recurrences occurred during withdrawal of steroids or after they had been stopped. PMCID: PMC1039578 PMID: 7028083 [PubMed - indexed for MEDLINE] 5684. Br J Ophthalmol. 1981 Aug;65(8):539-41. Herpes zoster ophthalmicus: a medical review. Lightman S, Marsh RJ, Powell D. Patients with herpes zoster undergo extensive screening to detect underlying malignant disease which is compromising their immunity. In a retrospective survey of 1000 patients with herpes zoster ophthalmicus 12 patients had malignant disease which was known on presentation. No new cases were detected or discovered on follow-up. Three patients developed a disseminated rash, but none of these had an underlying malignant disease. PMCID: PMC1039577 PMID: 6975119 [PubMed - indexed for MEDLINE] 5685. Nervenarzt. 1981 Aug;52(8):477-80. [Transcutaneous electrical nerve stimulation (TNS) in the treatment of chronic neurological pain (author's transl)] [Article in German] Klingler D, Kepplinger B. PMID: 6974312 [PubMed - indexed for MEDLINE] 5686. Neurology. 1981 Aug;31(8):1030-2. Hemispheric infarction after herpes zoster ophthalmicus: computed tomography and angiography. Kuroiwa Y, Furukawa T. PMID: 6973708 [PubMed - indexed for MEDLINE] 5687. Minerva Med. 1981 Jul 14;72(28):1863-8. [Methisoprinol in the therapy of herpes zoster] [Article in Italian] Tinozzi CC, Romagna E, Macchi G. PMID: 6166902 [PubMed - indexed for MEDLINE] 5688. JAMA. 1981 Jul 10;246(2):132-4. Administration of levodopa for relief of herpes zoster pain. Kernbaum S, Hauchecorne J. Forty-seven outpatients with herpes zoster, seen within five days of onset of the eruption, received ten days' administration of oral levodopa and benserazide or placebo in a double-blind controlled study. Both the total patient group and high-risk group, eg, those with either ophthalmic zoster or those older than 65 years, were analyzed. Both groups were comparable in terms of demographic and pathological criteria. Vomiting was the only side effect observed in both groups. A significant decrease in intensity of pain was seen in the group receiving levodopa from the third day, and complete cessation of both pain and sleep disturbances was more frequent in the patients. Two months later, postherpetic neuralgia was also less frequent in the group that received levodopa. PMID: 7017177 [PubMed - indexed for MEDLINE] 5689. Rev Med Chir Soc Med Nat Iasi. 1981 Jul-Sep;85(3):443-5. [Clinical aspects of the varicella-zoster virus infection] [Article in Romanian] Brauner E, Mihalache D, Rădulescu A, Cercel I, Mihul V, Oană C, Iosefsohn I, Iosifescu V. PMID: 7335992 [PubMed - indexed for MEDLINE] 5690. West J Med. 1981 Jul;135(1):62-6. Reflex sympathetic dystrophy of the lower extremity: a complication of herpes zoster with dramatic response to propranolol. Visitsunthorn U, Prete P. PMCID: PMC1272926 PMID: 7257382 [PubMed - indexed for MEDLINE] 5691. Hosp Pract (Off Ed). 1981 Jul;16(7):109-21. Antiviral agents: clinical status report. Whitley RJ, Alford CA. Recently, the clinical focus in antiviral chemotherapy has been on the use of ara-A in herpes infections-HSV encephalitis, zoster in the immunosuppressed, and neonatal herpes. In this last article of a four-part series, the authors review clinical studies that have to date led to the licensing of ara-A for HSV encephalitis but have not yet clearly defined its role in the immunosuppressed or in neonates. PMID: 6788666 [PubMed - indexed for MEDLINE] 5692. Am J Med Sci. 1981 Jul-Aug;282(1):12-7. Antibody responses to varicella-zoster virus and the role of antibody in host defense. Gershon AA, Steinberg SP. Antibody titers to varicella-zoster (VZ) virus in persons aged 1-85 years were measured. Through age 50, the percent of seropostitive individuals continued to rise. There was no fall in geometric mean titer with aging, and there may have been an increase in VZ antibody titer in older persons. Thus, a fall in VZ antibody with increasing age does not seem likely to account for the increased incidence of zoster in the elderly. Similarly, immunocompromised patients who are more likely to develop zoster than normals did not have lower VZ antibody titers than normal persons. Finally, immunocompromised persons with disseminated zoster had antibody titers that were somewhat higher that those of immunocompromised persons with localized zoster. It appears that humoral immunity has little or no influence on either the development or the course of herpes zoster. PMID: 6267940 [PubMed - indexed for MEDLINE] 5693. Minerva Pediatr. 1981 Jun 15;33(11):549. [Brachial zoster in an infant] [Article in Italian] De Benedetto F. PMID: 7254159 [PubMed - indexed for MEDLINE] 5694. Z Arztl Fortbild (Jena). 1981 Jun 1;75(11-12):553-5. [Difficult diagnoses or diagnostic errors in general practice] [Article in German] Brandt H. PMID: 7303754 [PubMed - indexed for MEDLINE] 5695. Arch Dermatol. 1981 Jun;117(6):377. Cutaneous pseudolymphoma at the site of resolving herpes zoster. Sánchez JL, Méndez JA, Palacio R. PMID: 7247435 [PubMed - indexed for MEDLINE] 5696. Ann Allergy. 1981 Jun;46(6):344. Influenza vaccine treatment of herpes of the eye. Baker J. PMID: 6972716 [PubMed - indexed for MEDLINE] 5697. Antiviral Res. 1981 Jun;1(2):73-96. An assessment of antiviral drugs for the management of infectious diseases in humans. Galasso GJ. PMID: 6175275 [PubMed - indexed for MEDLINE] 5698. Rev Clin Esp. 1981 May 31;161(4):265-7. [Severe thrombopenia in disseminated herpes zoster] [Article in Spanish] Cuesta J, Montalar J, Redón J, Lacruz J, Herranz C, Caballero M. PMID: 7280336 [PubMed - indexed for MEDLINE] 5699. Harefuah. 1981 May 15;100(10):463-4. [Herpes zoster and paralytic ileus] [Article in Hebrew] Burshtein A, Resnick Z. PMID: 6895509 [PubMed - indexed for MEDLINE] 5700. Nippon Ganka Gakkai Zasshi. 1981 May 10;85(5):415-8. [Serum complement fixing antibody in herpetic ocular diseases (author's transl)] [Article in Japanese] Wu JS, Yamanishi R, Kaneko M, Uchida Y. PMID: 6973922 [PubMed - indexed for MEDLINE] 5701. Med Clin (Barc). 1981 May 10;76(9):377-80. [Infections due to herpes-varicella viruses in Hodgkin's disease (author's transl)] [Article in Spanish] Redón J, Herranz C, Montalar J, Navarro JR, Blanes A, Munarriz B, Reynés G, Caballero M. The infections due to herpes-varicella viruses occurring in 191 patients with Hodgkin's disease form the basis of this report. There were overall 41 episodes (26.7%) in 40 patients, distributed as follows: varicella in three cases, atypical herpes-varicella in two cases, and herpes zoster in 36 cases, the latter showing systemic spread in seven instances, one to the central nervous system (myelitis) and six to the skin. The mortality was 2.5% of all infections, and 33% of the varicella cases. Morbidity was apparent as postherpetic neuralgia in seven patients (19.4%), postherpetic paraplegia in one case (2.5%), and severe thrombocytopenia in another case (2.5%). The statistical study of the factors contributing to the development of reactivation episodes demonstrated that neither age, sex, or previous splenectomy were influential. The results obtained in relation to the stage and histologic type of Hodgkin's disease can not be fully evaluated because of the artifact introduced by other variables such as type of therapy and observation time. There was a clear relationship with the aggressiveness of therapy, because 81.7% of the viral episodes occurred in patients submitted to total radiotherapy with or without chemotherapy, or with partial radiotherapy plus chemotherapy. In the patients with systemic spread there was a clear relationship with prior splenectomy (p less than 0.005). The clinical features of these patients are commented upon. PMID: 6264237 [PubMed - indexed for MEDLINE] 5702. Wiad Lek. 1981 May 1;34(9):775-7. [Case of cutaneous systemic herpes zoster] [Article in Polish] Marcinów M, Sysak-Wróbel H. PMID: 7281679 [PubMed - indexed for MEDLINE] 5703. Dermatol Monatsschr. 1981 May;167(5):303-4. [Combined treatment of herpes zoster using microwaves, ultrasonics, vitamins and antiseptics (author's transl)] [Article in German] Todorov N, Kirjakova N, Madjarova J. PMID: 7274498 [PubMed - indexed for MEDLINE] 5704. Arch Fr Pediatr. 1981 May;38(5):337-43. [Varicella and herpes zoster in 83 children treated for malignancies (author's transl)] [Article in French] Gruson S, Mouchnino G, Reinert P, Patte C. 57 children treated for malignant diseases presented with varicella and 26 with herpes zoster. Evolution of varicella was benign in 33 children but was complicated in 24, resulting in the death of 6 children. No child died of herpes zoster. The severity of skin and lung symptoms was of no prognostic value but digestive symptoms were associated with severe forms of the disease. Immuno-stimulation was of no use. Vidarabine did not improve the death rate; acycloguanosine is currently under study. PMID: 7259420 [PubMed - indexed for MEDLINE] 5705. Ann Ophthalmol. 1981 May;13(5):579-80. Cicatricial ectropion of the upper lid secondary to herpes zoster ophthalmicus. Smith JP, Lavine DM. PMID: 6973306 [PubMed - indexed for MEDLINE] 5706. Ann Intern Med. 1981 May;94(5):712-3. Herpes zoster during gold therapy. Fam AG, Paton TW, Cowan DH. PMID: 6786152 [PubMed - indexed for MEDLINE] 5707. Neurol Neurochir Pol. 1981 May-Jun;15(3):283-9. [Suppressor cell activity in multiple sclerosis and other nervous system diseases. Preliminary report] [Article in Polish] Czernicki J, Offierska M, Maciejek Z, Tchórzewski H, Chmielewski H. 3H-Thymidine incorporation was assessed in concanavalin A-stimulated cultures of peripheral blood lymphocytes of healthy subjects and multiple sclerosis patients. At the same time the counts of T and B lymphocytes were determined in peripheral blood and the activity of suppressor cells was determined in vitro by the method of Shou et all. in these patients and in other neurological diseases. The studied immunological parameters showed some variability in patients with multiple sclerosis: at the time of exacerbations the activity of suppressor cells decreased and the mitogenic response to Con A was impaired. In remissions and in slowly progressive cases of multiple sclerosis the activity of suppressor cells was increased, particularly in elderly patients. The reported investigations demonstrated that disturbances in the functions of suppressor cells occur also in other neurological diseases. The role of the observed disturbances in the pathogenesis of multiple sclerosis is discussed. PMID: 6458774 [PubMed - indexed for MEDLINE] 5708. Postgrad Med. 1981 May;69(5):159-63, 166-9, 172. Common groin eruptions: diagnosis and treatment. Fragola LA Jr, Watson PE. Most common groin lesions are caused by fungi, bacteria, psychogenic factors, viruses, parasites, or tumors. The workup of all patients with an inguinal skin disorder should include a history, physical examination, microscopic examination and culture of scrapings from the eruption, and examination of the eruption by Wood's light. Agents useful in treating groin lesions include topical and systemic corticosteroids and antibiotics, antipruritic agents, Burow's solution, and lindane. Prolonged use of high-potency topical corticosteroids can be deleterious. PMID: 6453332 [PubMed - indexed for MEDLINE] 5709. J Infect Dis. 1981 May;143(5):693-9. A rapid radioimmunoassay using 125I-labeled staphylococcal protein A for antibody to varicella-zoster virus. Richman DD, Cleveland PH, Oxman MN, Zaia JA. A sensitive radioimmunoassay for serum antibody to varicella-zoster virus is described; it uses 125I-labeled staphylococcal protein A and a specially designed immunofiltration apparatus. The assay accurately distinguishes between individuals who are susceptible and those who are immune to infection with varicella-zoster virus. In addition, it can detect passive antibody in recipients of varicella-zoster immune globulin. This radioimmunoassay also detects the heterologous antibody responses that occasionally occur in patients infected with herpes simplex virus, which also have been detected by other antibody assays. The particular advantages of this assay are the use of noninfectious reagents, the speed of execution (less than 3 hr), the requirement for only small quantities of serum (30 microliters), the objectivity of end-point determination, and the capability of screening large numbers of sera. Consequently, this radioimmunoassay is especially useful for the rapid identification of susceptible individuals, which is essential for the appropriate management of patients and hospital personnel after exposure to varicella. PMID: 6263987 [PubMed - indexed for MEDLINE] 5710. Rev Clin Esp. 1981 Apr 30;161(2):99-102. [Immunologic observations on healthy children with a background of herpes zoster] [Article in Spanish] Santana R, Ramiŕez A, Ruiz-Maldonado R, Plaza A. PMID: 6974384 [PubMed - indexed for MEDLINE] 5711. Minerva Med. 1981 Apr 28;72(17):1071-82. [Pharmacokinetic and clinical evaluation of cefoxitin] [Article in Italian] Soranzo ML, Eandi M, Capra E, Salassa B, Bosio G, Bramato C, Andrini L, Andreoni G, Di Nola F. An investigation conducted on healthy volunteers showed that cefoxitin quickly reaches high plasma concentrations, and is almost completely excreted via the urine within 6 hours. In a series of 21 cases treated with 2 g i.v. in 100 ml of a 5% glucose solution two or three times a day, a clinical cure was achieved in 20, and marked improvement in the remaining patient. PMID: 6785672 [PubMed - indexed for MEDLINE] 5712. Neuropatol Pol. 1981 Apr-Jun;19(2):229-41. [Macrophage reactions of the cerebrospinal fluid in the course of viral and bacterial meningitis] [Article in Polish] Polewska-Jeske A. PMID: 6272162 [PubMed - indexed for MEDLINE] 5713. Indian J Ophthalmol. 1981 Apr;29(1):37-8. Herpes zoster ophthalmicus in children (reports of two cases). Panda A, Sood NN, Dayal Y, Bhatia IM. PMID: 6269994 [PubMed - indexed for MEDLINE] 5714. Am J Med. 1981 Apr;70(4):882-6. Successful treatment with acyclovir of an immunodeficient patient infected simultaneously with multiple herpesviruses. Cupps TR, Straus SE, Waldmann TA. A patient with recurrent simultaneous chronic infections, including cytomegalovirus pneumonia, disseminated zoster and perineal herpes simplex infection, whose immune responses were deficient (immunodeficient), is presented. Following treatment with acyclovir (19-(2-hydroxyethoxymethyl)guanine), this patient had a rapid remission of these viral infections. The patient's clinical improvement is remarkable considering the duration of the viral infections and the continued immune deficiency. Acyclovir appears to act by a highly selective activation by and inhibition of viral enzymes. Prospective trials of this agent in immunosuppressed patients with herpes virus infections seem warranted. PMID: 6259942 [PubMed - indexed for MEDLINE] 5715. N Engl J Med. 1981 Mar 26;304(13):789. No predisposition to herpes zoster with chemotherapy of breast cancer. Markman M, Abeloff MD. PMID: 7464891 [PubMed - indexed for MEDLINE] 5716. Wiad Lek. 1981 Mar 1;34(5):435-7. [Case of paralysis of the lower limb in herpes zoster] [Article in Polish] Klimek A, Bogucki A. PMID: 7281669 [PubMed - indexed for MEDLINE] 5717. Br J Dermatol. 1981 Mar;104(3):351-2. Herpes zoster. Sklar SH, Wigand JS. PMID: 7213570 [PubMed - indexed for MEDLINE] 5718. J Pediatr. 1981 Mar;98(3):368-73. Prophylaxis of varicella in high-risk children: dose-response effect of zoster immune globulin. Orenstein WA, Heymann DL, Ellis RJ, Rosenberg RL, Nakano J, Halsey NA, Overturf GD, Hayden GF, Witte JJ. Immunodeficient patients who were presumed to be susceptible received zoster immune globulin prophylaxis after exposure to varicella. The highest clinical attack rate (35.9%) was seen in household contacts; the lowest attack rate (0%) was observed in children exposed at school. Among household contacts, 48 of 100 patients who received high titer ZIG (reciprocal complement fixation titer greater than or equal to 2,560) developed fourfold rises in serum CF antibody between pre- and 48-hour post-treatment specimens, compared to only one of 34 patients treated with lower titer ZIG lots (P less than 0.001). Patients who developed fourfold antibody rises were significantly less likely to contract clinical varicella (P less than 0.01). Patients who received high titer ZIG also had significantly lower risks of death (P = 0.025) and complications (P = 0.006). Among ZIG-treated patients who contracted clinical varicella, 80% developed mild disease (less than 100 pox), and the median incubation period was prolonged. Immunodeficient children exposed to varicella benefit from ZIG prophylaxis and higher titer ZIG is of greatest benefit. PMID: 7205447 [PubMed - indexed for MEDLINE] 5719. Rev Med Suisse Romande. 1981 Mar;101(3):221-7. [Ocular complications of zona ophthalmica] [Article in French] Zografos L, Chamot L. PMID: 6973181 [PubMed - indexed for MEDLINE] 5720. Ann Neurol. 1981 Mar;9(3):251-66. Multifocal varicella-zoster virus leukoencephalitis temporally remote from herpes zoster. Horten B, Price RW, Jimenez D. Two patients with cancer, one with Hodgkin's disease and the other with a granulosa cell tumor of the ovary, developed a progressive, eventually fatal infection of the central nervous system exhibiting multifocal symptoms and signs. Pathologically, gross abnormalities of the brain resembled those in progressive multifocal leukoencephalopathy (PML), with discrete and confluent plaque-like lesions concentrated in the white matter, particularly along the gray-white junction. Microscopically, pathological changes differed distinctly from those associated with PML; in addition to confluent foci of white matter injury characterized by early demyelination and subsequent necrosis, prominent Cowdry type A eosinophilic intranuclear inclusions were noted in oligodendrocytes, astrocytes, and neurons. By electron microscopy, intranuclear spherical particles consistent in size and appearance with herpesvirus nucleocapsids were found within the lesions. Immunoperoxidase studies detected varicella-zoster virus (VZV) antigens in infected cells, implicating this virus as the responsible agent despite a lapse of many months between the cutaneous herpes zoster and onset of cerebral symptoms in both patients. PMID: 6261672 [PubMed - indexed for MEDLINE] 5721. J Clin Neuroophthalmol. 1981 Mar;1(1):53-5. Stellate block for trigeminal zoster. Olson ER, Ivy HB. Stellate ganglion block for relief of pain and prevention of ophthalmic complications in trigeminal herpes zoster has been advised for many years. In a series of 27 patients, control of pain was dramatic after local anesthetic block of the stellate ganglion. This report is presented to stimulate renewed interest in this old form of therapy. Because of the retrospective nature of this investigation, the lack of adequate numbers and the absence of controls, no conclusions on efficacy of treatment can be made. However, enough hope of success is presented to justify a controlled series in a large metropolitan area where adequate numbers of patients can be accumulated for a double-blind protocol. PMID: 6213645 [PubMed - indexed for MEDLINE] 5722. Radiography. 1981 Mar;47(555):67-72. What do we really know about Interferon ? Cartwright S. PMID: 6168004 [PubMed - indexed for MEDLINE] 5723. Nippon Gan Chiryo Gakkai Shi. 1981 Feb 20;16(1):1-7. [Herpes zoster infection and radiation therapy (author's transl)] [Article in Japanese] Hayakawa K, Okazaki A, Mitsuhashi N, Ito I, Niibe H. PMID: 7264410 [PubMed - indexed for MEDLINE] 5724. Geriatrics. 1981 Feb;36(2):53-63. Office management of viral skin infections in the elderly. Raimer SS, Pursley TV. PMID: 7450510 [PubMed - indexed for MEDLINE] 5725. Tohoku J Exp Med. 1981 Feb;133(2):121-8. Cytological and immunological examination of cerebrospinal fluid in 9 patients with Ramsay Hunt's syndrome. Nakamura S, Takase S, Itahara K, Ogata M, Shigeta S. The purpose of the present study was to carry out the immunological and cytological examination of cerebrospinal fluid in 9 patients with Ramsay Hunt's syndrome. The results obtained were as follows: Among the serum immunoglobulins, IgG in 1 and IgM in 5 of 9 cases increased. The Varicella Zoster antibody titer was significantly elevated in sera of all 9 cases and in CSF of all 7 examined cases. There ws positive fluorescence to Varicella Zoster virus in 2 (Cases 8 and 9) of 4 cases in which CSF smears were examined. The cells showing fluorescence were 10.5% in the former and 1.5% in the latter. Pleocytosis was found in all cases and CSF cell counts ranged from 52 to 2,000/3 mm3 in the early stage. In 3 cases immunoglobulin containing cells (IgG and IgM) were seen about 2-20% within 2 weeks of onset. IgG contents in all and IgG% in 8 of 9 cases, IgA concentration in 7 and IgA% in 7 of 9 cases were increased. These results support the view that the Varicella Zoster virus spreads to the meninges and CSF from ganglions in patients with Ramsay Hunt's syndromes. PMID: 6267732 [PubMed - indexed for MEDLINE] 5726. J Infect Dis. 1981 Feb;143(2):274-80. Rapid diagnosis of varicella-zoster virus infections by countercurrent immunoelectrophoresis. Frey HM, Steinberg SP, Gershon AA. A simple, accurate, and rapid method for laboratory diagnosis of varicella-zoster virus (VZV) infections using countercurrent immunoelectrophoresis (CIE) is described. CIE uses zoster convalescent-phase serum to detect VZV antigen in vesticular fluid. Eighty-six patients were studied, 58 with VZV infections and 28 with vesicular or bullous rashes due to causes other than VZV infection. All patients with documented VZV infection had positive CIE tests for VZV, and the controls were uniformly negative. VZV antigen could be detected up to 15 (varicella) or 16 (zoster) days after the onset of rash. The sensitivity of CIE for detection of VZV antigen was compared with results of viral isolation, immune adherence hemmagglutination, and an indirect enzyme-linked immunosorbent assay. PMID: 6260875 [PubMed - indexed for MEDLINE] 5727. Cesk Dermatol. 1981 Feb;56(1):11-6. [An immunological study of herpes zoster patients III--specific immunity (author's transl)] [Article in Czech] Vacek Z, Trlifajová J, Doutlík S, Vasícková M, Ryba M. PMID: 6260390 [PubMed - indexed for MEDLINE] 5728. Wiad Lek. 1981 Feb 1;34(3):199-204. [Current methods of treating herpes zoster] [Article in Polish] Rubisz-Brzezińska J, Zebracka T, Brzezińska-Wcisło L. PMID: 6167075 [PubMed - indexed for MEDLINE] 5729. Cutis. 1981;27(1):40-2. Recurrences of herpes zoster. Nordlund JJ. PMID: 7471805 [PubMed - indexed for MEDLINE] 5730. J Pediatr. 1981 Jan;98(1):71-3. Zoster in infancy: failure to maintain virus latency following intrauterine infection. Brunell PA, Kotchmar GS Jr. PMID: 7452407 [PubMed - indexed for MEDLINE] 5731. Acta Neurochir (Wien). 1981;58(3-4):259-63. Symptomatic herpes zoster and sciatica. A case report. Clavel M. The author reports a case of a 44-year-old woman with sciatica due to a herniated lumbar disc complicated by the appearance of a zoster eruption over the same, or nearly the same, dermatome. Among the causative factors that trigger herpes zoster prolapsed intervertebral disc is not usually included. PMID: 7315555 [PubMed - indexed for MEDLINE] 5732. Scand J Infect Dis. 1981;13(4):301-2. Herpes zoster and hepatitis B: detection of Hepatitis B surface antigen in vesicle fluid. Norkrans G, Vahlne A, Iwarson S. PMID: 7313584 [PubMed - indexed for MEDLINE] 5733. Intervirology. 1981;15(2):103-10. Detection of specific IgA antibodies in serum of patients with varicella and zoster infections. Levy E, Sarov I. A sensitive solid-phase, enzyme-linked immunosorbent assay (ELISA) was developed for detection of serum IgA antibodies to varicella-zoster virus (VZV). The antigen consisted of a sonically disrupted extract of VZV-infected human embryo cells. Rabbit antihuman IgA peroxidase conjugate was used to detect human IgA bound to viral antigens. In parallel, IgM and IgG antibodies to VZV were studied by ELISA and by an immunoperoxidase antibody to membrane antigen technique, respectively. VZV IgA antibodies were detected in high titers in all 5 varicella and 8 zoster patients. Specific VZV IgM antibodies were detected in all 5 varicella patients, but only in 2 of 8 zoster patients. No VZV IgA antibodies (less than 40) were detected in 50 healthy control sera. Neither were they found in paired sera of 5 patients with herpes simplex infections, 2 patients with Epstein-Barr virus infections, and 5 patients with human cytomegalovirus infections. The potential application of ELISA IgA techniques in serodiagnosis of both primary and reactivated VZV infections is discussed. PMID: 7298297 [PubMed - indexed for MEDLINE] 5734. Eur Neurol. 1981;20(4):330-3. Amyotrophic lateral sclerosis following Herpes zoster infection in a patient with immunodeficiency. Maida E, Kristoferitsch W. PMID: 7274314 [PubMed - indexed for MEDLINE] 5735. Otolaryngol Pol. 1981;35(1):17-25. [Loss of chorda tympani function and the secretory efficiency of the parotid gland (author's transl)] [Article in Polish] Kulczyński B. PMID: 7254850 [PubMed - indexed for MEDLINE] 5736. Zh Nevropatol Psikhiatr Im S S Korsakova. 1981;81(2):47-52. [Clinical picture and pathogenesis of generalized forms of herpes zoster] [Article in Russian] Smirnov IuK, Shishov AS, Mal'tseva NN, Kharin IO, Papilova BI. Clinical examination of 83 patients with generalized herpes zoster has given the authors grounds to regard this disease as a result of activation of latent varicella-zoster virus. This assumption was confirmed by the results of indirect hemagglutination inhibition tests with 37 serum specimens taken from 18 patients. Treatment with antibiotics, the drug proper-myl, and by dehydration was the more effective, the earlier the patients were admitted to the clinic. Dehydration, proper-myl and combination of chloramphenicol with dehydration produced a more beneficial effect than the antibiotic alone. Five patients died. Problems of pathogenesis are discussed. PMID: 7234260 [PubMed - indexed for MEDLINE] 5737. Int J Dermatol. 1981 Jan-Feb;20(1):65-8. Treatment of herpes zoster and postzoster neuralgia by subcutaneous injection of triamcinolone. Epstein E. Based on a study of 400 patients (272 patients with herpes zoster and 128 with postzoster neuralgia), the subcutaneous injection of triamcinolone in saline is concluded to be a safe and effective measure for reducing pain. The acute eruption and symptoms of herpes zoster cleared in an average of less than four days. Postzoster neuralgia developed in only 2.9% of the patients, although nearly 70% of these patients were more than 50 years of age. In cases of postzoster neuralgia, 35% cleared completely; 28.9% improved enough so that they could live with the occasional pain, itching, or numbness, and therapy was not beneficial for an additional 15.6%, and it failed in 18.7% of the cases. The results were satisfactory in 63.9% of the patients, and the side effects were minimal. PMID: 7203770 [PubMed - indexed for MEDLINE] 5738. Scand J Infect Dis. 1981;13(4):257-62. Treatment of trigeminal and thoracic zoster with idoxuridine. Wildenhoff KE, Esmann V, Ipsen J, Harving H, Peterslund NA, Schønheyder H. A double-blind random selection comparison was made of the therapeutic effects in acute herpes zoster of 40% idoxuridine (IDU) dissolved in dimethyl sulphoxide (DMSO) compared with DMSO and saline flavoured with garlic. Thoracic (80 patients) and trigeminal (42 patients) zoster were investigated separately. The patients were evaluated daily until skin healing and then at 1, 3 and 6 months by registering pain, paraesthesia and sensitivity disturbances as well as by clinical and photographic evaluation of the skin lesions. Duration of pain was positively correlated to age, to delayed healing and to elevated temperature in the acute phase of zoster. The period of pain before skin eruption was considerably longer in thoracic than in trigeminal zoster, while the latter was associated with a more severe inflammatory reaction, more neurologic sequelae, but also by a faster healing of the skin lesions. IDU was highly effective in shortening the period of pain and improving skin healing in trigeminal zoster, while no effect of IDU was observed in thoracic zoster. The reason for this difference is presently not understood. PMID: 7031859 [PubMed - indexed for MEDLINE] 5739. Trans Ophthalmol Soc U K. 1981;101(1):3-5. Drug treatment of herpes zoster. McGill J, James C, Hiscott P, Worstman T, Williams JH, Copplestone A, Larkin M. PMID: 6985235 [PubMed - indexed for MEDLINE] 5740. Bull Soc Belge Ophtalmol. 1981;193:49-56. Preliminary results of oral BVDU treatment of herpes zoster ophthalmicus. Maudgal PC, Dralands L, Lamberts L, De Clercq E, Descamps J, Missotten L. PMID: 6979370 [PubMed - indexed for MEDLINE] 5741. Ophthalmologica. 1981;183(3):143-7. Unilateral inferior altitudinal hemianopsia, Argyll Robertson pupil and dendritic keratitis in a young patient with herpes zoster. Sammartino A, Fusco R, de Crecchio G, Magli A. The authors describe a young patient with herpes zoster and discuss the etiopathogenesis of the complications which included unilateral inferior altitudinal hemianopsia, Argyll Robertson pupil and dendritic keratitis. PMID: 6975913 [PubMed - indexed for MEDLINE] 5742. Vasa. 1981;10(1):58-63. [Larvate temporal arteritis with skin manifestation following herpes zoster ophthalmicus] [Article in German] Bardach H, Lindemayr H, Obiditsch-Mayer I. PMID: 6972129 [PubMed - indexed for MEDLINE] 5743. Acta Neuropathol Suppl. 1981;7:156-9. "Thalamic" dementia in herpes encephalitis: clinico-pathological report. Pilleri G, Pietrini V, Tagliavini F, Trabattoni G, Lechi A. Herpes zoster (HZ) primary affections of the CNS are rare and, in most of the reported patients, are representing variously extended forms of ascending myelitis. Our examination concerns a man who at the age of 37 developed apathy after a feverish episode with iridocyclitis. Six months later an ophthalmic HZ was diagnosed and thenceforth the patient showed a dementia with Korsakow's syndrome, apathy and a right hemipalsy, and diplopia appeared; the later symptoms remitted after steroid therapy. Post-mortem examination revealed a slowly progressive encephalitis with symmetrical impairment of the anterior ventral, medial, and centrum medianum of the thalamus. The HZ origin of the lesions and the relation between their site and the peculiar form of dementia, to be ascribed to the "thalamic" ones, are discussed. A vasculitis process can be hypothesized considering both the symmetrical localisation and the microscopical aspects of the lesions. PMID: 6971556 [PubMed - indexed for MEDLINE] 5744. Geriatrics. 1981 Jan;36(1):81-90. Herpes zoster and the aging eye. Weingeist TA. Although most patients with herpes zoster are otherwise healthy, all should be screened for occult neoplastic disease. Treatment is frustrating and nonspecific. Postherpetic neuralgia is especially difficult to manage and tends to be more severe among geriatric patients. All patients with trigeminal nerve involvement should be referred to an ophthalmologist for evaluation and possible treatment of ocular complications. PMID: 6969681 [PubMed - indexed for MEDLINE] 5745. Feldsher Akush. 1981;46(10):55-7. [Shingles: herpes zoster] [Article in Russian] Sagalov GM. PMID: 6913509 [PubMed - indexed for MEDLINE] 5746. J Fr Otorhinolaryngol Audiophonol Chir Maxillofac. 1981 Jan;30(1):59-61. [Auricular zona] [Article in French] Martin C. PMID: 6450822 [PubMed - indexed for MEDLINE] 5747. J Fr Otorhinolaryngol Audiophonol Chir Maxillofac. 1981 Jan;30(1):11-7. [Facial paralysis and generalized infectious diseases] [Article in French] Martin C, Martin H, Viala JJ, Guastalla JP. PMID: 6450813 [PubMed - indexed for MEDLINE] 5748. Verh Dtsch Ges Pathol. 1981;65:203-7. [Investigations to demonstrate latent viral infection of varicella-Zoster-virus in human spinal ganglia] [Article in German] Wolff MH, Büchel F, Gullotta F, Helpap B, Schneweis KE. PMID: 6289549 [PubMed - indexed for MEDLINE] 5749. Ter Arkh. 1981;53(10):135-40. [Viral infections in pregnancy] [Article in Russian] Farber NA. PMID: 6274053 [PubMed - indexed for MEDLINE] 5750. Prog Clin Pathol. 1981;8:239-267. Advances in clinical virology. Peterson LR, Balfour HH Jr. PMID: 6272358 [PubMed - indexed for MEDLINE] 5751. J Med Virol. 1981;8(2):89-101. Detection of antibody to varicella-zoster virus by competitive and IgM-antibody capture immunoassay. Tedder RS, Mortimer PP, Lord RB. A simple, sensitive, and specific competitive solid phase immunoassay for antibody to varicella-zoster virus (anti-VZV) is described. The assay uses reagents that can easily be prepared and is sparing of viral antigen. Using a solid phase coated with sheep IgG from a serum raised against human mu-Fc, the same reagents will accurately detect anti-VZV IgM. The competitive assay divided sera from children from adults into immune and nonimmune groups that closely correlated with a history of previous VZV illness. It was not affected by the presence or absence of antibody to other herpes viruses. The IgM antibody capture assay demonstrated the presence of anti-VZV IgM in sera from patients with both varicella and zoster and gave negative results in patients with infections unrelated to VZV and in healthy blood donors. PMID: 6271923 [PubMed - indexed for MEDLINE] 5752. J Immunol Methods. 1981;43(3):283-90. Production of monospecific antibodies to varicella zoster virus antigen in rabbits tolerant to human IgG and immunized with antigen immunoprecipitated with human IgG from zoster reconvalescent sera. Hansen BL, Vestergaard BF, Hansen GN. A method for production of antisera specific to a single antigen of a human infectious agent is described with varicella zoster virus (VZV) as a model. Microisolation of immunochemically pure antigen contained in defined immunoprecipitates was achieved by crossed immunoelectrophoresis of a crude antigenic preparation (detergent solubilized, VZV infected cells) into agarose gel containing zoster reconvalescent immunoglobulin. Immunization of rabbits made tolerant to human IgG with immunoprecipitates resulted in the production of antibodies to the antigen part of the immunoprecipitate. The method represents a short cut to the production of heterologous diagnostic antisera to defined antigens of human infectious agents. PMID: 6265561 [PubMed - indexed for MEDLINE] 5753. Infect Immun. 1981 Jan;31(1):436-44. Immune response after exposure to varicella zoster virus: characterization of virus-specific antibodies and their corresponding antigens. Zweerink HJ, Neff BJ. Fourteen varicella zoster virus antigens were identified that induce antibodies during primary and recurrent infections. These antigens, which included the major nucleocapsid polypeptide (molecular weight, 155,000) and three glycoproteins (molecular weights, 130,000, 88,000, and 60,000, respectively) plus a number of minor antigens, were identified in radioimmunoprecipitation assays, using [35S]methionine-labeled extracts of cells infected with varicella zoster virus and sera from patients with primary and recurrent viral infections. No significant and reproducible differences were observed between early convalescent sera from cases with natural chicken pox and sera from cases with zoster in their ability react with viral antigens. Sera that were taken many years after episodes of chicken pox still retained their ability to react with the major viral antigens. PMCID: PMC351802 PMID: 6260665 [PubMed - indexed for MEDLINE] 5754. Arch Neurol. 1981 Jan;38(1):49-51. Recurrent herpes zoster encephalitis. A complication of systemic lupus erythematosus. O'Donnell PP, Pula TP, Sellman M, Camenga DL. A middle-aged woman had five discrete episodes of herpes zoster. The first attack consisted of uncomplicated herpes zoster ophthalmicus. The subsequent four episodes involved thoracic, cervical, and finally sacral dermatomes and were complicated by myelitis or encephalomyelitis. During the most recent attack, while she was receiving corticosteroids, varicella-zoster virus was cultured from the CSF. In addition, the patient had strong evidence of systemic lupus erythematosus, with a history of Raynaud's phenomenon, migratory arthralgia, and unexplained anemia before the first attack of zoster with subsequent development of a positive lupus cell preparation and elevated antinuclear antibody levels. PMID: 6257212 [PubMed - indexed for MEDLINE] 5755. Tex Rep Biol Med. 1981-1982;41:532-7. Effect of interferon on systemic herpesvirus infections. Kern ER, Glasgow LA. PMID: 6189219 [PubMed - indexed for MEDLINE] 5756. Microbiol Immunol. 1981;25(3):295-303. Anticomplement immunofluorescence for the titration of antibody to varicella-zoster virus. Shigeta S, Baba M, Ogata M, Iijima S, Murai C. Anticomplement immunofluorescence (ACIF) was tested for its use for the titration of antibody against varicella-zoster virus (VZV). ACIF antibody responses of patients with VZV infection were specific for VZV antigen and heterotypic responses to herpes simplex virus type-1 and cytomegalovirus antigens were not observed. Comparative studies of ACIF, membrane immunofluorescence (MIF) and indirect immunofluorescence (IF), using acetone-fixed antigen, were carried out with nonimmune sera and convalescent sera of patients who had recovered from varicella, herpes zoster and Rumsey Hunt disease. Nonspecific staining occurred with some nonimmune sera at a 1:4 dilution in the MIF and IF tests, after freezing and thawing of the serum, but not in the ACIF test. The antibody titers in convalescent sera agreed well in these three methods and the highest titer was obtained by MIF. The titers in ACIF and IF were similar but the ACIF antibody decreased earlier than the IF antibody during convalescence. On the other hand there was a discrepancy between the titers of ACIF and those of MIF and IF antibody in the sera of healthy adults, all sera with titers higher than 10 in the MIF and IF tests had titers below 10 in the ACIF test. The average titer of ACIF antibody declined to less than 10 with increasing age (13 to more than 20 years), whereas the MIF antibody increased during the same period of life. PMID: 6166838 [PubMed - indexed for MEDLINE] 5757. Antimicrob Agents Chemother. 1981 Jan;19(1):193-5. Short-course human leukocyte interferon in treatment of herpes zoster in patients with cancer. Merigan TC, Gallagher JG, Pollard RB, Arvin AM. Because of encouraging results when human leukocyte interferon was given for 5 to 7 days to treat early localized herpes zoster in patients with cancer, a small placebo-controlled, randomized, double-blind trial was set up involving only 48 h of therapy. In this trial, there was no effect on acute pain or disease progression in the primary dermatome. However, a modest but significant effect was noted in that distal cutaneous spread was diminished in the treated patients compared with the controls and the treated patients had diminished severity and duration of postherpetic neuralgia. No evidence of impairment in varicella-zoster-specific lymphocyte transformation was observed in interferon-treated patients. PMCID: PMC181382 PMID: 6166245 [PubMed - indexed for MEDLINE] 5758. Lab Delo. 1981;(4):249. [Micromethod of detecting spontaneous rosette-forming T-lymphocytes] [Article in Russian] Semenova EN, Mal'khonov VB. PMID: 6164870 [PubMed - indexed for MEDLINE] 5759. J Neurol. 1981;224(4):297-300. Transient contralateral hemiplegia after ophthalmic zoster. Therapeutic problems in elderly patients. Landi G, Calloni MV, Scarlato G. Delayed ipsilateral carotid arteritis is a known complication of herpes zoster ophthalmicus. The case of a 70-year-old man with two TIAs following ophthalmic zoster is reported, and the therapeutic problems in elderly patients are discussed. PMID: 6162932 [PubMed - indexed for MEDLINE] 5760. Rev Med Interna Neurol Psihiatr Neurochir Dermatovenerol Med Interna. 1981 Jan-Feb;33(1):93-6. [Generalized zona zoster, induced repeatedly by cytosine-arabinoside and rubidomycin therapy, in a patient with chronic granulocytic leukemia in a blastic crisis] [Article in Romanian] Ciocoiu A, Munteanu N, Berceanu S. PMID: 6114541 [PubMed - indexed for MEDLINE] 5761. Cutis. 1981;27(1):40. Dehydroemetine therapy for herpes zoster. Hoehn GH. PMID: 6110514 [PubMed - indexed for MEDLINE] 5762. Can Med Assoc J. 1980 Dec 6;123(11):1115-9. Breast cancer, cough and vesicular eruptions. Wigle RD, Treloar ME. PMCID: PMC1704948 PMID: 6257367 [PubMed - indexed for MEDLINE] 5763. Am J Med. 1980 Dec;69(6):881-5. Herpes zoster in patients with treated Wegener's granulomatosis. A possible role for cyclophosphamide. Cupps TR, Silverman GJ, Fauci AS. In review of the ongoing protocol for the treatment of Wegener's granulomatosis with cyclophosphamide at te National Institutes of Health, an increased incidence of herpes zoster infection was noted. There were a total of nine episodes in seven of a total of 65 patients with a 255 patient year follow-up. The infections occurred while the patients were in complete clinical remission during immunosuppressive therapy. Cutaneous dissemination was noted in two episodes, but no visceral or central nervous system involvement was noted despite continuation of immunosuppressive therapy. The major causal factor of the increased incidence of herpes zoster appeared to be the cyclophosphamide therapy. PMID: 7446553 [PubMed - indexed for MEDLINE] 5764. Nippon Rinsho. 1980 Dec;38(12):4686-91. [Liver cirrhosis with manifest Hunt's syndrome: pleural and ascitic fluid] [Article in Japanese] Nakura E, Miyazaki R, Ishibashi J, Mikami R, Takahashi H, Saeki K. PMID: 7253245 [PubMed - indexed for MEDLINE] 5765. J Neurol Neurosurg Psychiatry. 1980 Dec;43(12):1146-7. Cranial herpes zoster: a case report and a hypothesis. Ward C, Karsh J, Calne DB. PMCID: PMC490791 PMID: 7217963 [PubMed - indexed for MEDLINE] 5766. Pain. 1980 Dec;9(3):355-62. Cryocautery of sensitized skin areas for the relief of pain due to post-herpetic neuralgia. Suzuki H, Ogawa S, Nakagawa H, Kanayama T, Tai K, Saitoh H, Ohshima Y. Fourteen patients whose post-herpetic neuralgia could not be alleviated by conventional methods were treated with cryocautery using a stick of solid carbon dioxide (dry ice) applied directly to the hyperesthetic skin areas of the cutaneous scars. Follow-up evaluation revealed that 5 of 14 subjects maintained excellent pain relief and another 5 subjects showed good relief. Ten subjects discontinued further therapeutic procedures after cryocautery even though some low grade pain persisted. We believe that cryocautery of localized skin areas is a valuable method for treating patients with post-herpetic neuralgia who have not been improved by conventional methods. Disadvantages of this procedure are discussed. PMID: 7208080 [PubMed - indexed for MEDLINE] 5767. J Dermatol. 1980 Dec;7(6):443-7. Disseminated zoster. Nigam P, Dayal SG, Dubey AL. PMID: 7026639 [PubMed - indexed for MEDLINE] 5768. Ophthalmology. 1980 Dec;87(12):1202-7. Common viral eye diseases and latent infections. Nesburn AB. PMID: 6972503 [PubMed - indexed for MEDLINE] 5769. Klin Monbl Augenheilkd. 1980 Dec;177(6):794-7. [Diagnosis and treatment of neuroparalytic zoster keratitis (author's transl)] [Article in German] Turss R. In severe zoster keratitis many pathogenic factors are involved. In addition to viral manifestations, the cornea is often affected by anterior uveitis or secondary glaucoma. Neuroparalytic keratitis causes lowered blinking frequency and decreased tear secretion. In addition, zoster ulcerations of the upper lid margin mechanically disturb reformation of the tear film and weaken the lipid layer by necrosis of the Meibomian glands. Ointments reduce break-up time and parasympathicolytic mydriatics further decrease tear secretion. When the average time between two blinks is shorter than the tear film break-up time, a "dry eye" condition usually develops. The appropriate treatment in such cases is thorough prevention of evaporation. PMID: 6970853 [PubMed - indexed for MEDLINE] 5770. J Clin Microbiol. 1980 Dec;12(6):764-7. Varicella-zoster-associated encephalitis: detection of specific antibody in cerebrospinal fluid. Gershon A, Steinberg S, Greenberg S, Taber L. Varicella-zoster (VZ) antibody measured by indirect immunofluorescence was used to identify patients with encephalitis due to VZ virus. In 15 of 16 (94%) patients with VZ infection and clinical evidence of central nervous system involvement, VZ antibody was present at a titer of 1:2 or greater in cerebrospinal fluid. In contrast, no VZ antibody was detected in the cerebrospinal fluid of seven patients with VZ infections without clinical signs of central nervous system involvement, nor was any detected in the cerebrospinal fluid of 25 patients with malignant or demyelinating disease or encephalitis due to other viral or toxic agents. All of these patients had detectable serum VZ antibody. Thus, in this study the presence of detectable VZ antibody in cerebrospinal fluid measured by indirect immunofluorescence seemed to correlate with clinical evidence of central nervous system involvement due to this virus. PMCID: PMC273693 PMID: 6273449 [PubMed - indexed for MEDLINE] 5771. Acta Virol. 1980 Dec;24(6):406-14. Cell-mediated immunity to varicella-zoster virus as assessed by the migration inhibition test. Trlifajová J, Svejcar J, Svandová E, Ryba M, Pekárek J. The migration inhibition method was used to test cell-mediated immunity to varicella-zoster (VZ) virus in 10 varicella and 11 herpes zoster patients. Control groups consisted of eight children susceptible to VZ infection on serological evidence and 49 normal persons of different age categories. Depending on the positivity criterion adopted, positive results during disease were obtained in 43% or 90% or all tests performed in varicella patients and 47% or 74% in herpes zoster patients. Irrespective of which criterion of positivity was applied, a high rate of positive results was obtained in the normal control groups; in the age range from 20--44 years it was comparable to that for patients. This finding would suggest a high activity of VZ virus among the human population. Since a positive result in migration inhibition test offers evidence of recent contact with antigen, either exogeneous contact with VZ infection or endogenous contact with latent VZ virus must have been involved. PMID: 6111201 [PubMed - indexed for MEDLINE] 5772. Cutis. 1980 Nov;26(5):524-5. Disseminated Herpes zoster: a rapid diagnostic test using electron microscopy. Burkhart CG, DeStephens J. PMID: 7460624 [PubMed - indexed for MEDLINE] 5773. J Antimicrob Chemother. 1980 Nov;6(6):733-6. Triple drug therapy of Herpes zoster infection occurring in patients with reticulo-endothelial neoplasia--a preliminary study. Busk CM, Earl HM, Wrigley PF, Lister TA. PMID: 7440466 [PubMed - indexed for MEDLINE] 5774. Br Med J. 1980 Nov 1;281(6249):1178. Oral (E)-5-(2-bromovinyl)-2'-deoxyuridine in severe herpes zoster. de Clercq E, Degreef H, Wildiers J, de Jonge G, Drochmans A, Descamps J, de Somer P. PMCID: PMC1714507 PMID: 7427624 [PubMed - indexed for MEDLINE] 5775. Am J Gastroenterol. 1980 Nov;74(5):423-7. Fatal massive hepatic necrosis from varicella-zoster hepatitis. Ross JS, Fanning WL, Beautyman W, Craighead JE. An unusual case of varicella-zoster hepatitis is reported which resulted in fatal massive hepatic necrosis in a 64-year old white female. The patient had had chickenpox 30 years prior to death but no cutaneous zoster at any time. The liver showed typical eosinophilic intranuclear inclusions and herpesvirus virions were demonstrated by electron microscopy. Indirect immunofluorescent serologic studies confirmed remote and recent infection by varicella-zoster virus. The potential significance of an incidental splenectomy performed 14 months before death and the general role of immunosuppression in the incidence and dissemination of varicella-zoster are discussed. The features of 13 reported cases of herpes simplex hepatitis are briefly reviewed. PMID: 7234819 [PubMed - indexed for MEDLINE] 5776. Int J Dermatol. 1980 Nov;19(9):510-1. Segmental abdominal zoster paresis. Garcia RL. PMID: 6448826 [PubMed - indexed for MEDLINE] 5777. J Clin Microbiol. 1980 Nov;12(5):651-5. Direct immunofluorescence staining for detection of herpes simplex and varicella-zoster virus antigens in vesicular lesions and certain tissue specimens. Schmidt NJ, Gallo D, Devlin V, Woodie JD, Emmons RW. Direct immunofluorescence (IF) staining was compared with virus isolation for detection of herpes simplex viruses (HSV) and varicella-zoster virus (VZV) directly in clinical materials. These included 199 vesicular lesion specimens and 280 tissue specimens. Correspondence between IF and isolation results was 88% in testing for HSV in lesion specimens and 98% in testing for HSV in various tissue (mostly brain) specimens. Overall, IF was positive for 82% of the specimens in which HSV was demonstrated, and virus was isolated from 89% of the HSV-positive specimens. IF was markedly more sensitive than isolation for demonstrating VZV in lesion and tissue specimens, detecting all of the specimens positive for VZV, whereas isolation detected only 23%. IF detected VZV antigen in a number of lesion specimens taken late after onset, past the time when they would be expected to yield infectious virus. Specificity of positive IF reactions for HSV or VZV in the absence of virus isolation was supported by the facts that (i) staining was obtained with only a single, presumably homologous, immune conjugate, (ii) clinical symptoms were compatible with infection with the virus for which positive IF findings were obtained, and (iii) positive electron microscopy findings for herpesviruses or positive serological results for VZV were also obtained in some instances. Factors to be considered in achieving specificity of IF staining for these human herpesviruses are discussed. PMCID: PMC273664 PMID: 6268653 [PubMed - indexed for MEDLINE] 5778. Med J Aust. 1980 Nov 1;2(9):518. Herpes zoster and tetracosactrin. Silberman D. PMID: 6259503 [PubMed - indexed for MEDLINE] 5779. Int J Dermatol. 1980 Nov;19(9):514-6. Herpes zoster in a husband and wife. Feinstein A, Trau H, Schewach-Millet M. The wife of a 75-year-old man with zoster began to suffer from this disease some 24 days after is appeared in her husband. Although zoster is generally regarded to be an endogenously noncommunicable disease, the case reported herein suggests that the infection was exogenously communicated. The literature pointing up that zoster may possibly be acquired exogenously, particularly in immunosuppressed patients, is extensively reviewed. PMID: 6253406 [PubMed - indexed for MEDLINE] 5780. Srp Arh Celok Lek. 1980 Nov;108(11):1111-7. [Immunological status in herpes zoster] [Article in Serbian] Petrović M, Kostić A, Lesić Lj, Sasić M. PMID: 6171894 [PubMed - indexed for MEDLINE] 5781. Wiad Lek. 1980 Oct 1;33(19):1587-90. [Neurological complications of generalized herpes zoster] [Article in Polish] Chmielewski H, Pniewski S, Lisiewicz J. PMID: 7467335 [PubMed - indexed for MEDLINE] 5782. Cutis. 1980 Oct;26(4):417-9. Herpes zoster developing after a spider bite. Heller AW, Kelly AP. A patient was bitten on the hand by a spider and subsequently hemorrhagic herpes zoster developed at the site of the bite as well as over most of the area distal to the elbow (innervated by cutaneous nerves C5-C8). Mild systemic symptoms of nausea, abdominal cramping, and visual disturbances responded to the intravenous administration of calcium gluconate. There was residual paresthesia of the C5-C8 dermatome but no atrophy. This is the first reported case of herpes zoster precipitated by a spider bite. PMID: 7418443 [PubMed - indexed for MEDLINE] 5783. Cutis. 1980 Oct;26(4):378-9. Recurrences in herpes zoster. Epstein E. Five persons who had had two attacks of zoster were culled from a series of 400 persons with herpes zoster or postzoster neuralgia (incidence, 1.25 percent). The likelihood of a person having an attack of this virus infection is considered to be between 1 and 2 percent. Hence it is possible that an episode of herpes zoster confers only temporary protection against a second attack. These figures indicate that recurrences are uncommon but do appear as often as primary attacks appear in those who never had this condition previously. PMID: 7418436 [PubMed - indexed for MEDLINE] 5784. Clin Otolaryngol Allied Sci. 1980 Oct;5(5):303-10. Acute facial paralysis: a virological study. Mulkens PS, Bleeker JD, Schröder FP. A serological study using the complement fixation reaction for herpes zoster virus (HZV) and herpes simplex virus (HSV) was carried out on 120 patients with Bell's palsy and 5 with Ramsay-Hunt syndrome. Three Bell's palsy patients (2.5%) showed a significant HZV antibody titre rise. In no case was a rise of HSV antibody titre observed. Two Ramsay-Hunt patients showed a significant rise of HZV antibody titre. Rise of HSV antibody titre was not observed in this group either. The Monosticon test to exclude infectious mononucleosis, proved to be negative in all cases of Bell's palsy. In 2 cases of Bell's palsy, a biopsy specimen for virus isolation was obtained during a decompression operation. No virus could be cultured from the epineurium of the first patient. That of the second patient was found to contain HSV type I. There was no serological evidence of a HSV antibody titre rise. PMID: 6254700 [PubMed - indexed for MEDLINE] 5785. Br Med J. 1980 Sep 27;281(6244):871. Acupuncture and postherpetic neuralgia. Jolly C. PMCID: PMC1714230 PMID: 7427486 [PubMed - indexed for MEDLINE] 5786. N Engl J Med. 1980 Sep 18;303(12):703. Atypical generalized zoster with lymphadenitis mimicking lymphoma. Kaplowitz LG. PMID: 7402262 [PubMed - indexed for MEDLINE] 5787. Rinsho Shinkeigaku. 1980 Sep;20(9):713-6. [A case of Ramsay Hunt syndrome with encephalitis (author's transl)] [Article in Japanese] Yamasaki M, Nomura S, Sera H, Segawa Y, Sarai K. PMID: 7460433 [PubMed - indexed for MEDLINE] 5788. Rev Fr Transfus Immunohematol. 1980 Sep;23(4):439-48. [Anti-varicella-zona immunoglobulins. Discovery of antibodies and method of formation] [Article in French] Janot C, Perrier P, Schooneman F, Streiff F, Stoltz JF, Avenard G, Amouch JP. The screening of zoster's antibodies has been performed in blood donors population and persons convalescing from herpes zoster. The results show that 25% of blood donors and 83,5% of convalescents have respectively a titer of CF antibody of 8. Plasma units were pooled and the pool had a final titer of CF antibody of 16. Varicella zoster immunoglobulin prepared by alcohol fractionation had a fluorescent antibody titer of 1 024 and a CF antibody of 512. These results are discussed and compared with those of literature. PMID: 7455486 [PubMed - indexed for MEDLINE] 5789. Arch Ophthalmol. 1980 Sep;98(9):1656. Stellate block for trigeminal herpes zoster. Olson ER, Ivy HB. PMID: 7425932 [PubMed - indexed for MEDLINE] 5790. Vestn Dermatol Venerol. 1980 Sep;(9):54-6. [Herpes zoster in a patient with chronic lympholeukemia] [Article in Russian] Zabel J, Karas Z, Lugowska D. PMID: 7424160 [PubMed - indexed for MEDLINE] 5791. J Indian Med Assoc. 1980 Sep 1;75(5):95. Ramsay Hunt syndrome with an unusual presentation. Shrivastava MP. PMID: 7217697 [PubMed - indexed for MEDLINE] 5792. Int J Dermatol. 1980 Sep;19(7):362-74. Ulcerative lesions of the oral cavity. Cohen L. PMID: 6998877 [PubMed - indexed for MEDLINE] 5793. Kango Gijutsu. 1980 Sep;26(12):1657-63. [Clinical course and nursing of patients with herpes zoster] [Article in Japanese] Shinahara S, Shimada Y, Shoji K, Hosoda T. PMID: 6903617 [PubMed - indexed for MEDLINE] 5794. Rev Infect Dis. 1980 Sep-Oct;2(5):761-800. Infections in patients with Hodgkin's disease: a clinical study of 300 consecutive adult patients. Notter DT, Grossman PL, Rosenberg SA, Remington JS. Patterns of infection were investigated in 300 consecutive adult patients with Hodgkin's disease who were followed for an average of 5.7 years after diagnosis. Serious infection other than cutaneous herpes zoster infection developed in 21% of the 300 patients. Sixty percent of the episodes of serious infection were microbiologically documented (MDSI). Bacteremia was the most frequent MDSI, and Streptococcus pneumoniae was the most common organism causing MDSI. Bacteremia due to S. pneumoniae occurred in 3% of the 300 patients, was rarely fatal, and almost always was associated with prior relapse of Hodgkin's disease and with prior extensive combined modality therapy. The incidence of bacteremia due to S. pneumoniae among patients who had received extensive radiation therapy plus chemotherapy was 5.5%. Identifiable factors predisposing patients to infection were present at the time of all but two of the 68 episodes of MDSI that were observed. Patients who had received extensive radiotherapy plus chemotherapy had a higher incidence of subsequent episodes of serious infection and MDSI than did those who had received extensive radiotherapy alone. Among patients without Hodgkin's disease at autopsy but with infection contributing to death, only four patients lacked other major compromising illnesses. Patients cured of Hodgkin's disease who remained free of major second illnesses or long-term complications of prior treatment rarely developed MDSI other than infections caused by the post-splenectomy spectrum of organisms, regardless of the extent of prior cumulative immunosuppressive therapy. PMID: 6763305 [PubMed - indexed for MEDLINE] 5795. J Clin Microbiol. 1980 Sep;12(3):367-74. Immunoglobulins M and G to varicella-zoster virus measured by solid-phase radioimmunoassay: antibody responses to varicella and herpes zoster infections. Arvin AM, Koropchak CM. Both immunoglobulin M (IgM) and IgG antibodies to varicella-zoster virus (VZV) were detectable in a solid-phase radioimmunoassay with 125I-labeled goat antisera to human immunoglobulins. Primary infection with VZV was associated with early production of IgM and IgG antibodies and rapid development of lymphocyte transformation to VZV antigen. Among eight subjects with varicella tested 1 to 4 days after onset, seven patients had IgG and six patients had IgM antibodies; all patients had both IgG and IgM antibodies within 7 days. An IgM response was documented by radioimmunoassay in 18 of 26 patients with herpes zoster. VZV antibodies could be assayed by radioimmunoassay in unfractionated serum with commercial goat antisera to human immunoglobulins and commercial VZV antigen. VZV-specific IgG binding was present in all sera from 42 subjects with a VZB antibody titer of greater than or equal to 1:8 as determined by indirect immunofluorescence and cellular immunity to VZV as determined by lymphocyte transformation and who had had varicella at least 20 years before testing. The geometric mean titer was 1:6,309, and titers were greater than or equal to 1:16,384 in 20 subjects. Antibody was present as determined by radioimmunoassay in 14 samples negative by complement fixation and in five samples negative by complement fixation and immune adherence hemagglutination. No specific binding was observed in 21 sera from subjects who were not immune to VZV as determined by indirect immunofluorescence or lymphocyte transformation despite the presence of herpes simplex or cytomegalovirus antibody indicated by complement fixation in 15 sera. High titers of VZV IgM antibody were detected in unfractionated sera despite the presence of high titers of VZV IgG antibody. The VZV radioimmunoassay provided a sensitive and practical method for measuring VZV IgG and IgM antibodies. PMCID: PMC273592 PMID: 6260833 [PubMed - indexed for MEDLINE] 5796. Ann Intern Med. 1980 Sep;93(3):414-9. An outbreak of varicella-zoster virus infection among cancer patients. Morens DM, Bregman DJ, West CM, Greene MH, Mazur MH, Dolin R, Fisher RI. An outbreak of varicella-zoster infection occurred among patients of the Medicine Branch, National Cancer Institute, National Institutes of Health. Epidemiologic investigation suggested that the outbreak was due to two distinct types of disease. One type was acquired without previous exposure to other diseased patients and invariably associated with dermatomal lesions. The other, an a typical form, was associated with person-to-person transmission and equivocal initial dermatomal distribution and had an incubation period of approximately 11 to 25 days. Despite the diagnosis of zoster, the latter probably was varicella, occurring in patients who were immunodeficient because of disease, debility, and chemotherapy. PMID: 6254415 [PubMed - indexed for MEDLINE] 5797. Hosp Pract. 1980 Sep;15(9):91-3, 97, 100-1 passim. Varicella vaccination: where do we go from here? Brunell PA. Although meager knowledge of the virus raises serious safety questions, the risk of death from varicella in immunocompromised children justifies further trials. In the meantime, passive immunization is a safe and relatively effective alternative. PMID: 6250972 [PubMed - indexed for MEDLINE] 5798. Antibiotiki. 1980 Sep;25(9):695-710. [Clinical use of interferon and its inducers] [Article in Russian] Nosik NN, Ershov FI. PMID: 6158289 [PubMed - indexed for MEDLINE] 5799. Br Med J. 1980 Aug 30;281(6240):622. Acupuncture and postherpetic neuralgia. Lewith GT, Field J. PMCID: PMC1713891 PMID: 7427403 [PubMed - indexed for MEDLINE] 5800. Lancet. 1980 Aug 30;2(8192):474. Idoxuridine for herpes zoster. Esmann V, Wildenhoff KE. PMID: 6106115 [PubMed - indexed for MEDLINE] 5801. Am Fam Physician. 1980 Aug;22(2):117-8. Lymphoma with herpes zoster. Andrus MS, Cigtay OS. A herpes zoster infection in patients with lymphoma has been associated with subsequent metastatic disease involving the spinal cord and vertebrae of the affected dermatome segment. This correlation can be used in planning radiation therapy to avert neurologic complications secondary to spinal cord involvement. PMID: 7405780 [PubMed - indexed for MEDLINE] 5802. AJR Am J Roentgenol. 1980 Aug;135(2):263-7. CT of central nervous system infections in immunocompromised patients. Enzmann DR, Brant-Zawadzki M, Britt RH. The computed tomographic (CT) scan appearance of parenchymal central nervous system (CNS) infection in 12 immunosuppressed patients was unlike that of the usual bacterial abscess in immunologically intact hosts. The lesions were poorly circumscribed and of low density. Contrast enhancement was minimal and did not assume a "ring" configuration. These CT scan findings heralded a poor prognosis. Compared to the neuropathologic findings, the CT scan generally underestimated the extent of involvement. Three other compromised patients were better able to localize the infection. This successful defense was manifested on their CT scans as the more typical "ring" pattern of contrast enhancement. Patients with this CT scan appearance of their CNS infection had a better prognosis. PMID: 6773324 [PubMed - indexed for MEDLINE] 5803. Ann Intern Med. 1980 Aug;93(2):282-3. Herpes zoster in patients with small-cell carcinoma of the lung receiving combined modality treatment. Feld R, Evans WK, DeBoer G. Herpes zoster, a rare complication in patients with solid tumours, was observed in 13 of 161 (8.1%) patients with small-cell anaplastic carcinoma of the lung treated in a prospective combined modality therapy trial. Induction therapy consisted of three courses of cyclophosphamide, doxorubicin, and vincristine, followed by thoracic radiation. Maintenance chemotherapy with oral lomustine, procarbazine, and methotrexate was given for 1 year. Most herpes zoster cases (11) occurred while patients were on maintenance chemotherapy. Three patients developed nonfatal disseminated herpes zoster and one, postherpetic neuralgia. Herpes zoster may be a relatively frequent complication of prolonged aggressive treatment of small-cell carcinoma of the lung. PMID: 6250436 [PubMed - indexed for MEDLINE] 5804. Infect Immun. 1980 Aug;29(2):369-75. Cell-mediated and humoral immunity to herpesviruses during and after herpes zoster infections. Sørensen OS, Haahr S, Møller-Larsen A, Wildenhoff K. The influence of herpes zoster virus infection on cell-mediated and humoral immunity to varicella-zoster virus (VZV), cytomegalovirus, and herpes simplex virus (HSV) was followed in 17 zoster patients from the first week to 6 months after start of eruptions. The clinical responses were registered and correlated to the immune responses. A significant depression in blast transformation on stimulation of lymphocytes with all three antigens was found on days 1 to 5 compared with transformations later after zoster eruptions and compared with controls. Phytohemagglutinin exhibited the same stimulation in the different groups and controls. No significant differences in interferon production in the various groups and controls were found on stimulation with the VZV and HSV antigens. All zoster patients became seropositive by complement fixation to VZV a few days after start of the zoster eruption. Two zoster patients showed a fourfold rise in complement fixation antibodies to HSV. Three patients had changes in complement fixation titers to cytomegalovirus, which could indicate new infection or reactivation of infection with this virus. A significant lower transformation index to VZV was found during the first 9 days in zoster patients with fever compared with patients without fever. The relevance of this observation is discussed in relation to a previous similar observation from our group. PMCID: PMC551127 PMID: 6163709 [PubMed - indexed for MEDLINE] 5805. Med Hypotheses. 1980 Aug;6(8):773-9. Delivery of antiviral chemotherapeutic agents to neurons by retrograde axonal transport. Fox JS, White DO. It may be possible to eliminate herpes simplex or zoster viruses from the neurons of carriers by treatment with an antiviral chemotherapeutic agent such as adenine arabinoside, ribavirin or acyclovir, coupled to a compound such as horseradish peroxidase that undergoes retrograde axonal transport. PMID: 6160375 [PubMed - indexed for MEDLINE] 5806. S Afr Med J. 1980 Jul 19;58(3):112-6. Cimetidine in the treatment of herpesvirus infections. van der Spuy S, Levy DW, Levin W. In August 1977 a patient developed herpes zoster just before she commenced a course of cimetidine (Tagamet; Smith, Kline & French) for a chronic gastric ulcer. She experienced both rapid relief of the ulcer symptoms and, rather unexpectedly, dramatic relief of the herpetic pain and rapid disappearance of the eruption. On the basis of this observation cimetidine was prescribed to 21 patients with herpes zoster. The results continued to be encouraging in all but 3 patients. The trial was therefore extended to other herpesvirus infections. In all but 1 of 7 patients with herpes labialis the blisters were aborted, and in 1 patient with herpes keratitis the result was also encouraging, the attacks being markedly shortened in duration and reduced in frequency. The results of this preliminary trial warrant a systematic scientific inquiry into the potential role of cimetidine in the treatment of hypesvirus infection, as well as a study of the mechanisms involved. PMID: 6250237 [PubMed - indexed for MEDLINE] 5807. Lancet. 1980 Jul 19;2(8186):154-5. Varicella-zoster virus affecting immigrant nurses. Hastie IR. PMID: 6105332 [PubMed - indexed for MEDLINE] 5808. Lancet. 1980 Jul 5;2(8184):43. Herpes zoster of upper gastrointestinal tract. Gatell Artigas JM, Bru Saumell C, Aused Faure R, Llebaria C. PMID: 6104261 [PubMed - indexed for MEDLINE] 5809. Riv Neurol. 1980 Jul-Aug;50(4):231-40. [Selective percutaneous thermorhizotomy in the surgical treatment of facial pain: personal considerations in light of 180 patients treated] [Article in Italian] Frank F, Gaist G, Frank G, Galassi E, La Pace L, Benfenati A, Zoni R. The purpose of this paper is to report the experience of the authors regarding the treatment of the primitive and secondary facial pains by Percutaneous Selective Thermorhizotomy (P.S.T.), 180 patients having been treated in the period of two years. The immediate postoperative control has obtained 156 good results (86,6%), 10 medium results (5,5%) and 14 (7,7%) unsuccessful. The failure of the P.S.T. in the treatment of the post-zosterian neuralgias, in the atypical and in the vascular pains is stated. The P.S.T. appears resolutive in the "tic doloreux" and secondary painful syndromes. A far follow up was performed (4 months-2 years) on 94 patients and a good result was kept at 64,2% among all of them. The shortage of the postoperative not expected collateral effect is also stated. The causes of unsuccessful and poor results (mistaking in the choice of the patient or tecnical mistaking) are discussed. It is finally suggested a careful personal value of the patient candidated to operation, in order to reduce the poor results and therefore improve the successful ones. PMID: 7466219 [PubMed - indexed for MEDLINE] 5810. Med Tekh. 1980 Jul-Aug;(4):47-9. [Thermography and ultrasonic methods of diagnosis in neurology] [Article in Russian] Karlov VA, Stulin ID, Shmyrev VI. The results of a 10-year experience with application in a neurological clinic of modern non-invasive thermovision and ultrasonic methods are described. Some 5000 patients with various distrubances in the central and peripheral nervous system, and 1000 nonneurological patients were examined with a view to detect subclinical forms of cerebrovascular insufficiency. Recommendations are given for improving technical characteristics of the Soviet thermovisors. PMID: 7402040 [PubMed - indexed for MEDLINE] 5811. J Neurol Sci. 1980 Jul;47(1):21-34. The process dynamics of viral and bacterial diseases of the central nervous system. Felgenhauer K, Ackermann R, Schliep G. Several patients with herpes simplex encephalitis developed a prolonged humoral immune reaction within the central nervous system, which was evaluated by the measurement of locally synthesized immunoglobulin fractions in cerebrospinal fluid. Such phasic immune responses seem to occur predominantly in CNS infections with herpes and myxo/paramyxo viruses. In many cases the B-cell response follows a primary neutrophilic and a secondary mononuclear phase. Most benign viral encephalomeningitis cases lack this type of strong local B-cell activity. This is also true in most cases of bacterial meningitis, that recover after a strong neutrophilic attack and a minor mononuclear reaction. The initial phase of a purulent meningitis is characterized by a complete breakdown of the blood-CSF barrier. This occurs also in some cases of "apurulent bacterial meningitis", that are characterized by very low CSF-cell counts in spite of a totally broken barrier. The "compartmental leucopenia" is interpreted as an imbalance between the supply from the blood and an intense phagocytic consumption within the CSF space. The influence of the hydrodynamic size of viruses on the mode of entry into the central nervous system and on the dynamics of the inflammatory reactions is discussed. PMID: 6967952 [PubMed - indexed for MEDLINE] 5812. Geriatrics. 1980 Jul;35(7):41-50. Ocular pain in the elderly: simple symptom or hidden danger? Stokoe NL. PMID: 6966597 [PubMed - indexed for MEDLINE] 5813. Trans Ophthalmol Soc U K. 1980 Jul;100(Pt 2):253-6. Neurogenic facial pain. Schott GD. Neurogenic facial pain can be classified as either paroxysmal or persistent. Trigeminal neuralgia is the commonest example of the former, and postherpetic neuralgia, atypical facial pain, and tension head and facial pains are examples of the latter. The cause of many of these pains is poorly understood, the complex neuroanatomy of the head and neck being a contributory factor. Even when the aetiology is known, the mechanism whereby pain is produced is usually obscure. While treatment with drugs and surgical measures for trigeminal neuralgia are often satisfactory, and acupuncture for pain due to "muscle tension" may be beneficial, there is often little effective treatment for a considerable proportion of patients with neurogenic facial pain. PMID: 6943844 [PubMed - indexed for MEDLINE] 5814. Dtsch Med Wochenschr. 1980 Jun 27;105(26):916. [Post-zosteric pain] [Article in German] Dorndorf W. PMID: 7408670 [PubMed - indexed for MEDLINE] 5815. Ned Tijdschr Geneeskd. 1980 Jun 21;124(25):1023-4. [Course and prognosis of herpes zoster in unselected patients] [Article in Dutch] Sanders HW. PMID: 7402380 [PubMed - indexed for MEDLINE] 5816. Lancet. 1980 Jun 21;1(8182):1337-9. Antiviral treatment of varicella zoster and herpes simplex. [No authors listed] PMID: 6155581 [PubMed - indexed for MEDLINE] 5817. Z Hautkr. 1980 Jun 15;55(12):773-81. [Results of a field study using idoxuridine in dimethylsulfoxide in the treatment of herpes zoster and herpes simplex] [Article in German] Reichhart W. PMID: 7415359 [PubMed - indexed for MEDLINE] 5818. Orv Hetil. 1980 Jun 8;121(23):1393-5. [Isoprinosine: therapeutic action and studies in recurrent herpes] [Article in Hungarian] Nékám K, Török K, Láng I, Gergely P, Petrányi G. PMID: 6160447 [PubMed - indexed for MEDLINE] 5819. Semin Oncol. 1980 Jun;7(2):174-83. Complications of radiation treatment of Hodgkin's disease. Thar TL, Million RR. PMID: 7444471 [PubMed - indexed for MEDLINE] 5820. Arch Neurol. 1980 Jun;37(6):391. Herpes zoster with facial paralysis: an unusual manifestation. Krol TC, Mullen GM. PMID: 7387475 [PubMed - indexed for MEDLINE] 5821. Arch Surg. 1980 Jun;115(6):753-4. Posttraumatic herpes zoster. Stahl RS, Frazier WH. Musculoskeletal trauma and its sequelae account for a large proportion of visits to acute health care facilities and practitioners of multiple medical specialties. There is a long-recognized association of posttraumatic pain with herpes zoster and three illustrative cases were encountered. Simple bony, nerve root, or soft-tissue abnormality may be mimicked by various stages of such processes. Serial observations are emphasized and proposed pathophysiology and therapy reviewed. Studies of acute and convalescent complement fixation titers and viral cultures of vesicular fluid in such cases would be of further interest. PMID: 7387363 [PubMed - indexed for MEDLINE] 5822. Am J Dis Child. 1980 Jun;134(6):618-9. Herpes zoster in early infancy. Dworsky M, Whitley R, Alford C. PMID: 7386437 [PubMed - indexed for MEDLINE] 5823. Semin Oncol. 1980 Jun;7(2):202-11. Hodgkin's disease in children. Derek R, Jenkin T, Berry MP. PMID: 7003718 [PubMed - indexed for MEDLINE] 5824. Arch Surg. 1980 Jun;115(6):751-2. Varicella-zoster infections in pediatric renal transplant recipients. Hurley JK, Greenslade T, Lewy PR, Ahmadian Y, Firlit C. Varicella-zoster infections developed in ten of 76 children receiving a renal transplant during 1973 to 1978. Two children had varicella and one died during this infection. Eight children had herpes zoster and one experienced encephalitis. In the latter group, reduction of prednisone and azathioprine therapy resulted in rejection and loss of the graft in two of three patients in whom this drug therapy was altered. PMID: 6992736 [PubMed - indexed for MEDLINE] 5825. Neurology. 1980 Jun;30(6):582-7. Selective decline in cellular immune response to varicella-zoster in the elderly. Miller AE. The incidence of herpes zoster rises markedly in the aged. We evaluated the hypothesis that cellular immunity to varicella-zoster (VZ) viral antigens may be impaired in aged subjects. We found that the lymphocyte proliferation to VZ antigen was less in older asymptomatic individuals than in normal young controls. In contrast, responses to other antigens did not differ. Antibody titers to VZ were similar in both young and old subjects. Impairment of cellular immunity to VZ, on a population basis, may contribute to the increased risk of herpes zoster in the elderly. PMID: 6247671 [PubMed - indexed for MEDLINE] 5826. Med Times. 1980 Jun;108(6):47-52. Herpes zoster--the best approach. Nuss DD. PMID: 6155589 [PubMed - indexed for MEDLINE] 5827. Fortschr Med. 1980 May 22;98(19):731-5. [Lesions of the oral mucosa in dermatologic diseases] [Article in German] Zaun H. Concerning differential diagnosis of mucosal lesions of the mouth the frequent occurrence of eruptions of skin diseases in the oral cavity has to be taken into consideration. The accompanying mucosa symptoms of dermatological diseases are observed under the clinical picture of aphthae, leucoplacia or stomatitis like phenomenon. PMID: 7399384 [PubMed - indexed for MEDLINE] 5828. MMW Munch Med Wochenschr. 1980 May 16;122(20):761-2. [Multifactorial therapy of chest pain in medical practice] [Article in German] Gross D. PMID: 6771590 [PubMed - indexed for MEDLINE] 5829. Can J Neurol Sci. 1980 May;7(2):153-5. Herpes zoster mandibularis. Lewis ME, Warren KG. A case of Herpes zoster of the mandibular nerve in an 80 year old man is reported. Herpes zoster infection affecting only the mandibular branch of the trigeminal nerve is rare. It is proposed that the distribution of lesions is a consequence of a unique latent site of the virus within neurons of the gasserian ganglion innervating the mandibular division of the trigeminal nerve. PMID: 7407721 [PubMed - indexed for MEDLINE] 5830. Vrach Delo. 1980 May;(5):101-6. [Clinical and laboratory diagnosis of herpes type diseases] [Article in Russian] Mikhaĭlenko AA, Kuznetsova EE, Iovlev VI. PMID: 7395152 [PubMed - indexed for MEDLINE] 5831. Br J Dermatol. 1980 May;102(5):551-5. Do corticosteroids prevent post-herpetic neuralgia? Keczkes K, Basheer AM. Forty otherwise healthy patients over 50 years of age with early, severe painful herpes zoster were randomly allocated to two groups for treatment. Twenty patients received prednisolone 40 mg daily with gradual reduction over a period of 4 weeks, whilst the other twenty patients received carbamazepine 100 mg four times daily. Thirteen of the twenty patients (65%) in the carbamazepine treated group developed post-herpetic neuralgia lasting up to 2 years, whilst only three of the twenty prednisolone treated patients (15%) had post-herpetic neuralgia lasting up to 6 months only. Thus the incidence and duration of post-herpetic neuralgia were considerably redudced in the prednisolone treated group. In neither group did disseminated zoster or other complications occur. PMID: 7387900 [PubMed - indexed for MEDLINE] 5832. Endoscopy. 1980 May;12(3):134-5. Gastric involvement in herpes zoster. Wisløff F, Bull-Berg J, Myren J. A 76-year-old man with herpes zoster affecting the 7th thoracic dermatome on the right side was referred for gastroscopy because of anorexia, nausea, vomiting and burning epigastric pain. Lesions were seen along the greater curvature of the stomach suggesting mucosal herpes zoster. PMID: 7379763 [PubMed - indexed for MEDLINE] 5833. J Med Assoc Ga. 1980 May;69(5):345-9. Current trends in dermatology. Pirozzi DJ. PMID: 7373172 [PubMed - indexed for MEDLINE] 5834. Clin Pharmacol Ther. 1980 May;27(5):690-6. Plasma levels and urinary excretion of vidarabine after repeated dosing. Buchanan RA, Kinkel AW, Alford CA Jr, Whitley RJ. Vidarabine (Vira-A) was given intravenously for 5 days to 5 immunosuppressed patients with herpes zoster. The daily dose, 10 mg/kg, was given by slow infusion over 12 hr. Blood samples were taken at 0, 1, 2, 4, 8, and 12 hr on days 1, 3, and 5. Twenty-four-hour urine specimens were collected before treatment and on days 1, 3, and 5. Blood and urine specimens were assayed for vidarabine and its principal metabolite, hypoxanthine arabinoside (ara-Hx), by high pressure liquid chromatography. The results showed that vidarabine is quickly deaminated; virtually all of the drug present in the plasma and urine was in the form of ara-Hx. The highest plasma level, approximately 3 microgram/ml, was at the end of the infusion period. The urinary excretion of ara-Hx accounted for between 40% and 50% of the dose. The renal clearance values varied, but were close to the expected glomerular filtration rate of 125 ml/min. The plasma levels and the excretion levels were much the same on days 1, 3, and 5, indicating that drug did not cumulate. The results of the study were consistent with those observed in single-dose studies. The results indicated that the infusion of vidarabine is clinically appropriate, since therapeutic plasma levels are reached promptly, drug is rapidly excreted, and there is no cumulation. PMID: 7371366 [PubMed - indexed for MEDLINE] 5835. J Assoc Physicians India. 1980 May-Jun;28(5-6):125-32. Herpes-zoster in malignancy. Gopal R, Advani SH, Dinshaw KT, Nair CN, Desai PB. PMID: 7216984 [PubMed - indexed for MEDLINE] 5836. Internist (Berl). 1980 May;21(5):260-5. [The acute headache from the neurological viewpoint] [Article in German] Poeck K. PMID: 7002844 [PubMed - indexed for MEDLINE] 5837. Klin Med (Mosk). 1980 May;58(5):47-9. [Clinical aspects of VZ viral hepatitis and the aggravating effect of herpes zoster on the course of infectious and serum viral hepatitis] [Article in Russian] Pak SG, Brodov LE, Burnatseva VV, Bogin IB. PMID: 6247538 [PubMed - indexed for MEDLINE] 5838. Br Heart J. 1980 May;43(5):597-9. Herpes zoster pericarditis. Winfield CR, Joseph SP. A healthy 22-year-old man developed acute varicella pericarditis, characterised by an enanthem with diagnostic rising titres of varicella zoster antibodies but without the typical exanthem. This, the third reported case of varicella pericarditis, is the first to be documented without a typical varicella eruption. PMCID: PMC482348 PMID: 6246908 [PubMed - indexed for MEDLINE] 5839. Monatsschr Kinderheilkd. 1980 May;128(5):248-50. [Preliminary animal experimental results and clinical experiences with the antiviral agent adenine arabinoside monophosphate in encephalitis from herpes group and varicella-zoster infections] [Article in German] Sauer O, Huth E, Lenard HG, Schneider H, von Haselberg L, Nettesheim HJ, Werner GT. PMID: 6158680 [PubMed - indexed for MEDLINE] 5840. Rev Infect Dis. 1980 May-Jun;2(3):393-407. Live attenuated Varicella-Zoster vaccine. Gershon AA. Varicella-zoster (VZ) virus causes two diseases, varicella and zoster. Because it was recognized that, after varicella, latent VZ virus persisted in the host and because varicella was thought to be a milde disease, there was little impetus in North America to develop a live VZ vaccine. More recently, it has become apparent that currently available methods of prevention and treatment of severe varicella are not always efficacious. With the development of a live attenuated VZ vaccine by Takahashi and the successful use of the vaccine in immunocompromised children in Japan, there has been an increased interest in North America in immunization against varicella. In this article the natural history of VZ infections and the immunologic reactions to VZ virus are described, and the development and use of VZ vaccine in Japan are reviewed. Plans for trials of VZ vaccine in immunocompromised North American children are outlined. The major questions concerning the large-scale use of VZ vaccine are presented. PMID: 6158080 [PubMed - indexed for MEDLINE] 5841. N Engl J Med. 1980 Apr 17;302(16):903-7. Drug therapy: antiviral agents (first of two parts). Hirsch MS, Swartz MN. PMID: 6987519 [PubMed - indexed for MEDLINE] 5842. N Engl J Med. 1980 Apr 10;302(15):848-51. Atypical generalized zoster with lymphadenitis mimicking lymphoma. Patterson SD, Larson EB, Corey L. PMID: 6244490 [PubMed - indexed for MEDLINE] 5843. Contact Dermatitis. 1980 Apr;6(3):170-1. Contact allergy to idoxuridine. Sensitization following treatment of herpes zoster. Thormann J, Wildenhoff KE. A total of 45 of 60 patients with herpes zoster previously treated with topical idoxuridine 5-40% in dimethylsulfoxide were patch tested 2 years later with idoxuridine 0.5% and 5% in petrolatum. Three (7%) showed positive reactions. Idoxuridine is considered a weak sensitizer, but in strong concentrations and in active solvents, which increases absorption, there seems to be a risk of sensitization. PMID: 7389323 [PubMed - indexed for MEDLINE] 5844. J Dermatol. 1980 Apr;7(2):161-2. Local anesthesia for Herpes Zoster. Ogata A, Tomoda T, Tanaka S, Kudo S. PMID: 6991573 [PubMed - indexed for MEDLINE] 5845. J Dermatol. 1980 Apr;7(2):157-9. A semiquantitative analysis of skin sensitivity changes in Herpes zoster. Matsubara M, Kagami K, Maeda M, Yasuno H, Uchida T, Suzuki N. PMID: 6991572 [PubMed - indexed for MEDLINE] 5846. Cutis. 1980 Apr;25(4):424-6. Dehydroemetine therapy for herpes zoster. A comparison with corticosteroids. Hernandez-Perez E. A study involving forty patients, all sixty years of age or over, compared the use of dehydroemetine in twenty and triamcinolone in twenty for the treatment of herpes zoster. Pretreatment evolution was less than ten days. Patients treated with dehydroemetine did not experience postherpetic neuralgia, and in fourteen pain completely disappeared at the end of only one series of treatment, which in four patients consisted of only three injections. Postherpetic neuralgia developed in only eight patients out of those treated with triamcinolone, and in four pain persisted for more than six months. The results of laboratory tests, including cardiovascular evaluation, remained normal with both drugs. PMID: 6102504 [PubMed - indexed for MEDLINE] 5847. Clin Ter. 1980 Mar 15;92(5):561-4. [List of prescriptions for therapy of herpes zoster] [Article in Italian] Fanelli V. PMID: 7449328 [PubMed - indexed for MEDLINE] 5848. Ned Tijdschr Geneeskd. 1980 Mar 15;124(11):377-9. [The importance of early diagnosis of herpes zoster] [Article in Dutch] van der Drift JH. PMID: 6966034 [PubMed - indexed for MEDLINE] 5849. Ugeskr Laeger. 1980 Mar 10;142(11):694-5. [Urinary retention in herpes zoster] [Article in Danish] Nielsen SS. PMID: 7368341 [PubMed - indexed for MEDLINE] 5850. J Am Optom Assoc. 1980 Mar;51(3):296-7. Soft contact lens bandage for Ramsay Hunt syndrome with facial palsy. Yamane SJ. A patient under the primary care of a physician was referred to a military O.D. who subsequently referred the patient to the author as a consulting contact lens specialist. The patient exhibited the Ramsay Hunt Syndrome and was unable to blink or close her right eye. Patching had been attempted but was discontinued due to the neuralgia of the epidermal tissue of the lids. A hydrophilic contact lens was used to bandage the cornea. The patient was thereby able to maintain corneal integrity until the viral problem subsided and she regained her ability to function normally through the interdisciplinary cooperation of the eye care of professionals. PMID: 7372990 [PubMed - indexed for MEDLINE] 5851. Am J Med. 1980 Mar;68(3):386-8. Arthralgia associated with acute urinary retention. A syndrome of probable viral etiology. Murphy TF, Senterfit LB, Christian CL. Four patients are described in whom paresthesia and arthralgia developed in association with acute urinary retention. Neurologic and musculoskeletal complaints persisted for varying periods, up to five year, after cessation of urinary symptoms. Significantly elevated titers to Herpes simplex and Herpes zoster viruses were observed in three and four subjects, respectively, although none exhibited cutaneous lesions of herpetic infection. The symptom complex, presumably the result of viral radiculitis, may present in varying patterns that can be confused with lumbar disc protrusion, obstructive uropathy or primary rheumatic disorder. Diagnostic studies requisite for documentation of a viral etiology of the syndrome are discussed. PMID: 7361806 [PubMed - indexed for MEDLINE] 5852. J Urol. 1980 Mar;123(3):426-7. Acute motor paralytic bladder in renal transplant patients with anogenital herpes infection. Jacobs SC, Herbert LA, Piering WF, Lawson RK. We report on 2 renal transplant patients in whom acute urinary retention developed after anogenital herpes infections. In 1 case a reversible bladder motor and sensory neuropathy occurred secondary to herpes simplex virus infections. In the other case a motor paralytic bladder developed secondary to an anogenital varicella-zoster infection. Documentation was by carbon dioxide cystometrography and denervation hypersensitivity testing. Both cases were reversible without alteration of the immunosuppressive regimens. PMID: 6987416 [PubMed - indexed for MEDLINE] 5853. Bull Soc Ophtalmol Fr. 1980 Mar;80(3):289-90. [Ocular zona and herpes in patients under immunosuppressive agents. Apropos of 9 cases] [Article in French] Lagoutte F, Campagne JC, Monroy J, Le Rebeller MJ. PMID: 6965894 [PubMed - indexed for MEDLINE] 5854. Stomatologiia (Mosk). 1980 Mar-Apr;59(2):25-6. [DNAse treatment of herpes of the maxillofacial area] [Article in Russian] Mashkilleĭson NA, Tkach EV. PMID: 6929581 [PubMed - indexed for MEDLINE] 5855. Rinsho Byori. 1980 Mar;28(3):227-34. [Autopsy study on disseminated herpes virus infection (author's transl)] [Article in Japanese] Yamada T, Sakurai I, Uchida T, Shikata T. PMID: 6246290 [PubMed - indexed for MEDLINE] 5856. Br Med J. 1980 Feb 23;280(6213):561-2. Herpes zoster in pregnancy. McKinlay WJ. PMCID: PMC1601403 PMID: 7370577 [PubMed - indexed for MEDLINE] 5857. Lancet. 1980 Feb 16;1(8164):354-6. Human anti-chickenpox immunoglobulin in the prevention of chickenpox. Evans EB, Pollock TM, Cradock-Watson JE, Ridehalgh MK. Human anti-chickenpox immunoglobulin (zoster immune globulin, ZIG) was largely ineffective in preventing infection in forty-three high-risk contacts of chickenpox. Twenty-nine of these non-immune infants and children who had been in close contact with cases of varicella became infected, and symptoms developed in twenty-four. Since ZIG may modify chickenpox it should continue to be given to high-risk contacts until the availability of a simple and sensitive test makes it possible to identify those who are susceptible. However, ZIG is not necesary for infants whose mothers have chickenpox or zoster five or more days before delivery, since all such infants (eleven) had varicella-zoster antibody at birth. PMID: 6101802 [PubMed - indexed for MEDLINE] 5858. Med Klin. 1980 Feb 15;75(4):133. [Trends in the chemotherapy of viral infections] [Article in German] Eggers HJ. PMID: 7374614 [PubMed - indexed for MEDLINE] 5859. Pediatriia. 1980 Feb;(2):23-6. [Complications of glomerulonephritis in children] [Article in Russian] Naumova VI, Fonareva LP, Lukillianova NS, Zakharchenko LP. PMID: 7360583 [PubMed - indexed for MEDLINE] 5860. Arch Dermatol. 1980 Feb;116(2):160. Herpes zoster in a 4-month-old infant. Laude TA, Rajkumar S. PMID: 7356346 [PubMed - indexed for MEDLINE] 5861. Srp Arh Celok Lek. 1980 Feb;108(2):143-8. [Treatment of zoster paralysis of the facial nerve] [Article in Serbian] Brkić M, Zecević M, Cancarević M. PMID: 7244860 [PubMed - indexed for MEDLINE] 5862. Am J Ophthalmol. 1980 Feb;89(2):255-8. Penetrating keratoplasty in Mooren's ulcer. Brown SI, Mondino BJ. Two patients had bilateral, simultaneous Mooren's ulcers that progressed to almost total loss of the corneal stroma in all eyes. The conjunctival epithelium eventually healed over these thinned corneas and the eyes were free of pain and inflammation. Three of the four eyes had combined 7.5-mm penetrating corneal transplants and cataract extractions performed at least four months after disease activity had subsided. All transplants have remained transparent from one to three years postoperatively and there has been no evidence of recurrence of Mooren's ulcers. PMID: 6986779 [PubMed - indexed for MEDLINE] 5863. Am J Med. 1980 Feb;68(2):214-8. Herpes zoster and small cell bronchogenic carcinoma. Huberman M, Fossieck BE Jr, Bunn PA Jr, Cohen MH, Ihde DC, Minna JD. In nine of 74 (12 per cent) consecutive, previously untreated patients with small cell bronchogenic carcinoma receiving combination chemotherapy herpes zoster developed. This is the highest frequenzy reported for this viral infection in patients with nonlymphoproliferative solid tumors. Cutaneous dissemination developed in six of the nine patients, but visceral involvement did not occur. The major difference between the patients with herpes zoster and those without was the superior duration of median survival for the infected patients. No relationship could be established between the development of herpes zoster and the extent of neoplastic disease, prior radiotherapy, treatment with specific chemotherapeutic agents or corticosteroids, cutaneous anergy or granulocytopenia. Serum specimens obtained from six of the nine patients prior to their infection demonstrated the preexistence of varicella zoster antibodies. As more effective and intensive chemotherapy prolongs the survival of patients with solid tumors, it is possible that the frequency of herpes zoster infection may approach that observed in patients with lymphoproliferative malignancies. PMID: 6243858 [PubMed - indexed for MEDLINE] 5864. Med Klin. 1980 Jan 4;75(1):6. [What is the treatment for herpes zoster pain?] [Article in German] Wassilew S. PMID: 7366524 [PubMed - indexed for MEDLINE] 5865. JAMA. 1980 Jan 4;243(1):56-8. Herpes zoster after splenectomy. A study of patients without malignancy. Manning DM, Luparello FJ, Arena VC Jr. Follow-up information was obtained on 102 unselected patients who had undergone splenectomy for nonmalignant disease (ie, trauma, surgical complications, and hematologic indications). In 422 postsplenectomy years, three cases of herpes zoster were observed, two of which were associated with generalized cutaneous dissemination. This incidence is no greater than that reported elsewhere for age-matched normal population. We conclude that in patients without malignancy, splenectomy does not predispose to herpes zoster, but may play a role in cutaneous dissemination. PMID: 6965312 [PubMed - indexed for MEDLINE] 5866. Acta Neuropathol. 1980;52(1):59-68. Changes of the central nervous system in herpes zoster. Ruppenthal M. Postmortem examination was conducted in eight cases of neurocutaneous herpes zoster. One generalized case with diffuse and focal meningoencephalomyelitis showed numerous infiltrates in the subarachnoid space and along the cerebral ventricles. Intranuclear inclusion bodies could be demonstrated for the first time in ependymal and in arachnoidal cells, and viral capsids were found in the latter. The parenchymal lesions, lying predominantly in the white matter, were characterized by inflammation, hemorrhage, axonal swellings, demyelination, and intranuclear inclusions in oligodendrocytes. In the second generalized case there was a granulomatous giant cell angiitis with intranuclear inclusions bodies in the vessel walls. Out of four cases with localized damage of the central nervous system (CNS), three showed demyelination as the main alteration. In another case there was a hitherto undescribed calcifying coagulation necrosis of a spinal ganglion. PMID: 7435157 [PubMed - indexed for MEDLINE] 5867. Ter Arkh. 1980;52(9):44-7. [Herpes zoster in lymphogranulomatosis] [Article in Russian] Shishkin IP, Oliper TV. PMID: 7434230 [PubMed - indexed for MEDLINE] 5868. Med Pregl. 1980;33(1-2):9-11. [An analysis of the clinical picture of herpes zoster] [Article in Serbian] Stanković K, Arnerić S, Janković D, Kojić D, DjorDjević L. PMID: 7412728 [PubMed - indexed for MEDLINE] 5869. Pediatriia. 1980;(1):71-2. [Varicella-zoster infection in kidney diseases in children] [Article in Russian] Naumova VI, Lukillianova NS, Fonareva LP. PMID: 7383777 [PubMed - indexed for MEDLINE] 5870. Vestn Otorinolaringol. 1980 Jan-Feb;(1):50-5. [Clinical aspects and diagnosis of herpes zoster oticus] [Article in Russian] Romanenko DA. PMID: 7376320 [PubMed - indexed for MEDLINE] 5871. Acta Med Iugosl. 1980;34(1):55-62. Treatment of herpes zoster with PUVA. A clinical, serological and histological follow-up-study. Vukas A, Gligora M, Batistić B, Zambal Z. PMID: 7368961 [PubMed - indexed for MEDLINE] 5872. Int J Dermatol. 1980 Jan-Feb;19(1):49-50. Acquired leukonychia striata. Zizmor J, Deluty S. PMID: 7358442 [PubMed - indexed for MEDLINE] 5873. Arch Dermatol. 1980 Jan;116(1):20. Progressive zosteriform macular pigmented lesions. Simões GA, Piva N. PMID: 7352760 [PubMed - indexed for MEDLINE] 5874. Henry Ford Hosp Med J. 1980;28(1):67-70. Herpes zoster encephalitis: successful therapy with vidarabine. Wees SJ, Madhavan T. PMID: 7287499 [PubMed - indexed for MEDLINE] 5875. Haematologia (Budap). 1980;13(1-4):225-37. Lymphocyte marker testing in relation to the clinical use of dialyzed leukocyte extract containing transfer factor (DLE-LTF). Peetoom F, Florey MJ. PMID: 7250812 [PubMed - indexed for MEDLINE] 5876. Acta Neurochir Suppl (Wien). 1980;30:245-58. Deep brain stimulation in mesencephalic lemniscus medialis for chronic pain. Mundinger F, Salomão JF. Stereotactic deep brain stimulation (DBS) with chronically implanted special devices intermittently activated by the patient himself has led to a new concept in the treatment of chronic central pain, such as the thalamic pain syndrome, herpes-zoster neuralgia, anaesthesia dolorosa, radicular and plexus lacerations, stump pain with and without causalgia and cancer pain. Our results in 32 cases (March 31, 1979) with lemniscus medialis stimulation, including the specific and nonspecific somatosensory nuclei or periaqueductal gray matter show in 53% of our cases, a reduction of pain of over 50%. The follow-up period was 47 months. These results are better than those obtained from stimulating only one of the systems. Mesencephalic lemniscus medialis DBS, introduced by one of the authors (Mundinger), leads to a functional blockade of spinothalamic, lemniscus medialis and spino-reticular systems. In cases where a positive morphine test had been done previously, endorphin secretion also plays a role. It is assumed that the effect of endorphin production lasts longer than the stimulation itself, especially in periaqueductal mesencephalic gray matter and medial pulvinar stimulation. PMID: 7008520 [PubMed - indexed for MEDLINE] 5877. J Int Med Res. 1980;8(1):1-6. Preliminary results of a clinical trial relative to the use of rifamycin SV in the treatment of herpes zoster. Bruni L, Califano A, De Angelis G, Montagnani A, Pisani M, Pezzarossa G, Pozzo G, Reali D, Rebora A, Zanca A. In a controlled clinical trial undertaken in ten Italian centres, rifamycin SV was compared to associations of various drugs such as erythromycin, aureomycin, multivitamin preparations, etc, in the treatment of herpes zoster. Up to now 144 patients, suffering from herpes zoster at different localizations, were divided into three groups and randomly given either rifamycin SV by intramuscular injection and topically, or rifamycin SV by injection only, or the routine treatment used at the particular centre in question. To evaluate the effectiveness of the treatments, the presence of subjective and objective symptoms was determined before treatment started and daily thereafter. The duration, in days, of the most important symptoms, such as erythema, vesicles, scabs and pain, was considered for this partial evaluation. All the above-mentioned symptoms constantly showed a shorter duration in the two groups treated with rifamycin SV compared to the group treated with other therapies, with differences as significant on statistical calculation as they were important on the level of a clinical evaluation of the disease's course. PMID: 6987112 [PubMed - indexed for MEDLINE] 5878. Bull Soc Belge Ophtalmol. 1980;187(1):1-192. Superficial keratitis. Maudgal PC, Missotten L. PMID: 6970603 [PubMed - indexed for MEDLINE] 5879. Eur Neurol. 1980;19(5):327-9. A case of facial diplegi following herpes zoster ophthalmicus. Shoji H, Hirose K, Uono M, Koya M. A 71-year-old man developed a facial diplegia following right ophthalmic zoster. Neurological examination also revealed loss of reflexes in the lower limbs with increase of CSF protein. Unusual cases of the Ramsay Hunt syndrome and Guillain-Barré syndrome seen with herpes zoster were reviewed. These cases including our case may suggest that the bilateral involvement or its wider spread throughtout nervous tissue can rarely occur in the Ramsay Hunt syndrome and its subgroups. PMID: 6967406 [PubMed - indexed for MEDLINE] 5880. Neuroradiology. 1980;19(5):279-82. Post-herpetic aneurysm in the intrapetrosal portion of the internal carotid artery. Gürsoy G, Aktin E, Bahar S, Tolun R, Ozden B. The occurrence of an aneurysm, 2 x 2.5 cm in size, in the intrapetrosal portion of the internal carotid artery in a 24-year-old female patient, during the course of herpes zoster ophthalmicus, is described. PMID: 6967196 [PubMed - indexed for MEDLINE] 5881. Agents Actions Suppl. 1980;7:49-54. Cytotoxic drugs in rheumatoid arthritis. Amor B. PMID: 6941686 [PubMed - indexed for MEDLINE] 5882. Zh Nevropatol Psikhiatr Im S S Korsakova. 1980;80(4):607-18. [Pain: neurophysiologic and clinical aspects] [Article in Russian] Starobinets MKh, Volkova LD. PMID: 6773277 [PubMed - indexed for MEDLINE] 5883. Bull Soc Belge Ophtalmol. 1980;190:71-86. Varicella-zoster virus in the human corneal endothelium: a case report. Maudgal PC, Missotten L, De Clercq E, Descamps J. PMID: 6269677 [PubMed - indexed for MEDLINE] 5884. Prog Clin Biol Res. 1980;47:21-49. New developments with new vaccines. Hilleman MR. PMID: 6259664 [PubMed - indexed for MEDLINE] 5885. Q J Med. 1980 Spring;49(194):219-31. The effects of viral infections on renal transplants and their recipients. Warrell MJ, Chinn I, Morris PJ, Tobin JO. A prospective study of viral infections occurring after 188 renal transplants in 167 patients showed active cytomegalovirus (CMV) infection after 52 per cent of transplantations. All 37 CMV seronegative cases who received grafts from seronegative donors remained free of infection, while 24 (70.6 per cent) of 34 seronegative recipients whose donors were seropositive developed primary CMV infection (p less than 0.001). The diagnosis of 92 per cent of these primary infections was made between one and two months after grafting. Secondary CMV infection was found in 71 (62 per cent) of 114 seropositive cases, and the frequency of infection was not affected by the CMV status of the renal donor. Neither acute rejection episodes nor total graft rejections were associated with primary or secondary infections. CMV was isolated from a colonic abscess and the relationship of the virus to the intestinal disease is discussed. Herpes simplex virus was isolated from 47 per cent of cases and 32 per cent had an increase in antibody titre. Zoster was seen in nine patients, representing an incidence of 3.4 per cent per year. Other viral or mycoplasmal infections diagnosed included 71 due to respiratory tract pathogens, and a single case of hepatitis B. None of these infections was particularly severe or frequent and no association with graft rejection was detected. PMID: 6254109 [PubMed - indexed for MEDLINE] 5886. Int Ophthalmol Clin. 1980 Fall;20(3):149-61. Ocular antiviral therapy. Pavan-Langston D. PMID: 6252111 [PubMed - indexed for MEDLINE] 5887. Arch Dermatol Res. 1980;268(1):65-70. Skin test with Varicella-zoster virus antigen on herpes zoster patients. Hata S. Intracutaneous injection of Varicella-zoster (V-Z) viral antigen was performed on 55 patients with herpes zoster. All of them reacted positively after 10 days. The patients in the acute stage responded weakly wereas those in the convalescent phase developed a stronger reaction. The intensity of the reaction did not correlate with the number of days of illness. Positive reactions were observed in those patients who had suffered from herpes zoster several years ago. Complement fixing antibody titers did not parallel the intensity of skin reaction. PMID: 6251751 [PubMed - indexed for MEDLINE] 5888. J Hyg Epidemiol Microbiol Immunol. 1980;24(2):192-9. Varicella morbidity in Czechoslovakia. Trlifajová J, Svandová E, Havrlantová M, Galetková A. Data are presented on varicella and herpes zoster morbidity notified in Czechoslovakia in the years 1970 to 1978. The notified varicella incidence is compared with serologically confirmed varicella incidence among the selected groups of children up to the age of 12 from the North-Moravia region. Comparative analysis revealed a considerable difference between the notified and serologically detected cases of varicella. The highest rate of notified varicella was recorded in children of 3 and 4 years of age, while the highest incidence of seropositive cases was detected among the 2-year-old children. The cumulative notified morbidity involved about 35% of 6-year-old and 45% of 12-year-old children, whereas specific antibodies against the varicella-zoster virus were found in about 60% of 6-year-old and 90% of 12-year-old children. The titres of virus-specific antibodies were determined by the method of indirect hemagglutination reaction. No serological methods are applicable for herpes zoster morbidity studies in the population. PMID: 6251130 [PubMed - indexed for MEDLINE] 5889. Intervirology. 1980;13(4):214-22. Enzyme-linked immunosorbent assay for detection of virus-specific IgM antibodies to varicella-zoster virus. Hacham M, Leventon-Kriss S, Sarov I. A sensitive enzyme-linked immunosorbent assay (ELISA) is described for detection of varicella-zoster virus (VZV) IgM antibodies. The antigen consisted of a sonically disrupted extract of VZV-infected human embryo cells. The tested sera were absorbed with Staphylococcus aureus (strain Cowan I) before analysis. Rabbit anti-human IgM peroxidase conjugate was used to detect human IgM bound to viral antigen. The results were compared with those obtained by the indirect fluorescent antibody to membrane antigen (IFAMA) technique. Comparison of titers obtained by ELISA with those obtained by IFAMA for sera of chickenpox patients showed agreement between the results in 8 of 9 patients. In 1 chickenpox patient, no VZV IgM antibodies could be detected by IFAMA, while a titer of 3,200 was obtained by ELISA. The ELISA technique described gave titers more than 100 times higher than those obtained by IFAMA. VZV IgM antibody was detected by ELISA and IFAMA in only 1 of 5 zoster patients. No VZV IgM antibodies were found by ELISA in 45 control sera (healthy adults and hospitalized patients with various other diseases). Neither were they found in paired sera of 6 patients with acute herpes simplex infections, 2 patients with Epstein-Barr virus infections, and 3 patients with human cytomegalovirus infections. PMID: 6248482 [PubMed - indexed for MEDLINE] 5890. Transplantation. 1980;29(1):47-50. Varicella-zoster virus infection after marrow transplantation for aplastic anemia or leukemia. Atkinson K, Meyers JD, Storb R, Prentice RL, Thomas ED. Nearly one-half of marrow transplant recipients who survive at least 6 months develop varicella-zoster virus (VZV) infection. Of 92 cases studied, 82 occurred within the first 12 months after transplant. Only one patient had recurrent infection. Seventy-seven patients had herpes zoster, 22 with subsequent cutaneous dissemination, and 15 had varicella. The overall mortality rate was 8%, and all deaths occurred within 9 months of transplant. Twenty-six of 32 patients studied had significant rises in VZV antibody during recovery. Among patients with acute leukemia, those with syngeneic transplants had a significantly lower incidence of VZV infection than those with allogeneic transplants. Incidence was slightly, but not significantly, decreased among patients with aplastic anemia. In contrast to other infections, the incidence of VZV infection was not influenced by graft-versus-host disease or predicted by the results of dinitrochlorobenzene skin testing. PMID: 6245486 [PubMed - indexed for MEDLINE] 5891. Arch Intern Med. 1980 Jan;140(1):28-9. Zoster immune globulin. Spitler LE. PMID: 6243457 [PubMed - indexed for MEDLINE] 5892. Riv Emoter Immunoematol. 1980;27(3-4):142-50. [Isoprinosine in the therapy of herpes zoster occurring in patients with malignant lymphoproliferative diseases] [Article in Italian] Corridori S, Vender A, Lago A, Cerrato P. PMID: 6176005 [PubMed - indexed for MEDLINE] 5893. Med Cutan Ibero Lat Am. 1980;8(4-6):105-8. [Herpes simplex and herpes varicella-zoster. Cytological and ultrastructural study] [Article in Spanish] García Cantón JA, Navarrete Ortega M, Rafael Ribas E. Nuclear staining qualities, and cell morphology depart from normal when epithelial cells are infected by herpes virus hominis and herpes varicella-zoster (1). The cytopathic changes produced by both viruses are similar and constant enough to be considered characteristic of the infection. Since the skin vesicles are readily accessible for examination, it is easy to scrape infected cells from the floor of the exposed blister and establish the diagnosis. The simplest and most common method would be by light microscopy utilizing conventional staining. When the circumstances warrant it and the facilities are available, the virus itself can be demonstrated by electron microscopy with material obtained in the same fashion. This paper deals with two cases in which the initial diagnosis of the disease was made by cytologic examination and the presence of virus subsequently verified by electron microscopy. PMID: 6168875 [PubMed - indexed for MEDLINE] 5894. Can Anaesth Soc J. 1980 Jan;27(1):40-6. The response to epidural steroid injections in chronic dorsal root pain. Forrest JB. Thirty-seven patients with long-standing post-herpetic neuralgia and 27 with post-traumatic neuralgia (PTN) were treated with three epidural injections each of methylprednisolone acetate (Depo Medrol) given at weekly intervals. Differential subarachnoid or epidural block was done in all patients and placebo responders were excluded from the study. Mean age, duration of symptoms, and pain intensity measured by visual analogue scale were similar in both groups. Visual analogue scale ratings were reduced one month after treatments from both groups. Visual analogue scale ratings were reduced one month after treatments from pretreatment values of 84.4 and 78.7 to 9.6 and 15.2 in the post-herpetic and post-traumatic groups respectively, and were further reduced to 4.6 and 11.6 respectively after one year when 89 per cent of patients in the post-herpetic group and 59 per cent of patients in the post-traumatic group were completely pain free. Side effects were minor in all cases. It is suggested that this is the treatment of choice in post-herpetic and post-traumatic neuralgia where steroid administration is not contraindicated. PMID: 6153292 [PubMed - indexed for MEDLINE] 5895. Arch Intern Med. 1980 Jan;140(1):52-4. Zoster immune globulin prophylaxis of disseminated zoster in compromised hosts. A randomized trial. Stevens DA, Merigan TC. Herpes zoster can be a severe, and sometimes fatal, virus infection in its disseminated form in immunocompromised hosts. Previous studies have suggested that delay in appearance of antibody to varicella-zoster virus occurs as one defect in such patients. In this study, pooled gamma-globulin (normal serum globulin [NSG]) and zoster immune globulin ([ZIG] prepared from convalescent zoster patients) were compared for their ability to prevent dissemination of early localized zoster in immunocompromised hosts. Either agent was given intramuscularly in randomized double-blind fashion within nine days of onset of zoster in 97 patients. Despite greater than 100-fold differences in titer of anti-varicella-zoster virus antibody, ZIG did not appear superior to NSG in prophylaxis of dissemination or diminishing postherpetic pain in zoster in immunocompromised hosts. Zoster immune globulins should be reserved for prophylaxis and modification of varicella, where its beneficial effect has been demonstrated. PMID: 6153260 [PubMed - indexed for MEDLINE] 5896. Lancet. 1979 Dec 15;2(8155):1267-70. Parenteral acyclovir therapy for herpesvirus infections in man. Selby PJ, Powles RL, Janeson B, Kay HE, Watson JG, Thornton R, Morgenstern G, Clink HM, McElwain TJ, Prentice HG, Corringharn R, Ross MG, Hoffbrand AV, Brigden D. Acyclovir is a new antiviral agent which is highly active against herpesviruses in vitro and in laboratory animals. Twenty-three cancer patients with cutaneous and/or systemic herpes zoster or herpes simplex infections were treated with parenteral acyclovir. All had received previous specific treatment for their malignant disease and ten had undergone bone-marrow transplantation. The drug seemed to arrest the progress of the infections and was most effective when given early. Although two patients showed transient increases in blood-urea, possibly the result of acyclovir, the drug was remarkably non-toxic in the doses used. PMID: 93183 [PubMed - indexed for MEDLINE] 5897. Vestn Dermatol Venerol. 1979 Dec;(12):40-2. [Ramsay Hunt syndrome in herpes zoster] [Article in Russian] Zorin PM, Spiridonova SP, Korobkova OK, Chumenko NV. PMID: 525023 [PubMed - indexed for MEDLINE] 5898. Arch Intern Med. 1979 Dec;139(12):1337-8. Herpes zoster. Of antibodies and antivirals. Rand KH. PMID: 518215 [PubMed - indexed for MEDLINE] 5899. Ann Intern Med. 1979 Dec;91(6):842-6. Prolonged herpes-zoster infection associated with immunosuppressive therapy. Gallagher JG, Merigan TC. Unusually prolonged zoster was observed in four patients, two with cardiac transplants, one with acute lymphocytic leukemia, and one with diffuse histiocytic lymphoma. Lesions increased in number and persisted for 5 to 24 weeks before beginning to resolve. Specific cellular-immune responsiveness to varicella-zoster virus was markedly depressed during these infections. Absolute numbers of T lymphocytes were also very low. Reducing immunosuppressive therapy to increase immune responses appeared to initiate resolution of zoster lesions and halt dissemination. In one patient treatment with adenine arabinoside was also needed for resolution of disseminated zoster. This syndrome appears to be counterpart of the prolonged mucocutaneous herpes-simplex infection previously reported in immunosuppressed cardiac and renal transplant patients. PMID: 391116 [PubMed - indexed for MEDLINE] 5900. Nippon Hifuka Gakkai Zasshi. 1979 Dec;89(14):1031-9. [A case of disseminated, cutaneous deep candidiasis associated with Hodgkin's disease (author's transl)] [Article in Japanese] Okada T, Iwao E, Kawatsu T, Yamada T, Matsuda K, Machino H, Miki Y. PMID: 317116 [PubMed - indexed for MEDLINE] 5901. J Fr Ophtalmol. 1979 Dec;2(12):723-6. [A posterior dislocation of the lens in herpes zoster (author's transl)] [Article in French] Loffredo A, Cennamo G, Sammartino A. The authors report a case of posterior dislocation of the lens during the natural history of a clinical case of herpes zoster. An echographic B-scan study was carried out to reveal the position and the size and the shape of dislocated lens, together with its structure and that of ocular media. After a discussion on the possible aetiology of the lens dislocation it was considered due to herpes zoster disease, and are reported the possible mechanism of zonula alteration. PMID: 317083 [PubMed - indexed for MEDLINE] 5902. Am J Med. 1979 Dec;67(6):935-40. Fever in systemic lupus erythematosus. Stahl NI, Klippel JH, Decker JL. The frequency, causes, clinical and laboratory features, and outcome of febrile episodes in 160 hospitalized patients with systemic lupus erythematosus were reviewed. Eighty-three febrile episodes were identified in 63 patients and were ascribed to active lupus erythematosus alone (60 per cent), infections (23 per cent) and miscellaneous causes (17 per cent). Bacteremia was present in nine of the 19 infectious episodes and resulted in a fatal outcome in a third of the patients. Leukocytosis, neutrophilia, shaking chills and normal levels of anti-DNA antibodies were associated with infection in febrile patients with lupus erythematosus. PMID: 316284 [PubMed - indexed for MEDLINE] 5903. Aust N Z J Med. 1979 Dec;9(6):702-4. An unusual case of flaccid paralysis of both lower limbs following herpes zoster. Chapman BA, Beaven DW. A 57-year-old man with left T8-9 cutaneous Herpes Zoster lesions and subsequent development of flaccid paralysis of both lower limbs is reported. Viral studies strongly supported a diagnosis of Herpes Zoster. No other cause for the paralysis was found. The time interval between the cutaneous lesions and the motor weakness, the clinical course and good recovery suggest a causal relationship. The dermatomal and myotomal dissociation has been well-documented on the ipsilateral side, but involvement of the contralateral side is rare. This would appear to be unusual in that there was bilateral weakness of "LMN type". PMID: 294930 [PubMed - indexed for MEDLINE] 5904. Arch Intern Med. 1979 Dec;139(12):1341-5. Serum antibody levels as risk factors in the dissemination of herpes zoster. Mazur MH, Whitley RJ, Dolin R. Serum antibody levels against varicella-zoster virus (VZV) were examined by immune adherence hemagglutination assay (IAHA), indirect fluorescent antibody (IFA) assay, and complement fixation techniques in 67 immunocompromised patients with localized and disseminated herpes zoster. In the serum obtained initially, undetectable IAHA titers were found in 56.5% of the patients with disseminated zoster compared with 18.2% of those with localized zoster. When serum obtained within the first seven days of illness was analyzed, undetectable IAHA titers and IFA titers of less than 32 were noted in 77.8% of those with disseminated zoster but in only 18.5% of those with localized disease. Peak serum antibody titers in patients with disseminated zoster were eventually equal to or greater than those in localized zoster. The patient groups were comparable in age, underlying disease, and therapy, although Hodgkin's disease was more frequent in patients with disseminated zoster. Thus, the absent IAHA or low IFA levels of circulating antibody early in illness were highly significant risk factors in dissemination of virus in herpes zoster. PMID: 229783 [PubMed - indexed for MEDLINE] 5905. Lancet. 1979 Nov 24;2(8152):1144. Herpes zoster of the stomach. MacGregor GA. PMID: 91884 [PubMed - indexed for MEDLINE] 5906. Z Hautkr. 1979 Nov 15;54(22):1002-7. [Skin diseases and monoclonal gammopathies] [Article in German] Kövary PM, Macher E. PMID: 539033 [PubMed - indexed for MEDLINE] 5907. ZFA (Stuttgart). 1979 Nov 10;55(31):1763-9. [Herpes zoster. Nosology, clinical aspects and therapy] [Article in German] Gottwald W. PMID: 93829 [PubMed - indexed for MEDLINE] 5908. Lancet. 1979 Nov 3;2(8149):953. Herpes zoster of the stomach. Wisløff F, Bull-Berg J, Myren J. PMID: 91038 [PubMed - indexed for MEDLINE] 5909. Ann Dermatol Venereol. 1979 Nov;106(11):917-9. [Zoster-like Darier's disease] [Article in French] Verret JL, Halligon J, Fortier P, Schnitzler L. PMID: 539703 [PubMed - indexed for MEDLINE] 5910. Ann Intern Med. 1979 Nov;91(5):727-30. Cardiac ganglionitis associated with sudden unexpected death. James TN, Zipes DP, Finegan RE, Eisele JW, Carter JE. In a postmortem study of the hearts of two young women who died suddenly and unexpectedly, we found a remarkably similar and distinctive ganglionitis, predominantly in the region of the sinus node. Both women had ventricular fibrillation at the time of collapse. Vesicular neuritis and older neural degeneration were present in other regions of the heart. Except for focal fibromuscular dysplasia of the sinus node artery and atrioventricular node artery of one heart, there was no other significant anatomic abnormality in either heart. The functional significance of this cardiac ganglionitis is unclear, but its location in and around the conduction system makes it a possible cause of the fatal electrical instability. Recognition that ganglionitis of the heart may be associated with sudden death should stimulate a number of additionally useful studies. PMID: 496105 [PubMed - indexed for MEDLINE] 5911. Sb Lek. 1979 Nov-Dec;81(11-12):344-6. [Investigation of the specific immunological reaction in the course of herpes zoster by means of the LAI test (author's transl)] [Article in Czech] Vasícková M, Fadrhoncová A, Jandová A, Heyberger K, Doutlík S, Vacek Z, Coupek J, Sanitrák J. PMID: 390686 [PubMed - indexed for MEDLINE] 5912. Curr Probl Pediatr. 1979 Nov;10(1):1-46. Therapeutic control of viral infections: chemotherapy, interferon and gamma globulin. St Geme JW Jr. PMID: 94280 [PubMed - indexed for MEDLINE] 5913. Klin Padiatr. 1979 Nov;191(6):566-71. [Preliminary clinical experiences with adenine arabinoside monophosphate (ARA-AMP) in encephalitis due to viruses of the herpes group and varicella/zoster infections (author's transl)] [Article in German] Sauer O, Werner GT, Schneider H, Lenard HG, von Haselberg L, Nettesheim HJ. Adenine arabinoside monophosphate (ARA-AMP) is a new antiviral agent with significant activity against DNA viruses of the herpes group. It appears to be superior to cytosine arabinoside and iodoxuridine in severe herpes simplex infections. Unlike cytosine arabinoside and idoxuridine ARA-AMP has only minimal myelosuppressive and immunosuppressive properties. The original compound, adenine arabinoside (ARA-A) which has been used in the United States in the last years had the disadvantage of poor solubility and tissue penetrance. Compared to adenine arabinoside the monophosphate ester of this compound has the advantage of better solubility and is more slowly metabolized in humans. In eight children with virus induced encephalitis ARA-AMP was well tolerated, we could not observe any severe side effects. A case of herpes simplex encephalitis showed a complete recovery. However it has to be pointed out that in herpes simplex encephalitis ARA-AMP should be given early in the course of infection to have a beneficial effect, therefore an early diagnosis is of utmost importance. A case of generalized herpes zoster healed up within about a week. Of course these are very preliminary results which must be confirmed by further experiences. PMID: 92592 [PubMed - indexed for MEDLINE] 5914. Schweiz Rundsch Med Prax. 1979 Oct 23;68(43):1401-5. [Clinical experiences with the interferon therapy (author's transl)] [Article in German] Flury F, Wegmann T. PMID: 523431 [PubMed - indexed for MEDLINE] 5915. Br Med J. 1979 Oct 6;2(6194):829-30. Viral infections in renal allograft recipients treated with long-term immunosuppression. Spencer ES, Andersen HK. Thirty-nine renal allograft recipients who had received continuous immunosuppression for six to 13 years were examined clinically and virologically for evidence of past or present viral infection. Twenty-five had common warts, usually on the hands. In most the warts had appeared about one year after transplantation; once present, they never disappeared. Six patients had had a zoster rash from two months to four years after transplantation. None had had jaundice, and there was no change in the frequency of colds or non-specific fibrile illness. Four patients had no cytomegalovirus complement-fixing antibodies throughout the observation period; in the other 35 the antibody titre had risen appreciably during the first three to four months after transplantation. Antibody titres were high (mean 64) at follow-up, being only slightly lower than the highest titres achieved during the immediate postoperative period. None of the patients had had symptomatic cytomegalovirus infection, and in only two was the virus isolated from the urine at follow-up; the titres were extremely low. No changes occurred in the frequency of herpes simplex eruptions. Although all patients had herpes simplex humoral antibody, none excreted the virus. Although cytomegalovirus antibody titres were high, virus excretion was rare, indicating that chronic cytomegalovirus infection in these patients is immunologically well controlled. PMCID: PMC1596660 PMID: 228789 [PubMed - indexed for MEDLINE] 5916. Dis Colon Rectum. 1979 Oct;22(7):503-4. Herpes zoster causing apparent low colonic obstruction. Kesner KM, Bar-Maor JA. PMID: 583331 [PubMed - indexed for MEDLINE] 5917. Br J Clin Pract. 1979 Oct;33(10):291-3. Outbreak of chickenpox and herpes zoster in a geriatric hospital. Rahman M. PMID: 526415 [PubMed - indexed for MEDLINE] 5918. Cutis. 1979 Oct;24(4):360, 379, 451 passim. Transfer factor treatment of viral diseases. Khan A. PMID: 509979 [PubMed - indexed for MEDLINE] 5919. J Infect Dis. 1979 Oct;140(4):601-4. Antibody to varicella-zoster virus-induced membrane antigen: immunoperoxidase assay with air-dried target cells. Haikin H, Leventon-Kriss S, Sarov I. A technique using indirect immunoperoxidase antibody to membrane antigen (IPAMA) was developed for detection of IgG antibody to varicella-zoster virus (VZV). The IPAMA technique utilizes glass slides with air-dried VZV-infected cells, which can be stored at -70 C and used for several months without loss of sensitivity. Antibody titers measured by the IPAMA technique were comparable to those measured by the technique using indirect fluorescent antibody to membrane antigen (IFAMA) for sera obtained from 63 medical students as well as sera from three patients with chicken pox and nine with herpes-zoster infection, and the sensitivity of the IPAMA was equal to that of the IFAMA technique. No cross-reactivity with antibodies to other herpesviruses was observed. PMID: 229177 [PubMed - indexed for MEDLINE] 5920. Rev Med Interna Neurol Psihiatr Neurochir Dermatovenerol Neurol Psihiatr Neurochir. 1979 Oct-Dec;24(4):305-8. [Movement disorders after herpes zoster] [Article in Romanian] Antoneanu M. PMID: 161055 [PubMed - indexed for MEDLINE] 5921. Ir Med J. 1979 Sep 28;72(9):399-401. The management of post herpetic pain using sodium valproate and amitriptyline. Raftery H. PMID: 389881 [PubMed - indexed for MEDLINE] 5922. Fortschr Med. 1979 Sep 27;97(36):1543-7. [Chest pain: differential diagnosis in general practice] [Article in German] Schranz W. In patients with chest pain somatic pain (thoracic wall pain) has to be differentiated from visceral pain (organ pain). History and careful physical examination are diagnostic in most cases. Presented are rare and not well-known diseases like valvular aortic stenosis, idiopathic hypertrophic subaortic stenosis and the mitral valve prolapse syndrome. Not seldom they are masked by angina pectoris-like symptoms, although in general the coronary arteries are normal. In acute chest pain differential diagnostic considerations have to include lung embolism, acute pericarditis, spontaneous pneumothorax, acute dissecting aneurysm of the aorta and diseases of the gastrointestinal tract as well. Only after exclusion of any organic cause the diagnosis of "effort syndrome" may be made. PMID: 499963 [PubMed - indexed for MEDLINE] 5923. JAMA. 1979 Sep 21;242(12):1259-60. Distribution of adenine arabinoside and interferon. Whitley RJ, Arvin A, Galasso G, Dunnick J. PMID: 480535 [PubMed - indexed for MEDLINE] 5924. S Afr Med J. 1979 Sep 1;56(12):491-4. Therapeutic use of zoster-immune plasma: A report of 8 cases. Dickson DN, Heath M. Varicella and herpes zoster can be serious or even fatal diseases in immunocompromised patients. However, they can be prevented or markedly attenuated by the administration of zoster-immune globulin (ZIG) or zoster-immune plasma (ZIP), but there is no established treatment once these disorders have occurred. Eight such patients were treated with ZIP, with promising results. PMID: 550378 [PubMed - indexed for MEDLINE] 5925. J Tenn Med Assoc. 1979 Sep;72(9):664-6. Case report--Herpes zoster affecting three noncontiguous dermatomes in a child with cancer. Feldman S, Novak R, Malone W. PMID: 537357 [PubMed - indexed for MEDLINE] 5926. Geriatrics. 1979 Sep;34(9):41-7. Herpes zoster: a geriatric disease. Becker LE. Both the incidence and the severity of herpes zoster increase with advancing age. Postherpetic neuralgia may persist for more than a year. Treatment is usually symptomatic, and early corticosteroid therapy should be considered in patients over age 50. Psychotropic drugs also may be indicated to overcome depression. PMID: 467981 [PubMed - indexed for MEDLINE] 5927. Riv Patol Nerv Ment. 1979 Sep-Oct;100(5):275-87. [Ophthalmic herpes zoster and delayed contralateral hemiparesis: a chance occurrence (author's transl)] [Article in Italian] Barontini F, Tonini R. A 57 years-old woman developed a right hemiparesis with dysphasia four weeks after left Herpes Zoster Ophthalmicus. The CSF was normal while cerebral angiography showed segmental narrowing of the left carotid syphon and terminal branches. The patient's condition improved during the next few days with almost full recovery. Herpes Zoster Ophthalmicus followed by a controlateral hemiparesis or hemiplegia is a relatively infrequent clinical syndrome. After a review of the relevant literature and discussion of the various theories of causation, the authors suggest a chance relation between the two pathological conditions. PMID: 318026 [PubMed - indexed for MEDLINE] 5928. Clin Perinatol. 1979 Sep;6(2):331-46. Congenital herpesvirus infections. Andiman WA. PMID: 230005 [PubMed - indexed for MEDLINE] 5929. J Clin Pathol. 1979 Sep;32(9):859-81. Herpesviruses. Timbury MC, Edmond E. PMCID: PMC1145845 PMID: 229129 [PubMed - indexed for MEDLINE] 5930. Cutis. 1979 Sep;24(3):279-84. Therapy update 1979. Rees RB. PMID: 157858 [PubMed - indexed for MEDLINE] 5931. Albrecht Von Graefes Arch Klin Exp Ophthalmol. 1979 Sep;211(3):183-6. Axoplasmic transport blockage therapy in herpes zoster ophthalmicus. Chihara E. Three patients with herpes zoster ophthalmicus were treated with an oral administration of colchicine and corticosteroid, while another seven were given systemic corticosteroid, vitamins, and sedatives. Colchicine inhibited the formation of new skin lesions but did not suppress the already grown vesicles. The effect of colchicine was attributed to a blockage of intra-axonal dissemination by neurotrophic virus. PMID: 92895 [PubMed - indexed for MEDLINE] 5932. Nurs Times. 1979 Aug 16;75(33):1405-7. Ophthalmic herpes zoster. Marsh RJ. PMID: 314101 [PubMed - indexed for MEDLINE] 5933. Rheumatol Rehabil. 1979 Aug;18(3):170-3. Herpes zoster and lower motor neurone paresis. Molloy MG, Goodwill CJ. Fifteen cases of herpes zoster with lower motor neurone paresis involving the upper and lower limbs are reviewed. Five patients had an underlying disease--three had rheumatoid arthritis, two of whom were on prednisolone; one had chronic lymphatic leukaemia and one lymphosarcoma. Details are given of the time relationship between onset of pain, the appearance of the skin eruption and the later muscle weakness. Electromyographic evidence was available in 12 patients. The difficulty of assessing the muscle power in the presence of severe pain is discussed. Prognosis was generally very good; 11 patients recovered fully, three improved and one was unchanged after 5 months, when he died of lymphosarcoma. One patient was lost to follow-up at 5 months but was improving at the time. PMID: 582857 [PubMed - indexed for MEDLINE] 5934. Drugs. 1979 Aug;18(2):122-9. Relief of facial pain. Anthony M. PMID: 487956 [PubMed - indexed for MEDLINE] 5935. Med Sestra. 1979 Aug;38(8):42-3. [Use of diadynamic currents in herpes zoster] [Article in Russian] Sviatova VV. PMID: 316095 [PubMed - indexed for MEDLINE] 5936. Rinsho Shinkeigaku. 1979 Aug;19(8):496-503. [Herpes zoster ophthalmicus followed by contralateral hemiparesis (author's transl)] [Article in Japanese] Onoda M, Takahashi A. PMID: 315296 [PubMed - indexed for MEDLINE] 5937. Aust N Z J Med. 1979 Aug;9(4):440-3. A study of synovial fluid and cytology in arthritis associated with herpes zoster. Cunningham AL, Fraser JR, Clarris BJ, Hobbs JB. A case of herpes zoster complicated by acute arthritis with effusions is described. The white cell count in the synovial fluid was low, with a predominance of neutrophils. The synovium showed superficial deposits of fibrin, slight intimal hyperplasia, and subintimal polymorph infiltration. Varicella virus was not detected by culture or electron microscopy, but varicella antigen was demonstrated in the cytoplasm of macrophages in the effusion. Other findings did not determine whether the antigen had appeared in the joint from circulating immune complexes, or following synovial phagocytosis or proliferation of virus. PMID: 292386 [PubMed - indexed for MEDLINE] 5938. Hautarzt. 1979 Aug;30(8):432-3. [Paralytic abdominal hernia in zoster] [Article in German] Landthaler M, Heuser M. In a 56 year old patient with zoster in the thoracic segments 10 and 11 an abdominal hernia developed. The hernia was caused by peripheral motorial paresis. PMID: 159877 [PubMed - indexed for MEDLINE] 5939. Cesk Dermatol. 1979 Aug;54(4):212-4. [Zoster--treatment by drop infiltration with procaine (author's transl)] [Article in Czech] Herold K, Frey T, Holan V, Jirásková M, Labohý P, Machácková J, Zloský P. PMID: 93517 [PubMed - indexed for MEDLINE] 5940. Ugeskr Laeger. 1979 Jul 9;141(28):1891-6. [Epidemiology, pathogenesis, clinical picture and treatment of herpes zoster] [Article in Danish] Grønvall B, Esmann V, Wildenhoff KE. PMID: 473409 [PubMed - indexed for MEDLINE] 5941. J Postgrad Med. 1979 Jul;25(3):171-3. Herpes generalisata assoicated with diabetes mellitus and pulmonary tuberculosis (a case report). Panwar RB, Kochar DK, Gupta BS, Bhatnagar LK, Saxena HC. PMID: 529170 [PubMed - indexed for MEDLINE] 5942. Clin Plast Surg. 1979 Jul;6(3):377-88. Current surgical treatment of intratemporal facial palsy. Fisch U. PMID: 487707 [PubMed - indexed for MEDLINE] 5943. Neurol Neurochir Pol. 1979 Jul-Aug;13(4):439-42. [Rare care of Ramsay Hunt syndrome associated with herpes zoster of the glossopharyngeal nerve] [Article in Polish] Bluma Z, Lyczak P, Bronowicki E. The authors describe a rare coexistence of Ramsay Hunt syndrome with glossopharyngeal zoster in a 67-year-old patient. A trial of systematization of the nomenclature of Ramsay Hunt syndrome is suggested, on the basis of certain anatomophysiological data. It is concluded that in zoster involvement of the sensory elements in the geniculate ganglion and in otic ganglion should be accompanied by taste sensitivity disturbances, but often the patients fail to notice these disturbances and routine taste testing shows also no such tase impairment. Routine use of electrogustometry is postulated since this makes possible diagnostic-prognostic assessment followed by selection of appropriate treatment. PMID: 481694 [PubMed - indexed for MEDLINE] 5944. Infect Immun. 1979 Jul;25(1):170-4. Cellular and humoral immune responses to varicella-zoster virus in immunocompromised patients during and after varicella-zoster infections. Gershon AA, Steinberg SP. Humoral and cell-mediated immune responses to varicella-zoster (V-Z) virus were assessed in patients during and after V-Z infections. Ongoing V-Z infections was associated with minimal cellular immunity but not necessarily with poor humoral immunity. Recovery from V-Z infection was associated with a vigorous cellular immune response. Cell-mediated immunity to V-Z virus was demonstrable for years after varicella, but responses were lower in immunocompromised patients than in normal individuals. PMCID: PMC414434 PMID: 225270 [PubMed - indexed for MEDLINE] 5945. J Infect Dis. 1979 Jul;140(1):33-41. Antibody to early antigens of varicella-zoster virus during varicella and zoster. Gerna G, Cereda PM, Cattaneo E, Achilli G, Gerna MT. IgG antibody to the early antigens of varicella-zoster virus (VZV) was studied during both varicella and zoster by the indirect immunoperoxidase antibody technique. In parallel, complement-fixing, immune-adherence hemagglutinating, IgG, and IgM antibodies to VZV were studied. In both varicella and zoster infections, antibody to the early antigens of VZV appeared three to five days after onset of infection, reached a peak during the second week, and progressively decreased in titer until it disappeared, usually within two months. This antibody usually appeared slightly later than IgG or IgM antibody and grossly correlated with IgM antibody in varicella. In zoster infections, IgM antibody to VZV was not found by the immune-adherence hemagglutination assay at a titer of greater than or equal to 1:4, whereas antibody to the early antigens showed a curve similar to that found in varicella. It is suggested that antibody to the early antigens of VZV be considered as a marker of acute VZV infection, which is associated with a specific and significant IgM antibody response in varicella but not in zoster. PMID: 88490 [PubMed - indexed for MEDLINE] 5946. Clin Ter. 1979 Jun 30;89(6):589-93. [The treatment of herpes zoster with hemocoagulase (Bothrops Jararaca venom)] [Article in Italian] De Candia O, Baghiris D. PMID: 397028 [PubMed - indexed for MEDLINE] 5947. Rev Neuropsiquiatr. 1979 Jun;42(2):104-13. [Inflammatory reaction in the csf in 2 cases of Herpes Zoster: trigeminal and facial] [Article in Spanish] Cuba JM, Castro C. PMID: 547346 [PubMed - indexed for MEDLINE] 5948. Nursing (Lond). 1979 Jun;(3):115, 125. Photo test: shingles. [No authors listed] PMID: 317145 [PubMed - indexed for MEDLINE] 5949. Laryngoscope. 1979 Jun;89(6 Pt 1):906-17. Total facial nerve exploration: transmastoid, extralabyrinthine, and subtemporal indications and results. May M. Increasingly, surgeons are using a middle fossa approach though craniotomy to reach the labyrinthine segment of the facial nerve and geniculate ganglion in patients with intact hearing. This paper describes a transmastoid operation that provide exposure of the labyrinthine segment of the facial nerve without performance of a craniotomy. In this procedure the geniculate ganglion and labyrinthine segments of the facial nerve were exposed, while cochleovestibular function was spared; recovery of the facial nerve in patients with Bell's palsy or herpes zoster oticus (even the patients with a dry eye) was favourably influenced. PMID: 312987 [PubMed - indexed for MEDLINE] 5950. J Fam Pract. 1979 Jun;8(6):1217-33. Dermatoses of the scalp. Osment LS. By judicious consideration of the clinical appearance, by direct examination with magnification, and by culture results, skin biopsy, and other laboratory results, the clinician is able to diagnose most pathological conditions of the scalp. The scalp participates in many systemic disorders and frequently is the chief site of involvement. Similarly, many generalized disorders limited to the skin exhibit their most typical manifestations in the scalp. Whenever a diagnosis eludes the investigator, more than likely he or she has not considered all of the etiological possibilities or has not pursued an adequate laboratory investigation. A few scalp diseases initially present nonspecific clinical pictures. By utilizing follow-up examinations at appropriate intervals, the diagnosis can eventually be made. Once a diagnosis is made, appropriate treatment will generally produce satisfactory improvement or cure. Nevertheless, a few generally rare conditions will defy the physician's most enlightened and aggressive therapy. PMID: 156243 [PubMed - indexed for MEDLINE] 5951. Am J Ophthalmol. 1979 Jun;87(6):814-8. Intraocular penetration of trifluridine. Pavan-Langston D, Nelson DJ. We studied intraocular penetration of topically applied trifluridine in five patients with herpetic keratitis undergoing penetrating keratoplasty. We compared the concentration of trifluridine and its metabolite 5-carboxy 2'-deoxyuridine in the aqueous humor to those of normal control patients undergoing routine cataract extraction without preoperative antiviral therapy. Significant concentrations of intact trifluridine were achieved in the acqueous humor after topical application of 1% trifluridine ophthalmic drops. The metabolite, 5-carboxy 2'-deoxyuridine, was not found in the aqueous humor. Unlike idoxuridine and vidarabine, it is possible to achieve therapeutic levels of trifluridine at intraocular sites that would be advantageous in the treatment of deep herpetic disease involving the stroma and iris. PMID: 110152 [PubMed - indexed for MEDLINE] 5952. Ugeskr Laeger. 1979 May 7;141(19):1288-9. [Idoxuridine treatment of herpes virus infections] [Article in Danish] Wildenhoff KE, Esmann V. PMID: 222029 [PubMed - indexed for MEDLINE] 5953. Rev Laryngol Otol Rhinol (Bord). 1979 May-Jun;100(5-6):313-5. [Medical and surgical treatment of herpes zoster facial paralysis] [Article in French] Pietruski J. PMID: 542743 [PubMed - indexed for MEDLINE] 5954. Age Ageing. 1979 May;8(2):75-80. Motor complications of herpes zoster. Pathy MS. Motor involvement is uncommon in herpes zoster. Of 14 subjects observed over an arbitrary period of five years, nine had flaccid limb paralyses, involving the upper limb in eight patients. Recovery was not always complete and occurred over a period of nine weeks to four years. PMID: 463678 [PubMed - indexed for MEDLINE] 5955. Ann Allergy. 1979 May;42(5):295-305. Treatment of active herpes virus infections with influenza virus vaccine. Miller JB. A system for treating active virus infections with very small, precisely determined doses of specific killed-virus vaccine is described. Results indicate that the discomforts of influenza and herpes virus infections usually disappear within 30 minutes after injection of the vaccine. The relief occurs during testing and repeated subcutaneous injections produce rapid healing. PMID: 453646 [PubMed - indexed for MEDLINE] 5956. Ann Otol Rhinol Laryngol. 1979 May-Jun;88(3 Pt 1):303-10. Acute vestibular paralysis in herpes zoster oticus. Proctor L, Perlman H, Lindsay J, Matz G. A case of herpes zoster oticus is presented in which the lateral and superior semicircular canals of the labyrinth were affected unilaterally. The results of several electronystagmographic examinations are described and correlated with the patient's description of symptoms. This case study indicates that disease affecting the lateral semicircular canal is reliably detected by the conventional caloric test. However, the fact that the posterior semicircular canal remained intact could not be inferred from the results of the caloric test in this case. Also the appearance of nystagmus upon eye closure appears to have been a more sensitive index of the state of the disease process than was the caloric test. PMID: 313735 [PubMed - indexed for MEDLINE] 5957. Del Med J. 1979 May;51(5):253-64. Management of the "red eye". Lipkowitz J, Abel R Jr. PMID: 313348 [PubMed - indexed for MEDLINE] 5958. Neurology. 1979 May;29(5):726-9. Optic neuropathy and ophthalmoplegia in herpes zoster oticus. Carroll WM, Mastaglia FL. A 55-year-old man with herpes zoster oticus and minimal cutaneous involvement developed reversible optic neuropathy, and ocular motor and cerebellar abnormalities. Serologic changes confirmed infection with herpes zoster. A demyelinating process seems likely to have been responsible for these lesions. It is suggested that herpes zoster antibody titers should be measured whenever the syndrome of polyneuritis cranialis of acute onset is being investigated. PMID: 312472 [PubMed - indexed for MEDLINE] 5959. Rev Paul Med. 1979 May-Jun;93(5-6):101-3. [Electron microscopy diagnosis of herpes zoster virus in cancer patients] [Article in Portuguese] Leite JB, Marques AF, Teixeira MI, Ueda M, Weigl DR, Bianchi A, De Andréa ML, Lopes A, Gomes OM. PMID: 229536 [PubMed - indexed for MEDLINE] 5960. Rinsho Shinkeigaku. 1979 May;19(5):277-82. [Immunological study of 7 cases with Ramsay Hunt's syndrome (author's transl)] [Article in Japanese] Nakamura S, Takase S, Itahara K, Ogata M, Shigeta S. PMID: 225075 [PubMed - indexed for MEDLINE] 5961. J Pediatr. 1979 May;94(5):743-6. Zoster immune plasma prophylaxis of varicella: a follow-up report. Balfour HH Jr, Groth KE. PMID: 221631 [PubMed - indexed for MEDLINE] 5962. J Neurol Neurosurg Psychiatry. 1979 May;42(5):452-7. Nervous system complications of herpes zoster: immunofluorescent demonstration of varicella-zoster antigen in CSF cells. Peters AC, Versteeg J, Bots GT, Lindeman J, Smeets RE. PMCID: PMC490232 PMID: 221620 [PubMed - indexed for MEDLINE] 5963. N Engl J Med. 1979 Apr 19;300(16):923-4. Is it true what they say about interferon? Weimar W, Schellekens H. PMID: 423945 [PubMed - indexed for MEDLINE] 5964. Z Hautkr. 1979 Apr 15;54(8):326-7. [Diagnosis and therapy of virus-induced skin diseases] [Article in German] Rohde B. PMID: 442750 [PubMed - indexed for MEDLINE] 5965. Ann Ophthalmol. 1979 Apr;11(4):568-70. Trochlear nerve palsy in a case of herpes zoster ophthalmicus. Scharf J, Meyer E, Zonis S. A case of trochlear nerve palsy in herpes zoster ophthalmicus is presented. The rarity of fourth nerve involvement in herpes zoster is emphasized. PMID: 572196 [PubMed - indexed for MEDLINE] 5966. Postgrad Med. 1979 Apr;65(4):143-50. Herpes zoster oticus. Uncommon but recognizable cause of facial paralysis. Vest C, Munneke JA, Smith R. Three cases of herpes zoster oticus illustrate the manifestations of this relatively uncommon cause of facial paralysis. Topographic analysis, in which functions of facial nerve branches are assessed, helps establish the level of facial nerve involvement. Sequential faradic stimulation testing often is a sensitive prognostic indicator of recovrey of facial nerve function, particularly if nerve excitability persists. A few recent reports support the use of systemic steroid therapy for herpes zoster oticus; opinions vary regarding the efficacy of surgical decompression for facial paralysis. Although general principles cannot be deduced from three cases, each case discussed exemplifies an important aspect of management. The prognostic significance of results of nerve stimulation tests is illustrated by the complete return of facial nerve function in our first patient. Our second patient's response to systemic steroid therapy supports recent reports of the value of such agents in herpes zoster oticus. Partial return of facial nerve function in our third patient two months after onset of paralysis accentuates the importance of a period of observation before a nerve graft or other rehabilitative procedures are undertaken. PMID: 424347 [PubMed - indexed for MEDLINE] 5967. Klin Monbl Augenheilkd. 1979 Apr;174(4):595-8. [Herpes zoster-exophthalmus without ophthalmoplegia (author's transl)] [Article in German] Siegert P, Utermann D, Pohlenz O. A case of exophthalmic myositis was identified by a secondary herpes zoster exacerbation. The herpes zoster exophthalmus in this case remained - in contrast to all other cases so far published - free of signs of ophthalmoplegia and retrobulbar neuritis with visual acuity loss. PMID: 313475 [PubMed - indexed for MEDLINE] 5968. J Am Optom Assoc. 1979 Apr;50(4):457-63. Dendriform keratitis. Terry JE. Since the cornea responds to various toxic stimuli by swelling and ulcerating, these changes may assume a dendriform pattern. A case of herpes simplex dendritic keratitis is presented along with its treatment. In addition, several other etiologic sources of an arborescent keratitis are discussed as to their differentiation and management implication. PMID: 313414 [PubMed - indexed for MEDLINE] 5969. Can J Ophthalmol. 1979 Apr;14(2):99-101. [Ophthalmic herpes: treatment of herpetic neuralgia by repeated stellate block] [Article in French] Laflamme MY, Labrecque B, Mignault G. Eight cases of herpes zoster with severe neuralgic pain were treated by repeated stellate blocks, 5 during the acute stage and the 3 others later on. Of the 5 patients treated during the acute stage 3 were cured, the pain disappearing completely. Four other patients were substantially improved. Only one case was a failure. It is important to begin the injections soon after the beginning of the illness, preferably in the first couple of weeks after the rash appears. PMID: 313235 [PubMed - indexed for MEDLINE] 5970. Rev Chir Oncol Radiol O R L Oftalmol Stomatol Ser Oftalmol. 1979 Apr-Jun;23(2):99-102. [Study of viral uveitis] [Article in Romanian] Stefănescu-Dima A. PMID: 228359 [PubMed - indexed for MEDLINE] 5971. J Hyg (Lond). 1979 Apr;82(2):319-36. Specific immunoglobulin responses after varicella and herpes zoster. Cradock-Watson JE, Ridehalgh MK, Bourne MS. The indirect immunofluorescence technique has been used to titrate the specific immunoglobulins in 200 sera from 64 patients with varicella, and 195 sera from 67 patients with herpes zoster. IgG and IgM antibodies were detected in all patients with varicella, and IgA in 59 (92%). All three classes of antibody appeared 2--5 days after the onset of the rash, increased virtually simultaneously and reached maximum titres during the second and third weeks. IgG then declined slowly, but never became undetectable and was still present in five subjects who were retested after 2--4 years; it was present in 88 out of 100 healthy young adults and probably persists indefinitely after varicella. IgA and IgM antibodies declined more rapidly and were not detected in specimens taken more than a year after the illness. IgA, however, may possibly persist in some cases since low titres were found in 8 out of 88 young adults who possessed IgG antibody and had presumably had varicella in the past. IgA responses were significantly weaker in children under the age of 6 years than in older children and adults. Six out of 67 patients with zoster were tested at various times before the onset of the rash: IgG antibody was detected in all. IgG was present in all sera taken after the onset of the rash, increased rapidly after 2--5 days, reached maximum titres during the second and third weeks and then declined slowly. IgA antibody was detected in 66 patients (99%) and IgM in 52 (78%); both types of antibody followed transient courses, as in varicella. Maximum titres of IgG and complement-fixing antibodies were greater after zoster than after varicella, but the differences were not significant. IgA and IgM titres in young adults with zoster were significantly lower than in older patients, and also lower than in young adults with varicella. Increases in varicella-zoster antibody in patients with herpes simplex virus infections consisted mainly of IgG, sometimes IgA, but never IgM. PMCID: PMC2130148 PMID: 219110 [PubMed - indexed for MEDLINE] 5972. Int J Oral Surg. 1979 Apr;8(2):149-54. Herpes zoster of the maxillary branch of the trigeminus nerve. Virological and serological studies. Sato M, Urade M, Shirasuna K, Yura Y, Yoshida H, Yanagawa T, Morimoto M, Kobayashi A, Hamamura Y, Kubo K, Miyazaki T. A 70-year-old male had erythematous and vesiculous lesions in the area of the right maxillary branch of the trigeminus nerve and was clinically diagnosed as having herpes zoster; virological and serological investigations of this case were carried out. Consequently, an electron microscopic observation revealed a great number of virus particles of herpes type in the vesiculous lesion and in baby hamster kidney BHK21/WI-21 cells, cultured after inoculating the fluid from the vesicle formed on the patient's upper lip or from serum harvested during the viremia. When BHK21/WI-21 cells infected with this virus were tested for antigenicity by an indirect immunofluorescent staining technique, they showed a positive staining to antivaricella-zoster virus. When serum of this patient was assayed fof the antibody level against varicella-zoster virus by the complement fixation test at various time intervals during the therapeutic period, this antibody titer on recovery period showed a threefold increase in comparison to that at onset. From these findings, this infectious disease was precisely diagnosed as herpes zoster. PMID: 112072 [PubMed - indexed for MEDLINE] 5973. Br Med J. 1979 Mar 24;1(6166):818. Shingles: a belt of roses from Hell. Schreuder M, Fothergill WT. PMCID: PMC1598439 PMID: 435807 [PubMed - indexed for MEDLINE] 5974. Br Med J. 1979 Mar 24;1(6166):818. Shingles: a belt of roses from Hell. Juel-Jensen B. PMCID: PMC1598473 PMID: 435806 [PubMed - indexed for MEDLINE] 5975. Lancet. 1979 Mar 24;1(8117):668. Cranial-nerve involvement in herpes zoster. Pahor AL. PMID: 85899 [PubMed - indexed for MEDLINE] 5976. Lancet. 1979 Mar 24;1(8117):668. Cranial-nerve involvement in herpes zoster. Morgan-Capner P, Crofts MA, Sharp JC. PMID: 85898 [PubMed - indexed for MEDLINE] 5977. J Neurol. 1979 Mar 22;220(2):125-30. Rapid diagnosis of viral neuroinfections by immunofluorescent and immunoperoxidase technics. Maltseva N, Manovich Z, Seletskaya T, Kaptsova T, Nikulina V. The results of immunofluorescent (IF) and immunoperoxidase (IP) technics applied for the detection of antigen in cerebrospinal fluid (CSF) cells in patients with mumps, herpes zoster and herpes simplex meningitis and meningoencephalitis are presented. Thirty patients were under study. The detection of mumps and herpes zoster viral antigen in CSF cells was possible in 100% of cases investigated. Herpes simplex virus antigen was detected in four of seven cases with symptoms of severe meningoencephalitis. Complement fixation (CF) antibodies to herpes simplex virus (type I) and positive seroconversion were detected in the four latter patients. The diagnostic value of the methods used for the detection of mumps, herpes simplex and herpes zoster viral antigens in CSF cells of patients is discussed. PMID: 87496 [PubMed - indexed for MEDLINE] 5978. Nurs Mirror. 1979 Mar 15;148(11):52, 30. Picture quiz: herpes zoster. Iveson-Iveson J. PMID: 254181 [PubMed - indexed for MEDLINE] 5979. Nouv Presse Med. 1979 Mar 10;8(11):843-5. [The treatment of organic pain of the peripheral nervous system using clomipramine. 30 cases (author's transl)] [Article in French] Castaigne P, Laplane D, Morales R. Clomipramine used alone is an affective analgesic against organic pain due to a lesion of the peripheral nervous system, in particular post-herpetic pain. The quality of the result is related to the dose, and hence to tolerance. Fluohydrocortisone is the most powerful drug against orthostatic hypotension, the chief cause of limitation of treatment. No complications were seen, even in very elderly patients. PMID: 221881 [PubMed - indexed for MEDLINE] 5980. Ann Ophthalmol. 1979 Mar;11(3):405-6. Optic neuritis in a child with herpes zoster. Monroe LD. A 9-year-old black boy was admitted to the hospital for treatment of herpes zoster involving the trigeminal nerve distribution on the left half of his face. Consulting examination of his eye on the involved side revealed moderate iritis as well as papillitis and diffuse retinitis. PMID: 453745 [PubMed - indexed for MEDLINE] 5981. Geburtshilfe Frauenheilkd. 1979 Mar;39(3):209. [On spasm of the bladder sphincter in a case of herpes zoster (author's transl)] [Article in German] Grimmeke F. Report on a 64-year old patient with extensive Herpes zoster of the trunk. The patient presented with urinary retention which stopped after 4 tablets of the chemotherapeutic agent Flumidin. This effect of Flumidin was unknown to the manufacturer and reports on this effect in the literature were not located. PMID: 437454 [PubMed - indexed for MEDLINE] 5982. Am J Med. 1979 Mar;66(3):457-62. Herpesvirus infection of the esophagus and other visceral organs in adults. Incidence and clinical significance. Buss DH, Scharyj M. PMID: 433952 [PubMed - indexed for MEDLINE] 5983. J Antimicrob Chemother. 1979 Mar;5(2):126-8. Local idoxuridine treatment of herpes simplex and zoster. Verbov J. PMID: 429246 [PubMed - indexed for MEDLINE] 5984. West J Med. 1979 Mar;130(3):271. Autoimmune therapy for herpes zoster. Lawrence RM. PMCID: PMC1238601 PMID: 425513 [PubMed - indexed for MEDLINE] 5985. Int J Dermatol. 1979 Mar;18(2):142-5. Zosteriform inflammatory metastatic carcinoma. Hodge SJ, Mackel S, Owen LG. A 57-year-old man presented with chest wall lesions and swelling of his left arm. The rapid onset of vesicular lesions in a dermatomal distribution resulted in an initial diagnosis of herpes zoster. Cutaneous biopsy revealed adenocarcinoma and further evaluation revealed a primary source of pulmonary adenocarcinoma. Lymphatic spread of tumor cells is the most likely source of the zosteriform skin lesions, but other possibilities are discussed. PMID: 422313 [PubMed - indexed for MEDLINE] 5986. Harefuah. 1979 Mar 1;96(5):219-22. [Laboratory diagnosis of varicella-zoster virus infections] [Article in Hebrew] Leventon-Kriss S, Rannon L, Yoffe R. PMID: 396181 [PubMed - indexed for MEDLINE] 5987. Am J Dis Child. 1979 Mar;133(3):283-4. Zoster-like eruption due to echovirus 6. Meade RH 3rd, Chang TW. A unilateral vesiculobullous eruption associated with fever was seen on the neck, shoulder, and upper part of the chest of a 7-year-old boy. Although three dermatomes in all were involved, the lesions resembled herpes zoster. The patient had had varicella in infancy. Culture of fluid from several bullae yielded echovirus 6; however, and serum neutralizing antibody to this virus rose in titer from 1:32 to 1:640. It is suggested that echovirus 6 and other enteroviruses may cause a number of vesicular eruptions that resemble herpes zoster and similar infections. Viral culture, while often difficult to obtain, is the only way to identify the cause of eruptions like this one. PMID: 371385 [PubMed - indexed for MEDLINE] 5988. Arch Neurol. 1979 Mar;36(3):179. Herpes zoster ophthalmicus. Vincent FM, Sullivan JK, Freemon FR. PMID: 312096 [PubMed - indexed for MEDLINE] 5989. Prim Care. 1979 Mar;6(1):169-94. Recent developments in immunization. Fedson DS. PMID: 223185 [PubMed - indexed for MEDLINE] 5990. Br Med J. 1979 Feb 17;1(6161):490. Shingles: a belt of roses from hell. [No authors listed] PMCID: PMC1597739 PMID: 427427 [PubMed - indexed for MEDLINE] 5991. Dtsch Med Wochenschr. 1979 Feb 16;104(7):265. [Levodopa therapy of zoster] [Article in German] Fuchs T. PMID: 761522 [PubMed - indexed for MEDLINE] 5992. Br Med J. 1979 Feb 3;1(6159):346. Shingles: a belt of roses from Hell. [No authors listed] PMCID: PMC1597706 PMID: 421119 [PubMed - indexed for MEDLINE] 5993. Br Med J. 1979 Feb 3;1(6159):321-3. ABC of Ophthalmology. Common or difficult diagnoses. Gardiner PA. PMCID: PMC1597690 PMID: 311236 [PubMed - indexed for MEDLINE] 5994. J Pediatr. 1979 Feb;94(2):223-30. Cell-mediated immunity to varicella-zoster virus infection in subjects with lymphoma or leukemia. Patel PA, Yoonessi S, O'Malley J, Freeman A, Gershon A, Ogra PL. Normal subjects and patients with lymphoma or leukemia were tested for the levels of lymphocytes, E-rosette--forming T-cells, serum and vesicle fluid interferon, and specific in vitro proliferative response to varicella-zoster antigen after clinical varicella or herpes zoster illness. The effect of polyinosinic acid/polycytidilic acid on the immune response was also evaluated. The development of VZ specific cell-mediated response in normal subjects was characterized by intense proliferative activity eight to ten days after the onset of illness, with significant decline 70 to 80 days later. The responses in subjects with lymphoma or leukemia were much lower. Few subjects with chickenpox or zoster with lymphoma or leukemia died during the infection. Death was associated with significant depletion of E-rosette--forming T-cells, and grossly deficient specific cellular response to VZ antigen. Treatment with Poly IC frequently induced elevations in serum as well as vesicle fluid interferon levels, and increased the proliferative activity of lymphocytes against VZ antigen. PMID: 762611 [PubMed - indexed for MEDLINE] 5995. Obstet Gynecol. 1979 Feb;53(2):175-81. Herpes zoster during pregnancy. Brazin SA, Simkovich JW, Johnson WT. Herpes zoster has rarely been noted to occur during pregnancy. We report the case of a woman at 37 weeks' gestation who developed herpes zoster and 3 weeks later delivered a normal infant. A 6-month follow-up has revealed no sequelae in the child. Pertinent clinical aspects of herpes zoster and a review of the literature indicating a favorable prognosis for infants exposed in utero are presented. PMID: 418971 [PubMed - indexed for MEDLINE] 5996. Pediatrics. 1979 Feb;63(2):301-19. Standard and special human immune serum globulins as therapeutic agents. Stiehm ER. PMID: 375173 [PubMed - indexed for MEDLINE] 5997. SSO Schweiz Monatsschr Zahnheilkd. 1979 Feb;89(2):125-6. [Herpes zoster in the mouth] [Article in German] Kaldarar G, Golland G. Herpes zoster is a viral disease with cutaneous and mucous manifestations. They occur in 30% cases in the trigeminal area and in 7.2% cases in other parts of the head. Typical manifestations are nevralgias simulating dental pain, also vesicles with an erythematous halo located in the territory of the second and third trigemial branch. They erupt on the skin, the lips, tongue, palate and cheeks. Zosteric nevralgia may extend into the territory of the first trigeminal. There is no known causal therapy and local treatments are but unsatisfactory pallatives. PMID: 293026 [PubMed - indexed for MEDLINE] 5998. Rev Infirm. 1979 Feb;29(2):42-7. [Zona] [Article in French] Ghanassia JP. PMID: 253383 [PubMed - indexed for MEDLINE] 5999. SSO Schweiz Monatsschr Zahnheilkd. 1979 Feb;89(2):135-45. [Clinical aspect of herpes zoster and the pathogenesis of symptomatic cranial nerve zosters] [Article in German] Dielert E. The prognosis of shingles is generally good, however if cranial nerves are affected, the course of disease may be very serious. It is still doubtful if latent virus-in the sense of a trigger mechanism-may be activated by dental surgical interventions and cause a symptomatic herpes zoster of cranial nerves. Serious loss of teeth as an oral manifestation of shingles, with panostitis and retarded healing show the seriousness of the tissue changes. The virus can invade the plexus between the facial and trigeminal nerves and can thus travel within the same epineural sheath from one nerve to the other. It follows that in each case of a herpes zoster of cranial nerves, irrespective of location, no dental surgery should be undertaken, even in the initial stage, because - it may increase the extension of the disease along the nerves - it may cause a viraemia - it may initiate uncalled for intraoperative and postoperative complications. Therapy with high doses of antibiotics is indicated. PMID: 229550 [PubMed - indexed for MEDLINE] 6000. Cutis. 1979 Feb;23(2):144, 146-7, 152. Immunization: varicella-zoster vaccine. Heim LR. PMID: 217569 [PubMed - indexed for MEDLINE] 6001. Br Med J. 1979 Jan 6;1(6155):5. Shingles: a belt of roses from Hell. [No authors listed] PMCID: PMC1597516 PMID: 216456 [PubMed - indexed for MEDLINE] 6002. Lancet. 1979 Jan 6;1(8106):38-9. Herpes zoster of right glossopharyngeal nerve. Clark J. PMID: 83479 [PubMed - indexed for MEDLINE] 6003. Scand J Infect Dis. 1979;11(3):185-6. Herpes zoster in infancy. David TJ, Williams ML. Three cases of herpes zoster occurring in infancy are reported. In each case the mother had chickenpox in pregnancy. PMID: 524067 [PubMed - indexed for MEDLINE] 6004. Neurol Neurochir Pol. 1979;13(5):565-7. [Recurrent multifocal lesions of the nervous system after herpes zoster] [Article in Polish] Zelazny S, Filar H. The authors report a case of zoster with signs of transverse myelitis and peripheral involvement of the facial nerve. The fact that tranverse myelitis developed late after zoster and was followed by facial nerve palsy is stressed. The involvement of these nervous structures occurred in a way suggesting exacerbations. In the light of literature data and the described case the authors state that zoster with complications in the form of multifocal nervous system involvement occurring at different time intervals is infrequent. PMID: 522944 [PubMed - indexed for MEDLINE] 6005. Eur Neurol. 1979;18(3):149-56. Zoster meningitis and radiculomeningitis after tick bite. Cytological findings in cerebrospinal fluid. Shoji H, Dommasch D. Cytological changes in 9 samples of cerebrospinal fluid (CSF) from 5 patients with zoster meningitis and 12 samples from 5 patients with radiculomeningitis after tick bite were examined. 5 days after the onset of the skin eruption, the CSF cells in zoster meningitis consisted of many mononuclear blast forms--large lymphocytes and 'immature' plasma cells. 11-15 days after the onset of the skin rash, they were replaced by small lymphocytes, some 'mature' plasma cells and monohistiocytes. In radiculomeningitis after tick bite, however, the CSF cells examined 10-21 days after the onset of radicular pain consisted of many large lymphocytes, immature plasma cells and a few neutrophils. From these findings, it might be suggested that the acute meningeal reaction of zoster meningitis subsides within about 1 week after the onset of the skin rash, but that of radiculomeningitis after tick bite continues at least for 2-3 weeks after the onset of radicular pain. PMID: 477687 [PubMed - indexed for MEDLINE] 6006. Dermatologica. 1979;158(3):210-3. [Trigeminal zona with necrosis of the upper jaw] [Article in French] Delbrouck-Poot F, Reginster JP. PMID: 446827 [PubMed - indexed for MEDLINE] 6007. J Laryngol Otol. 1979 Jan;93(1):93-8. Herpes zoster of the larynx--how common? Pahor AL. Herpes zoster of the larynx is considered to be rare, but on reviewing the literature it is noted that some authors considered it to be more common than already acclaimed. Herpes may prove to be a common cause of cord palsies presently labelled as idiopathic and serological tests for herpes should be asked for. Of note is the fact that the cord palsy of a herpetic lesion can be short-lived and that earache is a common symptom. In this paper four cases of herpes laryngis are presented. It is advised that the larynx should be examined in all cases of herpes zoster of the head and neck. PMID: 429891 [PubMed - indexed for MEDLINE] 6008. Antimicrob Agents Chemother. 1979 Jan;15(1):142-4. Inappropriate antidiuretic hormone following adenine arabinoside administration. Ramos E, Timmons RF, Schimpff SC. A patient with disseminated herpes zoster developed a syndrome of inappropriate antidiuretic hormone and profound hyponatremia secondary to the administration of adenine arabinoside. PMCID: PMC352616 PMID: 426502 [PubMed - indexed for MEDLINE] 6009. Int Urol Nephrol. 1979;11(4):363-6. Herpes zoster and acute rejection crisis of renal homograft. Járay J, Perner F, Alföldy F, Darvas K, Kokas P. The case of a patient developing acute rejection crisis 8 months after transplantation in the prodromal stage of a herpes zoster infection is reported. The joint therapeutic measures resulted in suppression of rejection and control of the infection. Complications did not occur. The case suggests a definite association between the viral infection and acute homograft rejection. The case report is followed by a critical review of the pertinent literature. PMID: 395127 [PubMed - indexed for MEDLINE] 6010. Scand J Infect Dis. 1979;11(1):1-9. Treatment of herpes zoster with idoxuridine ointment, including a multivariate analysis of symptoms and signs. Wildenhoff KE, Ipsen J, Esmann V, Ingemann-Jensen J, Poulsen JH. A double-blind, random selection comparison was made of the therapeutic effects in acute herpes zoster of (A) 40% idoxuridine (IDU) dissolved in dimethyl sulphoxide (DMSO), or one of the following ointments: (B) a basis of polyethylene glycol, (C) a basis with 60% DMSO, (D) a basis with 5% IDU and 60% DMSO, and (E) a basis with 40% IDU and 60% DMSO. Each group comprised 20 patients. The patients were evaluated daily until skin healing and then at 1,3, and 6 months by registering 4 neurological signs, 5 clinical evaluations of skin pathology and 4 photographic evaluations of the skin lesions. A 'profile' of the effect of each treatment was computed by calculating normalized means for each of the 13 variables. A non-random distribution of the clinical and photographic variables indicated a statistically significant, but small therapeutic effect of treatment A on skin healing, whereas no convincing effect on pain or sensitivity disturbances was established. Treatments B-E were without positive effects. The information given by the highly interdependent variables were computed for each variable and for groups of variables after appropriate scoring. It was found that the photographic evaluation contributed evidence independent of the clinical evaluation of skin pathology. A multiple correlation analysis revealed that age was positively correlated to the duration of pain and to delayed healing, that rapid healing was intimately connected to no or short-lived pain, and surprisingly that zoster in the trigeminal area healed faster than in other locations without being correlated to less pain. Treatment A must necessarily be reevaluated taking into account proper controls as well as age and affected dermatomes. PMID: 368965 [PubMed - indexed for MEDLINE] 6011. Med Pediatr Oncol. 1979;7(3):285-97. The incidence of post-splenectomy sepsis and herpes zoster in children and adolescents with Hodgkin disease. Green DM, Stutzman L, Blumenson LE, Brecher ML, Thomas PR, Allen JE, Jewett TC, Freeman AI. The occurrence of sepsis due to Streptococcus pneumoniae and Hemophilus influenza and of herpes zoster (HZ) was reviewed in a series of 72 consecutive, previously untreated children and adolescents with Hodgkin disease. There was not a statistically significant difference in the risk of developing sepsis within five years of diagnosis between patients who had (16.6%) or had not (6.2%) undergone splenectomy. Sepsis occurred most frequently among patients treated initially with total nodal irradiation and combination chemotherapy. The estimated risk of HZ during the first five years after diagnosis was 34%. Patients treated initially with irradiation and combination chemotherapy had a significantly greater risk of developing HZ than patients treated initially with only irradiation (P less than 0.05). Although trends were present which suggested that splenectomy and the extent of disease at diagnosis may influence the occurrence of HZ, these did not achieve statistical significance. Survival was not influenced by the occurrence of HZ. PMID: 317350 [PubMed - indexed for MEDLINE] 6012. Trans Ophthalmol Soc N Z. 1979;31:64-8. Assessment of cytosine arabinoside in the management of herpes zoster ophthalmicus. Wellings PC. PMID: 316216 [PubMed - indexed for MEDLINE] 6013. Rev Stomatol Chir Maxillofac. 1979;80(5):239-41. [Zoster ophthalmicus : a problem in general practice (author's transl)] [Article in French] Laufer J, Tsamis JD. The authors describe several cases of zoster, including some patients who developed skin or bone necrosis, and discuss the principal therapeutics proposed at the present time. PMID: 315093 [PubMed - indexed for MEDLINE] 6014. J Pediatr Ophthalmol Strabismus. 1979 Jan-Feb;16(1):33-4. Isolated pupillary paralysis in a case of herpes zoster. Sen DK. The clinical findings in a 16-year-old boy with unilateral isolated pupillary paralysis in a case of herpes zoster ophthalmicus is described because of the extreme rarity of the condition. The condition appeared to be due to a partial third nerve lesion affecting only the fibers subserving the light and near reflexes. PMID: 312315 [PubMed - indexed for MEDLINE] 6015. Am J Med. 1979 Jan;66(1):3-5. Interferons. Tamm I, Sehgal PB. PMID: 283690 [PubMed - indexed for MEDLINE] 6016. Med Microbiol Immunol. 1979;167(4):275-83. Infection and persistence of varicella-zoster virus in lymphoblastoid Raji cell line. Leventon-Kriss S, Gotlieb-Stematsky T, Vonsover A, Smetana Z. Infection of Raji cells by varicella-zoster virus (VZV) resulted in permissive infection with establishment of a persistently infected lymphoblastoid cell line. VZV antigens of the membrane and nuclear type, as detected by the indirect immunofluorescence membrane antigen (IFAMA) and anticomplement immunofluorescence (ACIF) tests, were observed. Minute amounts of infectious virus were detected by co-cultivation of VZV-infected Raji cells (Raji-VZV), with permissive human embryo fibroblasts (HEF). The virus isolated was found to be similar to the parent strain. Transient induction of Epstein-Barr viral capsid antigen (EB-VCA) was also observed. The persistently infected Raji-VZV cell line, when free of EB-VCA, was found suitable for measuring antibodies to varicella-zoster virus. The possible interaction in the infected Raji cells between EBV, which is implicated in human malignancy, and VZV which belongs also to the herpes group of viruses, is discussed. PMID: 232537 [PubMed - indexed for MEDLINE] 6017. J Hyg Epidemiol Microbiol Immunol. 1979;23(3):332-9. Radioimmunoassay for antibodies in varicella-zoster virus serology. Trlifajova J, Pokorný J, Nĕmecek V, Ryba M. The method of RIA for antibodies was employed with success in VZ virus serology. The method is suitable for testing VZ antibodies in the course of varicella or herpes zoster disease as well as for determining anamnestic titres. Its advantages are stability of antigen, objective reading of results and applicability to testing large serum sets. PMID: 231068 [PubMed - indexed for MEDLINE] 6018. Electrodiagn Ther. 1979;16(4):185-209. [Electrotherapy of peripheral nerve disorders] [Article in French] Dumoulin J, de Bisschop G. PMID: 230956 [PubMed - indexed for MEDLINE] 6019. Adv Ophthalmol. 1979;38:288-96. Developmental aspects of adenine arabinoside for parenteral therapy of human herpesvirus infections. Whitley RJ, Alford CA. PMID: 230722 [PubMed - indexed for MEDLINE] 6020. Zh Nevropatol Psikhiatr Im S S Korsakova. 1979;79(8):1011-6. [Pathogenetic analysis of the Ramsay Hunt syndrome] [Article in Russian] Umanskiĭ KG, Smirnov IuK, Shishov AS. PMID: 225911 [PubMed - indexed for MEDLINE] 6021. Int Ophthalmol Clin. 1979 Summer;19(2):135-67. Ocular surface manifestations of the major viruses. Chu W, Pavan-Langston D. The ocular surface is often the first site of involvement by viral infections. Background information, clinical presentations, and current treatment of three major viruses--herpes simplex, varicella-zoster, and adenovirus, have been presented in detail in this chapter. The effects of adenoviruses are usually transient and may be regarded as a nuisance. Infection with herpes simplex or varicella-zoster may lead to prolonged activity of the disease and life-long treatment with occasional loss of useful vision. It is apparent that our understanding of the clinical behavior of the major viruses has increased in recent years. Therapeutic criteria and modalities have also improved for some of the complications of the viruses. Much work needs to be done for some of the other manifestations, i.e., failure of reepithelialization, stromal melting, scarring, vascularization, and inflammation. PMID: 222704 [PubMed - indexed for MEDLINE] 6022. Indian J Ophthalmol. 1979 Jan;26(4):50-1. Herpes zoster in children. Gupta S, Soodan SS, Pahda SP, Bali FS. PMID: 220193 [PubMed - indexed for MEDLINE] 6023. J Clin Microbiol. 1979 Jan;9(1):1-10. Sensitive solid-phase radioimmunoassay for detection of human immunoglobulin G antibodies to varicella-zoster virus. Friedman MG, Leventon-Kriss S, Sarov I. A sensitive solid-phase radioimmunoassay for detection of antibodies to varicella-zoster virus (VZV) is described. The antigen consisted of a sonically disrupted extract of VZV-infected human embryo cells. 125I-labeled rabbit anti-human immunoglobulin G (IgG) specific for the Fc portion of human IgG was used to detect human IgG bound to viral antigen. With this technique, 193 human sera were evaluated for their IgG antibody titer against ZVZ. Subjects included 62 healthy adults, 33 young children (12 healthy), and 49 patients. Titers obtained by the radioimmunoassay were compared with those obtained by indirect fluoresence antibody staining of membrane antigen. The radioimmunoassay technique described gave titers approximately 5 X 10(4) times higher than those shown by indirect fluorescence. It can be used for routine diagnosis, but is especially suited to determining immune status to VZV, as defined by presence or absence of antibodies to the virus; for epidemiological studies; or for determining patients at risk who are exposed to the virus. No heterotypic titer rises to VZV were observed in sera with fourfold or greater rises to Epstein-Barr virus or cytomegalovirus. Sera of eight subjects with fourfold or greater titer rises to herpes simplex virus reacted in various ways: in six cases no significant change occurred in titer to VZV; one had a significant decrease in titer by the radioimmunoassay; and one had a significant increase. Possible reasons for these titer changes are discussed. PMCID: PMC272947 PMID: 219015 [PubMed - indexed for MEDLINE] 6024. Arch Virol. 1979;59(1-2):59-67. Differences in antibody responses in varicella, herpes zoster and after vaccination. Kimoto T, Kurimura T. Difference in antibody responses between varicella and herpes zoster was reconfirmed by complement fixation (CF) test and by platelet aggregation (PA) test. Rise in PA antibody level was observed only in patients with herpes zoster, but not in patients with varicella, while the increase in CF antibody was demonstrated in both types of the diseases. Among 235 healthy children, CF antibody was detected in 42 children and out of these 25 also had PA antibody. Sera of 116 individuals who were vaccinated with a live vaccine comprised of varicella-herpes zoster virus (VZV) were tested for CF and PA antibodies. Within six months after vaccination, 81.3 per cent of the vaccinees demonstrated the rise in CF antibody alone, and only one vaccinee possessed low level of PA antibody. Six months to 1 year after vaccination, CF antibody in 12 out of 13 vaccinees fell to undetectable level. Later than 1 year after vaccination, 9 out of 28 vaccinees possessed CF antibody. Two out of these 9 vaccinees also had PA antibody. The PA antigens prepared from viruses isolated either from a varicella patient or a herpes zoster patient responded similarly to the sera of herpes zoster patients, but no response was detected with sera of varicella patients. PA and CF antibody titers of herpes zoster patients showed a high degree of correlation. PMID: 218537 [PubMed - indexed for MEDLINE] 6025. Clin Lab Haematol. 1979;1(2):95-107. Allogeneic bone marrow transplantation for severe aplastic anaemia--the London experience. Barrett AJ. Using the Seattle protocol with minor modifications, 23 patients with severe aplastic anaemia received allogeneic bone marrow transplants from HLA/mixed leucocyte culture matched sibs in three London centres between 1973 and 1977. Ten patients (43.5%) are alive 6 months to 5 years after transplantation, and are well with full haemopoietic reconstitution, two with autologous bone marrow recovery following the graft procedure. A failure of the marrow graft to take, or take followed by rejection occurred in 12 patients (52%). Failure of marrow recovery was associated with a high early mortality from bacterial or fungal infection. The only survivors amongst those who rejected the first graft were four patients in whom a subsequent graft from the same donor was successful, and two in whom autologous recovery occurred. Graft versus host disease (GVHD) occurred in seven patients, and was fatal in one case. The most frequent complication after successful engraftment was varicella-zoster infection which occurred in five patients and was fatal in one patient. The overall results compare favourably with those from other transplant centres, but the high rate of graft rejection and low incidence of GVHD differ from other series. The results should encourage further referral of patients with severe AA for bone marrow transplantation. PMID: 43792 [PubMed - indexed for MEDLINE] 6026. S Afr Med J. 1978 Dec 30;54(27):1119. [Griseofulvin in the treatment of herpes zoster] [Article in Afrikaans] Nel PD. PMID: 746474 [PubMed - indexed for MEDLINE] 6027. Soins. 1978 Dec 20;23(24):27-30. [Herpes] [Article in French] Lachiver LD, Laverdet C. PMID: 227119 [PubMed - indexed for MEDLINE] 6028. West J Med. 1978 Dec;129(6):465-8. Herpes zoster. Reuler JB. Herpes zoster is a disorder frequently encountered in adults. The natural history is often poorly appreciated and management is frustrating. Recent studies have critically evaluated newer therapeutic modalities. The epidemiology, clinical manifestations, complications and therapeutic alternatives of herpes zoster deserve review. PMCID: PMC1238433 PMID: 735044 [PubMed - indexed for MEDLINE] 6029. Cesk Dermatol. 1978 Dec;53(6):363-6. [Immunological investigation of patients with herpes zoster. II. Autoimmune reactions (author's transl)] [Article in Czech] Doutlík S, Vacek Z, Hanáková L, Vasícková M. PMID: 729021 [PubMed - indexed for MEDLINE] 6030. Internist (Berl). 1978 Dec;19(12):659-63. [Interferon: its effects and clinical application] [Article in German] Siegert R. PMID: 370046 [PubMed - indexed for MEDLINE] 6031. Pain. 1978 Dec;5(4):367-71. Chlorprothixene (taractan) in post-herpetic neuralgia and other severe chronic pains. Nathan PW. Two trials of chlorprothixene were carried out, mainly on patients with moderate to severe post-herpetic neuralgia. When the drug was given as 50 mg b.d. to outpatients, unpleasant side-effects were more important than slight effects in alleviating pain. When the drug was given as 50 mg 6 hourly to inpatients for 5 days only, there was alleviation of constant chronic pain in a third of the patients; the effect is still lasting over a period of months in a few patients. The side-effects during the course of treatment are prominent. It is concluded that the drug is worth trying in the course recommended by Farber and Burks [1] when other means of controlling postherpetic neuralgia have failed. It would be best to give the course only to inpatients. PMID: 368703 [PubMed - indexed for MEDLINE] 6032. Med Microbiol Immunol. 1978 Nov 17;166(1-4):177-86. Detection of antibodies to varicella zoster virus by radioimmunoassay and enzyme immunoassay techniques. Friedman MG, Haikin H, Leventon-Kriss S, Joffe R, Goldstein V, Sarov I. An enzyme assay for the detection of antibodies to varicella-zoster membrane antigen (IPAMA) and a solid phase radioimmunoassay (RIA) which utilizes infected cell lysates as antigen are described. The results have been compared with those obtained by the indirect fluorescent antibody to membrane antigen (IFAMA) technique. It was found that IPAMA was equal in sensitivity to IFAMA. No cross-reactivity was found with other herpes group viruses. The IPAMA appears to give objective results, is easily and rapidly performed, and is recommended as a routine test for serological diagnosis of varicella-zoster infection. The RIA method is about 100 times more sensitive than IPAMA and IFAMA. The RIA is specific and has the potential of determining lower levels of antibody than other serological methods currently in use. PMID: 82905 [PubMed - indexed for MEDLINE] 6033. Sem Hop. 1978 Nov 8-15;54(37-40):1185-7. [Interest of the use of pain drug in hyperalgic ophthalmic herpes zoster (author's transl)] [Article in French] Salvadori M, Creisson G. In ophthalmic herpes, very frequent residual pain may be the cause of severe facial neuralgia which may persist for many years. These cases of neuralgia often occur in the elderly and raise difficult therapeutic problems. Tiapride which is a neuro-visceral mediator of the substituted benzamide family gave excellent results in 3 cases of ophthalmic herpes zoster in the elderly. The dosage was 200 to 300 mg daily by the intramuscular route, then by the oral route. Tolerance was excellent. PMID: 33451 [PubMed - indexed for MEDLINE] 6034. Vopr Virusol. 1978 Nov-Dec;(6):742-3. [Prospects for the clinical use of interferon] [Article in Russian] [No authors listed] PMID: 749355 [PubMed - indexed for MEDLINE] 6035. Rocky Mt Med J. 1978 Nov-Dec;75(6):317-9. Myelopathy associated with Herpes Zoster. Cole M. PMID: 725440 [PubMed - indexed for MEDLINE] 6036. Am J Med. 1978 Nov;65(5):738-44. Herpes zoster at the NIH: a 20 year experience. Mazur MH, Dolin R. One hundred and seven cases of herpes zoster in a hospitalized population with a variety of illnesses during a 20 year period were reviewed. Zoster occurred throughout the year, without seasonal predominance, and was most frequent in lymphoproliferative malignancy. In the majority, lesions were confined to the skin in one or more adjacent dermatomes (localized zoster) and were most frequent in the thoracic region. In 15 per cent of the cases, cutaneous dissemination of the lesions developed; this occurred four to 11 days after the onset of dermatomal lesions, and in one-third of these there was central nervous system involvement. Dissemination of zoster, however, directly resulted in only one death. Predisposing factors for zoster included local irradiation and, occasionally, surgery in subsequently involved areas. There were trends for more frequent splenectomies in patients with Hodgkin's disease in whom zoster subsequently developed, and for more frequent corticosteroid therapy in patiens with disseminated zoster. Advanced stage of Hodgkin's disease, in itself, was not associated with development of zoster, and the onset of zoster did not herald a poor prognosis for the underlying disease. Herpes zoster was, thus, largely a source of increased morbidity rather than mortality in the population studied, and multiple factors appeared to predispose to the development of zoster in this group of patients. PMID: 581329 [PubMed - indexed for MEDLINE] 6037. Am J Ophthalmol. 1978 Nov;86(5):611-4. Peripheral corneal ulcers with herpes zoster ophthalmicus. Mondino BJ, Brown SI, Mondzelewski JP. Four patients with herpes zoster ophthalmicus developed peripheral corneal ulcers with steep central edges. An anterior uveitis was associated with all cases. One patient developed bilateral corneal ulcers that were typical of Mooren's ulcer and eventually destroyed both corneas. The other three cases were unilateral and were not relentlessly progressive. PMID: 309729 [PubMed - indexed for MEDLINE] 6038. Zh Mikrobiol Epidemiol Immunobiol. 1978 Nov;(11):121-4. [Several epidemiologic features of the spread of chickenpox and herpes zoster] [Article in Russian] Shargorodskaia VA, Baronin AV. Epidemiological and statistical data of herpes zoster and chickenpox by such indices as morbidity level, periodicity and month-by-month changes in the incidence of these diseases were compared. The study included 2345 herpes zoster and 11116 chickenpox cases in the course of 5 years (1972--1976). In comparison with herpes zoster, the intensity of chickenpox spread among the population was on the average 4.7 times greater. Of the total number of chickenpox cases the percentage of herpes zoster contituted 21.0. Chickenpox morbidity had marked seasonal cyclic nature with the amplitude of seasonal variations of about 8; as to herpes zoster--there was no annual or seasonal cyclicity. Thus, in the development of chickenpox and herpes zoster epidemic process there was revealed a peculiar tendency inherent to each of these infections; no common epidemiological and statistical regularities in the spread intensity, annual periodicity and seasonal cyclicity were detected. PMID: 153076 [PubMed - indexed for MEDLINE] 6039. Mil Med. 1978 Nov;143(11):788-9. Genital Herpes Zoster: a case resembling primary herpes progenitalis with distal urethral involvement. Robinson TA, Kuruc SG, Knauf SP. PMID: 101907 [PubMed - indexed for MEDLINE] 6040. Minerva Chir. 1978 Oct 15;33(19):1325-38. [False acute abdomen] [Article in Italian] Quarti-Trevano GM, Pagani M, Poma S, Bruni M, Lochis D, Bracale M, Salvini A. PMID: 692915 [PubMed - indexed for MEDLINE] 6041. S Afr Med J. 1978 Oct 14;54(16):638. [Griseofulvan in the treatment of herpes zoster] [Article in Afrikaans, English] [No authors listed] PMID: 741272 [PubMed - indexed for MEDLINE] 6042. Med Klin. 1978 Oct 13;73(41):1437-41. [Infectious urethritis] [Article in German] Qadripur SA. PMID: 703671 [PubMed - indexed for MEDLINE] 6043. Med J Aust. 1978 Oct 7;2(8):387. Herpes zoster followed by "spontaneous" perforation of the colon. Evans DJ. PMID: 310506 [PubMed - indexed for MEDLINE] 6044. Isr J Med Sci. 1978 Oct;14(10):1014-8. The relation between therapy and herpes zoster in Hodgkin's disease. Ramot B, Modan M, Berkowicz M, Meytes D, Shochat J. The rate of occurrence of herpes zoster (HZ) was analyzed by the life table method in 108 Hodgkin's disease (HD) patients, diagnosed and treated during the years 1969 to 1976. Three groups, divided according to the degree of severity of the disease, were compared. The cumulative rate of occurrence of HZ at the end of the third year after diagnosis was higher in the group with intermediately extensive disease than in that with the most extensive disease (35 vs. 23%), but the difference was not significant. At the end of the fifth year, the rate was almost identical in both groups (35.3 and 35.6%, respectively). The group with the least severe form of HD had a very low HZ rate (2.2%), which was significantly different from the other two groups and close to the rate reported for normal populations. The five-year mortality rate was 0.0, 20.3 and 40.6%, respectively, in the three groups. These findings were interpreted to mean that in more advanced stages of HD, therapy and not the severity of the disease is the main factor determining the incidence of HZ. Extended field irradiation followed by a few courses of combined chemotherapy appear to have an effect similar to that of prolonged chemotherapy. PMID: 738866 [PubMed - indexed for MEDLINE] 6045. Mo Med. 1978 Oct;75(10):515-8. Herpes zoster in Hodgkin's disease. Mill WB, Frisse ME. PMID: 703748 [PubMed - indexed for MEDLINE] 6046. Arch Pathol Lab Med. 1978 Oct;102(10):527-9. Glomerulonephritis with Hodgkin's disease and herpes zoster. Ma KW, Golbus SM, Kaufman R, Staley N, Londer H, Brown DC. A patient who had been treated for Hodgkin's disease was infected with herpes zoster. Shortly thereafter, glomerulonephritis mediated by anti-glomerular basement membrane (anti-GBM) antibody occurred. The diagnosis was confirmed by the presence of circulating anti-GBM antibody, immunofluorescence, and elution. Results of immunofluorescence of a lymph node disclosed deposits of IgG on the vascular and stromal connective tissue, in a pattern similar to that seen when heterologous anti-GBM antibody reacted with the node. Because of the known nephritogenic potential of solid lymphoid tissues, this finding suggests a possible relationship between his tumor and his glomerular disease. The role of zoster infection remains undefined. PMID: 581342 [PubMed - indexed for MEDLINE] 6047. Zh Mikrobiol Epidemiol Immunobiol. 1978 Oct;(10):58-61. [Clinical immunological characteristics of herpes zoster] [Article in Russian] Smirnov IuK, Shishov AS, Mal'tseva NN. Changes of antibody formation of 96 patients with various clinical forms of herpes zoster were traced by indirect hemagglutination inhibition test. Four variants of the immunological response were distinguished; clinical characteristics of each of these groups is presented. The initial antibody level failed to determine the severity of the course of the disease in herpes zoster. PMID: 218405 [PubMed - indexed for MEDLINE] 6048. Dermatol Monatsschr. 1978 Oct;164(10):715-9. [Transketolase activity as a parameter for the vitamin B1 provision in some dermatoses (herpes zoster, psoriasis, drug eruptions, excema, and urticaria) (author's transl)] [Article in German] Grimm U, Brömmel C, Külbel P. PMID: 153861 [PubMed - indexed for MEDLINE] 6049. N Engl J Med. 1978 Sep 21;299(12):664. Sympathetic block for herpes zoster. DeBacker LJ. PMID: 683246 [PubMed - indexed for MEDLINE] 6050. Arthritis Rheum. 1978 Sep-Oct;21(7):798-802. Herpes zoster in patients with systemic lupus erythematosus. Moutsopoulos HM, Gallagher JD, Decker JL, Steinberg AD. In the context of prospective trials of immunosuppressive drugs in systemic lupus erythematosus (SLE) nephritis, 83 patients were studied with regard to development of herpes zoster. Herpes zoster was found to occur with high frequency (21%) in patients with SLE nephritis treated with immunosuppressive agents. The course of herpes zoster was benign: no deaths occurred and only 2 of the 18 patients developed generalized disease, which resolved without sequelae. Specific antiviral therapy was not necessary and there appears to be no need to decrease immunosuppressive medications. Zoster occurred when the SLE was relatively inactive and did not exacerbate the SLE. No statistical difference in the incidence of zoster was found among the patient groups treated with different immunosuppressive regimens. PMID: 697950 [PubMed - indexed for MEDLINE] 6051. Arch Dermatol. 1978 Sep;114(9):1383. Granuloma annulare at sites of healing herpes zoster. Guill MA, Goette DK. PMID: 686755 [PubMed - indexed for MEDLINE] 6052. J Dent Assoc Thai. 1978 Sep-Oct;28(5):182-8. [Oral herpes zoster] [Article in Thai] Srisuwan S, Sittikong M. PMID: 291608 [PubMed - indexed for MEDLINE] 6053. Trans Ophthalmol Soc U K. 1978 Sep;98(3):343-7. Role of the corneal nerves in destructive disease of the cornea. Mackie IA. PMID: 224534 [PubMed - indexed for MEDLINE] 6054. Ann Intern Med. 1978 Sep;89(3):375-88. NIH conference. Herpes zoster-varicella infections in immunosuppressed patients. Dolin R, Reichman RC, Mazur MH, Whitley RJ. PMID: 210697 [PubMed - indexed for MEDLINE] 6055. South Med J. 1978 Sep;71(9):1134-40. Current status of antiviral chemotherapy. Whitley RJ, Alford CA. PMID: 210524 [PubMed - indexed for MEDLINE] 6056. EEG EMG Z Elektroenzephalogr Elektromyogr Verwandte Geb. 1978 Sep;9(3):172-8. [EMG-findings and nerve conduction velocity in herpes zoster disease (author's transl)] [Article in German] Risos A. We have performed a myography on three patients and an additional study of the nerve conduction velocity (CV) on two adult patients suffering from herpes zoster. It could be demonstrated that the affected muscles can suffer at the same time a neuropathy as well as a myopathy. We found fibrillations and CV-reduction also in clinically healthy nerves and muscles. The abnormal findings were most prominent in the clinically affected segments and often suggested an in portio lesion of the motor unit. The infiltration of the spinal ganglion appears to have no paramount significance for the understanding of this disease. PMID: 100313 [PubMed - indexed for MEDLINE] 6057. Cancer. 1978 Sep;42(3):1046-56. Hodgkin's disease: radiotherapeutic management at a cancer oriented community hospital. Saxe BI, Mandel PR. Seventy-eight patients with Hodgkin's disease were treated with radiation therapy between July 1966 and July 1976 (30 Stage I, 28 Stage II, 20 Stage III). The mean follow-up period is greater than 5 years. 90% of Stage I, 86% of Stage II, 65% of Stage III, and 82% (64/78) of all patients are NED after radiotherapy alone. Since laparotomy option (1970) 89% (50/56) of patients are NED. Fourteen patients were failures. Chemotherapy "rescued" 6 of 14. Seven have died, 1 is alive with disease, and 1 died of leukemia. Absolute survival is 90% (70/78). Failures were more frequent in patients with unfavorable histological types (9/14), and Stage III disease, primarily IIIS+ or B category (7/14). Sites of failures were mainly extranodal, primarily lung (10/14) and bone (2/14), and are consistent with hematogenous dissemination. Laparotomy performed in 41 patients identified unsuspected splenic involvement in 9 cases (22%), but was a distinct failure in confirming most "small node" positive lymphangiograms. Two patients developed acute myelocytic leukemia, both while NED 5 years posttherapy. One patient had also received adjunctive MOPP. There has been no impairment in the quality of survival that could be directly attributed to radiotherapy. PMID: 100196 [PubMed - indexed for MEDLINE] 6058. Antimicrob Agents Chemother. 1978 Sep;14(3):495-7. Inosiplex for localized herpes zoster in childhood cancer patients: preliminary controlled study. Feldman S, Hayes FA, Chaudhary S, Ossi M. By multiple criteria, inosiplex-a reputed stimulator of virus-sensitized lymphocytes-had no demonstrable therapeutic effects in a preliminary controlled study of patients with localized herpes zoster and cancer. Lymphocytes from the six drug-treated patients were no more responsive to varicella-zoster antigen and phytohemagglutinin than were lymphocytes from seven patients who received a placebo. PMCID: PMC352489 PMID: 81655 [PubMed - indexed for MEDLINE] 6059. S Afr Med J. 1978 Aug 26;54(9):368-9. Herpes zoster of the chest wall and gynaecomastia. A case report. Epstein S. Herpes zoster in a young male at puberty, associated with aggravation of gynaecomastia on the same side as the intercostal nerve involvement, is described. PMID: 715635 [PubMed - indexed for MEDLINE] 6060. Dtsch Med Wochenschr. 1978 Aug 25;103(34):1317-8. [Interferon: therapeutic uses in reach?] [Article in German] Lindenmann J. PMID: 679829 [PubMed - indexed for MEDLINE] 6061. Fortschr Med. 1978 Aug 24;96(32):1589-97. [The virostatic effect of adenine-arabinoside monophosphate. Experimental findings and preliminary clinical experiences] [Article in German] Werner GT, Bömer H, Metzger E, Sauer O, Schneider H, Schubert E, Treuner J. Adenine arabinoside (Ara-A), a synthetic nucleoside, is an antiviral agent, which is effective against poxviruses and viruses of the herpes group. The monophosphate (Ara-AMP) has the great advantage of better solubility, compared to the parent compound. Experimental studies show the outstanding effect of Ara-AMP on the encephalitis by vaccinia-virus in white mice. Even after immunesuppression by total body irradiation, the survival rate of the Ara-AMP treated animals was significantly higher compared to the untreated controls. In experimental vaccinia-virus infections in rabbits, who had undergone total body irradiation. Ara-AMP has a favourable influence upon the course of the disease and the prognosis. Some clinical observations in children with immunesuppression, who suffered from generalized zoster of varicella-infections, are reported. Furthermore in cases of viral encephalitis Ara-AMP was successful. Controlled studies of a greater number of patients on the therapeutic value of Ara-AMP in infections with DNS-viruses are needed. PMID: 680620 [PubMed - indexed for MEDLINE] 6062. S Afr Med J. 1978 Aug 5;54(6):224. Griseofulvin in the treatment of herpes zoster. Joubert JD. PMID: 715595 [PubMed - indexed for MEDLINE] 6063. Cancer. 1978 Aug;42(2):787-92. Childhood Hodgkin's disease in Uganda: a ten year experience. Olweny CL, Katongole-Mbidde E, Kiire C, Lwanga SK, Magrath I, Ziegler JL. Between 1967 and 1977, 48 patients with Hodgkin's disease under 16-years-old were treated with MOPP chemotherapy alone at the Uganda Cancer Institute because radiotherapy facilities are not available. Thirty-eight percent had early stage disease (stages I-IIIA). Prolonged first remissions were achieved in 74% of 42 complete responders. Of 11 patients who relapsed, 5 had prolonged second remissions induced by MOPP. Three patients were lost to follow-up and 15 of the remaining 45 died: 12 of these from progressive Hodgkin's disease, 2 from unrelated causes and 1 from Burkitt's lymphoma after 4 months remission from Hodgkin's disease. Acturial survival for all patients is 67% (75% for stages I-IIIA and 60% for stages IIIB-IV). Treatment complications included Herpes zoster and gynaecomastia. The latter is probably related to gonadal dysfunction. All stages of childhood Hodgkin's disease can be successfully managed with MOPP chemotherapy alone. PMID: 687386 [PubMed - indexed for MEDLINE] 6064. South Med J. 1978 Aug;71(8):909-10. Cytosine arabinoside for varicella zoster: a second look. DuBois RE. Herpes zoster and disseminated herpes zoster, or varicella (V-Z), continue to be dreaded complications of patients with immunosuppression. Currently, there is no available therapy for V-Z, except for general supportive measures. Seven cases of V-Z are presented, showing the results of cytosine arabinoside administration when given as an intermittent intravenous infusion. The results compare favorably with previously unsuccessful continuous intravenous infusion. It is suggested that further evaluation of the intermittent administration of cytosine arabinoside for V-Z would be worthwhile. PMID: 684470 [PubMed - indexed for MEDLINE] 6065. Cancer. 1978 Aug;42(2):437-41. Complications of total nodal irradiation of Hodgkin's disease stages III and IV. Poussin-Rosillo H, Nisce LZ, Lee BJ. One hundred twenty-seven patients with Hodgkin's disease, Stages III-IV, received total nodal irradiation. Of these, 101 patients were managed primarily by radiation therapy employing the split course sequential segmental radiation technique called the "3 & 2". A dose of 3800-4000 rad is delivered in 2 phases in an overall period of 12 to 13 weeks (TDF 61-64; 1094-1148 rets). For various reasons, the remaining 26 patients received their mantle irradiation to full doses 3800-4000 rad in 4 weeks (TDF 63-66; 1112-1184 rets) without rest periods and a few were irradiated after failing chemotherapy. Of the 101 patients treated between 1969-1974 using the "3 & 2" technique, 2 developed pericarditis (2.0%), none manifested symptomatic pneumonitis (0%), and 3 hypothyroidism )3.0%). The low incidence of severe complications is primarily the result of the technique employed to give total nodal irradiation. The overall incidence of Herpes Zoster was 42% (53/127), and there was a slightly higher incidence when TNI was given following splenectomy. PMID: 679147 [PubMed - indexed for MEDLINE] 6066. J Fr Ophtalmol. 1978 Aug-Sep;1(8-9):535-45. [Viral infections of the anterior segment (author's transl)] [Article in French] Lagoutte F. A focus on the pathogenesis, clinical manifestations and therapy. Contemporary ideas on viral infections of the anterior segment are examined.--The pathogenesis of lesions (viral activity, delayed hypersensitivity reaction), the clinical aspects of herpes infections of the anterior segment are the result of the relative importance of these two factors. Schematically--dendritic keratitis infiltrates and stromal necrosis and hypopion represent active viral infection. Disciform keratitis, oedematous keratitis, serous iridocyclitis represent delayed hypersensitivity reaction. Corticosteroids are contrindicated in the former cases and recommended in the latter.--Special features concerning zoster inflammations of the anterior segment are considered.--An important number of adenoviral anterior segment infections are also reported and their benign nature stressed. PMID: 152779 [PubMed - indexed for MEDLINE] 6067. Arch Dermatol Res. 1978 Jul 28;262(2):173-6. Double blind trial in the treatment of herpes simplex and herpes zoster with adenine arabinoside and idoxuridine. Theodoridis A, Sivenas C, Vagena A, Capetanakis J. In a double blind trial adenine arabinoside (Vidarabine) and Idoxuridine (IDU) were tested in herpes simplex and herpes zoster infections. Adenine arabinoside covered 19 patients with HSV and 6 with HZ while IDU 19 with HSV and 6 with HZ. From the statistical analysis it was found that Vidarabine acts shorter than IDU in HSV P less than 0.01, while in HZ no significant difference P less than 0.5 was found, possibly due to the small number of patients tested. PMID: 356754 [PubMed - indexed for MEDLINE] 6068. Minerva Med. 1978 Jul 21;69(35):2391-4. [A case of the Ramsay-Hunt syndrome (herpes zoster of the geniculate ganglion) with concomitant C2 and C3 nerve involvement] [Article in Italian] Cimino T, Giacobbi D. A case of Ramsay-Hunt syndrome (herpes zoster of the genicular ganglion with paresis of the facial nerve) presenting concomitant involvement of the sensitive nerve roots C2 and C3 is reported. The main aetiopathogenetic hypotheses as reported in the literature are presented and an attempt made to formulate a standard aetiopathogenetic theory comprising lesions to the motor nerve fibres and those of the sensitive nerve fibres. PMID: 683589 [PubMed - indexed for MEDLINE] 6069. N Engl J Med. 1978 Jul 20;299(3):130-2. Current concepts in ophthalmology. Uveitis and the immunologically compromised host. O'Connor GR. PMID: 307182 [PubMed - indexed for MEDLINE] 6070. Schweiz Rundsch Med Prax. 1978 Jul 18;67(29):1064-73. [Trigeminal neuralgia, diagnostic aspects and treatment (author's transl)] [Article in German] Mumenthaler M. PMID: 307757 [PubMed - indexed for MEDLINE] 6071. Lancet. 1978 Jul 8;2(8080):84. Interferon treatment of herpes zoster. [No authors listed] PMID: 78306 [PubMed - indexed for MEDLINE] 6072. Surg Neurol. 1978 Jul;10(1):50-3. Pathological studies of spinal nerve ganglia in relation to intractable intercostal pain. Smith FP. Pathological examination, by light and electron microscopy, of spinal nerve ganglia surgically removed in treatment of intractable intercostal pain, has shown changes in sensory cells, whether the etiology of the pain has been trauma related to intercostal nerve, or infection by herpes zoster virus. The possible role of the sensory cell changes in accounting for causalgic type pain is discussed. PMID: 684607 [PubMed - indexed for MEDLINE] 6073. Arch Ophthalmol. 1978 Jul;96(7):1233-5. Isolated trochlear nerve palsies in herpes zoster ophthalmicus. Grimson BS, Glaser JS. The clinical course of six patients with isolated trochlear nerve palsy as the only ocular motor manifestation of herpes zoster ophthalmicus has been analyzed. Spontaneous recovery occurred in only three. Review of the literature does not clarify the mechanism of such palsies, which potentially may result from the following conditions: local orbital muscle inflammation and ischemia; contiguous intracavernous spread of inflammation from the trigeminal nerve; and a concurrent but independent motor neuropathy or ganglionitis. PMID: 307378 [PubMed - indexed for MEDLINE] 6074. Dent Update. 1978 Jul-Aug;5(5):295, 298-311. Oral manifestations of communicable diseases. Scully C, Williams G. PMID: 290541 [PubMed - indexed for MEDLINE] 6075. Am J Clin Pathol. 1978 Jul;70(1 Suppl):170-4. Varicella-zoster virus. Prospects for active immunization. Gershon AA. A live attenuated varicella-zoster (V-Z) virus vaccine has been developed and tested by Dr. M. Takahashi and his colleagues in Japan. This vaccine appears to prevent varicella and is associated with minimal side effects even in patients at high risk to develop severe varicella. Antibody to V-Z virus appears after V-Z vaccination. This antibody has been detected by a variety of serologic technics, and it has been demonstrated to persist for as long as two years after vaccination. Thus far, V-Z vaccine has not been associated with subsequent zoster, but long-term studies will be required before this possibility can be ruled out. PMID: 210654 [PubMed - indexed for MEDLINE] 6076. Cutis. 1978 Jul;22(1):61-4. Cytologic examination and viral and bacterial culture in herpes simplex, herpes zoster, and varicella. Veien NK. Cytologic examination of epithelial cells from the base of vesicles, virus isolation, and bacterial culture were carried out in thirty-one patients with herpes simplex, in eleven patients with herpes zoster, and in three patients with varicella. Determination of herpes simplex complement fixation reaction was made in the patients with herpes simplex. Cytologic manifestations consistent with herpes were found 65 percent of patients with herpes simplex, while herpesvirus hominis was isolated in 77 percent of these patients. Diagnostic cytologic manifestations were found in 82 percent of the patients with herpes zoster or varicella. Varicella-zoster virus was isolated in 27 percent of these patients. The presence of pathogenic bacteria did not seem to influence the frequency of virus isolation or finding of characteristic cytologic features. PMID: 208820 [PubMed - indexed for MEDLINE] 6077. Cancer. 1978 Jul;42(1):159-63. Cell-mediated immunity to varicella zoster virus in children being treated for cancer. Hayes FA, Feldman S. Stimulation of lymphocytes by varicella-zoster virus (VZV) antigen was measured in vitro for 37 healthy adults and children and for 35 children who developed herpes zoster or varicella while receiving anticancer therapy. For 35 of the control group the history of varicella infection correlated with the in vitro response of lymphocytes to VZV antigen. A specific lymphocyte response was observed following 32 of the 37 episodes of VZV infection in the 35 children with malignancy. Re-evaluation 7--12 months following the acute infection revealed that the in vitro response to VZV antigen was lost in six of 19 patients who remained in remission and in all patients who relapsed and received reinduction therapy. Although there was some suggestion that development of a cell mediated response early in the infection decreased the incidence of skin dissemination of the virus in herpes zoster, no consistent correlation could be made between lymphocyte responsiveness in vitro and dissemination of disease or the duration of the appearance of new lesions. PMID: 208747 [PubMed - indexed for MEDLINE] 6078. Fortschr Med. 1978 Jun 15;96(23):1253. [Treatment of herpes simplex] [Article in German] [No authors listed] PMID: 658878 [PubMed - indexed for MEDLINE] 6079. MMW Munch Med Wochenschr. 1978 Jun 2;120(22):757-60. [Improvement of zoster therapy by adamantine] [Article in German] Barolin GS, Saurugg D, Zechner G. In the course of 3 years we observed a considerable improvement of herpes zoster in 44 patients being treated with amantadine. The periods of pain and efflorescence were shortened to 1/3 of the values usually experienced and painful post-zoster complications did not occur. The therapeutic effect depends on a) beginning treatment with high doses as early as possible, b) combination of local and systemic administration of adamantine, c) continuation of treatment for several weeks with gradually reducing doses. Harmless side-effects which are easily controlled are dryness of mouth, slight fall in blood pressure and insignificant general stimulation. In old people half the standard dose should be given in the beginning and particular attention paid to symptoms of restlessness on account of a possible delirium. Severe disorders of renal function are a contraindication. PMID: 307138 [PubMed - indexed for MEDLINE] 6080. Prim Care. 1978 Jun;5(2):263-80. Cutaneous signs of internal malignant disease. Sibrack LA. An awareness of various dermatoses which reflect internal malignancy will facilitate the physician's ability to recognize or even anticipate malignant disease. There have been several previous reports on this subject. This review emphasizes the nonspecific cutaneous changes associated with malignancy. New skin markers of cancer are also discussed. PMID: 210475 [PubMed - indexed for MEDLINE] 6081. N Engl J Med. 1978 Jun 1;298(22):1239-41. Current concepts in ophthalmology: Corneal disease. Thoft RA. PMID: 206829 [PubMed - indexed for MEDLINE] 6082. Wien Klin Wochenschr. 1978 May 26;90(11):372-4. [Percutaneous cervical anterolateral cordotomy (author's transl)] [Article in German] Schröttner O. A brief history of percutaneous high cervical anterolateral cordotomy is followed by a review of the anatomy and neurophysiology of the spinothalamic tract. Then a report is presented of the results of 40 percutaneous cordotomies carried out on 32 patients at the Department of Neurosurgery, University of Graz. Operative procedure, indications and advantages of this functional operation are discussed. PMID: 276205 [PubMed - indexed for MEDLINE] 6083. ZFA (Stuttgart). 1978 May 20;54(14):783-94. [Radiotherapy of neurologic diseases] [Article in German] Walther E. PMID: 664824 [PubMed - indexed for MEDLINE] 6084. Minerva Med. 1978 May 5;69(22):1517-22. [Amyotrophy caused by herpes zoster. Description of 5 cases] [Article in Italian] Artuso G, Ferrari G, Fiaschi A. Radicular paralysis is the most frequent, though usually less serious, complication of Herpes Zoster, being observed in rather less than 5% of patients. The site affected--leaving aside exceptional cases--it that of the gangliar and radicular district where the eruption occurs. A clinical and neurophysiological study was made of 5 patients with loss of strength and trophism on the part of muscles in the eruption site within 2 to 5 weeks after the onset of Herpes. Routine blood chemistry tests were run, together with spinal puncture in three cases. The EMG data pointed to variously severe neurogenic distress referable to myeloradicular involvement. Subsequent clinical and EMG controls demonstrated gradual, though slow improvement. This finding is in line with the literature data. PMID: 683555 [PubMed - indexed for MEDLINE] 6085. JAMA. 1978 May 5;239(18):1877-9. Evaluation of zoster immune plasma. Treatment of cutaneous disseminated zoster in immunocompromised patients. Groth KE, McCullough J, Marker SC, Howard RJ, Simmons RL, Najarian JS, Balfour HH Jr. Zoster immune plasma (ZIP) was evaluated for treatment of cutaneous disseminated zoster in immunocompromised hosts. Twenty patients were studied: 13 were enrolled in a double-blind protocol, five received ZIP under an open protocol, and two were observed without receiving a transfusion. In the double-blind study, eight patients actually received ZIP; five were given plasma lacking varicella-zoster virus antibodies (control plasma). The clinical course of zoster in the group given ZIP was the same as that of patients given control plasma or no transfusions. Because ZIP did not alter the clinical course of zoster and because zoster patients produced high-antibody titers without ZIP, we concluded that ZIP is not useful for treatment of cutaneous disseminated zoster and should be reserved for prevention or modification of varicella in exposed, susceptible immunocompromised patients. PMID: 205687 [PubMed - indexed for MEDLINE] 6086. N Engl J Med. 1978 May 4;298(18):981-7. Human leukocyte interferon for the treatment of herpes zoster in patients with cancer. Merigan TC, Rand KH, Pollard RB, Abdallah PS, Jordan GW, Fried RP. We tested the effect of human leukocyte interferon on early localized herpes zoster infections in three placebo-controlled, randomized double-blind trials involving 90 patients with cancer. There were no significant differences in pretreatment severity of infection or nature of underlying disease in the groups. Higher dosages of more purified interferon in the second and third trials produced a significant (P less than or equal to 0.01) decrease in cutaneous dissemination. No dissemination occurred in those receiving the highest dosage (5.1 x 10(5) U per kilogram per day) (P less than or equal to 0.025). The number of days of new-vesicle formation in the primary dermatome decreased (mean, 2.3 days, P less than or equal to 0.05) in this group. Treated patients had a trend toward less acute pain, and significantly (P less than or equal to 0.05) diminished severity of post-herpetic neuralgia, at the two highest dosage levels. Visceral complications were six times less frequent in interferon recipients. High-dosage interferon appeared effective in limiting cutaneous dissemination, visceral complications and progression within the primary dermatome. PMID: 347294 [PubMed - indexed for MEDLINE] 6087. Rev Laryngol Otol Rhinol (Bord). 1978 May-Jun;99(5-6):307-22. [Idiopathic facial paralysis and facial paralysis due to herpes zoster (follow-up and therapeutic indications)] [Article in French] Fleury P, Basset JM, Compère JF. PMID: 705103 [PubMed - indexed for MEDLINE] 6088. Aust Fam Physician. 1978 May;7(5):497-503. The long term complications of viral illness. Boughton CR. PMID: 666663 [PubMed - indexed for MEDLINE] 6089. Mayo Clin Proc. 1978 May;53(5):336-8. Herpes zoster reactivation of phantom limb pain. Wilson PR, Person JR, Su DW, Wang JK. A case is reported in which a herpes zoster infection caused recurrence of phantom limb pain in a man whose left arm had been amputated 7 years previously. It is, to our knowledge, the first such case reported, and it shows the importance of peripheral mechanisms in the generation of phantom limb pain. PMID: 642600 [PubMed - indexed for MEDLINE] 6090. Pediatr Clin North Am. 1978 May;25(2):339-55. Viral infections of the skin. Herpes simplex, herpes zoster, warts, and molluscum contagiosum. Jarratt M. PMID: 353674 [PubMed - indexed for MEDLINE] 6091. Practitioner. 1978 May;220(1319):723-33. Eye problems. Stokoe NL. PMID: 307244 [PubMed - indexed for MEDLINE] 6092. Stomatol DDR. 1978 May;28(5):318-25. [Pyoderma and dermatoviroses in the maxillofacial region] [Article in German] Kleine-Natrop HE. PMID: 276955 [PubMed - indexed for MEDLINE] 6093. Harefuah. 1978 Apr;94(7-8):243-4. [Treatment of herpes zoster and chicken pox] [Article in Hebrew] Rubinstein E. PMID: 669464 [PubMed - indexed for MEDLINE] 6094. Ann Neurol. 1978 Apr;3(4):374-5. Granulomatous angiitis with preceding varicella zoster. Rosenblum WI, Hadfield MG, Young HF. PMID: 666286 [PubMed - indexed for MEDLINE] 6095. Wiad Lek. 1978 Apr 1;31(7):477-8. [2 cases of Ramsay-Hunt syndrome] [Article in Polish] Marks E. PMID: 664679 [PubMed - indexed for MEDLINE] 6096. Probl Gematol Pereliv Krovi. 1978 Apr;23(4):48-51. [Herpes zoster in lymphogranulomatosis patients] [Article in Russian] Unukova EN, Kuznetsov VP, Kaverzneva MM. PMID: 652754 [PubMed - indexed for MEDLINE] 6097. JAMA. 1978 Mar 13;239(11):1034-5. Varicella-zoster virus vaccine. Brunell PA. PMID: 203727 [PubMed - indexed for MEDLINE] 6098. Ann Otolaryngol Chir Cervicofac. 1978 Mar;95(3):240-8. [Effect of herpes zoster virus on the facial nerve (apropos of 33 cases)] [Article in French] Brémond G, Garcin M, Magnan J, Pech-Gourg F, Acotto J. PMID: 666227 [PubMed - indexed for MEDLINE] 6099. Pediatr Pol. 1978 Mar;53(3):389-91. [Case of congenital zoster] [Article in Polish] Kacprzak-Bergman I, Jankowski A. PMID: 652428 [PubMed - indexed for MEDLINE] 6100. Arch Surg. 1978 Mar;113(3):253-4. Epidural injection of local anesthetic and steroids for relief of pain secondary to herpes zoster. Perkins HM, Hanlon PR. We treated 12 cases of cutaneous herpes zoster (HZ) with epidural bupivacaine and methylprednisolone acetate. Treatment was effective for HZ of less than seven weeks' duration. The course of HZ of greater than three months' duration (postherpetic neuralgia) was not improved. The administration of epidural bupivacaine plus methylprednisolone acetate was no more effective than when bupivacaine alone was used. Epidural injection of bupivacaine with or without methylprednisolone acetate is the treatment of choice for the pain of cutaneous HZ. PMID: 580364 [PubMed - indexed for MEDLINE] 6101. Bull Soc Ophtalmol Fr. 1978 Mar;78(3):241. [Blepharorraphy using fascia lata (proceedings)] [Article in French] Chassaing J. PMID: 311702 [PubMed - indexed for MEDLINE] 6102. Am J Ophthalmol. 1978 Mar;85(3):378-82. Orbital apex syndrome secondary to herpes zoster ophthalmicus. Kattah JC, Kennerdell JS. Two women, one with Hodgkin's disease and the other with no malignancy, developed herpes zoster with optic neuropathy and total ophthalmoplegia. Both patients developed an associated mild meningoencephalitis with a predominantly lymphocytic spinal fluid reaction that cleared spontaneously. The patient with Hodgkin's disease suffered a protracted course of the disease and developed a secondary bacterial endophthalmitis that necessitated an envisceration of the left eye. The patient without evidence of immunologic deficit recovered quickly with administration of corticosteroids. PMID: 306754 [PubMed - indexed for MEDLINE] 6103. Hautarzt. 1978 Mar;29(3):147-52. [Severe generalized courses of zoster due to cellular immunologic defects. Importance of an absolute or relative T-cell deficiency] [Article in German] Runne U. Four patients with chronic lymphatic leukaemia, M. Hodgkin and metastatic breast carcinoma developed particularly severe generalised herpes zoster, with complications of herpes zoster pneumonia, signs of encephalitis and phrenic nerve paresis. Virus specific complement-fixing antibodies increased regularly or delayed, without strict correlation to the clinical course. However, in all these cases there was a relative or absolute deficiency of T-lymphocytes in the peripheral blood, as a result of the underlying illness and of treatment with cytostatic agents. Because of the vital role of cell-mediated immunity in the control of the varicella-zoster virus (VZV), the observed T-cell deficiency seems to be an important pre-condition for the development of severe generalised herpes zoster. PMID: 305913 [PubMed - indexed for MEDLINE] 6104. Biken J. 1978 Mar;21(1):15-23. Studies on neutralization of varicella-zoster virus and serological follow-up of cases of varicella and zoster. Asano Y, Takahashi M. PMID: 208504 [PubMed - indexed for MEDLINE] 6105. Vopr Virusol. 1978 Mar-Apr;(2):247-51. [Rapid diagnosis of infections caused by the chickenpox-herpes zoster viruses] [Article in Russian] Mal'tseva NN, Marennikova SS, Ertte AP, Avdeenko MM. A diagnostic preparation for the indirect hemagglutination test (IHA) was obtained by sensitization of fixed tannin-treated sheep erythrocytes with IgG-fractions from human herpes zoster convalescent sera. A high specificity of the preparation was established in comparative experiments. It could detect the varicella-herpes-zoster virus antigen in 100% of specimens from patients. The IHA test with this erythrocyte diagnostic preparation is simple, economic, gives the results within 1-1 1/2 hours after the specimens arrive in the laboratory. A great advantage of this test ipesviruses. PMID: 208309 [PubMed - indexed for MEDLINE] 6106. Odontostomatol Proodos. 1978 Mar-Apr;32(2):68-75. [Clinical study of 227 cases of herpes zoster] [Article in Greek, Modern] Katsampas A, Laskares G, Kapetanakes I. PMID: 111183 [PubMed - indexed for MEDLINE] 6107. Br Med J. 1978 Feb 11;1(6109):343-4. Prognosis of the Ramsay Hunt syndrome. Heathfield KW, Mee AS. Thirty-six cases of herpes zoster complicated by facial paralysis (the Ramsay Hunt syndrome) seen over 10 years were reviewed to determine the subjective degree of recovery (ascertained by questionnaire) and residual disability (ascertained by re-examination). Eighteen patients made a full recovery, most within three months; 14 patients were left with only mild residual signs. In only four patients was the final result regarded as unsatisfactory. Outcome was not adversely influenced by age. The facial paralysis of the Ramsay Hunt syndrome thus carries a generally favourable prognosis. PMCID: PMC1602888 PMID: 623985 [PubMed - indexed for MEDLINE] 6108. JAMA. 1978 Feb 6;239(6):518-9. Ophthalmology. Blodi FC. PMID: 304494 [PubMed - indexed for MEDLINE] 6109. Otolaryngol Clin North Am. 1978 Feb;11(1):63-9. Viral causes of sudden inner ear deafness. Jaffe BF. Clinical, pathologic, and laboratory studies suggesting a viral etiology for sudden deafness have been presented. Although a cause and effect relationship has not been proven, the frequent close association between viral infection and sudden deafness constitutes a strong argument in favor of a viral etiology of sudden deafness in about one of three patients with sudden deafness. PMID: 662357 [PubMed - indexed for MEDLINE] 6110. Cesk Otolaryngol. 1978 Feb;27(1):29-32. [Association of herpes zoster with facial nerve paralysis] [Article in Czech] Hybásek I, Kristenová I. PMID: 657322 [PubMed - indexed for MEDLINE] 6111. Haematologica. 1978 Feb;63(1):56-60. Treatment with transfer factor of herpes zoster varicella infection in Hodgkin's disease. Silvino G, Rubertelli M, Cristofolini M, Sagramoso Z, Pisciolli F, Dalri P. PMID: 417972 [PubMed - indexed for MEDLINE] 6112. Klin Oczna. 1978 Feb;48(2):71-2. [Ophthalmic zoster treated with cytosine arabinoside (author's transl)] [Article in Polish] Peterlejtner E. PMID: 306475 [PubMed - indexed for MEDLINE] 6113. Oral Surg Oral Med Oral Pathol. 1978 Feb;45(2):214-9. Intraoral isolated herpes zoster. Eisenberg E. A case of herpes zoster limited to the right palate and the edentulous alveolar ridge in the absence of concurrent skin lesions or predisposing systemic disease is presented. Because of the relative rarity of isolated mucous membrane lesions of this viral disease, the tendency for intraoral vesicles to break down and ulcerate early, and, in this patient, the additional clinical findings of marked swelling and induration, malignancy rather than herpes zoster was suspected; cytologic smear furthered the suggestion of the former. A biopsy provided the definitive diagnosis. PMID: 272603 [PubMed - indexed for MEDLINE] 6114. J Clin Microbiol. 1978 Feb;7(2):114-7. Immune adherence hemagglutination test applied to the study of herpes simplex and varicella-zoster virus infections. Gillani A, Spence L. The immune adherence hemagglutination (IAHA) test has been used successfully to detect antibody to herpes simplex (HS) virus and varicella-zoster (V-Z) virus. Comparative studies between the complement-fixation (CF) test and the IAHA test revealed that, in most cases, the IAHA test was more sensitive than the CF test. Furthermore, diagnosis on the basis of a fourfold change in antibody titer was made more rapidly by the IAHA test. The IAHA test was found to be a very simple and practical technique requiring only a few hours for completion compared with the conventional CF test which required up to 24 h. In addition, both sera and cerebrospinal fluids could be tested in very low dilutions in the IAHA test, so that very low levels of antibody could be detected. Also, the IAHA test detected antibody to V-Z virus more frequently than did the CF test in adults with a history of varicella occurring 9 to 30 years prior to sampling. The level of cross-reaction between HS and V-Z viruses was examined by both the CF test and the IAHA test, and no major differences between the two techniques were found. PMCID: PMC274875 PMID: 204662 [PubMed - indexed for MEDLINE] 6115. J Fr Ophtalmol. 1978 Feb;1(2):133-8. [Light and electron microscopy in one case of herpes zoster keratitis (author's transl)] [Article in French] Berard M, Merlihot JM, Mouillac-Gambarelli N, Choux R, Andrac L. One case of herpes zoster keratitis studied after corneal graft is described. Light and electron microscopy investigations show severe pathological changes under the coneal epithelium: Bowman's layer disruption, superficial stromal alterations, sub-epithelial phagocyte proliferation with lipid and mucopolysaccharid vacuolar deposits, abnormal vascularization of the posterior stroma. The authors stress on this interesting ultrastructural study because of very rare cases of the same disease reported in the literature. PMID: 149810 [PubMed - indexed for MEDLINE] 6116. Br Med J. 1978 Jan 21;1(6106):177. Cervical herpes zoster and shoulder pain. Eban R. PMCID: PMC1602824 PMID: 620251 [PubMed - indexed for MEDLINE] 6117. Br Med J. 1978 Jan 7;1(6104):49. Bell's palsy and herpes simplex. Juel-Jensen BE. PMCID: PMC1602468 PMID: 620152 [PubMed - indexed for MEDLINE] 6118. Actas Dermosifiliogr. 1978 Jan-Feb;69(1-2):41-52. [Childhood herpes zoster. Apropos of 14 cases] [Article in Spanish] Naranjo R, Delgado V, Armijo Lozano R, Camacho F, De Dulanto F, Herrera E, Armijo M. PMID: 749559 [PubMed - indexed for MEDLINE] 6119. Contemp Anesth Pract. 1978;1:55-70. An outpatient pain service. Howland DE, Howland LA. PMID: 738054 [PubMed - indexed for MEDLINE] 6120. Cesk Dermatol. 1978;53(5):303-7. [Immunological study of patients with herpes zoster. I. General immunological reactivity (author's transl] [Article in Czech] Vacek Z, Doutlík S, Hanáková L, Vasícková M, Fadrhoncová A. PMID: 729012 [PubMed - indexed for MEDLINE] 6121. Klin Monbl Augenheilkd. 1978;172(6):876-9. [Cotton thread method for measuring lacrimation (author's transl)] [Article in German] Kurihashi K. Instead of filter paper, a fine cotton thread was used. One test consists of 3 or more consecutive measurements. Six patients with Hunt's syndrome were tested with this new method. All of the six showed lacrimal deficiency on the involved side. PMID: 692022 [PubMed - indexed for MEDLINE] 6122. Neurol Neurochir Pol. 1978 Jan-Feb;12(1):97-100. [Atypical case of the Ramsay-Hunt syndrome] [Article in Polish] Filar H, Zelazny S. The authors report a case of Ramsay-Hunt syndrome during cervical zoster in the C2--C4 area. The case reserves attention in view of the fact that facial nerve paralysis and paralysis of both parts of the right acoustic nerve occurred as a second exacerbation of the disease 16 days after the onset. Permanent hearing impairment in the right ear after regression of facial nerve paralysis and paralysis of the vestibular part of the acoustic nerve were also exceptionally rare signs. PMID: 634439 [PubMed - indexed for MEDLINE] 6123. Cancer. 1978 Jan;41(1):95-9. Herpes zoster and varicella infections in children with Hodgkin's disease: an analysis of contributing factors. Reboul F, Donaldson SS, Kaplan HS. 181 children with Hodgkin's disease were analyzed with respect to the occurrence of herpes zoster and varicella (HZ-V) infections, possible contributing factors, and prognostic significance. The overall frequency of HZ-V was 34.8%. The occurrence in stage I was significantly lower than in other stages. Previous splenectomy was not found to increase significantly the risk of infection. High-risk patients were those receiving extensive radiotherapy plus combination chemotherapy; 56% developed HZ-V infections in this group. The frequency with extensive field radiotherapy alone was 23.8%. 80% of infections occurred during the first year after completion of treatment. Their occurrence was not a poor prognostic sign in terms of relapse or fatality, even when occurring late. The high frequency of disseminated infection (27%) with its subsequent morbidity should lead toward a better understanding of the immunologic deficiencies in these patients and the possible role of prophylactic measures, in patients undergoing extensive radiotherapy in combination with multiagent chemotherapy. PMID: 626945 [PubMed - indexed for MEDLINE] 6124. Vrach Delo. 1978 Jan;(1):116-8. [Treatment of herpes zoster with dimethyl sulfoxide] [Article in Russian] Grushkov VM, Todoriv VD. PMID: 625924 [PubMed - indexed for MEDLINE] 6125. Z Hautkr. 1978 Jan 1;53(1):5-9. [Lichen planus zosteriformis] [Article in German] Nagy G, Husz S, Szücs L. PMID: 622849 [PubMed - indexed for MEDLINE] 6126. Geriatrics. 1978 Jan;33(1):95-101. Differentiating the causes of chest pain. Zoob M. PMID: 620930 [PubMed - indexed for MEDLINE] 6127. Scand J Infect Dis. 1978;10(1):21-7. Effect of transfer factor and zoster immunoglobulin in patients with varicella-zoster infection and malignancy. Winsnes R, Frøland SS, Degré MI. Immunotherapy was given to 13 patients suffering from lymphoproliferative diseases complicated by varicella-zoster (VZ) infection. Five patients received transfer factor (TF) only, 6 received TF and zoster immunoglobulin (ZIG), and 2 received ZIG only. ZIG did not seem to alter the course of the infection. Cessation of vesicle formation and initiation of crust formation took place within 1 day after the first injection of TF in 5 patients with a localized zoster. In 4 patients suffering from an early dissemination of VZ infection, cessation of vesicle formation took place within 1 day (1 patient), 2 days (1 patient), 3 days (1 patient) or 4 days (1 patient) after the first injection of TF. An increase in serum interferon was observed in 4 of 9 patients who received TF, while no increase in serum interferon was observed in the control groups. Administration of a high-titer ZIG preparation did not seem to depress the humoral antibody response when combined with TF therapy. Therapy with TF in combination with ZIG seemed to have a beneficial effect in patients with malignancy when administered early in the acute VZ infection. PMID: 580314 [PubMed - indexed for MEDLINE] 6128. Otolaryngol Pol. 1978;32(1):101-3. [Generalized herpes zoster in the course of reticulosarcoma histiocyticum of the tonsil] [Article in Polish] Białowas J, Hervy T. PMID: 351520 [PubMed - indexed for MEDLINE] 6129. Dent Update. 1978 Jan-Feb;5(1):25, 62. Picture quiz: basal cell carcinoma, herpes zoster and a dental sinus. [No authors listed] PMID: 290519 [PubMed - indexed for MEDLINE] 6130. Klin Padiatr. 1978 Jan;190(1):73-82. [Treatment of ALL in children. Results and side effects with a modification of protocol memphis VII (author's transl)] [Article in German] Wehinger H, Fürste HO, Imm W, Luthardt T, Sauer M, Slania J, Dilger M. 42 patients with ALL were treated according to the following protocol: induction with vincristine + prednisone (+/- L-asparaginase), CNS-prophylaxis with cranial irradiation (2400 rads) and intrathecal methotrexate, maintenance for 3 years with 6-MP 50 mg/m2/d p.o. + MTX 75-150 mg/m2/2 wk i.v. X 4, alternating in a cyclic fashion with 6-MP 50 mg/m2/d p.o. + cyclophophshamide 600 mg/m2/2 wk i.v. X 4. The observation time is 24-67 (median 49) months. The actuarial complete remission curve shows 40% continuous complete remissions at 36 months and 30% at 60 months.--The frequency and temporal distribution of typical infectious complications are presented. The incidence of varicella was comparable to that in a southgerman normal control group (5,7% per year). During treatment there were two zoster manifestations per one varicella case, the incidence of zoster being 1 case per 106 patient-months, viz 11,4% per year. PMID: 273117 [PubMed - indexed for MEDLINE] 6131. IARC Sci Publ. 1978;(24 Pt 1):87-96. Characterization of human varicella-zoster virus DNA. Hyman RW, Iltis JP, Oakes JE, Rapp F. The DNA of varicella-zoster virus (VZV) has been characterized by sucrose gradient sedimentation, restriction enzyme cleavage with either EcoRI or HindIII site-specific endonucleases, and by isopycnic banding in caesium chloride. Comparisons of the DNAs from different clinical isolates have been made. DNAs from VZVs isolated from either varicella or herpes zoster are indistinguishable on the basis of size and restriction enzyme cleavage pattern. The buoyant density in caesium chloride of the DNA of VZV isolated from varicella was reproducibly slightly lower than that of the DNA of VZV isolated from herpes zoster. PMID: 221365 [PubMed - indexed for MEDLINE] 6132. Major Probl Clin Pediatr. 1978;19:184-208. Viral infections. Weintraub R. In summary, viral infections of the skin that occur at adolescence include those typical of childhood and those associated with sexual maturity. Herpes simplex Type II, molluscum contagiosum, and venereal warts, diseases that have shown a marked increase, are in the latter group. Certain diseases, such as rubella, herpes simplex, varicella, and condylomata acuminata, which may lead to laryngeal papillomas, are particularly important because of their effects on the newborn infant. The epidemiological pattern of viral infections changes, and new viruses gain prominence while others fade in importance as causes of disease. Because of this, we can expect new viral entities and changes in earlier ones. PMID: 211352 [PubMed - indexed for MEDLINE] 6133. J Clin Microbiol. 1978 Jan;7(1):6-11. Quantitation of antibodies to varicella-zoster virus by immune adherence hemagglutination. Wong CL, Castriciano S, Chernesky MA, Rawls WE. Immune adherence hemagglutination was compared with the complement fixation test as a means of measuring antibodies to varicella-zoster virus. Analysis of acute- and convalescent-phase sera from patients infected with varicella-zoster or with herpes simplex virus showed the immune adherence hemagglutination test to be more sensitive than the complement fixation test, and greater cross-reactivity between the two viruses appeared to be associated with the increased sensitivity. The two assay methods were used to measure antibodies to varicella-zoster virus in 265 sera obtained from patients of different ages as well as sera from 26 patients with leukemia. There were 35 cases where antibodies were detected by immune adherence hemagglutination but not by complement fixation, whereas in five cases the converse was found. Our findings support the contention that immune adherence hemagglutination is the method of choice for detecting antibodies to varicella-zoster virus. PMCID: PMC274847 PMID: 203604 [PubMed - indexed for MEDLINE] 6134. Major Probl Clin Pediatr. 1978;17:327-47. Prevention, treatment, and antiviral chemotherapy. Hanshaw JB, Dudgeon JA. PMID: 202814 [PubMed - indexed for MEDLINE] 6135. Major Probl Clin Pediatr. 1978;17:192-208. Varicella-zoster infections. Hanshaw JB, Dudgeon JA. PMID: 202811 [PubMed - indexed for MEDLINE] 6136. Res Clin Stud Headache. 1978;5:102-21. Stereotactic treatment of head and neck pain. Gildenberg PL. PMID: 79197 [PubMed - indexed for MEDLINE] 6137. Z Orthop Ihre Grenzgeb. 1978;116(2):199-203. [The Sudeck-Leriche syndrome as a disturbance in distant regions of the body, clinical picture, and histology (author's transl)] [Article in German] Kirsch K. On the whole, every Sudeck-Leriche syndrome represents a serious complication. The causal noxae are various in nature. In a large case material during a period of observation extending over 26 years a Sudeck-Leriche syndrome was observed as a disturbance in distant regions of the body only in rare cases, for example after herpes zoster, apoplexy, and confusion of the cervical part of the medulla, with cervical and lumbal root irritations, etc. Histological findings in the case of Sudeck-Leriche syndrome are very rarely presented in literature. Histological investigations by the author carried out on muscle tissue in the case of Sudeck-Leriche syndrome yielded remarkable findings with a transition from functional to morphologically irreversible alterations. These alterations were present both in vessels and muscle fibers. PMID: 77594 [PubMed - indexed for MEDLINE] 6138. Ann Anesthesiol Fr. 1978;19(5):417-21. [Transcutaneous electrotherapy in the treatment of chronic post-zoster pain] [Article in French] Salar G. Transcutaneous electrotherapy has been employed in 112 patients with chronic pains of various origins. The immediate and long term results are not considered, at whole, satisfactory, especially for length and quality of the obtained improvement. Only patients with chronic post-zoosterian neuralgia had good results, or immediate either at long term, especially in intercostal pains. In the contrary in acute cases of this nevralgia, there were not satisfactory improvements. PMID: 29537 [PubMed - indexed for MEDLINE] 6139. Ann Anesthesiol Fr. 1978;19(5):409-16. [Transcutaneous electroanalgesia in peripheral deafferentation syndromes] [Article in French] Sindou M. PMID: 29536 [PubMed - indexed for MEDLINE] 6140. Minerva Med. 1977 Dec 29;68(63):4253-6. [Cephalic zoster with involvement of the 5th, 7th, 8th, 9th and 10th cranial nerves] [Article in Italian] Cicala S, Di Ciommo V, Massini R. A case of cephalic zoster with involvement of the 5th, 7th, 8th, 9th and 10th left cranial nerves is described. The anatomopathological findings are surveyed. These show that lesions are often found in several areas of the nervous system. The pathogenesis of these forms is examined, with particular reference to the mechanism of involvement of several cranial nerves. It is felt that this is primarily due to reactivation of the virus in several ganglia. PMID: 202894 [PubMed - indexed for MEDLINE] 6141. Clin Ter. 1977 Dec 15;83(5):541-7. [Treatment of degenerative and inflammatory joint diseases with or without a new synthetic substance (parsalmide). Controlled clinical trial] [Article in Italian] Napoli A, Alderuccio B, Nannetti A. PMID: 343972 [PubMed - indexed for MEDLINE] 6142. Harefuah. 1977 Dec 1;93(11):362-3. [Motor lesions in herpes zoster] [Article in Hebrew] Streifler M, Weiss S. PMID: 608653 [PubMed - indexed for MEDLINE] 6143. J Laryngol Otol. 1977 Dec;91(12):1073-5. Bell's palsy--Varicella Zoster and meningitis. Yalaburgi SB, Mistry PK. Two cases with Bell's palsy due to Varicella Zoster virus in children are reported. It is suggested that pyogenic meningitis resulting in lowered body resistance reactivated the latent V.Z. virus. PMID: 604398 [PubMed - indexed for MEDLINE] 6144. J Neurol. 1977 Dec 1;217(1):75-8. Contralateral facial palsy in a case of cervical zoster. Shoji H, Krauseneck P, Samtleben T. PMID: 75255 [PubMed - indexed for MEDLINE] 6145. Clin Ter. 1977 Nov 30;83(4):431-42. [Current status of the clinical aspects and treatment of infectious diseases in old age] [Article in Italian] [No authors listed] PMID: 342179 [PubMed - indexed for MEDLINE] 6146. Br Med J. 1977 Nov 5;2(6096):1193. Congenital abnormalities and maternal herpes zoster. Webster MH, Smith CS. PMCID: PMC1632218 PMID: 412551 [PubMed - indexed for MEDLINE] 6147. Actas Dermosifiliogr. 1977 Nov-Dec;68(11-12):643-50. [Ramsay Hunt syndrome (region of the geniculate ganglion). Dissemination caused by cortcioids and treated with griseofulvin] [Article in Spanish] García Almagro D, García Pérez M. PMID: 613740 [PubMed - indexed for MEDLINE] 6148. Practitioner. 1977 Nov;219(1313):731-7. Facial pain. Young RF. PMID: 594025 [PubMed - indexed for MEDLINE] 6149. Chin Med J (Engl). 1977 Nov;3(6):399-406. Audiofrequency electrotherapy in skin diseases. [No authors listed] PMID: 414895 [PubMed - indexed for MEDLINE] 6150. Br J Ophthalmol. 1977 Nov;61(11):677-82. External ocular motor palsies in ophthalmic zoster: a review. Marsh RJ, Dulley B, Kelly V. Seventy-seven new patients suffering from ophthalmic zoster and a selected group of 69 old patients were carefully examined with regard to external ocular movements. An incidence of 31% of ocular pareses was found in the new patients, and 58 in all were analysed. We were surprised to find several of these were contralateral and bilateral palsies. 28% of the palsies were asymptomatic, due to diplopia being present only in extremes of gaze and the rapid development of suppression in the affected eye. The theories of aetiology of these pareses are discussed. PMCID: PMC1043096 PMID: 338027 [PubMed - indexed for MEDLINE] 6151. Med Weter. 1977 Nov;33(11):674-7. [Clinical and laboratory use of IDU (5-iodo-2-desoxyuridine)] [Article in Polish] Swiecicka-Grabowska G. PMID: 304817 [PubMed - indexed for MEDLINE] 6152. Klin Monbl Augenheilkd. 1977 Nov;171(5):791-5. [Cytarabine treatment of herpes zoster (author's transl)] [Article in German] Grüner HJ, Fechner PU. Systemic treatment of herpes zoster becomes possible by cytarabine. Complications of herpes zoster ophthalmicus such as relapsing corneal ulceration, perforation or scarring, secondary glaucoma, Argyll Robertson pupils, extraocular muscle palsies, and optic atrophy, as well as postherpetic neuralgia can be prevented by the use of this drug. For this reason the authors believe treatment with cytarabine to be the therapy of choice in herpes zoster. PMID: 304504 [PubMed - indexed for MEDLINE] 6153. Br Dent J. 1977 Nov 1;143(9):297-300. Tooth exfoliation and osteonecrosis of the jaw following herpes zoster. Cooper JC. PMID: 270353 [PubMed - indexed for MEDLINE] 6154. Ann Sclavo. 1977 Nov-Dec;19(6):1133-43. [Characteristics of the complement-fixing antibody response for varicella-zoster virus in patients with herpes zoster] [Article in Italian] Trivello R, Peserico A, Moschen ME, Romano M. PMID: 218503 [PubMed - indexed for MEDLINE] 6155. Nippon Hifuka Gakkai Zasshi. 1977 Nov;87(12):754-6. [Viral immunofluorescent technic--virus] [Article in Japanese] Miyoshi K. PMID: 203735 [PubMed - indexed for MEDLINE] 6156. Arch Otolaryngol. 1977 Nov;103(11):641-4. Acute peripheral facial palsy. Part of a cranial polyneuropathy? Djupesland G, Degré M, Stien R, Skrede S. In 14 of 16 consecutive patients with acute peripheral facial palsy, one or more (up to four) other nerves were involved. The nerves affected in addition to the facial nerve were as follows: trigeminal (ten patients), vestibular (eight), cochlear (six), vagus (one), and upper cervical (five). Virus was not isolated from any of the patients. A fourfold increase or decrease in complement-fixing antibody titers was present in eight patients (in four, varicella-zoster; in one, varicella-zoster and mumps; in two, cytomegalovirus; in one, mumps). Further, two of the patients with varicella-zoster antibodies showed clinical signs of herpes zoster oticus. About one fourth of all patients had an increase of ESR and of alpha2-globulins in serum, and two thirds of them had increased gamma-globulins in CSF. Acute peripheral facial palsy seems to be part of a cranial polyneuropathy and may be caused by a viral infection. PMID: 200210 [PubMed - indexed for MEDLINE] 6157. Virology. 1977 Oct 15;82(2):345-52. Comparison of the DNAs of varicella-zoster viruses isolated from clinical cases of varicella and herpes zoster. Iltis JP, Oakes JE, Hyman RW, Rapp F. PMID: 199993 [PubMed - indexed for MEDLINE] 6158. Z Hautkr. 1977 Oct 1;52(19):988-98. [Casuistic contribution to zoster with special regard to the viscero-cutaneous reflexes (VCR) as localization factors] [Article in German] Krause H, Eissfeld K. PMID: 910543 [PubMed - indexed for MEDLINE] 6159. Arch Sci Med (Torino). 1977 Oct-Dec;134(4):481-5. [Topical treatment of some dystrophic and inflammatory lesions of the skin and soft tissues] [Article in Italian] Palmieri B, Boraldi F. An investigation has been carried out on lysozyme cleasing antiphlogistic granulogenic activity when topically applied to various lesions such as varicous ulcers, bed sores, herpetic infections or actinic ulcerative processes. 38 patients who had undergone surgery and were affected with these lesions, were treated with lysozyme ointment applied twice daily for 15 days. Parameters for evaluating the therapeutic effect of the drug were, besides the typical subjective symptomatology, planimetry of the lesions, hyperemia and perilesional erythema. At the end of the investigation it was observed that lysozyme applications had favourable restorative effects and, in the case of herpetic lesions, complete resolution was achieved. Tolerance was satisfactory, although in 2 cases treatment had to be precautionarily discontinued having the subject complained of reacutization of pruritus. PMID: 610695 [PubMed - indexed for MEDLINE] 6160. Scott Med J. 1977 Oct;22(4):311-3. Development and therapeutic uses of topical 5% idoxuridine (IDU). Dawber RP. PMID: 337484 [PubMed - indexed for MEDLINE] 6161. Arch Neurol. 1977 Oct;34(10):640-1. Herpes zoster ophthalmicus with contralateral hemiplegia. Pratesi R, Freemon FR, Lowry JL. A 48-year-old man developed left hemiparesis nine weeks after herpes zoster skin lesions had appeared over the right forehead. Cerebral angiography showed bilateral changes consistent with cerebral arteritis. The patient's condition worsened after the angiographic procedure. Reports from the literature as well as the present case suggest that arteritis and ischemia best explain contralateral neurological symptoms that occur suddenly following herpes zoster ophthalmicus. PMID: 303089 [PubMed - indexed for MEDLINE] 6162. Bull N Y Acad Med. 1977 Oct;53(8):731-48. Herpes simplex and herpes zoster keratouveitis: diagnosis and management. Pavan-Langston D. PMCID: PMC1807398 PMID: 302725 [PubMed - indexed for MEDLINE] 6163. J Pediatr. 1977 Oct;91(4):597-600. A viremic phase for herpes zoster in children with cancer. Feldman S, Chaudary S, Ossi M, Epp E. Eight childhood cancer patients with herpes zoster were serially tested for the presence of varicella-zoster virus in blood. Cell cultures of leukocyte-rich plasma from four patients were positive for the virus. In this study viremia was clearly related to dissemination of dermal lesions-the spread of zoster lesions outside an infected dermatome. The child with the longest viremic phase, five days, had the longest and most severe course of skin dissemination, as well as biochemical evidence of hepatitis. One patient with viremia had advanced embryonal carcinoma and died of disseminated tumor before her clinical course could be evaluated. These observations, the first to document a viremic phase for herpes zoster in immunosuppressed children, furnish an added criterion for evaluation of antiviral drugs and live-virus vaccines in the treatment and prevention of varicella-zoster infections. PMID: 198521 [PubMed - indexed for MEDLINE] 6164. Dtsch Med Wochenschr. 1977 Sep 30;102(39):1402. [Cross infectivity of varicella and herpes zoster] [Article in German] Nasemann T. PMID: 913265 [PubMed - indexed for MEDLINE] 6165. Nouv Presse Med. 1977 Sep 10;6(29):2601. [Action of L-dopa on the eruption and pain of zona] [Article in French] Bonafé JL, Rumeau H, Durand JR, Coulombel F, Courret B, Carles P, Armand JP, Jover A. PMID: 909741 [PubMed - indexed for MEDLINE] 6166. Nippon Ganka Gakkai Zasshi. 1977 Sep 10;81(9):1260-7. [Effect of Varicella-zoster virus on cultured human cornea fibroblast (author's transl)] [Article in Japanese] Matsuda K. PMID: 204175 [PubMed - indexed for MEDLINE] 6167. Nippon Rinsho. 1977 Sep 10;35(9):2758-62. [Varicella virus and herpes zoster] [Article in Japanese] Yasuda T. PMID: 200776 [PubMed - indexed for MEDLINE] 6168. J Pediatr Ophthalmol. 1977 Sep-Oct;14(5):296-8. Retrobulbar neuritis and central serous chorioretinopathy. Godel V, Blumenthal M, Regenbogen L. PMID: 925845 [PubMed - indexed for MEDLINE] 6169. Br J Med Psychol. 1977 Sep;50(3):283-8. Psychological aspects of post-herpetic neuralgia: some clinical observations. Pilowsky I. PMID: 911701 [PubMed - indexed for MEDLINE] 6170. Am Fam Physician. 1977 Sep;16(3):84-92. Evaluation of the patient with chronic facial pain. Dalessio DJ. A major difficulty in the investigation of chronic facial pain has been a practical classification permitting the selection of appropriate diagnostic procedures to elucidate the etiology of the pain and to provide appropriate therapy. Categorization of facial pain syndromes into vascular, neuritic, muscular, rheumatic, traction and inflammatory and psychogenic groups provides a useful approach to the problem. Despite the utility of this method and advances in noninvasive diagnostic techniques, many pain syndromes remain refractory to full understanding and/or therapy and will test the physician's patience and perseverance. PMID: 900012 [PubMed - indexed for MEDLINE] 6171. J Trop Med Hyg. 1977 Sep;80(9):200-3. Fatal herpes zoster in Burkitt's lymphoma following contact with chicken pox. Adeniyi A, Laditan AA, Seriki O. Burkitt's lymphoma presented atypically in a six-year-old Nigerian girl with back pain, oliguria and facial oedema following a fall at school. Two weeks later, she developed bilateral ptosis, hepatomegaly and ascites. Burkitt's lymphoma cells were found in both ascitic and cerebrospinal fluids. She was successfully treated with intravenous cyclophosphamide and intrathecal methotrexate but later developed fatal herpes zoster at the same time as the resident doctor developed chicken pox. Chart's review showed that she had been in brief contact with chicken pox during a short stay in a transit ward prior to full admission. PMID: 592465 [PubMed - indexed for MEDLINE] 6172. AJR Am J Roentgenol. 1977 Sep;129(3):463-7. Cerebral granulomatous angiitis: case report and literature review. Faer MJ, Mead JH, Lynch RD. Granulomatous angiitis is a pathologically distinct central nervous system segmental vasculitis of unknown etiology and pathogenesis which may be indirectly related to herpes zoster infections. The condition primarily affects adults and presents with nonspecific, unexplained progressive neurological dysfunction. The cerebrospinal fluid is often under increased pressure and contains excess protein and white cells, mostly lymphocytes. The necrotizing vasculitis primarily affects the small intracranial arteries and veins and alters vascular permeability, ind,cing cerebral edema. Angiography demonstrates segmental, diffuse, distal vascular irregularity and narrowing, while computed tomography shows poorly defined, diffuse, non-contrast-enhancing low density areas with or without mass effect. In the approprite clinical setting, the angiographic and CT findings should be highly suggestive. The possibility of efficious therapeutic intervention makes early diagnosis important. CT can also be used to monitor therapeutic response. PMID: 409201 [PubMed - indexed for MEDLINE] 6173. Bull Soc Ophtalmol Fr. 1977 Sep-Oct;77(8-9):839-41. [Post-herpes zoster keratitis: ultrastructural study of a case] [Article in French] Berard-Badier M, Merlihot JM, Mulfinger H, Mouillac N, Choux R. PMID: 307438 [PubMed - indexed for MEDLINE] 6174. Am J Ophthalmol. 1977 Sep;84(3):329-31. Herpes zoster ophthalmicus associated with delayed retinal thrombophlebitis. Hesse RJ. A 58-year-old woman developed typical herpes zoster ophthalmicus associated with delayed retinal thrombophlebitis and subsequent vitreous hemorrhage. Fluorescein angiography confirmed a diagnosis of thrombophlebitis and demonstrated sparing of the arteriolar circulation. The retinopathy cleared spontaneously and visual acuity returned to 6/6 (20/20). PMID: 302647 [PubMed - indexed for MEDLINE] 6175. Ann Neurol. 1977 Sep;2(3):249. Attempts to recover varicella virus from ganglia. Plotkin SA, Stein S, Snyder M, Immesoete P. PMID: 215073 [PubMed - indexed for MEDLINE] 6176. J Dermatol. 1977 Aug;4(4):129-35. Electron microscopic observations on the lesions of herpes zoster with topical application of interferon. Uyeda K, Kagami K, Sotomatsu S. Department of Dermatology, Kyoto Prefectural University of Medicine, 465 Kajii-cho Hirokoji, Kawaramachi, Kamikyoku, Kyoto 603, Japan. The lesions of herpes zoster in three patients were investigated electron microscopically before and after topical application of interferon. In the blister, on the 5th to 7th day after its formation, the following were seen: acantholytic cells with virus particles in the nucleus and cytoplasm, multinucleated cells derived from keratinocytes, edematous and degenerated keratinocytes containing virus particles and tonofibrillar materials, macrophages with many large vacuoles, neutrophils, lymphocytes and Langerhans's cells. After the first application of interferon, the findings for keratinocytes were the same as those of before application and keratinocytes were frequently found adjacent to macrophages. The macrophages were large and had numerons large vacuoles in the cytoplasm. After the second application of interferon, virus particles were often seen in the vacuoles of the macrophages in comparison with that before application. In the cytoplasm of macrophages, acantholytic keratinocytes and tonofibrillar materials were phagocytized. Many virus particles were seen in the vacuoles of some acantholytic keratinocytes. It was concluded from these findings that the macrophages accelerated the phagocytotic activity of the virus particles. PMID: 15461339 [PubMed - indexed for MEDLINE] 6177. Arch Neurol. 1977 Aug;34(8):489-91. Antibodies to varicella zoster in cerebrospinal fluid. Bieger RC, Van Scoy RE, Smith TF. The neurologic complications of varicella-zoster (VZ) virus infections are manifested as zoster with or without CNS involvement, encephalomyelitis, or ocular involvement. Usually the association of VZ virus in these conditions has been determined by finding VZ antibodies in the serum. In a few instances, VZ antibodies have been detected in the CSF. We report two cases of VZ virus infection followed by neurologic complications involving the CNS in which VZ antibodies were present in the CSF. These two cases underscore the need and value of determining the presence of VZ antibodies in the CSF in certain instances. PMID: 889481 [PubMed - indexed for MEDLINE] 6178. J Oral Surg. 1977 Aug;35(8):663-6. The Ramsay Hunt syndrome: a dynamic demonstration of applied anatomy. Myall RW, Smith MJ. The clinical features of herpes zoster of the geniculate ganglion were reviewed and related to the functional anatomy of the seventh cranial nerve. An illustrative case highlights many of the features of the syndrome that was first described by Ramsay Hunt. The significance of facial palsy is discussed in the light of its distribution. PMID: 267191 [PubMed - indexed for MEDLINE] 6179. J Laryngol Otol. 1977 Jul;91(7):551-64. Results of treatment in peripheral facial paralysis. A 25-year study. Wynn Parry CB, King PF. PMID: 894113 [PubMed - indexed for MEDLINE] 6180. Obstet Gynecol. 1977 Jul;50(1):35-9. Erosions and ulcers of the vulva: diagnosis, incidence, and management. Young AW Jr, Tovell HM, Sadri K. In a study of 877 patients with disorders of the vulva seen at a vulva clinic, 375 (43%) presented with an erosion or ulceration or a condition in which an erosion or ulceration developed as a complicating feature. One hundred sixty-one of these patients had a sexually transmitted disease. This report identifies the conditions associated with erosions and ulcerations of the vulva by incidence and provides a simple clinical classification of them as an aid in diagnosis. Methods of study of this group of diseases and their management are discussed. PMID: 876519 [PubMed - indexed for MEDLINE] 6181. Neurology. 1977 Jul;27(7):646-9. Imitation synkinesia and sensory control of movement. Cambier J, Dehen H. Immitation synkinesia is usually associated with thalamic or parietal lesions. Analysis of three cases shows that the lesions may affect the posterior columns of the spinal cord or even the peripheral nervous system. In our cases, two facts stand out, a large measure of integrity of motor activity and predominant disturbances of lemniscal sensation. Imitation synkinesia should therefore not be seen as due to a lesion of a particular structure but to the disorganization of the lemniscal system at any level. Functional interconnection between the lemniscal and motor systems occurs only in the cerebral cortex. In the light of this fact, imitation synkinesia can be interpreted as the loss of particular functions in the principal cortical motor neurons. PMID: 559970 [PubMed - indexed for MEDLINE] 6182. Int J Dermatol. 1977 Jul-Aug;16(6):464-75. Antiviral drugs. Kaufman HE. PMID: 408279 [PubMed - indexed for MEDLINE] 6183. Int J Dermatol. 1977 Jul-Aug;16(6):476-87. Laboratory diagnosis of microbiological skin disease. Benn RA. PMID: 330425 [PubMed - indexed for MEDLINE] 6184. Nippon Hifuka Gakkai Zasshi. 1977 Jul;87(8):493-500. [Studies on the effect of herpes virus infections on human cell-mediated immunity. 1. Lymphocyte subpopulations in the peripheral blood from patients with herpes zoster and herpes simplex (author's transl)] [Article in Japanese] Urushibata O. PMID: 302873 [PubMed - indexed for MEDLINE] 6185. Z Hautkr. 1977 Jul 1;52(13):691-8. [Pathogenesis and topography of Herpes zoster in childhood and in adult age] [Article in German] Nagy G, Varga G. PMID: 197719 [PubMed - indexed for MEDLINE] 6186. Compr Ther. 1977 Jul;3(7):42-8. Ocular and systemic antiviral activity of vidarabine. Pavan-Langston D, Hess F. PMID: 195767 [PubMed - indexed for MEDLINE] 6187. N Engl J Med. 1977 Jun 16;296(24):1372-7. Cellular immunity and herpesvirus infections in cardiac-transplant patients. Rand KH, Rasmussen LE, Pollard RB, Arvin A, Merigan TC. We observed severe infection with herpes simplex virus in cardiac-transplant patients despite their high serum antibody levels to this virus. Therefore, we sought to correlate clinical susceptibility to two herpesvirus (simplex and zoster) infections with specific cellular immunity, assessed by the transformation and interferon responses of peripheral blood mononuclear cells to heat-inactivated antigens. Transformation and interferon response to herps simplex virus was maximally depressed immediately after transplantation, the time when severe and prolonged infection with herps simplex virus occurred. Six months to six years after transplantation, both clinical susceptibility and cellular immunity to herpes simplex virus were normal. Herpes zoster infections were more frequent than normal at all times after cardiac transplantation; depressed or absent cellular responses to the varicella zoster virus paralleled that susceptibility. In these patients the risk of severe herpesvirus infections correlated with depressed cellular immune responses to the specific viral agent involved. PMID: 193008 [PubMed - indexed for MEDLINE] 6188. MMW Munch Med Wochenschr. 1977 Jun 10;119(23):817-8. [Therapy of herpes zoster with sodium pentosan polysulfate] [Article in German] Raff M, Fanta D. PMID: 196192 [PubMed - indexed for MEDLINE] 6189. Aust Fam Physician. 1977 Jun;6(6):643-8. Chronic pain syndromes in the elderly. Morley JB. In this paper the painful syndromes of temporal arteritis, polymyalgla rheumatica, glaucoma, trigeminal neuralgia, post-herpetic neuralgia, and temporomandibular joint dysfunction have been described. These conditions occur commonly in the elderly. The dangers of blindness occurring in temporal arteritis or polymyalgia rheumatica, the importance of early diagnosis in glaucomatous headache, the value of Tegretol in trigeminal neuralgia, the paucity of therapeutic agents in post-herpetic neuralgia and the value of dental treatment in tempor-mandibular joint dysfunction have been stressed. PMID: 880167 [PubMed - indexed for MEDLINE] 6190. Arch Dermatol. 1977 Jun;113(6):848-9. Acquired zosteriform cavernous hemangiomas: brief clinical observation. Steinway DM, Fretzin DF. PMID: 869560 [PubMed - indexed for MEDLINE] 6191. Klin Monbl Augenheilkd. 1977 Jun;170(6):837-42. [Secondary glaucoma and uveitis: hypertensive uveitis (author's transl)] [Article in German] Witmer R. The secondary rise of i.o. pressure in uveitis may lead to a true secondary glaucoma or to hypertensive uveitis. The etiology of the endogenous inflammation does not seem to play a role. Pathogenetically the occlusion of the pupil with the formation of iris bombé and the obliteration of the chamber angle by exudate are important factors, while the hypersecretion of aqueous humor plays a minor role. Medical treatment consists in mydriatics and steroids. Surgical treatment depends on the pathogenetic mechanism and consists either in sector iridectomy or a filtering procedure. PMID: 302364 [PubMed - indexed for MEDLINE] 6192. Monatsschr Kinderheilkd. 1977 Jun;125(6):655-9. [Prognosis of prenatal varicella-zoster-infections in relation to their onset during pregnancy (author's transl)] [Article in German] Balg G. 7 children were observed, whose mothers had Varicella-Zoster-Virus-infection. 3 of these children developed postnatal Herpes Zoster without Varicella in their history; 1 child had Varicella in the neonatal period. There are indications that primary infection with Varicella-Zoster-Virus during the first four months of pregnancy may cause deformities in the child; the same during the last five days of pregnancy increases the risk of varicella with a complicated course in the newborn. Independent of the time of infection during pregnancy the prognosis of a secondary Varicella-Zoster-Virus-infection in the mother seems always to be good for the child. Aspects of the child's immunological maturation, still incomplete at birth, are discussed and can help to understand the different prognoses during pregnancy. The importance of serological diagnosis has been emphasized. PMID: 196188 [PubMed - indexed for MEDLINE] 6193. Am J Surg. 1977 Jun;133(6):719-22. Effect of cytosine arabinoside on Herpes virus infection in renal allograft recipients. Chatterjee SN, Fiala M, Myles RA. Cytosine arabinoside (Ara-C) was used for treatment of severe symptomatic cytomegalovirus (CMV)-herpes infections that were seen in nineteen of 174 renal allograft recipients. Ara-C was administered by continuous intravenous infusion at a mean dose of 35 mg/m2 daily for three to four days. Side effects were few and minor in nature. All cases of herpes simplex and herpes zoster, which usually have a prolonged and sometimes unfavorable course in immunosuppressed patients, cleared promptly with no recurrence. All nine patients, except one who had CMV infection with the symptom complex of fever and retinitis or pneumonitis, responded satisfactorily. In the three patients in whom the CMV titers were available, there was a significant decrease in titer within two weeks after treatment. This pilot study of Ara-C in treatment of CMV-herpes infections in immunosuppressed renal allograft recipients suggests a degree of efficacy and safety in the drug that would justify a carefully designed, controlled study. PMID: 194496 [PubMed - indexed for MEDLINE] 6194. Am J Dis Child. 1977 Jun;131(6):693-6. Prevention or modification of varicella using zoster immune plasma. Balfour HH Jr, Groth KE, McCullough J, Kalis JM, Marker SC, Nesbit ME, Simmons RL, Najarian JS. Zoster immune plasma (ZIP) was given to 31 susceptible immunocompromised children one to seven days (median, two days) following household, playmate, or hospital exposures to varicella. The average amount of ZIP transfused was 7 ml/kg. Twenty-one children did not develop varicella or persistent antibodies to varicella-zoster virus (VZV). Eight (26%) of the 31 contracted clinical varicella. Seven cases were mild, but in one child, who was given ZIP seven days after exposure, visceral disease developed and the child died. Two children had subclinical varicella that was documented by persistence of VZV antibodies for at least ten months after passive immunization. Because none of the 30 children given ZIP one to six days following exposure had severe varicella, we conclude that ZIP is effective in preventing or modifying varicella in immunocompromised patients if given shortly after exposure. PMID: 194476 [PubMed - indexed for MEDLINE] 6195. Angiology. 1977 Jun;28(6):394-402. Ambulatory use of sympathetic nerve blocks: present day clinical indications. Rickles JA. PMID: 68691 [PubMed - indexed for MEDLINE] 6196. Schweiz Rundsch Med Prax. 1977 May 10;66(19):565-72. [Lupus erythematosus, modern aspects (author's transl)] [Article in French] Canavese JC. PMID: 69300 [PubMed - indexed for MEDLINE] 6197. Z Hautkr. 1977 May 1;52(9):533-6. [Interferon and herpes] [Article in German] Wyler R. Interferon, a protein produced by cells, is the only non-toxic antiviral inhibiting virus multiplication in the cell. Although the industrial-technical production of the substance is more expensive the exogenic interferon treatment (interferon which is produced in cell cultures is being administered to the organism) is preferred to the endogenous interferon therapy (by application of slightly-toxic substances the organism is stimulated to produce interferon) since with the first therapy the factor toxicity can be neglected. Clinical trials with exogenous interferon treatment of herpes virus infections of men gave encouraging results, they must however be confirmed by double blind studies. Should it come to a clinical application of interferon on a large scale, first of all methods of production must be worked out to make available sufficient exogenous interferon for treatment of patients. PMID: 868204 [PubMed - indexed for MEDLINE] 6198. Riv Patol Nerv Ment. 1977 May-Jun;98(3):151-8. [EMG prognosis of facial palsy associated with herpes zoster oticus (Ramsay-Hunt's syndrome). A longitudinal study of 11 cases (author's transl] [Article in Italian] Fardin P, Negrin P, Peserico A. Eleven patients with peripheral facial palsy associated with geniculate herpes zoster (Ramsay-Hunt's syndrome) have been followed-up clinically and electromyographically. Each patient was examined three times: within the first week, at the end of the third week and 3-4 months after the onset of symptoms. Only in three cases the facial palsy evolved satisfactorily, with an almost total recovery within three weeks. In eight cases the recovery was delayed and incomplete, with residual, and often severe, hemifacial spasm. This study confirms the rather poor prognosis of peripheral facial palsy in Ramsay-Hunt's syndrome. The importance of detecting even slight signs of herpetic eruption in any case of apparently "idiopathic" peripheral facial palsy is emphasized. PMID: 616017 [PubMed - indexed for MEDLINE] 6199. MMW Munch Med Wochenschr. 1977 Apr 22;119(16):543-6. [Significance of diabetes mellitus in the activation of the varicella zoster virus (author's transl)] [Article in German] Neu I, Rodiek S. Eruptive herpes zoster infection (VZV) and its primary and secondary diseases are reported in 28 patients aged between 25 and 85 years. In 2 cases, malignant primary diseases were found. In 16 patients, a disorder of glucose utilization was diagnosed, 8 of them accompanied by a disorder of fat metabolism and 5 by a hyperuricemia. In one case a severe encephalomyelitis was observed. In 2 patients the activation of the VZV infection was related to the cytostatic or immunosuppressive therapy of a generalized Hodgkin's disease and a multiple sclerosis. Once a liver abscess as a sequel to amebic dysentery was diagnosed and once a megaloplastic anemia with symptoms of a funicular myelopathy following a vitamin B12 deficiency syndrome. In VZV infection the search for basal metabolic disorders is of particular importance. PMID: 194145 [PubMed - indexed for MEDLINE] 6200. Lancet. 1977 Apr 16;1(8016):863. Herpes zoster with bladder involvement. McCracken D. PMID: 67375 [PubMed - indexed for MEDLINE] 6201. N Engl J Med. 1977 Apr 7;296(14):824. Real vs. pseudo-shingles. Siegel AJ. PMID: 840294 [PubMed - indexed for MEDLINE] 6202. Probl Gematol Pereliv Krovi. 1977 Apr;22(4):49-51. [Obtaining interferon-containing donor plasma and a study of its therapeutic properties in herpes zoster] [Article in Russian] Skurkovich SV, Ol'shanskaia NV, Eremkina EI, Arkhipova NA, Klinova EG. PMID: 896714 [PubMed - indexed for MEDLINE] 6203. Wiad Lek. 1977 Apr 1;30(7):565-7. [Diagnostic difficulties in zoster prior to eruption of vesicles] [Article in Polish] Batko B. PMID: 855339 [PubMed - indexed for MEDLINE] 6204. South Med J. 1977 Apr;70(4):495-7. Gamma heavy chain disease--presenting as pancytopenia and splenomegaly. Baker AS, Lankford P, Krantz SB, Buchanan RD. A patient with gamma heavy chain disease (Franklin's disease) was discovered during evaluation for pancytopenia and splenomegaly. Lymphadenopathy, palatal edema, and infiltration of the bone marrow palatal edema, and infiltration of the bone marrow with abnormal cells were all absent. Serum and urine protein electrophoresis demonstrated a monoclonal protein migrating in the beta region. Immunoelectrophoresis showed that it reacted with antibodies against the Fc fragment of IgG heavy chains (gamma chains) but not with antibodies against kappa and lambda but not with antibodies against kappa and lambda light chains of Fab fragments. In the first year after detection of the disease, the patient had acute cholecystitis and disseminated herpes zoster. Sixteen months after diagnosis he died of overwhelming pneumonia caused by Pseudomonas aeruginosa and lebsiella neumoniae. A striking feature of his illness was his asymptomatic presentation, with pancytophenia and splenomegaly the only indication of this disease. PMID: 403613 [PubMed - indexed for MEDLINE] 6205. Bull Soc Ophtalmol Fr. 1977 Apr;77(4):489-90. [A rare complication of ophthalmic zona: scleral perforation with hernia of the ciliary body] [Article in French] Jallet G, Lecuyer J, Béchetoille A. PMID: 305300 [PubMed - indexed for MEDLINE] 6206. J Infect Dis. 1977 Apr;135(4):659-63. A longitudinal study of varicella-zoster virus infections in renal transplant recipients. Luby JP, Ramirez-Ronda C, Rinner S, Hull A, Vergne-Marini P. A serum bank maintained for renal transplant recipients allowed for a longitudinal study of antibody responses before and after herpes zoster. Renal transplant recipients without herpes zoster served as controls. Antibody responses to varicella-zoster virus, herpes simplex virus type 1, and cytomegalovirus were measured. The serological responses following herpes zoster were prompt and sustained (in the majority of cases), transient, or not present at all. Zoster without an eruption occurred (apparent only on retrospective chart review) and furnished an explanation for unexplained unilateral pain syndromes in these patients. Asymptomatic rises in titer of antibody to varicella-zoster virus not explained by rises in antibody to herpes simplex virus occurred in both groups. This latter finding points to an unstable relation between virus and host and supports and hypothesis of Hope-Simpson that subclinical release of virus with resulting antigenic stimulation may maintain immunity to varicella-zoster virus. Patients with herpes zoster and controls did not differ in several humoral immune parameters that might have explained the occurrence of herpes zoster. There was no evidence that herpes zoster precipitated renal graft rejection. PMID: 192807 [PubMed - indexed for MEDLINE] 6207. Boll Ist Sieroter Milan. 1977 Mar 31;56(1):70-3. Complement fixing antibody to varicella-zoster virus in different age groups and after zoster. Moschen ME, Peserico A, Trivello R. The titer of complement fixing antibody to Varicella-Zoster virus was studied in sera from 215 normal persons living in Padua and its province and from 39 Zoster patients. About 74% of sera from normal persons aged 21-80 years had antibody titers larger than or equal to 1/4. Lower titers were present in the age groups 1-20 years and 81-90 years. Sera from Zoster patients had high titers from the second week following the onset of the rash. They were still comparatively high until the fifth month, sometimes remaining detectable even after a year or more. PMID: 193530 [PubMed - indexed for MEDLINE] 6208. Fortschr Med. 1977 Mar 24;95(12):757-828. [Common virus infections of the skin. Molluscum contagiosum, herpes zoster, herpes simplex, condylomata acuminata, verrucae vulgares] [Article in German] Menzel I. The clinical diagnosis, etiology and predisposing factors of these common viral skin diseases are discussed with special emphasis on new therapeutic approaches. PMID: 558140 [PubMed - indexed for MEDLINE] 6209. ZFA (Stuttgart). 1977 Mar 20;53(8):441-3. [Myocardial infarct simulating cases of herpes zoster] [Article in German] Révai S, König E. PMID: 860592 [PubMed - indexed for MEDLINE] 6210. Med Welt. 1977 Mar 18;28(11):519-24. [Inflammatory diseases of the central nervous system with prevalent spinal symptoms] [Article in German] Wolf G. PMID: 853913 [PubMed - indexed for MEDLINE] 6211. Br Med J. 1977 Mar 5;1(6061):638. Chemotherapy for varicella-zoster infections. Juel-Jensen B. PMCID: PMC1605260 PMID: 843848 [PubMed - indexed for MEDLINE] 6212. Lancet. 1977 Mar 5;1(8010):551. Herpes zoster with bladder involvement. Gottheiner TI, Pokroy N, Gregory MC. PMID: 65653 [PubMed - indexed for MEDLINE] 6213. Ann N Y Acad Sci. 1977 Mar 4;284:284-8. Clinical experiences using the antiviral 1-beta-D-ribofuranosyl-1,2,4-triazole-3-carboxamide (ribavirin) in Mexico. Zertuche HF, Perches RD. Follow-up of the use of ribavirin in 390 human patients in Mexico indicates the drug has been used to treat a variety of virus infections. No toxic manifestations of the drug were reported, and the subjective results suggest possible antiviral efficacy. A double-blind, placebo-controlled study using topically applied 5% ribavirin in ointment base against herpes zoster in cancer patients indicates definite efficacy against this specific disease. PMID: 360903 [PubMed - indexed for MEDLINE] 6214. Dtsch Med Wochenschr. 1977 Mar 4;102(9):312-6. [Is cytarabine an effective drug against herpes zoster? (author's transl)] [Article in German] Orfanos CE, Weese A, Runne U, Kratka J, Goerz G. Although herpes zoster is a viral infection with spontaneous healing, the skin eruption is painful and there may be serious complications. Cytarabine was administered to 91 patients with the disease. It was given by quick infusion or intravenously twice daily for five days. An open, uncontrolled study of 61 patients suggested that the drug was beneficial without serious side effects. But in a double-blind randomised study of 30 patients there was no significant effect on the course of the disease. The mean healing time for skin blisters in segmental uncomplicated zoster was 8.4 days with cytarabine and 6.5 days with a placebo. PMID: 319973 [PubMed - indexed for MEDLINE] 6215. Actas Dermosifiliogr. 1977 Mar-Apr;68(3-4):195-200. [Disseminated herpes zoster. Varicella] [Article in Spanish] Rodríguez Cañas T. PMID: 868599 [PubMed - indexed for MEDLINE] 6216. Vojnosanit Pregl. 1977 Mar-Apr;34(2):102-3. [Etiology of Bell's palsy] [Article in Serbian] Rasić M. PMID: 867933 [PubMed - indexed for MEDLINE] 6217. Zh Ushn Nos Gorl Bolezn. 1977 Mar-Apr;(2):103-4. [3 cases of herpes zoster oticus] [Article in Russian] Gol'dsteĭn MA, Rodina KM. PMID: 855446 [PubMed - indexed for MEDLINE] 6218. Nervenarzt. 1977 Mar;48(3):145-6. [Herpes zoster lesion of the sympathetic trunk (author's transl)] [Article in German] Schliack H, Godt P. PMID: 854135 [PubMed - indexed for MEDLINE] 6219. Laryngoscope. 1977 Mar;87(3):372-9. Auditory symptoms associated with herpes zoster or idiopathic facial paralysis. Byl FM, Adour KK. Auditory symptoms (hyperacusis, tinnitus, decreased hearing) have long been recognized to accompany herpetic or idiopathic facial paralysis. Twenty-nine percent of 1,080 patients with idiopathic facial paralysis and 37 percent of 172 with herpes zoster oticus facial paralysis had auditory symptoms. Abnormal related sensori-neural hearing loss was documented in only 11 of these 377 patients with auditory complaints. All of the 11 had a diagnosis of herpes zoster oticus. Sensori-neural hearing loss occurs in only about 6.5 percent of patients with herpes zoster facial paralysis, and no confirmed case of such loss in idiopathic facial paralysis has been reported. In patients presenting with sensori-neural hearing loss accompanying facial paralysis believed to be idiopathic, herpes zoster should be suspected even in the absence of vesicles. Factors favorable for recovery of auditory function include age 64 years or younger, mild initial hearing loss, a cochlear pattern of hearing loss, and absence of vertigo. Recovery of auditory function does take place; however, a high-tone sensori-neural loss may persist except in younger patients. PMID: 557156 [PubMed - indexed for MEDLINE] 6220. Z Hautkr. 1977 Mar 1;52(5):145-50. [Life-threatening generalized varioloid zoster with zoster pneumonia due to combined immunologic deficiency. Increased contagiousness of this disease] [Article in German] Runne U, Szekeres L. There is a clear-cut correlation between the clinical course of an herpes zoster and the quality of immune response. A varioloid generalized herpes zoster accompanied by zoster-pneumonia developed in a forty years old female patient with metastasizing breast cancer treated with x-ray and cytostatic drugs. The particularly serious course of this herpes zoster was brought about by combined immune deficiency, consisting of low level of circulating T-lymphocytes (5/mm3) and for a long time lacking rise of complement fixing antibody titer. Under these conditions an enhanced replication and massive haematogenous spread of varicella-zoster virus took place. The increased contagiosity of this case is indicated by a varicella infection in the patient's two children, appearing after a regular incubation period. Patients with cellular or combined immune deficiency are potentially exposed to danger of herpes zoster and may serve as a source of infection for susceptible persons. PMID: 300529 [PubMed - indexed for MEDLINE] 6221. Infect Immun. 1977 Mar;15(3):850-4. Complement-fixing reactivity of Varicella-Zoster virus subunit antigens with sera from homotypic infections and heterotypic Herpes simplex virus infections. Schmidt NJ, Dennis J, Lennette EH. Various subunit antigens of varicella-zoster (V-Z) virus were examined for complement-fixing (CF) activity with sera from homotypic infections and from herpes simplex virus (HSV) infections in which a CF antibody titer rise was demonstrated with crude V-Z antigen. The subunit antigens included nucleocapsids, envelopes, a soluble antigen produced from infected culture fluids by sucrose density gradient centrifugation, a soluble antigen produced by reducing the volume of clarified infected culture fluids, a soluble antigen derived from infected cell lysates, a "viral" antigen consisting largely of enveloped particles with a few nucleocapsids, and a cell membrane-associated antigen. None was more suitable than crude V-Z antigen for serodifferentiation of V-Z virus and HSV infections. The envelope antigen, cell membrane antigen, and the soluble antigen prepared by density gradient centrifugation showed little reactivity with sera from varicella and HSV infections, but gave high antibody titers with sera from zoster infections, suggesting that a secondary V-Z virus infection is required to produce an antibody response to these subunit antigens. Patients with varicella and zoster infections and the selected patients with HSV infections all showed significant CF antibody responses to the other V-Z subunit antigens. PMCID: PMC421451 PMID: 192677 [PubMed - indexed for MEDLINE] 6222. Geriatrics. 1977 Mar;32(3):77-9. Varicella and herpes zoster: comparisons in the old and young. Myers MG. PMID: 191332 [PubMed - indexed for MEDLINE] 6223. Rev Fr Transfus Immunohematol. 1977 Mar;20(1):109-15. [Detection of antibodies against rubella, herpes zoster and chickenpox for preparation of special or specific gamma globulins] [Article in French] Herzog F. PMID: 70052 [PubMed - indexed for MEDLINE] 6224. JAMA. 1977 Feb 28;237(9):871-2. Herpesvirus infection. Sklar SH. PMID: 189100 [PubMed - indexed for MEDLINE] 6225. Br Med J. 1977 Feb 5;1(6057):378. Chemotherapy for varicella-zoster infections. Walden PA, Newlands ES, Coleman JC, Tattersall MH, Bagshawe KD. PMCID: PMC1604516 PMID: 837111 [PubMed - indexed for MEDLINE] 6226. J Med Assoc State Ala. 1977 Feb;46(8):31-4. Herpes Zoster and herpes simplex management with influenza virus vaccine. Brown AM. PMID: 836475 [PubMed - indexed for MEDLINE] 6227. Br J Surg. 1977 Feb;64(2):143-4. Herpes zoster and paralytic ileus: a case report. Johnson JN, Sells RA. A case of herpes zoster presenting as intestinal obstruction is described. Clinical and radiological evidence of intestinal obstruction was obtained. The mechanisms by which herpes zoster may cause an ileus are discussed. PMID: 578122 [PubMed - indexed for MEDLINE] 6228. Mil Med. 1977 Feb;142(2):165-6. Zoster immune plasma procurement in military hospitals-- a proposal. Fisher WB. PMID: 401970 [PubMed - indexed for MEDLINE] 6229. Zentralbl Bakteriol Orig A. 1977 Feb;237(1):1-34. [Sulphated glycosaminoglycans as virus inhibitors. 4th communication: clinical aspects of zoster with the proposal of a new treatment (author's transl)] [Article in German] Voss H, Pohle HD, Museteanu C. On the base of plaque inhibition tests in at least three virus-host-systems and successful treatment of mice with experimentally induced yellow fever encephalitis a well known sulphated glycosaminoglycan (GAGPS) "L5" was used as therapeutic agent in cases of zoster infection in man. The material was applied as 1% solution in water continuously on lint and rewettet for several days until nearly complete healing was achieved. The clinical course of 18 patients of former years (12 women, 6 men) was compared with 26 cases (19 women, 7 men) treated additionally with the new substance. All of them were carefully observed in the Rudolf-Virchow-Hospital in Berlin. Besides of registrating data as age and sex of the patients and the seasonal distribution of cases the course of illness was analyzed. The mean duration before admission to the hopsital was 4,9 days in the control group and 7,2 days in the L5-patients. Signs of organ diseases possibly acting as trigger mechanism for the remanifestation of the zoster were nearly twice in number in L5 cases than in the controls. Despite of this unfavorable stiutation the main parameters showed a clear tendency to return earlier to normal values in the GAGPS group. The fever was shortened. The blood lymphocytes normalized better with mean absolute values of 2400 in the L5-group and 3029 per m(3) in the control cases. The fall of the cell number in the liquor cerebrospinalis was more rapidly in the GAGPS treatment. The mean stay in the hospital was 33,2 days in L5 cases and 44,6 days in control patients respectively in the main group of age between 60 and 80 years. One death in the GAGPS group corresponded to four in the control group. In the local skin area the edema disappeared rapidly with beginning of treatment. Confluent vesicles flattened within 24 to 48 hours and no further efflorescences were seen. Pain diminished in few days. The good results justify continued trials. PMID: 190822 [PubMed - indexed for MEDLINE] 6230. ZFA (Stuttgart). 1977 Jan 31;53(3):164-8. [Infectious exanthemas] [Article in German] Grundler E. PMID: 320776 [PubMed - indexed for MEDLINE] 6231. Br Med J. 1977 Jan 29;1(6056):286. Chemotherapy for varicella-zoster infections. Dawber R. PMCID: PMC1604183 PMID: 837071 [PubMed - indexed for MEDLINE] 6232. Fortschr Med. 1977 Jan 20;95(3):119-22, 152-8. [Therapy of herpes zoster through active premunization. 2. Treatment of zoster patients, results of experimental and clinical studies, treatment results] [Article in German] Mayr VA, Stickl H, Westhues M, Gillesberger W, Schwarz D, Bibrack B. A brief review of the previous and generally inadequate methods for the treatment of Herpes Zoster is presented. The concept of "active premunization" by appropriate inducer to provide an objective treatment is defined. A "Premunization Inducer" (PIND) based on a particular non-infectious preparation of an avian pox ("avipox") virus has been shown to enhance non-specific defence mechanisms in the host by T-cell stimulation and to inhibit virus proliferation by the induction of Interferon. The mode of action, efficacy against different viruses and the safety of the preparation is described and discussed. 114 patients with Herpes Zoster were treated with this "premunization Inducer" either orally (for buccal absorption) or by means of a nasal spray. There were no side effects and in all cases there was a marked reduction in the duration of the illness up to the shedding of the last scab (about 15 days instead of the more usual 31 days). Pain was relieved in some cases within 6 hours and in the remainder within 2 days: a rapid resolution of the inflammation could be observed. There were practically no signs of postherpetic neurological complications among the patients treated (the usual incidence of post-herpetic neuritis is around 18%). The treatment of Herpes I and Herpes II infection other viral conditions will be reported elsewhere. PMID: 838422 [PubMed - indexed for MEDLINE] 6233. Fortschr Med. 1977 Jan 13;95(2):87-93. [Therapy of herpes zoster uring active premunization. 1. Therapeutic possibilities: bases and the principle of premunition--premunization] [Article in German] Mayr A, Stickl H, Westhues M, Gillesberger W, Schwarz D, Bibrack B. PMID: 832835 [PubMed - indexed for MEDLINE] 6234. N Z Med J. 1977 Jan 12;85(579):3-6. Transfer factor therapy: clinical experience and the role of the E rosette assay. Sutherland DC, Wilson JD, Douglas R. Transfer factor has been administered to 17 patients, most with infectious diseases of various kinds. In 12 patients the therapy was followed by a definite clinical improvement although in most cases conventional chemotherapy was given concomitantly. In all cases where clinical improvement followed the sheep red cell or E rosette assay showed low values initially, with an improvement following therapy. This test of T lymphocyte function may be useful both in predicting patients likely to respond to transfer factor, and in monitoring response to treatment. As no specific assay of transfer factor activity is available, an in vivo rise in E rosette formation following transfer factor administration serves as a crude indicator that the injected material has some biological activity. PMID: 319390 [PubMed - indexed for MEDLINE] 6235. J Int Med Res. 1977;5(5):378-81. The use of betadine antiseptic paint in the treatment of Herpes simplex and Herpes Zoster. Woodbridge P. Twenty-two patients with Herpes Simplex were treated with Betadine (povidone iodine) Antiseptic paint and seven with 5% idoxuridine in dimethyl sulphoxide, also one patient with bilateral lesions was treated with the two solutions, one on each side. The povidone iodine alcohol solution appeared to be at least as effective as the idoxuridine with minimal side-effects (some stinging in two patients). Good results were also obtained with this solution in twelve patients with Herpes Zoster. PMID: 913866 [PubMed - indexed for MEDLINE] 6236. Acta Neurochir (Wien). 1977;38(1-2):65-72. Postherpetic craniofacial dysaesthesiae: their management by stereotaxic trigeminal nucleotomy. Schvarcz JR. PMID: 899896 [PubMed - indexed for MEDLINE] 6237. Neurol Neurochir Pol. 1977;11(3):375-7. [Case of Frankl-Hochwart syndrome (polyneuritis cranials menieriformis)] [Article in Polish] Klimek A. In a 19-year-old man sudden Bell's palsy developed and after 2 days vertigo and peripheral-type nystagmus supervened. ENG demonstrated presence of spontaneous nystagmus on right gaze and lack of excitability of the left horizontal canal. The cerebrospinal fluid was normal, virological examination failed to demonstrate presence of antibodies to zoster virus or a rise of antibodies to enteroviruses. Vertigo and nystagmus disappeared within several days. Bell's palsy regressed later. The results of virological investigations cast doubt on the views of these authors who regard Frankl-Hochwart syndrome as a variety of Ramsay Hung Syndrome. In the presently reported case the possibility of zoster virus being the cause of the disease has been ruled out. PMID: 882215 [PubMed - indexed for MEDLINE] 6238. Dermatologica. 1977;154(5):301-4. Motor paralysis complicating herpes zoster. Nord E, Weinberger A, Benjamin D, Pinkhas J. PMID: 863072 [PubMed - indexed for MEDLINE] 6239. Nippon Rinsho. 1977 Fall;35 Suppl 2:3150-1, 3516-7. [Diplopia and frontal headache (protein fractionation and immunoglobulin analysis): (myeloma and disseminating herpes zoster)] [Article in Japanese] Shibata S, Yamada H, Shibata M, Aoyama S, Yamashita S. PMID: 611266 [PubMed - indexed for MEDLINE] 6240. Sangre (Barc). 1977;22(6):1022-5. [Agglutinating anti-Duffy antibody of IgM type (author's transl)] [Article in Spanish] Martin Vega C, Gallart MT, Murcia C, Ribera A, Armengol R. PMID: 601669 [PubMed - indexed for MEDLINE] 6241. Int J Radiat Oncol Biol Phys. 1977 Jan-Feb;2(1-2):1-19. Long-term side effects in irradiated patients with Hodgkin's disease. Slanina J, Musshoff K, Rahner T, Stiasny R. PMID: 557465 [PubMed - indexed for MEDLINE] 6242. J Med Virol. 1977;1(2):79-93. Pharmacologic effects of polyinosinic-polycytidylic acid in man. Freeman AI, Al-Bussam N, O'Malley JA, Stutzman L, Bjornsson S, Carter WA. Twenty-four patients with cancer and concomitant infections with either herpes virus hominis or varicella zoster virus were treated with polyinosinic-polycytidylic acid (rIn.rCn) to determine: 1) the reliability of rIn.rCn to induce interferon production, and 2) the toxicity of the drug. Seven additional patients with herpes zoster were observed as controls. Two lots of rIn.rCn were used; Lot 1 was consistently effective in stimulating serum interferon at doses of 9 and 12 mg/kg, whereas Lot 2 was effective at doses of 3-12 mg/kg. There was no correlation between rIn.rCn doses within these ranges and the resultant interferon levels. Generally, peak serum interferon occurred within the first day. Toxicity to rIn.rCn consisted of fever in 21/24 patients, mild elevation of liver enzymes in 8/24 patients, and laboratory abnormalities of coagulation in 9 patients. The coagulation abnormalities appeared linearly related to the dose of rIn.rCn used. All these abnormalities were reversible, and none were considered severe of life-threatening. Since rIn.rCn was effective in stimulating interferon and since toxicity was considered acceptable, a randomized double-blind study was initiated to determine whether rIn.rCn is effective in the treatment of herpes zoster. PMID: 347034 [PubMed - indexed for MEDLINE] 6243. Bull Mem Soc Fr Ophtalmol. 1977;89:206-10. [Results of lamellar and perforating grafts in herpetic kerato-uveitis] [Article in French] Witmer R. PMID: 346111 [PubMed - indexed for MEDLINE] 6244. Cutis. 1977 Jan;19(1):98-100. Widespread cutaneous herpes simplex type II infection. Rosenberg FW, Schachter RK, Givan K. The case of an adult who survived a widespread culture-proven cutaneous herpes simplex type II infection is presented. The authors believe it is the first such case. The virus was demonstrated by its cytopathic effect in Vero cell culture. Large, swollen syncytial cells and holes in the cell sheet, typical of the changes produced by the herpes simplex virus type II, were noted. Photodynamic inactivation therapy with acriflavine dye and fluorescent light was employed. PMID: 319958 [PubMed - indexed for MEDLINE] 6245. Postgrad Med J. 1977;53 Suppl 4:104-9. Studies on the concomitant use of carbamazepine and clomipramine for the relief of post-herpetic neuralgia. Gerson GR, Jones RB, Luscombe DK. PMID: 304576 [PubMed - indexed for MEDLINE] 6246. Can J Ophthalmol. 1977 Jan;12(1):66-7. Herpes zoster conjunctival ulceration. Kline LB, Jackson B. A 70 year old man acquired a herps zoster infection of the ophthalmic division of his right trigeminal nerve. During the course of the illness he developed the rare complication of a cojunctival ulcer. It is suggested that the ulceration may be the result of an ischemic ischemic vasculitis. PMID: 300270 [PubMed - indexed for MEDLINE] 6247. Neurology. 1977 Jan;27(1):100-1. Evidence of viral cause in granulomatous angiitis. Gilbert GJ. PMID: 299928 [PubMed - indexed for MEDLINE] 6248. Trans Ophthalmol Soc N Z. 1977;29:133-6. Post-herpetic neuralgia, treatment and prevention. Haas LF. PMID: 269547 [PubMed - indexed for MEDLINE] 6249. J Med Virol. 1977;1(3):209-17. Immunotherapy of viral infections with transfer factor. Mazaheri MR, Hamblin AS, Zuckerman AJ. It has been reported that dialysable leucocyte extract preparations, thought to contain transfer factor, may be used therapeutically for the treatment of a variety of immunodeficiency syndromes. Clinical and laboratory studies have suggested that such preparations, in addition to transferring specific cellular immunity may also contain non-specific adjuvant activities. Attempts at immunotherapy of viral infections are described against a background of current research on the biological and biochemical properties of leucocyte dialysates. PMID: 204742 [PubMed - indexed for MEDLINE] 6250. Arch Virol. 1977;55(1-2):1-24. Virus infections after transplantation in man. Brief review. Ho M. PMID: 200197 [PubMed - indexed for MEDLINE] 6251. Bull Pan Am Health Organ. 1977;11(2):153-6. The herpesvirus group. Melnick JL. Several agents in the herpesvirus group are known to infect man. They cause a wide variety of conditions, ranging from coldsores to chickenpox and shingles. At the same time a number of the herpesviruses have been linked with malignant diseases in both lower animals and man. PMID: 198052 [PubMed - indexed for MEDLINE] 6252. Int Ophthalmol Clin. 1977 Fall;17(3):109-20. Viral uveitis. Abelson MB, Pavan-Langston D. PMID: 197040 [PubMed - indexed for MEDLINE] 6253. Ateneo Parmense Acta Biomed. 1977;48(2):167-92. [Trigeminal herpes zoster] [Article in Italian] Bottazzi D, Gariboldi L, Pelizza A. The authors, after a brief discussion about etiopathogenesis, istopathological changes and principal symptomatologic and therapeutic elements of Herpes Zoster, present three personal observations of Herpes Zoster facialis, two affecting only the third branch of the trigeminus nerve and one only its second branch. Finally they discuss, basing on clinical peculiarities, a possible diagnostic localization of the disease. PMID: 196603 [PubMed - indexed for MEDLINE] 6254. Pediatrics. 1977 Jan;59(1):8-12. Protective efficacy of vaccination in children in four episodes of natural varicella and zoster in the ward. Asano Y, Nakayama H, Yazaki T, Ito S, Isomura S. It was previously reported that a live varicella vaccine (Oka strain) has been developed and that the immediate vaccination of hospitalized children was effective for prevention of spread of varicella in a ward. Six to nine months later, there were four separate episodes of varicella and zoster in the same ward. Eighteen children (11 with nephrotic syndrome, 6 with nephritis, and 1 with hepatitis) with no history of varicella were inoculated with a live vaccine before or immediately after admittance or occurence of the varicella and zoster cases. Twelve of them had been receiving steroid therapy and 15 of the 18 were found to be seronegative by complement fixation and neutralization tests before the vaccination. All of them became seropositive after vaccination without any clinical symptoms. The longest period between vaccination and exposure was nine months. None of the vaccinees exhibited varicella symptoms after exposure. Serological follow-up of ten vaccinated children was done, and booster responses were observed in some of them after exposure. These results suggest that the live vaccine affords immunity to the recipients. If hospitalized children are vaccinated before or immediately after exposure, isolation of the patient is unnecessary. PMID: 190584 [PubMed - indexed for MEDLINE] 6255. J Immunol Methods. 1977;14(2):183-95. Solid-phase radioimmunoassay of herpes simplex virus IgG and IgM antibodies. Kalimo KO, Ziola BR, Viljanen MK, Granfors K, Toivanen P. A solid-phase radioimmunoassay for detection of herpes simplex virus-specific IgG and IgM antibodies in human serum specimens is presented. Virus antigen is adsorbed on polystyrene balls and antibodies which attach to the antigen are detected by 125I-labeled antihuman-gamma or antihuman-mu immunoglobulins. A total of 76 specimens have been tested. The appearance of virus-specific IgG and IgM antibodies in primary herpetic infections was readily demonstrated. When serum samples from patients with past exposure to herpes simplex virus were tested, endpoint titers of virus-specific IgG antibodies were found to be 8 to 2048 times higher than titers determined by a complement fixation test. Apparent cross reactivity with varicella-zoster virus was observed in the present radioimmunoassay. PMID: 190320 [PubMed - indexed for MEDLINE] 6256. Am J Med. 1977 Jan;62(1):77-85. Herpes zoster and impaired cell-associated immunity to the varicella-zoster virus in patients with Hodgkin's disease. Ruckdeschel JC, Schimpff SC, Smyth AC, Mardiney MR Jr. Thirty-two patients with Hodgkin's disease and 12 normal donors were studied for their in vitro lymphocyte responsiveness to a membrane-associated varicella-zoster (VZ) antigen. When compared to the normal donors, patients with Hodgkin's disease in whom radiotherapy was recently completed and those with active, recurrent disease had markedly impaired cell-associated immunity to VZ antigen. In addition, there was a suggestion that patients in long-term remission who had received primary combined modality therapy (radiotherapy plus chemotherapy) had an impaired response when compared to normal persons or to patients who had received single modality therapy. Newly diagnosed, untreated patients with Hodgkin's disease did not differ significantly from normal persons as a group but two of six were unresponsive to the VZ antigen whereas all normal subjects were responsive. Most patients in remission for at least one year following therapy had normal in vitro responsiveness. In two patients herpes zoster developed after the demonstration of absent in vitro lymphocyte reactivity to the VZ antigen. PMID: 189604 [PubMed - indexed for MEDLINE] 6257. J Oral Surg. 1977 Jan;35(1):51-3. Facial herpes zoster. Atterbury RA. PMID: 186575 [PubMed - indexed for MEDLINE] 6258. Dermatologica. 1977;155(3):183-4. [Intercostal zona and congenital in difference to pain] [Article in French] Wilmaers M, Mestdagh C, Stoupel N. PMID: 70383 [PubMed - indexed for MEDLINE] 6259. Nurs Mirror Midwives J. 1976 Dec 9;143(24):75. ABC of diseases. [No authors listed] PMID: 1050721 [PubMed - indexed for MEDLINE] 6260. Lancet. 1976 Dec 4;2(7997):1219-22. Herpes zoster with dysfunction of bladder and anus. Jellinek EH, Tulloch WS. Herpes zoster may give rise to dysfunction of bladder and anus. Mucosal lesions have been reported, and 7 cases are described with retention, loss of sensation, or incontinence. Sacral shingles is associated with sensory loss and flaccid detrusor paralysis. Lumbar shingles may cause retention, and zoster at higher levels can also damage the spinal cord. Recovery is usually complete. The implication for schemes of bladder innervation is discussed. PMID: 63042 [PubMed - indexed for MEDLINE] 6261. Arch Dermatol. 1976 Dec;112(12):1755-6. Herpes zoster. Case report of possible accidental inoculation. Su WP, Muller SA. A 30-year-old healthy male physician developed grouped, papulovesicular lesions along the dermatomes of T1 and T2 of the left side of his body. The onset occurred two days after he accidentally pricked his right index finger with a needle that had been used to aspirate the acute papulovesicular lesion of a patient with severe herpes zoster. The clinical appearance and dermatomal distribution, the subsequent clinical course, the skin biopsy findings, and the substantial increase in complement-fixing antibody titer to the varicella-zoster (V-Z) virus in the convalescent serum samples are strong evidence for herpes zoster. Although it is generally believed that person-to-person transmission of zoster is rare and that herpes zoster results from the reactivation of a latent varicella virus, the present case suggests that zoster can be acquired from exogenous infection with a V-Z virus, at least in certain circumstances. PMID: 1008568 [PubMed - indexed for MEDLINE] 6262. Int J Dermatol. 1976 Dec;15:762-9. Treatment of zoster and postzoster neuralgia by the intralesional injection of triamcinolone: a computer analysis of 199 cases. Epstein E. On the basis of this study of 111 patients with herpes zoster and 88 with postherpetic neuralgia, it is suggested that the intradermal injection of triamcinolone in saline is a valuable treatment. Mild complications were pain, hemorrhage, abscesses, atrophy, moon face and possibly thrombophlebitis. Zoster patients required treatment for about half as long as those in previously reported control series. In patients treated for active herpes zoster, postzoster neuralgia occurred with about one-third of the frequency noted in other series. In postzoster neuralgia, the patient was benefited sufficiently in 62.5% of the cases to find that life was worth living again. PMID: 992927 [PubMed - indexed for MEDLINE] 6263. Brain. 1976 Dec;99(4):673-94. The neurological complications of cardiac transplantation. Hotson JR, Pedley TA. Review of the neurological complications encountered in 83 patients who received cardiac homografts over a seven-year period leads to the following conclusions: (1) Neurological disorders are common in transplant recipients, occurring in over 50 per cent of patients. (2) Infection was the single most frequent cause of the neurological dysfunction, being responsible for one-third of all CNS complications. (3) The infective organisms were typically those considered to be usually of low pathogenicity: fungi, viruses, protozoa and an uncommon bacterial strain. (4) Other clinical neurological syndromes were related to vascular lesions, often apparently from cerebral ischaemia or infarction occurring during the surgical procedure, metabolic encephalopathies, cerebral microglioma, acute psychotic episodes and back pain from vertebral compression fractures. (5) The infectious complications and probably the development of neoplasms de novo, are related to immunosuppressive therapy which impairs virtually all host defence mechanisms and alters the nature of the host's response to infective agents or other foreign antigens. (6) Because neurological symptoms and signs were usually those of behavioural changes or deterioration in intellectual performance, the neurological examination was often of little value in diagnosing the nature or even the anatomical site of the neuropathological process. (7) The possibility of an infectious origin of the neurological manifestations must be aggressively pursued even in the absence of fever and a significantly abnormal spinal fluid examination. The diagnostic error made most frequently was to ascribe neurological symptoms erroneously to metabolic disturbances or to "intensive care unit psychosis" when they were in fact due to unrecognized CNS infection. (8) Maintenance of mean cardiopulmonary bypass pressures above 70 mmHg, particularly in patients with known arteriosclerosis, may reduce operative morbidity. (9) Though increased diagnostic accuracy is possible with routine use of a variety of radiological and laboratory techniques, two further requirements probably must be met before a significant reduction in the frequency of neurological complications will occur: the advent of greater immunospecificity in suppressing rejection of the grafted organ while preserving defences against infection; and a more effective armamentarium of antiviral and antifungal drugs. PMID: 192413 [PubMed - indexed for MEDLINE] 6264. JAMA. 1976 Nov 8;236(19):2174-5. Herpes zoster and neoplastic disease. Rhodes AR. PMID: 989806 [PubMed - indexed for MEDLINE] 6265. Compr Psychiatry. 1976 Nov-Dec;17(6):781-5. Dementia dialytica: a new psychotic organic brain syndrome. Scheiber SC, Ziesat H Jr. PMID: 991609 [PubMed - indexed for MEDLINE] 6266. Arch Ophthalmol. 1976 Nov;94(11):1899-1902. Herpetic corneal epithelial disease. Marsh RJ, Fraunfelder FT, McGill JI. The clinical differentiation of corneal epithelial lesions due to herpes simplex or herpes zoster may be confusing. Practical clinical tests, including the use of topical ocular stains, are useful to differentiate corneal epithelial lesions caused by these two viruses. Two distinctive types of zoster corneal epithelial disease may be seen; an early dendritic form, and a delayed form characterized by corneal mucus plaques that may take a dendriform pattern. These plaques are composed of mucus that is adherent to swollen, degenerating epithelial cells. The clinical differentiation between these two viruses is essential since topically applied corticosteroids are contraindicated in epithelial herpes simplex and often are indicated in the management of epithelial herpes zoster. PMID: 62568 [PubMed - indexed for MEDLINE] 6267. Wien Klin Wochenschr. 1976 Oct 29;88(20):664-7. [Virological investigations in peripheral idiopathic facial pareses (author's transl)] [Article in German] Mitschke H. Virological investigations were carried out on the serum of 62 patients suffering from peripheral facial pareses. The aetiology was definitely attributable to a virus infection in 12 of these cases. Neuropathological changes induced by these neurotropic viruses, predisposing anatomical features and pathogenesis are discussed. Since only symptomatic treatment is possible, the importance of active immunization, where available, is stressed in the prevention of virus diseases; a decrease in morbidity could lead to a reduction in neurological complications. PMID: 186960 [PubMed - indexed for MEDLINE] 6268. Med Welt. 1976 Oct 8;27(41):1973-8. [Basic text: Herpes zoster] [Article in German] Clauss H, Dahmer J, Weinrich W. PMID: 994805 [PubMed - indexed for MEDLINE] 6269. Indian J Ophthalmol. 1976 Oct;24(3):36-7. Trigeminofacial herpeszoster--a case report. Anandakannan K. PMID: 1088557 [PubMed - indexed for MEDLINE] 6270. Ann Otolaryngol Chir Cervicofac. 1976 Oct-Nov;93(10-11):713-6. [A case of multilocular zona] [Article in French] Labayle MJ, Lachmann. PMID: 1088389 [PubMed - indexed for MEDLINE] 6271. Am J Ophthalmol. 1976 Oct;82(4):628-30. Temporal artery biopsy in herpes zoster ophthalmicus with delayed arteritis. Victor DI, Green WR. A 58-year-old man developed herpes zoster ophthalmicus with delayed hemiparesis. Temporal artery biopsy confirmed the presence of a vasculitis. Electron microscopy of the temporal artery failed to reveal viral particles. Herpes zoster ophthalmicus with delayed arteritis appeared to be a contiguous spread of vasculitis to the carotid system and not a direct viral invasion. PMID: 1086062 [PubMed - indexed for MEDLINE] 6272. Laryngoscope. 1976 Oct;86(10):1572. Red chorda tympani nerve in Herpes Zoster oticus. May M. A red chorda tympani nerve was previously reported as a finding limited to patients with Bell's palsy. This is a report of red chorda tympani nerve observed in 3 of 10 patients with Herpes Zoster oticus in whom the chorda tympani was visible. It is speculated that the red discoloration is due to a viral inflammatory process and, therefore, when this sign is present in a patient with idiopathic peripheral facial paralysis, a viral neuropathy should be suspected. PMID: 966922 [PubMed - indexed for MEDLINE] 6273. Nouv Presse Med. 1976 Sep 25;5(31):1997. [Treatment of zona and varicella. Effectiveness of lysozyme] [Article in French] Brisset CH. PMID: 980721 [PubMed - indexed for MEDLINE] 6274. Ugeskr Laeger. 1976 Sep 13;138(38):2302-5. [Chronic herpes zoster pain treated with transcutaneous electric stimulation] [Article in Danish] Juul-Jensen P, Malmros R, Pedersen B, Sorensen K. PMID: 1086017 [PubMed - indexed for MEDLINE] 6275. Ugeskr Laeger. 1976 Sep 13;138(38):2305-9. [Treatment of acute herpes zoster with acupuncture and sympathetic blocks. A controlled study] [Article in Danish] Nielsen SE, Valentin N, Lewinski A. PMID: 968976 [PubMed - indexed for MEDLINE] 6276. Ugeskr Laeger. 1976 Sep 13;138(38):2299-301. [Herpes zoster treated by photodynamic inactivation] [Article in Danish] Larsen PO, Hage E, Seidelin J. PMID: 788272 [PubMed - indexed for MEDLINE] 6277. Nippon Hifuka Gakkai Zasshi. 1976 Sep 10;86(10):615-22. [Clinical study and treatment of herpes zoster (author's transl)] [Article in Japanese] Sasada K, Yasue T, Akutsu J, Shinjô H. PMID: 1034792 [PubMed - indexed for MEDLINE] 6278. Nippon Hifuka Gakkai Zasshi. 1976 Sep 10;86(10):623-8. [Pathology and pathogenesis of varicella and zoster (author's transl)] [Article in Japanese] Aoyama Y, Kurata T, Hondo R, Ogiwara H. PMID: 189104 [PubMed - indexed for MEDLINE] 6279. Neurol India. 1976 Sep;24(3):159. Herpes zoster ophthalmicus with abducens nerve inolvement. Dinakar I. PMID: 1088176 [PubMed - indexed for MEDLINE] 6280. Rinsho Shinkeigaku. 1976 Sep;16(9):649-53. [Case of herpes zoster ophthalmicus with contralateral hemiplegia] [Article in Japanese] Nishimaru K, Kamei H. PMID: 1087597 [PubMed - indexed for MEDLINE] 6281. Zh Nevropatol Psikhiatr Im S S Korsakova. 1976 Sep;76(9):1315-8. [Intensive therapy of herpes zoster with deoxyribonuclease] [Article in Russian] Gutorov AN, Lesnikov EP, Salganik RI. PMID: 1015134 [PubMed - indexed for MEDLINE] 6282. Klin Med (Mosk). 1976 Sep;54(9):90-7. [Lesions of the nervous system caused by viruses of the herpes group] [Article in Russian] Tsuker MB. PMID: 1003925 [PubMed - indexed for MEDLINE] 6283. Hautarzt. 1976 Sep;27(9):463. [Combination of IDU and DMSO in zoster?] [Article in German] Nasemann T. PMID: 993025 [PubMed - indexed for MEDLINE] 6284. Surv Ophthalmol. 1976 Sep-Oct;21(2):91-9. Herpes simplex: the primary infection. Ostler HB. A primary infection with herpes simplex virus (HSV) occurs at some time in the life of almost every member of the population, especially among those living in crowded, unsanitary conditions. In many cases the lesions are subclinical, and in most cases they are self-limited even when clinical. In a few patients, such as the newborn infant, the patient with concomitant eczema, or the patient with reduced immunity, the primary infection may become severe, generalized, and life-threatening. Type 1 HSV has a predilection for a number of sites, including the oral cavity, the eye, and the skin; and type 2 HSV has a predilection for the genital area and for the newborn. PMID: 982271 [PubMed - indexed for MEDLINE] 6285. Surv Ophthalmol. 1976 Sep-Oct;21(2):136-4709ENG. The management of ocular herpesvirus infections. Ostler HB. The many treatment methods in current use for every known complaint only seem to aggravate the difficulty of treating ocular herpes simplex virus (HSV) infections, which are generally self-limited in the immunocompetent host. The cornea is already a somewhat immune-deficient tissue since its lack of blood vessels separates it partially from the host, and treatment with glucocorticoids, which are immunosuppressive, increases the risk of damaging complications such as scarring, prolonged morbidity, bacterial or fungal superinfection, and the occasional corenal perforation. Accepted methods of treatment of specific lesions, are discussed, as are some methods that are not yet accepted, but which seem promising. Herpes zoster may result in scarring and significant loss of vision even without the use of glucocorticoids, the disease often manifesting itself in the already compromised host. The major complication is postherpetic neuralgia. None of the available treatment methods has been fully satisfactory, and every effort should be made to prevent eye lesions in patients with early infection of the ophthalmic branch of the trigeminal nerve. Stimulation of cellular immunity by various means appears to offer some new promise for control of the disease. Management of varicella, cytomegalovirus, and infectious mononucleosis are also discussed. PMID: 790617 [PubMed - indexed for MEDLINE] 6286. Surv Ophthalmol. 1976 Sep-Oct;21(2):148-59. The ocular manifestations of herpes zoster, varicella, infectious mononucleosis, and cytomegalovirus disease. Ostler HB, Thygeson P. Herpes zoster, caused by varicella-zoster (V-Z) virus which also causes varicella (chickenpox), is usually a benign self-limited disease. However, when the ophthalmic division of the trigeminal nerve is affected, the ocular disease (ophthalmic zoster), although also usually mild and self-limited, may have severe complications (corneal scarring, glaucoma, iris atrophy, posterior synechiae, scleritis, motor disturbances, optic neuritis, retinitis, anterior segment necrosis, and phthisis bulbi and servere postherpetic neuralgia). Varicella affects the eye rarely (except for the typical lid lesions), but associated conjunctival and corneal lesions, iridocyclitis, glaucoma, chorioretinitis, and optic nerve lesions have been described. Infectious mononucleosis may involve the eye either by direct involvement or from a remote focus such as the central nervous system. Ocular manifestations of cytomegalovirus disease is usually limited to the choroid and retina unless involvement of the developing embryo occurs prior to the development of the eye. PMID: 185734 [PubMed - indexed for MEDLINE] 6287. Cutis. 1976 Sep;18(3):427-32. Herpes zoster in the elderly. Miller LH. Herpes zoster is a self-limited disorder which in most cases resolves without complications. The specific defect in host immunity that permits activation of latent V-Z virus and the occurrence of herpes zoster in both healthy and debilitated individuals has not yet been identified. In some patients, particularly the aged, complications occur during the acute phase of the disease or there are sequelae that may incapacitate the patient later. The most important of these is postherpetic neuralgia. In the elderly the chance of developing neuralgia following herpes zoster is about 50%. Involvement of the eye may produce minimal scarring or permanent blindness. There is an increasing incidence and severity of herpes zoster in association with malignant disease and in particular with Hodgkin's disease. Treatment of herpes zoster in the elderly should be determined by presenting symptoms. Topical medication such as the basic shake lotion is helpful. Personal experience and published reports suggest that early systemic administration of corticosteroids to healthy patients with severe herpes zoster pain with lessen the occurrence of postherpetic neuralgia. Administration of herpes zoster immune globulin is only effective in reducing the morbidity or preventing varicella in high risk individuals. ZIG does not affect the clinical course of herpes zoster. PMID: 65246 [PubMed - indexed for MEDLINE] 6288. Vestn Dermatol Venerol. 1976 Aug;(8):71-4. [Shingles as a provoking factor in psoriasis] [Article in Russian] Lipets ME, Gavrikov VV, Shibaeva LN. PMID: 983286 [PubMed - indexed for MEDLINE] 6289. Arch Dermatol. 1976 Aug;112(8):1178. Letter: Glutaraldehyde in treating herpes simplex and herpes zoster. Gordon HH. PMID: 821400 [PubMed - indexed for MEDLINE] 6290. AJR Am J Roentgenol. 1976 Aug;127(2):273-6. Colonic changes of herpes zoster. Menuck LS, Brahme F, Amberg J, Sherr HP. The lesions of herpes zoster of the colon were observed in three cases. Small polygonal mucosal blebs or small ulcerations involving a short segment of the colon and appearing in a reasonable time relationship with the cutaneous manifestations either in a corresponding or noncorresponding dermatome should enable diagnosis of this unusual condition. Recognition of this entity in the presence of these skin lesions should be obvious and therefore helpful in avoiding more aggressive and invasive diagnostic procedures. PMID: 182006 [PubMed - indexed for MEDLINE] 6291. J Neurol Sci. 1976 Aug;28(4):427-47. Unusual manifestations of herpes zoster. A clinical and electrophysiological study. Gardner-Thorpe C, Foster JB, Barwick DD. The literature on complicated herpes zoster is summarized in this paper. The case histories of 18 patients with herpes zoster are presented. Two patients had encephalitis, 2 had myelitis and the other 14 patients had various types of lower motor neurone disturbance. Both patients with encephalitis--one of who developed choreo-athetosis during the illness--recovered fully. Only 1 of the 2 patients with myelitis recovered fully; the other remains severely paraparetic and the reason for her incomplete recovery may be related to the presence of generalized arteriolar disease associated with seronegative rheumatoid disease. One patient developed a Guillain-Barre syndrome 3 weeks after the onset of herpes zoster. Recovery in the 15 patients with lower motor neurone involvement has been slow butcomplete--or almost complete--in all but 1, a patient with persistent facial weakness as part of the Ramsay Hunt syndrome and who also had weakness of one upper limb. Seven other patients had lower limb weakness. In 2 patients the weakness was confined to abdominal myotomes and 2 other patients had urinary retention. Electromyographic abnormalities were found in the muscles which were weak and frequently also in muscles which appeared strong. It is emphasized that neurological disturbances other than sensory abnormalities may be found in patients with herpes zoster. Motor complications of various types are not uncommon. PMID: 181539 [PubMed - indexed for MEDLINE] 6292. JAMA. 1976 Jul 26;236(4):345-6. Letter: "Ramsay Hunt, Ramsay-Hunt, or Hunt's syndrome?". Litt JZ. PMID: 947045 [PubMed - indexed for MEDLINE] 6293. Trans Ophthalmol Soc U K. 1976 Jul;96(2):334-7. Current management of ophthalmic herpes zoster. Marsh RJ. PMID: 1087768 [PubMed - indexed for MEDLINE] 6294. Can J Ophthalmol. 1976 Jul;11(3):217-22. [Zona ophthalmica and dendritic keratitis] [Article in French] Laflamme MY, Kurstak C, Kurstak E, Moriset R. Two cases of herpes zoster ophthalmicus with dendritic keratitis are reported. Virological studies confirmed the double infection with herpes simplex type 1 virus in the corneal lesions and herpes zoster virus in the cutaneous lesions. We suggest the use of the immunoperoxidase test to identify the viral agent mainly because of its rapid and specific results. We are against the use of local steroids in dendritic keratitis unless the etiological agent is proved to be herpes zoster virus and not herpes simplex virus. PMID: 949630 [PubMed - indexed for MEDLINE] 6295. Br J Plast Surg. 1976 Jul;29(3):245-6. Herpes zoster involving a skin graft. Kikuchi I, Isa F. PMID: 779906 [PubMed - indexed for MEDLINE] 6296. Arch Pathol Lab Med. 1976 Jul;100(7):386-91. Necrotizing retinopathy with herpes zoster ophthalmicus: a light and electron microscopical study. Schwartz JN, Cashwell F, Hawkins HK, Klintworth GK. A necrotizing retinopathy following a vesicular cutaneous eruption in the distribution of the right trigeminal nerve developed in a patient who had been receiving systemic corticosteroid therapy one week prior to the onset of herpes zoster ophthalmicus. Seven weeks after the herpetic symptoms began, the patient died of pneumonia following an intracerebral hematoma. At postmortem examination, unexpected multiple focal and confluent lesions, which corresponded to areas of extensive retinal necrosis, were observed in the fundus of the right eye. Intranuclear inclusions with a perinuclear halo were identified within the affected sensory retina. Electron microscopy of the retinal lesions disclosed round to oval enveloped viral particles that were characteristic of the herpes viruses. A mild lymphocytic infiltrate was evident in a demyelinated right Gasserian ganglion. Demyelination and necrosis of the right trigeminal sensory tract and adjacent areas were evident within the brain stem. PMID: 180930 [PubMed - indexed for MEDLINE] 6297. Wien Klin Wochenschr. 1976 Jun 11;88(12):393-6. [Dermatological complications after renal transplantation (author's transl)] [Article in German] Kopsa H, Schmidt P, Zazgornik J, Kotzaurek R, Pils P, Thurner J. 58 renal transplant patients were submitted to dermatological check-up investigations at regular intervals over a mean period of 26.2 months after surgery. 98% of the case material showed dermatological complications. In an analysis of the findings in 55 patients with infectious complications, viral infections occurred in 40, bacterial in 30 and mycotic infections in 20 patients. Dermatological manifestations of non-dermatological complications were mainly due to immunosuppressive therapy. The data stress the necessity of optimum cooperation between dermatologists and the attendant physician in the case of renal transplant patients. PMID: 133539 [PubMed - indexed for MEDLINE] 6298. Med J Aust. 1976 Jun 5;1(23):862-5. The response to acupuncture therapy in patients with chronic disabling pain. Yuen RW, Vaughan RJ, Dyer H, Giles KE. Twenty-one patients had acupuncture treatment for chronic, disabling pain. Ten (47.5%) thought they had obtained worthwhile relief by the time treatment was completed. Six (30%) had no or negligible benefit and five (25%) had some aggravation of their pain at some stage of the procedure. In this group of patients, with the technique we describe, we were unable to achieve the high degree of short-term success claimed by other workers. Until further scientific studies can confirm the value of acupuncture in medical practice, we urge caution in the use of this procedure. PMID: 135199 [PubMed - indexed for MEDLINE] 6299. Arch Fr Pediatr. 1976 Jun-Jul;33(6):569-98. [Interstitial pneumopathies in children treated for malignant diseases] [Article in French] Lemerle J, Backes C, Lallemand D, Lejeune JA, Reinert P. The authors report 21 cases of severe interstitial pneumonitis observed in 1974 in Paris, in children with malignancies, either solid tumours or leukemias. Twelve patients died. The incidence of these complications in children with intensive chemotherapy and the clinical symptoms which may reveal them are reviewed; the bad prognosis of measles in these patients is stressed. Radiological findings are described and the possible wrong diagnoses are listed. Among viral infections, measles is the severest and its diagnosis is often difficult. Pneumocystis carinii infection is frequent. The use of surgical pulmonary biopsy and other diagnostic procedures is discussed. The immune status of these patients has been studied, which revealed severe impairement of cellular immunity, including low lymphocyte count, while humoral immunity was not changed. Symptomatic treatment may include oxygen supply and mechanical respiratory help, dietary management, and attempts towards non specific immune system stimulation. Aetiologic treatment is essentially the treatment of Pneumocystis carinii, which is discussed. Diagnosis and treatment of pneumonitis in immunosuppressed patients being very difficult, emphasis is made on the prevention of this accident, including caution in the handling of chemotherapy protocols. PMID: 1085139 [PubMed - indexed for MEDLINE] 6300. Aust Fam Physician. 1976 Jun;5(5):616-21. The mouth in health and disease. Murrell TG. Medical, dental and psychiatric conditions may cause dysfunction of the mouth in health and disease. The principle of clinical assessment of the patient, which includes a thorough assessment of the physical, social and psychological factors, is of paramount importance. This paper has attempted to describe some of the more common conditions affecting the mouth in general practice, and to underline important causes of pain which can occur in the face arising from conditions in the mouth. PMID: 985213 [PubMed - indexed for MEDLINE] 6301. J Radiol Electrol Med Nucl. 1976 Jun-Jul;57(6-7):549-51. [The treatment of herpes zoster by ultraviolet actinotherapy. Study of 200 cases (author's transl)] [Article in French] Szigeti B, Chapiro J, Saint-Girons JM. The authors analysed the cases of 200 patients treated for early herpes zoster by ultraviolet actinotherapy. This simple treatment should ideally be applied: - to clean skin, without dye nor ointment; - over the entire root area, and not only to the vesicles; - obtaining from the outset frank erythema, uniform, and without a healthy skin interval. Under these conditions, 95% of successful results were obtained in 3 to 8 days. The occasional failures appear to be related either to faulty technique or to a deep-seated localisation beyond the fied of action of the ultraviolet rays. PMID: 957291 [PubMed - indexed for MEDLINE] 6302. Clin Haematol. 1976 Jun;5(2):311-28. Viral infections and haematological malignancies. Feldman S, Cox F. PMID: 181191 [PubMed - indexed for MEDLINE] 6303. J Infect Dis. 1976 Jun;133 Suppl:A184-91. Adenine arabinoside for therapy of herpes zoster in immunosuppressed patients: preliminary results of a collaborative study. Ch'ien LT, Whitley RJ, Alford CA Jr, Galasso GJ. Eighty-seven immunosuppressed patients (53 with localized and 34 with disseminated herpes zoster) from 10 institutions were enrolled in a controlled therapeutic trial of adenine arabinoside. A crossover design was employed; thus, 47 patients received drug for five days and then received placebo, and 40 were given the two substances in the opposite order. Resolution of acute pain and the cutaneous lesions were graded during a 10-day observation period. During the initial five-day period, treated patients showed a statistically significant resolution of pain and cutaneous lesions. Surprisingly, in many untreated patients, natural resolution occurred during this period so that crossover data could not be adequately assessed. Effects on visceral disease also could not be judged, because such disease was uncommon. Ratings of late complications such as postherpetic neuralgia were confused by the crossover design. Toxicity posed no problem. The data further emphasized the potential usefulness of adenine arabinoside as an antiviral chemotherapeutic agent, but also clearly indicated the need for a double-blind study to define this usefulness and to determine how it can most practically be used, if the risk-benefit factor remains favorable. PMID: 180198 [PubMed - indexed for MEDLINE] 6304. J Infect Dis. 1976 Jun;133 Suppl:A101-8. Treatment of infections due to Herpesvirus in humans: a critical review of the state of the art. Alford CA Jr, Whitley RJ. Results of experimental trials with antiviral agents in humans have varied from encouraging to controversial to negative, usually as a result of the difficulty in defining the true therapeutic index (ratio of efficacy to toxicity) of toxic drugs for the treatment of diseases that are potentially severely debilitating or lethal. Reasons for current difficulties relate mainly to inadequacies of preclinical studies and the lack of appropriate controls. The inadequacies include poor definition of the effect of drugs or viruses on cellular metabolism, incomplete pharmacologic studies in animals or humans, and, because of the latter, inappropriate animal models. In human trials, historical data have often been used instead of true controls because of the presumed severity of candidate diseases. Use of such data led to a false impression of drug efficacy, an impression later refuted when proper control studies demonstrated that the range of disease was much greater than had been previously supposed. Data bearing on these points for the most commonly employed experimental compounds (cytosine arabinoside, adenine arabinoside, and 5-iodo-2'-deoxyuridine) are contrasted to highlight difficulties as well as to provide perspectives for antiviral chemotherapy of herpesvirus infections. PMID: 180191 [PubMed - indexed for MEDLINE] 6305. JFORL J Fr Otorhinolaryngol Audiophonol Chir Maxillofac. 1976 Jun;25(6):435-43. [Facial paralysis in children. Apropos of 82 cases] [Article in French] Garcin M, Magnan J, Long FX, Bremond G. PMID: 137275 [PubMed - indexed for MEDLINE] 6306. N Engl J Med. 1976 May 27;294(22):1233-4. Editorial: Efficacy of adenine arabinoside in herpes zoster. Merigan TC. PMID: 772429 [PubMed - indexed for MEDLINE] 6307. N Engl J Med. 1976 May 27;294(22):1193-9. Adenine arabinoside therapy of herpes zoster in the immunosuppressed. NIAID collaborative antiviral study. Whitley RJ, Ch'ien LT, Dolin R, Galasso GJ, Alford CA Jr. We evaluated adenine arabinoside treatment of herpes zoster in immunodeficient patients in a randomized, controlled crossover study. The two study groups had similar characteristics. In spite of rapid natural healing, those receiving adenine arabinoside over the first five days had accelerated clearance of virus from vesicles (P = 0.01), and cessation of new vesicle formation (P = 0.004), and a shorter time to total pustulation (P = 0.001). Factors modifying the response to therapy included age, underlying disease, and the duration of zoster prior to therapy. Clinical toxicity was minimal. Laboratory assessment of bone-marrow, liver and renal function showed insignificant alterations as a result of therapy. These studies show that adenine arabinoside is a drug with promise for therapy of systemic herpes zoster in immunocompromised patients. It is most efficacious when administered during the first six days of disease (P = 0.001) to those who have reticuloendothelial neoplasia (P = 0.001) and are less than 38 years of age (P = 0.001). PMID: 177866 [PubMed - indexed for MEDLINE] 6308. Nouv Presse Med. 1976 May 15;5(20):1285-8. [Preventive and therapeutic effect convalescent zona and varicella sera in high risk children (659 cases)] [Article in French] Gaiffe M, Herzog F, Schweisguth O. Study of 659 cases treated with serum from patients convalescent after herpes zoster and chickenpox over a period of two and a half years in French hospital departments, showed the obvious effectiveness of this type of therapy which seems to be better than that of zoster specific gamma globulin used by other workers since we obtained protection against chickenpox in 90 p. cent of cases, and attenuation of chickenpox in 82 p. cent. It would seem that these results could be improved by increasing the doses used. PMID: 59342 [PubMed - indexed for MEDLINE] 6309. South Med J. 1976 May;69(5):576-8. Herpes zoster: correlation of age, sex, distribution, neuralgia, and associated disorders. Brown GR. The influence of sex and age on the distribution of lesions, incidence of postherpetic neuralgia, and related disorders in herpes zoster is reported. Results were obtained by reviewing the records of 140 outpatients with herpes zoster seen over a ten-year period. Trigeminal involvement and post-herpetic neuralgia were more common in patients over 50 years of age. The most common sites of lesions in all ages were the thoracic dermatomes, between T-1 and T-8. The distribution of lesions and the incidence of postherpetic neuralgia did not vary between the sexes. High incidences of diabetes and cataracts were found to be associated with herpes zoster infection. Clinical carcinoma of the prostate was a frequent finding in men with herpes zoster over age 50. In those patients with malignancies, there was no correlation between distribution of zoster lesions and location of malignancy. PMID: 1273613 [PubMed - indexed for MEDLINE] 6310. Masui. 1976 May;25(5):484-9. [Application of acupuncture to the treatment of herpes zoster] [Article in Japanese] Nagai Y, Ito T, Inoue S, Maehara K, Yamada S. PMID: 987258 [PubMed - indexed for MEDLINE] 6311. J Trop Med Hyg. 1976 May;79(5):94-6. Lactation associated with herpes zoster pectoralis. Bhattacharya SK, Girgla HS. The phenomenon of lactation associated with herpes zoster is unexpected. To our knowledge such an association has been reported only once. A case is reported in whom spontaneous lactation occurred in the ipsilateral breast following herpes zoster. It is believed to have resulted from stimulation of the intercostal nerve endings supplying the overlying skin of the breast. PMID: 945354 [PubMed - indexed for MEDLINE] 6312. Monatsschr Kinderheilkd. 1976 May;124(5):411-3. [Varicella-zoster virus infections. Course, virologic findings and therapeutic trials in healthy and in immunologic disease children] [Article in German] Luthardt T, Wehinger H. PMID: 934134 [PubMed - indexed for MEDLINE] 6313. Acta Otolaryngol. 1976 May-Jun;81(5-6):462-7. Acute facial palsy. Some clinical and virological observations. Berg R, Forsgren M, Schiratzki H. A prospective clinical and virological study on 44 patients with acute, peripheral facial paralysis was carried out in consecutive cases during one year. In 9 cases varicella-zoster infections were serologically established. In 5 additional patients an associated varicella-zoster, or herpes simplex, infection was possible. Of the 9 confirmed cases, 6 were clinically diagnosed as zoster oticus, whereas on clinical grounds, 3 were regarded as Bell's palsy. No evidence was obtained of associated enterovirus, mumps, measles, cytomegalovirus, tick-borne encephalitis virus, para-influenza virus, mononucleosis or Mycoplasma pneumoniae infection. PMID: 179268 [PubMed - indexed for MEDLINE] 6314. ASDC J Dent Child. 1976 May-Jun;43(3):184-6. Herpes zoster in Hodgkin's disease: unusual oral sequelae. Chenitz JE. PMID: 178705 [PubMed - indexed for MEDLINE] 6315. Ann Sclavo. 1976 May-Jun;18(3):393-446. [Problems of the prenatal prophylaxis of the viral infections (author's transl)] [Article in Italian] Piersantelli N, Guida B, Robert L. The present review will supply an simple notice over the characters of every one viral infection interesting the materne-faetal conditions, and also propose the most convenient intervention for each observed type. A not small lot of these problems are not resolved in the field of the antiviral immunity regarding the mother and newborn. PMID: 65942 [PubMed - indexed for MEDLINE] 6316. Med Klin. 1976 Apr 23;71(17):706-10. [CSF-evaluation in unilateral, bilateral and alternant facial paralysis (author's transl)] [Article in German] Engelhardt P. Etiology of idiopathic facial paralysis remains mostly unknown because further investigations seem unnecessary being the only symptom. Differentiated evaluation of CSF however for cytological or proteinous abnormalities should be performed aside serological examinations. In 9 patients treated within 8 months in our hospital diagnosis could be made by these procedures. Inflammation, if cause of facial paralysis, can only call pleocytosis, if localised within or next to the leptomeninges; protein of CSF perhaps will increase, if local inflammation of the nerve is more distant to subarachnoid space. "Idiopathic facial paralysis" however will not exclude focal inflammation far from subarachnoid space. Surgical decompression should not be performed without previous examination of CSF in regard of it's uncertain success. PMID: 1272168 [PubMed - indexed for MEDLINE] 6317. Lakartidningen. 1976 Apr 14;73(16):1537. [Case of herpes zoster in a 4-month-old child] [Article in Swedish] Quiding-Boström R. PMID: 1263679 [PubMed - indexed for MEDLINE] 6318. Med J Aust. 1976 Apr 3;1(14):472-3. Surgical relief of post-herpetic pain by excision of scarred skin. Weidmann MJ. This paper deals with the problems of post-herpetic pain. The various modes of treatment which have been tried for its relief are discussed as is our experience of excision of the scarred area of skin. The procedure has been found to offer worthwhile pain relief to a significant number of patients. PMID: 933921 [PubMed - indexed for MEDLINE] 6319. Zentralbl Bakteriol Orig A. 1976 Apr;234(3):413-6. Varicella-zoster antibodies in adult patient with haemoblastoses. Trlifajová J, Lukásová M, Janele J, Jelínek J. Indirect haemagglutination (IH) antibodies to varicella-zoster (VZ) virus were investigated, under the identical conditions of a single experiment, in a group of patients with haemoblastoses and 80 normal adults of equal age groups. Statistical significance of the differences in VZ antibody geometric mean titres between the individual haemoblastoses and normal controls was examined by means of variance analysis. A significantly raised mean titre was still found in the Hodgkin's disease group. PMID: 180728 [PubMed - indexed for MEDLINE] 6320. J Laryngol Otol. 1976 Apr;90(4):373-9. Peripheral facial palsy and herpes zoster infection. Mair IW, Flugsrud LB. A clinical and virological study of 133 consecutive cases of peripheral facial palsy has provided evidence for simultaneous infection with the varicella-zoster virus in 9 patients (6-8 per cent). Seven of these presented differing but typical manifestations of the Ramsay Hunt syndrome, and the diagnosis was therefore strongly suspected on the basis of the clinical findings alone. The remaining two patients had neither herpetiform rash nor involvement of the eighth cranial nerve, and had been diagnosed in the clinic as typical cases of Bell's palsy. In this series the incidence of zoster infection in apparent idiopathic facial palsy was 1-8 per cent. PMID: 178812 [PubMed - indexed for MEDLINE] 6321. J Laryngol Otol. 1976 Apr;90(4):365-71. Varicella-zoster virus and facial palsy. Leeming RD. Two cases of Ramsey-Hunt Syndrome are reported, one of which presented features of the Guillain-Barré Syndrome. It is suggested that the varicella-zoster virus is an aetiological factor in the Guillain-Barré Syndrome. PMID: 178811 [PubMed - indexed for MEDLINE] 6322. Proc Soc Exp Biol Med. 1976 Apr;151(4):762-5. Detection of antibody to Varicella-Zoster virus by immune adherence hemagglutination. Gershon AA, Kalter ZG, Steinberg S, Kuhns WJ. A serologic test for measurement of antibody to V-Z virus by immune adherence hemagglutination is described. Initial evaluation of the test has shown it to be highly sensitive, specific, rapid, and simple to perform. The V-Z antigen may be stored at -70 degrees, and the test could be performed in any routine serology laboratory. PMID: 177988 [PubMed - indexed for MEDLINE] 6323. JAMA. 1976 Mar 29;235(13):1339-42. Vidarabine therapy for severe herpesvirus infections. An unusual syndrome of chronic varicella and transient immunologic deficiency. Aronson MD, Phillips CF, Gump DW, Albertini RJ, Phillips CA. Six patients with severe herpesvirus infections were successfully treated with vidarabine. One patient had a previously undescribed syndrome of chronic cutaneous varicella infection of eight months' duration, associated with transient but complete duppression of lymphocyte response to conconavalin A. Other diagnoses were severe varicella pneumonia, progressive cytomegalovirus pneumonia associated with acute lymphocytic leukemia, herpes simplex encephalitis, severe zoster associated with stage IV lymphoma, and disseminated herpes simplex in a patient receiving high doses of steroids. All patients showed cessation of new lesions or abrupt clinical improvement between days 2 and 4 after initiation of therapy, and all were cured of their clinical infection. Dramatic improvement in all of our patients and the minimal toxicity observed make vidarabine suitable for use in severe herpesvirus infections. PMID: 175176 [PubMed - indexed for MEDLINE] 6324. Wiad Lek. 1976 Mar 15;29(6):537-9. [Case of severe encephalitis in zoster] [Article in Polish] Kucharska-Demczuk K, Fabian F. PMID: 1266233 [PubMed - indexed for MEDLINE] 6325. Wiad Lek. 1976 Mar 15;29(6):525-7. [Embryopathia herpetica] [Article in Polish] Maszkiewicz W, Zaniewska J. PMID: 1266231 [PubMed - indexed for MEDLINE] 6326. Postgrad Med. 1976 Mar;59(3):181-4. Eye disorders: Looking at the eye for clues to systemic disease. Sacks JG. There are many systemic diseases in which eye signs detectable without an ophthalmoscope may be present. Examples are congenital glaucoma in neurofibromatosis, corneal involvement in mycosis fungoides, chloroma in leukemia, and uveitis and glaucoma in herpes zoster. PMID: 817277 [PubMed - indexed for MEDLINE] 6327. Br J Oral Surg. 1976 Mar;13(3):282-8. Dental complications of cytotoxic therapy in Hodgkin's disease--a case report. Vickery IM, Midda M. A case of trigeminal zoster in a patient with disseminated Hodgkin's disease is described. Although one case of maxillary tooth loss in a comparable patient has previously been recorded, this is the first report of mandibular tooth loss. The aetiological significance of Beomycin and I-(2-chloroethyl)-3-cyclohexyl-I-nitrosourea (C.C.N.U.) is discussed and an hypothesis for post-zoster tooth exfoliation is suggested. PMID: 56949 [PubMed - indexed for MEDLINE] 6328. Nurs Times. 1976 Feb 19;72(7):262-5. Herpes zoster--a parasitic fossil. Hope-Simpson RE. PMID: 175355 [PubMed - indexed for MEDLINE] 6329. MMW Munch Med Wochenschr. 1976 Feb 6;118(6):155-60. [The problem of vitamin B6/B12 acne. A contribution on acne medicamentosa (author's transl)] [Article in German] Braun-Falco O, Lincke H. Deterioration of acne vulgaris or eruption of an acneiform exanthema could be established during treatment with vitamin B6 and/or vitamin B12 in 14 patients. Females were by far the more frequently affected. The appearance of skin symptoms, even outside the age groups typically affected by acne vulgaris is characteristic. The clinical appearance of acneiform exanthema occurring during treatment with vitamin B6 or B12 consists of loosely disseminated small papules or papulopustules on the face (especially on the forehead and chin), on the upper parts of the back and chest and spreading to the upper arm. The pathogensis of the change is not yet certain. The acneiform rash generally fades within a short time after vitamin B6 or vitamin B12 treatment has been stopped. PMID: 130553 [PubMed - indexed for MEDLINE] 6330. Radiology. 1976 Feb;118(2):429-31. Herpes zoster in children with stage I-III Hodgkin's disease. Goodman R, Jaffe N, Filler R, Cassady JR. Herpes zoster infection developed in 12 (52%) of 23 children with Stage I-III Hodgkin's disease but had no prognostic significance. Of these 23 patients, 22 are presently alive without evidence of active Hodgkin's disease. The authors conclude that a combination of factors is important in the high incidence of herpes zoster, including more aggressive staging as well as more aggressive irradiation and chemotherapy, and that the results in their series would seem to justify continuation of this approach to staging and treatment in such cases. PMID: 1250979 [PubMed - indexed for MEDLINE] 6331. J Assoc Physicians India. 1976 Feb;24(2):123-6. Association of herpes zoster with antigen positive hepatitis and chronic active hepatitis. Singh RP, Pullimood BM, Johnson S. PMID: 1002658 [PubMed - indexed for MEDLINE] 6332. Pathol Biol (Paris). 1976 Feb;24(2):127-31. [Virus infections in man during immunodepression (author's transl)] [Article in French] Bricout F, Huraux JM, Nicolas JC, Bogossian M, Descamps P. The authors review virus infections observed in patients undergoing immunosuppressive treatment. The herpes virus, in particular the cytomegalovirus, are the most important cause. However, the role of the virus itself in an unfavourable course is variously assessed. The mechanism of the virus infection is discussed, whether primary infection, exogenous or endogenous re-infection. The latter seems to be the most frequent, at least in the case of the herpes viruses. PMID: 179044 [PubMed - indexed for MEDLINE] 6333. JFORL J Fr Otorhinolaryngol Audiophonol Chir Maxillofac. 1976 Feb;25(2):105-7. [Clinical aspects of paralysis caused by cold and viral paralysis] [Article in French] Perrin C. PMID: 130439 [PubMed - indexed for MEDLINE] 6334. Br Med J. 1976 Jan 24;1(6003):224. Letter: Intravenous cytarabine in treatment of herpes zoster in haematological malignancy. Kernbaum S. PMCID: PMC1638399 PMID: 1247798 [PubMed - indexed for MEDLINE] 6335. Nouv Presse Med. 1976 Jan 17;5(3):148. [Letter: Treatment of recurrent corneal herpes and ophthalmic zona with levamisole] [Article in French] Lods F. PMID: 1083507 [PubMed - indexed for MEDLINE] 6336. Br Med J. 1976 Jan 17;1(6002):131-2. Trigeminal zoster producing facial paralysis and postural hypotension. [No authors listed] PMCID: PMC1638598 PMID: 174771 [PubMed - indexed for MEDLINE] 6337. J Indian Med Assoc. 1976 Jan 16;66(2):41-2. Herpes zoster-transverse myelitis. Rao KS, Ramana Murty DV. PMID: 1032505 [PubMed - indexed for MEDLINE] 6338. Sem Hop. 1976 Jan 9;52(2):99-103. [Infectious complications observed during the use of antimitotic agents in hematology] [Article in French] Schaison G, Weil M, Backes C, Jacquillat CL, Bussel A, Perol Y. During acute lymphoblastic leukemia in children, bacterial infections occur during initial treatment, whereas virus infections are observed during remission. Mycoses and pneumocystis carinii infections are the commonest late complications. During agranulocytosis, any prolonged fever should be considered as due to infection and probably septicemia. The bacteria are usually of digestive origin. Antibiotic therapy is only very inconstantly efficacious, and the course follows closely the number of granular cells, thus justifying the use of white cell transfusions. PMID: 185705 [PubMed - indexed for MEDLINE] 6339. J Laryngol Otol. 1976 Jan;90(1):101-4. Oral vesiculo-bullous lesions. Haskell R. PMID: 1254998 [PubMed - indexed for MEDLINE] 6340. Int J Dermatol. 1976 Jan-Feb;15(1):67-8. Letter: Herpes zoster, simplex and steroids. Sauer GC. PMID: 1245373 [PubMed - indexed for MEDLINE] 6341. Oftalmol Zh. 1976;(2):150-1. [Herpes zoster ophthalmicus hemorrhagicus associated with late skin porphyria, staphylococcal pyoderma and diabetes mellitus] [Article in Russian] Gytsu FI, Bobu IF, Boishtian VI. PMID: 1088178 [PubMed - indexed for MEDLINE] 6342. ADM. 1976 Jan-Feb;33(1):52-4. [Herpes zoster] [Article in Spanish] Schein B. PMID: 1072723 [PubMed - indexed for MEDLINE] 6343. Verh Dtsch Ges Inn Med. 1976;82 Pt 2:1614-6. [Herpes zoster in splenectomized patients with Hodgkin's disease] [Article in German] Zeile G, Roux A, Gamm H. PMID: 1030060 [PubMed - indexed for MEDLINE] 6344. Klin Anasthesiol Intensivther. 1976;(12):49-67. [Significance of opsonification in antimicrobial defense and its therapeutic consequences] [Article in German] Mondorf AW, Schaffstein A, Fischer M. PMID: 1029768 [PubMed - indexed for MEDLINE] 6345. Zh Ushn Nos Gorl Bolezn. 1976;(6):75-7. [Herpes zoster oticus] [Article in Russian] Parkhomovskiĭ MA, Gadzhiev RSh. PMID: 1023681 [PubMed - indexed for MEDLINE] 6346. Cutis. 1976 Jan;17(1):63-6. Herpes zoster: a cause of acute detrusor muscle paralysis. Plotnick H. The essence of this report is to apprise the dermatologist of this fascinating but unusual complication of herpes zoster and to underscore the help he may give in establishing the diagnosis along with assisting in the management of this disorder. PMID: 1017225 [PubMed - indexed for MEDLINE] 6347. Acta Otorhinolaryngol Belg. 1976;30(1):84-9. The transmeatal approach to the geniculate ganglion. Helms J. PMID: 983703 [PubMed - indexed for MEDLINE] 6348. Acta Neurol (Napoli). 1976 Jan-Feb;31(1):104. [Anatomo-clinical study of a case of encephalitis due to Herpes zoster] [Article in Italian] Leonardi A, Vitale A, Meneghini S. PMID: 970251 [PubMed - indexed for MEDLINE] 6349. Acta Neurol Belg. 1976 Jan-Feb;76(1):21-5. The syndrome of the posterior retroparotid space. De Vooght H, Van den Bergh R. A case of Villaret's syndrome, possibly secondary to herpes zoster, is presented. The topography of the lesion in this rare disease is discussed as well as the differential diagnosis. PMID: 961371 [PubMed - indexed for MEDLINE] 6350. Rev Inst Med Trop Sao Paulo. 1976 Jan-Feb;18(1):24-7. [Treatment of herpes zoster with cytarabine] [Article in Portuguese] de Moraes VM, Neto VA, Pasternak J, Oselka GW, Levi GC. PMID: 778975 [PubMed - indexed for MEDLINE] 6351. Res Clin Stud Headache. 1976;4:18-36. Headaches and head pains associated with diseases of the eye. Behrens MM. PMID: 775580 [PubMed - indexed for MEDLINE] 6352. Am J Ophthalmol. 1976 Jan;81(1):86-8. Zosteriform herpes simplex. Forrest WM, Kaufman HE. PMID: 766634 [PubMed - indexed for MEDLINE] 6353. Ophthalmic Semin. 1976;1(3):227-52. Herpes zoster ophthalmicus. Weinhoff ML. Herpes zoster ophthalmicus is not an uncommon disease and is more prevalent among debilitated and seriously ill patients. It is caused by the same virus causing varicella. The exact trigger mechanism is unknown, as well as much of the pathogenesis. The disease is more uncommon among the elderly and usually runs a benign course. Approximately 50% of the patients develop ocular complications ,the most frequent of these being keratitis, iritis, secondary glaucoma and extraocular muscle involvement. The most striking pathologic features are the lymphocytic infiltration of the long ciliary nerves and the vasculitis of the vessels accompanying them. The most controversial aspect of the disease is that of treatment. Almost every therapeutic regimen has been attempted in a disease whose natural course is self-limited. The future will add more to our knowledge of the pathogenesis of the disease and shed more light on the efficacy of various treatments. PMID: 191772 [PubMed - indexed for MEDLINE] 6354. Int J Radiat Oncol Biol Phys. 1976 Jan-Feb;1(3-4):317-20. Virus infections. Stevens DA, Merigan TC. PMID: 184072 [PubMed - indexed for MEDLINE] 6355. Wien Klin Wochenschr Suppl. 1976;53:3-28. [Prognostic assessment in peripheral facial nerve paralysis with particular reference to electroneurography (author's transl)] [Article in German] Mamoli B. Electrophysiological investigations were carried out on 20 healthy controls and 130 patients with peripheral facial nerve paralysis. The aetiology was as follows: idiopathic (Bell's palsy) in 60 cases, viral in 29, traumatic in 18, postoperative in 4, in connexion with chronic otitis media in 6, diabetes mellitus in 4, positive rheumatological tests in 3, disturbed lipid metabolism in 2, the Melkersson-Rosenthal syndrome in 1, as a complication of pregnancy in 2, and in association with a tumour in 1 case. The compound action potential (CAP) of the orbicularis oris muscle was determinedi n 370 occasions in a right/left comparision, the record of the muscle response was intergrated over the time of action (IAR) on 32 occasions and trison of 255 occasions. The normal values are given in the first place and their dependence of the age of the subject. Then, the prognostic sifnficance of the above-mentioned parameters is investigated in cases of peripheral facial nerve paralysis. It is apparent that the determination of the CAP in a right/left comparison is a valuable prognostic guide as early as the 4th day, insofar as a decrease in this parameter of under 50% can be interpreted as a favourable sign and satisfactory reversal of the paralysis can be expected within 6-8 weeks. By contrast, a decrease of over 70% in the CAP is a bad prognostic sign, indicative of presumably only a poor trend to reversal of the paralysis. An intermediate depression of the CAP in the range of 50-70% signifies an expected moderate recovery within 6-8 weeks ahe case of CAP determination at the time of maximum amplitude depression (as opposed to the 4th day), then a decrease of less than 70% is taken to be indicative of satisfactory functional recovery within 6-8 weeks; a decrease of 95-100% signifies a bad prognosis, whilst a decrease amounting to between 70 and 95% carries an uncertain prognosis. The maximum decrease in amplitude was registered on the 8th day on average; the range lay between the 4th and the 14th day. An exception to these figures was the delayed response of the CAP in the case of 6 patients, 5 of whom showed a maximum decrease during the 3rd week and the last patient as late as the 4th week following the onset of facial nerve paresis. Similar reliance can be placed on the prognostic value of the IAR. however, the decrease in the IAR is smaller than that of the CAP measured on the same potential in a right/left comparison, so that a decrease in the IAR of over 60% can already herald a poor recovery. Repeated determination of the latency in cases of facial nerve paralysis showed that the mean latency value for the entire group of patients was slightly prolonged at the end of the 1st week, but the latency values obtained in any one particular patient are of no prognostic significance. A comparison between CAP and latency values obtained with the opposite (i.e... PMID: 181919 [PubMed - indexed for MEDLINE] 6356. Scand J Infect Dis. 1976;8(1):27-35. Early diagnosis of virus-caused vesicular rashes by immunofluorescence on skin biopsies. I. Varicella, zoster and herpes simplex. Olding-Stenkvist E, Grandien M. The use of immunofluorescence (IF) for the rapid identification of varicella-zoster (V-Z) and herpes simplex (HS) antigen in frozen sections of biopsies of early non-vesicular skin lesions was investigated. Direct IF, using fluorescein- isothiocyanate- conjugated immuoglobulin (FITC Ig) of paired human anti-V-Z sera and FITC-conjugated negative and positive anti-V-Z-monkey Ig, yielded specific fluorescence of virus antigen in all 14 varicella cases investigated and in 10/11 zoster cases. In contrast, indirect IF, using paired human anti-zoster sera and a sheep anti-human Ig FITC, was not satisfactorily specific, since staining with the anti-human Ig FITC alone also yielded fluorescence of infected cells in some cases. In 6/8 cases of HS infection, specific fluorescence of virus antigen was obtained by direct IF, using FITC-conjugated negative and positive guinea-pig anti-HS Ig. Because of the often predominant distribution of virus antigen to the corium and the skin appendages, punch biopsies are apparently better than scraped material, at least in the prevesicular stage. PMID: 178050 [PubMed - indexed for MEDLINE] 6357. Cutis. 1976 Jan;17(1):103-9. Herpes zoster: a combined therapy regimen. Ferrara RJ. A combined method of therapy for the routine management of herpes zoster in most all age groups is presented. The uniformly gratifying results of this treatment prompted this report. A total of 105 known cases of acute herpes zoster in which this regimen was employed during the past 15 years was analyzed in this study. Clinical observations before and after treatment are presented with discussion of clinical factors, treatment and conclusions. PMID: 65242 [PubMed - indexed for MEDLINE] 6358. Folia Haematol Int Mag Klin Morphol Blutforsch. 1976;103(5):660-71. [Possibilities for the treatment of varicella-herpes zoster infections in juvenile leukemia] [Article in German] Exadaktylos P, Grävinghoff J. Chicken pox and herpes zoster represent afraid complications in patients with malignant diseases which may take a noxious course. During the sequence of two chicken pox epidemias in 1973 in children with acute lymphoblastic leukaemias, the prevention and therapeutic possibilities were checked again. Chicken pox or herpes zoster convalescent sera being compatible for blood groups and zoster-immunoglobulin were not available. At the time of the epidemia the first reports on the effect of cytarabine (Alexan) were published. Moreover, we received an information on the therapeutic application of small pox vaccine inactivated with formaldehyde (vaccinia antigen) in adults with herpes zoster and herpes labialis. From 10 children with leukaemias, who were affected with chicken pox or herpes zoster, 7 received up to 1.0 ml of inactivated small pox vaccine intramuscularly on the first day of manifestation. In 6 of the patients there were no new efflorescences on the third day. A third child died. First of all it seems probable that this influence may be due to an induction of interferon formation. Further studies will have to elucidate to what extent this mechanism will also be efficient in severe cases of immunosuppression. PMID: 64406 [PubMed - indexed for MEDLINE] 6359. Ther Umsch. 1976 Jan;33(1):37-48. [Genital infections by viruses, mycoplasma and chlamydozoa (author's transl)] [Article in German] Nasemann TH, Nolte B. PMID: 61630 [PubMed - indexed for MEDLINE] 6360. Scand J Infect Dis. 1976;8(3):129-37. Early diagnosis of virus-caused vesicular rashes by immunofluorescence on skin biopsies. II. Poxvirus (vaccinia). Olding-Stenkvist E, Grandien M, Espmark A. Immunofluorescence (IF) was used to demonstrate vaccinia virus antigen in frozen sections of skin biopsies from the site of revaccination in 42 individuals. The immunoglobulin (Ig) of a rabbit anti-vaccinia serum and the Ig of the pre-immune serum conjugated with fluorescein-isothiocyanate (FITC) was employed. 11/13 biopsies taken 1 day after vaccination were positive in the IF test as were 13/13 biopsies taken 2 days and 14/16 biopsies taken 3 days after vaccination. Even minute quantities of virus antigen were easily detected. The applicability of the test and the advantage of using biopsy material in early rashes of vaccinia and variola is discussed. The reliability of the direct IF using conjugated antisera against vaccinia-variola, varicella-zoster and herpes simplex virus for differentiating between maculopapular rashes was proved in a coded test. PMID: 61622 [PubMed - indexed for MEDLINE] 6361. J Neurol. 1976;213(3):269-71. Meningitis associated with herpes zoster. Immunofluorescent demonstration of varicella-zoster antigens in CSF cells. Shoji H, Koya M, Ogiwara H. PMID: 61267 [PubMed - indexed for MEDLINE] 6362. MMW Munch Med Wochenschr. 1975 Dec 19;117(51-52):1999-2004. [Eight years experience of pain clinics (author's transl)] [Article in German] Nakazaki K, Yuda Y, Wakasugi B. The first pain clinic in Japan was organized and operated by anesthesiologists at the University of Tokyo. Today, many universities and large hospitals have set up pain clinics in their anesthetics department and have made great progress in the management of diseases in this filed. Almost all those institutions use oriental methods like acupuncture, ryodoraku and kyo in addition to standard methods. At our pain clinic, nerve block has been the sole method from the beginning. Neither drugs (except carbamazepine, imipramine and ergotamine) nor oriental methods have been used. The pain clinic ought to be separated from the anesthetics department and operated independently, having its own wards. PMID: 818509 [PubMed - indexed for MEDLINE] 6363. Acta Neuropathol. 1975 Dec 8;33(2):105-17. Pathology of the human spinal ganglia in varicella-zoster virus infection. Nagashima K, Nakazawa M, Endo H. Spinal ganglia from a patient who died on the 6th day of varicella infection were examined by immunofluorescence and electron microscopy, and were compared with spinal ganglia from a patient dying on the 17th day of herpes zoster infection. In herpes zoster, typical intranuclear inclusion bodies were found in neurons, satellite cells and fibroblast-like cells of the ganglia, which contained numerous naked virus particles. In varicella, few changes were found by light microscopy but viral antigen was detected in a few neurons and satellite cells by immunofluorescence. Electron microscopy revealed scattered virus particles near the nuclear membrane of a neuron, satellite cells and capsular cells and enveloped particles in the cytoplasm of satellite cells. The particles in the nuclei were mostly naked virions with specific crescent-like inner-nuclear structure; those in the cytoplasm had complete and incomplete envelopes and showed pleomorphism. A "virus-like" intranuclear filament found in mononuclear cells in herpes zoster and a "plexiform vermicellar array" found in the nuclei of neurons in varicella are at present considered to be non-specific nuclear changes caused probably by viral infections. PMID: 173126 [PubMed - indexed for MEDLINE] 6364. JAMA. 1975 Dec 8;234(10):1049-51. Should patients with zoster receive zoster immune globulin? Uduman SA, Gershon AA, Brunell PA. Zoster developed in 55 patients, and 15, generalized disease occurred. Twelve of 14 patients with dissemination had prompt appearance of both complement-fixing (CF) antibody and fluorescent antibody against varicella-zoster (VS) membrane antigen (FAMA). The geometric mean titers of VZ antibody from the first to the fifth and the sixth through the tenth days following onset of zoster were similar in patients with localized and generalized involvement. Two patients with disseminated zoster had undetectable CF antibody, but VZ FAMA was demonstrable. Because the clinical course of zoster appears to be unrelated to the serologic response to VZ virus, it is unlikely that administration of antibody with zoster would be benefit in this disease. PMID: 171458 [PubMed - indexed for MEDLINE] 6365. Med J Malaysia. 1975 Dec;30(2):156-9. Ramsay-Hunt syndrome with complete recovery of cranial nerves. Ponniah RD. PMID: 1228383 [PubMed - indexed for MEDLINE] 6366. Z Hautkr. 1975 Dec 1;50(23):947-50. [Herpes zoster as cause of an epidemic spread of varicella and zoster in a children's hospital] [Article in German] Günther S. During infancy zoster is not so rare as generally stated. In this age group the infection seems often to be unrecognised, because commonly it produces little or atypical body reactions. In children the infectivity of zoster is more serious than in adults, but in the absence of antibodies, varicella develops. Therefore zoster has been considered as an immunologically modified form of varicella. In my own experience, one case of zoster caused epidemics of varicella and zoster in a paediatric hospital. The pathogenesis and epidemiology of the two diseases have been discussed. PMID: 1202778 [PubMed - indexed for MEDLINE] 6367. Arch Dermatol. 1975 Dec;111(12):1658. Letter: Herpes zoster in early pregnancy. Jackson R. PMID: 1200673 [PubMed - indexed for MEDLINE] 6368. Br Med J. 1975 Nov 8;4(5992):335-7. Diseases of the central nervous system. Meningitis and encephalitis. Smith CC. PMCID: PMC1675201 PMID: 172185 [PubMed - indexed for MEDLINE] 6369. Lijec Vjesn. 1975 Nov;97(10):585-6. [Long-term results in the treatment of zoster by rimaktan] [Article in Croatian] Brnobić A, Balić A. PMID: 1223572 [PubMed - indexed for MEDLINE] 6370. J Assoc Physicians India. 1975 Nov;23(11):783-4. Zoster myelitis (a case report). Sachdeva JR, Behal RA, Singh J. PMID: 1223078 [PubMed - indexed for MEDLINE] 6371. Vestn Otorinolaringol. 1975 Nov-Dec;(6):116-7. [Circinate herpes of the ear (herpes zoster oticus)] [Article in Russian] Maerovich IM. PMID: 1209846 [PubMed - indexed for MEDLINE] 6372. Am J Med. 1975 Nov;59(5):695-701. Infections in 92 splenectomized patients with Hodgkin's disease. A clinical review. Schimpff SC, O'Connell MJ, Greene WH, Wiernik PH. Infections that occurrred in 92 previously untreated patients with Hodgkin's disease were reviewed from the time of laprotomy and splenectomy. Pneumonias occurred in nine patients with urinary tract infections in twelve during the immediate postoperative period. Severe bacterial infections did not occur in any patients during initial radiation therapy, adjuvant chemotherapy (stages I through IIIA), initial intensive chemotherapy (stages IIIB and IV) or during remission. Severe infections occurred in eight profoundly granulocytopenic patients with recurrent Hodgkin's disease. Streptococcus (Diplococcus) pneumoniae and Hemophilus spp infections were distinctly uncommon during the remission period. Herpes zoster, however, was very common developing in 22 of 92 (24 per cent) patients. Predisposing factors to herpes zoster included sex (female more than male), therapy (radiation plus chemotherapy more than chemotherapy alone), and age (less than 30 years of age more often than 30 to 50 years of age). Severe infection was uncommon in these patients except in ascociation with specific predisposing factors such as the immediate postoperative state of prolonged granulocytopenia associated with recurrent Hodgkin's disease or its therapy. Splenectomy per se did not affect either the incidence or the severity of infection during this period of 12+ months of observations per patient. PMID: 1200037 [PubMed - indexed for MEDLINE] 6373. Am Fam Physician. 1975 Nov;12(5):142-4. Sympathetic block in herpes zoster. Masud KZ, Forster KJ. PMID: 1199909 [PubMed - indexed for MEDLINE] 6374. Z Hautkr. 1975 Nov 1;50(21):909-11. [Possibilities in the use of interferon inducer substance in the treatment of viral dermatoses] [Article in German] Buchvald J, Borecky L, Doskocil J. PMID: 1108471 [PubMed - indexed for MEDLINE] 6375. Nippon Ganka Gakkai Zasshi. 1975 Oct 10;79(10):1542-9. [Study of Herpes zoster keratitis; demonstration of virus particles in corneal scrapings (author's transl)] [Article in Japanese] Hayashi S. PMID: 173166 [PubMed - indexed for MEDLINE] 6376. Nihon Kyobu Shikkan Gakkai Zasshi. 1975 Oct;13(10):621-5. [Varicella-zoster pneumonia--an adult case occuring in the course of Hodgkin's disease following herpes zoster (author's transl)] [Article in Japanese] [No authors listed] PMID: 1241046 [PubMed - indexed for MEDLINE] 6377. Minerva Anestesiol. 1975 Oct;41(10):468-77. [Postherpetic neuralgias] [Article in Italian] Delfino U. PMID: 1230661 [PubMed - indexed for MEDLINE] 6378. Srp Arh Celok Lek. 1975 Oct;103(10):895-8. [Case of herpes zoster and varicella in a child] [Article in Serbian] Hadzić M, Kujundzić M. PMID: 1228914 [PubMed - indexed for MEDLINE] 6379. J Pediatr Surg. 1975 Oct;10(5):677-84. Complications of abdominal exploration and splenectomy in staging children with Hodgkin's disease. Wayne ER, Kosloske A, Holton CP, Burrington JD, Hatch EI. Until alternate diagnostic methods are discovered, the staging procedure seems to be the most reliable method to establish the presence or absence of abdominal involvement in Hodgkin's disease. Our experience with staging laparotomy in 22 children raises serious questions as to both the risk of operation and the prognostic value of a negative abdominal exploration. Routine use of the staging laparotomy may not be justified in clinical Stage IA patients with lymphocyte-predominant cell type. Because of the hazards and limitations of the staging procedure, vigorous attempts would seem to be indicated to identify subcategories of patients in whom the likelihood of intraabdominal involvement is so small as to negate the value of surgical staging. PMID: 1185454 [PubMed - indexed for MEDLINE] 6380. Dent Clin North Am. 1975 Oct;19(4):643-56. General dentistry and oral medicine in the hospital. Greenberg MS. General dentistry in a hospital should not be confined to restorative dentistry happens to be performed in a hospital dental clinic. In addition to expertise in restorative dentistry and other dental specialties, general practitioners participating in hospital programs must also be students of two major areas-- diagnosis of diseases involving the head and neck as well as dental management of patients with severe medical disease. In the preceding short review a few examples of disorders about which the hospital dentist may be consulted were reviewed along with the proper protocol for requesting and answering consultations. This list is necessarily short and incomplete. A different group of disorders could have been discussed in this article. The competent hospital dentist must be a continual student of disease and its possible effect upon dental treatment and oral diagnosis. The task is formidable but rewarding and interesting. PMID: 169170 [PubMed - indexed for MEDLINE] 6381. Vestn Otorinolaringol. 1975 Sep-Oct;(5):91. [Case of herpes zoster oticuls] [Article in Russian] Khanamiran RM, Grigorian MA. PMID: 1231148 [PubMed - indexed for MEDLINE] 6382. Antimicrob Agents Chemother. 1975 Sep;8(3):289-94. Evaluation of topical polyinosinic acid-polycytidylic acid in treatment of localized herpes zoster in children with cancer: a randomized, double-blind controlled study. Feldman S, Hughes WT, Darlington RW, Kim HK. Twenty-four children with cancer and localized herpes zoster were randomized to receive either topical polyinosinic acid-polycytidylic acid [poly(I:C)] or a saline placebo. Solutions containing 1.0 or 2.5 mg of drug per ml were applied to the lesions every 3 h, seven times a day for 7 consecutive days. Serial, standardized color photographs were used to evaluate the progression of lesions and maximum percentage of dermatome involvement. In patients receiving poly(I:C), the median days of new lesions after therapy was 2.0 days as opposed to 3.5 days in placebo-treated patients. This difference was not statistically significant. Moreover, the total median days of lesions and percentage of dermatome involvement were similar in both groups, as were complications. Neither the concentration nor the total dose of drug was related to the outcome of infection. We conclude that topical poly(I:C), as used in this study, was of no benefit in treatment of localized herpes zoster. PMCID: PMC429308 PMID: 1101820 [PubMed - indexed for MEDLINE] 6383. Vestn Oftalmol. 1975 Sep-Oct;(5):63-5. [Combined viral infections and their role in the development and clinical course of keratitis in children] [Article in Russian] Katargina LA, Zaĭtseva NS, Murav'eva TV. PMID: 190751 [PubMed - indexed for MEDLINE] 6384. Infect Immun. 1975 Sep;12(3):606-13. Neutralizing antibody responses to varicella-zoster virus. Schmidt NJ, Lennette EH. Neutralization of varicella-zoster (V-Z) virus by human sera and immune rhesus monkey sera was enhanced by fresh guinea pig complement. There was no marked difference in the degree to which complement enhanced neutralization by sera from current V-Z virus infections and sera from long-past varicella infections. Immunoglobulin G neutralizing antibody in sera from varicella cases was enhanced by complement to a slightly higher degree than was immunoglobulin M (IgM) antibody, and immunoglobulin G neutralizing antibody in immune monkey sera was enhanced to a much greater degree than was IgM antibody. There was a rapid decline in the complement requirement of IgM neutralizing antibodies over the course of immunization of the rhesus monkeys. V-Z neutralizing antibody titers in the presence of complement were higher than complement-fixing titers of the same sera in all groups of individuals studied. IgM neutralizing antibody for V-Z virus was demonstrable in all cases of varicella but in only 1 of 22 zoster cases, and V-Z IgM neutralizing antibody was not detectable in primary herpes simplex virus infections in which heterotypic antibody titer rises occurred to V-Z virus. Complement-fixing antibody for V-Z virus was absent in 19S serum fractions which contained IgM neutralizing antibody for the virus. PMCID: PMC415330 PMID: 170206 [PubMed - indexed for MEDLINE] 6385. Vestn Dermatol Venerol. 1975 Sep;(9):58-61. [Hemodesis and rheopolyglucine in the treatment of patients with some dermatoses] [Article in Russian] Fedotov VP, Chekina AP. PMID: 133560 [PubMed - indexed for MEDLINE] 6386. Med J Aust. 1975 Aug 9;2(6):224-5. The management of facial pain. Eadie MJ. PMID: 1160773 [PubMed - indexed for MEDLINE] 6387. J R Coll Gen Pract. 1975 Aug;25(157):571-5. Postherpetic neuralgia. Hope-Simpson RE. PMCID: PMC2157719 PMID: 1195231 [PubMed - indexed for MEDLINE] 6388. Va Med Mon (1918). 1975 Aug;102(8):609-13. Facial nerve paralysis in herpes oticus. McGovern FH. PMID: 1163098 [PubMed - indexed for MEDLINE] 6389. South Med J. 1975 Aug;68(8):1043-5. Bladder dysfunction secondary to herpes zoster. Kent MW, Guerriero WG. PMID: 1162403 [PubMed - indexed for MEDLINE] 6390. Practitioner. 1975 Aug;215(1286):226-9. Idoxuridine in the treatment of herpes zoster. Simpson JR. An uncontrolled, double-blind, random-selection study of fifty consecutive patients with attacks of herpes zoster treated with one of two concentrations (5 per cent or 40 per cent) of idoxuridine (IDU) in dimethyl sulphoxide (DMSO) has shown that, over all, the patients fared better than would have been expected had they been treated only symptomatically. There was no apparent difference between the two concentrations of idoxuridine in regard to either side-effects or benefits. In 17 of the fifty patients the skin lesions healed more rapidly than would have been expected without treatment, and pain was relieved more rapidly than expected in 26 of the 47 patients in whom it was a feature of the attack. Side-effects, which included a transient stinging or burning sensation in 29 patients and acute sensitivity to idoxuridine (confirmed by patch-testing) in one, did not lead to withdrawal of any patient from the trial. Three patients complained of an unpleasant, garlicky taste during treatment. No significant abnormalities were noted in liver-function tests and in white-cell or platelet counts in patients in either treatment group. The solutions of idoxuridine in dimethyl sulphoxide were provided by W.B. Pharmaceutical Ltd. PMID: 1101247 [PubMed - indexed for MEDLINE] 6391. Eur J Cancer. 1975 Aug;11suppl:79-94. Non-bacterial infections associated with neoplastic disease. Armstrong D, Chmel H, Singer C, Tapper M, Rosen PP. PMID: 176031 [PubMed - indexed for MEDLINE] 6392. Laryngol Rhinol Otol (Stuttg). 1975 Aug;54(8):654-8. [Neurootological findings in zoster oticus (author's transl)] [Article in German] Aust G. Zoster oticus is an important disorder in neurootological routine diagnostics. However, the neurotoxic zoster virus is not being confined to the nerval periphery. Therefore as well typical peripheral as well as typical central as well as combined reactional patterns are to be found by neurootological functions tests. By selection and adaptation of tests optimal diagnostics can be completed in the vestibular-ocular, the vestibular-spinal and retinal-ocular sensory motory systems. Thus disorders as such can be identified and additionally localised. The peripheral zoster oticus can be differentiated from the central zoster encephalitis. These findings are demonstrated by typical case reports. PMID: 129636 [PubMed - indexed for MEDLINE] 6393. Hautarzt. 1975 Jul;26(7):383-4. [Anorectal symptom complex in zoster sacralis] [Article in German] Reichardt F, Vogt HJ. Disorder by hemorrhoids can occasionally be caused by sacral herpes zoster. Only exact local inspection in connection with the anamnestic statement of neuralgic pain as well as hurting sensations of the rectum leads to the proper diagnosis. PMID: 1213893 [PubMed - indexed for MEDLINE] 6394. Surg Neurol. 1975 Jul;4(1):9-11. Intracerebral toxoplasmosis presenting as a mass lesion. Schulhof LA, Russell JR. Intracerebral toxoplasmosis is an uncommon condition and for it a produce an intracerebral mass is rare. A case is reported in a patient also suffering from lymphosarcoma, who had received immunosuppressive therapy and who had recently had herpes zoster ophthalmica. PMID: 1174391 [PubMed - indexed for MEDLINE] 6395. Physiotherapy. 1975 Jul;61(7):217. SWD for herpes zoster. Barnett M. PMID: 1161861 [PubMed - indexed for MEDLINE] 6396. Arch Dermatol. 1975 Jul;111(7):910-2. Low-dosage cytarabine therapy for herpes zoster with pneumonia. Baron M, Wechsler HL. Disseminated herpes zoster infection is frequently fatal. Cytarabine (cytosine arabinoside), a drug of variable efficacy, has offered some hope in the treatment of this condition. In this case of disseminated herpes zoster infection with pneumonia, there was remarkable recovery after low-dosage cytarabine infusion. The findings suggest that doses of the drug not exceeding 30 mg/sq m of body surface per 24 hours (30 mg/sq m/24 hr) may well be virucidal but not cytohematotoxic. PMID: 1147637 [PubMed - indexed for MEDLINE] 6397. Geriatrics. 1975 Jul;30(7):110-5. Facial pain: diagnostic dilemma, therapeutic challenge. Poser CM. PMID: 1140563 [PubMed - indexed for MEDLINE] 6398. Dtsch Krankenpflegez. 1975 Jul;28(7):396-8. [Examination report on nursing care of a child with herpes zoster and lymphogranulomatosis] [Article in German] Maier R. PMID: 1040566 [PubMed - indexed for MEDLINE] 6399. J Immunol. 1975 Jul;115(1):230-3. Characteristics of immune interferon produced by human lymphocyte cultures compared to other human interferons. Valle MJ, Jordan GW, Haahr S, Merigan TC. A factor with antiviral activity has been produced in vitro by combined macrophage-lymphocyte cultures from patients with recent herpes labialis in response to HSV antigen stimulation. It has been designated "immune interferon" and characterized in comparison to several other human interferons. It was shown to be relatively unstable at pH 2 and at 56 degrees C. Rabbit anti-human leukocyte interferon serum was shown to be less active against immune interferon than against diploid cell interferon or against vesicle fluid interferon. The possibility of immune interferon being a totally different anti-viral protein or a protein with certain shared antigen determinants or structures with classical viral interferon is discussed. A simplified method for the assay of anti-interferon sera with microtiter plates is also described. PMID: 239056 [PubMed - indexed for MEDLINE] 6400. J Infect Dis. 1975 Jul;132(1):49-54. Varicella-Zoster Immunoglobulins during Varicella, Latency, and Zoster. Brunell PA, Gershon AA, Uduman SA, Steinberg S. Antibodies to membrane antigens of cells infected by varicella-zoster virus were detected by immunofluorescence. Rises in varicella-zoster IgA, IgG, and tigM were detected after both varicella and zoster. Prompt antibody responses were observed in patients with generalized zoster as well as in those with localized zoster. A delayed response was found, moreover, in one patient who did not develop disseminated disease. Antibody to varicella-zoster virus was detected in the sera of all three patients tested prior to and in all but one of 63 patients tested soon after onset of zoster. The level of varicella-zoster IgA and IgG rose in two of three immune patients after household exposure to infection with varicella-zoster virus. Varicella-zoster IgG was detected in the cord blood of infants whose mothers were immune to varicella. PMID: 169308 [PubMed - indexed for MEDLINE] 6401. J Neurol. 1975 Jun 9;209(2):149-50. A case of peripheral facial palsy following varicella. Shoji H, Hirose K, Uono M, Sugita R, Hondo R. PMID: 51052 [PubMed - indexed for MEDLINE] 6402. Br J Dermatol. 1975 Jun;92(6):625-30. Viral warts, herpes simplex and herpes zoster in patients with secondary immune deficiencies and neoplasms. Morison WL. The incidence of viral warts, recurrent herpes simplex and herpes zoster has been assessed in a group of patients with possible secondary immune deficiency states and compared to a control group. Patients with cell-mediated immune deficiency appear to be more prone to warts and zoster infection as compared to patients with humoral immune deficiency. Recurrent herpes simplex infection was not increased in either group. PMID: 1101940 [PubMed - indexed for MEDLINE] 6403. Acta Ophthalmol (Copenh). 1975 Jun;53(3):450-7. Conjunctival sensitivity in pathological cases, with simultaneous measurement of corneal and lid margin sensitivity. Norn MS. A total of 209 pathological eyes each had 17 localities tested for sensitivity (cornea, caruncle, upper and lower lid margins (centrally, medially and laterally), and corresponding localities on the palpebral conjunctiva, and upper and lower halves of the bulbar conjunctiva). Reduced conjunctival sensitivity is seen in pemphigoid (excluding the lid margin) in contact lens wearers, at sites of nerves transected during operation and in rare cases of infectious conjunctivitis. Isolated corneal hypaesthesia is seen in bacterial or fungal keratitis. In herpes, the hypaesthesia extends over the bulbar conjunctiva, in zoster, over wider areas (including the lid margin). The sensitivity is normal in keratoconjunctivitis sicca and chronic conjunctivitis. In neurological diseases the hyposensitivity could include the cornea, conjunctiva and lid margin. The conclusion is drawn that a study of the conjunctivo-corneal sensitivity can give differential diagnostic information, provided the normal sensitivity range is known. This has been set out in a Table in 10-year age groups. PMID: 1101626 [PubMed - indexed for MEDLINE] 6404. Int J Dermatol. 1975 Jun;14(5):341-4. Corticosteroids in herpes simplex and zoster. Smith EB, Powell RF. PMID: 1080136 [PubMed - indexed for MEDLINE] 6405. Ann Intern Med. 1975 Jun;82(6):778-83. Ineffectiveness of subcutaneous cytosine arabinoside in localized herpes zoster. Betts RF, Zaky DA, Douglas RG Jr, Royer G. Cytosine arabinoside (cytarabine) was evaluated in a randomized double-blind controlled study for the treatment of localized herpes zoster. Cytarabine was administered subcutaneously in a dose of 50 mg/m-2 body surface area once daily for 4 days, always within 14 days of onset of the first symptom and usually within 7 days. Thirty patients given cytarabine and 30 patients given placebo were well matched with respect to age, sex, and length and severity of presenting rash and pain as well as underlying disease. There was no difference in the rate of disappearance of pain or rash in either treatment group. More patients given cytarabine than patients given placebo had minimal pain and significantly more cytarabine-treated patients had persistence of neurological symptoms at 6 months' follow-up. Acute side effects, though mild, were significantly increased in the cytarabine-treated patients especially with respect to nausea and vomiting and decrease in platelet count. Cytarabine administered in this dose subcutaneously had no beneficial effect and was associated with mild side effects and persistence of neurological symptoms. PMID: 166586 [PubMed - indexed for MEDLINE] 6406. JFORL J Fr Otorhinolaryngol Audiophonol Chir Maxillofac. 1975 Jun;24(6):463-4. [Auricular zona and associated forms] [Article in French] Claux J, Coll J. PMID: 126296 [PubMed - indexed for MEDLINE] 6407. Dtsch Med Wochenschr. 1975 May 23;100(21):1205. [Letter: Zoster therapy] [Article in German] Nasemann T. PMID: 1132334 [PubMed - indexed for MEDLINE] 6408. Nurs Times. 1975 May 8;71(19):732-3. Post-herpetic neuralgia. Nathan PW. PMID: 1129191 [PubMed - indexed for MEDLINE] 6409. Am J Med Sci. 1975 May-Jun;269(3):399-401. Herpes zoster induced urinary retention in Hodgkin's disease. Shaukat MS. A patient with Hodgkin's disease with acute urinary retention caused by herpes zoster is presented. Two other similar cases previously reported in the literature are reviewed along with a review of English literature on herpes zoster causing urinary retention and on other genitourinary problems in Hodgkin's disease. Because of increased incidence of herpes zoster in Hodgkin's disease, recognition of this complication is stressed since other causes of actue urinary retention in Hodgkin's disease have serious implications. PMID: 1155496 [PubMed - indexed for MEDLINE] 6410. Arch Ophthalmol. 1975 May;93(5):382-3. Delayed trochlear nerve palsy in a case of zoster oticus. Keane JR. A 57-year-old man with herpes zoster oticus developed a delayed fourth nerve palsy followed by transient intermittent sixth nerve weakness. Trochlear nerve lesions occur rarely with zoster, particularly in the absence of zoster ophthalmicus. A knowledge of the wide range of motor manifestations and the chronicity of meningitis with zoster will afford earlier diagnosis without resort to arteriography. PMID: 1147811 [PubMed - indexed for MEDLINE] 6411. Hautarzt. 1975 May;26(5):287-8. [Letter: Isolation of zoster patients] [Article in German] Nasemann T. PMID: 168169 [PubMed - indexed for MEDLINE] 6412. J Infect Dis. 1975 May;131(5):509-15. Cellular events in zoster vesicles: relation to clinical course and immune parameters. Stevens DA, Ferrington RA, Jordan GW, Merigan TC. The cellular responses in zoster vesicles was studied chronologically in 30 patients, some of whom were compromised hosts with disseminated disease. Cell counts were low initially but rose abuptly later. Polymorphonuclear leukocytes predominated at all times in the vesicular fluid and in the cells adherent to the vesicle base. The abrupt rise in the number of cells generally coincided with an abrupt rise in the titer of vesicular interferon; both increases preceded resolution of local infection and cessation of cutaneous dissemination in disseminated disease, but the sequence of the increases was variable. The peak interferon titer correlated with cessation of dissemination better than did peak cell counts, and the timing of the local events contrasted with appearance of complement-fixing antibody, which commonly occurred after the resolution of disease. Possible interpretations are that a few sensitized lymphocytes may initiate the defensive response, produce interferon, and/or produce chemotactic factors that augment the polymorphonuclear response. The appearance of polymorphonuclear cells may be a nonspecific inflammatory response, or these cells or the deeper mononuclear infiltrate seen in biopsies may contribute to the rise in local interferon. PMID: 165243 [PubMed - indexed for MEDLINE] 6413. Ugeskr Laeger. 1975 Apr 28;137(18):1003. [Letter: Treatment of herpes zoster] [Article in Danish] Ibsen B. PMID: 1145814 [PubMed - indexed for MEDLINE] 6414. N Engl J Med. 1975 Apr 3;292(14):755. Letter: Ara-C and disseminated zoster. Hines JD, Cowan DH, Nankervis GA. PMID: 1113791 [PubMed - indexed for MEDLINE] 6415. Wiad Lek. 1975 Apr 1;28(7):585-8. [Vincristine neurotoxicity and zoster. A possible potentiating effect] [Article in Polish] Jedrzejczak WW, Chmielowski K, Siekierzyński M. PMID: 1130055 [PubMed - indexed for MEDLINE] 6416. Indian J Ophthalmol. 1975 Apr;23(1):39-41. Herpes simplex uveitis in zoster ophthalmicus. Dhir SP, Jain IS, Sehghal S. PMID: 169199 [PubMed - indexed for MEDLINE] 6417. Hautarzt. 1975 Apr;26(4):181-90. [Virus propagation, virus replication and virus elimination in the human skin in zoster] [Article in German] Orfanos CE, Runne U. The purpose of this study was to investigate the spreading, the replication and the elimination of Varicella-Zoster-Virus (ZV) in human skin. Typical skin lesions of thoracic zoster in different stages of development and of exanthematic vesicles in ophthalmic zoster were examined under the electron microscope. We found that ZV may be detected in fully developed vesicular skin lesions only, whereas in immature lesions and in the surrounding non involved skin axonal alterations may be seen, with no ZV present. The replication of the virus in the skin takes place almost exclusively in the malpighian keratinocytes of the involved epidermis. Blister formation in zoster is basically a result of the acantholysis of the infected epidermal cells. Mature ZV are then extruded into the intercellar space and become phagocytised by mononuclear cells which infiltrate the epidermis and eliminate the virus in large phagolysosomes. Only few virions were found in the dermis extracellularly or in dermal macrophages. In some of these cells stages of ZV-replication were also seen. Other cell types (i.e. Langerhans cells) were rarely infected. The application of the periodic acid-silver methenamine technique (PASM) in zoster revealed that a glycoprotein-rich coat surrounds each mature virion, obviously originating from the plasma membrane of the infected keratinocytes. This coat may be reason for the ability of the ZV to adhere on the cell surface and to infect the cell. PMID: 168168 [PubMed - indexed for MEDLINE] 6418. Nouv Presse Med. 1975 Mar 29;4(13):976. [Letter: L-dopa and zona] [Article in French] Péraldi A. PMID: 1144043 [PubMed - indexed for MEDLINE] 6419. Biochim Biophys Acta. 1975 Mar 20;417(1):25-53. Oncogenic Herpes viruses. zur Hausen H. PMID: 164249 [PubMed - indexed for MEDLINE] 6420. Ugeskr Laeger. 1975 Mar 17;137(12):689-90. [Letter: Treatment of herpes zoster] [Article in Danish] Larsen AK. PMID: 1145794 [PubMed - indexed for MEDLINE] 6421. Lakartidningen. 1975 Mar 12;72(11):1087-8. [Is zoster a sign of undiagnosed cancer?] [Article in Swedish] Molin L. PMID: 1128038 [PubMed - indexed for MEDLINE] 6422. Med Times. 1975 Mar;103(3):49-55. Dermatology mediquiz. Case 9. Leavell UW Jr. PMID: 1113637 [PubMed - indexed for MEDLINE] 6423. Scand J Urol Nephrol. 1975 Mar 6-7;(29 Suppl):133-4. Herpesvirus infections in renal allograft recipients. Spencer ES. 17 of 37 immunosuppressed renal allograft recipients developed clinical and/or serological evidence of herpes simplex virus infections, 7 of 83 developed a zoster rash, 85 of loo had evidence of cytomegalovirus infection and in 3 of 30 an active Epstein-Barr virus was seen. PMID: 181840 [PubMed - indexed for MEDLINE] 6424. Neurol Neurochir Pol. 1975 Mar-Apr;9(2):211-5. [Ramsay Hunt syndrome with involvement of facial and statoacoustic nerves] [Article in Polish] Fryze C, Kugler R, Standziak A. PMID: 1153055 [PubMed - indexed for MEDLINE] 6425. Ann Med Interne (Paris). 1975 Mar;126(3):177-81. [Paraneoplastic dermatoses] [Article in French] Barrière H. PMID: 1122088 [PubMed - indexed for MEDLINE] 6426. Arch Dermatol. 1975 Mar;111(3):396. Letter: Post-herpes zoster neuralgia: response to vitamin E therapy. Cochrane T. PMID: 1119838 [PubMed - indexed for MEDLINE] 6427. Riv Patol Nerv Ment. 1975 Mar-Apr;96(2):82-6. [Motor complications during Herpes zoster of the ophtalmic branch of the trigeminal nerve. Electromyographic study of 7 cases (author's transl)] [Article in Italian] Negrin P, Peserico A. It has been recently shown that in addition to ganglia the nerve is involved during Herpes Zoster. Electromyographic investigations of the masseter muscle, were carried out on the side of the skin lesions in 7 cases of Herpes Zoster of the first trigeminal branch. In 4 cases there was a partial denervation, possibly due to a mononeuritis of the motor branch of the trigeminal nerve. It is probable that systematic electromyographic examinations may demonstrate a higher proportion of motor complications during Herpes Zoster than previously accepted. PMID: 1084549 [PubMed - indexed for MEDLINE] 6428. Med Times. 1975 Mar;103(3):88-9. 10 questions in neurology. [No authors listed] PMID: 803603 [PubMed - indexed for MEDLINE] 6429. J Infect Dis. 1975 Mar;131(3):225-9. Treatment of varicella-zoster virus infections with adenine arabinoside. Johnson MT, Buchanan RA, Luby JP, Mikulec D. Twenty-three patients with complicated varicella-zoster virus infections were treated with adenine arabinoside. Of 14 patients with herpes zoster, 13 had malignancy treated with irradiation and cytotoxic agents or steroids. Although the duration of active vesicle formation in these patients ranged from two to 14 days before therapy, no new lesions appeared after the fourth day of treatment with adenine arabinoside. Zoster encephalitis developed in one patient on the third day of treatment, and severe postherpetic neuralgia was seen in three patients. Of nine treated patients with primary varicella, six improved, including five with evidence of varicella pneumonia. Two of the three patients with varicella who died were immunosuppressed and had progressive viral pneumonia with persistently high titers of virus in vesicular fluid; the third pateint was a child with Reye's syndrome. Double-blind controlled studies will be necessary to demonstrate the efficacy of adenine arabinoside in the treatment of infections with varicella-zoster virus. PMID: 165242 [PubMed - indexed for MEDLINE] 6430. Rev Clin Esp. 1975 Feb 28;136(4):365-9. [Transitory acute glaucoma: complication of herpes zoster] [Article in Spanish] Jordano J, Abu-Yaghi EN, Sánchez Ortega R. PMID: 1079366 [PubMed - indexed for MEDLINE] 6431. Ned Tijdschr Geneeskd. 1975 Feb 22;119(8):313-4. [Facial paralysis] [Article in Dutch] Jongkees LB. PMID: 1143589 [PubMed - indexed for MEDLINE] 6432. Drug Ther Bull. 1975 Feb 14;13(4):13-5. Drugs for herpes zoster. [No authors listed] PMID: 1218508 [PubMed - indexed for MEDLINE] 6433. Med Welt. 1975 Feb 14;26(7):306-8. [Pseudo-epitheliomatic hyperplasia on herpes zoster cicatrices in a patient with chronic myelosis] [Article in German] Korting GW, Brökelschen HU. PMID: 1054778 [PubMed - indexed for MEDLINE] 6434. Geriatrics. 1975 Feb;30(2):87-8, 91-5. Skin infections may be outward signs of inner disorders. Allison JR Jr, Rist T. PMID: 1123158 [PubMed - indexed for MEDLINE] 6435. Vrach Delo. 1975 Feb;(2):151-2. [Case of encephalitis in herpes zoster] [Article in Russian] Aleksandrov IuS. PMID: 1136397 [PubMed - indexed for MEDLINE] 6436. Rinsho Shinkeigaku. 1975 Feb;15(2):75-80. [Cytosine arabinoside treatment for ophthalmic herpes zoster with meningitis] [Article in Japanese] Shoji H, Hanakago R, Uono M, Koya M, Ogiwara H. PMID: 1088884 [PubMed - indexed for MEDLINE] 6437. Geriatrics. 1975 Feb;30(2):117-24, 129-31. Tracing the outward course of leukemia-lymphomas. Bluefarb SM. PMID: 123518 [PubMed - indexed for MEDLINE] 6438. Ann N Y Acad Sci. 1975 Jan 27;243:395-402. Dimethyl sulfoxide therapy in various dermatological disorders. Sehtman L. PMID: 1055556 [PubMed - indexed for MEDLINE] 6439. Med Klin. 1975 Jan 24;70(4):141-5. [Ocular complications in ophthalmic zoster (author's transl)] [Article in German] Schmitt H. Ocular complications occur in about 50% of cases of ophthalmic zoster. They include inflammatory reactions of the eyelid, conjunctivitis, scleritis, keratitis, iridocyclitis, secondary glaucoma, optic neuritis, internal ophthalmoplegia, ocular motor palsies and exophthalmos. Very dangerous complications are a concomitant facial paralysis and a neuroparalytic keratitis. Then a tarsorrhaphy should be done in time. An ophthalmologist should be consulted, when the side of the tip of the nose presents vesicles (Hutchinson's rule). PMID: 1079072 [PubMed - indexed for MEDLINE] 6440. Nurs Times. 1975 Jan 16;71(3):97-9. Pain in the face. Sambrook MA. PMID: 1110906 [PubMed - indexed for MEDLINE] 6441. J Endod. 1975 Jan;1(1):32-5. Herpes zoster associated with pulpless teeth. Gregory WB Jr, Brooks LE, Penick EC. PMID: 1061768 [PubMed - indexed for MEDLINE] 6442. Acta Otorhinolaryngol Belg. 1975;29(6):976-96. [Topical and differential diagnosis of facial paralysis. Study based on 1000 cases] [Article in Dutch] Clement PA, Devriese PP. The functional and clinical investigation of peripheral facial paralysis is discussed by the authors in brief. On ground of the scheme of Sturm the relativity of topographical diagnosis is demonstrated. According to their frequency in a statistic of 1009 cases the different causes of facial palsy are discussed as well as the problems involved in differential diagnosis. PMID: 1229825 [PubMed - indexed for MEDLINE] 6443. J Cutan Pathol. 1975;2(6):322-3. Herpes zoster. Myers RP, Montes LF. PMID: 1219049 [PubMed - indexed for MEDLINE] 6444. Dermatologica. 1975;150(6):366-8. Generalized mastocytosis, relapsing herpes zoster and polyradiculoneuritis. Kalz F. A 68-year-old woman suffering from a longstanding urticaria pigmentosa with mast cell infiltrations in bones had two attacks of herpes zoster. The second herpes zoster attack was followed by a severe polyradiculoneuritis (Guillain-Barré syndrome). The sequence of events suggests an immunological deficiency. PMID: 1201812 [PubMed - indexed for MEDLINE] 6445. J R Coll Gen Pract. 1975 Jan;25(150):29-32. Herpes zoster in general practice. Ross CA, Brown WK, Clarke A, Caldwell WF, Gordon ER, Harvey J, McAlister AM, McGlone J, Prentice RT, Thorburn W, Tobias C. PMCID: PMC2157665 PMID: 1177201 [PubMed - indexed for MEDLINE] 6446. ORL J Otorhinolaryngol Relat Spec. 1975;37(1):1-18. An evoked electromyographic test for peripheral facial palsy. Sato I, Kumagami H. The purpose of the present study was to determine the degree of nerve degeneration in patients with facial palsy from the number of spikes in M-wave which were induced from the facial muscle by means of a bipolar concentric needle electrode when the facial nerve was stimulated. Ten normal cases between 14 and 72 years of age and 46 cases with facial palsy between 12 and 73 years of age were examined. Histopathological findings of ten denervated nerves were studied to determine to what extent this method may reflect the state of nerve degeneration. PMID: 1169741 [PubMed - indexed for MEDLINE] 6447. Eur Neurol. 1975;13(4):332-8. Motor lesions in herpes zoster. Incidence and special features. Weiss S, Streifler M, Weiser HJ. In the review of 117 patients hospitalized for herpes zoster (HZ) during the 10-year-period of 1960-1969, six patients with motor paralysis of the limbs were found. The incidence of motor paralysis in HZ which ranges in the literature between 0.5 and 31%, was 18% in our series. Reasons for these differences are discussed. An uncommon feature, local recurrence of HZ with motor deficit pertaining to the same segments is reported, and joint subluxation, a rare complication of motor HZ, is also described. The importance of looking for diaphragmatic paralysis and motor deficit in the thoracoabdominal segments, not readily revealed in routine examination, is stressed. PMID: 1149753 [PubMed - indexed for MEDLINE] 6448. Birth Defects Orig Artic Ser. 1975;11(1):367-9. Effects of fetal thymus transplantation on defective cellular immunity. Kirkpatrick CH, Wells SA, Burdick JF, Smith TK. PMID: 1148387 [PubMed - indexed for MEDLINE] 6449. Trans Pa Acad Ophthalmol Otolaryngol. 1975 Spring;28(1):36-41. Interpretation of hearing tests in retrocochlear lesions. Young IM. PMID: 1145700 [PubMed - indexed for MEDLINE] 6450. Scand J Infect Dis. 1975;7(1):7-10. Herpes zoster and recurrent herpes simplex. Ross CA. 87 patients with the clinical diagnosis of herpes zoster were seen during a one-year period in 8 general practices in Glasgow, the rate per 1 000 practice population being approximately 2.4. Of these, 78 (90%) had serological evidence of active infection with herpes zoster. A history of recurrent herpes simplex was obtained in 25 (32%) of the 78 patients with confirmed herpes zoster; 63 (81%) of these 78 had complement-fixing (CF) antibodies to herpes simplex. Thus, latent herpes simplex infection did not prevent herpes zoster nor modify the severity of herpes zoster. In most of the patients CF antibodt to varicella-zoster was not detected within 5 days from appearance of the rash. After the acute phase of the illness CF antibody titres fell fairly rapidly, the geometric mean titre being 189 at 2-4 weeks after the rash, 27 from 3-6 months, and 8 from 12-18 months. The rapid rise and decline in CF antibody after herpes zoster infection compared with the unchanging CF titres associated with recurrent herpes simplex infection suggest that varicella-zoster and herpes simplex virus differ in their mechanism of latency. PMID: 1145136 [PubMed - indexed for MEDLINE] 6451. Am Fam Physician. 1975 Jan;11(1):108-10. Otalgia. Beddoe GM. PMID: 1109535 [PubMed - indexed for MEDLINE] 6452. Trans St Johns Hosp Dermatol Soc. 1975;61(1-2):35-43. Laboratory diagnosis of cutaneous herpes simplex and varicella--zoster infections. Kurtis B. PMID: 1105909 [PubMed - indexed for MEDLINE] 6453. Scand J Infect Dis. 1975;7(1):1-5. Human interferon therapy for herpes zoster in adults. Emödi G, Rufli T, Just M, Hernandez R. Of 37 patients with herpes zoster 28 were treated with human exogenous interferon and 9 received only culture medium. The interferon was produced in leukocyte cultures and was given intramuscularly in one daily dose of 1 million units for 5-8 days. In the interferon-treated patients interferon was detectable in serum (peak level 1-5 hours after interferon injections) and in vesicle fluid, and in some patients also in urine samples. Anti-interferon antibodies were not found. Of the 28 interferon-treated patients 8 had a slight temperature increase and 4 showed a transient local reaction. In the interferon treated group of patients the duration of pain was shortened and the development of crust formation was enhanced compared with the control group. PMID: 1096292 [PubMed - indexed for MEDLINE] 6454. Bull Soc Ophtalmol Fr. 1975 Jan;75(1):37-40. [Ophthalmic zona in a child. Attempt at treatment by macrophagic stimulation] [Article in French] Lods MF. PMID: 1081918 [PubMed - indexed for MEDLINE] 6455. Ophthalmologica. 1975;171(3):237-43. Ocular toxoplasmosis, trigeminal herpes zoster and pulmonary tuberculosis in a patient with Hodgkin's disease. Troussaint D, Vanderhaeghen JJ. PMID: 1079591 [PubMed - indexed for MEDLINE] 6456. Int Ophthalmol Clin. 1975 Winter;15(4):171-85. Varicella-zoster ophthalmicus. Pavan-Langston D. PMID: 178619 [PubMed - indexed for MEDLINE] 6457. Acta Otolaryngol. 1975 Jan-Feb;79(1-2):67-80. Degenerative changes in the human vestibular sensory epithelia. Rosenhall U, Rubin W. A study of the vestibular end organs from humans of different ages is presented. The inner ears were exposed by microdissection, and the vestibular sensory regions were either sectioned and studied with light or electron microscopy, or prepared and studied with the surface specimen technique. A change, which can be related to aging, is the accumulation of lipofuscin inclusions in sensory and supporting cells, especially pronounced in the type I sensory cell. Changes of the hair bundles, such as disarrangement of cilia, increased fragility of cilia and formation of giant cilia, have also been observed in aged individuals. In three cases there was a history of vestibular disturbance of vertigo. All three cases had shown caloric hypo-reactivity. In two cases, one with a history of herpes zoster oticus and another with a brain stem glioma, no morphological changes which could be attributed to the diseases, were found. The third case showed degeneration of macula utriculi and the lateral and superior cristae, possibly as a result of vascular disturbance. PMID: 167544 [PubMed - indexed for MEDLINE] 6458. Kansenshogaku Zasshi. 1975 Jan;49(1):18-24. [Seroepidemiological study of varicella-zoster virus by complement fixation reaction] [Article in Japanese] Ono Y, Takahashi C, Miyoshi K, Ideguchi S, Sasaki M. PMID: 165248 [PubMed - indexed for MEDLINE] 6459. Eur J Cancer. 1975 Jan;11(1):51-7. Herpes zoster-varicella infection in malignant lymphomas. Influence of splenectomy and intensive treatment. Monfardini S, Bajetta E, Arnold CA, Kenda R, Bonadonna G. PMID: 48460 [PubMed - indexed for MEDLINE] 6460. Int Arch Allergy Appl Immunol. 1975;48(2):161-70. Determination of serum C9 level by immunodiffusion. Elevation in patients with infectious or allergic skin diseases. Kawachi-Takahashi S, Tanaka K, Takahashi M, Kawashima T, Shimada K. The measurement of the ninth component of complement (C9) in human serum can be easily carried out by the Mancini method using antiserum raised against purified C9. The average C9 level in 29 healthy adults was 44.5 plus or minus 10.6 mug/ml. The serum C9 level was often elevated in patients with infectious or allergic skin diseases. The C9 level remained normal in most patients with collagen diseases. The availability of the monospecific antiserum has permitted identifying C9 in human serum as alpha2-globulin. PMID: 46851 [PubMed - indexed for MEDLINE] 6461. Lakartidningen. 1974 Dec 24;71(52):5352. [Herpes zoster in children] [Article in Swedish] Melgård BJ. PMID: 4449300 [PubMed - indexed for MEDLINE] 6462. Tidsskr Nor Laegeforen. 1974 Dec 10;94(34-36):2409. [Letter: Prevention against varicella and herpes zoster in individuals with impaired immunological defence] [Article in Norwegian] Moe FJ. PMID: 4374773 [PubMed - indexed for MEDLINE] 6463. Lancet. 1974 Dec 7;2(7893):1396-7. Letter: Serum-copper in Hodgkin's disease before and after herpes zoster. Thorling EB, Thorling K. PMID: 4143363 [PubMed - indexed for MEDLINE] 6464. Physiotherapy. 1974 Dec;60(12):386. Short-wave diathermy for herpes zoster. Allberry J, Manning FR, Smith EE. PMID: 4467201 [PubMed - indexed for MEDLINE] 6465. Vestn Dermatol Venerol. 1974 Dec;(12):58-60. [Therapeutic efficacy of oxoline and adimal in viral and presumedly viral dermatoses] [Article in Russian] Samsonov VA, Nikitina MN, Mizonova TP. PMID: 4446746 [PubMed - indexed for MEDLINE] 6466. J Infect Dis. 1974 Dec;130(6):673-6. Cytosine arabinoside for localized herpes zoster in patients with cancer: failure in a controlled trial. Schimpff SC, Fortner CL, Greene WH, Wiernik PH. PMID: 4372276 [PubMed - indexed for MEDLINE] 6467. J Miss State Med Assoc. 1974 Dec;15(12):512-4. Recurrent radial nerve palsy. Grotta JC, Tipton AC Jr. PMID: 4216637 [PubMed - indexed for MEDLINE] 6468. Transplant Proc. 1974 Dec;6(4):389-93. Infectious complications of marrow transplantation. Clift RA, Buckner CD, Fefer A, Lerner KG, Neiman PE, Storb R, Murphy M, Thomas ED. PMID: 4155156 [PubMed - indexed for MEDLINE] 6469. South Med J. 1974 Nov;67(11):1365-7. Vesicular metastatic melanoma. MacWilliams P, Noojin RO. PMID: 4610774 [PubMed - indexed for MEDLINE] 6470. J Am Osteopath Assoc. 1974 Nov;74(3):244-6. Herpes zoster oticus: report of a case. Gilroy GL. PMID: 4496990 [PubMed - indexed for MEDLINE] 6471. Pediatrics. 1974 Nov;54(5):658. Letter: Zoster immune globulin shortage! Brunell PA, Gershon AA. PMID: 4453479 [PubMed - indexed for MEDLINE] 6472. Vestn Dermatol Venerol. 1974 Nov;(11):55-6. [Spinal cord involvement in herpes zoster] [Article in Russian] Bateĭko VIa, Sonina EE. PMID: 4446728 [PubMed - indexed for MEDLINE] 6473. Can J Neurol Sci. 1974 Nov;1(4):239-41. Spinal myoclonus in association with herpes zoster infection: two case reports. Dhaliwal GS, McGreal DA. Two cases of segmental spinal myoclonus, attributed to herpes zoster infection, are presented. The findings support the suggestion made by Campbell and Garland (1956) that "subacute myoclonic spinal neuronitis" is of viral origin. Both patients were receiving immuno-suppressive treatment when the myoclonus developed. The value of carbamazepine in therapy is mentioned. PMID: 4441989 [PubMed - indexed for MEDLINE] 6474. Rocky Mt Med J. 1974 Nov;71(11):645-9. Acute lymphoblastic leukemia of childhood: results of combination therapy. Hutter JJ Jr, Hays T, Holton CP, Mayer CM, Baum ES, Chapman KE, Phillips LK, Haerr M. PMID: 4372664 [PubMed - indexed for MEDLINE] 6475. J Infect Dis. 1974 Nov;130(5):495-501. Cell-mediated immunity to varicella-zoster virus: in vitro lymphocyte responses. Jordan GW, Merigan TC. PMID: 4370611 [PubMed - indexed for MEDLINE] 6476. Cah Med. 1974 Oct 30;15(11):703-6. [Ocular herpes zoster] [Article in French] Deodati F, Arne JL. PMID: 4548855 [PubMed - indexed for MEDLINE] 6477. Br Med J. 1974 Oct 19;4(5937):165. Letter: Post-herpetic pruritus. Liddell K. PMCID: PMC1612298 PMID: 4153745 [PubMed - indexed for MEDLINE] 6478. Br Med J. 1974 Oct 12;4(5936):108. Letter: Zoster in families. Mackenzie J. PMCID: PMC1612174 PMID: 4370162 [PubMed - indexed for MEDLINE] 6479. Nippon Ganka Gakkai Zasshi. 1974 Oct 10;78(10):1073-8. [Study on herpes zoster keratitis] [Article in Japanese] Uchida Y, Kameyama K, Kameko M, Inoue S, Yoda Y. PMID: 4616619 [PubMed - indexed for MEDLINE] 6480. Wien Med Wochenschr. 1974 Oct 5;124(40):577-81. [Myoclonus: Features, pathophysiology and clinical importance] [Article in German] Bauer G. PMID: 4215238 [PubMed - indexed for MEDLINE] 6481. Klin Monbl Augenheilkd. 1974 Oct;165(4):650-5. [On-suturing of cornea as therapy for serious chronic corneal diseases (author's transl)] [Article in German] Reuscher A. PMID: 4615206 [PubMed - indexed for MEDLINE] 6482. Med Times. 1974 Oct;102(10):78-92. "All that palsies is not Bell's". Glasscock ME 3rd. PMID: 4456133 [PubMed - indexed for MEDLINE] 6483. South Med J. 1974 Oct;67(10):1171-4. Herpes zoster with motor paresis. Goodman CE, Kenrick MM. PMID: 4413670 [PubMed - indexed for MEDLINE] 6484. Practitioner. 1974 Oct;213(1276 SPEC NO):508-18. Virus diseases. Juel-Jensen BE. PMID: 4376235 [PubMed - indexed for MEDLINE] 6485. Rev Chir Oncol Radiol O R L Oftalmol Stomatol Otorinolaringol. 1974 Oct-Dec;19(5):389-93. [Pharyngeal zona] [Article in Romanian] Florescu V, Florescu R. PMID: 4283191 [PubMed - indexed for MEDLINE] 6486. Pol Tyg Lek. 1974 Sep 30;29(39):1665-7. [Marcaine block in the treatment of zoster] [Article in Polish] Aroński A, Wasik F, Majda A. PMID: 4410073 [PubMed - indexed for MEDLINE] 6487. Lakartidningen. 1974 Sep 18;71(38):3489. [Confusion of uncertain etiology in Hodgkin's disease] [Article in Swedish] Mannheimer C. PMID: 4409023 [PubMed - indexed for MEDLINE] 6488. Wiad Lek. 1974 Sep 15;27(16):1513-6. [Zoster in the course of acute leukemia in children] [Article in Polish] Armata J, Zajaczkowski J, Depowska T. PMID: 4528376 [PubMed - indexed for MEDLINE] 6489. Z Hautkr. 1974 Sep 15;49(18):781-9. [Lethality problems in dermatology] [Article in German] Jänner M. PMID: 4282787 [PubMed - indexed for MEDLINE] 6490. Br Med J. 1974 Sep 14;3(5932):686. Letter: Chickenpox from herpes zoster. Wilkinson PJ, Jones JV, Reeves DS, Asplin CM. PMCID: PMC1611648 PMID: 4425803 [PubMed - indexed for MEDLINE] 6491. Br Med J. 1974 Sep 7;3(5931):609-10. Epidermolysis in a case of severe cytomegalovirus infection. Müller-Stamou A, Senn HJ, Emödy G. PMCID: PMC1611580 PMID: 4370972 [PubMed - indexed for MEDLINE] 6492. Br Med J. 1974 Sep 7;3(5931):626. Letter: Zoster in three children in family. Hope-Simpson RE. PMCID: PMC1611575 PMID: 4370956 [PubMed - indexed for MEDLINE] 6493. Cesk Oftalmol. 1974 Sep;30(5):370-4. [Unusual cerebral complication in ocular herpes zoster] [Article in Czech] Rehůrek J, Hanák L, Rehůrková M. PMID: 4547113 [PubMed - indexed for MEDLINE] 6494. Przegl Dermatol. 1974 Sep-Oct;61(5):697-700. [Gangrenous zoster in the course of acute lymphatic leukemia] [Article in Polish] Czarnacki P, Czarecki S. PMID: 4529181 [PubMed - indexed for MEDLINE] 6495. Oral Surg Oral Med Oral Pathol. 1974 Sep;38(3):372-7. Carcinoembryonic antigen and herpes zoster as diagnostic aids in malignant neoplasia. Report of a case. Burns JC. PMID: 4528457 [PubMed - indexed for MEDLINE] 6496. Ital Gen Rev Dermatol. 1974 Sep-Dec;11(3):207-13. Skin and diabetes. II. Incidence of diabetes in a group of patients with herpes zoster. Calandra P, Lisi P. PMID: 4470104 [PubMed - indexed for MEDLINE] 6497. Arch Dermatol. 1974 Sep;110(3):466-7. Letter: Flexible collodion. Krulig L, Jacobs PH. PMID: 4451402 [PubMed - indexed for MEDLINE] 6498. Z Hautkr. 1974 Sep 1;49(17):733. [Dynamics of the viral attack and cellular rejection reaction in the skin during segmental and exanthematous zoster] [Article in German] Orfanos CE, Runne U. PMID: 4440077 [PubMed - indexed for MEDLINE] 6499. Sov Med. 1974 Sep;0(9):150-1. [Vesicular dermatoses in elderly and aged persons] [Article in Russian] Dobzhanskiĭ SI, Suvorov AP. PMID: 4411496 [PubMed - indexed for MEDLINE] 6500. Hum Pathol. 1974 Sep;5(5):519-50. Lymphadenopathy simulating the malignant lymphomas. Dorfman RF, Warnke R. PMID: 4137045 [PubMed - indexed for MEDLINE] 6501. Br Med J. 1974 Aug 24;3(5929):523. Letter: Idoxuridine in herpes zoster. Simpson JR. PMCID: PMC1611243 PMID: 4414264 [PubMed - indexed for MEDLINE] 6502. Br Med J. 1974 Aug 17;3(5928):473. Letter: Treatment of genital herpes. Gosling PH. PMCID: PMC1611429 PMID: 4414450 [PubMed - indexed for MEDLINE] 6503. Fortschr Med. 1974 Aug 8;92(22):877-81 contd. [Localization of skin diseases in the face. Visceral-reflectoric facial zones] [Article in German] Hauser W. PMID: 4278441 [PubMed - indexed for MEDLINE] 6504. Ned Tijdschr Geneeskd. 1974 Aug 3;118(31):1194-6. [Virus and sudden loss of perceptive hearing] [Article in Dutch] Bom MM. PMID: 4602551 [PubMed - indexed for MEDLINE] 6505. Am J Surg. 1974 Aug;128(2):219-24. Clinical manifestations of adrenal hemorrhage. Clark OH, Hall AD, Schambelan M. PMID: 4846502 [PubMed - indexed for MEDLINE] 6506. Am J Ophthalmol. 1974 Aug;78(2):255-61. Iritis and iris atrophy in Herpes zoster ophthalmicus. Marsh RJ, Easty DL, Jones BR. PMID: 4546563 [PubMed - indexed for MEDLINE] 6507. Proc R Soc Med. 1974 Aug;67(8):757-9. Lupus nephritis: response to azathioprine. Forbes MJ, Sinclair L. PMCID: PMC1645836 PMID: 4424087 [PubMed - indexed for MEDLINE] 6508. Ugeskr Laeger. 1974 Jul 29;136(31):1751-2. [Letter: Cortisone treatment in herpes zoster] [Article in Danish] Hoher AJ. PMID: 4547052 [PubMed - indexed for MEDLINE] 6509. JAMA. 1974 Jul 22;229(4):457-8. Editorial: Focus on cutaneous host-defense failure in transplant recipients. Hersh EM, Freireich EJ. PMID: 4600401 [PubMed - indexed for MEDLINE] 6510. JAMA. 1974 Jul 15;229(3):302-4. Herpes zoster ophthalmicus and delayed contralateral hemiparesis. Relationship of the syndrome to central nervous system granulomatous angiitis. Gilbert GJ. PMID: 4546095 [PubMed - indexed for MEDLINE] 6511. Br Med J. 1974 Jul 6;3(5922):41. Idoxuridine in Herpes Zoster. [No authors listed] PMCID: PMC1611409 PMID: 4601209 [PubMed - indexed for MEDLINE] 6512. J Urol. 1974 Jul;112(1):100-4. Diamminodichloroplatinum in the chemotherapy of testicular tumors. Higby DJ, Wallace HJ Jr, Albert D, Holland JF. PMID: 4858106 [PubMed - indexed for MEDLINE] 6513. South Med J. 1974 Jul;67(7):808-12. Chlorprothixene therapy for herpes zoster neuralgia. Farber GA, Burks JW. PMID: 4834739 [PubMed - indexed for MEDLINE] 6514. J Infect Dis. 1974 Jul;130(1):56-62. Administration of human leukocyte interferon in herpes zoster. I. Safety, circulating, antiviral activity, and host responses to infection. Jordan GW, Fried RP, Merigan TC. PMID: 4601181 [PubMed - indexed for MEDLINE] 6515. Rev Odontostomatol (Paris). 1974 Jul-Aug;3(4):357-8. [Post-operative viral complication] [Article in French] Treyssac P. PMID: 4532788 [PubMed - indexed for MEDLINE] 6516. Stomatologiia (Mosk). 1974 Jul-Aug;53(4):93-4. [Clinical picture and treatment of herpes zoster of the mouth mucosa] [Article in Russian] Danilov LN. PMID: 4529340 [PubMed - indexed for MEDLINE] 6517. N Y State J Med. 1974 Jul;74(8):1367-72. Zoster immune globulin. Regional production and allocation. Ross AH, Klein SW, McKennett B, Kraminer A, Caifa K. PMID: 4528120 [PubMed - indexed for MEDLINE] 6518. Z Hautkr. 1974 Jul 1;49(13):582. [Case demonstration: Neviform telangiectases following herpes zoster, Fegeler's syndrome?] [Article in German] Kuhlhoff A. PMID: 4419038 [PubMed - indexed for MEDLINE] 6519. Arch Belg Dermatol. 1974 Jul-Sep;30(3):117-58. [Internal malignant tumors and cutaneous symptoms] [Article in French] De Bersaques J, Dockx P. PMID: 4377396 [PubMed - indexed for MEDLINE] 6520. Hautarzt. 1974 Jul;25(7):313-8. [Interferon and interferon stimulation. New items in therapy of viral infections] [Article in German] Fanta D, Söltz-Szötz J. PMID: 4369595 [PubMed - indexed for MEDLINE] 6521. Br J Dermatol. 1974 Jul;91(1):111-3. Recurrent herpes simplex virus infections. Higgins PG. PMID: 4369124 [PubMed - indexed for MEDLINE] 6522. J Natl Med Assoc. 1974 Jul;66(4):284-91. Microbial opportunism in clinical medicine. Poindexter HA, Washington TD. PMCID: PMC2609206 PMID: 4367817 [PubMed - indexed for MEDLINE] 6523. Am J Chin Med (Gard City N Y). 1974 Jul;2(3):247-60. Effect of auriculo-acupuncture on pain. Leung CY, Spoerel WE. PMID: 4278068 [PubMed - indexed for MEDLINE] 6524. Blood. 1974 Jul;44(1):56-75. Treatment of established human graft-versus-host disease by antithymocyte globulin. Storb R, Gluckman E, Thomas ED, Buckner CD, Clift RA, Fefer A, Glucksberg H, Graham TC, Johnson FL, Lerner KG, Neiman PE, Ochs H. PMID: 4275768 [PubMed - indexed for MEDLINE] 6525. Lancet. 1974 Jun 22;1(7869):1293. Letter: Herpes simplex and herpes zoster in neoplasia. Morison WL. PMID: 4134180 [PubMed - indexed for MEDLINE] 6526. Ugeskr Laeger. 1974 Jun 17;136(25):1398-9. [Letter: Observation of herpes zoster patients during ACTH (Synacten depot) treatment] [Article in Danish] Roesdahl H. PMID: 4366486 [PubMed - indexed for MEDLINE] 6527. Br Med J. 1974 Jun 8;2(5918):526-7. Idoxuridine in herpes zoster: further evaluation of intermittent topical therapy. Dawber R. PMCID: PMC1610936 PMID: 4600903 [PubMed - indexed for MEDLINE] 6528. Br J Dermatol. 1974 Jun;90(6):718. Letter: Anogenital herpes zoster in two cases of Wegener's granulomatosis. Roupe G. PMID: 4852692 [PubMed - indexed for MEDLINE] 6529. J Med Assoc State Ala. 1974 Jun;43(12):742-4. Management of herpes zoster with H-influenza vaccine, a preliminary report. Brown AM. PMID: 4847301 [PubMed - indexed for MEDLINE] 6530. J Infect Dis. 1974 Jun;129(6):747. Letter: Zoster-immune globulin for congenital varicella. St Geme JW Jr. PMID: 4834286 [PubMed - indexed for MEDLINE] 6531. Bruns Beitr Klin Chir. 1974 Jun;221(4):309-12. [The significance of serotherapy in herpes zoster diseases following kidney allotransplantation] [Article in German] Hierholzer E, Bosse K, Käckell MY, Hölscher M, Zühlke V. PMID: 4607452 [PubMed - indexed for MEDLINE] 6532. Otolaryngol Clin North Am. 1974 Jun;7(2):369-73. Herpes zoster oticus and facial paralysis. Crabtree JA. PMID: 4600185 [PubMed - indexed for MEDLINE] 6533. Otolaryngol Clin North Am. 1974 Jun;7(2):433-6. Facial nerve paralysis in children. Linthicum FH Jr. PMID: 4599266 [PubMed - indexed for MEDLINE] 6534. Otolaryngol Clin North Am. 1974 Jun;7(2):309-30. The pathophysiology of otologic facial paralysis. Antoli-Candela F Jr, Stewart TJ. PMID: 4599259 [PubMed - indexed for MEDLINE] 6535. Lijec Vjesn. 1974 Jun;96(6):375-7. [Clinical use of interferon] [Article in Croatian] Vodopija A. PMID: 4549315 [PubMed - indexed for MEDLINE] 6536. Srp Arh Celok Lek. 1974 Jun;102(6):467-71. [Hypertensive keratoiritis in Herpes zoster] [Article in Serbian] Tomović J, Artiko G, Parunović A. PMID: 4548771 [PubMed - indexed for MEDLINE] 6537. Hautarzt. 1974 Jun;25(6):267-77. [Virus diseases of the skin] [Article in German] Söltz-Szöts J, Fanta D. PMID: 4368308 [PubMed - indexed for MEDLINE] 6538. Am Fam Physician. 1974 Jun;9(6):70-4. Recent therapeutic advances for common cutaneous problems. Zuehlke RL. PMID: 4275327 [PubMed - indexed for MEDLINE] 6539. JAMA. 1974 May 13;228(7):876. Editorial: Varicella-zoster infections: zoster immune globulin. Hussey HH. PMID: 4362716 [PubMed - indexed for MEDLINE] 6540. Lancet. 1974 May 4;1(7862):871. Letter: Possible prevention of bronchial carcinoma by recurrent Herpes simplex. Ross CA, Tyrrell WF. PMID: 4132827 [PubMed - indexed for MEDLINE] 6541. Arch Dermatol. 1974 May;109(5):692-4. Herpes zoster with neurogenic bladder dysfunction. Izumi AK, Edwards J Jr. PMID: 4828538 [PubMed - indexed for MEDLINE] 6542. Trans Am Acad Ophthalmol Otolaryngol. 1974 May-Jun;78(3):OP391-8. Therapeutic experience with soft contact lenses. Gould HL. PMID: 4546205 [PubMed - indexed for MEDLINE] 6543. Dent Update. 1974 May-Jun;1(7):354-6, 358, 360 passim. The diagnosis and mangement of oral ulceration. Part 2. Nally FF. PMID: 4531399 [PubMed - indexed for MEDLINE] 6544. Dent Update. 1974 May-Jun;1(7):354-6. 358, 360 passim. The diagnosis and management of oral ulceration. Part 2. Nally FF. PMID: 4531398 [PubMed - indexed for MEDLINE] 6545. Oral Surg Oral Med Oral Pathol. 1974 May;37(5):657-62. Necrosis of maxilla in patient with herpes zoster. Report of a case. Hall HD, Jacobs JS, O'Malley JP. PMID: 4524373 [PubMed - indexed for MEDLINE] 6546. J Am Osteopath Assoc. 1974 May;73(9):762-4. Hunt's syndrome: report of a case. Vogelgesang GW. PMID: 4494605 [PubMed - indexed for MEDLINE] 6547. Arch Pathol. 1974 May;97(5):331-3. Herpesvirus varicellae isolated from human dorsal root ganglia. Bastian FO, Rabson AS, Yee CL, Tralka TS. PMID: 4362032 [PubMed - indexed for MEDLINE] 6548. J Lab Clin Med. 1974 May;83(5):768-77. The monocyte disorder with herpes zoster. Twomey JJ, Gyorkey F, Norris SM. PMID: 4274508 [PubMed - indexed for MEDLINE] 6549. N Engl J Med. 1974 Apr 18;290(16):914. Letter: Possible bone-marrow depression by Ara-A therapy for disseminated herpes zoster. Gottlieb JA, Bodey GP Sr. PMID: 4816977 [PubMed - indexed for MEDLINE] 6550. Masui. 1974 Apr;23(4):340-5. [Statistical observation on 1,000 cases of facial nerve paralysis--with special refernce to the etiology of Bell's palsy] [Article in Japanese] Totoki T, Yuda Y, Tamesa T, Kawahara M, Tsumeda M. PMID: 4858653 [PubMed - indexed for MEDLINE] 6551. Masui. 1974 Apr;23(4):333-9. [Treatment of herpes zoster in the pain clinic] [Article in Japanese] Tamesa T, Wakasugi B, Yuda Y, Nishisaka T, Kato H. PMID: 4858652 [PubMed - indexed for MEDLINE] 6552. Br J Urol. 1974 Apr;46(2):193-200. The genito-urinary manifestations of herpes zoster. Three case reports and a review of the literature. Richmond W. PMID: 4823892 [PubMed - indexed for MEDLINE] 6553. Pediatrics. 1974 Apr;53(4):476-80. Efficacy of zoster immune globulin. Judelsohn RG, Meyers JD, Ellis RJ, Thomas EK. PMID: 4823323 [PubMed - indexed for MEDLINE] 6554. Uirusu. 1974 Apr;24(1):83-4. [Complement-binding antibody level in herpes zoster patients] [Article in Japanese] Hata S. PMID: 4478245 [PubMed - indexed for MEDLINE] 6555. Uirusu. 1974 Apr;24(1):78-80. [Antibody response in chickenpox and herpes zoster] [Article in Japanese] Moda S, Ota E, Miura H, Iijima S. PMID: 4478243 [PubMed - indexed for MEDLINE] 6556. JAMA. 1974 Apr 1;228(1):27. Letter: Smallpox vaccine for herpes zoster. Chang SL. PMID: 4406140 [PubMed - indexed for MEDLINE] 6557. Clin Exp Immunol. 1974 Apr;16(4):565-73. Cell-mediated and humoral immune responses or renal transplant recipients with cytomegalovirus infections. Lopez C, Simmons RL, Park BH, Najarian JS, Good RA. PMID: 4377553 [PubMed - indexed for MEDLINE] 6558. Riv Ital Stomatol. 1974 Apr-Jun;29(4,6):227-56. [Oral manifestations of eruptive infections viewing the disease in general] [Article in Italian] Gombos F, Matarasso S, Valletta G. PMID: 4373816 [PubMed - indexed for MEDLINE] 6559. S Afr Med J. 1974 Mar 31;47(12):506. Letter: Herpes zoster. Abelson JB. PMID: 4826754 [PubMed - indexed for MEDLINE] 6560. Nippon Rinsho. 1974 Mar;32(3):632-5. [Herpes zoster occurring consecutively in hospitalized children with systemic lupus erythematosus] [Article in Japanese] Ueda K, Arihiro H, Nunoue T, Hirano Y, Goya N. PMID: 4858995 [PubMed - indexed for MEDLINE] 6561. Przegl Dermatol. 1974 Mar-Apr;61(2):187-91. [Molluscum contagiosum and zoster gangrenosus in the course of lymphogranulomatosis maligna] [Article in Polish] Wranicz A, Dyla G. PMID: 4832862 [PubMed - indexed for MEDLINE] 6562. Z Hautkr. 1974 Mar 1;49(5):183-8. [Experiences with a new treatment of skin virus diseases] [Article in German] Schüle D. PMID: 4828150 [PubMed - indexed for MEDLINE] 6563. Ann Intern Med. 1974 Mar;80(3):310-20. Chronic mucocutaneous candidiasis: immunologic and antibiotic therapy. Kirkpatrick CH, Smith TK. PMID: 4816171 [PubMed - indexed for MEDLINE] 6564. Int J Dermatol. 1974 Mar-Apr;13(2):69-75. Herpes simplex and varicella-zoster: comparative histopathology of 77 cases. McSorley J, Shapiro L, Brownstein MH, Hsu KC. PMID: 4596285 [PubMed - indexed for MEDLINE] 6565. Indian J Ophthalmol. 1974 Mar;22(1):36-7. Herpes zoster ophthalmicus and varicella. Maria DL, Kulkarni RG. PMID: 4548690 [PubMed - indexed for MEDLINE] 6566. Neurochirurgie. 1974 Mar-Apr;20(2):117-24. [Treatment of certain types of pain with implantable thalamic stimulators] [Article in French] Mazars G, Merienne L, Cioloca C. PMID: 4418054 [PubMed - indexed for MEDLINE] 6567. Am J Med. 1974 Mar;56(3):280-9. Association of renal allograft rejection with virus infections. Lopez C, Simmons RL, Mauer SM, Najarian JS, Good RA, Gentry S. PMID: 4360465 [PubMed - indexed for MEDLINE] 6568. N Engl J Med. 1974 Feb 14;290(7):409-10. Letter: Cytosine arabinoside for herpes zoster. [No authors listed] PMID: 4543931 [PubMed - indexed for MEDLINE] 6569. Orv Hetil. 1974 Feb 10;115(6):327-8. [Psoriasis against the background of herpes zoster] [Article in Hungarian] Angyal J, Magyar M. PMID: 4839527 [PubMed - indexed for MEDLINE] 6570. Dtsch Med Wochenschr. 1974 Feb 8;99(6):262. [Letter: Therapy of zoster] [Article in German] Kraus S. PMID: 4812424 [PubMed - indexed for MEDLINE] 6571. Br J Dermatol. 1974 Feb;90(2):235. Letter: Herpes zoster of the anogenital area affecting urination and defaecation. Waugh MA. PMID: 4819143 [PubMed - indexed for MEDLINE] 6572. Z Gesamte Hyg. 1974 Feb;20(2):116. [Artificial polynucleotides as inducers of interferon] [Article in German] Heidel G. PMID: 4598964 [PubMed - indexed for MEDLINE] 6573. Gut. 1974 Feb;15(2):94-8. Viral antibodies and autoantibodies in chronic liver disease. Triger DR, Kurtz JB, Wright R. Our previous observations of highly significant increases in high titre antibodies to measles and rubella in patients with chronic active hepatitis have been extended and it has been shown that these reactions do not occur in other forms of liver disease. Significant increases in antibody titres to cytomegalovirus have also been found in patients with chronic active hepatitis (p<0.001) and alcoholic and primary biliary cirrhosis (p<0.05). Antibody titres to herpes simplex, varicella/zoster, parainfluenza I, and Mycoplasma pneumoniae in all forms of chronic liver disease did not differ from controls. Immunofluorescent autoantibodies were correlated with the viral antibodies and a highly significant correlation with strongly positive antismooth muscle and antinuclear antibodies and measles antibody titres in particular was noted. The possible significance of this correlation is discussed in terms of the hypothesis that the intact liver plays a significant role in the sequestering of antigens. PMCID: PMC1412906 PMID: 4362374 [PubMed - indexed for MEDLINE] 6574. Arch Ophtalmol Rev Gen Ophtalmol. 1974 Feb;34(2):115-9. [A case of zona ophthalmica in a child] [Article in French] Spiritus M, Michiels J, Evrard P. PMID: 4277115 [PubMed - indexed for MEDLINE] 6575. Internist (Berl). 1974 Feb;15(2):66-70. [Immunologic phenomena in lymphogranulomatosis] [Article in German] Scheurlen PG. PMID: 4151855 [PubMed - indexed for MEDLINE] 6576. N Engl J Med. 1974 Jan 31;290(5):243-5. Zoster immune globulin. A further assessment. Gershon AA, Steinberg S, Brunell PA. PMID: 4358055 [PubMed - indexed for MEDLINE] 6577. Br Med J. 1974 Jan 5;1(5896):33-5. Medicine in old age. Disturbances of the special senses and other functions. Nicholson WJ. PMCID: PMC1632845 PMID: 4808821 [PubMed - indexed for MEDLINE] 6578. Pol Przegl Radiol Med Nukl. 1974;38(2):205-10. [Symptomatic zoster in patients with Hodgkin's disease treated at the Radiotherapy Department of the Medical Academy in the years 1960-1971] [Article in Polish] Kukolewska-Machnicka J. PMID: 4840287 [PubMed - indexed for MEDLINE] 6579. Vrach Delo. 1974;4:149-51. [Treatment of dermatoses of viral and non-viral etiology with interferon] [Article in Russian] Borzov MV, Kuznetsov VP, Lobanovskiĭ GI. PMID: 4831848 [PubMed - indexed for MEDLINE] 6580. Otolaryngol Pol. 1974;28(1):95-8. [Late results of treatment of herpes zoster oticus] [Article in Polish] Kowalska-Kulesza K. PMID: 4821574 [PubMed - indexed for MEDLINE] 6581. Br J Dermatol. 1974 Jan;90(1):110-1. Letter: Herpes zoster following primary smallpox vaccination. Verbov J. PMID: 4811832 [PubMed - indexed for MEDLINE] 6582. Adv Neurol. 1974;6:107-26. Transfer factor in diseases of the central nervous system. Graybill JR. PMID: 4614652 [PubMed - indexed for MEDLINE] 6583. Int Ophthalmol Clin. 1974 Spring-Summer;14(1-2):422-68. The eye and its disorders. 23. The cornea and sclera. Trevor-Roper PD. PMID: 4608134 [PubMed - indexed for MEDLINE] 6584. Can J Ophthalmol. 1974 Jan;9(1):72-8. Therapeutic soft contact lenses. A survey. Hurwitz JJ, Dixon WS, Sloan A. PMID: 4544901 [PubMed - indexed for MEDLINE] 6585. Khirurgiia (Sofiia). 1974;27(6):544-5. [Simulation of acute cholecystitis by herpes zoster] [Article in Bulgarian] Lomkin AN, Danailov LN. PMID: 4465509 [PubMed - indexed for MEDLINE] 6586. Verh Dtsch Ges Inn Med. 1974;80:1693-6. [Experiences with cytosine-arabinoside in treatment of zoster] [Article in German] Bruntsch U, Reis HE, Schmidt CG. PMID: 4454516 [PubMed - indexed for MEDLINE] 6587. Folia Med Cracov. 1974;16(4):441-61. [Functional state of the facial nerve and organ of hearing and equilibrium following aural Herpes zoster] [Article in Polish] Kwiatkowska J. PMID: 4448427 [PubMed - indexed for MEDLINE] 6588. Med Chir Dig. 1974;3(3):179-80. [Herpetic esophagitis. Endoscopic diagnosis] [Article in French] Favier C, Barbotte P, Davouze R, Balmes JL, Bert JM. PMID: 4431263 [PubMed - indexed for MEDLINE] 6589. Neurol Neurochir Pol. 1974 Jan-Feb;8(1):127-30. [Polyneuropathy with leukemoid reaction in cerebrospinal fluid as a late complication of zoster] [Article in Polish] Stroińska-Kusiowa B, Ciszewska L. PMID: 4407721 [PubMed - indexed for MEDLINE] 6590. Trans Pac Coast Otoophthalmol Soc Annu Meet. 1974;55:129-36. The changing characteristics of herpes zoster keratouveitis. Thygeson P. PMID: 4377330 [PubMed - indexed for MEDLINE] 6591. Dev Biol Stand. 1974;27:31-6. Studies on the purification of normal immunoglobulin for intravenous use. Walsh JJ. PMID: 4376994 [PubMed - indexed for MEDLINE] 6592. Zh Nevropatol Psikhiatr Im S S Korsakova. 1974;74(11):1637-42. [Neuritis of the facial nerve] [Article in Russian] Khondkarian OA, Zavalishin IA. PMID: 4375372 [PubMed - indexed for MEDLINE] 6593. Adv Neurol. 1974;6:53-67. Viral infections of the developing nervous system. Johnson KP. PMID: 4374881 [PubMed - indexed for MEDLINE] 6594. Arch Gesamte Virusforsch. 1974;45(4):382-5. Varicella virus isolation from spinal ganglion. Shibuta H, Ishikawa T, Hondo R, Aoyama Y, Kurata K, Matumoto M. PMID: 4374161 [PubMed - indexed for MEDLINE] 6595. Rev Otoneuroophtalmol. 1974 Jan-Feb;46(1):53-64. [Neuro-ophthalmologic complications of ophthalmic zoster. Discussion of 126 observations] [Article in French] Flament J, Bronner A. PMID: 4373812 [PubMed - indexed for MEDLINE] 6596. Clin Neurosurg. 1974;21:278-310. Stimulation of the posterior columns of the spinal cord for pain control: indications, technique, and results. Sweet WH, Wepsic JG. PMID: 4371724 [PubMed - indexed for MEDLINE] 6597. Prog Med Virol. 1974;18(0):160-77. Persistent infections with herpesviruses. Jack I. PMID: 4371164 [PubMed - indexed for MEDLINE] 6598. Scand J Infect Dis. 1974;6(2):113-6. Rapid diagnosis and typind of herpesvirus hominis by the fluorescent antibody method. Vestergaard BF, Thybo H. PMID: 4369110 [PubMed - indexed for MEDLINE] 6599. Arch Neurol. 1974 Jan;30(1):109. Decreased cerebrospinal fluid glucose level in herpes zoster meningitis. Report of a case. Wolf SM. PMID: 4357129 [PubMed - indexed for MEDLINE] 6600. Arch Ophtalmol Rev Gen Ophtalmol. 1974 Jan;34(1):45-59. [Therapeutic and optical fitting of soft hydrophilic contact lenses. (Apropos of 53 cases] [Article in French] Lumbroso P, Fourny A. PMID: 4278931 [PubMed - indexed for MEDLINE] 6601. Scand J Immunol. 1974;3(1):51-60. Complex formation between monoclonal IgM and albumin. Harboe M, Folling I. PMID: 4208200 [PubMed - indexed for MEDLINE] 6602. Zentralbl Bakteriol Orig A. 1974;227(1-4):392-400. [Use of the IgM fraction from patients' sera in general virus serology for diagnostic purposes] [Article in German] Wolff MH, Marklein G, Schneweis KE, Stifter G. PMID: 4154618 [PubMed - indexed for MEDLINE] 6603. Scand J Urol Nephrol. 1974;8(2):96-9. Herpes zoster as a cause of urinary retention. Pettersson S, Scherstén T, Sundin T. PMID: 4134361 [PubMed - indexed for MEDLINE] 6604. Br Med J. 1973 Dec 22;4(5894):693-5. Treatment of acute herpes zoster with amantadine hydrochloride (Symmetrel). Galbraith AW. PMCID: PMC1587865 PMID: 4591000 [PubMed - indexed for MEDLINE] 6605. Pol Tyg Lek. 1973 Dec 10;28(50):1983-4. [Oxolin in treatment of zoster] [Article in Polish] Niedzielska H, Tkaczewski W. PMID: 4771020 [PubMed - indexed for MEDLINE] 6606. Dtsch Med Wochenschr. 1973 Dec 7;98(49):2373. [Letter: No corticosteroids in acute herpes zoster] [Article in German] Windischbauer G. PMID: 4543528 [PubMed - indexed for MEDLINE] 6607. Int J Clin Pharmacol. 1973 Dec;8(4):337-49. [Diagnosis and therapy of the secondary disease: dermatology] [Article in German] Tronnier H. PMID: 4787609 [PubMed - indexed for MEDLINE] 6608. Arch Dermatol. 1973 Dec;108(6):855-6. Letter: Post-herpes zoster neuralgia: response to vitamin E therapy. Ayres S Jr, Mihan R. PMID: 4764718 [PubMed - indexed for MEDLINE] 6609. Klin Monbl Augenheilkd. 1973 Dec;163(6):762-4. [Use of contact lenses in the treatment of chronic keratopathies (author's transl)] [Article in German] Hilsdorf C, Gussmann H. PMID: 4596606 [PubMed - indexed for MEDLINE] 6610. Klin Monbl Augenheilkd. 1973 Dec;163(6):661-71. [The artificial corneal epithelium (author's transl)] [Article in German] Turss R, Reim M. PMID: 4545186 [PubMed - indexed for MEDLINE] 6611. Laryngoscope. 1973 Dec;83(12):2029-34. Electronystagmographic comparison of acute idiopathic and herpes zoster facial paralysis. Adour KK, Doty HE. PMID: 4358988 [PubMed - indexed for MEDLINE] 6612. J Urol Nephrol (Paris). 1973 Dec;79(12 Pt 2):487-8. [Spontaneously cured pancytopenia due to intravesical thio-tepa, apropos of one case] [Article in French] Archimbaud JP, Calcat P, Martel JP. PMID: 4216648 [PubMed - indexed for MEDLINE] 6613. Lancet. 1973 Dec 1;2(7840):1276. Letter: Varicella may protect against zoster. Ikada J, Kagami K, Yamamoto Y. PMID: 4128615 [PubMed - indexed for MEDLINE] 6614. Dtsch Med Wochenschr. 1973 Nov 30;98(48):2293-8. [Treatment of herpes zoster with cytarabine (author's transl)] [Article in German] Reis HE, Bruntsch U, Schmidt CG. PMID: 4587114 [PubMed - indexed for MEDLINE] 6615. Ugeskr Laeger. 1973 Nov 26;135(48):2634. [Topical treatment of herpes zoster] [Article in Danish] Jensen JI. PMID: 4782910 [PubMed - indexed for MEDLINE] 6616. Br Med J. 1973 Nov 24;4(5890):475-8. Diseases of the skin. Treatment of skin infections and infestations. Ive FA. PMCID: PMC1587605 PMID: 4758454 [PubMed - indexed for MEDLINE] 6617. Med J Aust. 1973 Nov 24;2(21):956. Editorial: Herpes zoster ophthalmicus treated with cytarabine. [No authors listed] PMID: 4543929 [PubMed - indexed for MEDLINE] 6618. Minerva Med. 1973 Nov 17;64(82):4354-66. [Clinical studies of the therapeutic activity of an association of dicloxacillin and hetacillin] [Article in Italian] Giannelli F, Cattaneo E. PMID: 4765439 [PubMed - indexed for MEDLINE] 6619. Nouv Presse Med. 1973 Nov 17;2(41):2752. [Letter: Cytosine arabinoside and generalized zoster] [Article in French] Huis J, Van Vaerenbergh PM, Kindt R. PMID: 4589880 [PubMed - indexed for MEDLINE] 6620. Sem Hop. 1973 Nov 14;49(46):3073-8. [Skin manifestations of Hodgkin's disease. Apropos of a study of 94 patients with this disease] [Article in French] Amblard P, Schaerer R, Sotto JJ, Martel J, Bensa JC, Fillon JP. PMID: 4360043 [PubMed - indexed for MEDLINE] 6621. Z Allgemeinmed. 1973 Nov 10;49(31):1522-3. [A severe neck-shoulder-arm syndrome as a prodrome of segmental herpes zoster] [Article in German] Briese HH. PMID: 4131490 [PubMed - indexed for MEDLINE] 6622. Dtsch Med Wochenschr. 1973 Nov 2;98(44):2098. [Letter: Neuralgia following zoster] [Article in German] Ueberholz FK. PMID: 4758634 [PubMed - indexed for MEDLINE] 6623. Nervenarzt. 1973 Nov;44(11):604-5. [Is there a syndrome of the arteria sulcocommissuralis?] [Article in German] Suchenwirth R. PMID: 4773627 [PubMed - indexed for MEDLINE] 6624. Psychiatr Pol. 1973 Nov-Dec;7(6):649-53. [Cerebral complications in the course of herpes zoster. Description of a case] [Article in Polish] Jezyna C, Kość B. PMID: 4773053 [PubMed - indexed for MEDLINE] 6625. Urology. 1973 Nov;2(5):568-70. Bladder dysfunction with herpes zoster. Masih BK, Brosman SA. PMID: 4767178 [PubMed - indexed for MEDLINE] 6626. Eye Ear Nose Throat Mon. 1973 Nov;52(11):416-7. Intralesional triamcinolone therapy in herpes zoster and postzoster neuralgia. Epstein E. PMID: 4757429 [PubMed - indexed for MEDLINE] 6627. Ann Intern Med. 1973 Nov;79(5):747-8. Letter: Herpes zoster: transfer factor therapy. Drew WL, Blume MR, Miner R, Silverberg I, Rosenbaum EH. PMID: 4751749 [PubMed - indexed for MEDLINE] 6628. Arch Phys Med Rehabil. 1973 Nov;54(11):528-9. Herpes zoster-induced bladder paralysis. Pryor J. PMID: 4748322 [PubMed - indexed for MEDLINE] 6629. Br J Ophthalmol. 1973 Nov;57(11):849-51. Virus aetiology of certain cases of lacrimal obstruction. Bouzas AG. PMCID: PMC1215231 PMID: 4544774 [PubMed - indexed for MEDLINE] 6630. J Med Soc N J. 1973 Nov;70(11):836-8. Herpes zoster and multiple myeloma. Saidi P, Uhlman WE, Goldberg I. PMID: 4518508 [PubMed - indexed for MEDLINE] 6631. Arch Neurol. 1973 Nov;29(5):309-13. Herpes zoster myelitis. Evidence for viral invasion of spinal cord. Hogan EL, Krigman MR. PMID: 4355263 [PubMed - indexed for MEDLINE] 6632. N Engl J Med. 1973 Oct 25;289(17):912-3. Cytosine arabinoside versus virus or man? Karchmer AW, Hirsch MS. PMID: 4580785 [PubMed - indexed for MEDLINE] 6633. N Engl J Med. 1973 Oct 25;289(17):873-8. Adverse effect of cytosine arabinoside on disseminated zoster in a controlled trial. Stevens DA, Jordan GW, Waddell TF, Merigan TC. PMID: 4354007 [PubMed - indexed for MEDLINE] 6634. Arch Otolaryngol. 1973 Oct;98(4):258-64. Histopathology of deafness due to postnatal viral disease. Lindsay JR. PMID: 4778641 [PubMed - indexed for MEDLINE] 6635. J Neurol Sci. 1973 Oct;20(2):149-59. Herpes zoster oticus and facial paralysis (Ramsay Hunt syndrome). Clinico-pathologic study and review of literature. Aleksic SN, Budzilovich GN, Lieberman AN. PMID: 4750874 [PubMed - indexed for MEDLINE] 6636. Arch Ophthalmol. 1973 Oct;90(4):268-70. Dendritic lesions in herpes zoster ophthalmicus. Piebenga LW, Laibson PR. PMID: 4542874 [PubMed - indexed for MEDLINE] 6637. Arch Otolaryngol. 1973 Oct;98(4):218-27. Fetal consequences of maternal viral infections in pregnancy. Hardy JB. PMID: 4360342 [PubMed - indexed for MEDLINE] 6638. J Am Dent Assoc. 1973 Oct;87(5):1055-73. Virologic and immunologic aspects of major oral ulcerations. Lennette EH, Magoffin RL. PMID: 4359602 [PubMed - indexed for MEDLINE] 6639. J Invest Dermatol. 1973 Oct;61(4):212-22. Varicella-zoster virus. Luby JP. PMID: 4355281 [PubMed - indexed for MEDLINE] 6640. Med Klin. 1973 Sep 28;68(39):1261-5. [Generalized herpes zoster with Landry's ascending paralysis (author's transl)] [Article in German] Schley G, Anlauf M, Kratzsch E, Cremer W, Kuwert E. PMID: 4746853 [PubMed - indexed for MEDLINE] 6641. Neurol Psihiatr Neurochir. 1973 Sep-Oct;18(5):407-22. [On the role of the infectious factor in pathology of the temporal lobe] [Article in Romanian] Cincă I, Dimitriu R. PMID: 4790476 [PubMed - indexed for MEDLINE] 6642. Br J Dermatol. 1973 Sep;89(3):285-8. Herpes zoster of the anogenital area affecting urination and defaecation. Fugelso PD, Reed WB, Newman SB, Beamer JE. PMID: 4743431 [PubMed - indexed for MEDLINE] 6643. Arch Dermatol. 1973 Sep;108(3):427. Varicella, herpes zoster infections, and congenital defects. Rosenthal D, Morris N. PMID: 4729772 [PubMed - indexed for MEDLINE] 6644. Indian J Ophthalmol. 1973 Sep;21(3):131-3. Herpes zoster ophthalmicus followed by varicella in a young adult. Shukla IM, Tiwari SK, Billore OP. PMID: 4549850 [PubMed - indexed for MEDLINE] 6645. Kokubyo Gakkai Zasshi. 1973 Sep;40(3):264-8. [A case of topical application of Rifampicin with blocks of the infra-orbital nerve and the stellate ganglion in the treatment of herpes zoster (author's transl)] [Article in Japanese] Motegi K, Banba S, Shimizu M, Ueno T, Suzuki N. PMID: 4519999 [PubMed - indexed for MEDLINE] 6646. Tumori. 1973 Sep-Oct;59(5):343-50. Immunologic deficiency in Hodgkin's disease. Sokal JE. PMID: 4360756 [PubMed - indexed for MEDLINE] 6647. Appl Microbiol. 1973 Sep;26(3):410-6. Complement-fixing antigens produced by varicella-zoster virus in tissue culture. Martin ML, Palmer EL. The complement-fixing antigens present in tissue cultures infected with varicella-zoster virus were separated into four components. There were (i) a cell-free soluble antigen, (ii) a cell-associated soluble antigen, (iii) a cell membrane-associated antigen, and (iv) a virion antigen. All four antigens were reactive with sera from patients with varicella or zoster, and about 90% of the total complement-fixing activity was found to be nonvirion associated. PMCID: PMC379801 PMID: 4356464 [PubMed - indexed for MEDLINE] 6648. J Natl Cancer Inst. 1973 Sep;51(3):733-42. Clinical and laboratory investigations on man: systemic administration of potent interferon to man. Strander H, Cantell K, Carlström G, Jakobsson PA. PMID: 4355215 [PubMed - indexed for MEDLINE] 6649. Harefuah. 1973 Aug 15;85(4):176-7. [Herpes zoster with severe constipation and urinary retention] [Article in Hebrew] Ben-Assuly S, Bassan H. PMID: 4756190 [PubMed - indexed for MEDLINE] 6650. Br Med J. 1973 Aug 4;3(5874):275-9. Antiviral chemotherapy: the first decade. Bauer DJ. PMCID: PMC1586765 PMID: 4579293 [PubMed - indexed for MEDLINE] 6651. Vestn Dermatol Venerol. 1973 Aug;47(8):16-9. [Treatment of herpes zoster with emetine] [Article in Russian] Damtsov VI. PMID: 4767947 [PubMed - indexed for MEDLINE] 6652. Br J Dermatol. 1973 Aug;89(2):175-7. Herpes zoster complicating myocardial infarction. Benaim ME, Smith DR. PMID: 4726893 [PubMed - indexed for MEDLINE] 6653. Am J Dis Child. 1973 Aug;126(2):178-84. Herpes zoster in children with cancer. Feldman S, Hughes WT, Kim HY. PMID: 4353308 [PubMed - indexed for MEDLINE] 6654. Ann Intern Med. 1973 Aug;79(2):225-8. Herpes B virus encephalomyelitis presenting as ophthalmic zoster. A possible latent infection reactivated. Fierer J, Bazely P, Braude AI. PMID: 4125441 [PubMed - indexed for MEDLINE] 6655. Br Med J. 1973 Jul 21;3(5872):149. Infantile herpes zoster after intrauterine exposure to varicella. Lewkonia IK, Jackson AA. PMCID: PMC1586369 PMID: 4352725 [PubMed - indexed for MEDLINE] 6656. Lancet. 1973 Jul 14;2(7820):57-60. Treatment of intractable pain by acupuncture. Bowsher D, Mumford J, Lipton S, Miles J. PMID: 4123617 [PubMed - indexed for MEDLINE] 6657. Ugeskr Laeger. 1973 Jul 2;135(27):1428-30. [Use of the fluorescent antibody method in rapid diagnosis of Herpesvirus hominis (herpes simplex virus)] [Article in Danish] Vestergaard BF, Thybo H. PMID: 4357008 [PubMed - indexed for MEDLINE] 6658. Klin Med (Mosk). 1973 Jul;51(7):40-2. [Herpes zoster infection in patients with lymphoid proliferative diseases] [Article in Russian] Loginskiĭ VE. PMID: 4786260 [PubMed - indexed for MEDLINE] 6659. Zh Ushn Nos Gorl Bolezn. 1973 Jul-Aug;33(4):107-8. [Herpes zoster oticus] [Article in Russian] Mironenko IuT. PMID: 4771238 [PubMed - indexed for MEDLINE] 6660. Minerva Anestesiol. 1973 Jul-Aug;39(7):356-9. [Osmotic subarachnoidal neurolysis in the treatment of cervico-thoracic pain] [Article in Italian] Comelli FL, Manzin E, Manani G, Andrioli G, Salar G, Nori L. PMID: 4753515 [PubMed - indexed for MEDLINE] 6661. Hautarzt. 1973 Jul;24(7):298-301. [New possibilities of herpes simplex therapy in the dermatological practice] [Article in German] Weitgasser H. PMID: 4541990 [PubMed - indexed for MEDLINE] 6662. Int Surg. 1973 Jul;58(7):469-72. Therapeutic effect of flush fitting scleral lenses and hydrogel bandage lenses. Gould HL. PMID: 4541534 [PubMed - indexed for MEDLINE] 6663. Ann Otol Rhinol Laryngol. 1973 Jul-Aug;82(4):577-83. Viral disease of the labyrinth. I. Review of the literature and discussion of the role of cytomegalovirus in congenital deafness. Strauss M, Davis GL. PMID: 4366282 [PubMed - indexed for MEDLINE] 6664. JAMA. 1973 Jun 25;224(13):1748-9. Herpes zoster and neurogenic bladder dysfunction. Izumi AK, Edwards J Jr. PMID: 4740167 [PubMed - indexed for MEDLINE] 6665. Dtsch Med Wochenschr. 1973 Jun 22;98(25):1275-6. [Therapy of herpes zoster] [Article in German] Nasemann T. PMID: 4541370 [PubMed - indexed for MEDLINE] 6666. Nurs Mirror Midwives J. 1973 Jun 22;136(25):30-1. Post-herpetic neuralgia. Hardy TK. PMID: 4489271 [PubMed - indexed for MEDLINE] 6667. Proc R Soc Med. 1973 Jun;66(6):541-3. Treatment of pain: organization of a pain clinic: treatment of acute herpes zoster. Colding A. PMCID: PMC1645017 PMID: 4781808 [PubMed - indexed for MEDLINE] 6668. Practitioner. 1973 Jun;210(260):794-8. The management of neuralgias complicating herpes zoster. Gale DA. PMID: 4731061 [PubMed - indexed for MEDLINE] 6669. J Urol. 1973 Jun;109(6):938-40. Anuria secondary to mechanical obstruction caused by a Candida fungus ball. Turner RW, Grigsby TH, Enright JR, Chance HL, Frazier TC, Womack CT, Lang EK. PMID: 4575809 [PubMed - indexed for MEDLINE] 6670. Invest Ophthalmol. 1973 Jun;12(6):391-7. National Eye Institute: summary report of the cornea task force. Morris JM. PMID: 4574984 [PubMed - indexed for MEDLINE] 6671. Indian J Ophthalmol. 1973 Jun;21(2):92-3. Herpes zoster ophthalmicus and varicella (a case report). Malik SR, Bansal RK. PMID: 4545230 [PubMed - indexed for MEDLINE] 6672. Clin Exp Immunol. 1973 Jun;14(2):181-5. Cell-mediated immunity to Varicella-Zoster antigen in acute Herpes zoster (shingles). Russell AS, Maini RA, Bailey M, Dumonde DC. PMCID: PMC1553793 PMID: 4352254 [PubMed - indexed for MEDLINE] 6673. Arch Pathol. 1973 Jun;95(6):411-5. Spinal ganglion in herpes zoster. A light and electron microscopic study. Ghatak NR, Zimmerman HM. PMID: 4349633 [PubMed - indexed for MEDLINE] 6674. Minerva Med. 1973 May 29;64(39):2077-9. [Use of distamycin A in the therapy of various viral cutaneous diseases due to VZ] [Article in Italian] Bassetti D. PMID: 4352475 [PubMed - indexed for MEDLINE] 6675. Nouv Presse Med. 1973 May 12;2(19):1306. [Therapeutic action of emetine in zona] [Article in French] Bolgert M. PMID: 4712675 [PubMed - indexed for MEDLINE] 6676. Natl Cancer Inst Monogr. 1973 May;36:465-8. Herpes zoster: recent studies. Stevens DA, Merigan TC. PMID: 4744604 [PubMed - indexed for MEDLINE] 6677. Natl Cancer Inst Monogr. 1973 May;36:463-4. Herpes zoster infections in lymphoma patients. Goffinet DR, Glastein E, Kaplan HS. PMID: 4744603 [PubMed - indexed for MEDLINE] 6678. Rheumatol Rehabil. 1973 May;12(2):74-6. Paralysis and arthropathy in herpes zoster. Quin CE. PMID: 4741421 [PubMed - indexed for MEDLINE] 6679. Postgrad Med. 1973 May;53(6):207-10. Neuralgia. Loeser JD. PMID: 4701613 [PubMed - indexed for MEDLINE] 6680. Br J Ophthalmol. 1973 May;57(5):344-6. Retinal arteritis complicating herpes zoster ophthalmicus. Brown RM, Mendis U. PMCID: PMC1214898 PMID: 4541366 [PubMed - indexed for MEDLINE] 6681. Ann Clin Lab Sci. 1973 May-Jun;3(3):224-33. Unusual pulmonary infections in immunodeficiency. Valdés-Dapena MA. PMID: 4540864 [PubMed - indexed for MEDLINE] 6682. Odontol Foren Tidskr. 1973 May;37(2):95-100. [Different degrees of pain in the area of teeth and jaws] [Article in Swedish] Ahlberg T. PMID: 4516861 [PubMed - indexed for MEDLINE] 6683. Clin Pediatr (Phila). 1973 May;12(5):299-301. The prevention and treatment of varicella-zoster infection in patients at high risk. Movassaghi N. PMID: 4349544 [PubMed - indexed for MEDLINE] 6684. Am J Ophthalmol. 1973 May;75(5):795-8. Fluorescent antibody study of herpes zoster keratitis. Hayashi K, Uchida Y, Oshima M. PMID: 4122380 [PubMed - indexed for MEDLINE] 6685. JAMA. 1973 Apr 2;224(1):122-3. Failure of cytarabine in varicella-zoster infections. Davis CM, VanDersarl JV, Coltman CA Jr. PMID: 4347648 [PubMed - indexed for MEDLINE] 6686. Am Rev Respir Dis. 1973 Apr;107(4):661-4. In vitro and in vivo cellular immunity in anergic miliary tuberculosis. Waxman J, Lockshin M. PMID: 4697674 [PubMed - indexed for MEDLINE] 6687. J Clin Pathol. 1973 Apr;26(4):268-72. Indirect cutaneous immunofluorescence. II. Clinical significance. Burnham TK. Sera of 532 patients with bullous diseases, connective tissue diseases and malignancies were tested for pemphigus epidermal intercellular fluorescence (ICF) and for the bullous pemphigoid ;tubular' band by the indirect fluorescent antibody technique. Human normal skin cryostat sections were used. The band and ICF were seen primarily only in bullous pemphigoid and pemphigus respectively, Some indirect band and ICF-negative patients demonstrated positive direct results in involved skin. suggesting that direct tests should be performed in indirect negative patients clinically thought to have pemphigus or bullous pemphigoid. No close correlation was found between disease activity and positive or negative indirect tests in bullous pemphigoid and pemphigus. Steroids did not interfere with positive results of this diagnostically extremely valuable test. PMCID: PMC477703 PMID: 4573789 [PubMed - indexed for MEDLINE] 6688. J Infect Dis. 1973 Apr;127(4):415-23. Passive immunization against varicella-zoster infections and other modes of therapy. Brunell PA, Gershon AA. PMID: 4571702 [PubMed - indexed for MEDLINE] 6689. Bull Soc Ophtalmol Fr. 1973 Apr;73(4):613-5. [Oculomotor paralysis with late recognition of its etiology. Apropos of 2 cases] [Article in French] Catros MA. PMID: 4546637 [PubMed - indexed for MEDLINE] 6690. Radiology. 1973 Apr;107(1):109-10. Cranial arteritis associated with herpes zoster. Case report with angiographic findings. Walker RJ 3rd, el-Gammal T, Allen MB Jr. PMID: 4540172 [PubMed - indexed for MEDLINE] 6691. Br Med J. 1973 Mar 31;1(5856):799-800. Herpes simplex and zoster. [No authors listed] PMCID: PMC1588939 PMID: 4348480 [PubMed - indexed for MEDLINE] 6692. Br Med J. 1973 Mar 24;1(5855):737-8. Herpes simplex and zoster. [No authors listed] PMCID: PMC1588825 PMID: 4694698 [PubMed - indexed for MEDLINE] 6693. Br Med J. 1973 Mar 17;1(5854):679. Postherpetic neuralgia. Pearce J. PMCID: PMC1588593 PMID: 4692724 [PubMed - indexed for MEDLINE] 6694. Med Klin. 1973 Mar 16;68(11):351-5. [Differential diagnosis and therapy of headache] [Article in German] Funk F. PMID: 4691983 [PubMed - indexed for MEDLINE] 6695. Minerva Med. 1973 Mar 3;64(11):517-24. [Detection of complement fixing antibodies against Herpes simplex virus (and other neurotropic viruses) in patients with multiple sclerosis] [Article in Italian] Ortona L, Pizzigallo E, Gelfo P. PMID: 4350584 [PubMed - indexed for MEDLINE] 6696. Lancet. 1973 Mar 3;1(7801):481. The windmills of shingles. Macrae AD. PMID: 4120386 [PubMed - indexed for MEDLINE] 6697. Rev Otoneuroophtalmol. 1973 Mar-Apr;45(2):153-6. [A case of probable bilateral otitic zona] [Article in French] Delobel R, Charbonnel A, Fève JR, Hervochon JP. PMID: 4792628 [PubMed - indexed for MEDLINE] 6698. Vestn Dermatol Venerol. 1973 Mar;47(3):73-4. [2 cases of herpes zoster in children with infectious hepatitis] [Article in Russian] Vanat SV, Vanat IM. PMID: 4730106 [PubMed - indexed for MEDLINE] 6699. Vestn Dermatol Venerol. 1973 Mar;47(3):68-73. [Clinical aspects and therapy of the neurological lesions in herpes zoster] [Article in Russian] Kalamkarian AA, Kochetkov VD. PMID: 4730105 [PubMed - indexed for MEDLINE] 6700. Ann Otolaryngol Chir Cervicofac. 1973 Mar;90(3):214-9. [Cervico-cephalic zona with multiple localizations, complicated by facial paralysis, successfully treated by surgery] [Article in French] Lallemant Y, Gehanno P, Happich JL. PMID: 4717373 [PubMed - indexed for MEDLINE] 6701. Union Med Can. 1973 Mar;102(3):624-8. [The pain clinic at the Centre Hospitalier de l'Université Laval] [Article in French] Paradis B. PMID: 4713501 [PubMed - indexed for MEDLINE] 6702. Monatsschr Kinderheilkd. 1973 Mar;121(3):101-4. [Herpes zoster in childhood] [Article in German] Panteliadis CP. PMID: 4696920 [PubMed - indexed for MEDLINE] 6703. Vestn Dermatol Venerol. 1973 Mar;47(3):8-13. [Use of interferons and interferonogens in dermatology (a review)] [Article in Russian] Shcherbakov IM. PMID: 4581062 [PubMed - indexed for MEDLINE] 6704. Med Sestra. 1973 Mar;32(3):8-10. [Herpes zoster] [Article in Russian] Bol'shakova GM. PMID: 4540817 [PubMed - indexed for MEDLINE] 6705. Br Med J. 1973 Feb 17;1(5850):406-10. Herpes simplex and zoster. Juel-Jensen BE. PMCID: PMC1588333 PMID: 4347938 [PubMed - indexed for MEDLINE] 6706. Lancet. 1973 Feb 17;1(7799):369. "Catching" shingles? Slack PM, Taylor-Robinson D. PMID: 4121953 [PubMed - indexed for MEDLINE] 6707. Lancet. 1973 Feb 3;1(7797):267-8. Dermal transmission of virus as a cause of shingles. Smith JH. PMID: 4119415 [PubMed - indexed for MEDLINE] 6708. N Engl J Med. 1973 Feb 1;288(5):266-7. Ramsay Hunt with contralateral Bell's. Kelly A. PMID: 4682226 [PubMed - indexed for MEDLINE] 6709. Wiad Lek. 1973 Feb 1;26(3):259-61. [Rare case of damage of the ophthalmic and oculomotor nerves during zoster] [Article in Polish] Lebensztejn W, Jackiewicz H. PMID: 4347619 [PubMed - indexed for MEDLINE] 6710. Med J Aust. 1973 Jan 6;1(1):22-6. Clinical uses of human blood fractions. Schiff P. PMID: 4686436 [PubMed - indexed for MEDLINE] 6711. Lancet. 1973 Jan 6;1(7793):38. Cytosine arabinoside in herpes zoster. Fortuny IE, Weiss R, Theologides A, Kennedy BJ. PMID: 4118554 [PubMed - indexed for MEDLINE] 6712. Munch Med Wochenschr. 1973 Jan 5;115(1):10-2. [Diagnosis of smallpox] [Article in German] Ehrengut W. PMID: 4346543 [PubMed - indexed for MEDLINE] 6713. Trans Am Ophthalmol Soc. 1973;71:246-53. The changing character of infectious corneal disease: emerging opportunistic microbial forms (1928-1973). Thygeson P, Spencer WH. PMCID: PMC1310495 PMID: 10949603 [PubMed - indexed for MEDLINE] 6714. Scand J Infect Dis. 1973;5(4):277-8. Herpes simplex-herpes zoster immunity. Kouvalainen K, Ruuskanen O, Eskola J, Hopsu-Havu VK. PMID: 4780364 [PubMed - indexed for MEDLINE] 6715. Zh Nevropatol Psikhiatr Im S S Korsakova. 1973;73(2):172-4. [Experience with the treatment of acute viral meningitis with nucleases] [Article in Russian] Panov AG, Lobzin VS, Sichko ZhV. PMID: 4743264 [PubMed - indexed for MEDLINE] 6716. Adv Otorhinolaryngol. 1973;20:144-54. Otological manifestations of viral disease. Paparella MM. PMID: 4710506 [PubMed - indexed for MEDLINE] 6717. Otorinolaringologie. 1973 Jan-Feb;18(1):53-5. [Total otic zona with involvement of other cranial nerves] [Article in Romanian] Tânţăreanu C, Jurca N. PMID: 4691995 [PubMed - indexed for MEDLINE] 6718. HNO. 1973 Jan;21(1):19-20. [Taste disorders at the soft palate in facial paralysis] [Article in German] Rollin H. PMID: 4687662 [PubMed - indexed for MEDLINE] 6719. Ann Intern Med. 1973 Jan;78(1):149-50. Infections after splenectomy. Cormia FE Jr, Campos LT. PMID: 4682302 [PubMed - indexed for MEDLINE] 6720. Trans Ophthalmol Soc U K. 1973;93(0):181-92. Herpes zoster keratitis. Marsh RJ. PMID: 4546383 [PubMed - indexed for MEDLINE] 6721. Vestn Oftalmol. 1973;3:58-62. [Classification of herpetic eye disease] [Article in Russian] Kasparov AA. PMID: 4543276 [PubMed - indexed for MEDLINE] 6722. Zh Nevropatol Psikhiatr Im S S Korsakova. 1973;73(3):352-5. [Movement disorders in herpes zoster] [Article in Russian] Krison ED. PMID: 4542636 [PubMed - indexed for MEDLINE] 6723. Klin Padiatr. 1973 Jan;185(1):57-63. [Herpez zoster in childhood--demonstration of complicated forms] [Article in German] Kellerer H, Kerl H. PMID: 4540237 [PubMed - indexed for MEDLINE] 6724. Arch Ophthalmol. 1973 Jan;89(1):21-4. Herpes zoster ophthalmicus treated with cytarabine. Pierce LE, Jenkins RB. PMID: 4539773 [PubMed - indexed for MEDLINE] 6725. Diastema. 1973;4(1):9-12 passim. Herpes zoster--a review of the literature and a case-history of trigeminal nerve involvement. Adami AA. PMID: 4525622 [PubMed - indexed for MEDLINE] 6726. Annee Ther Clin Ophtalmol. 1973;24:105-25. [Ophthalmic herpes zoster: current data] [Article in French] Bronner A, Flament J. PMID: 4374896 [PubMed - indexed for MEDLINE] 6727. Int Ophthalmol Clin. 1973 Winter;13(4):103-23. Corticosteroid therapy in corneal disease. I. Hyndiuk RA, Chin GN. PMID: 4361430 [PubMed - indexed for MEDLINE] 6728. Adv Otorhinolaryngol. 1973;20:155-77. Cochlear pathology in viral disease. Friedmann I. PMID: 4351033 [PubMed - indexed for MEDLINE] 6729. J Hyg Epidemiol Microbiol Immunol. 1973;17(1):26-36. Indirect haemagglutination reaction with varicella-zoster virus antigen. Trlifajová J, Pokorný J, Ryba M, Strízová V. PMID: 4350836 [PubMed - indexed for MEDLINE] 6730. Arch Ophthalmol. 1973 Jan;89(1):25-9. Herpes zoster dendritic keratitis. Pavan-Langston D, McCulley JP. PMID: 4346381 [PubMed - indexed for MEDLINE] 6731. Zentralbl Allg Pathol. 1973;117(2):127-31. [Vascular lesions of the liver and of the spleen in Zoster generalisatus (author's transl)] [Article in German] Timmel H. PMID: 4147771 [PubMed - indexed for MEDLINE] 6732. Acta Derm Venereol. 1973;53(5):359-62. Synthetic lysine vasopressin in herpetic neuralgia. Forssman O, Leczinsky CG, Mulder J. PMID: 4127469 [PubMed - indexed for MEDLINE] 6733. Padiatr Padol. 1973;8(4):412-9. [Zoster Pneumonia in Children (author's transl)] [Article in German] Kellerer K. PMID: 4126833 [PubMed - indexed for MEDLINE] 6734. Br Med J. 1972 Dec 2;4(5839):522-3. Specific IgM antibody in serum of patients with herpes zoster infections. Ross CA, McDaid R. PMCID: PMC1788756 PMID: 4566017 [PubMed - indexed for MEDLINE] 6735. Pediatrics. 1972 Dec;50(6):930-1. Report of severe herpes zoster in a 13 and one-half-year-old boy whose chickenpox infection may have been acquired in utero. Lyday JH. PMID: 4673901 [PubMed - indexed for MEDLINE] 6736. Vrach Delo. 1972 Dec;12:128-9. [Chickenpox associated with herpes zoster in an adult] [Article in Russian] Vasilenko RA, Svirid GM, Bitiuk AB. PMID: 4659201 [PubMed - indexed for MEDLINE] 6737. Br J Clin Pract. 1972 Dec;26(12):553-4. Audiological findings in patients with Bell's palsy. Korczyn AD. PMID: 4649364 [PubMed - indexed for MEDLINE] 6738. Klin Monbl Augenheilkd. 1972 Dec;161(6):635-40. [Suture problems in keratoplasty in cases of cicatrical and dystrophic corneas] [Article in German] Mackensen G, Witschel H. PMID: 4570631 [PubMed - indexed for MEDLINE] 6739. Surg Clin North Am. 1972 Dec;52(6):1501-12. Infection and renal transplantation. Turcotte JG. PMID: 4564431 [PubMed - indexed for MEDLINE] 6740. Ann Ocul (Paris). 1972 Dec;205(12):1339-44. [Solitary chorioretinal site and M paraproteinemia] [Article in French] Bianchi G, Stucchi CA. PMID: 4541115 [PubMed - indexed for MEDLINE] 6741. Clin Obstet Gynecol. 1972 Dec;15(4):1010-4. Herpes zoster of the vulva. Brown D. PMID: 4346315 [PubMed - indexed for MEDLINE] 6742. Arch Ophthalmol. 1972 Dec;88(6):697. Anaphylactic shock and corticotropin. Shapiro RD. PMID: 4343606 [PubMed - indexed for MEDLINE] 6743. Munch Med Wochenschr. 1972 Nov 17;114(46):2029-34. [The neck, shoulder and arm pain syndrome. Diagnosis and surgical therapy] [Article in German] Kollmannsberger A, Leheta F, Mackert B. PMID: 4678703 [PubMed - indexed for MEDLINE] 6744. Pediatrics. 1972 Nov;50(5):718-22. Prevention of varicella in high risk children: a collaborative study. Brunell PA, Gershon AA, Hughes WT, Riley HD Jr, Smith J. PMID: 5084186 [PubMed - indexed for MEDLINE] 6745. Bull Soc Ophtalmol Fr. 1972 Nov;72(11):1073-6. [Diagnostic problems in herpes simplex and zona] [Article in French] Martenet AC. PMID: 4542919 [PubMed - indexed for MEDLINE] 6746. Mich Med. 1972 Nov;71(32):929-35. Motor neuropathy associated with herpes zoster. Levine MC. PMID: 4343425 [PubMed - indexed for MEDLINE] 6747. Pediatr Pol. 1972 Oct;47(10):1287-8. [Case of abducent nerve palsy in the course of lumbar herpes zoster in a 3-year-old boy] [Article in Polish] Split W, Zawadzki Z. PMID: 5085414 [PubMed - indexed for MEDLINE] 6748. Z Haut Geschlechtskr. 1972 Oct 1;47(19):33-4 passim. [Simultanous occurrence of herpes simplex and herpes zoster] [Article in German] Angyal J. PMID: 4636984 [PubMed - indexed for MEDLINE] 6749. J Neurosurg. 1972 Oct;37(4):412-7. Stereotaxic trigeminal tractotomy for post-herpetic facial pain. Hitchock ER, Schvarcz JR. PMID: 4560952 [PubMed - indexed for MEDLINE] 6750. Rev Otoneuroophtalmol. 1972 Oct-Dec;44(5):431-2. [Cephalic zona] [Article in French] Bronner A, Gerhard JP, Flament J. PMID: 4542219 [PubMed - indexed for MEDLINE] 6751. Rev Circ Argent Odontol. 1972 Oct;35(3):22-5. [Treatment of viral lesions--herpes simplex, herpes zoster and herpangina--with the antiviral agent isoprinosine] [Article in Spanish] Muracciole JC, Vilarino JA, Muracciole MA. PMID: 4512766 [PubMed - indexed for MEDLINE] 6752. J Laryngol Otol. 1972 Oct;86(10):1031-55. Herpes zoster of the head and neck. Payten RJ, Dawes JD. PMID: 4342869 [PubMed - indexed for MEDLINE] 6753. J Med Lyon. 1972 Sep 5;53(232):1105-7. [Terebrant and recurring herpes and zona in the course of hemopathies (treated with immunosuppressive agents)] [Article in French] Laugier P, Orusco M. PMID: 4344441 [PubMed - indexed for MEDLINE] 6754. Tohoku J Exp Med. 1972 Sep;108(1):55-62. Virologic studies of generalized herpes zoster. Ikeda S, Kimura A, Shiono H, Kogasaka R, Nakao T. PMID: 4346171 [PubMed - indexed for MEDLINE] 6755. Med Clin North Am. 1972 Sep;56(5):1175-92. Herpes genitalis. Young AW Jr. PMID: 4340869 [PubMed - indexed for MEDLINE] 6756. Med Klin. 1972 Aug 25;67(34):1094. [Therapy of herpes zoster] [Article in German] Vivell O. PMID: 5071457 [PubMed - indexed for MEDLINE] 6757. Sygeplejersken. 1972 Aug 24;72(33):8-10. [Treatment of shingles (herpes zoster) with sympathetic blocking] [Article in Danish] Colding A. PMID: 4488937 [PubMed - indexed for MEDLINE] 6758. Z Allgemeinmed. 1972 Aug 20;48(23):1050-3. [Herpes zoster and its therapy using honey-procaine] [Article in German] Fink G. PMID: 5075044 [PubMed - indexed for MEDLINE] 6759. N Y State J Med. 1972 Aug 15;72(16):2094-6. Guillain-Barré syndrome in herpes zoster. Singh S, Malhotra V, Malhotra RP. PMID: 4505338 [PubMed - indexed for MEDLINE] 6760. Practitioner. 1972 Aug;209(250):204. Corticosteroids and herpes. Gold S. PMID: 5078233 [PubMed - indexed for MEDLINE] 6761. Z Laryngol Rhinol Otol. 1972 Aug;51(8):494-8. [Exogenous factors in acute hearing disorders] [Article in German] Stange G. PMID: 5076575 [PubMed - indexed for MEDLINE] 6762. Arch Dermatol. 1972 Aug;106(2):204-7. Herpes zoster in children. Rogers RS 3rd, Tindall JP. PMID: 5048220 [PubMed - indexed for MEDLINE] 6763. South Med J. 1972 Aug;65(8):995-7. Cytosine arabinoside therapy for Herpes Zoster in a patient with systemic lupus erythematosus. Vandersarl JV, Davis CM, Fenton RM, Panettiere F. PMID: 5044434 [PubMed - indexed for MEDLINE] 6764. Klin Monbl Augenheilkd. 1972 Aug;161(2):206-9. [Zoster ophthalmicus leading to loss of the eye] [Article in German] Hübner H. PMID: 4539180 [PubMed - indexed for MEDLINE] 6765. N Z Med J. 1972 Aug;76(483):112-3. Muscle paralysis and herpes zoster. [No authors listed] PMID: 4508810 [PubMed - indexed for MEDLINE] 6766. J Infect Dis. 1972 Aug;126(2):193-5. Rapid diagnosis of varicella-zoster infections by agar-gel diffusion. Uduman SA, Gershon AA, Brunell PA. PMID: 4340928 [PubMed - indexed for MEDLINE] 6767. Z Haut Geschlechtskr. 1972 Aug 1;47(15):Suppl:17-9. [Gangrenous herpes zoster imitating penicilline lesions] [Article in German] Angyal J, Mesko E. PMID: 4264078 [PubMed - indexed for MEDLINE] 6768. Nurs Mirror Midwives J. 1972 Jul 28;135(4):25-7. Facial pain. Foster JB. PMID: 4484255 [PubMed - indexed for MEDLINE] 6769. Br Med J. 1972 Jul 15;3(5819):130-1. Zoster and Hodgkin's disease. [No authors listed] PMCID: PMC1788622 PMID: 5039773 [PubMed - indexed for MEDLINE] 6770. Pol Tyg Lek. 1972 Jul 3;27(27):1051-3. [Generalized zoster in the course of chronic myelocytic leukemia] [Article in Polish] Kościński R, Durkalec J. PMID: 4506284 [PubMed - indexed for MEDLINE] 6771. Rev Asoc Odontol Argent. 1972 Jul;60(7):335-7. [Herpes zoster of the 2d trigeminal branch with prodromal toothache] [Article in Spanish] Banquer E, Laterza A. PMID: 4504628 [PubMed - indexed for MEDLINE] 6772. J Am Dent Assoc. 1972 Jul;85(1):139-41. Postherpetic (trigeminal) neuralgia: report of case. Weisengreen HH. PMID: 4503585 [PubMed - indexed for MEDLINE] 6773. Pediatr Pol. 1972 Jul;47(7):833-41. [Infectivity period of varicella and zoster in the light of virological examinations] [Article in Polish] Czubkowska I. PMID: 4341032 [PubMed - indexed for MEDLINE] 6774. Arch Dermatol. 1972 Jul;106(1):130. Use of cytarabine for herpesvirus infections. Gordon HH. PMID: 4339022 [PubMed - indexed for MEDLINE] 6775. Am J Ophthalmol. 1972 Jul;74(1):142-4. Herpes zoster ophthalmicus with nasociliary nerve involvement. Schwartz DE. PMID: 4338611 [PubMed - indexed for MEDLINE] 6776. Munch Med Wochenschr. 1972 Jun 30;114(26):1234-6. [Ciclacillin in the dermatologic practice] [Article in German] Weitgasser H. PMID: 5068222 [PubMed - indexed for MEDLINE] 6777. Ann Otol Rhinol Laryngol. 1972 Jun;81(3):331-8. Temporal bone pathology in herpes oticus. Zajtchuk JT, Matz GJ, Lindsay JR. PMID: 5030759 [PubMed - indexed for MEDLINE] 6778. J Neurosurg. 1972 Jun;36(6):751-5. Evaluation of rhizotomy. Review of 12 years' experience. Onofrio BM, Campa HK. PMID: 5030403 [PubMed - indexed for MEDLINE] 6779. Am J Clin Pathol. 1972 Jun;57(6):737-50. Laboratory diagnosis of viral infections: general principles. Lennette EH. PMID: 4554720 [PubMed - indexed for MEDLINE] 6780. Infect Immun. 1972 Jun;5(6):835-9. Indirect hemagglutination test for varicella-zoster infection. Furukawa T, Plotkin SA. An indirect hemagglutination test has been adapted for use with varicella-zoster serology. Antigen was made in infected WI-38 human diploid cell line. The indirect hemagglutination antigen seemed to be a subunit of the virus particle. The antibodies measured in the test are well correlated with neutralizing and complement-fixing antibodies in cases of zoster but not in cases of varicella. PMCID: PMC422449 PMID: 4344091 [PubMed - indexed for MEDLINE] 6781. Nippon Ganka Gakkai Zasshi. 1972 Jun;76(6):344-51. [Study of herpes simplex skin test in herpetic keratitis. I] [Article in Japanese] Kameyama K. PMID: 4340972 [PubMed - indexed for MEDLINE] 6782. Wien Klin Wochenschr. 1972 May 26;84(21):337-40. [Differential diagnosis of smallpox] [Article in German] Söltz-Szöts J, Fanta D. PMID: 4114305 [PubMed - indexed for MEDLINE] 6783. Practitioner. 1972 May;208(247):687-8. Treatment of herpes zoster with short-wave diathermy to the spinal cord. Allberry J, Manning FR, Smith EE. PMID: 5070968 [PubMed - indexed for MEDLINE] 6784. J Clin Invest. 1972 May;51(5):1170-8. Interferon, antibody, and other host factors in herpes zoster. Stevens DA, Merigan TC. The influence of several factors on the course of herpes zoster was studied in 151 patients. Dissemination of zoster was associated with the presence of a concurrent disease, especially Hodgkin's disease, and/or the use of immunosuppressive therapy. Several host-immune parameters, including quantitative immunoglobulins, circulating lymphocyte counts, delayed hypersensitivity to multiple skin test antigens, and lymphocyte transformation to phytohemagglutinin did not correlate with dissemination of disease. Development of virus-specific complement-fixing antibody (CFA) was delayed in some patients with disseminated disease. Vesicle interferon (V-IF) titers were low early in the disease in patients with localized and disseminated zoster and then rose, usually abruptly, to a peak value and declined as pustulation and crusting occurred. However, titers in patients with localized disease rose at an earlier time. This could be seen in terms of time to development of intermediate values of V-IF or by the day on which the sharpest rise occurred. In 15 carefully studied patients with disseminated disease, the development of the maximum V-IF response was followed within 48 hr by cessation of dissemination. Half of the patients in this group had no CFA detectable until after dissemination had ceased. These findings suggest at least two host factors whose interaction might determine host response to zoster; local interferon production (possibly mediated by sensitized lymphocytes) and humoral antibody, acting to prevent or shorten dissemination of an initially local disease. PMCID: PMC292247 PMID: 5020430 [PubMed - indexed for MEDLINE] 6785. Neurology. 1972 May;22(5):459-66. Segmental zoster paresis--a disease profile. Thomas JE, Howard FM Jr. PMID: 4673442 [PubMed - indexed for MEDLINE] 6786. Klin Monbl Augenheilkd. 1972 May;160(5):540-50. [The influence of various factors of donor material on the success of corneal transplantation] [Article in German] Meyer HJ, Arnecke H. PMID: 4561732 [PubMed - indexed for MEDLINE] 6787. Rev Otoneuroophtalmol. 1972 May-Jun;44(3):267-9. [Ophthalmic zoster and vascular pseudo-papillitis] [Article in French] Rossazza C, Jezegabel C, Moser M, Larmande AM. PMID: 4541053 [PubMed - indexed for MEDLINE] 6788. Practitioner. 1972 May;208(247):607-13. Herpes zoster. Church R. PMID: 4538457 [PubMed - indexed for MEDLINE] 6789. Dent Dig. 1972 May;78(5):242-6. Herpes zoster of the maxillary nerve: report of a case. Hatziotis JC. PMID: 4503358 [PubMed - indexed for MEDLINE] 6790. Ther Umsch. 1972 May;29(5):320-5. [Maternal infections and pregnancy] [Article in French] Meylan J. PMID: 4339081 [PubMed - indexed for MEDLINE] 6791. J Natl Med Assoc. 1972 May;64(3):217-21. Hodgkin's disease, failing immunity and varicella-zoster. Camiel MR, Benninghoff DL. PMCID: PMC2608913 PMID: 4338490 [PubMed - indexed for MEDLINE] 6792. Appl Microbiol. 1972 May;23(5):1001-9. Immunoperoxidase localization of herpes zoster virus and simian virus 40 in cell culture. Shabo AL, Petricciani JC, Kirschstein RL. The immunoperoxidase technique was used in an electron microscopy study to localize the virions of herpes zoster virus and simian virus 40 in cell cultures. Intranuclear and intracytoplasmic virions of herpes zoster virus were easily and specifically identified due to intense staining by the finely granular, black reaction product. With simian virus 40, intranuclear virions were not stained, whereas intracytoplasmic particles appeared densely black. There was essentially no background staining. Advantages of this technique over the ferritin-labeled antibody method include simpler preparative procedures for reagents, greater penetrability of the antibody conjugate, and internal amplification which substantially improves the ability to localize sites of antigen-antibody reaction. We believe that the immunoperoxidase method can be successfully applied to a wide variety of problems involving viral antigens. PMCID: PMC380490 PMID: 4113252 [PubMed - indexed for MEDLINE] 6793. Nippon Ganka Gakkai Zasshi. 1972 Apr 15;76 Suppl:5. [Herpes corneae--methods of diagnosis] [Article in Japanese] Uchida Y. PMID: 4555174 [PubMed - indexed for MEDLINE] 6794. Nippon Ganka Gakkai Zasshi. 1972 Apr 15;76 Suppl:7. [Herpes corneae--a virological study] [Article in Japanese] Kobayashi S. PMID: 4537377 [PubMed - indexed for MEDLINE] 6795. Nippon Ganka Gakkai Zasshi. 1972 Apr 15;76 Suppl:6. [Herpes cornea--a morphological study] [Article in Japanese] Kitano S. PMID: 4537376 [PubMed - indexed for MEDLINE] 6796. J Neurol Neurosurg Psychiatry. 1972 Apr;35(2):170-5. Polyneuritis and herpes zoster. Dayan AD, Ogul E, Graveson GS. PMCID: PMC494031 PMID: 5037030 [PubMed - indexed for MEDLINE] 6797. Arch Otolaryngol. 1972 Apr;95(4):383-90. Electrogustometry in facial palsy. Tomita H, Okuda Y, Tomiyama H, Kida A. PMID: 5018262 [PubMed - indexed for MEDLINE] 6798. Arch Otolaryngol. 1972 Apr;95(4):376-82. Electrodiagnosis in facial palsy. Yanagihara N, Kishimoto M. PMID: 5018261 [PubMed - indexed for MEDLINE] 6799. Saishin Igaku. 1972 Apr;27(4):685-91. [Cryosurgery in ophthalmology] [Article in Japanese] Takeuchi M. PMID: 4554712 [PubMed - indexed for MEDLINE] 6800. Neurology. 1972 Apr;22(4):348-54. Granulomatous angiitis of the nervous system in cases of herpes zoster and lymphosarcoma. Rosenblum WI, Hadfield MG. PMID: 4552715 [PubMed - indexed for MEDLINE] 6801. Bull Soc Ophtalmol Fr. 1972 Apr;12(4):437-9. [Symptomatic ophthalmic zona associated with intracranial aneurysm] [Article in French] Hamard H, Fougères R, Saïd G, Bonsch M, Brégeat P. PMID: 4540645 [PubMed - indexed for MEDLINE] 6802. Dermatol Monatsschr. 1972 Apr;158(4):278-81. [Herpes zoster encephalitis (case report)] [Article in German] Profirov D. PMID: 4537398 [PubMed - indexed for MEDLINE] 6803. Bord Med. 1972 Apr;5(7):771-6. [Herpesvirus infection in Hodgkin's disease] [Article in French] Hoerni B, Simon G, Chauvergne J. PMID: 4341310 [PubMed - indexed for MEDLINE] 6804. Dtsch Zahnarztl Z. 1972 Apr;27(4):273-82. [Acute inflammation of the marginal periodontium. Cytological characteristics of the acute gingivitis] [Article in German] Lange DE. PMID: 4339270 [PubMed - indexed for MEDLINE] 6805. Lab Invest. 1972 Apr;26(4):391-402. Electron microscopy of zosteriform herpes simplex infection in the mouse. Dillard SH, Cheatham WJ, Moses HL. PMID: 4336537 [PubMed - indexed for MEDLINE] 6806. Arch Otolaryngol. 1972 Apr;95(4):364-8. Varicella-Zoster virus in idiopathic facial palsy. Tomita H, Hayakawa W. PMID: 4336152 [PubMed - indexed for MEDLINE] 6807. Dtsch Gesundheitsw. 1972 Mar 30;27(13):583-6. [Geriatric problems in herpes zoster] [Article in German] Harnack K, Brüschke G, Schulz FH. PMID: 5040768 [PubMed - indexed for MEDLINE] 6808. Pol Tyg Lek. 1972 Mar 20;27(12):463-4. [Treatment of herpes zoster with ionoflux] [Article in Polish] Aleksandrowicz J. PMID: 5020086 [PubMed - indexed for MEDLINE] 6809. Med J Malaya. 1972 Mar;26(3):201-4. Herpes zoster with severe neurological complication. A report of two cases. Ghee LT. PMID: 5031016 [PubMed - indexed for MEDLINE] 6810. Prensa Med Mex. 1972 Mar-Apr;37(3):159-60. [Treatment of U herpes zoster and herpes simplex with isoprinosine] [Article in Spanish] Stenberg TH, Macotela Ruiíz E. PMID: 4559678 [PubMed - indexed for MEDLINE] 6811. Med Clin North Am. 1972 Mar;56(2):353-70. Viral infection and immunity. Dent PB, Larke RP. PMID: 4553194 [PubMed - indexed for MEDLINE] 6812. Hautarzt. 1972 Mar;23(3):140-2. [Experience with furosemide in the therapy of ophthalmic herpes zoster] [Article in German] Felten G. PMID: 4537261 [PubMed - indexed for MEDLINE] 6813. J Mich State Dent Assoc. 1972 Mar;54(3):102-5. Case report: odontalgia resulting from prodromal herpes zoster. Heiman JL. PMID: 4501023 [PubMed - indexed for MEDLINE] 6814. Acta Cytol. 1972 Mar-Apr;16(2):178-85. Cytology of ocular lesions. Naib ZM. PMID: 4335757 [PubMed - indexed for MEDLINE] 6815. Trans Am Acad Ophthalmol Otolaryngol. 1972 Mar-Apr;76(2):297-300. XXVII Wherry Memorial Lecture. Steroid therapy in otolaryngology. Baker DC Jr. PMID: 4147548 [PubMed - indexed for MEDLINE] 6816. Dtsch Med Wochenschr. 1972 Feb 25;97(8):307. [Pleural effusion in herpes zoster] [Article in German] Ackermann R. PMID: 5058431 [PubMed - indexed for MEDLINE] 6817. Cancer. 1972 Feb;29(2):461-5. Herpes zoster in Hodgkin's disease. Clinical, histologic, and immunologic correlations. Wilson JF, Marsa GW, Johnson RE. PMID: 5013547 [PubMed - indexed for MEDLINE] 6818. Ann Intern Med. 1972 Feb;76(2):241-54. Varicella-Zoster infection in patients with cancer. Schimpff S, Serpick A, Stoler B, Rumack B, Mellin H, Joseph JM, Block J. PMID: 4333228 [PubMed - indexed for MEDLINE] 6819. Ann Intern Med. 1972 Feb;76(2):235-40. Herpes Zoster-Varicella infections and lymphoma. Goffinet DR, Glatstein EJ, Merigan TC. PMID: 4333227 [PubMed - indexed for MEDLINE] 6820. Ned Tijdschr Geneeskd. 1972 Jan 29;116(5):200. [Cytosine arabinoside in the treatment of severe herpes zoster and varicella] [Article in Dutch] Goudsmit R. PMID: 5028760 [PubMed - indexed for MEDLINE] 6821. Med J Aust. 1972 Jan 29;1(5):227-30. "Atypical" Ramsay Hunt syndrome. Steffen R, Selby G. PMID: 4337072 [PubMed - indexed for MEDLINE] 6822. Lancet. 1972 Jan 29;1(7744):263. Causation of shingles. Thomas M, Robertson WJ. PMID: 4109722 [PubMed - indexed for MEDLINE] 6823. Lancet. 1972 Jan 15;1(7742):151. Exogenous or endogenous causation of shingles. Taylor-Robinson D, Slack PM. PMID: 4109010 [PubMed - indexed for MEDLINE] 6824. Pediatrics. 1972 Jan;49(1):102-9. Facial paralysis in children. Manning JJ, Adour KK. PMID: 5062083 [PubMed - indexed for MEDLINE] 6825. Rev Port Estomatol Cir Maxilofac. 1972 Jan-Jun;12(1):37-65. [Dermatological diseases with oral localization] [Article in Portuguese] da Silva N. PMID: 5028377 [PubMed - indexed for MEDLINE] 6826. Cesk Neurol Neurochir. 1972;35(6):318-23. [Spinal ganglionectomy in intercostal postherpetic neuralgia] [Article in Czech] Zvĕrina E, Fuchsová M. PMID: 4681789 [PubMed - indexed for MEDLINE] 6827. Cesk Neurol. 1972;35(6):318-23. [Spinal ganglionectomy during intercostal postherpetic neuralgia] [Article in Czech] Zvĕrina E, Fuchsová M. PMID: 4669256 [PubMed - indexed for MEDLINE] 6828. Annee Ther Clin Ophtalmol. 1972;23:229-34. [Deep herpetic keratitis] [Article in French] François P. PMID: 4615622 [PubMed - indexed for MEDLINE] 6829. Ann Ocul (Paris). 1972 Jan;205(1):69-71. [Procedure to follow in metaherpetic keratitis] [Article in French] Hervouet F. PMID: 4556603 [PubMed - indexed for MEDLINE] 6830. Can J Ophthalmol. 1972 Jan;7(1):13-8. The practical management of ocular infections. II. Viral infections. DeVoe AG. PMID: 4550705 [PubMed - indexed for MEDLINE] 6831. Bull Mem Soc Fr Ophtalmol. 1972;85(0):378-84. [Immunologic examination in cases of ophthalmic zona] [Article in French] Trux E, Veres J. PMID: 4546621 [PubMed - indexed for MEDLINE] 6832. Dermatologica. 1972;145(2):146-53. [Clinical case reports] [Article in French] Laugier P, Brun R, Orusco M, Hunziker N, Reiffers J, Vidmar B, Bauquis R, Posternak F. PMID: 4542006 [PubMed - indexed for MEDLINE] 6833. Am J Ophthalmol. 1972 Jan;73(1):62-7. Cellular immunity in chronic ophthalmic disorders. 2. Leukocyte migration inhibition in diseases of the cornea. Shore B, Leopold IH, Henley WL. PMID: 4536637 [PubMed - indexed for MEDLINE] 6834. Am J Ophthalmol. 1972 Jan;73(1):56-61. Cellular immunity in chronic ophthalmic disorders. I. Lymphocyte stimulation and protein synthesis. Henley WL, Okas S, Waithe W, Hirschhorn K, Leopold IH. PMID: 4536636 [PubMed - indexed for MEDLINE] 6835. Acta Neurol Scand Suppl. 1972;51:397-400. Relapsing herpes zoster myelitis. Nyberg-Hansen R. PMID: 4514360 [PubMed - indexed for MEDLINE] 6836. J Clin Pathol Suppl (R Coll Pathol). 1972;6:46-50. Varicella-zoster and related viruses. McCarthy K. PMCID: PMC1347250 PMID: 4376154 [PubMed - indexed for MEDLINE] 6837. J Clin Pathol Suppl (R Coll Pathol). 1972;6:152-3. Systems of virus survival. Fraser KB. PMCID: PMC1347265 PMID: 4376150 [PubMed - indexed for MEDLINE] 6838. J Clin Pathol Suppl (R Coll Pathol). 1972;6:121-31. Immune responses in persistent virus infections. Allison AC. PMCID: PMC1347261 PMID: 4376149 [PubMed - indexed for MEDLINE] 6839. Scand J Infect Dis. 1972;4(2):91-6. Infantile herpes zoster. Kouvalainen K, Salmi A, Salmi TT. PMID: 4341818 [PubMed - indexed for MEDLINE] 6840. Scand J Infect Dis. 1972;4(2):83-9. Varicella and herpes zoster: differences in antibody response revealed by the platelet aggregation technique. Palosuo T. PMID: 4341817 [PubMed - indexed for MEDLINE] 6841. Scand J Infect Dis. 1972;4(1):23-5. Herpes zoster in childhood. McKendrick GD, Raychoudhury SC. PMID: 4336586 [PubMed - indexed for MEDLINE] 6842. Br J Dermatol. 1972 Jan;86(1):40-8. Experimental zosteriform herpes simplex virus infection in mouse skin. Robinson TW, Dover JR. PMID: 4334153 [PubMed - indexed for MEDLINE] 6843. J Neurol Sci. 1972;15(1):35-48. Herpes Zoster. Demonstration of virus in trigeminal nerve and ganglion by immunofluorescence and electron microscopy. Esiri MM, Tomlinson AH. PMID: 4332851 [PubMed - indexed for MEDLINE] 6844. J Clin Pathol Suppl (R Coll Pathol). 1972;6:1-7. Host-virus relationship with special reference to Newcastle disease and serum hepatitis. Waterson AP. PMCID: PMC1347243 PMID: 4218239 [PubMed - indexed for MEDLINE] 6845. Arch Dermatol Forsch. 1972;244:409-11. [Therapy of herpes simplex and herpes zoster] [Article in German] Nasemann T. PMID: 4119338 [PubMed - indexed for MEDLINE] 6846. J Infect Dis. 1972 Jan;125(1):82-4. Prevention and control of varicella-zoster infections. Judelsohn RG. PMID: 4109437 [PubMed - indexed for MEDLINE] 6847. Lancet. 1971 Dec 18;2(7738):1349-50. Dermal transmission of virus as a cause of shingles. Thomas M, Robertson WJ. PMID: 4108266 [PubMed - indexed for MEDLINE] 6848. Schweiz Rundsch Med Prax. 1971 Dec 7;60(49):1649-53. [Clinical forms and abnormal localizations of herpes simplex] [Article in French] Reiffers J, Hunziker N, Porto e Souza L, Laugier MP. PMID: 5140047 [PubMed - indexed for MEDLINE] 6849. Schweiz Rundsch Med Prax. 1971 Dec 7;60(49):1636-8. [Generalized herpes zoster] [Article in French] Vidmar B, Porto e Souza L, Harms M. PMID: 5140044 [PubMed - indexed for MEDLINE] 6850. Can Med Assoc J. 1971 Dec 4;105(11):1125-6. Immunosuppressive therapy in the rheumatic diseases. [No authors listed] PMCID: PMC1931368 PMID: 4948506 [PubMed - indexed for MEDLINE] 6851. Med J Aust. 1971 Dec 4;2(23):1179-80. Multiple cranial nerve involvement with herpes zoster. Parker WJ. PMID: 4332487 [PubMed - indexed for MEDLINE] 6852. G Ital Dermatol Minerva Dermatol. 1971 Dec;46(12):542-3. [Therapeutic activity of rifomycin in herpes zoster] [Article in Italian] Finzi AF, Solaroli C, Sagramoso Sacchetti Z. PMID: 5172215 [PubMed - indexed for MEDLINE] 6853. Rev Rhum Mal Osteoartic. 1971 Dec;38(12):797-806. [Complications and sequelae of immunosuppressive therapy of rheumatoid arthritis] [Article in French] Deshayes P, Rénier JC, Bregeon C, Houdent G. PMID: 5170383 [PubMed - indexed for MEDLINE] 6854. Therapeutique. 1971 Dec;47(10):915-7. [Zosterian facial paralysis] [Article in French] Thureau E. PMID: 5145562 [PubMed - indexed for MEDLINE] 6855. Kinderarztl Prax. 1971 Dec;39(12):561-5. [Varicella and corticosteroids] [Article in German] Heyne K. PMID: 5140552 [PubMed - indexed for MEDLINE] 6856. Arch Dis Child. 1971 Dec;46(250):886. Herpes zoster serum in chicken-pox contacts with depressed immunological responses. Caunt AE, Hall EG, Mainwaring D. PMCID: PMC1647929 PMID: 5129214 [PubMed - indexed for MEDLINE] 6857. Postgrad Med. 1971 Dec;50(6):153-7. Herpes Zoster in the elderly. Rogers RS 3rd, Tindall JP. PMID: 5128036 [PubMed - indexed for MEDLINE] 6858. Br Med J. 1971 Nov 20;4(5785):491-2. Aetiology of Bell's palsy. Korczyn AD. PMCID: PMC1799628 PMID: 5125299 [PubMed - indexed for MEDLINE] 6859. Br Med J. 1971 Nov 20;4(5785):442-3. Neurology of the leukaemias and lymphomas. [No authors listed] PMCID: PMC1799656 PMID: 5125274 [PubMed - indexed for MEDLINE] 6860. Br J Ophthalmol. 1971 Nov;55(11):761-5. Herpes zoster ophthalmicus with trochlear nerve involvement after alcohol injection into the Gasserian ganglion. Boucherat RJ. PMCID: PMC1208548 PMID: 5316102 [PubMed - indexed for MEDLINE] 6861. Am J Ophthalmol. 1971 Nov;72(5):998-1011. Pathogenesis of occlusion of the central retinal vessels. Hayreh SS. PMID: 5315812 [PubMed - indexed for MEDLINE] 6862. Trans Am Acad Ophthalmol Otolaryngol. 1971 Nov-Dec;75(6):1284-301. Facial paralysis in 403 consecutive patients: emphasis on treatment response in patients with Bell's palsy. Adour KK, Swanson PJ Jr. PMID: 5153092 [PubMed - indexed for MEDLINE] 6863. Arch Dermatol. 1971 Nov;104(5):562. Systemic lupus erythematosus, miliary tuberculosis, and bilateral herpes zoster occurring in a Chinese woman. Lewis RJ, Mitchell JC. PMID: 5120186 [PubMed - indexed for MEDLINE] 6864. Oral Surg Oral Med Oral Pathol. 1971 Nov;32(5):752-9. Viral infections of the skin and mouth: a selected review. Muller SA. PMID: 4329250 [PubMed - indexed for MEDLINE] 6865. Med J Aust. 1971 Oct 16;2(16):796-8. Cytotoxic therapy in rheumatoid disease. Thorpe P, Hassal J, York J. PMID: 4940712 [PubMed - indexed for MEDLINE] 6866. Z Haut Geschlechtskr. 1971 Oct 15;46(20):755-60. [New methods in the treatment of viral skin diseases] [Article in German] Söltz-Szöts J. PMID: 4329920 [PubMed - indexed for MEDLINE] 6867. Munch Med Wochenschr. 1971 Oct 8;113(41):1338-45. [Atypical poliovirus infections] [Article in German] Pohle HD, Muşeţeanu C, Grützner L. PMID: 4331306 [PubMed - indexed for MEDLINE] 6868. Br Med J. 1971 Oct 2;4(5778):2-3. Aetiology of Bell's palsy. [No authors listed] PMCID: PMC1799187 PMID: 4328920 [PubMed - indexed for MEDLINE] 6869. Nippon Ganka Kiyo. 1971 Oct;22(10):922-5. [Non-framin used diseases of the ophthalmological field] [Article in Japanese] Matsuda K, Azumi K, Nakamura Y. PMID: 5316939 [PubMed - indexed for MEDLINE] 6870. Jibiinkoka. 1971 Oct;43(10):779-87. [Hunt's syndrome--etiology and treatment] [Article in Japanese] Minowada H. PMID: 5169973 [PubMed - indexed for MEDLINE] 6871. Jibiinkoka. 1971 Oct;43(10):737-45. [Disorders of the facial nerve and localization of the lesion] [Article in Japanese] Kumagami H, Watanabe I. PMID: 5169968 [PubMed - indexed for MEDLINE] 6872. Indian J Dermatol. 1971 Oct;17(1):9-12. Post herpetic neuralgia and facial palsy treated with prednisolone. Sehgal VN, Rege VL, Vadiraj SN, Borker PS. PMID: 5142130 [PubMed - indexed for MEDLINE] 6873. Z Haut Geschlechtskr. 1971 Oct;46(19):538-44. [Cutaneous paraneoplastic syndromes] [Article in German] Herzberg JJ. PMID: 5137238 [PubMed - indexed for MEDLINE] 6874. Cesk Dermatol. 1971 Oct;46(5):192-5. [Drop infusion as a method for local drug administration] [Article in Czech] Holan V. PMID: 5121701 [PubMed - indexed for MEDLINE] 6875. Int J Dermatol. 1971 Oct-Dec;10(4):227-32. Neurocutaneous herpes simplex. Selmanowitz VJ. PMID: 4331379 [PubMed - indexed for MEDLINE] 6876. Lancet. 1971 Sep 25;2(7726):712. Cytosine arabinoside and herpes zoster. Foerster J, Hryniuk W. PMID: 4105748 [PubMed - indexed for MEDLINE] 6877. Nat New Biol. 1971 Sep 22;233(38):115. Inhibition of leucocyte migration by corneal antigen in chronic viral keratitis. Henley WL, Shore B, Leopold IH. PMID: 5315327 [PubMed - indexed for MEDLINE] 6878. N Engl J Med. 1971 Sep 9;285(11):637. 5-HIAA and HVA in spinal fluid and herpes zoster oticus. Johansson B, Roos BE. PMID: 5563972 [PubMed - indexed for MEDLINE] 6879. Am J Ophthalmol. 1971 Sep;72(3):555-7. Occurrence of herpes zoster ophthalmicus in a child with absent immunoglobulin A and deficiency of delayed hypersensitivity. Kielar RA, Cunningham GC, Gerson KL. PMID: 5315092 [PubMed - indexed for MEDLINE] 6880. Med Ann Dist Columbia. 1971 Sep;40(9):573-6. Disseminated herpes zoster: treatment with cytosine arabinoside. Neilan BA, Schechter GP. PMID: 5286391 [PubMed - indexed for MEDLINE] 6881. Masui. 1971 Sep;20(10):903-5. [Nerve block therapy in the treatment of herpes zoster] [Article in Japanese] Tamesa T, Wakasugi B, Yuda Y, Takahashi A, Hanaki C. PMID: 5166778 [PubMed - indexed for MEDLINE] 6882. Med Times. 1971 Sep;99(9):29 passim. What's your diagnosis? Owen LG. PMID: 5110376 [PubMed - indexed for MEDLINE] 6883. Policlinico Prat. 1971 Sep 1;78(17):724-31. [Skin manifestations of visceral neoplasms] [Article in Italian] Stocchi F. PMID: 5098509 [PubMed - indexed for MEDLINE] 6884. Saishin Igaku. 1971 Sep;26(29):1716-20. [Pulmonary findings in viral infections] [Article in Japanese] Kaji M. PMID: 4330707 [PubMed - indexed for MEDLINE] 6885. Rev Med Liege. 1971 Sep;26(17):589-91. [Latent viral infections] [Article in French] Regnister M. PMID: 4329411 [PubMed - indexed for MEDLINE] 6886. Cesk Dermatol. 1971 Sep;46(4):161-5. [Gamma globulin in the treatment of some dermatoses] [Article in Czech] Rozsívalová V, Dlabalová H. PMID: 4107521 [PubMed - indexed for MEDLINE] 6887. Lancet. 1971 Aug 14;2(7720):374-5. Cytosine arabinoside and herpes zoster. Juel-Jensen BE. PMID: 4105070 [PubMed - indexed for MEDLINE] 6888. Hautarzt. 1971 Aug;22(8):333-5. [Immunoglobin changes in herpes zoster] [Article in German] Reichel W, Bosse K. PMID: 5566687 [PubMed - indexed for MEDLINE] 6889. Br J Prev Soc Med. 1971 Aug;25(3):147-51. Expected and observed values for the prescription of vitamin B 12 in England and Wales. Cochrane AL, Moore F. PMCID: PMC478645 PMID: 5564956 [PubMed - indexed for MEDLINE] 6890. Calif Med. 1971 Aug;115(2):6-10. Triamcinolone-procaine in the treatment of zoster and postzoster neuralgia. Epstein E. Twenty-four patients with herpes zoster were treated with injections of 2 percent procaine hydrochloride containing 2 mg of triamcinolone per ml. The treatments were given subcutaneously under the cutaneous lesions and in areas of pain. The results were excellent in 22 patients. There was one failure-postzoster neuralgia in an 82-year-old woman. Of 12 patients with postherpetic neuralgia, eight had improvement of 70 to 90 percent and three had complete relief. There were no significant complications in either group. PMCID: PMC1518011 PMID: 5563819 [PubMed - indexed for MEDLINE] 6891. Physiotherapy. 1971 Aug;57(8):374. The use of ice-cube massage for the relief of chronic pain following herpes ophthalmicus. Marshall CM. PMID: 5314989 [PubMed - indexed for MEDLINE] 6892. Oral Surg Oral Med Oral Pathol. 1971 Aug;32(2):221-34. Herpes zoster of the oral and facial structures. Report of five cases and discussion. Nally FF, Ross IH. PMID: 5284107 [PubMed - indexed for MEDLINE] 6893. N Engl J Med. 1971 Jul 29;285(5):294. Zoster-like disease in infants and young children. Mok CH. PMID: 4326260 [PubMed - indexed for MEDLINE] 6894. Lancet. 1971 Jul 17;2(7716):166. Cytosine arabinoside and herpes zoster. Mann JR. PMID: 4104494 [PubMed - indexed for MEDLINE] 6895. Vnitr Lek. 1971 Jul;17(7):652-9. [Relation of herpes zoster to chronic inflammatory rheumatic diseases and to collagenoses] [Article in Czech] Vachtenheim J. PMID: 5564643 [PubMed - indexed for MEDLINE] 6896. Neurochirurgia (Stuttg). 1971 Jul;14(4):127-33. [Results and complications of surgery for trigeminal neuralgia] [Article in German] Grunert V, Pendl G, Sunder-Plassmann M. PMID: 5562108 [PubMed - indexed for MEDLINE] 6897. Tandlaegebladet. 1971 Jul;75(7):567-75. [A case of zoster otticus and zoster mandibularis] [Article in Danish] Bessermann-Nielsen M. PMID: 5286316 [PubMed - indexed for MEDLINE] 6898. J Am Osteopath Assoc. 1971 Jul;70(11):1196-8. Herpes simplex: diagnosis and management. Ulbrich AP. PMID: 5207190 [PubMed - indexed for MEDLINE] 6899. Klin Med (Mosk). 1971 Jul;49(7):130-1. [Lichen circumscriptus in myocardial infarct] [Article in Russian] Misevichus IR, Stanaĭtite NI. PMID: 5151419 [PubMed - indexed for MEDLINE] 6900. G Mal Infett Parassit. 1971 Jul;23(7):618-49. [Herpes zoster] [Article in Italian] Bartolozzi G, Bernini G. PMID: 5140781 [PubMed - indexed for MEDLINE] 6901. Cancer. 1971 Jul;28(1):170-4. Systemic syndromes associated with neoplastic disease including cancer of the colon. Bartholomew LG, Schutt AJ. PMID: 5110627 [PubMed - indexed for MEDLINE] 6902. Am J Ophthalmol. 1971 Jul;72(1):205-98. The corneal graft: a multiple variable analysis of the penetrating keratoplasty. Moore TE Jr, Aronson SB. PMID: 4945363 [PubMed - indexed for MEDLINE] 6903. Acta Virol. 1971 Jul;15(4):293-300. Antigenic relationship between varicella-herpes zoster and herpes simplex viruses studied by the gel precipitation reaction. Trlifajová J, Sourek J, Ryba M. PMID: 4398080 [PubMed - indexed for MEDLINE] 6904. G Mal Infett Parassit. 1971 Jul;23(7):689-729. [Eye diseases due to herpesvirus. (Herpesvirus hominis, varicella-zoster virus)] [Article in Italian] Frezzotti R, Guerra R. PMID: 4334709 [PubMed - indexed for MEDLINE] 6905. Vestn Oftalmol. 1971 Jul-Aug;4:73-5. [Therapeutic effect of interferonogen in herpetic keratitis] [Article in Russian] Tkacheva EI, Gvozdilova DA, Smorodintsev AA. PMID: 4111285 [PubMed - indexed for MEDLINE] 6906. J Am Geriatr Soc. 1971 Jun;19(6):495-504. Geriatric herpes zoster. Rogers RS 3rd, Tindall JP. PMID: 5094651 [PubMed - indexed for MEDLINE] 6907. Am J Dig Dis. 1971 Jun;16(6):535-9. Herpes zoster and chronic active hepatitis. Rosenfield AT, Schermer DR, Gospe JM, Hartley RA. PMID: 5089543 [PubMed - indexed for MEDLINE] 6908. Invest Ophthalmol. 1971 Jun;10(6):408-14. Florenal in treatment of herpesvirus and adenovirus eye diseases. Maichuk YF. PMID: 4325306 [PubMed - indexed for MEDLINE] 6909. Dtsch Med Wochenschr. 1971 May 21;96(21):924-5. [Zoster-neuralgia] [Article in German] Hirschmann J. PMID: 5580387 [PubMed - indexed for MEDLINE] 6910. Arch Dermatol. 1971 May;103(5):513-4. Local recurrence of generalized herpes zoster following x-irradiation. Guss SB, Sober AJ, Rosenberg GL, Arndt KA. PMID: 5580294 [PubMed - indexed for MEDLINE] 6911. Mo Med. 1971 May;68(5):314-6. Oral histoplasmosis followed by herpes zoster. Case report. Dawson RB, Boyle P, Joseph DJ. PMID: 5578301 [PubMed - indexed for MEDLINE] 6912. Arch Oftalmol B Aires. 1971 May-Jun;46(5):21-4. [Ocular lesions in ophthalmic herpes. Physiopathological aspects] [Article in Spanish] Victoria V, Couto J, Cattani N. PMID: 5316076 [PubMed - indexed for MEDLINE] 6913. Mt Sinai J Med. 1971 May-Jun;38(3):303-10. Roentgen and pathological changes in the gastrointestinal tract in herpes zoster generalizata: a unique case and brief review. Khilnani MT, Keller RJ. PMID: 5314215 [PubMed - indexed for MEDLINE] 6914. Hautarzt. 1971 May;22(5):204-6. [Clinical aspects and nosogeny of concomitant facial paresis in ophthalmic zoster] [Article in German] Bandmann HJ, Lukacs I. PMID: 5314142 [PubMed - indexed for MEDLINE] 6915. Laryngoscope. 1971 May;81(5):620-35. Indications for surgical decompression of the facial nerve. Alford BR, Sessions RB, Weber SC. PMID: 5157367 [PubMed - indexed for MEDLINE] 6916. Therapeutique. 1971 May;47(5):509-12. [Physiopathology and treatment of flashing pains] [Article in French] Cambier J, Dehen H. PMID: 4327347 [PubMed - indexed for MEDLINE] 6917. Lancet. 1971 May 1;1(7705):913. Zoster and chickenpox. Hesling G. PMID: 4102057 [PubMed - indexed for MEDLINE] 6918. S Afr Med J. 1971 Apr 10;45(15):406-7. Some ophthalmological aspects of headache. MacGregor JM. PMID: 5579348 [PubMed - indexed for MEDLINE] 6919. S Afr Med J. 1971 Apr 10;45(15):397-9. Some diseases involving the eye and the skin. Gordon W. PMID: 4996205 [PubMed - indexed for MEDLINE] 6920. N Engl J Med. 1971 Apr 8;284(14):765-73. Recurrent viral infection (reinfection). Chang TW. PMID: 4323312 [PubMed - indexed for MEDLINE] 6921. Lancet. 1971 Apr 3;1(7701):690. Understanding zoster. [No authors listed] PMID: 4101624 [PubMed - indexed for MEDLINE] 6922. Bord Med. 1971 Apr;4(4):1021-30. [Diagnostic problems in infectious complications of Hodgkin's disease] [Article in French] Hoerni B, Aubertin J, Simon G, Chauvergne J. PMID: 5562239 [PubMed - indexed for MEDLINE] 6923. Klin Monbl Augenheilkd. 1971 Apr;158(4):517-26. [Susceptibility of corneal herpes to treatment] [Article in German] Marquardt R, Roth HW. PMID: 5314194 [PubMed - indexed for MEDLINE] 6924. Oral Surg Oral Med Oral Pathol. 1971 Apr;31(4):494-501. Clinicopathologic observations in prodromal herpes zoster of the fifth cranial nerve. Report of a case. Hudson CD, Vickers RA. PMID: 5279023 [PubMed - indexed for MEDLINE] 6925. Ann Ophthalmol. 1971 Apr;3(4):355-7 passim. Herpetic keratouveitis. Clinical experiences. Sugar HS. PMID: 4950519 [PubMed - indexed for MEDLINE] 6926. Wis Med J. 1971 Apr;70(4):116-20. Therapy of viral, mycoplasmal and rickettsial infections. Rytel MW, Coonrod JD. PMID: 4101370 [PubMed - indexed for MEDLINE] 6927. Med Interna (Bucur). 1971 Mar;23(3):341-56. [Lymphadenopathies with "atypical" lymphomonocytosis] [Article in Romanian] Ciobanu V, Zălaru MC, Suteanu S, Popescu M, Pambuccian G, Barbu A, Bistreanu I. PMID: 5574931 [PubMed - indexed for MEDLINE] 6928. Stomatologia (Bucur). 1971 Mar-Apr;18(2):113-8. [Herpes zoster and its oral manifestations] [Article in Romanian] Popa E, Marcu N, Gergel L, Urtilă E. PMID: 5280542 [PubMed - indexed for MEDLINE] 6929. Acta Virol. 1971 Mar;15(2):171-3. Varicella-zoster virus cultivation in cell cultures of non-primate origin. Sefcovicová L. PMID: 4396416 [PubMed - indexed for MEDLINE] 6930. J Invest Dermatol. 1971 Mar;56(3):193-9. Experimental zoster-like herpes simplex in hairless mice. Constantine VS, Francis RD, Mason BH. PMID: 4326622 [PubMed - indexed for MEDLINE] 6931. Cesk Oftalmol. 1971 Mar;27(2):122-5. [Ocular herpes zoster. A review] [Article in Czech] Veselý L. PMID: 4324845 [PubMed - indexed for MEDLINE] 6932. Proc R Soc Med. 1971 Feb;64(2):119-24. A Regional Radiotherapy Centre: its development, scope and limitations. Rhys-Lewis RD. PMCID: PMC1812489 PMID: 5548920 [PubMed - indexed for MEDLINE] 6933. Internist (Berl). 1971 Feb;12(2):66-7. [Differential diagnosis of the "heart attack", with special emphasis on the stenocardial syndrome] [Article in German] Budelmann G. PMID: 4926814 [PubMed - indexed for MEDLINE] 6934. Arch Ophtalmol Rev Gen Ophtalmol. 1971 Feb;31(2):109-18. [Ophthalmic zona: isolation of a viral strain from the aqueous humor] [Article in French] Denis-Lassalle J, Clay C, Gherardi-Bakalova M, Offret G. PMID: 4324326 [PubMed - indexed for MEDLINE] 6935. N Engl J Med. 1971 Jan 7;284(1):24-6. Zoster-like disease in the newborn due to herpes-simplex virus. Music SI, Fine EM, Togo Y. PMID: 4321028 [PubMed - indexed for MEDLINE] 6936. Sov Med. 1971 Jan;34(1):151-2. [Treatment of herpes simplex and herpes zoster by chlorophyll preparations] [Article in Russian] Belen'kiĭ GB, Krikun BL. PMID: 5580231 [PubMed - indexed for MEDLINE] 6937. Rev Neurol (Paris). 1971 Jan;124(1):76-9. [Radiodermatitis after treatment of neurologic diseases] [Article in French] Dufourmentel C, Mouly R. PMID: 5563583 [PubMed - indexed for MEDLINE] 6938. Vestn Oftalmol. 1971;2:52-4. [Use of leukocytic interferon in combination with herpetic polyvaccine in herpetic keratitis] [Article in Russian] Abadzhian GA, Maevskaia TM. PMID: 5314361 [PubMed - indexed for MEDLINE] 6939. Vestn Oftalmol. 1971;2:48-51. [Comparative evaluation of the therapeutic effectiveness of interferon preparations in herpetic keratitis] [Article in Russian] Abadzhian GA, Balezina TI, Korabel'nikova NI, Fadeeva LL. PMID: 5314360 [PubMed - indexed for MEDLINE] 6940. Nippon Koku Geka Gakkai Zasshi. 1971;17(6):505-8. [Clinical study on oral mucosal disease (VII). Case report of herpes zoster in the area of the third division of trigeminal nerve] [Article in Japanese] Matsuda N, Kato J, Okubo S. PMID: 5292856 [PubMed - indexed for MEDLINE] 6941. Arch Ital Sci Med Trop Parassitol. 1971 Jan-Jun;52(1):51-8. [Clinical case of hyperthyroidism complicating the course of herpes zoster] [Article in Italian] De Carlo M, Ricciuti M. PMID: 5172546 [PubMed - indexed for MEDLINE] 6942. Trans Pa Acad Ophthalmol Otolaryngol. 1971 Fall;24(2):116-20. Symposium: the pediatric concern of ophthalmology and otolaryngology. Pediatrics. Smith DS. PMID: 5134065 [PubMed - indexed for MEDLINE] 6943. Annee Ther Clin Ophtalmol. 1971;22:177-85. [Superficial herpetic keratitis] [Article in French] François P. PMID: 4950318 [PubMed - indexed for MEDLINE] 6944. Verh Dtsch Ges Inn Med. 1971;77:850-6. [Recent aspects of antiviral therapy] [Article in German] Wacker A. PMID: 4949706 [PubMed - indexed for MEDLINE] 6945. Brain. 1971;94(2):307-20. Neurological syndromes in the reticuloses. Currie S, Henson RA. PMID: 4936866 [PubMed - indexed for MEDLINE] 6946. Scand J Infect Dis. 1971;3(3):183-7. Studies on the specificity of the complement fixation test in cytomegalovirus infections. With special reference to possible cross-reactions with other herpesvirus antigens. Andersen HK, Godtfredsen A, Spencer ES. PMID: 4331836 [PubMed - indexed for MEDLINE] 6947. Arch Gesamte Virusforsch. 1971;33(3):288-95. Antigenic relationship between human cytomegalovirus, herpes simplex, and varicella-zoster virus studied by complement-fixation. Krech U, Jung M. PMID: 4329637 [PubMed - indexed for MEDLINE] 6948. Postgrad Med. 1971 Jan;49(1):87-92. Oral reflections of infectious diseaes. 1. Shklar G. PMID: 4321922 [PubMed - indexed for MEDLINE] 6949. Arch Dermatol. 1971 Jan;103(1):45-9. Further electron microscopic observations of herpes zoster virus. Hasegawa T. PMID: 4321802 [PubMed - indexed for MEDLINE] 6950. Oftalmol Zh. 1971;26(1):29-32. [Comparative effectiveness of gamma-globulin, deoxyribonuclease and kerecid in herpetic keratitis] [Article in Russian] Zagaigora EP. PMID: 4105822 [PubMed - indexed for MEDLINE] 6951. Zh Mikrobiol Epidemiol Immunobiol. 1971;48(6):126-31. [Human immunoglobulins and their role in infectious pathology (review)] [Article in Russian] Stefani DV. PMID: 4105768 [PubMed - indexed for MEDLINE] 6952. Br Med J. 1970 Dec 26;4(5738):776-80. Treatment of zoster with idoxuridine in dimethyl sulphoxide. Results of two double-blind controlled trials. Juel-Jensen BE, MacCallum FO, Mackenzie AM, Pike MC. PMCID: PMC1820395 PMID: 4925077 [PubMed - indexed for MEDLINE] 6953. Dtsch Med Wochenschr. 1970 Dec 4;95(49):2500. [Herpes zoster in old age] [Article in German] Hirschmann J. PMID: 5486571 [PubMed - indexed for MEDLINE] 6954. Arch Otolaryngol. 1970 Dec;92(6):632-5. Herpes zoster oticus. Harner SG, Heiny BA, Newell RC. PMID: 5486960 [PubMed - indexed for MEDLINE] 6955. Arch Dermatol. 1970 Dec;102(6):680-92. Skin markers of malignancy. Newbold PC. PMID: 4251202 [PubMed - indexed for MEDLINE] 6956. Am J Ophthalmol. 1970 Dec;70(6):886-97. The effect of structural alteration on anterior ocular inflammation. Aronson SB, Moore TE Jr, O'Day DM. PMID: 4099190 [PubMed - indexed for MEDLINE] 6957. N Engl J Med. 1970 Nov 26;283(22):1222-3. Interferon and herpes zoster. Ho M. PMID: 4319628 [PubMed - indexed for MEDLINE] 6958. N Engl J Med. 1970 Nov 26;283(22):1182-7. Cutaneous interferon production in patients with Hodgkin's disease and other cancers infected with varicella or vaccinia. Armstrong RW, Gurwith MJ, Waddell D, Merigan TC. PMID: 4319626 [PubMed - indexed for MEDLINE] 6959. Wien Med Wochenschr. 1970 Nov 21;120(47):846-8. [Indication for Sjöqvist's tractotomy and its results] [Article in German] Grunert V, Sunder-Plassmann M, Pendl G. PMID: 5481430 [PubMed - indexed for MEDLINE] 6960. Lancet. 1970 Nov 21;2(7682):1065-6. Zoster sine herpete causing acute trigeminal neuralgia. Easton HG. PMID: 4098355 [PubMed - indexed for MEDLINE] 6961. Minerva Otorinolaringol. 1970 Nov-Dec;20(6):236-7. [Herpes zoster of the ear] [Article in French] Papathanassopoulos AM. PMID: 5514484 [PubMed - indexed for MEDLINE] 6962. J Med Soc N J. 1970 Nov;67(11):729-30. Herpes zoster ophthalmicus. With ipsilateral parotitis; coincidence or association? Marshall FA. PMID: 5312154 [PubMed - indexed for MEDLINE] 6963. Klin Monbl Augenheilkd. 1970 Nov;157(5):593-604. [The cryoextraction of cataract and its influence on cryo-ophthalmology] [Article in German] Krwawicz T. PMID: 4924123 [PubMed - indexed for MEDLINE] 6964. Postgrad Med J. 1970 Nov;46(541):653-8. Zoster, a recrudescence of VZ virus infection. Blank H, Eaglstein WH, Goldfaden GL. PMCID: PMC2467108 PMID: 4321947 [PubMed - indexed for MEDLINE] 6965. Lakartidningen. 1970 Oct 21;67(43):4993-5. [Headache (8): ophthalmologic point of view] [Article in Swedish] Wulfing B. PMID: 5312262 [PubMed - indexed for MEDLINE] 6966. Br Med J. 1970 Oct 10;4(5727):117. Dentistry, herpes zoster, and varicella. Easton HG. PMCID: PMC1819650 PMID: 5471761 [PubMed - indexed for MEDLINE] 6967. Hinyokika Kiyo. 1970 Oct;16(10):574-85. [Herpes zoster causing bladder atony] [Article in Japanese] Yachiku S, Nagata H, Kashiwai K. PMID: 5529393 [PubMed - indexed for MEDLINE] 6968. Masui. 1970 Oct;19(11):1205-12. [Indication of effects of treatment at the pain clinic--with special reference to chest pain] [Article in Japanese] Hyodo M. PMID: 5528943 [PubMed - indexed for MEDLINE] 6969. Arch Belg Dermatol Syphiligr. 1970 Oct-Dec;26(4):579-80. [Auricular zona] [Article in French] Morimont M, Morimont P. PMID: 5512156 [PubMed - indexed for MEDLINE] 6970. J Infect Dis. 1970 Oct;122(4):335-8. Herpes-zoster meningoencephalitis. Norris FH Jr, Leonards R, Calanchini PR, Calder CD. PMID: 5504713 [PubMed - indexed for MEDLINE] 6971. J Assoc Physicians India. 1970 Oct;18(10):853-4. Lower extremity paralysis complicating herpes zoster. Lal S, Lebbai MS. PMID: 5503061 [PubMed - indexed for MEDLINE] 6972. Am J Med. 1970 Oct;49(4):480-3. Zoster, reinfection or activation of latent virus? Observations on the antibody response. Miller LH, Brunell PA. PMID: 4320119 [PubMed - indexed for MEDLINE] 6973. Hautarzt. 1970 Oct;21(10):437-43. [Dermatological news from America. I] [Article in German] Hollander A. PMID: 4254917 [PubMed - indexed for MEDLINE] 6974. Br Med J. 1970 Sep 5;3(5722):587. Paralysis in herpes zoster. Anderson JP. PMCID: PMC1701582 PMID: 5454365 [PubMed - indexed for MEDLINE] 6975. Sist Nerv. 1970 Sep-Oct;22(5):298-302. [Clinical evaluation of the use of G-32883 in trigeminal neuralgia] [Article in Italian] Gentili E. PMID: 5514248 [PubMed - indexed for MEDLINE] 6976. J Urol. 1970 Sep;104(3):422-5. Urinary retention associated with herpes zoster. Ray B, Wise GJ. PMID: 5459977 [PubMed - indexed for MEDLINE] 6977. J Tenn Med Assoc. 1970 Sep;63(9):758-64. Immunological competence and infectious disease. [No authors listed] PMID: 5456563 [PubMed - indexed for MEDLINE] 6978. Mod Treat. 1970 Sep;7(5):973-98. Cutaneous inflammations of the male genitalia. Young AW Jr. PMID: 4327026 [PubMed - indexed for MEDLINE] 6979. Appl Microbiol. 1970 Sep;20(3):497-504. Experience with electron microscopy in the differential diagnosis of smallpox. Long GW, Nobel J Jr, Murphy FA, Herrmann KL, Lourie B. The usefulness of negative-contrast electron microscopy in the rapid differential diagnosis of poxvirus and herpesvirus exanthems is described in this study of 301 specimens from patients with vesicular exanthematous diseases. Specimens from patients with smallpox, various forms of vaccination complications, varicella, zoster (shingles), and herpes simplex are included in this evaluation. Electron microscopy, when applied to the study of lesion material, was found to be more sensitive than the classical techniques of virus isolation in the diagnosis of both poxvirus and herpes/varicella virus infections. However, since specific identification of a virus within a group cannot be made morphologically by electron microscopy, it is recommended that both electron microscopy and virus isolation methods be employed for the routine differential diagnosis of vesicular exanthematous diseases in the reference diagnostic laboratory. PMCID: PMC376966 PMID: 4322005 [PubMed - indexed for MEDLINE] 6980. Nippon Ganka Gakkai Zasshi. 1970 Sep;74(9):1293-300. [On the significance of local immunoglobulin and antibody production of anterior chamber tissues] [Article in Japanese] Miyanaga Y, Yoshida K. PMID: 4097355 [PubMed - indexed for MEDLINE] 6981. Br Med J. 1970 Aug 15;3(5719):407. Dentistry, herpes zoster, and varicella. Eggleston D, Nally F. PMCID: PMC1701249 PMID: 5451602 [PubMed - indexed for MEDLINE] 6982. Naika. 1970 Aug;26(2):340-8. [Clinical statistics on leukemia with herpes zoster] [Article in Japanese] Takahashi I, Ishizaki M, Saito K, Nagao T, Kinoshita H. PMID: 5449757 [PubMed - indexed for MEDLINE] 6983. Nippon Ganka Gakkai Zasshi. 1970 Aug;74(8):645-50. [Immunofluorescence study of herpes zoster keratitis] [Article in Japanese] Oshima M. PMID: 4917514 [PubMed - indexed for MEDLINE] 6984. Br Med J. 1970 Aug 1;3(5717):251-4. Clinically evident, non-terminal infections with herpesviruses and the wart virus in immunosuppressed renal allograft recipients. Spencer ES, Andersen HK. PMCID: PMC1701173 PMID: 4317670 [PubMed - indexed for MEDLINE] 6985. Br Med J. 1970 Jul 25;3(5716):222. Dentistry, herpes zoster, and varicella. West RJ. PMCID: PMC1701165 PMID: 5448789 [PubMed - indexed for MEDLINE] 6986. Munch Med Wochenschr. 1970 Jul 17;29:1367-70. [Dexamonosone as a rheuma therapeutic agent] [Article in German] Schopen RD. PMID: 5468380 [PubMed - indexed for MEDLINE] 6987. Indian J Dermatol. 1970 Jul;15(4):105-6. Facial paralysis complicating herpes zoster. Lal S, Sawhney KL, Arunthathi S. PMID: 5482743 [PubMed - indexed for MEDLINE] 6988. Bull Soc Fr Dermatol Syphiligr. 1970 Jul;77(1):130-3. [Frequency of motor and neurotrophic complications of zona of the limbs] [Article in French] Bureau Y, Barrière H, Litoux P, Bureau B. PMID: 5430028 [PubMed - indexed for MEDLINE] 6989. Arzneimittelforschung. 1970 Jul;20(7):930-1. [Treatment of chronic pain syndromes. Analgesic effect of a neuroleptic] [Article in German] Lützenkirchen H, Mertens HG. PMID: 4248468 [PubMed - indexed for MEDLINE] 6990. Ann Ottalmol Clin Ocul. 1970 Jun;96(6):291-6. [Ophthalmic herpes zoster with total ophthalmoplegia, retrobulbar neuritis and Argyll-Robertson. Clinical contribution] [Article in Italian] Perotti S, Manfredini U. PMID: 5314996 [PubMed - indexed for MEDLINE] 6991. Practitioner. 1970 Jun;204(224):838-42. A survey of the use of vitamin B12 in general practice. Ellis FR, Nasser S, Wrighton RJ. PMID: 5271299 [PubMed - indexed for MEDLINE] 6992. Biken J. 1970 Jun;13(2):133-43. Studies of herpes zoster virus in vitro. II. An autoradiographic study of intranuclear inclusions. Nii S, Maeda Y. PMID: 4319270 [PubMed - indexed for MEDLINE] 6993. Br Med J. 1970 May 16;2(5706):379. Paralysis in herpes zoster. [No authors listed] PMCID: PMC1700299 PMID: 5420601 [PubMed - indexed for MEDLINE] 6994. Am Rev Respir Dis. 1970 May;101(5):755-8. Diaphragmatic paralysis caused by herpes zoster. Dutt AK. PMID: 5444742 [PubMed - indexed for MEDLINE] 6995. Paraplegia. 1970 May;8(1):14-8. Intramedullary spinal cord metastasis from mammary carcinoma. Mastaglia FL, Kakulas BA. PMID: 5423699 [PubMed - indexed for MEDLINE] 6996. Przegl Dermatol. 1970 May-Jun;57(3):345-9. [Diadynamic currents in the treatment of some skin diseases] [Article in Polish] Bowszyc J, Brozozowski J. PMID: 5310966 [PubMed - indexed for MEDLINE] 6997. Dent J Malaysia Singapore. 1970 May;10(1):39-43. Herpes Zoster. Lee HT, Soon SK. PMID: 5271013 [PubMed - indexed for MEDLINE] 6998. Nurs Mirror Midwives J. 1970 May 1;130(18):17. Herpes zoster. Parry WH. PMID: 5199816 [PubMed - indexed for MEDLINE] 6999. Rinsho Byori. 1970 May;18(5):379-82. [Serodiagnosis of herpes zoster and varicella by immunofluorescence; determination of antibody titer] [Article in Japanese] Shigeta S, Goto S, Koriyama H, Ishitoya Y, Kumasaka T. PMID: 4916050 [PubMed - indexed for MEDLINE] 7000. Arch Ophthalmol. 1970 May;83(5):637-57. Cornea and sclera. Laibson PR. PMID: 4315586 [PubMed - indexed for MEDLINE] 7001. Wiad Lek. 1970 May 1;23(9):769-71. [Generalized zoster in lymphatic leukemia] [Article in Polish] Lemańczyk M, Kamińska E. PMID: 4195445 [PubMed - indexed for MEDLINE] 7002. JAMA. 1970 Apr 13;212(2):322. Herpes zoster with motor involvement. Greenberg J. PMID: 5467243 [PubMed - indexed for MEDLINE] 7003. Rev Med Liege. 1970 Apr 1;25(7):231-3. [Zona and postzona pain] [Article in French] Lapière CH. PMID: 5446801 [PubMed - indexed for MEDLINE] 7004. Cesk Dermatol. 1970 Apr;45(2):70-3. [Paraneoplastic dermatoses] [Article in Czech] Jílek M. PMID: 5445711 [PubMed - indexed for MEDLINE] 7005. Ann Ocul (Paris). 1970 Apr;203(4):371-8. [The use of DNAase in the treatment of herpetic ocular diseases] [Article in French] Colain AA, Salganik RI, Mikhailovskaya IE, Gorban IM. PMID: 5310478 [PubMed - indexed for MEDLINE] 7006. Med Ann Dist Columbia. 1970 Apr;39(4):195-7. Herpes zoster in children. Saracli T, Scott RB. PMID: 5270303 [PubMed - indexed for MEDLINE] 7007. Arch Ophtalmol Rev Gen Ophtalmol. 1970 Apr;30(4):337-55. [Infectious pathology. II. Viral pathology] [Article in French] Verin P. PMID: 4317303 [PubMed - indexed for MEDLINE] 7008. Practitioner. 1970 Apr;204(222):523-8. Facial paralysis. Kendall D. PMID: 4315340 [PubMed - indexed for MEDLINE] 7009. JAMA. 1970 Mar 16;211(11):1831-3. Hospital-acquired herpes zoster following exposure to chickenpox. Berlin BS, Campbell T. PMID: 4313291 [PubMed - indexed for MEDLINE] 7010. Z Haut Geschlechtskr. 1970 Mar 15;45(6):Suppl:29-36. [Virus diseases of the external female genitalia. 2. Zoster (Gürtelrose, zona, shingles)] [Article in German] Grimmer H. PMID: 5513210 [PubMed - indexed for MEDLINE] 7011. Lancet. 1970 Mar 14;1(7646):572. Varicella and cytosine arabinoside. Juel-Jensen BE. PMID: 4190397 [PubMed - indexed for MEDLINE] 7012. JAMA. 1970 Mar 9;211(10):1681-3. The effects of early corticosteroid therapy on the skin eruption and pain of herpes zoster. Eaglstein WH, Katz R, Brown JA. PMID: 4905733 [PubMed - indexed for MEDLINE] 7013. Sem Hop. 1970 Mar 8;46(12):791-813. ["Cancer-chronic lymphoid leukemia" association. 27 cases extracted from a series of 365 cases of chronic lymphoid leukemia and review of the literature] [Article in French] Coeur P, Morel P, Gentilhomme O. PMID: 4315229 [PubMed - indexed for MEDLINE] 7014. Z Haut Geschlechtskr. 1970 Mar 1;45(5):23-8 passim. [Virus diseases of the external female genitalia. 1. Herpes (simplex) genitalis (herpes progenitalis, herpes venereus, vulvitis or vulvovaginitis herpetica)] [Article in German] Grimmer H. PMID: 5420457 [PubMed - indexed for MEDLINE] 7015. Klin Monbl Augenheilkd. 1970 Mar;156(3):405-9. [Zoster ophthalmicus in hematological diseases] [Article in German] Eichholtz W. PMID: 5314282 [PubMed - indexed for MEDLINE] 7016. Klin Monbl Augenheilkd. 1970 Mar;156(3):305-17. [Zoster and the eye] [Article in German] Nover A. PMID: 5314281 [PubMed - indexed for MEDLINE] 7017. Proc Soc Exp Biol Med. 1970 Mar;133(3):750-3. Persistence of phosphoglucomutase (PGM) polymorphism in long-term lymphoid lines. Conover JH, Hathaway P, Glade PR, Hirschhorn K. PMID: 5265246 [PubMed - indexed for MEDLINE] 7018. Arch Maragliano Patol Clin. 1970 Mar-Apr;26(2):127-37. [On a reticulosarcomatosis with positive Paul-Bunnell-Davidsohn seroreaction] [Article in Italian] Arcuri F, Robert L. PMID: 4930287 [PubMed - indexed for MEDLINE] 7019. Naika. 1970 Mar;25(3):421-6. [Zoster encephalitis] [Article in Japanese] Takahashi A. PMID: 4910672 [PubMed - indexed for MEDLINE] 7020. Thromb Diath Haemorrh. 1970 Feb 28;23(1):159-69. Second phase platelet aggregation induced by adenosine diphosphate in patients with cerebral vascular disease and in control subjects. Danta G. PMID: 5420427 [PubMed - indexed for MEDLINE] 7021. Br Med J. 1970 Feb 14;1(5693):382-3. Paralysed hemidiaphragm and shingles. [No authors listed] PMCID: PMC1699201 PMID: 5434652 [PubMed - indexed for MEDLINE] 7022. Vestn Khir Im I I Grek. 1970 Feb;104(2):133-4. [Herpes zoster simulating acute abdomen] [Article in Russian] Pomosov DV, Zhitniuk RI. PMID: 5429924 [PubMed - indexed for MEDLINE] 7023. Arch Dermatol. 1970 Feb;101(2):238-9. Herpes zoster with ocular destruction. Wallk S, McNeese J. PMID: 5308661 [PubMed - indexed for MEDLINE] 7024. Shinkei Kenkyu No Shimpo. 1970;14(3):443-8. [Case of myasthenic syndrome developing in the course of herpes zoster encephalomeningitis] [Article in Japanese] Hiyamuta E, Okudaira N, Kase M. PMID: 5531592 [PubMed - indexed for MEDLINE] 7025. Folia Allergol (Roma). 1970 Jan-Feb;17(1):61-70. [Autoantibodies in pemphigus and related diseases] [Article in Italian] Panconesi E, Bigazzi PL. PMID: 5445778 [PubMed - indexed for MEDLINE] 7026. Zh Nevropatol Psikhiatr Im S S Korsakova. 1970;70(1):76-80. [Changes in the bioelectric activity of the brain in typical trigeminal neuralgia and facial sympathalgia] [Article in Russian] Erokhina LG, Puchinskaia LM. PMID: 5425804 [PubMed - indexed for MEDLINE] 7027. Oftalmol Zh. 1970;25(5):351-4. [Papain treatment of corneal diseases] [Article in Russian] Starkov GL, Saprykin ID, Savinykh VI. PMID: 5312240 [PubMed - indexed for MEDLINE] 7028. Oftalmol Zh. 1970;25(2):138. [Results of treatment of herpetic keratitis with kerecid at the regional ophthalmologic dispensary] [Article in Russian] Zagaigora EP. PMID: 5311909 [PubMed - indexed for MEDLINE] 7029. Klin Oczna. 1970;40(4):579-81. [Abducens paresis as a complication of zoster ophthalmicus] [Article in Polish] Horodeński J, Ledzińska K. PMID: 5311410 [PubMed - indexed for MEDLINE] 7030. Sb Ved Pr Lek Fak Karlovy Univerzity Hradci Kralove. 1970;13(2):119-23. [Ganglionitis in herpes zoster] [Article in German] Nozicka Z, Vortel V. PMID: 5275065 [PubMed - indexed for MEDLINE] 7031. Pathol Microbiol (Basel). 1970;36(5):279-80. [Demonstrations from clinical bacteriology] [Article in German] Reber H. PMID: 4935367 [PubMed - indexed for MEDLINE] 7032. Trans St Johns Hosp Dermatol Soc. 1970;56(2):117-21. Treatment of rheumatoid arthritis with cytotoxic and antimetabolic drugs. Currey HL. PMID: 4933579 [PubMed - indexed for MEDLINE] 7033. Mie Med J. 1970 Jan;19(3):189-92. Lupus erythematosus and herpes zoster. Hamaguchi T, Kotani Y, Imanaka S, Morito S, Kawamura Y. PMID: 4923873 [PubMed - indexed for MEDLINE] 7034. Gerontol Clin (Basel). 1970;12(5):283-7. Diaphragmatic paralysis following herpes zoster. Shivalingappa G. PMID: 4918559 [PubMed - indexed for MEDLINE] 7035. Acta Virol. 1970 Jan;14(1):25-34. Preparation of concentrated intracellular precipitating antigens of varicella-zoster and herpes simplex viruses and results obtained with them in the gel precipitation reaction. Trlifajová J, Sourek J, Ryba M. PMID: 4392074 [PubMed - indexed for MEDLINE] 7036. Monatsschr Ohrenheilkd Laryngorhinol. 1970;104(9):409-12. [Irreversible nerve damages after herpes zoster oticus] [Article in German] Bauer E, Keintzel K. PMID: 4331876 [PubMed - indexed for MEDLINE] 7037. Trans Ophthalmol Soc U K. 1970;90:899-930. Herpes zoster ophthalmicus. Scheie HG. PMID: 4326688 [PubMed - indexed for MEDLINE] 7038. J Laryngol Otol. 1970 Jan;84(1):65-70. The incidence of herpes zoster antibodies in patients with peripheral facial palsy. Peitersen E, Caunt AE. PMID: 4323301 [PubMed - indexed for MEDLINE] 7039. Arch Klin Exp Dermatol. 1970;239(1):22-9. [Experimental herpes simplex virus infection of the skin of hairless mice] [Article in German] Munk K, Jung EG. PMID: 4320161 [PubMed - indexed for MEDLINE] 7040. Ann Anat Pathol (Paris). 1970 Jan-Mar;15(1):129-52. [Viral diseases of the nervous system] [Article in French] Tommasi M, Berard-Baier M, Toga M, Vedrenne C. PMID: 4315389 [PubMed - indexed for MEDLINE] 7041. J Oral Med. 1970 Jan-Mar;25(1):7-11. Chronic oral ulceration. Cohen L. PMID: 4313952 [PubMed - indexed for MEDLINE] 7042. Acta Derm Venereol. 1970;50(1):69-73. Treatment of herpes zoster and postzoster neuralgia by the sublesional injection of triamcinolone and procaine. Epstein E. PMID: 4191892 [PubMed - indexed for MEDLINE] 7043. J Immunol. 1970 Jan;104(1):23-7. Demonstration of viral antibody activity in two immunoglobulin G subclasses in patients with varicella-zoster virus infection. Leonard LL, Schmidt NJ, Lennette EH. PMID: 4189103 [PubMed - indexed for MEDLINE] 7044. Br Med J. 1969 Dec 13;4(5684):667-9. Facial pain. Foster JB. PMCID: PMC1630213 PMID: 5359924 [PubMed - indexed for MEDLINE] 7045. Z Arztl Fortbild (Jena). 1969 Dec 1;63(23):1249-52. [Zoster. A study on the clinical aspects and rational therapy of zoster (Z.) in the consulting hour] [Article in German] Bittersohl R. PMID: 5404741 [PubMed - indexed for MEDLINE] 7046. J Urol. 1969 Dec;102(6):689-92. Herpes zoster causing bladder atony. Constantian HM. PMID: 5372022 [PubMed - indexed for MEDLINE] 7047. Rev Paul Med. 1969 Dec;75(6):361-70. [Infection following renal transplantation] [Article in Portuguese] Ianhez LE, Sabbaga E, de Góes GM, Cabral AD, de Campos-Freire JG. PMID: 4906881 [PubMed - indexed for MEDLINE] 7048. Arch Neurol. 1969 Dec;21(6):559-70. Varicella-Zoster encephalomyelitis. A morphologic and virologic study. McCormick WF, Rodnitzky RL, Schochet SS Jr, McKee AP. PMID: 4311227 [PubMed - indexed for MEDLINE] 7049. Vestn Dermatol Venerol. 1969 Dec;45(12):58-60. [Role of ointments containing hydrocortisone and prednisolone in the therapy of dermatoses in children] [Article in Russian] Lipets ME. PMID: 4246375 [PubMed - indexed for MEDLINE] 7050. Orv Hetil. 1969 Nov 30;110(48):2813-4. [Viral diseases of the mouth mucosa treated with Morgalin] [Article in Hungarian] Sallay K, Gürtler A. PMID: 5362772 [PubMed - indexed for MEDLINE] 7051. Med Welt. 1969 Nov 29;48:2636-49. [Treatment of neurologic diseases with synthetic corticotropin (beta-1-24-corticotropin)] [Article in German] Steinbrecher W. PMID: 4318400 [PubMed - indexed for MEDLINE] 7052. G Mal Infett Parassit. 1969 Nov;21(11):849-52. [Distamycin A in therapy of most severe types of herpes zoster] [Article in Italian] Bassetti D. PMID: 5397338 [PubMed - indexed for MEDLINE] 7053. Nippon Jibiinkoka Gakkai Kaiho. 1969 Nov;72(11):2072-80. [Case of Hunt's syndrome with special reference to chronological observation on hearing disorder] [Article in Japanese] Tsuiki T, Nakamura H. PMID: 5390936 [PubMed - indexed for MEDLINE] 7054. Vrach Delo. 1969 Nov;11:132-4. [Recurrent herpes zoster] [Article in Russian] Iliutovich GM. PMID: 5384402 [PubMed - indexed for MEDLINE] 7055. Blood. 1969 Nov;34(5):706-11. Cytosine arabinoside therapy for disseminated herpes zoster in a patient with IgG pyroglobulinemia. McKelvey EM, Kwaan HC. PMID: 5352659 [PubMed - indexed for MEDLINE] 7056. Br Med J. 1969 Nov 1;4(5678):303. Herpes zoster and multiple sclerosis. Beebe GW, Kurtzke JF. PMCID: PMC1629671 PMID: 5345951 [PubMed - indexed for MEDLINE] 7057. Vestn Oftalmol. 1969 Nov-Dec;6:82-4. [Possibility of the virus carrier state in conjunctival epithelium in ocular herpes] [Article in Russian] Voronova NS, Glukhovskaia SS. PMID: 5309752 [PubMed - indexed for MEDLINE] 7058. Am J Ophthalmol. 1969 Nov;68(5):824-8. Circulating lymphoid cells in chronic viral keratitis. Henley WL, Paltrowitz IM, Heopold IH, Hirschhorn K, Glade PR. PMID: 5308007 [PubMed - indexed for MEDLINE] 7059. N Z Med J. 1969 Nov;70(450):317-20. The enhancing effect of dimethylsulfoxide vehicle upon the anti-viral actions of 5-iododeoxyuridine. Turnbull BC, MacGregor I, Stringer HC. PMID: 5264455 [PubMed - indexed for MEDLINE] 7060. J Pract Nurs. 1969 Nov;19(11):27 passim. Herpes Zoster: a nursing challenge. Judd E. PMID: 5196279 [PubMed - indexed for MEDLINE] 7061. Ann Ocul (Paris). 1969 Nov;202(11):1105-22. [Pathological anatomy of endogenous uveitis] [Article in French] Hervouët F. PMID: 4324131 [PubMed - indexed for MEDLINE] 7062. Vopr Virusol. 1969 Nov-Dec;14(6):646-55. [Virus infections and intrauterine pathology] [Article in Russian] Oganesian OT, Rutova VV, Chebotarev VV. PMID: 4312949 [PubMed - indexed for MEDLINE] 7063. Vestn Dermatol Venerol. 1969 Nov;43(11):76-7. [Herpes zoster developing during treatment with griseofulvin] [Article in Russian] Chistiakov AM. PMID: 4246091 [PubMed - indexed for MEDLINE] 7064. Br J Dermatol. 1969 Nov;81(11):874-6. Management of herpes zoster. Ashton H, Beveridge GW, Stevenson CJ. PMID: 4188178 [PubMed - indexed for MEDLINE] 7065. J Iowa Med Soc. 1969 Nov;59(11):1035-6. A chickenpox preventive for high-risk children and adults. [No authors listed] PMID: 4186782 [PubMed - indexed for MEDLINE] 7066. Br Med J. 1969 Oct 11;4(5675):62. Passive immunization against chicken-pox. [No authors listed] PMCID: PMC1629478 PMID: 4186271 [PubMed - indexed for MEDLINE] 7067. J Urol Nephrol (Paris). 1969 Oct-Nov;75(10):826-30. [Acute urinary retention in zona] [Article in French] Arvis G, Aboulker P. PMID: 5363699 [PubMed - indexed for MEDLINE] 7068. Br J Dis Chest. 1969 Oct;63(4):222-6. Cervical herpes zoster and diaphragmatic paralysis. Anderson JP, Keal EE. PMID: 5346817 [PubMed - indexed for MEDLINE] 7069. Int Z Klin Pharmakol Ther Toxikol. 1969 Oct;2(4):371-3. Review of therapeutic properties of emetine in nonamoebic infections. Synek P, Synek V. PMID: 4903989 [PubMed - indexed for MEDLINE] 7070. Br J Plast Surg. 1969 Oct;22(4):382-3. Self-medication of herpes zoster with an arsenic paste. A case report. Fakirbhai MD. PMID: 4902101 [PubMed - indexed for MEDLINE] 7071. Can J Ophthalmol. 1969 Oct;4(4):387-9. Optic atrophy following herpes zoster ophthalmicus in a child. Ahmad M, Bowen SF Jr, Burke R. PMID: 4186212 [PubMed - indexed for MEDLINE] 7072. Dtsch Med Wochenschr. 1969 Sep 12;94(37):1861-6. [Segmental motor pareses in herpes zoster] [Article in German] Schliack H, Schneider H. PMID: 5356319 [PubMed - indexed for MEDLINE] 7073. Anesth Analg. 1969 Sep-Oct;48(5):816-23. Intrathecal cold saline solution: a new approach to pain (evaluation). Collins JR, Juras EP, VanHouten RJ, Spruell L. PMID: 5820362 [PubMed - indexed for MEDLINE] 7074. HNO. 1969 Sep;17(9):278-9. [A case of herpes zoster of the vagus nerve with paresis of the recurrent nerve and partial deglutition paralysis] [Article in German] Grüter L. PMID: 5405516 [PubMed - indexed for MEDLINE] 7075. Ann Otolaryngol Chir Cervicofac. 1969 Sep;86(9):509-16. [Electronystagmography in spontaneous facial paralysis] [Article in French] Bouche J, Freche C, Tronche R, Ray J, Adrianjatovo J. PMID: 5361811 [PubMed - indexed for MEDLINE] 7076. Postgrad Med. 1969 Sep;46(3):257-8. How I treat herpes zoster. Wilhelmj CM Jr. PMID: 5344254 [PubMed - indexed for MEDLINE] 7077. Fracastoro. 1969 Sep-Oct;62(5):474-84. [Herpes zoster and neoplasms (case contribution and radiotherapy)] [Article in Italian] Donati E. PMID: 4923241 [PubMed - indexed for MEDLINE] 7078. Ann Urol (Paris). 1969 Sep;3(3):139-41. [Acute urinary retention in herpes zoster] [Article in French] Arvis G, Aboulker P. PMID: 4311470 [PubMed - indexed for MEDLINE] 7079. Obstet Gynecol. 1969 Sep;34(3):434-66. Herpes vulvitis. Dickie EG. PMID: 4308748 [PubMed - indexed for MEDLINE] 7080. Hifuka Kiyo. 1969 Aug;64(3):209-12. [Therapeutic effects of Cepharantine on herpes zoster] [Article in Japanese] Shimizu M, Morito S, Kawamura Y. PMID: 5393937 [PubMed - indexed for MEDLINE] 7081. J Am Osteopath Assoc. 1969 Aug;68(12):1265-8. The syndrome of postherpetic neuralgia: complication and an approach to therapy. Hallaq IY, Harris JD. PMID: 5195921 [PubMed - indexed for MEDLINE] 7082. J Med Microbiol. 1969 Aug;2(3):317-25. Laboratory studies on the varicella-zoster virus. Meurisse EV. PMID: 4325755 [PubMed - indexed for MEDLINE] 7083. N Engl J Med. 1969 Jul 31;281(5):273. Booster effect of herpes zoster. Shaw EB. PMID: 4183007 [PubMed - indexed for MEDLINE] 7084. Med J Aust. 1969 Jul 5;2(1):27-8. The use of intravenous procaine infusion in the treatment of postherpetic neuralgia. Collins EB. PMID: 5799007 [PubMed - indexed for MEDLINE] 7085. Arch Neurol. 1969 Jul;21(1):25-31. Virus-like particles in myositis accompanying herpes zoster. Norris FH Jr, Dramov B, Calder CD, Johnson SG. PMID: 5772548 [PubMed - indexed for MEDLINE] 7086. Rev Otoneuroophtalmol. 1969 Jul-Aug;41(5):241-50. [Rhythmic segmental myoclonus of spinal cord origin. Apropos of 2 cases] [Article in French] Castaigne P, Cambier J, Laplane D, Cathala HP, Brunet P, Pierrot-Deseilligny E. PMID: 5403127 [PubMed - indexed for MEDLINE] 7087. Ann Ocul (Paris). 1969 Jul;2(7):751-62. [Charles de Saint-Yves (1667-1736)] [Article in French] Munchow W. PMID: 4926646 [PubMed - indexed for MEDLINE] 7088. Br Med J. 1969 Jun 21;2(5659):765-6. Immunity to cancer. Wyburn-Mason R. PMCID: PMC1983564 PMID: 5786776 [PubMed - indexed for MEDLINE] 7089. Arch Sci Med (Torino). 1969 Jun;126(6):369-72. [A case of herpes zoster appearing during pulmonary sarcoidosis. (Its clinical significance)] [Article in Italian] Cascone A. PMID: 5363535 [PubMed - indexed for MEDLINE] 7090. J All India Ophthalmol Soc. 1969 Jun;17(3):120. Herpes Zoster ophthalmicus involving the nasociliary nerve alone. Pandey R. PMID: 5308858 [PubMed - indexed for MEDLINE] 7091. Voen Med Zh. 1969 Jun;6:44-5. [Low frequency impulse currents in therapeutic practice] [Article in Russian] Ievlev VA, Likholetova AG. PMID: 4308888 [PubMed - indexed for MEDLINE] 7092. Postgrad Med J. 1969 Jun;45(524):382-5. Herpes encephalitis. I. The clinical picture. Campbell AM. PMCID: PMC2466716 PMID: 4307947 [PubMed - indexed for MEDLINE] 7093. J Hyg (Lond). 1969 Jun;67(2):343-52. Neutralization tests with varicella-zoster virus. Caunt AE, Shaw DG. PMCID: PMC2130719 PMID: 4183291 [PubMed - indexed for MEDLINE] 7094. Am J Ophthalmol. 1969 Jun;67(6):873-96. Corticosteroid therapy in central stromal keratitis. Aronson SB, Moore TE Jr. PMID: 4182154 [PubMed - indexed for MEDLINE] 7095. N Engl J Med. 1969 May 29;280(22):1237-8. Passive immunization against chicken pox. Janeway CA. PMID: 4181207 [PubMed - indexed for MEDLINE] 7096. N Engl J Med. 1969 May 29;280(22):1191-4. Prevention of varicella by zoster immune globulin. Brunell PA, Ross A, Miller LH, Kuo B. PMID: 4181206 [PubMed - indexed for MEDLINE] 7097. Minerva Med. 1969 May 2;60(35):1703-5. [New therapy of herpes zoster. (Preliminary note)] [Article in Italian] Rossi GD. PMID: 5790014 [PubMed - indexed for MEDLINE] 7098. Acta Pathol Jpn. 1969 May;19(2):115-49. Ultrastructural zonation of the human adrenal cortex. Kawaoi A. PMID: 5394735 [PubMed - indexed for MEDLINE] 7099. Zentralbl Bakteriol Orig. 1969 May;210(1):140-3. [Encephalitis and myelitis in herpes zoster] [Article in German] Jezek P, Houbal V. PMID: 5361075 [PubMed - indexed for MEDLINE] 7100. Mil Med. 1969 May;134(5):341-7. Practical and theoretical considerations in Nerve Excitability (NE) testing. Hale MS, Silverstein H. PMID: 4976907 [PubMed - indexed for MEDLINE] 7101. Scand J Infect Dis. 1969 May;1(1):47-9. Varicelliform eruptions in herpes zoster--some clinical and serological observations. Oberg G, Svedmyr A. PMID: 4329058 [PubMed - indexed for MEDLINE] 7102. Br Med J. 1969 Apr 26;2(5651):218-20. Herpes zoster and multiple sclerosis. Lenman JA, Peters TJ. PMCID: PMC1983101 PMID: 4305401 [PubMed - indexed for MEDLINE] 7103. JAMA. 1969 Apr 14;208(2):326-31. Hodgkin's disease. Dorfman R, Reinhard E, Wessler S, Avioli LV. PMID: 5818486 [PubMed - indexed for MEDLINE] 7104. Indian J Med Sci. 1969 Apr;23(4):210-3. Incidence of chickenpox and herpes zoster among the armed forces persons--a preliminary communication. Seetaram K. PMID: 5799719 [PubMed - indexed for MEDLINE] 7105. Clin Chim Acta. 1969 Apr;24(1):111-20. Presence of L-amino-acid oxidase in the blood in pemphigus, dermatitis herpetiformis Duhring and herpes zoster. Mecher T, Masszi J. PMID: 5780154 [PubMed - indexed for MEDLINE] 7106. Br J Urol. 1969 Apr;41(2):238-41. Herpes zoster causing retention of urine. Rankin JT, Sutton RA. PMID: 5769086 [PubMed - indexed for MEDLINE] 7107. Rev Med Chir Soc Med Nat Iasi. 1969 Apr-Jun;73(2):459-62. [Considerations on 2 cases of buccal zona] [Article in Romanian] Haimovici A, Constantin I, Feodorov D. PMID: 5306557 [PubMed - indexed for MEDLINE] 7108. Eye Ear Nose Throat Mon. 1969 Apr;48(4):216-8. Coexisting herpes zoster and herpes simplex ocular involvement. Giles CL. PMID: 5304977 [PubMed - indexed for MEDLINE] 7109. Vestn Dermatol Venerol. 1969 Apr;43(4):14-21. [The use of optic quantum generators (lasers) in dermatology (a review of foreign literature)] [Article in Russian] Khromov BM, Frygin NV. PMID: 4905002 [PubMed - indexed for MEDLINE] 7110. Proc R Soc Med. 1969 Apr;62(4):374-8. 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PMID: 5306658 [PubMed - indexed for MEDLINE] 7187. Ann Ottalmol Clin Ocul. 1968 Aug;94(8):1011-26. [New treatment of ophthalmic herpes zoster with the hemocoagulating fraction of Bothrops jacaraca venom (Hemocoagulase)] [Article in Italian] Valvo A. PMID: 5306657 [PubMed - indexed for MEDLINE] 7188. Sov Med. 1968 Aug;31(8):94-8. [On the problem of herpes zoster ophthalmicus] [Article in Russian] Kalamkarian AA, Kochetkov VD. PMID: 5306585 [PubMed - indexed for MEDLINE] 7189. J Oral Surg. 1968 Aug;26(8):534-6. Herpes zoster in childhood: report of case. Freedman GL, Hooley JR. PMID: 5243136 [PubMed - indexed for MEDLINE] 7190. Lancet. 1968 Jul 20;2(7560):170-1. Shingles. Elliott FA. PMID: 4173290 [PubMed - indexed for MEDLINE] 7191. Dtsch Gesundheitsw. 1968 Jul 4;23(27):1249-54. [On the epidemiology and therapy of herpes corneae] [Article in German] Pietruschka G. PMID: 5303003 [PubMed - indexed for MEDLINE] 7192. Cleve Clin Q. 1968 Jul;35(3):169-76. 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Br Med J. 1968 Jun 8;2(5605):577-80. Pain in the face. Miller H. PMCID: PMC1991759 PMID: 5654625 [PubMed - indexed for MEDLINE] 7200. Lancet. 1968 Jun 8;1(7554):1242. Shingles. [No authors listed] PMID: 4172788 [PubMed - indexed for MEDLINE] 7201. Minerva Dermatol. 1968 Jun;43(6):288-95. [Treatment of zoster with high doses of oral lysozyme] [Article in Italian] Strani GF. PMID: 5745066 [PubMed - indexed for MEDLINE] 7202. Ann Ottalmol Clin Ocul. 1968 Jun;94(6):668-74. [Yeast therapy in ophthalmic herpes zoster] [Article in Italian] Mazza C, Panagis P. PMID: 5312163 [PubMed - indexed for MEDLINE] 7203. Hautarzt. 1968 Jun;19(6):256-9. [Contribution on the etiology of the Melkersson-Rosenthal syndrome] [Article in German] Dlabalová H, Danda J. PMID: 4979397 [PubMed - indexed for MEDLINE] 7204. Ned Tijdschr Geneeskd. 1968 May 18;112(20):964-5. [Herpes zoster with facial nerve paralysis] [Article in Dutch] Devriese PP. PMID: 5665020 [PubMed - indexed for MEDLINE] 7205. 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Arch Intern Med. 1968 May;121(5):458-62. Herpes zoster in a patient with Hodgkin's disease. Treatment with idoxuridine. Waltuch G, Sachs F. PMID: 5645723 [PubMed - indexed for MEDLINE] 7211. Am J Ophthalmol. 1968 May;65(5):686-8. Ophthalmic zoster in malignant disease. Blodi FC. PMID: 5301146 [PubMed - indexed for MEDLINE] 7212. Pediatr Clin North Am. 1968 May;15(2):337-44. Recent advances in pediatric ophthalmology. Frayer WC. PMID: 4872897 [PubMed - indexed for MEDLINE] 7213. Arch Neurol. 1968 May;18(5):583-9. Ramsay Hunt syndrome. Brody IA, Wilkins RH. PMID: 4869674 [PubMed - indexed for MEDLINE] 7214. Dermatol Wochenschr. 1968 Apr 27;154(17):385-7. [Treatment of herpes zoster with griseofulvin] [Article in German] Wolfram S. PMID: 5730767 [PubMed - indexed for MEDLINE] 7215. Z Haut Geschlechtskr. 1968 Apr 15;43(8):311-2. [Relationship between herpes zoster and gravidity, possibly exacerbation, also due to drugs] [Article in German] Nasemann T. 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N Engl J Med. 1968 Mar 28;278(13):743. Spread of Herpes-zoster virus. Johnson RT. PMID: 5638711 [PubMed - indexed for MEDLINE] 7223. N Engl J Med. 1968 Mar 28;278(13):743. Spread of Herpes-zoster virus. Massarelli JJ. PMID: 5638710 [PubMed - indexed for MEDLINE] 7224. Dtsch Med J. 1968 Mar 20;19(6):193-8 concl. [On the therapy of skin and veneral diseases. Review of the literature 1965-66] [Article in German] Walther H. PMID: 4181102 [PubMed - indexed for MEDLINE] 7225. Br Med J. 1968 Mar 16;1(5593):685. Zosteriform late cutaneous syphilide. Kodandapani C. PMCID: PMC1985394 PMID: 5640651 [PubMed - indexed for MEDLINE] 7226. Z Haut Geschlechtskr. 1968 Mar 15;43(6):243-6. [On the reciprocal modification of coexisting diseases] [Article in German] Streitmann B. PMID: 4233720 [PubMed - indexed for MEDLINE] 7227. Dtsch Med Wochenschr. 1968 Mar 8;93(10):435-8. ["Malignant zoster" in normoproteinemic plasmacytoma (Bence-Jones plasmacytoma)] [Article in German] Meiers HG, Gehrmann G. PMID: 5639657 [PubMed - indexed for MEDLINE] 7228. Med J Aust. 1968 Mar 2;1(9):350-1. Biperiden in the treatment of post-herpetic neuralgia. Lang GA. PMID: 5655175 [PubMed - indexed for MEDLINE] 7229. Radiobiol Radioter Fis Med. 1968 Mar-Apr;23(2):107-40. [Place of radiotherapy in the treatment of zona] [Article in Italian] Pezzi A. PMID: 5747121 [PubMed - indexed for MEDLINE] 7230. Kinderarztl Prax. 1968 Mar;36(3):101-3. [Zoster in children] [Article in German] Kyin UA. PMID: 5715779 [PubMed - indexed for MEDLINE] 7231. Neurology. 1968 Mar;18(3):308. EEG studies of recurrent herpetic infection in rabbits. Griffith JF, Kibrick S, Dodge PR. PMID: 5301470 [PubMed - indexed for MEDLINE] 7232. Riv Otoneurooftalmol. 1968 Mar-Apr;43(2):177-99. [Clinico-therapeutic considerations on cephalic herpes zoster] [Article in Italian] Bardin PG, Battaggia P. PMID: 4302965 [PubMed - indexed for MEDLINE] 7233. Horumon To Rinsho. 1968 Mar;16(3):177-88. [ACTH or adrenocortical hormone therapy in myasthenia gravis, myotonia and herpes zoster] [Article in Japanese] Takahashi A. PMID: 4300299 [PubMed - indexed for MEDLINE] 7234. Med Klin. 1968 Feb 16;63(7):256-9. [Experimental studies and clinical experience with gentamycin] [Article in German] Meyer-Rohn J. PMID: 5664711 [PubMed - indexed for MEDLINE] 7235. N Engl J Med. 1968 Feb 15;278(7):397. Effect of surgical scar on herpes zoster. Lorant A. PMID: 5635654 [PubMed - indexed for MEDLINE] 7236. Am J Dis Child. 1968 Feb;115(2):279-80. Geniculate ganglion syndrome (Hunt's syndrome, Herpes zoster oticus). Gellis SS, Feingold M, Black DC. PMID: 5636504 [PubMed - indexed for MEDLINE] 7237. Bull Soc Ophtalmol Fr. 1968 Feb;68(2):287-90. [Atypic cases of ophthalmic zona] [Article in French] Guyard M, Perdriel G, Ceruti F. PMID: 5313984 [PubMed - indexed for MEDLINE] 7238. Ann Ottalmol Clin Ocul. 1968 Feb;94(2):187-92. [Case of scleral staphyloma after scleritis caused by herpes zoster] [Article in Italian] Parducci F, Cappelli L. PMID: 5310495 [PubMed - indexed for MEDLINE] 7239. Curr Med Drugs. 1968 Feb;8(6):19-31. Herpes zoster. Morton O. PMID: 5305761 [PubMed - indexed for MEDLINE] 7240. Z Haut Geschlechtskr. 1968 Feb 1;43(3):79-83. [On a combination therapy of Zoster] [Article in German] Weber G, Roth WG. PMID: 5302107 [PubMed - indexed for MEDLINE] 7241. Ned Tijdschr Geneeskd. 1968 Jan 20;112(3):132-3. [Lung tumor (?) in herpes zoster] [Article in Dutch] Dagnelie PR. PMID: 5664980 [PubMed - indexed for MEDLINE] 7242. Sem Hop. 1968 Jan 20;44(4):239-44. [Study of the therapeutic action of a combination of vitamins B1, B6 and hydroxocobalamin in large doses] [Article in French] Pluvinage R. PMID: 4297112 [PubMed - indexed for MEDLINE] 7243. Atti Accad Fisiocrit Siena Med Fis. 1968;17(2):941-53. 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PMID: 5635963 [PubMed - indexed for MEDLINE] 7253. Gerontol Clin (Basel). 1968;10(2):116-27. Clinical uses of systemic deoxyribonuclease. Lloyd TW. PMID: 5635169 [PubMed - indexed for MEDLINE] 7254. Med Times. 1968 Jan;96(1):43-9. Herpes Zoster ophthalmicus. Prevention of ocular complications and therapy. Freiwald MJ. PMID: 5310992 [PubMed - indexed for MEDLINE] 7255. Vopr Kurortol Fizioter Lech Fiz Kult. 1968 Jan;33(1):83-4. [The use of diadynamic currents in pain syndromes in patients with herpes zoster] [Article in Russian] Shatova LI, Shaposhnikov PK. PMID: 5310630 [PubMed - indexed for MEDLINE] 7256. Trans Pac Coast Otoophthalmol Soc Annu Meet. 1968;49:185-95. The treatment of ocular inflammation with hydroxymesterone. Bedrossian RH. PMID: 5305896 [PubMed - indexed for MEDLINE] 7257. Z Alternsforsch. 1968;21(2):137-46. [Occurrence and course of inflammatory corneal diseases in various age groups] [Article in German] Marré M. PMID: 5303999 [PubMed - indexed for MEDLINE] 7258. Nippon Rinsho. 1968 Jan;26(1):132-7. [Inflammation and anti-inflammatory agents. Non-steroid anti-inflammatory drugs and eye diseases] [Article in Japanese] Tokuda H. PMID: 5303253 [PubMed - indexed for MEDLINE] 7259. Ophthalmologica. 1968;155(4):300-7. Acute anterior uveitis of unknown origin and its connection with herpes simplex. Hemmes GD. PMID: 5301409 [PubMed - indexed for MEDLINE] 7260. Proc Rudolf Virchow Med Soc City N Y. 1968-1969;27:1-9. Angina pectoris--true or false? Lax H. PMID: 5292174 [PubMed - indexed for MEDLINE] 7261. Arch Gesamte Virusforsch. 1968;25(1):52-7. Simultaneous rise in complement-fixing antibodies against herpesvirus hominis and varicella-zostervirus in patients with chickenpox and shingles. Schaap GJ, Huisman J. PMID: 4306835 [PubMed - indexed for MEDLINE] 7262. Zentralbl Allg Pathol. 1968;111(5):544-50. [Occurrence of giant cells in the lung] [Article in German] Meerbach W, Wöckel W, Güthert H. PMID: 4305292 [PubMed - indexed for MEDLINE] 7263. Pediatr Akus Ginekol. 1968;6:21-2. [Hydrocortisone treatment of some dermatoses in children] [Article in Ukrainian] Lipets' ME. PMID: 4247441 [PubMed - indexed for MEDLINE] 7264. Proc Aust Assoc Neurol. 1968;5(3):459-61. Specific neural stimulation for inhibition of pain. Sweet WH. PMID: 4179480 [PubMed - indexed for MEDLINE] 7265. Landarzt. 1967 Dec 31;43(36):1788-92. [What is new in the field of dermatology?] [Article in German] Walther H. PMID: 4235747 [PubMed - indexed for MEDLINE] 7266. Munch Med Wochenschr. 1967 Dec 15;109(50):2656-7. [Plasmacytoma with internittent left bundle-branch block and recurrent zoster] [Article in German] Kittel K. PMID: 5632011 [PubMed - indexed for MEDLINE] 7267. Wiad Lek. 1967 Dec 15;20(24):2191-6. [On the pathogenesis of meningocerebral complications in herpes zoster] [Article in Polish] Wichliński S. PMID: 5587206 [PubMed - indexed for MEDLINE] 7268. Minerva Dermatol. 1967 Dec;42(12):658-60. [On the radiotherapy of herpes zoster] [Article in Italian] Mazzola S, Braccio FN. PMID: 5622854 [PubMed - indexed for MEDLINE] 7269. Naika. 1967 Dec;20(6):1022-8. [Herpes zoster and progressive multifocal leukoencephalopathy] [Article in Japanese] Toyokura Y. PMID: 5598627 [PubMed - indexed for MEDLINE] 7270. Infirm Fr. 1967 Dec;90:13-5. [Zona] [Article in French] Poulain E. PMID: 5184001 [PubMed - indexed for MEDLINE] 7271. Arch De Vecchi Anat Patol. 1967 Dec;50(3):615-27. [In vivo studies, using the skin-window technic, on the inflammatory cellular reactivity in hodgkin's disease] [Article in Italian] Maglulo E, Carcò FP, Giraldi M, Sprovieri G. PMID: 4951032 [PubMed - indexed for MEDLINE] 7272. Jibiinkoka. 1967 Dec;39(12):1297-9. [Hunt's syndrome] [Article in Japanese] [No authors listed] PMID: 4300355 [PubMed - indexed for MEDLINE] 7273. Arch Dermatol. 1967 Dec;96(6):657-64. Association of zoster and malignant disorders in children. Muller SA. PMID: 4294716 [PubMed - indexed for MEDLINE] 7274. Arch Ophtalmol Rev Gen Ophtalmol. 1967 Dec;27(8):823-30. Some aspects of therapeutic keratoplasty. Leigh AG. PMID: 4230318 [PubMed - indexed for MEDLINE] 7275. Nippon Igaku Hoshasen Gakkai Zasshi. 1967 Nov 25;27(8):1083-7. [Herpes zoster following radiation therapy--the results of enquête] [Article in Japanese] Kobayashi T, Kiyono K, Nakanishi F, Sakamoto Y, Fujimori H. PMID: 4877843 [PubMed - indexed for MEDLINE] 7276. J Neurol Sci. 1967 Nov-Dec;5(3):441-55. Multiple sclerosis with amyotrophy complicated by oligodendroglioma. History of recurrent herpes zoster. Barnard RO, Jellinek EH. PMID: 6073212 [PubMed - indexed for MEDLINE] 7277. Arch Fr Mal App Dig. 1967 Nov;56(11):1126-7. [Icterigenic hepatitis with localized thoracic zona] [Article in French] Bert JM, Garrigues JM, Barthélémy. PMID: 5622136 [PubMed - indexed for MEDLINE] 7278. Vestn Dermatol Venerol. 1967 Nov;41(11):73-4. [Complex treatment with ultraviolet irradiation and diadynamic currents of the pain syndrome in herpes zoster] [Article in Russian] Serebriakova VM. PMID: 5621362 [PubMed - indexed for MEDLINE] 7279. J Clin Pathol. 1967 Nov;20(6):835-40. Further observations on inclusion-bearing cells in urinary sediment in infectious diseases. Boyd JF, Nedelkoska N. A study of the cytology of the urinary sediment in 43 patients with known viral diseases has revealed a variety of inclusion-bearing cells in 28.The morphology of the cells suggest that the changes recorded may be due to the viral infections, at least in some instances, bearing in mind the findings of workers quoted in our 1964 report that cellular changes very similar to those induced by virus infections can be initiated by non-viral stimuli. Multinucleate giant cells are occasionally found in chickenpox, measles, herpes simplex infection, and in mumps. PMCID: PMC473616 PMID: 5614069 [PubMed - indexed for MEDLINE] 7280. Br J Ophthalmol. 1967 Nov;51(11):775-9. Unusual corneal lesion following herpes ophthalmicus. Sears ML, Fenton RH. PMCID: PMC506493 PMID: 5299400 [PubMed - indexed for MEDLINE] 7281. Arch Ital Otol Rinol Laringol Patol Cervicofacc. 1967 Nov-Dec;78(6):801-11. [Herpes zoster oticus. Etiopathological and clinical considerations on a case with involvement of the bulbar vestibular nuclei] [Article in Italian] Dufour A, Felletti V. PMID: 4388659 [PubMed - indexed for MEDLINE] 7282. Z Haut Geschlechtskr. 1967 Oct 15;42(20):813-6. [Electrophoretic and serologic studies of herpes zoster] [Article in German] Ebner H, Söltz-Szöts J. PMID: 5596632 [PubMed - indexed for MEDLINE] 7283. Dtsch Gesundheitsw. 1967 Oct 5;22(40):1893-4. [Negative cholecyst-cholangiogram in herpes zoster in the 8th thoracic segment on the right side] [Article in German] Roth A, Ong Oei L. PMID: 5600836 [PubMed - indexed for MEDLINE] 7284. Dtsch Gesundheitsw. 1967 Oct 5;22(40):1889-92. [On therapeutic problems of herpes zoster] [Article in German] Stäps R, Maluschka R. PMID: 5600835 [PubMed - indexed for MEDLINE] 7285. Anaesthesia. 1967 Oct;22(4):568-74. 4 years' Pain Clinic experience. Swerdlow M. PMID: 6072474 [PubMed - indexed for MEDLINE] 7286. Boll Soc Med Chir Cremona. 1967 Oct-Dec;21(4):203-9. [On the use of Neuleptil in inveterate peripheral neuralgias (note on 5 treated cases)] [Article in Italian] Zanibelli G. PMID: 4387687 [PubMed - indexed for MEDLINE] 7287. Hippokrates. 1967 Sep 30;38(18):727-8. [Herpes "zoster" of the urinary bladder] [Article in German] Vogl A. PMID: 5610063 [PubMed - indexed for MEDLINE] 7288. Wiad Lek. 1967 Sep 15;20(18):1745-8. [Cerebrospinal meningitis in the course of herpes zoster] [Article in Polish] Wojciechowski L, Chromińska H. PMID: 6063484 [PubMed - indexed for MEDLINE] 7289. Z Haut Geschlechtskr. 1967 Sep 15;42(18):749-54. [Dermatological experience with dimethyl sulfoxide (DMSO)] [Article in German] Weitgasser H. PMID: 5591425 [PubMed - indexed for MEDLINE] 7290. Geriatrics. 1967 Sep;22(9):151-9. Herpes zoster in the elderly. Hope-Simpson RE. PMID: 6033209 [PubMed - indexed for MEDLINE] 7291. J Indian Med Assoc. 1967 Sep 1;49(5):237-40. Herpes zoster. A clinical study. Mathur MP, Mathur AK, Saxena HC, Bhatia RK. PMID: 5587620 [PubMed - indexed for MEDLINE] 7292. Gan No Rinsho. 1967 Sep;13(9):714-8. [Herpes zoster in radiotherapy for malignant tumors--report of 5 cases and significance of lysozyme preparations] [Article in Japanese] Kobayashi T, Kiyono K, Sakamoto Y, Fujimori H, Maruyama Y. PMID: 4874817 [PubMed - indexed for MEDLINE] 7293. Wien Med Wochenschr. 1967 Aug 19;117(32):764-5. [On the management of trigeminal neuralgia using Tegretol] [Article in German] Goldschmidt F. PMID: 5588056 [PubMed - indexed for MEDLINE] 7294. HNO. 1967 Jul;15(7):196-200. [Surgical treatment of facial parases and its problems] [Article in German] Kricheldorff H. PMID: 5608328 [PubMed - indexed for MEDLINE] 7295. Riv Neurobiol. 1967 Jul-Sep;13(3):438-46. [EMG findings in 2 cases of motor paralysis caused by herpes zoster] [Article in Italian] Perfetti CC, Lorizio A. PMID: 5596319 [PubMed - indexed for MEDLINE] 7296. Indian Pract. 1967 Jul;20(7):457-9. Cyanocobalamin (vitamin B 12) in the management of herpes zoster. Gupta AK, Mital HS. PMID: 5299609 [PubMed - indexed for MEDLINE] 7297. Stomatologia (Bucur). 1967 Jul-Aug;14(4):367-72. [Considerations on the geniculate zone (Ramsay-Hunt syndrome) and its nosologic relations with facial pain syndromes] [Article in Romanian] Pollingher B. PMID: 5244536 [PubMed - indexed for MEDLINE] 7298. Wien Med Wochenschr. 1967 Jun 24;117(25):670. [Zoster sacralis with involvement of the bladder] [Article in German] Weber H, Wolfram S. PMID: 5585448 [PubMed - indexed for MEDLINE] 7299. Lancet. 1967 Jun 3;1(7501):1230-1. Azauridine in viral eye infections. Myska V, Elis J, Plevová J, Rasková H. PMID: 4165149 [PubMed - indexed for MEDLINE] 7300. Acta Otolaryngol. 1967 Jun;63(6):533-50. Herpes zoster auris associated with facial nerve palsy and auditory nerve symptoms: a case report with histopathological findings. Blackley B, Friedmann I, Wright I. PMID: 6037903 [PubMed - indexed for MEDLINE] 7301. J Invest Dermatol. 1967 Jun;48(6):567-70. Role of some biologically active substances in the mechanism of blister formation. Kandhari KC, Bhide NK, Sood VK. PMID: 6028009 [PubMed - indexed for MEDLINE] 7302. Arch Otolaryngol. 1967 Jun;85(6):632-9. Audiologic findings in Ramsay Hunt syndrome. Harbert F, Young IM. PMID: 6024492 [PubMed - indexed for MEDLINE] 7303. J Med Bord. 1967 Jun;144(6):881-94. [Ideas on indications for intrathecal corticotherapy] [Article in French] Vallat JN, Lepetit JM, Léger J. PMID: 5633239 [PubMed - indexed for MEDLINE] 7304. Anaesthesist. 1967 Jun;16(6):172-4. [Block treatment of acute idiopathic herpes zoster] [Article in German] Colding A. PMID: 5617517 [PubMed - indexed for MEDLINE] 7305. Arch Oftalmol B Aires. 1967 Jun;42(6):131-5. [Treatment of ophthalmic herpes zoster with Urgociton using the Eriksen method] [Article in Spanish] Sampaolesi R. PMID: 5304899 [PubMed - indexed for MEDLINE] 7306. Am J Ophthalmol. 1967 Jun;63(6):1796-8. Complications of herpes zoster ophthalmicus. Ramsell TG. PMID: 5298081 [PubMed - indexed for MEDLINE] 7307. Bull Soc Ophtalmol Fr. 1967 May-Jun;67(5):511-4. [Dacryoadenitis due to zona associated with corneal lesions] [Article in French] Ravault MP, Moulin J, Girod M, Marin E. PMID: 5302534 [PubMed - indexed for MEDLINE] 7308. Am J Ophthalmol. 1967 May;63(5):992-3. Coexistent herpes zoster and herpes simplex. Acers TE, Vaile V 3rd. PMID: 5297901 [PubMed - indexed for MEDLINE] 7309. Br J Ophthalmol. 1967 May;51(5):350-1. Intercalary staphyloma in a case of herpes zoster ophthalmicus. Dugmore W. PMCID: PMC506397 PMID: 5297861 [PubMed - indexed for MEDLINE] 7310. Sem Ther. 1967 May;43(5):305-7. [Test of an antiviral treatment in some cutaneo-mucosal diseases] [Article in French] David V, Kuffer R. PMID: 4299985 [PubMed - indexed for MEDLINE] 7311. Monatsschr Kinderheilkd. 1967 May;115(5):356-64. [Immunoglobulin therapy] [Article in German] Hitzig WH. PMID: 4172852 [PubMed - indexed for MEDLINE] 7312. Landarzt. 1967 Apr 20;43(11):533-4. [Pain following herpes zoster] [Article in German] Nasemann T. PMID: 5585072 [PubMed - indexed for MEDLINE] 7313. Br J Clin Pract. 1967 Apr;21(4):207-8. Erythema multiforme major following herpes zoster. Freeman DM. PMID: 6041133 [PubMed - indexed for MEDLINE] 7314. Eye Ear Nose Throat Mon. 1967 Apr;46(4):444-50. Prevention of complications of herpes zoster ophthalmicus with special reference to steroid therapy. Freiwald MJ. PMID: 5298763 [PubMed - indexed for MEDLINE] 7315. Aust Dent J. 1967 Apr;12(2):83-91. Ulceration of the mouth in children. Kramer IR. PMID: 5229244 [PubMed - indexed for MEDLINE] 7316. Wien Med Wochenschr. 1967 Mar 25;117(12):286-9. [Value of cortisone in the management of virus encephalitis] [Article in German] Hohenegger M. PMID: 4296791 [PubMed - indexed for MEDLINE] 7317. Minerva Med. 1967 Mar 3;58(18 Suppl):776-8. [Use in geriatric therapy of a new preparation with anti-rheumatic action] [Article in Italian] Ronchi W, Bianchi F. PMID: 6021527 [PubMed - indexed for MEDLINE] 7318. Minerva Med. 1967 Mar 3;58(18 Suppl):753-6. [On the use of a new injectable antirheumatic-antiarthritic drug in some diseases of orthopedic importance] [Article in Italian] Salvagni A. PMID: 5297787 [PubMed - indexed for MEDLINE] 7319. Arch Dermatol. 1967 Mar;95(3):298. Zoster and herpes simplex. Simultaneous occurrence in the same patient. Kahn G. PMID: 6019800 [PubMed - indexed for MEDLINE] 7320. Vestn Dermatol Venerol. 1967 Mar;41(3):31-6. [Changes in the cerebrospinal fluid in herpes zoster] [Article in Russian] Boldyrev LP. PMID: 5603698 [PubMed - indexed for MEDLINE] 7321. Arch Ital Sci Med Trop Parassitol. 1967 Mar-Apr;48(3):99-103. [On a case of atypical herpes zoster. (Further clinical contribution to the study of the relations between herpes zoster and varicella)] [Article in Italian] De Carlo M, Ricciuti M. PMID: 5603352 [PubMed - indexed for MEDLINE] 7322. Arch Otolaryngol. 1967 Mar;85(3):298-302. Neuronitis vestibularis. Wlodyka J. PMID: 5297533 [PubMed - indexed for MEDLINE] 7323. Z Haut Geschlechtskr. 1967 Mar 1;43(5):211-6. [On the therapy of itching dermatoses in general practice] [Article in German] Zettl J. PMID: 4231073 [PubMed - indexed for MEDLINE] 7324. J Med Lyon. 1967 Feb 5;48(114):187-93. [Generalized zona and lymphosis: apropos of 2 cases, 1 of them associated with osseous Paget's disease] [Article in French] Duverne J, Brizard CP, Mounier R, Volle H. PMID: 5600101 [PubMed - indexed for MEDLINE] 7325. Am J Phys Med. 1967 Feb;46(1):544-54. Pain of neurologic interest. Drachman DA. PMID: 6067163 [PubMed - indexed for MEDLINE] 7326. Dan Med Bull. 1967 Feb;14(3):68-70. Herpes zoster in Hodgkin's disease. Bichel J, Thorling K. PMID: 6044405 [PubMed - indexed for MEDLINE] 7327. Am J Ophthalmol. 1967 Feb;63(2):326-30. Horner's syndrome with geniculate zoster occurring in association with trigeminal herpes in which the ophthalmic division was spared. Jarrett WH. PMID: 6018668 [PubMed - indexed for MEDLINE] 7328. Practitioner. 1967 Feb;198(184):280-2. Herpes zoster following vaccination. Heymann K. PMID: 5298624 [PubMed - indexed for MEDLINE] 7329. JAMA. 1967 Jan 30;199(5):315-7. Varicella-zoster infections in pregnancy. Brunell PA. PMID: 4162975 [PubMed - indexed for MEDLINE] 7330. Urol Int. 1967;22(3):222-6. Herpes zoster as a cause of urinary retention. Gernert JE, Bischoff AJ, Bors E. PMID: 6031944 [PubMed - indexed for MEDLINE] 7331. Bull Soc Belge Ophtalmol. 1967;146:264-72. [Zona and chorioretinal complications] [Article in French] Appelmans M, Lebas P. PMID: 5622638 [PubMed - indexed for MEDLINE] 7332. Oftalmol Zh. 1967;22(5):357-60. [Cryotherapy in herpetic and other diseases of the cornea] [Article in Russian] Zolotareva MM, Chvialeva KI. PMID: 5306355 [PubMed - indexed for MEDLINE] 7333. Riv Otoneurooftalmol. 1967 Jan-Feb;42(1):25-30. [Bilateral paralysis of the constrictory of the iris during herpes zoster of the opthalmic branch of the right trigeminal nerve] [Article in Italian] Dorello U. PMID: 5303079 [PubMed - indexed for MEDLINE] 7334. Klin Monbl Augenheilkd. 1967;150(4):523-9. [On the clinical features of zoster ophthalmicus] [Article in German] Thomann H. PMID: 5302465 [PubMed - indexed for MEDLINE] 7335. Acta Ophthalmol (Copenh). 1967;45(6):787-93. Zoster ophthalmicus. Local treatment with cortisone. Bergaust B, Westby RK. PMID: 5300717 [PubMed - indexed for MEDLINE] 7336. Klin Oczna. 1967;37(5):711-3. [Value of low temperature application in cataract extraction and treatment of corneal herpes] [Article in Polish] Lenkiewicz E. PMID: 5299561 [PubMed - indexed for MEDLINE] 7337. J Coll Gen Pract. 1967 Jan;13(1):110-4. The treatment of herpes simplex and zoster with Terramycin. Maran JI, Lawson SS, Hill AF, Ball JS. PMCID: PMC2237810 PMID: 4382532 [PubMed - indexed for MEDLINE] 7338. Prog Med Virol. 1967;9:35-104. Virus infections of the newborn. Eichenwald HF, McCraken GH Jr, Kindberg SJ. PMID: 4294436 [PubMed - indexed for MEDLINE] 7339. Bull Soc Fr Dermatol Syphiligr. 1967;74(2):168-70. [Viral pustulosis on Hailey-Hailey pemphigus] [Article in French] Mascaro JM, Badillet G, Noury JY. PMID: 4294016 [PubMed - indexed for MEDLINE] 7340. Hautarzt. 1967 Jan;18(1):31-5. [Effective treatment of viral skin diseases with combinations of proteolytic enzymes] [Article in German] Nasemann T, Schirren CG. PMID: 4291685 [PubMed - indexed for MEDLINE] 7341. Bull Soc Fr Dermatol Syphiligr. 1967;74(4):412-3. [Hematodermia. Generalized zona] [Article in French] Duperrat B, Escande JP, Pringuet R. 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PMID: 5929174 [PubMed - indexed for MEDLINE] 7390. Neurology. 1966 Apr;16(4):351-4. Isocitric dehydrogenase in the cerebrospinal fluid. Clinical usefulness of its determination. Van Rymenant M, Robert J, Otten J. PMID: 5948643 [PubMed - indexed for MEDLINE] 7391. Bull Soc Ophtalmol Fr. 1966 Apr;66(4):394-401. [Glaucomatous zoster algias and atropine] [Article in French] Sédan J. PMID: 5296956 [PubMed - indexed for MEDLINE] 7392. Landarzt. 1966 Mar 20;42(8):346-8. [Therapy of late zoster neuralgia] [Article in German] Absolon P. PMID: 5974225 [PubMed - indexed for MEDLINE] 7393. Vestn Otorinolaringol. 1966 Mar-Apr;28(2):90-1. [Observation of a case of herpes zoster oticus] [Article in Russian] Sidorchuk TV, Ponomarev VS. PMID: 6003065 [PubMed - indexed for MEDLINE] 7394. Actas Dermosifiliogr. 1966 Mar-Apr;57(3):104-6. [Generalized zoster with lethal course] [Article in Spanish] Jaqueti G, Ballesteros N, Corripio F. PMID: 5959649 [PubMed - indexed for MEDLINE] 7395. Bull Soc Fr Dermatol Syphiligr. 1966 Mar-Apr;73(2):157-60. [Apropos of zosterian pains. Their treatment with a new medicinal complex with a base of D-propoxyphene] [Article in French] Rollier R, Rollier M. PMID: 5914157 [PubMed - indexed for MEDLINE] 7396. Rev Med Moyen Orient. 1966 Mar-Apr;23(2):217-20. [Hodgkin's disease and zona] [Article in French] Haddad FS, Haddad FN, Ponthus P. PMID: 5227241 [PubMed - indexed for MEDLINE] 7397. Med Welt. 1966 Feb 12;7:360-2. [Clinical experience with the vitamin combination "Medivitan"] [Article in German] Jähnichen S. PMID: 4166612 [PubMed - indexed for MEDLINE] 7398. Dtsch Med Wochenschr. 1966 Feb 11;91(6):263-7. [On the clinical features, pathogenesis and therapy of herpes zoster especially on the incidence of zoster duplex unilateralis] [Article in German] Helle S. PMID: 4159458 [PubMed - indexed for MEDLINE] 7399. N Engl J Med. 1966 Jan 27;274(4):181-5. Serologic and virus-isolation studies of patients with varicella or herpes-zoster infection. Gold E. PMID: 4285450 [PubMed - indexed for MEDLINE] 7400. Zh Nevropatol Psikhiatr Im S S Korsakova. 1966;66(2):189-93. [Meningitis and meningoencephalitis in herpes zoster] [Article in Russian] Malkova EV. PMID: 6000256 [PubMed - indexed for MEDLINE] 7401. Z Kinderheilkd. 1966;97(4):291-8. [Studies on the enzyme activity in skin blister serum] [Article in German] Sitzmann FC. PMID: 5985318 [PubMed - indexed for MEDLINE] 7402. Gerontol Clin (Basel). 1966;8(2):70-6. A statistical and clinical study of herpes zoster. Hellgren L, Hersle K. PMID: 5925840 [PubMed - indexed for MEDLINE] 7403. Vestn Oftalmol. 1966 Jan-Feb;79(1):48-53. [Cytological changes in the epithelium of the cornea and conjunctiva in herpetic disease of the eye] [Article in Russian] Tarasova LN. PMID: 5298932 [PubMed - indexed for MEDLINE] 7404. Vestn Oftalmol. 1966 Jan-Feb;79(1):45-8. [The role of skin tests in the diagnosis and therapy of herpetic keratits] [Article in Russian] Lavrent'eva AM. PMID: 5298931 [PubMed - indexed for MEDLINE] 7405. Geriatrics. 1966 Jan;21(1):145-54. The etiology of uveitis in the aged. Bergaust B. PMID: 5295374 [PubMed - indexed for MEDLINE] 7406. Acta Med Scand Suppl. 1966;464:57-65. Smallpox outbreak and vaccination problems in Stockholm, Sweden 1963. 3. Diagnosis, clinical classification and symptoms, differential diagnosis and therapy. Ström J, Gerzén P, Herzenberg H, Jansson U, Ursing J, Werneman H. PMID: 5229014 [PubMed - indexed for MEDLINE] 7407. Haematologica. 1966;51(12):947-60. [Histioleukemia appearing during grave disseminated herpes zoster] [Article in Italian] Panelli G, Marigo S, Ferrero E. PMID: 4967330 [PubMed - indexed for MEDLINE] 7408. Acta Neurol Psychiatr Belg. 1966 Jan;66(1):53-75. [Clinical and anatomical study of 2 cases of zosterial encephalitis. Review and discussion of the literature] [Article in French] Perier O, Vanderhaeghen JJ, Franken L, Parmentier N. PMID: 4957520 [PubMed - indexed for MEDLINE] 7409. Int Ophthalmol Clin. 1966 Winter;6(4):869-901. Steroid therapy in uveitis. Coles RS. PMID: 4294917 [PubMed - indexed for MEDLINE] 7410. Klin Monbl Augenheilkd. 1966;149(4):449-57. [On the differential diagnosis of keratitis] [Article in German] Böke W, de Decker W. PMID: 4294222 [PubMed - indexed for MEDLINE] 7411. Vestn Dermatol Venerol. 1966 Jan;40(1):16-20. [On the causative agent of herpes zoster] [Article in Russian] Vasilenko PV. PMID: 4292669 [PubMed - indexed for MEDLINE] 7412. Vopr Virusol. 1966 Jan-Feb;11(1):73-6. [Some properties of various strains of Herpes simplex virus] [Article in Russian] Shubladze AK, Maevskaia TM. PMID: 4292047 [PubMed - indexed for MEDLINE] 7413. Zh Nevropatol Psikhiatr Im S S Korsakova. 1966;66(3):366-70. [Treatment of herpes zoster] [Article in Russian] Malkova EV. PMID: 4175032 [PubMed - indexed for MEDLINE] 7414. Pol Tyg Lek. 1965 Dec 6;20(49):1854-6. [Herpetic viral diseases and systemic lupus erythematosus] [Article in Polish] Vachtenheim J, Grossmann J. PMID: 5862123 [PubMed - indexed for MEDLINE] 7415. Bull Soc Ophtalmol Fr. 1965 Dec;65(12):1116-8. [Zosterian dacryo-adenitis] [Article in French] Paufique L, Bonnet M, Guyon M, Sinno W. PMID: 5295722 [PubMed - indexed for MEDLINE] 7416. Am J Ophthalmol. 1965 Dec;60(6):1111-4. Complications of herpes zoster ophthalmicus. Harrison EQ. PMID: 5295201 [PubMed - indexed for MEDLINE] 7417. Oral Surg Oral Med Oral Pathol. 1965 Dec;20(6):726-42. Bacteriostasis and virology of herpetic lesions of the face and oral mucous membranes. Levin HL. PMID: 5215963 [PubMed - indexed for MEDLINE] 7418. Med J Aust. 1965 Nov 20;2(21):869-72. Treatment of post-herpetic neuralgia. Woodforde JM, Dwyer B, McEwen BW, De Wilde FW, Bleasel K, Connelley TJ, Ho CY. PMID: 5852886 [PubMed - indexed for MEDLINE] 7419. Concours Med. 1965 Nov 20;87(47):6859-60. [Herpes zoster and chickenpox. The relations between these 2 diseases] [Article in French] Tournier P. PMID: 4284739 [PubMed - indexed for MEDLINE] 7420. Nippon Rinsho. 1965 Nov;23(11):2239-45. [Herpes zoster observed in malignant tumor patients, with special reference to their etiology and clinical value] [Article in Japanese] Sunada T, Tanaka S, Omoto T. PMID: 5895395 [PubMed - indexed for MEDLINE] 7421. Ther Ggw. 1965 Nov;104(11):1435-44. [Treatment of varicella zoster virus infections] [Article in German] Nasemann T. PMID: 5885562 [PubMed - indexed for MEDLINE] 7422. J Pediatr. 1965 Nov;67(5):763-71. Factors contributing to severity of herpes zoster in children. Bacon GE, Oliver WJ, Shapiro BA. PMID: 5845441 [PubMed - indexed for MEDLINE] 7423. Eye Ear Nose Throat Mon. 1965 Nov;44(11):71-5. Herpes zoster ophthalmicus---management. Jain BS, Srivastava KN. PMID: 5294365 [PubMed - indexed for MEDLINE] 7424. Dent Clin North Am. 1965 Nov:577-89. Acute lesions of the oral cavity. Huebsch RF. PMID: 5213629 [PubMed - indexed for MEDLINE] 7425. Rev Clin Esp. 1965 Oct 31;99(2):127-8. [Bronchopulmonary neoplasms preceded by generalized herpes zoster] [Article in Spanish] Dumm FR, Acuña F. PMID: 5865077 [PubMed - indexed for MEDLINE] 7426. Minerva Med. 1965 Oct 31;56(87):3681-95. [Action of the blood coagulating fraction of the venom of Bothrops jararaca on herpes zoster, herpes simplex and varicella. First clinico-therapeutic experiences] [Article in Italian] Sannino M, Felici A, Ferrea E. PMID: 5320396 [PubMed - indexed for MEDLINE] 7427. Dermatol Wochenschr. 1965 Oct 23;151(43):1235-7. [Development of a basal cell carcinoma into a completely undifferentiated tumor. Metastasis formation in zoster scar?] [Article in German] Scheicher-Gottron E, Matheis H. PMID: 5881899 [PubMed - indexed for MEDLINE] 7428. Calif Med. 1965 Oct;103(4):277-9. Acute herpes zoster. Successful treatment by continuous epidural analgesia. Marmer MJ. PMCID: PMC1515927 PMID: 5828176 [PubMed - indexed for MEDLINE] 7429. Calif Med. 1965 Oct;103(4):261-6. Muscle paralysis in herpes zoster. Rubin D, Fusfeld RD. Herpes zoster may, in some instances, cause motor paralysis as well as the usual sensory and cutaneous manifestations. It is suggested that the presence of electromyographic denervation potentials be used as the criterion of muscle paresis in order to avoid mistaking atrophy of disuse for true lower motor neuron disease. Use of the proper physical therapy procedures hastens the recovery of function and may serve to retard denervation atrophy and fibrosis in patients with muscle paralysis. PMCID: PMC1515929 PMID: 5828175 [PubMed - indexed for MEDLINE] 7430. Am J Ophthalmol. 1965 Oct;60(4):713-6. Canalicular inflammation in ophthalmic cases of herpes zoster and herpes simplex. Bouzas A. PMID: 5294609 [PubMed - indexed for MEDLINE] 7431. Proc Soc Exp Biol Med. 1965 Oct;120(1):56-9. Zoster-like lesions from herpes simplex virus in newborn rats. Tanaka S, Southam CM. PMID: 4285242 [PubMed - indexed for MEDLINE] 7432. Rev Clin Esp. 1965 Sep 30;98(6):412-5. [A case of multiple myeloma with generalized herpes, hyperlipemia and xanthomatosis] [Article in Spanish] Schuller Pérez A, Pérez Sotelo R, Barreiro Tella P, Martínez Fernández A, De Benito A, Alvarez P. PMID: 5865271 [PubMed - indexed for MEDLINE] 7433. Riforma Med. 1965 Sep 18;79(38):1037-43. [On two cases of acute benign idiopathic pericarditis in the course of infectious mononucleosis and herpes zoster] [Article in Italian] Colonna A, Solinas P. PMID: 5852765 [PubMed - indexed for MEDLINE] 7434. Riforma Med. 1965 Sep 11;79(37):1037-42. [On two cases of acute benign idiopathic pericarditis in the course of infectious mononucleosis and herpes zoster] [Article in Italian] Colonna A, Solinas P. PMID: 5852762 [PubMed - indexed for MEDLINE] 7435. Am J Med. 1965 Sep;39:452-63. VARICELLA-ZOSTER INFECTION IN HODGKIN'S DISEASE: CLINICAL AND EPIDEMIOLOGICAL ASPECTS. SOKAL JE, FIRAT D. PMID: 14338296 [PubMed - indexed for MEDLINE] 7436. Arch Intern Med. 1965 Sep;116:329-35. HERPES ZOSTER HOUSE EPIDEMIC IN STEROID-TREATED PATIENTS. A CLINICAL AND VIRAL STUDY. RADO JP, TAKO J, GEDER L, JENEY E. PMID: 14330618 [PubMed - indexed for MEDLINE] 7437. Jibiinkoka. 1965 Sep;37(9):887-90. [The use of Neuzym (lysozyme) in diseases of the ear, nose and throat] [Article in Japanese] Hine S. PMID: 5890548 [PubMed - indexed for MEDLINE] 7438. Sov Med. 1965 Sep;28(9):127-30. [Current status of the problem of the etiology and pathogenesis of herpes zoster] [Article in Russian] Malkova EV. PMID: 5871686 [PubMed - indexed for MEDLINE] 7439. Klin Med (Mosk). 1965 Sep;43(9):42-4. [Vegetative disturbances in herpes zoster] [Article in Russian] Bogolepov NK, Malkova EV. PMID: 5870048 [PubMed - indexed for MEDLINE] 7440. Bull Los Angeles Neurol Soc. 1965 Sep;30(3):148-52. Conservative treatment of post-herpetic neuralgia. Todd EM, Crue BL Jr, Vergadamo M. PMID: 5847972 [PubMed - indexed for MEDLINE] 7441. Acta Paedopsychiatr. 1965 Sep;32(9):260-9. [Zoster Encephalitis in early childhood] [Article in German] Schipkowensky N. PMID: 5322935 [PubMed - indexed for MEDLINE] 7442. J Lab Clin Med. 1965 Sep;66(3):403-12. Immunofluorescent staining in the laboratory diagnosis of varicella-zoster virus infections. Schmidt NJ, Lennette EH, Woodie JD, Ho HH. PMID: 5319786 [PubMed - indexed for MEDLINE] 7443. Wiad Lek. 1965 Aug 15;18(16):1349-51. [A case of generalized herpes zoster] [Article in Polish] Marks E, Szewczykowski J. PMID: 5853017 [PubMed - indexed for MEDLINE] 7444. Vrach Delo. 1965 Aug;8:148-9. [Catamnesis of patients who have had herpes zoster] [Article in Russian] Malkova EV. PMID: 5870979 [PubMed - indexed for MEDLINE] 7445. Vopr Okhr Materin Det. 1965 Aug;10(8):90-1. 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PMID: 5837719 [PubMed - indexed for MEDLINE] 7473. Br Med J. 1965 Apr 24;1(5442):1127-8. CONCURRENT HERPES ZOSTER AND VARICELLA. MULLER BK, GOMES WJ. PMCID: PMC2165507 PMID: 14270202 [PubMed - indexed for MEDLINE] 7474. N Y State J Med. 1965 Apr 1;65:913-7. MOTOR INVOLVEMENT IN HERPES ZOSTER. IDENTICAL LOWER EXTREMITY PARESIS. WESELEY MS, BARENFELD PA. PMID: 14265338 [PubMed - indexed for MEDLINE] 7475. Pediatria (Santiago). 1965 Apr-Jun;8(2):147-50. [Use of panthenol (Bepantol M. R.) in the treatment of herpes zoster] [Article in Spanish] Vucina I, Romero C, Salinas M, Pezoa L. PMID: 5842690 [PubMed - indexed for MEDLINE] 7476. Dis Chest. 1965 Apr;47(4):451. A renewed plea for the isolation of shingles. Report of a case. Weingarten CM. PMID: 5836927 [PubMed - indexed for MEDLINE] 7477. Osp Ital Chir. 1965 Apr;12(4):505-8. [The hospital of S. Antonio in Florence] [Article in Italian] Mannelli MA. PMID: 5318602 [PubMed - indexed for MEDLINE] 7478. 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COHEN L. PMID: 14241680 [PubMed - indexed for MEDLINE] 7505. Actas Dermosifiliogr. 1965 Jan-Feb;56(1):3-8. [Generalized herpes zoster in a patient with multiple myeloma] [Article in Spanish] Gomez ORBANEJA J, Gomezaaorbaneja J, Ledo Pozueta A, Sanchez Lozano de Sosa. PMID: 5874606 [PubMed - indexed for MEDLINE] 7506. Verh Dtsch Ges Kreislaufforsch. 1965;31:133-7. [Zoster cardiopathy] [Article in German] Siering H. PMID: 5871261 [PubMed - indexed for MEDLINE] 7507. Trans Ophthalmol Soc N Z. 1965;17:81-4. Motor anomalies in herpes zoster ophthalmicus. Wales HJ. PMID: 5295396 [PubMed - indexed for MEDLINE] 7508. Ophthalmologica. 1965;149(5):405-15. [On the pathological anatomy of uveitis] [Article in German] Landolt E. PMID: 5294162 [PubMed - indexed for MEDLINE] 7509. Acta Stomatol Belg. 1965;62(4):463-99. [Buccofacial zona] [Article in French] Servais R. PMID: 5218003 [PubMed - indexed for MEDLINE] 7510. Trans Ophthalmol Soc U K. 1965;85:369-78. 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[EXPERIENCES WITH THE PREPARATION "MEDIVITAN" IN HERPES ZOSTER IN GENERAL PRACTICE.] [Article in German] KOST W. PMID: 14324612 [PubMed - indexed for MEDLINE] 7522. Cardiol Prat. 1964 Oct;15:570-6. [MYOCARDIAL INFARCT ASSOCIATED WITH HERPES ZOSTER. DESCRIPTION OF A CASE.] [Article in Italian] CARIELLO M. PMID: 14292069 [PubMed - indexed for MEDLINE] 7523. Rev Med Chil. 1964 Oct;92:808-9. [USE OF PANTOTHENOL (BEPANTOL) IN THE TREATMENT OF HERPES ZOSTER.] [Article in Spanish] VUCINA I, ROMERO C, SALINAS M, PEZOA L. PMID: 14273926 [PubMed - indexed for MEDLINE] 7524. Ann Ottalmol Clin Ocul. 1964 Oct;90:585-96. [OBSERVATIONS ON THE AUTONOMIC COMPONENTS OF ZOSTER OPHTHALMICUS.] [Article in Italian] CREPALDI A. PMID: 14256768 [PubMed - indexed for MEDLINE] 7525. Ann Dermatol Syphiligr (Paris). 1964 Oct-Dec;91:505-11. [COMPARATIVE IMMUNOELECTROPHORETIC STUDY OF PROTEINS OF SERUM AND BLISTER FLUID IN BULLOUS DERMATOSES (60 CASES).] [Article in French] MOULIN G, MANUEL Y. PMID: 14237502 [PubMed - indexed for MEDLINE] 7526. J Immunol. 1964 Oct;93:643-8. INHIBITION BY METABOLIC ANALOGUES OF PLAQUE FORMATION BY HERPES ZOSTER AND HERPES SIMPLEX VIRUSES. RAPP F. PMID: 14219080 [PubMed - OLDMEDLINE] 7527. J Med Soc N J. 1964 Oct;61:441-6. DERMATOLOGIC PROBLEMS IN THE ELDERLY. SATULSKY EM. PMID: 14199354 [PubMed - indexed for MEDLINE] 7528. Sven Lakartidn. 1964 Sep 30;61:2909-15. [HERPES ZOSTER AND VARICELLAE. 2 CASES OF GENERALIZED HERPES ZOSTER AND CHRONIC LYMPHATIC LEUKEMIA.] [Article in Swedish] RECHT L. PMID: 14222121 [PubMed - indexed for MEDLINE] 7529. Orv Hetil. 1964 Sep 27;105:1839. [OUR EXPERIENCES WITH BIGUAMOR (PRELIMINARY REPORT).] [Article in Hungarian] PAJOR R, HEGEDUES J, BAJNOK G. PMID: 14192634 [PubMed - indexed for MEDLINE] 7530. Lancet. 1964 Sep 19;2(7360):610-1. TREATMENT OF HERPES ZOSTER WITH HIGH DOSES OF PREDNISONE. ELLIOTT FA. PMID: 14186147 [PubMed - indexed for MEDLINE] 7531. Zh Ushn Nos Gorl Bolezn. 1964 Sep-Oct;24:76-7. [2 CASES OF HERPES ZOSTER OTICUS.] [Article in Russian] MARKZITSER AL. PMID: 14322304 [PubMed - indexed for MEDLINE] 7532. Klin Med (Mosk). 1964 Sep;42:135-7. [HERPES ZOSTER OF THE TRIGEMINAL NERVE.] [Article in Russian] ERKHOV IS, EVLADOVA NA, STUPNIKOVA MN. PMID: 14246640 [PubMed - indexed for MEDLINE] 7533. Public Health Rep. 1964 Sep;79:839-42. CRUDE TISSUE CULTURE ANTIGEN FOR DETERMINATION OF VARICELLA-ZOSTER COMPLEMENT FIXING ANTIBODY. BRUNELL PA, CASEY HL. PMCID: PMC1915507 PMID: 14213793 [PubMed - OLDMEDLINE] 7534. Wis Med J. 1964 Sep;63:377-9. HERPES ZOSTER WITH INVOLVEMENT OF THE URINARY BLADDER. EWELL GH, STRAUGHN RA. PMID: 14208130 [PubMed - indexed for MEDLINE] 7535. Rinsho Ganka. 1964 Sep;18:1037-44. [VARIOUS PHASES OF OPHTHALMOPLEGIA (1).] [Article in Japanese] MOTOHASHI T, FUJIWARA T. PMID: 14205675 [PubMed - indexed for MEDLINE] 7536. Lancet. 1964 Aug 22;2(7356):382-5. INTERFERON IN HUMAN SERUM DURING CLINICAL VIRAL INFECTIONS. WHEELOCK EF, SIBLEY WA. PMID: 14173626 [PubMed - OLDMEDLINE] 7537. Hautarzt. 1964 Aug;15:403-8. [NON-SPECIFIC SKIN PHENOMENA IN MALIGNANT TUMORS OF INTERNAL ORGANS.] [Article in German] ANDREEV VC. PMID: 14252760 [PubMed - indexed for MEDLINE] 7538. Dermatol Wochenschr. 1964 Aug 1;150:112-6. [ZOSTER AS A PREMORBID STATE OF A CIRCUMSCRIBED SCLERODERMA.] [Article in German] ZIMMERMANN H. PMID: 14251395 [PubMed - indexed for MEDLINE] 7539. Neurology. 1964 Aug;14:744-50. HERPETIC NEURITIS: A LIGHT AND ELECTRON MICROSCOPIC STUDY. ZACKS SI, ELLIOTT FA, LANGFITT TW. PMID: 14206565 [PubMed - indexed for MEDLINE] 7540. Practitioner. 1964 Aug;193:217-9. THE NATURE OF HERPES ZOSTER. HOPE-SIMPSON RE. PMID: 14199641 [PubMed - indexed for MEDLINE] 7541. Arch Neurol. 1964 Aug;11:155-72. ZOSTER ENCEPHALOMYELITIS. ROSE FC, BRETT EM, BURSTON J. PMID: 14158522 [PubMed - indexed for MEDLINE] 7542. Orv Hetil. 1964 Jul 5;105:1273-5. [CASES OF HERPES ZOSTER DURING A PROLONGED STEROID THERAPY.] [Article in Hungarian] FUELOEP E. PMID: 14179214 [PubMed - OLDMEDLINE] 7543. Orv Hetil. 1964 Jul 5;105:1271-3. [GENERALIZED HERPES ZOSTER COMPLICATED BY MENINGITIS IN A PATIENT TREATED WITH CORTICOSTEROIDS.] [Article in Hungarian] TAKO J, RADO J. PMID: 14179213 [PubMed - OLDMEDLINE] 7544. Orv Hetil. 1964 Jul 5;105:1266-70. [GROUP OCCURRANCE OF HERPES ZOSTER IN PATIENTS TREATED WITH CORTICOSTEROIDS.] [Article in Hungarian] RADO J, TAKO J, GEDER L, JENEY E. PMID: 14179212 [PubMed - OLDMEDLINE] 7545. Dermatol Wochenschr. 1964 Jul 4;150:3-6. [THERAPEUTIC POTENTIALS OF GRISSEOFULVINGRISEOFULVIN AS AN ANTINEOPLASTIC AND ANTIVIRAL AGENT.] [Article in German] RANDAZZO SD, GIARDINA A. PMID: 14252716 [PubMed - indexed for MEDLINE] 7546. Arch Klin Exp Dermatol. 1964 Jul 3;220:105-28. [VIROLOGICAL AND SEROLOGICAL STUDIES IN HERPES ZOSTER.] [Article in German] SOELTZ-SZOETS J. PMID: 14253193 [PubMed - indexed for MEDLINE] 7547. Bristol Med Chir J. 1964 Jul;79:91-2. POLYNEURITIS COMPLICATING HERPES ZOSTER. ETUK ES, BRIDGES D. 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PMID: 14176022 [PubMed - OLDMEDLINE] 7553. Arch Dermatol. 1964 Jul;90:95-6. ZOSTER IN A PATIENT WITH ATOPIC DERMATITIS. VONGEMMINGEN GR, WINKELMANN RK. PMID: 14149733 [PubMed - indexed for MEDLINE] 7554. Gaz Med Fr. 1964 Jun 10;71:SUPPL:35-7. [USE OF TH-2152 IN PAINFUL SYNDROMES.] [Article in French] TASEI LA, ROY JC. PMID: 14160390 [PubMed - OLDMEDLINE] 7555. Klin Med (Mosk). 1964 Jun;42:134-5. [LESIONS OF THE URINARY BLADDER IN HERPES ZOSTER.] [Article in Russian] GOLUBEV IS, MAZO EB. PMID: 14243243 [PubMed - indexed for MEDLINE] 7556. Vestn Dermatol Venerol. 1964 Jun;38:26-9. [HERPES ZOSTER IN RHEUMATOID ARTHRITIS PATIENTS.] [Article in Russian] VACHTENHEIM J. PMID: 14229317 [PubMed - indexed for MEDLINE] 7557. Ann Ottalmol Clin Ocul. 1964 Jun;90:273-84. [HERPES ZOSTER AND OCULAR HYPERTENSION.] [Article in Italian] CHINAGLIA V, BELCI C. PMID: 14210351 [PubMed - indexed for MEDLINE] 7558. Int Ophthalmol Clin. 1964 Jun;4:311-24. OCULAR LESIONS ASSOCIATED WITH OTHER VIRAL DISEASES. 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[OBSERVATION ON HERPES ZOSTER OTICUS.] [Article in Russian] SEREBRIAKOVA SN. PMID: 14202062 [PubMed - indexed for MEDLINE] 7565. Proc Soc Exp Biol Med. 1964 May;116:144-9. A COMPLEMENT-FIXING ANTIGEN FOR VARICELLA-ZOSTER DERIVED FROM INFECTED CULTURES OF HUMAN FETAL DIPLOID CELLS. SCHMIDT NJ, LENNETTE EH, SHON CW, SHINOMOTO TT. PMID: 14200088 [PubMed - OLDMEDLINE] 7566. Bull Soc Fr Dermatol Syphiligr. 1964 May-Jun;71:367-71. [SENSITIVO-MOTOR ZONA OF THE LOWER EXTREMITY, REVEALING WALDENSTROM'S MACROGLOBULINEMIA.] [Article in French] DUVERNE J, BRIZARD CP, VOLLE H, DEMILLY J. PMID: 14195313 [PubMed - indexed for MEDLINE] 7567. Clinique (Paris). 1964 May;59:293-4. [A VIRUSTATIC AGENT WITH LOCAL ACTION.] [Article in French] WEKSTEIN C. PMID: 14169468 [PubMed - indexed for MEDLINE] 7568. Am J Ophthalmol. 1964 May;57:843-6. EPICANTHOID SECONDARY TO HERPES ZOSTER OPHTHALMICUS. GOLDSMITH MO. PMID: 14167202 [PubMed - indexed for MEDLINE] 7569. Practitioner. 1964 May;192:673-4. 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[DERMATO-NEUROLOGICAL OBSERVATIONS IN HERPES ZOSTER.] [Article in Russian] KALAMKARIAN AA, KOCHETKOV VD. PMID: 14200997 [PubMed - indexed for MEDLINE] 7576. Hell Iatr. 1964 Apr;33:386-90. [ON THE ETIOLOGICAL RELATIONSHIP BETWEEN CHICKENPOX AND HERPES ZOSTER.] [Article in Swedish] LOUTSIDES E. PMID: 14142866 [PubMed - indexed for MEDLINE] 7577. J Med Assoc State Ala. 1964 Apr;33:306-8. PARALYSIS OF THE DIAPHRAGM SECONDARY TO HERPES ZOSTER. DONALD TC. PMID: 14141884 [PubMed - indexed for MEDLINE] 7578. Minerva Med. 1964 Mar 28;55:966-7. [HERPES ZOSTER AND CHICKENPOX.] [Article in Italian] DINOLA F. PMID: 14137804 [PubMed - indexed for MEDLINE] 7579. Dia Med. 1964 Mar 26;36:212-3. [LOCAL TREATMENT OF SOME CUTANEOUS VIRUS DISEASES WITH IDU.] [Article in Spanish] VIGLIOGLIA PA, SARACENO EN, BERNAL A, ALGRANATTI A, RINALDI O. PMID: 14145583 [PubMed - indexed for MEDLINE] 7580. Vestn Dermatol Venerol. 1964 Mar;38:81. [HERPES ZOSTER OF THE ORAL MUCOSA AND TONGUE.] [Article in Russian] STURUA GA. PMID: 14183921 [PubMed - indexed for MEDLINE] 7581. Vestn Oftalmol. 1964 Mar-Apr;77:8-12. [EXPERIMENTAL AND CLINICAL STUDIES ON THE USE OF ENZYMES IN OPHTHALMOLOGY.] [Article in Russian] PROTOPOPOV BV, MURZIN AA. PMID: 14176837 [PubMed - indexed for MEDLINE] 7582. Klin Monbl Augenheilkd. 1964 Mar;144:219-29. [ON THE ETIOLOGY OF OCULAR MUSCLE PARALYSIS.] [Article in German] THOMANN H. PMID: 14176401 [PubMed - indexed for MEDLINE] 7583. Hautarzt. 1964 Mar;15:131. [ON MANIFESTATIONS IN THE COURSE OF CUTANEOUS VACCINATIONS DURING A VARIELA EPIDEMIC.] [Article in German] MIERZECKI H. PMID: 14171204 [PubMed - indexed for MEDLINE] 7584. Minerva Dermatol. 1964 Mar;39:81-8. [CURRENT STATUS AND FUTURE PROSPECTS OF THE THERAPEUTIC USE OF GRISEOFULVIN.] [Article in Italian] RANDAZZO SD, GIARDINA A. PMID: 14159835 [PubMed - OLDMEDLINE] 7585. Minerva Dermatol. 1964 Mar;39:81-8. [CURRENT STATUS AND FUTURE PROSPECTS OF THE THERAPEUTIC USE OF GRISEOFULVIN.] [Article in Italian] RANDAZZO SD, GIARDINA A. PMID: 14159568 [PubMed - OLDMEDLINE] 7586. Union Med Can. 1964 Mar;93:317-9. [LEVOMEPROMAZINE IN THE TREATMENT OF PRURIGINOUS DERMATOSES.] [Article in French] PANACCIO V. PMID: 14142346 [PubMed - indexed for MEDLINE] 7587. Rev Med Suisse Romande. 1964 Mar;84:215-7. [APROPOS OF ZONA AND VARICELLA.] [Article in French] BONARD EC. PMID: 14133464 [PubMed - indexed for MEDLINE] 7588. Rev Med Suisse Romande. 1964 Mar;84:211-4. [ZONA AND VARICELLA.] [Article in French] CHRISTELER A, KOENIG R. PMID: 14133463 [PubMed - indexed for MEDLINE] 7589. Am J Ophthalmol. 1964 Mar;57:392-7. PSEUDOMELANOMA OF THE IRIS AFTER HERPES ZOSTER OPHTHALMICUS. KLIEN BA, FARKAS TG. PMID: 14129246 [PubMed - indexed for MEDLINE] 7590. Acta Virol. 1964 Mar;8:135-42. LABORATORY DIAGNOSIS OF SMALLPOX AND SIMILAR VIRAL DISEASES BY MEANS OF TISSUE CULTURE METHODS. II. 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[ON DIFFERENTIAL DIAGNOSIS OF HERPES ZOSTER.] [Article in Russian] MALKOVA EV. PMID: 14177295 [PubMed - indexed for MEDLINE] 7596. Klin Monbl Augenheilkd. 1964 Feb;144:54-8. [ZOSTER EXOPHTHALMOS AND OPHTHALMOPLEGIA.] [Article in German] SIEGERT P. PMID: 14164546 [PubMed - indexed for MEDLINE] 7597. Z Laryngol Rhinol Otol. 1964 Feb;43:103-7. [VARICELLA - HERPES ZOSTER INFECTION.] [Article in German] ROSSBERG G, SCHAUPP H. PMID: 14162275 [PubMed - indexed for MEDLINE] 7598. Toulouse Med. 1964 Feb;65:267-72. [TERRAMYCIN OINTMENT WITH HYDROCORTISONE AND TERRAMYCIN NEBULIZER WITH HYDROCORTISONE AND GENERAL MEDICINE.] [Article in French] BARTHE JJ. PMID: 14143543 [PubMed - OLDMEDLINE] 7599. Hifuka Kiyo. 1964 Feb;59:31-6. [STATISTICAL OBSERVATIONS OF HERPES ZOSTER AND VARICELLA.] [Article in Japanese] NAMIKI S, TAKAHASHI H. PMID: 14134970 [PubMed - indexed for MEDLINE] 7600. J Indian Med Assoc. 1964 Feb 1;42:119-22. MANAGEMENT OF HERPES ZOSTER OPHTHALMICUS. A CLINICAL STUDY OF 78 CASES. JAIN BS, NATH J, SRIVASTAVA KN. PMID: 14126883 [PubMed - OLDMEDLINE] 7601. Am J Ophthalmol. 1964 Feb;57:205-13. RETINOPATHY OF OBSCURE (TOXIC?) ORIGIN IN HODGKIN'S DISEASE. KURZ GH. PMID: 14123443 [PubMed - OLDMEDLINE] 7602. Ann Phys Med. 1964 Feb;10:169-79. UNILATERAL LUMBO-SACRAL ROOT COMPRESSION. YATES DA. PMID: 14120545 [PubMed - indexed for MEDLINE] 7603. Orv Hetil. 1964 Jan 26;105:168-71. [APPENDICITIS AND INFECTIOUS DISEASES.] [Article in Hungarian] PODHRAGYAY L. PMID: 14133786 [PubMed - indexed for MEDLINE] 7604. Med Welt. 1964 Jan 11;33:110-1. [ON THE THERAPY OF HERPES ZOSTER OPHTHALMICUS.] [Article in German] DAMMER M. PMID: 14127681 [PubMed - indexed for MEDLINE] 7605. Bull Soc Ophtalmol Fr. 1964 Jan;64:109-14. [ACTION OF NL,NL-ANHYDROBIS-(BETA-HYDROXYETHYL)-BIGUANIDE HCL ON VIRAL OCULAR DISEASES.] [Article in French] PAUFIQUE L, MAGNARD P, MONTIBERT J. PMID: 14297429 [PubMed - indexed for MEDLINE] 7606. Arcisp S Anna Ferrara. 1964;17:1113-25. [THE RAMSAY-HUNT SYNDROME.] [Article in Italian] RUBERTI A, TOBALDIN G, BURIANI GF. PMID: 14265723 [PubMed - indexed for MEDLINE] 7607. Ber Zusammenkunft Dtsch Ophthalmol Ges. 1964;65:321-2. [NEW VIEWPOINTS ON THE THERAPY OF VIRUS DISEASES OF THE EYE.] [Article in German] BAUER F. PMID: 14260545 [PubMed - indexed for MEDLINE] 7608. Urol Int. 1964;18:96-9. [REFLEX-ANURIA.] [Article in German] BOSHAMER K. PMID: 14215749 [PubMed - indexed for MEDLINE] 7609. Klin Oczna. 1964;34:207-10. [EMETINE THERAPY OF HERPES ZOSTER OPHTHALMICUS.] [Article in Polish] GROSZ I. PMID: 14210058 [PubMed - indexed for MEDLINE] 7610. Otolaryngol Pol. 1964;18:287-9. [AVELLIS' SYNDROME RELATED TO HERPES ZOSTER.] [Article in Polish] JASIENSKA A, KUZNIARZ J. PMID: 14194015 [PubMed - indexed for MEDLINE] 7611. Oftalmol Zh. 1964;19:100-3. [ON PRIMARY HERPETIC KERATOCONJUNCTIVITIS IN CHILDHOOD.] [Article in Russian] KAPLINA KP. PMID: 14176573 [PubMed - indexed for MEDLINE] 7612. HNO. 1964 Jan;12:1-9. [THE CLINICAL PICTURE OF THE ZOSTER OTICUS WITH SPECIAL REFERENCE TO ACUTE DISORDERS AND PERMANENT DAMAGE OF THE ORGAN OF HEARING AND EQUILIBRIUM.] [Article in German] JATHO K, WAHLE H, SCHLOTHANE R, PAMPUS I. PMID: 14157995 [PubMed - indexed for MEDLINE] 7613. J New Drugs. 1964 Jan-Feb;45:38-45. CLINICAL EVALUATION OF SQ 10,269 IN PATIENTS WITH CHRONIC PAIN. CASS LJ, FREDERIK WS. PMID: 14157083 [PubMed - OLDMEDLINE] 7614. Vestn Oftalmol. 1964 Jan-Feb;77:60-1. [DIADYNAMIC CURRENTS IN THE TREATMENT OF HERPETIC KERATITIS.] [Article in Russian] PALAMARCHUK GS. PMID: 14149487 [PubMed - indexed for MEDLINE] 7615. Acta Ophthalmol (Copenh). 1964;42:193-200. OXYPHENBUTAZONE AND ITS USE IN OPHTHALMOLOGY. SVANE-KNUDSEN P. PMID: 14141420 [PubMed - OLDMEDLINE] 7616. Minerva Dermatol. 1964 Jan;39:4-10. [CUTANEOUS VIRAL DISEASES: THEIR FREQUENCY AND TRIAL OF AN ANTIVIRAL AGENT.] [Article in Italian] ELZAWAHRY M. PMID: 14135784 [PubMed - indexed for MEDLINE] 7617. Ophthalmologica. 1964;147:229-34. [OBSERVATIONS OF A MICROBIOLOGIST.] [Article in German] WIESMANN E. PMID: 14133723 [PubMed - indexed for MEDLINE] 7618. Schweiz Arch Neurol Neurochir Psychiatr. 1964;93:35-71. [ON THE CLINICAL PICTURE, PROGNOSIS AND THERAPY OF CRYPTOGENETIC PERIPHERAL FACIAL PARALYSIS WITH SPECIAL REFERENCE TO PREDNISONE THERAPY. CLINICAL STUDIES BASED ON 278 FOLLOW-UP CASES.] [Article in German] MUELLER GP. PMID: 14127224 [PubMed - indexed for MEDLINE] 7619. Jibiinkoka. 1964 Jan;36:45-7. [CASE OF HERPES ZOSTER OTICUS ACCOMPANIED BY MULTIPLE CRANIAL NERVE PARALYSIS.] [Article in Japanese] MARUYAMA R, TAKENOUE T, GOTO K. PMID: 14111131 [PubMed - indexed for MEDLINE] 7620. Gazz Int Med Chir. 1963 Dec 31;68:SUPPL:3281-94. [ON CHANGES IN LEUKOCYTE OXIDO-PEROXIDASE ENZYME ACTIVITY IN INFECTIOUS DISEASES.] [Article in Italian] FRACCHIA P, ANTOGNETTI RM, GIRALDI A. PMID: 14177571 [PubMed - indexed for MEDLINE] 7621. Med Klin. 1963 Dec 13;58:2052-4. [THE CONTROL OF PAIN STATES IN NEUROLOGICAL DISEASES BY NEUROBION.] [Article in German] STOERGER R, MENGI E, REINHARDT G. PMID: 14133384 [PubMed - indexed for MEDLINE] 7622. Dia Med. 1963 Dec 12;35:2059-60. [TREATMENT OF HERPES WITH DIHYDROERGOTAMINE.] [Article in Spanish] GORDON CJ. PMID: 14116560 [PubMed - indexed for MEDLINE] 7623. Gaz Med Fr. 1963 Dec 10;70:3721-8. [ZONA OF THE CRANIAL NERVES.] [Article in French] HAMARD H. PMID: 14102145 [PubMed - indexed for MEDLINE] 7624. Z Arztl Fortbild (Jena). 1963 Dec 1;57:1293-6. [ELECTROCARDIOGRAPHIC CHANGES IN HERPES ZOSTER.] [Article in German] PASTINSZKY I, KENEDI I. PMID: 14112844 [PubMed - indexed for MEDLINE] 7625. Arch Fr Pediatr. 1963 Dec;20:1225-7. [DIAGNOSTIC SIGNIFICANCE OF GIANT CELLS IN CERTAIN INFECTIOUS DISEASES IN CHILDREN.] [Article in French] KURKUS M, PSTRAGOWSKA W, ZALEWSKA I. PMID: 14099573 [PubMed - indexed for MEDLINE] 7626. Br J Clin Pract. 1963 Dec;17:715-9. AUDITORY HERPES ZOSTER WITHOUT AURICULAR ERUPTION. 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PMID: 14157886 [PubMed - indexed for MEDLINE] 7632. Rass Dermatol Sifilogr. 1963 Nov-Dec;16:247-52. [FIRST EXPERIENCES WITH AN INHIBITOR OF VIRAL DNA SYNTHESIS IN DERMATOLOGY.] [Article in Italian] PANCONESI E. PMID: 14127745 [PubMed - OLDMEDLINE] 7633. Hifuka Kiyo. 1963 Nov;58:214-6. [THERAPY OF SKIN DISEASES WITH PR-199 (SALVISOL) OINTMENT.] [Article in Japanese] OKAMOTO S. PMID: 14096285 [PubMed - indexed for MEDLINE] 7634. Naika. 1963 Nov;12:822-5. [ANGINA-LIKE PAIN.] [Article in Japanese] TAKAYASU M. PMID: 14096025 [PubMed - indexed for MEDLINE] 7635. J Indian Med Assoc. 1963 Nov 1;41:456-8. HERPES ZOSTER WITH AN UNUSUAL SEQUELA. SAXENA KN, SRIVASTAVA MC, TANDON MK. PMID: 14083193 [PubMed - indexed for MEDLINE] 7636. Orv Hetil. 1963 Oct 27;104:2031-4. [EXPERIMENTAL ISOLATION OF THE HERPES ZOSTER VIRUS.] [Article in Hungarian] GEDER L, KOLLER M, GOENCOEL E, JENEY E, GOENCOEL I. PMID: 14100358 [PubMed - OLDMEDLINE] 7637. Can Med Assoc J. 1963 Oct 26;89:871-3. THE OCULAR SEQUELAE OF THIRD CRANIAL NERVE PALSY. JOHNSTON AC, PRATT-JOHNSON JA. PMCID: PMC1921927 PMID: 14069610 [PubMed - indexed for MEDLINE] 7638. Bull Mem Soc Med Hop Paris. 1963 Oct 11;114:997-1003. [3 CASES OF GENERALIZED ZONA.] [Article in French] MAHOUDEAU D, BENAIM P, DUBRISAY J, GRUPPER C. PMID: 14098870 [PubMed - indexed for MEDLINE] 7639. Z Haut Geschlechtskr. 1963 Oct 1;35:183-7. [SUCCESSES AND LIMITATIONS OF LOCAL TREATMENT OF SKIN DISEASES WITH FLUOCINOLONE ACETONIDE ("JELLIN") FOIL BANDAGES.] [Article in German] HASSELMANN CM. PMID: 14109396 [PubMed - indexed for MEDLINE] 7640. Hautarzt. 1963 Oct;14:447-51. [ELECTRON MICROSCOPY AND TISSUE CULTURE AS AIDS FOR THE DIAGNOSIS AND DIFFERENTIAL DIAGNOSIS OF VIRAL DERMATOSES.] [Article in German] NASEMANN T, SCHIRREN CG. PMID: 14099981 [PubMed - OLDMEDLINE] 7641. Minerva Dermatol. 1963 Oct;38:339-42. [XENALAMINE IN SKIN DISEASES AND NON-GONOCOCCAL URETHRITIS.] [Article in Italian] DOGLIOTTI M. PMID: 14098401 [PubMed - indexed for MEDLINE] 7642. Minerva Dermatol. 1963 Oct;38:334-7. [ENERGETIC AND FAVORABLE ACTION OF MASSIVE DOSES OF GRISEOFULVIN IN A CASE OF HERPES ZOSTER.] [Article in Italian] RANDAZZO SD, GIARDINA A. PMID: 14098399 [PubMed - indexed for MEDLINE] 7643. Iryo. 1963 Oct;17:609-18. [DIAGNOSIS AND TREATMENT OF VERTIGO.] [Article in Japanese] INO H. PMID: 14092804 [PubMed - OLDMEDLINE] 7644. J Invest Dermatol. 1963 Oct;41:181-96. FLUORESCENCE MICROSCOPY IN DERMATOLOGY. MESCON H, GROTS IA. PMID: 14066596 [PubMed - indexed for MEDLINE] 7645. Surv Ophthalmol. 1963 Oct;54:377-92. UVEITIS ASSOCIATED WITH SYSTEMIC DISEASES. I. BACTERIAL INFECTIONS. COLES RS. PMID: 14057428 [PubMed - indexed for MEDLINE] 7646. Arch Dermatol. 1963 Oct;88:457-8. ZOSTER BRACHIALIS IN AN INFANT. PATNAIK R, THOMAS E. PMID: 14051356 [PubMed - indexed for MEDLINE] 7647. Can Med Assoc J. 1963 Sep 21;89:607-12. CURRENT CONCEPTS IN DERMATOLOGY. II. THE SKIN AND SYSTEMIC DISEASE. JACKSON R. PMCID: PMC1921701 PMID: 14063940 [PubMed - indexed for MEDLINE] 7648. Rhumatologie. 1963 Sep-Oct;15:227-37. [SYMPATHETIC NEURO-OSTEO-TROPHIC SYNDROME CAUSED BY ZONA. GENERAL OBSERVATIONS ON A NEW CASE.] [Article in French] LAPEYRE L, COMMANDRE F, BARALIS G, TARAMASCO H, GUILLEMIN R. PMID: 14194087 [PubMed - indexed for MEDLINE] 7649. Bull Soc Fr Dermatol Syphiligr. 1963 Sep-Oct;70:663-7. [RESULTS OBTAINED IN THE TREATMENT OF SEVERAL DERMATOSES WITH A BIGUANIDE DERIVATIVE.] [Article in French] DELUC J, LABOUCHE. PMID: 14120096 [PubMed - indexed for MEDLINE] 7650. Bull Soc Fr Dermatol Syphiligr. 1963 Sep-Oct;70:732-5. [POSSIBILITIES AND LIMITATIONS OF A BIGUANIDE DERIVATIVE (JD-1022) IN DERMATOLOGY.] [Article in French] HURIEZ C, DESMONS F, BOMBART M, FOSSATI R. PMID: 14119366 [PubMed - indexed for MEDLINE] 7651. Bull Soc Fr Dermatol Syphiligr. 1963 Sep-Oct;70:677-9. [ACTION OF VIRUSTAT IN DERMATOLOGY.] [Article in French] BONNET J, CALAS E, FLORENS A, CASTELAIN PY. PMID: 14119349 [PubMed - indexed for MEDLINE] 7652. Klin Med (Mosk). 1963 Sep;41:45-9. [POSTHERPETIC TRIGEMINAL NEURALGIA.] [Article in Russian] EROKHINA LG, MALKOVA EV. PMID: 14090835 [PubMed - indexed for MEDLINE] 7653. Med Trop (Mars). 1963 Sep-Oct;23:691-4. [ASCENDING POLYRADICULONEURITIC MANIFESTATIONS AND INTERCOSTAL ZONA.] [Article in French] LEVANTI J, VEDY J. PMID: 14086958 [PubMed - indexed for MEDLINE] 7654. J Laryngol Otol. 1963 Sep;77:783-8. CHICKENPOX AND HERPES ZOSTER OTICUS. NAESSEN R. PMID: 14064160 [PubMed - indexed for MEDLINE] 7655. Ther Ggw. 1963 Sep;102:1056-61. [TRIALS WITH THE PERCUTANEOUS USE OF BUTAZOLIDINE.] [Article in German] STEINHOFF H. PMID: 14057436 [PubMed - indexed for MEDLINE] 7656. Arch Dermatol. 1963 Sep;88:322-4. ZOSTER CAUSING VARICELLA. CURRENT DANGERS OF CONTAGION WITHOUT ISOLATION. BRODKIN RH. PMID: 14043626 [PubMed - indexed for MEDLINE] 7657. Hippokrates. 1963 Aug 31;34:672-3. [TRIALS OF LOCAL BUTAZOLIDINE TREATMENT IN DERMATOLOGICAL PRACTICE.] [Article in German] KOCH R. PMID: 14043936 [PubMed - indexed for MEDLINE] 7658. Dia Med. 1963 Aug 5;35:1184-7. [DIAPHRAGMATIC EVENTRATION.] [Article in Spanish] MANGUEL M, BRENER C. PMID: 14060218 [PubMed - indexed for MEDLINE] 7659. J Neurol Neurosurg Psychiatry. 1963 Aug;26:345-52. TRIGEMINAL ROOT AND GANGLION INJECTIONS USING PHENOL IN GLYCERINE FOR THE RELIEF OF TRIGEMINAL NEURALGIA. JEFFERSON A. PMID: 14043050 [PubMed - indexed for MEDLINE] 7660. Pol Tyg Lek. 1963 Jul 15;18:1057-60. [ON HERPES ZOSTER OTICUS.] [Article in Polish] OMULECKI M. PMID: 14074754 [PubMed - indexed for MEDLINE] 7661. Dtsch Z Nervenheilkd. 1963 Jul 10;185:183-90. [ON THE CORTISONE TREATMENT OF VARIOUS INFECTIOUS DISEASES OF THE NERVOUS SYSTEM.] [Article in German] WAHREN W. PMID: 14045383 [PubMed - indexed for MEDLINE] 7662. Psychiatr Neurol Neurochir. 1963 Jul-Oct;66:446-53. [CUTANEOUS SURGERY IN THE TREATMENT OF POST-HERPETIC NEURALGIA OF THE TRUNK.] [Article in French] VERBIEST H, CALLIAUW L. PMID: 14062208 [PubMed - indexed for MEDLINE] 7663. J Chronic Dis. 1963 Jul;16:677-701. INFECTIONS, FEVER AND HOST RESISTANCE IN NEOPLASTIC DISEASES. SILVER RT. PMID: 14047258 [PubMed - indexed for MEDLINE] 7664. Ther Ggw. 1963 Jul;102:837-40. [1ST TRIALS WITH MEDIVITAN IN HERPES ZOSTER.] [Article in German] NICKEL G, WALTHER H. PMID: 14045818 [PubMed - indexed for MEDLINE] 7665. Cesk Neurol. 1963 Jul;26:280-3. [ZOSTER POLYRADICULONEURITIS WITH MANIFESTATIONS OF LANDRY'S PARALYSIS.] [Article in Czech] NEVSIMAL O, LEHOVSKY M. PMID: 14042823 [PubMed - indexed for MEDLINE] 7666. Proc R Soc Med. 1963 Jul;56:615-6. Herpes zoster presenting with retention of urine. BURKE J. PMCID: PMC1897274 PMID: 14017040 [PubMed - indexed for MEDLINE] 7667. J Assoc Physicians India. 1963 Jul;11:597-9. Quadriplegia following herpes zoster. A case report. MERCHANT HC, RAMAMOORTHY K, CHOKSI ND, SHIKARIPURKAR NK, SHAH SR. PMID: 13934939 [PubMed - indexed for MEDLINE] 7668. Sem Hop. 1963 Jun 20;39:1553-4. [Digestive disorders during thoraco-abdominal zona (D5-L1).] [Article in French] DEBRAY C, MEHAUTM. PMID: 14026249 [PubMed - indexed for MEDLINE] 7669. Sem Hop. 1963 Jun 20;39:1540-50. [Paralysis of the large muscles of the abdomen during thoraco-abdominal zona (D5-l1).] [Article in French] DEBRAY C, MEHAUT M. PMID: 14026248 [PubMed - indexed for MEDLINE] 7670. Br Med J. 1963 Jun 15;1(5345):1605. Herpes zoster and steroid therapy. FRY A. PMCID: PMC2124268 PMID: 13959963 [PubMed - indexed for MEDLINE] 7671. Pol Tyg Lek. 1963 Jun 10;18:865-8. [ON THERAPEUTIC PROBLEMS IN HERPES ZOSTER.] [Article in Polish] GUTKOWSKA K. PMID: 14069111 [PubMed - indexed for MEDLINE] 7672. Med J Aust. 1963 Jun 8;50(1):850-3. Herpes zoster and its motor lesions, with a report of a case of phrenic nerve paralysis. SPIERS AS. PMID: 13990116 [PubMed - indexed for MEDLINE] 7673. Harefuah. 1963 Jun 2;64:371. [The chemotherapy of herpes zoster.] [Article in Hebrew] COHEN A. PMID: 14021988 [PubMed - indexed for MEDLINE] 7674. Laval Med. 1963 Jun;34:642-60. [Dermatosis and internal cancers.] [Article in French] BUREAU Y, BARRIERE H. PMID: 14016934 [PubMed - indexed for MEDLINE] 7675. Magy Radiol. 1963 Jun;15:161-3. [Herpes zoster following roentgen irradiation.] [Article in Hungarian] VETRO E. PMID: 13996975 [PubMed - indexed for MEDLINE] 7676. Pol Przegl Radiol Med Nukl. 1963 May-Jun;27:259-64. [SYMPTOMATIC HERPES ZOSTER DURING THE COURSE OF A NEOPLASTIC DISEASE.] [Article in Polish] OSINSKA M, ULKOWSKI M. PMID: 14057297 [PubMed - indexed for MEDLINE] 7677. Pol Przegl Radiol Med Nukl. 1963 May-Jun;27:259-64. [SYMPTOMATIC HERPES ZOSTER DURING THE COURSE OF A NEOPLASTIC DISEASE.] [Article in Polish] OSINSKA M, ULKOWSKI M. PMID: 14056688 [PubMed - indexed for MEDLINE] 7678. Skin (Los Angeles). 1963 May;2:151. The prodrome and syndrome of herpes zoster. RONCHESE F. PMID: 13982665 [PubMed - indexed for MEDLINE] 7679. W V Med J. 1963 May;59:120-2. Generalized herpes zoster (with case report and review of the literature). GILE JH. PMID: 13947852 [PubMed - indexed for MEDLINE] 7680. Med Klin. 1963 Apr 26;58:699-701. [Local recurrences in existing immunity. On the pathomechanism of zoster, lip herpes and other diseases.] [Article in German] HORING FO. PMID: 13954897 [PubMed - indexed for MEDLINE] 7681. Minerva Med. 1963 Apr 14;54:1064-5. [Varicella as a result of the corticoid therapy of herpes zoster.] [Article in Italian] MOSONYI L, GSIKY T, KUCSERA P. PMID: 13936188 [PubMed - indexed for MEDLINE] 7682. Lancet. 1963 Apr 6;1(7284):752. Korsakov's syndrome following herpes-zoster encephalitis. HALL P. PMID: 13952125 [PubMed - OLDMEDLINE] 7683. Bull Soc Fr Dermatol Syphiligr. 1963 Apr-May;70:202-4. [ACTION OF VIRUSTAT IN ZONA, HERPES AND APHTHOSA.] [Article in French] LAUGIER P, BULTE C. PMID: 14075178 [PubMed - indexed for MEDLINE] 7684. Arch Phys Med Rehabil. 1963 Apr;44:233-4. Ramsay Hunt syndrome: report of a case. SMITH IC. PMID: 13989443 [PubMed - indexed for MEDLINE] 7685. Med Bull US Army Eur. 1963 Apr;20:106. Phrenic paralysis due to herpes zoster. A case report. BEARD HW. PMID: 13969945 [PubMed - indexed for MEDLINE] 7686. Am J Clin Pathol. 1963 Apr;39:389-92. Diagnostic patterns-vesicular lesions of the skin. GOULD SE, HINERMAN DL, BATSAKIS JG, BEAMER PR. PMID: 13949564 [PubMed - indexed for MEDLINE] 7687. Lancet. 1963 Mar 23;1(7282):669-70. Hypertension with herpes zoster. SCHWARCZMANN P. PMID: 13987348 [PubMed - indexed for MEDLINE] 7688. Z Arztl Fortbild (Jena). 1963 Mar 15;57:320-4. [Herpes zoster and collagen diseases.] [Article in German] VACHTENHEIM J. PMID: 13995674 [PubMed - indexed for MEDLINE] 7689. Monatsschr Ohrenheilkd Laryngorhinol. 1963 Mar-May;97:115-21. [FACIAL PARALYSIS AS A COMPLICATION OF EAR DISEASES.] [Article in German] STRICKER G. PMID: 14081036 [PubMed - indexed for MEDLINE] 7690. Arch Dermatol. 1963 Mar;87:393-4. Two interesting cases of zoster. KILE RL. PMID: 14032597 [PubMed - indexed for MEDLINE] 7691. Arch Dermatol. 1963 Mar;87:393-4. Two interesting cases of zoster. KILE RL. PMID: 14032596 [PubMed - indexed for MEDLINE] 7692. Cesk Oftalmol. 1963 Mar;19:104-8. [On the problem of corneal nerve involvement in ocular herpes zoster.] [Article in Czech] SIMKOVA M. PMID: 13993037 [PubMed - indexed for MEDLINE] 7693. Br Med J. 1963 Feb 23;1(5329):493-6. Clinical clues in virus infections. TYRRELL DA. PMCID: PMC2123438 PMID: 13995046 [PubMed - indexed for MEDLINE] 7694. Orv Hetil. 1963 Feb 3;104:234-5. [Data on the clinical aspect of herpes zoster.] [Article in Hungarian] HEGEDUS S. PMID: 13953306 [PubMed - indexed for MEDLINE] 7695. Rev Bras Med. 1963 Feb;20:118-9. [BRIEF CASE-REPORTS.] [Article in Portuguese] MONTERA A. PMID: 14150276 [PubMed - indexed for MEDLINE] 7696. East Afr Med J. 1963 Feb;40:39-46. DERMATOLOGICAL PHOTOGRAPHY. HARGREAVES A. PMID: 14071690 [PubMed - indexed for MEDLINE] 7697. Z Gesamte Inn Med. 1963 Jan 15;18:63-5. [Defense against infection by insulin.] [Article in German] MESSNER J. PMID: 13935148 [PubMed - indexed for MEDLINE] 7698. Zh Nevropatol Psikhiatr Im S S Korsakova. 1963;63:1828-34. [LESIONS OF THE NERVOUS SYSTEM IN HERPES ZOSTER.] [Article in Russian] MALKOVA EV. PMID: 14189574 [PubMed - indexed for MEDLINE] 7699. Br J Ophthalmol. 1963 Jan;47:60-1. HERPES ZOSTER OPHTHALMICUS IN AN 8-YEAR-OLD CHILD. BIRKS DA. PMCID: PMC505751 PMID: 14186864 [PubMed - indexed for MEDLINE] 7700. J Egypt Med Assoc. 1963;46:1303-14. VIRUS SKIN DISEASES: FREQUENCY AND TRIAL OF AN ANTIVIRAL AGENT. ELZAWAHRY M. PMID: 14162107 [PubMed - indexed for MEDLINE] 7701. Prog Med Virol. 1963;5:219-94. VIRUS DISEASES ASSOCIATED WITH CUTANEOUS ERUPTIONS. WENNER HA, LOU TY. PMID: 14159144 [PubMed - indexed for MEDLINE] 7702. Nervenarzt. 1963 Jan;34:12-23. [DISORDERS OF THE FEMORAL NERVE. A CONTRIBUTION TO THEIR ETIOLOGY BY MEANS OF CATAMNESTIC EXAMINATIONS IN 22 CASES.] [Article in German] KAMMERER T. PMID: 14157237 [PubMed - indexed for MEDLINE] 7703. Arch Ortop. 1963;76:205-11. [ZONAL SACCROCOCCYGEAL DERMATITIS IN THE POSTOPERATIVE COURSE IN HEMILAMINECTOMY.] [Article in Italian] MARSANO R. PMID: 14133261 [PubMed - indexed for MEDLINE] 7704. Trans Ophthalmol Soc U K. 1963;83:647-51. HERPES ZOSTER OPHTHALMICUS. ORR HC. PMID: 14123180 [PubMed - indexed for MEDLINE] 7705. Acta Derm Venereol. 1963;43:544-7. BASOPHIL LEUKOCYTES IN LESIONS OF VARIOUS DERMATOSES. ASPEGREN N, FREGERT S, RORSMAN H. PMID: 14088644 [PubMed - OLDMEDLINE] 7706. Otolaryngol Pol. 1963;17:89-93. [HERPES ZOSTER OF THE UPPER RESPIRATORY TRACT.] [Article in Polish] KWILMAN A, RUDNY J. PMID: 14057975 [PubMed - indexed for MEDLINE] 7707. Pediatr Pol. 1963 Jan;38:27-32. [DIAGNOSTIC SIGNIFICANCE OF GIANT CELLS IN SOME INFECTIOUS DISEASES IN CHILDREN.] [Article in Polish] KURKUS M, PSTRAGOWSKA W, ZALEWSKA I. PMID: 14048494 [PubMed - indexed for MEDLINE] 7708. Gerontol Clin (Basel). 1963;5:77-86. The place of neurosurgery in the care of the aged. KERR AS. PMID: 14042145 [PubMed - indexed for MEDLINE] 7709. Clin Orthop Relat Res. 1963;27:200-5. Resistant herpes neuralgia. Case report. DAVIS ED. PMID: 14025464 [PubMed - indexed for MEDLINE] 7710. J Dent Res. 1963 Jan-Feb;2:343-7. Exfoliative cytology in evaluating oral lesions. COOKE BE. PMID: 14022793 [PubMed - indexed for MEDLINE] 7711. Sem Hop Ther Paris. 1963 Jan;39:24-8. [Study of Virustat in dermatology. Apropos of 34 cases.] [Article in French] VERNIER P, MENANTEAU JP. PMID: 13996851 [PubMed - indexed for MEDLINE] 7712. Oral Surg Oral Med Oral Pathol. 1963 Jan;16:120-2. Ramsey-Hunt syndrome (herpes zoster meningo-encephalitis). SWOOPE CC Jr. PMID: 13979744 [PubMed - indexed for MEDLINE] 7713. Med Esp. 1963 Jan;49:17-9. [Facial herpes-like process with involvement of several homolateral pairs of cranial nerves (extrinsic and intrinsic ophthalmoplegia, etc.)] [Article in Spanish] BARRAQUER-BORDAS L, DE ASPRER-CASADO J. PMID: 13969501 [PubMed - indexed for MEDLINE] 7714. Arch Dermatol. 1963 Jan;87:18-27. Cytodiagnosis of inflammatory dermatoses. GRAHAM JH, BINGUL O, BURGOON CB Jr. PMID: 13949775 [PubMed - indexed for MEDLINE] 7715. Acta Med Acad Sci Hung. 1963;19:23-30. Electrocardiographic changes associated with herpes zoster. PASTINSZKY I, KENEDI I. PMID: 13941740 [PubMed - indexed for MEDLINE] 7716. Med Welt. 1962 Dec 8;49:2615-7. [Disorders of bladder emptying and zoster.] [Article in German] BERGHAUS H. PMID: 13970710 [PubMed - indexed for MEDLINE] 7717. Fulorrgegegyogyaszat. 1962 Dec;8:182-6. [Postoperative sinus thrombosis following herpes zoster cephalicus.] [Article in Hungarian] JURCSAK L. PMID: 14029953 [PubMed - indexed for MEDLINE] 7718. Oral Surg Oral Med Oral Pathol. 1962 Dec;15:1434-6. Herpes zoster involving the fifth and tenth cranial nerves. BURTSCHI TA. PMID: 14017251 [PubMed - indexed for MEDLINE] 7719. Lille Med. 1962 Dec;7:1027-9. [An epidemic of zona.] [Article in French] WAROT P, FOISSAC-GEGOUX P. PMID: 13998967 [PubMed - indexed for MEDLINE] 7720. Fulorrgegegyogyaszat. 1962 Dec;8:182-6. [Postoperative sinus thrombosis following herpes zoster cephalicus.] [Article in Hungarian] JURCSAK L. PMID: 13958101 [PubMed - indexed for MEDLINE] 7721. Nervenarzt. 1962 Dec;33:538-40. [Herpes zoster oticus with multiple simultaneous cranial nerve deficiencies.] [Article in German] GUETSCHOW E. PMID: 13951161 [PubMed - indexed for MEDLINE] 7722. J Ultrastruct Res. 1962 Dec;7:409-17. Fine structure of the Zoster virus in human skin. LUTZNER MA. PMID: 13931855 [PubMed - indexed for MEDLINE] 7723. Presse Med. 1962 Nov 17;70:2343-5. [Relapsing typhoid fever, relapsing meningoencephalitis and herpes zoster.] [Article in French] PERROUTY P, DAOULAS R, BERTON M. PMID: 13942614 [PubMed - indexed for MEDLINE] 7724. Bull Soc Ophtalmol Fr. 1962 Nov;62:554-6. [A rare sequel of ophthalmic zona: fatty dystrophy of the cornea.] [Article in French] COLLIER M. PMID: 14022337 [PubMed - indexed for MEDLINE] 7725. Arch Neurol. 1962 Nov;7:423-6. Surgical treatment of postherpetic neuralgia. Results of skin undermining and excision in 14 patients. TINDALL GT, ODOM GL, VIETH RG. PMID: 13985113 [PubMed - indexed for MEDLINE] 7726. Fukushima Igaku Zasshi. 1962 Oct;12:329-33. [Herpes zoster after irradiation.] [Article in Japanese] KIMURA K, ANAZAWA A, TAKAKUDA K. PMID: 14041698 [PubMed - indexed for MEDLINE] 7727. Neurology. 1962 Oct;12:725-7. Postherpetic neuralgia. SEHGAL AD, GARDNER WJ. PMID: 13910276 [PubMed - indexed for MEDLINE] 7728. Med Klin. 1962 Sep 28;57:1651-2. [On the treatment of inflammatory neurological diseases with a vitamin-enzyme combination.] [Article in German] PRITZSCHE G. PMID: 13986258 [PubMed - indexed for MEDLINE] 7729. Med Klin. 1962 Sep 28;57:1644-7. [On cases of zoster ophthalmicus.] [Article in German] GRAEBER W. PMID: 13949722 [PubMed - indexed for MEDLINE] 7730. Pol Tyg Lek. 1962 Sep 3;17:1430-3. [A case of generalized herpes zoster with paresis during the course of chronic lymphatic leukemia.] [Article in Polish] SYC S, PEC K. PMID: 13979756 [PubMed - indexed for MEDLINE] 7731. Ned Tijdschr Geneeskd. 1962 Sep 1;106:1749-53. [Herpes and zoster.] [Article in Dutch] PRAKKEN JR. PMID: 14488476 [PubMed - indexed for MEDLINE] 7732. Bull Soc Fr Dermatol Syphiligr. 1962 Aug-Oct;69:828-9. [Xenalamine in the treatment of viral dermatoses of the herpes zona group. (Preliminary note)] [Article in French] COLOMB D. PMID: 14041487 [PubMed - indexed for MEDLINE] 7733. Bull Soc Fr Dermatol Syphiligr. 1962 Aug-Oct;69:828-9. [Xenalamine in the treatment of viral dermatoses of the herpes zona group. (Preliminary note)] [Article in French] COLOMB D. PMID: 14041395 [PubMed - indexed for MEDLINE] 7734. Bull Soc Fr Dermatol Syphiligr. 1962 Aug-Oct;69:828-9. [Xenalamine in the treatment of viral dermatoses of the herpes zona group. (Preliminary note)] [Article in French] COLOMB D. PMID: 14040724 [PubMed - indexed for MEDLINE] 7735. N C Med J. 1962 Aug;23:357-60. Abitylguanide (ABOB) in treating herpes zoster. WILKINSON JS. PMID: 14007060 [PubMed - indexed for MEDLINE] 7736. J Radiol Electrol Med Nucl. 1962 Aug-Sep;43:567-8. [105 cases of zoster treated by radiotherapy of the posterior roots.] [Article in French] WANGERMEZ C, ESBELIN R, WANGERMEZ J, WANGERMEZ A, BISCH X. PMID: 13998821 [PubMed - indexed for MEDLINE] 7737. Z Haut Geschlechtskr. 1962 Aug 1;33:77-84. [A special clinical course of Hodgkin's disease in herpes zoster.] [Article in German] RAAB W. PMID: 13972808 [PubMed - indexed for MEDLINE] 7738. Klin Monbl Augenheilkd Augenarztl Fortbild. 1962 Aug;141:116-22. [Atrophy of the optic nerve and ophthalmoplegia in ophthalmic zoster.] [Article in German] VOGELSANG K. PMID: 13926453 [PubMed - OLDMEDLINE] 7739. Am J Ophthalmol. 1962 Aug;54:298-301. Isolated abducens paresis complicating herpes zoster ophthalmicus. HERMANN JS. PMID: 13906716 [PubMed - OLDMEDLINE] 7740. Sem Med. 1962 Jul 12;121:158-61. [Action of vitamin B-1 and B-12 in massive doses in posterpes zoster neuralgia.] [Article in Spanish] RABINSTEIN S, BUMAGUIN DE RABINSTEIN S. PMID: 13972883 [PubMed - indexed for MEDLINE] 7741. Arch Intern Med. 1962 Jul;110:98-101. Herpes zoster generalisatus pneumonia. Varicella pneumonia in a patient with herpes zoster generalisatus; report of a case in a patient with Hodgkin's disease. KAIN HK, FELDMAN CA, COHN LH. PMID: 14453135 [PubMed - indexed for MEDLINE] 7742. Arch Ital Otol Rinol Laringol. 1962 Jul-Aug;73:485-512. [Herpes zoster oticus. (Clinical study and pathogenetic consideratkons on 10 cases)] [Article in Italian] CIS C, BORGO M. PMID: 14021417 [PubMed - indexed for MEDLINE] 7743. Arch Pediatr. 1962 Jul;79:263-5. Herpes zoster associated with small pox vaccination. SCHNECK H. PMID: 13908882 [PubMed - indexed for MEDLINE] 7744. Bull Soc Fr Dermatol Syphiligr. 1962 Jun-Jul;69:508-10. [Paralytic herpes zoster of the upper extremity. Electromyographic study.] [Article in French] BUREAU Y, BARRIERE H, GUIARD D, LITOUX, VEILHAN. PMID: 14016931 [PubMed - indexed for MEDLINE] 7745. Radiol Med. 1962 Jun;48:589-601. [Contribution to the pathogentic problem of herpes zoster in the course of irradiated neoplastic forms. Presentation of 21 personal cases.] [Article in Italian] CIAMPELLI I, CROCELLA R. PMID: 13879471 [PubMed - indexed for MEDLINE] 7746. Dtsch Med J. 1962 May 5;13:259-66. [Diseases caused by herpes viruses (herpes simplex, zoster, herpangina).] [Article in German] KOEPPE HW. PMID: 14457723 [PubMed - indexed for MEDLINE] 7747. Clin Med (Northfield Il). 1962 May;69:1173-4. Herpes zoster opthalmicus: systemic steroid therapy. SCHEIE HE, McLELLAN TG Jr. PMID: 15445866 [PubMed - indexed for MEDLINE] 7748. Actas Dermosifiliogr. 1962 May;53:236-7. [Presentation of a case of generalized gangrenous zona.] [Article in Spanish] ALVAREZ CASCOS M. PMID: 14012394 [PubMed - indexed for MEDLINE] 7749. Laryngoscope. 1962 May;72:653-63. Herpes zoster involving the head and neck. WELSH LW, WELSH JJ. PMID: 14006067 [PubMed - OLDMEDLINE] 7750. J Indian Med Assoc. 1962 Apr 1;38:345-6. Herpes ophthalmicus with varicella. BEHERA UC, MISRA MC. PMID: 13866581 [PubMed - indexed for MEDLINE] 7751. Practitioner. 1962 Mar;188:396-7. Herpes zoster as an infectious disease. WILSON JB. PMID: 14007363 [PubMed - indexed for MEDLINE] 7752. Hifuka No Rinsho. 1962 Mar;4:137-46. [Relation between herpes zoster and blister.] [Article in Japanese] SUZUKI S. PMID: 13918634 [PubMed - indexed for MEDLINE] 7753. Klin Med (Mosk). 1962 Mar;40:143-6. [A case of combined herpes zoster and chickenpox.] [Article in Russian] ASHMARIN IuIa, ORLOVA MV. PMID: 13862856 [PubMed - indexed for MEDLINE] 7754. Ugeskr Laeger. 1962 Jan 26;124:103-6. [Keratitis herpetica. Unfortunate results after treatment with corticosteroids.] [Article in Danish] MADSEN PH. PMID: 14468140 [PubMed - indexed for MEDLINE] 7755. Pol Tyg Lek. 1962 Jan 15;17:100-3. [Herpes zoster oticus (Ramsey Hunt syndrome).] [Article in Polish] OSWALDO-RUSINOWA A. PMID: 14037227 [PubMed - OLDMEDLINE] 7756. Ann Ottalmol Clin Ocul. 1962 Jan;88:22-7. [Observations on the use of prednisolone hemisuccinate in various ocular diseases.] [Article in Italian] PALIAGA GP. PMID: 14483331 [PubMed - indexed for MEDLINE] 7757. Otolaryngol Pol. 1962;16:381-6. [Herpes zoster oticus.] [Article in Polish] MALICKA K. PMID: 14468907 [PubMed - indexed for MEDLINE] 7758. Dtsch Z Nervenheilkd. 1962;183:589-99. [Meningoencephalitis after zoster with a tendency to torsion along the longitudinal axis and body image disorders.] [Article in German] KNUEPPEL H. PMID: 14457394 [PubMed - indexed for MEDLINE] 7759. Wien Z Nervenheilkd Grenzgeb. 1962;19:285-90. [Myelitis zosteriana.] [Article in German] RISTIC J, GOSPAVIC J, TIL E. PMID: 13974060 [PubMed - indexed for MEDLINE] 7760. Lek Wojsk. 1962;38:1115-20. [Herpes zoster cephalicus.] [Article in Polish] KWILMAN A, RUDNY J. PMID: 13927757 [PubMed - indexed for MEDLINE] 7761. Bull Soc Fr Dermatol Syphiligr. 1962 Jan-Mar;69:164-5. [Especially painful hemorrhagic zona, refractory to therapy, in a young woman undergoing corticotherapy for chronic evolutive polyarthritis.] [Article in French] VIGNON G, COLOMB D, BADY B. PMID: 13925889 [PubMed - indexed for MEDLINE] 7762. Neurol Neurochir Psychiatr Pol. 1962 Jan-Feb;12:131-3. [Recurrent herpes zoster of the face after a severe cranial injury.] [Article in Polish] STEPIEN M. PMID: 13916939 [PubMed - OLDMEDLINE] 7763. J Mich State Med Soc. 1962 Jan;61:60-2. Surgical treatment of postherpetic neuralgia by subdermal denervation. FARBMAN AA. PMID: 13891596 [PubMed - indexed for MEDLINE] 7764. Am J Med. 1962 Jan;32:25-31. Herpes zoster encephalitis. APPELBAUM E, KREPS SI, SUNSHINE A. PMID: 13861912 [PubMed - indexed for MEDLINE] 7765. Dia Med. 1961 Nov 20;33:2789. [Herpes zoster. Its treatment with histamine.] [Article in Spanish] SCOLNIK AJ. PMID: 13909886 [PubMed - indexed for MEDLINE] 7766. Boll Ocul. 1961 Nov;40:791-9. [Bilateral herpetic keratitis and Kaposi's varicelliform eruption.] [Article in Italian] MAGGI C. PMID: 14468270 [PubMed - indexed for MEDLINE] 7767. Clinique (Paris). 1961 Oct 15;56:498-500. [Radiotherapy in zona.] [Article in French] FRAIN C, DABAN C. PMID: 13894446 [PubMed - indexed for MEDLINE] 7768. Cas Lek Cesk. 1961 Oct 13;100:1284-9. [Experiences with vitamin B12 in neurological diseases, especially herpes zoster.] [Article in Czech] PRAGEROVA V, WAELSCH JH. PMID: 14488464 [PubMed - indexed for MEDLINE] 7769. Sem Hop. 1961 Oct 2;37:2653-60. [Herpes of the newborn with auriculo-ventricular dissociation. Clinical, anatomic and virological study.] [Article in French] BERNARD R, PAYAN H, TAMALET J, AUDIBERT G. PMID: 13868056 [PubMed - OLDMEDLINE] 7770. Ann Ottalmol Clin Ocul. 1961 Oct;87:578-82. [A case of isolated paralysis of the abducent nerve in the course of ophthalmic herpes zoster.] [Article in Italian] NUCCI E. PMID: 14480685 [PubMed - OLDMEDLINE] 7771. Dia Med. 1961 Oct;33(Special):2483-5. [Atypical cells in vesicles and in peripheral blood in zona (herpes zoster).] [Article in Spanish] MINOPRIO JL, DURANDEU A, ROSALES SR, LEMOS E. PMID: 14474356 [PubMed - indexed for MEDLINE] 7772. Acta Otolaryngol. 1961 Oct;53:536-8. Glossopharyngeal zoster. HEIBERG S. PMID: 13905965 [PubMed - indexed for MEDLINE] 7773. Rev Prat. 1961 Sep 11;11:2275-85. [Clinical forms and complications of zona (with the exclusion of ocular complications).] [Article in French] KISSEL P, DUREUX JB. PMID: 13756408 [PubMed - indexed for MEDLINE] 7774. Rev Prat. 1961 Sep 11;11:2287-94. [Ophthalmic zona.] [Article in French] FOREST A, JEGLOT A. PMID: 13700762 [PubMed - indexed for MEDLINE] 7775. Rev Prat. 1961 Sep 11;11:2327-33. [Treatment of herpes and zona.] [Article in French] CELICE J. PMID: 13691882 [PubMed - indexed for MEDLINE] 7776. Rev Prat. 1961 Sep 11;11:2263-73. [The herpes virus and the varicella-zona virus.] [Article in French] CATHALA F. PMID: 13691560 [PubMed - indexed for MEDLINE] 7777. Cas Lek Cesk. 1961 Sep 8;100:1141-5. [Lesions of the central nervous system during the course of herpes zoster.] [Article in Czech] DUNIEWICZ M, KROO A, DOBIAS J. PMID: 13888474 [PubMed - indexed for MEDLINE] 7778. Acta Med Scand. 1961 Sep;170:339-49. Herpes zoster--varicellae in cases of leukemia. A clinical report including determination of serum proteins and total hemolytic complement. NORDEN A, SWAHN B. PMID: 14480283 [PubMed - indexed for MEDLINE] 7779. J Mt Sinai Hosp N Y. 1961 Sep-Oct;28:473-4. Herpes zoster and varicella occurring in siblings following contact with chickenpox. REICH JS, BAUMAL A. PMID: 13740417 [PubMed - indexed for MEDLINE] 7780. Dia Med. 1961 Aug 7;33:1556-9. [Considerations on the therapeutic use of a proteolytic enzyme extracted from the gastric mucosa of the hog.] [Article in Spanish] SAGRERAS RP. PMID: 13745393 [PubMed - indexed for MEDLINE] 7781. N Z Med J. 1961 Aug;60:382-90. The myotonic convergence reaction of the pupil and herpes zoster: with a localisation of the lesion and a note on the corneal reflex. ALLEN IM. PMID: 13860544 [PubMed - indexed for MEDLINE] 7782. Arch Otolaryngol. 1961 Aug;74:178-80. The Ramsey Hunt syndrome. Report of a case with vestibular and cochlear involvement successfully treated with prednisolone acetate (Medrol). MADDOX HE 3rd. PMID: 13765051 [PubMed - indexed for MEDLINE] 7783. Orv Hetil. 1961 Jul 30;102:1470-2. [Rare cases of herpes zoster oticus and their treatment.] [Article in Hungarian] FURSTNER J, KRALOVANSZKY Z. PMID: 13702682 [PubMed - OLDMEDLINE] 7784. Minerva Med. 1961 Jul 4;52:2362-4. [Meniere-like syndrome caused by auricular zona.] [Article in Italian] BAROCCI C. PMID: 13687163 [PubMed - OLDMEDLINE] 7785. Dis Chest. 1961 Jul;40:74-5. Herpes zoster pneumonitis: case report. WILSON FW, MATLOCK TB. PMID: 13785652 [PubMed - indexed for MEDLINE] 7786. JAMA. 1961 Jun 24;176:1041-3. Treatment of herpetic pain and postherpetic neuralgia with intravenous procaine. SHANBROM E. PMID: 13750666 [PubMed - indexed for MEDLINE] 7787. Aust J Dermatol. 1961 Jun;6:54-8. Herpes zoster: intravenous procaine in the treatment of post-herpetic neuralgia. GUNTHER WW, SCHALIT I. PMID: 13902979 [PubMed - indexed for MEDLINE] 7788. Nippon Hifuka Gakkai Zasshi. 1961 Jun;71:642-50. [Electron microscopic study of viral diseases.] [Article in Japanese] DOHI J, OTA Y, AMANO F, MORI R, TAKAKI F, YASUDA H, SUZUKI A, WAKAMORI T. PMID: 13723471 [PubMed - indexed for MEDLINE] 7789. Jibiinkoka. 1961 Jun;33:519-24. [Herpes zoster of the external ear.] [Article in Japanese] ICHIHARA M, KOMATSU A, MATSUMOTO M. PMID: 13717362 [PubMed - OLDMEDLINE] 7790. J Hyg (Lond). 1961 Jun;59:249-58. The soluble antigens of varicella-zoster virus produced in tissue culture. CAUNT AE, RONDLE CJ, DOWNIE AW. PMCID: PMC2134421 PMID: 13691671 [PubMed - indexed for MEDLINE] 7791. Dia Med. 1961 May 22;33:789-98. [Observations on 65 cases of zona. Clinico-therapeutic deductions.] [Article in Spanish] D'AGOSTINO M. PMID: 13719120 [PubMed - indexed for MEDLINE] 7792. Trans Indiana Acad Ophthalmol Otolaryngol. 1961 May;44:5-7. Gamma globulin in the treatment of herpes zoster (a case report). SLAUGHTER HC. PMID: 13913826 [PubMed - indexed for MEDLINE] 7793. Bull Soc Ophtalmol Fr. 1961 May-Jun;5:345-7. [Physical therapy in zona ophthalmica.] [Article in French] CORDIER J, ALGAN B, STEHLIN H. PMID: 13881310 [PubMed - OLDMEDLINE] 7794. Med World. 1961 May;94:421-3. B12 peptide in shingles and chickenpox. JOLLES KE. PMID: 13790421 [PubMed - indexed for MEDLINE] 7795. Laboratorio. 1961 May;39:95-8. [On lesions of certain internal organs in herpes zoster.] [Article in Russian] MARTYNOV IV, ASHMARIN IuIa, BUROV GP. PMID: 13767614 [PubMed - indexed for MEDLINE] 7796. J Neurol Neurosurg Psychiatry. 1961 May;24:167-72. Herpes zoster and the Landry-Guillain-Barre syndrome. KNOX JD, LEVY R, SIMPSON JA. PMCID: PMC495383 PMID: 13757221 [PubMed - indexed for MEDLINE] 7797. Hawaii Med J. 1961 May-Jun;20:449-50. Zoster facialis. A case report. CLARK JR. PMID: 13693841 [PubMed - OLDMEDLINE] 7798. Sem Hop. 1961 Apr 8;37:1212-4. [Apropos of geniculate herpes zoster.] [Article in French] BEAL G. PMID: 13688198 [PubMed - indexed for MEDLINE] 7799. Ophthalmologica. 1961 Apr;141:271-7. [On the clinical aspects and therapy of herpes zoster ophthalmicus.] [Article in German] LEUENBERGER A. PMID: 13761274 [PubMed - OLDMEDLINE] 7800. Stud Gen (Berl). 1961 Apr;89:505-6. [Epidemic hepatitis and herpes zoster.] [Article in Undetermined Language] KRCIC M. PMID: 13754162 [PubMed - indexed for MEDLINE] 7801. Oral Surg Oral Med Oral Pathol. 1961 Apr;14:414-8. Herpes zoster of the mandibular nerve. Report of a case. GARDNER JA, HANFT RJ. PMID: 13703615 [PubMed - OLDMEDLINE] 7802. Rev Neurol (Paris). 1961 Apr;104:342-5. [Apropos of zosterian paralysis. 1. Zona of the geniculate ganglion with diaphragmatic paralysis. 2. Brachial zona with homolateral brachial paralysis, heterolateral crural paralysis and albumino-cytological dissociation of the cerebrospinal fluid.] [Article in French] CREMIEUX A, ROGER J, POINSO Y, RAMELLA B. PMID: 13696384 [PubMed - OLDMEDLINE] 7803. JAMA. 1961 Mar 25;175:1104-6. A false-positive Treponema pallidum complement fixation (TPCF) test. MANDEL EH, MARKEL J, KIM YP. PMID: 13766055 [PubMed - indexed for MEDLINE] 7804. JAMA. 1961 Mar 18;175:1008-10. Herpes zoster resembling acute varicella associated with multiple myeloma. YAFFEE HS, GREENBERG MS. PMID: 13787040 [PubMed - indexed for MEDLINE] 7805. J Indian Med Assoc. 1961 Mar 16;36:243-4. Geniculate herpes with herpes of the fifth cranial nerve and posterior roots of first two cervical nerves with facial paralysis. KAMDAR HR. PMID: 13751019 [PubMed - indexed for MEDLINE] 7806. Minerva Med. 1961 Mar 3;52:798-801. [Herpes zoster associated with acute meningoencephalitis with outcome of dementia.] [Article in Italian] MANZINI B. PMID: 13766358 [PubMed - indexed for MEDLINE] 7807. Arch Ital Otol Rinol Laringol. 1961 Mar-Apr;72:193-237. [Auricular herpes zoster.] [Article in Italian] TRIVELLA G, MASCIALINO L. PMID: 13922534 [PubMed - OLDMEDLINE] 7808. J Belge Med Phys Rhumatol. 1961 Mar-Apr;16:49-54. [Electromyography in 7 cases of zona with paralysis.] [Article in French] ROSSELLE N, VAN BETSBRUGGE A, DE DEKEN E, FOLLON H, LIGOT S. PMID: 13743671 [PubMed - indexed for MEDLINE] 7809. Vestn Otorinolaringol. 1961 Mar-Apr;23:23-7. [On the problem of herpes zoster oticus.] [Article in Russian] NIKOL'SKAIA MI. PMID: 13729106 [PubMed - indexed for MEDLINE] 7810. Tidsskr Nor Laegeforen. 1961 Mar 1;81:248-50. [Varicella-herpes zoster. A case of herpes zoster generalisatus.] [Article in Norwegian] ENGER SC. PMID: 13696864 [PubMed - indexed for MEDLINE] 7811. Presse Med. 1961 Feb 18;69:347-8. [Zona.] [Article in French] PESTEL M. PMID: 13734723 [PubMed - indexed for MEDLINE] 7812. Bull Off Chambre Synd Med Seine. 1961 Feb 10;56:233-5. [The anniversary of herpes zoster. A contribution to the history of neurodermatology.] [Article in German] LEIBBRAND W. PMID: 13760516 [PubMed - indexed for MEDLINE] 7813. Przegl Epidemiol. 1961;15:423-4. [Herpes zoster and chickenpox.] [Article in Polish] KRAJEWSKA B. PMID: 14459249 [PubMed - indexed for MEDLINE] 7814. An Fac Med Univ Repub Montev Urug. 1961;46:232-9. [Ophthalmic herpes zoster.] [Article in Spanish] FERRER J, VIGNALE A. PMID: 13892562 [PubMed - OLDMEDLINE] 7815. G Psichiatr Neuropatol. 1961;89:145-66. [Considerations on a case of unilateral Argyll Robertson pupil subsequent to ophthalmic zona.] [Article in Italian] TARASCHI G, TOSARELLI L. PMID: 13775290 [PubMed - indexed for MEDLINE] 7816. Wien Z Nervenheilkd Grenzgeb. 1961;18:224-35. [Lesion of the central nervous system during an attack of herpes zoster.] [Article in German] KROO AH, DUNIEWICZ M, DOBIAS J. PMID: 13754511 [PubMed - indexed for MEDLINE] 7817. Arch Ohren Nasen Kehlkopfheilkd. 1961;177:187-92. [On the histopathology of zoster oticus.] [Article in German] GRUENBERG H. PMID: 13709193 [PubMed - OLDMEDLINE] 7818. Srp Arh Celok Lek. 1960 Dec;88:1207-17. [Herpes zoster oticus.] [Article in Undetermined Language] DJORDJEVIC S, SIMONOVIC M. PMID: 13723185 [PubMed - indexed for MEDLINE] 7819. Arch Maragliano Patol Clin. 1960 Dec;16:987-1000. [Considerations on 2 cases of neuraxitis associated with herpes zoster.] [Article in Italian] GAMBARO GC, PAVERO A, DE GAETANI G. PMID: 13703247 [PubMed - indexed for MEDLINE] 7820. Oral Surg Oral Med Oral Pathol. 1960 Dec;13:1429-37. Herpes zoster-a primary manifestation of chronic lymphatic leukemia; report of a case. CHACONAS CP. PMID: 13692121 [PubMed - indexed for MEDLINE] 7821. J Med (Oporto). 1960 Nov 5;43:448-9. [Treatment of zona.] [Article in Portuguese] GEISER JD. PMID: 13704224 [PubMed - indexed for MEDLINE] 7822. Practitioner. 1960 Nov;185:680. A dressing for herpes zoster. CORBETT AC. PMID: 13695434 [PubMed - indexed for MEDLINE] 7823. Rum Med Rev. 1960 Oct-Dec;4:33-5. Varicellous herpes zoster, with special reference to 3 cases. DUNA F, VOICULESCU M. PMID: 13724958 [PubMed - indexed for MEDLINE] 7824. Lancet. 1960 Sep 24;2(7152):671-3. Alleviation of post-herpetic neuralgia. TEVERNER D. PMID: 13776135 [PubMed - indexed for MEDLINE] 7825. Dermatol Wochenschr. 1960 Sep 24;142:1049-54. [A contribution to the zoster problem.] [Article in German] HOCHLEITNER H. PMID: 13714779 [PubMed - indexed for MEDLINE] 7826. Ann Intern Med. 1960 Sep;53:523-33. Herpes zoster in hematologic neoplasias: some unusual manifestations. SHANBROM E, MILLER S, HAAR H. PMID: 13750664 [PubMed - indexed for MEDLINE] 7827. Minerva Dermatol. 1960 Sep;35:354-70. [On the histopathogenesis of leukoses. (Apropos of a case of generalized herpes zoster inlymphatic leukemia)] [Article in Italian] SAPUPPO A. PMID: 13746454 [PubMed - indexed for MEDLINE] 7828. Wis Med J. 1960 Sep;59:565-9. Herpes zoster generalisatus. CHELIUS CJ. PMID: 13692741 [PubMed - indexed for MEDLINE] 7829. Lyon Med. 1960 Aug 7;92:255-9. [Bucco-facial zona.] [Article in French] FREIDEL C, BERTOIN P, MATHIEU L, LOIRE. PMID: 13701677 [PubMed - OLDMEDLINE] 7830. Arch Dermatol. 1960 Aug;82:247-9. Herpes zoster trigeminal neural gia. Pain relief by alcoholic block of the great occipital nerve. SKILLERN SD, RODIN H. PMID: 13831475 [PubMed - indexed for MEDLINE] 7831. Strahlentherapie. 1960 Aug;112:587-94. [Herpes zoster after x-irradiation.] [Article in German] KOEHLER J. PMID: 13831012 [PubMed - indexed for MEDLINE] 7832. Bull Soc Fr Dermatol Syphiligr. 1960 Aug-Oct;67:814-5. [Generalized visceral zona in a leukemia patient.] [Article in French] THIERS H, COLOMB D, GATE A, FAYOLLE J, MIRAILLET P. PMID: 13776347 [PubMed - indexed for MEDLINE] 7833. S Afr Med J. 1960 Jul 9;34:594-5. A new approach to the treatment of herpes zoster. RAFF A. PMID: 14435806 [PubMed - indexed for MEDLINE] 7834. Med J Aust. 1960 Jul 9;47(2):63-4. Herpes zoster ophthalmicus and pregnancy. WILSON E. PMID: 13845047 [PubMed - indexed for MEDLINE] 7835. Minerva Fisioter Radiobiol. 1960 Jul-Aug;5:196-200. [Antalgic effectiveness of roentgenotherapy in various diseases.] [Article in Italian] MAGGI GC, GRASSI E. PMID: 13765218 [PubMed - OLDMEDLINE] 7836. Arch Pediatr Urug. 1960 Jul;31:379-82. [A case of association of zona ophthalmica and varicella in a 9-year-old boy.] [Article in Spanish] FOSSATI H, TAQUIOSI A, MASSERA MJ, DE BERTERRECHE JA. PMID: 13700954 [PubMed - indexed for MEDLINE] 7837. Sem Med. 1960 Jun 23;116:1249-50. [Clinical experience with promazine.] [Article in Spanish] RIU JA. PMID: 13741918 [PubMed - indexed for MEDLINE] 7838. Br Med J. 1960 Jun 4;1(5187):1713. Herpes zoster occuring in a patient with chicken-pox. TAYLOR-ROBINSON D. PMCID: PMC1967716 PMID: 13855032 [PubMed - indexed for MEDLINE] 7839. W V Med J. 1960 Jun;56:191-3. Treatment of herpes zoster ophthalmicus (with case reports). SHUPALA E. PMID: 14446332 [PubMed - indexed for MEDLINE] 7840. Minerva Dermatol. 1960 Jun;35:245-8. [Synergistic polyvitamin combination with ATP in the treatment of herpes zoster.] [Article in Italian] ALBERTAZZI F. PMID: 13792395 [PubMed - indexed for MEDLINE] 7841. Ann Inst Pasteur (Paris). 1960 May;98:750-3. [Preservation of the herpes virus.] [Article in French] LEPINE P, ARTZET F, CEO LIN G. PMID: 14415877 [PubMed - indexed for MEDLINE] 7842. Pa Med J. 1960 May;63:697-8. Use of protamide in the treatment of herpes zoster. BAKER AG. PMID: 13795972 [PubMed - indexed for MEDLINE] 7843. Minn Med. 1960 May;43:346. Herpes zoster treated with prednisolone. TUDOR RB. PMID: 13778550 [PubMed - indexed for MEDLINE] 7844. Monatsschr Ohrenheilkd Laryngorhinol. 1960 Apr;94:79-81. [Herpes zoster of the maxillary sinus confirmed by endoscopy.] [Article in German] WODAK E. PMID: 13845542 [PubMed - OLDMEDLINE] 7845. Rev Cubana Cardiol. 1960 Apr-Jun;21:57-74. [Electrocardiographical changes in herpes zoster.] [Article in Spanish] PUJOL J. PMID: 13738434 [PubMed - indexed for MEDLINE] 7846. Ann Ottalmol Clin Ocul. 1960 Apr;86:115-20. [Treatment of human herpetic keratitis with new synthetic antiviral agents.] [Article in Italian] PALIAGA GP. PMID: 13732226 [PubMed - indexed for MEDLINE] 7847. Munch Med Wochenschr. 1960 Mar 4;102:479-80. [Concordant zoster oticus in uniovular twins.] [Article in German] NEUSS O. PMID: 14426723 [PubMed - OLDMEDLINE] 7848. Riv Clin Pediatr. 1960 Mar;65:201-11. [Considerations on an epidemic of varicella caused by a case of herpes zoster in a tuberculous meningitis ward.] [Article in Italian] RAGAZZINI F. PMID: 14435842 [PubMed - indexed for MEDLINE] 7849. Sov Med. 1960 Mar;24:140-1. [On the effectiveness of pantothenic acid in the treatment of herpes zoster.] [Article in Russian] CHEBOTAREV KS. PMID: 13809543 [PubMed - indexed for MEDLINE] 7850. Rev Neuropsiquiatr. 1960 Mar;23:113-24. [Optic neuromyelitis zoster with pseudoileus.] [Article in Spanish] ROEDENBECK S. PMID: 13742668 [PubMed - indexed for MEDLINE] 7851. Clin Otorinolaringoiatr. 1960 Mar-Apr;12:133-47. [Pharyngo-otic zona: clinicoserological considerations.] [Article in Italian] CERESIA G, ROSSI M. PMID: 13691963 [PubMed - OLDMEDLINE] 7852. Sem Hop. 1960 Feb 18;36:497-505. [The role of the nervous system in the appearance of gynecomastia.] [Article in French] SEILLE G, de BRUX, ENTAT F. PMID: 14444636 [PubMed - OLDMEDLINE] 7853. R I Med J. 1960 Feb;43:104. Autohemotherapy in the treatment of post-herpetic pain. SCHIFF BL. PMID: 14442736 [PubMed - indexed for MEDLINE] 7854. Arch Ophthalmol. 1960 Feb;63:273-80. Herpes zoster ophthalmicus complicated by contralateral hemiplegia. LAWS HW. PMID: 14414739 [PubMed - OLDMEDLINE] 7855. Sov Med. 1960 Feb;24:140. [Treatment of herpes zoster with levomycetin.] [Article in Russian] ZEL'DIN GS. PMID: 13847196 [PubMed - indexed for MEDLINE] 7856. Minerva Dermatol. 1960 Feb;35:71-2. [Lymphatic leukemia and generalized herpes zoster.] [Article in Italian] CORICCIATI L. PMID: 13811973 [PubMed - indexed for MEDLINE] 7857. Bull Soc Fr Dermatol Syphiligr. 1960 Jan-Mar;67:163-6. [Cervicobrachial zona, followed by a sudden viral generalization.] [Article in French] PRUNIERAS M, de BEER. PMID: 14435152 [PubMed - indexed for MEDLINE] 7858. Rev Prat. 1960;32:38-41. [Foreign body of the cornea and zona. (Physiopathological and medicolegal considerations)] [Article in French] GIROIRE, CHARBONNEL, VERCELLETTO. PMID: 13850291 [PubMed - indexed for MEDLINE] 7859. Klin Monbl Augenheilkd Augenarztl Fortbild. 1960;136:230-3. [Zoster opthalmicus gangraenosus with loss of the eyeball.] [Article in German] DODEN W. PMID: 13817142 [PubMed - indexed for MEDLINE] 7860. J Chronic Dis. 1960 Jan;11:69-76. Postherpetic pain. CRIKELAIR GF, MINERVINI F. PMID: 13812864 [PubMed - indexed for MEDLINE] 7861. Bull Soc Fr Dermatol Syphiligr. 1960 Jan-Mar;67:15-7. [Pemphigus foliaceus complicated by zona, treated by the association of quinacrine, aureomycin in large doses and corticotherapy in small doses.] [Article in French] BOLGERT M, LE SOURD M, PEILLON F. PMID: 13802295 [PubMed - indexed for MEDLINE] 7862. Trans Am Ophthalmol Soc. 1960;58:245-62. The unfavorable effect of topical steroid therapy on herpetic keratitis. THYGESON P, HOGAN MJ, KIMURA SJ. PMCID: PMC1316376 PMID: 13776796 [PubMed - indexed for MEDLINE] 7863. Hautarzt. 1960 Jan;11:32-4. [The modification of herpes zoster by dihydroergotamine Sandoz.] [Article in German] MATANIC V. PMID: 13768026 [PubMed - indexed for MEDLINE] 7864. Annee Ther Clin Ophtalmol. 1960;11:387-98. [Medical treatment of ophthalmic zona.] [Article in French] SEDAN J, FARNARIER G. PMID: 13749567 [PubMed - OLDMEDLINE] 7865. Sven Lakartidn. 1959 Dec 23;56:3682-4. [Herpes zoster and acute abdomen.] [Article in Swedish] CULLHED I. PMID: 13813247 [PubMed - indexed for MEDLINE] 7866. Sven Lakartidn. 1959 Dec 18;56:3563-6. [Herpes zoster treated with N',N-anhydrobis(2-hydroxyethyl)-biguanide HC1 (ABOB).] [Article in Swedish] SCHERSTEN B. PMID: 14442681 [PubMed - indexed for MEDLINE] 7867. Nord Med. 1959 Dec 10;62:1767-71. [Herpes zoster oticus.] [Article in Norwegian] NORDAHL T. PMID: 14427561 [PubMed - OLDMEDLINE] 7868. Br J Exp Pathol. 1959 Dec;40:521-32. Chickenpox and herpes zoster. III. Tissue culture studies. TAYLOR-ROBINSON D. PMID: 13855031 [PubMed - indexed for MEDLINE] 7869. Br J Exp Pathol. 1959 Dec;40:517-20. Chickenpox and herpes zoster. II. Ouchterlony precipitation studies. TAYLOR-ROBINSON D, RONDLE CJ. PMID: 13855030 [PubMed - indexed for MEDLINE] 7870. Pa Med J. 1959 Dec;62:1827-30. Adrenal corticosteroids in herpes zoster. FREEMAN JT. PMID: 13824743 [PubMed - indexed for MEDLINE] 7871. Pol Tyg Lek. 1959 Nov 30;14:2106-9. [On herpetic meningospinal meningitis.] [Article in Polish] WOLSKI J. PMID: 13845778 [PubMed - indexed for MEDLINE] 7872. Hippokrates. 1959 Nov 15;30:789-91. [Experiences with the treatment of herpes zoster.] [Article in German] NEBEL C. PMID: 14426285 [PubMed - indexed for MEDLINE] 7873. J Indian Med Assoc. 1959 Nov 1;33:377-8. Herpes of the geniculate ganglion. SITARAMAN N. PMID: 14447232 [PubMed - indexed for MEDLINE] 7874. Montp Med. 1959 Nov;56:232-7. [The shoulder-hand syndrome in cervicobrachial zona.] [Article in French] SERRE H, SIMON L. PMID: 14445125 [PubMed - OLDMEDLINE] 7875. Practitioner. 1959 Nov;183:587-95. Herpes simplex and varicella-zoster. MACCALLUM FO. PMID: 14419272 [PubMed - indexed for MEDLINE] 7876. Bull Soc Ophtalmol Fr. 1959 Nov;8:737-41. [2 Rare ocular manifestations of ophthalmic zona: retinal periarteritis, "dysoric nodules".] [Article in French] COLLIER M. PMID: 13848209 [PubMed - OLDMEDLINE] 7877. Bull Soc Ophtalmol Fr. 1959 Nov;8:761-4. [Atypical tuberculous keratitis and corneal viroses.] [Article in French] THOMAS C, CORDIER J, ALGAN B. PMID: 13837917 [PubMed - OLDMEDLINE] 7878. Bull Soc Fr Dermatol Syphiligr. 1959 Nov-Dec;5:817-9. [Varicella or generalized zona of rapid development in a patient with myeloid leukemia.] [Article in French] DUPONT A, VANDAELE R. PMID: 13818743 [PubMed - indexed for MEDLINE] 7879. Bull Soc Ophtalmol Fr. 1959 Nov;8:742-7. [Left ophthalmic zona. Scleral complications, osteoporosis of the superior maxilla, congenital abnormalities of the iris and fundus of the eye.] [Article in French] COLLIER M. PMID: 13811239 [PubMed - OLDMEDLINE] 7880. Vie Med. 1959 Nov;40:999-1000. [Treatment of common zona.] [Article in French] AMIEL C. PMID: 13793181 [PubMed - indexed for MEDLINE] 7881. J Am Med Assoc. 1959 Oct 17;171:876-80. Herpes zoster in children. WINKELMANN RK, PERRY HO. PMID: 13856493 [PubMed - indexed for MEDLINE] 7882. Munch Med Wochenschr. 1959 Oct 2;101:1736-7. [Indications of a segmental manifestation of a latent herpes zoster.] [Article in German] ARNDT J, BUTTENBERG H. PMID: 13794339 [PubMed - OLDMEDLINE] 7883. Arch Ophthalmol. 1959 Oct;62:579-87. Treatment of herpes zoster ophthalmicus with corticotropin and corticosteroids. SCHEIE HG, McLELLAN TG Jr. PMID: 14442569 [PubMed - OLDMEDLINE] 7884. Ophthalmologica. 1959 Oct;138:311-4. [A new procedure for the treatment of keratitis herpetica.] [Article in German] ALBERTH B. PMID: 13792396 [PubMed - indexed for MEDLINE] 7885. Nord Med. 1959 Sep 24;62:1414-7. [Accumulation of cases of herpes zoster generalisatus.] [Article in Swedish] FLODERUS S, ROLANDER A. PMID: 13823542 [PubMed - indexed for MEDLINE] 7886. Sem Hop. 1959 Sep 18-28;35:2572-8. [Lymphadenia, terrain of choice for certain ectodermo-neurotropic viruses (the chickenpox-herpes zoster virus in particular).] [Article in French] BOUSSER J, CHRISTOL D, GROUBERMANN S. PMID: 13803382 [PubMed - indexed for MEDLINE] 7887. N Engl J Med. 1959 Sep 3;261:517-8. CORTISONE and herpes zoster. [No authors listed] PMID: 13857821 [PubMed - indexed for MEDLINE] 7888. Arch Ophthalmol. 1959 Sep;62:381-5. The treatment of ophthalmic herpes zoster with protamide. SCASSELLATI SFORZOLINI G. PMID: 14442262 [PubMed - indexed for MEDLINE] 7889. Ann Otolaryngol Chir Cervicofac. 1959 Sep;76:796-8. [Zona of the pneumogastric.] [Article in French] PONCET P, BARON G. PMID: 14433982 [PubMed - indexed for MEDLINE] 7890. J Am Osteopath Assoc. 1959 Sep;59:10-1. Herpes zoster ophthalmicus. GILLETT CF. PMID: 13850103 [PubMed - indexed for MEDLINE] 7891. Br Med Bull. 1959 Sep;15:197-200. Chickenpox and zoster. DOWNIE AW. PMID: 13817909 [PubMed - indexed for MEDLINE] 7892. Pol Tyg Lek. 1959 Aug 31;14:1619-20. [Two cases of generalized herpes zoster in chronic lymphatic leukemia.] [Article in Polish] WYSOCKI K, DURKALEC J. PMID: 13846312 [PubMed - indexed for MEDLINE] 7893. Wien Med Wochenschr. 1959 Aug 8;109:636-7. [Zoster changes of the eye.] [Article in German] KREIBIG W. PMID: 14411887 [PubMed - indexed for MEDLINE] 7894. J Med Liban. 1959 Aug;12:404-5. [Herpes zoster ophthalmicus.] [Article in Arabic] SALEEBY S. PMID: 14440936 [PubMed - indexed for MEDLINE] 7895. Br J Exp Pathol. 1959 Aug;40:398-409. Chickenpox and herpes zoster. 1. Complement fixation studies. TAYLOR-ROBINSON D, DOWNIE AW. PMID: 13837220 [PubMed - indexed for MEDLINE] 7896. Br J Ophthalmol. 1959 Aug;43:471-6. Lesions of the ciliary ganglion as a cause of Argyll Robertson and Adie pupils. CAMERON ME. PMCID: PMC509836 PMID: 13807165 [PubMed - indexed for MEDLINE] 7897. Ugeskr Laeger. 1959 Jul 30;121:1199-200. [Zoster ophthalmicus generalisatus.] [Article in Danish] NORN MS. PMID: 14427643 [PubMed - OLDMEDLINE] 7898. Ann N Y Acad Sci. 1959 Jul 21;81:6-16. A comparison of in vitro and in vivo characteristics as related to the pathogenesis of measles, varicella, and herpes zoster. CHEATHAM WJ. PMID: 13809542 [PubMed - indexed for MEDLINE] 7899. Scalpel (Brux). 1959 Jul 4;112(27):637-40. Not Available [Article in English, French] ROSSELLE N, DE DONCKER K, JOLIE P, VAN BETSBRUGGE A, LIGOT S, TORDEURS J, MAGNUS L. PMID: 13675753 [PubMed - indexed for MEDLINE] 7900. Br J Ophthalmol. 1959 Jul;43:438-9. Vitamin B12 and herpes zoster ophthalmicus. HEATON JM. PMCID: PMC509826 PMID: 14400447 [PubMed - indexed for MEDLINE] 7901. Arch Ital Otol Rinol Laringol. 1959 Jul-Aug;70:601-18. [Considerations on the pathogenesis of cochleo-vestibular manifestations associated with herpes zoster.] [Article in Italian] GIORDANO R, ZANOTTI G. PMID: 13828059 [PubMed - OLDMEDLINE] 7902. Ann Anat Pathol (Paris). 1959 Jul-Sep;4:574-86. [Anatomoclinical study of two cases of zosterian adenitis.] [Article in French] FRUHLING L, SACREZ R, LE GAL Y, PORTE P, DORNER M. PMID: 13825439 [PubMed - indexed for MEDLINE] 7903. Minerva Med. 1959 Jun 13;50(47):1921-4. [Medullary pseudoaplasia with leukemoid manifestation & hemorrhagic herpes zoster in relation to prednisone treatment for ulcerative colitis.] [Article in Italian] BILE G, MANES L, VENTRUTO V. PMID: 13674233 [PubMed - indexed for MEDLINE] 7904. Concours Med. 1959 May 30;81(22):2567-8. [Various cases of indolent zonas.] [Article in French] SIDI E, HINCKY M. PMID: 13663529 [PubMed - indexed for MEDLINE] 7905. N Engl J Med. 1959 May 21;260(21):1062-5. Herpes zoster involving the urinary bladder. MEYER R, BROWN HP, HARRISON JH. PMID: 13657339 [PubMed - indexed for MEDLINE] 7906. Z Haut Geschlechtskr. 1959 May 15;26(10):292-4. [Atypical courses in herpes zoster.] [Article in German] JANSON P. PMID: 13669574 [PubMed - indexed for MEDLINE] 7907. J Oral Surg Anesth Hosp Dent Serv. 1959 May;17(3):57-9. Herpes zoster of the mandibular division of the trigeminal nerve: report of a case. JARABAK JP. PMID: 13665436 [PubMed - OLDMEDLINE] 7908. J Neurol Neurosurg Psychiatry. 1959 May;22(2):120-3. Acute demyelinating disease complicating herpes zoster. McALPINE D, KUROIWA Y, TOYOKURA Y, ARAKI S. PMCID: PMC497361 PMID: 13655101 [PubMed - indexed for MEDLINE] 7909. Presse Med. 1959 Apr 25;67(21):859-60. [Is any efficiency to be attributed to herpes zoster treatments.] [Article in French] LE BEAU J, CASTAIGNE P, DELZANT O, GAILLARD G, MEYER DE SCHMID JJ, MOLLARET P. PMID: 13658016 [PubMed - indexed for MEDLINE] 7910. Sem Hop. 1959 Apr 12;35(17):1273-81. [Not Available] [Article in French] LAYANI F, DURUPT L, PAQUET J. PMID: 13646778 [PubMed - OLDMEDLINE] 7911. Bull Soc Ophtalmol Fr. 1959 Apr;No 4:304-9. [Medicolegal considerations on posttraumatic zona (in reality, abuses).] [Article in French] SEDAN J. PMID: 14444431 [PubMed - indexed for MEDLINE] 7912. Bull Soc Fr Dermatol Syphiligr. 1959 Apr-May;66:250-1. [Zona with double homolateral localization.] [Article in French] FOUSSEREAU J, HIRSCH C. PMID: 13824206 [PubMed - indexed for MEDLINE] 7913. Bull Soc Fr Dermatol Syphiligr. 1959 Apr-May;66:259-60. [Abdominocrural zona after metastasis of uterine cancer.] [Article in French] BONNET J, CALAS E, DAVIN A, COULIER L. PMID: 13802562 [PubMed - OLDMEDLINE] 7914. Z Haut Geschlechtskr. 1959 Apr 1;26(7):194-8. [Peroral and parenteral pyramidon-pyrazolidine therapy of erythema exudative multiforme, erythema nodosum contusiforme and zoster with irgapyrine.] [Article in German] MATANIC V. PMID: 13648551 [PubMed - indexed for MEDLINE] 7915. AMA Arch Neurol Psychiatry. 1959 Apr;81(4):433-8. Myeloradiculo-ganglionitis following zoster. PALFFY G, BALAZS A. PMID: 13636512 [PubMed - OLDMEDLINE] 7916. Sem Hop. 1959 Mar 4;35(11):872-5. [Emetine in the treatment of zona; report on five years of experience.] [Article in French] GRIVEAUD E, ACHARD J. PMID: 13646738 [PubMed - indexed for MEDLINE] 7917. J Belge Med Phys Rhumatol. 1959 Mar-Apr;14(2):81-84. [Not Available] [Article in French] DE GRAEVE R. PMID: 13654244 [PubMed - indexed for MEDLINE] 7918. Arch De Vecchi Anat Patol. 1959 Mar;29(1):265-75. [Two cases of herpes zoster of the ear.] [Article in Italian] GIAGNONI A. PMID: 13650830 [PubMed - indexed for MEDLINE] 7919. Laryngoscope. 1959 Mar;69(3):260-7. Facial paralysis: a method of treatment with massive doses of histamine. DEBLASIO SH. PMID: 13642934 [PubMed - OLDMEDLINE] 7920. AMA Arch Otolaryngol. 1959 Mar;69(3):266-75. Histopathology of the facial nerve in herpes zoster oticus. GULDBERG-MOLLER J, OLSEN S, KETTEL K. PMID: 13626314 [PubMed - OLDMEDLINE] 7921. AMA Arch Derm. 1959 Mar;79(3):299-304. Immunologic aspects of herpes simplex, herpes zoster, and vaccinia. BALDRIDGE GD. PMID: 13626226 [PubMed - indexed for MEDLINE] 7922. Med Klin (Munich). 1959 Feb 6;54(6):216-8. [Herpes zoster and cortisone therapy.] [Article in German] LYON E. PMID: 13643547 [PubMed - indexed for MEDLINE] 7923. Therapie. 1959;14:818-24. [The treatment of zona and of its associated pains. Study of the results obtained with levomepromazine.] [Article in French] SIGWALD J, BOUTTIER D, CAILLE F. PMID: 14446614 [PubMed - indexed for MEDLINE] 7924. Klin Monbl Augenheilkd Augenarztl Fortbild. 1959;135:1-31. [Zoster diseases of the eye.] [Article in German] KREIBIG W. PMID: 14411888 [PubMed - indexed for MEDLINE] 7925. Arch Psychiatr Nervenkr Z Gesamte Neurol Psychiatr. 1959;199:596-600. [Zoster and Landry's paralysis.] [Article in German] WANISSORN R. PMID: 13842835 [PubMed - indexed for MEDLINE] 7926. Acta Rheumatol Scand. 1959;5:157-63. Shoulder-hand syndrome and herpes zoster: report of a case with signs of vasodilatation and vasoconstriction in the same hand. GRAUDAL H. PMID: 13829051 [PubMed - OLDMEDLINE] 7927. Actas Dermosifiliogr. 1959 Jan-Feb;50(1):31-2. [Not Available] [Article in Spanish] LEDO DUNIPE E, LEDO POZUETA A. PMID: 13660977 [PubMed - indexed for MEDLINE] 7928. Z Laryngol Rhinol Otol. 1959 Jan;38(1):1-4. [Not Available] [Article in German] JEZEK A. PMID: 13648608 [PubMed - OLDMEDLINE] 7929. J Sci Med Lille. 1959 Jan;77(1):36-42. [Paralysis of the lower extremity following herpes zoster.] [Article in French] DEREUX J, VANDENHAUTE, MAHIEU M, PHILIPPE F. PMID: 13631677 [PubMed - OLDMEDLINE] 7930. Lyon Med. 1958 Nov 16;90(46):799-800 contd. [Temporary re-activation of positive results of a Nelson test in an elderly syphilitic with herpes zoster.] [Article in French] THIERS H, COLOMB D, FAYOLLE J, MOULIN G. PMID: 13612301 [PubMed - indexed for MEDLINE] 7931. Rev Neurol (Paris). 1958 Nov;99(5):535-57. [Encephalomyelitis caused by herpes zoster; anatomy & clinical manifestation of 2 case reports.] [Article in French] BOUDIN G, BARBIZET J, BRION S, PEPIN B. PMID: 13658792 [PubMed - OLDMEDLINE] 7932. J Laryngol Otol. 1958 Nov;72(11):926-8. A case of herpes zoster of the VIIth, VIIIth, IXth, Xth and XIth cranial nerves. CARTER BS. PMID: 13611412 [PubMed - OLDMEDLINE] 7933. Am J Ophthalmol. 1958 Nov;46(5 Part 1):741-2. Herpes zoster ophthalmicus; report of a case in a three and one-half-year-old child. GARRETT FE. PMID: 13595053 [PubMed - indexed for MEDLINE] 7934. Clin Proc Child Hosp Dist Columbia. 1958 Nov;14(11):254-7. Herpes zoster facialis. OBERMAN JW, PARKS MM. PMID: 13585647 [PubMed - OLDMEDLINE] 7935. Sven Lakartidn. 1958 Oct 3;55(40):2766-77. [Not Available] [Article in Swedish] LUNDMARK F. PMID: 13592720 [PubMed - indexed for MEDLINE] 7936. Arch Dis Child. 1958 Oct;33(171):437-9. Herpes zoster ophthalmicus in children. TUCKER SM. PMCID: PMC2012323 PMID: 13584024 [PubMed - indexed for MEDLINE] 7937. Lyon Med. 1958 Sep 21;90(38):373-8. [Segmentary dorsal myelitis & the cauda equina syndrome caused by herpes zoster: 2 clinical cases.] [Article in French] SCHOTT B, BOREL. PMID: 13589155 [PubMed - OLDMEDLINE] 7938. Minerva Med. 1958 Sep 15;49(74):3556-8. [Generalized herpes zoster during malignant hemopathy.] [Article in Italian] GRASSI A. PMID: 13600185 [PubMed - indexed for MEDLINE] 7939. Concours Med. 1958 Sep 13;80(37):3925-6. [Not Available] [Article in French] VERCELLETTO P. PMID: 13585795 [PubMed - indexed for MEDLINE] 7940. AMA Arch Derm. 1958 Sep;78(3):392-3. A clinical note on herpes zoster. GOLDBERG LC. PMID: 13570699 [PubMed - indexed for MEDLINE] 7941. Dia Med. 1958 Aug 21;30(58):2180-1. [Combined tetracycline & chloramphenicol in various neurological diseases: herpes zoster, neuraxitis & influenza with encephalic symptoms.] [Article in Spanish] CASTELLUCCIO R. PMID: 13586081 [PubMed - indexed for MEDLINE] 7942. Br Med J. 1958 Aug 16;2(5093):418-21. Zoster sine herpete. LEWIS GW. PMCID: PMC2026052 PMID: 13560886 [PubMed - indexed for MEDLINE] 7943. Physiotherapy. 1958 Aug 10;44(8):230-1. Ultra violet light for relief of post-herpetic pain. OWEN JM. PMID: 13590963 [PubMed - indexed for MEDLINE] 7944. Pharm Acta Helv. 1958 Aug-Oct;33(8-10):743-6. [Emetine treatment of zoster ophthalmicus.] [Article in German] FAVRE M, GOLDMANN H. PMID: 13601123 [PubMed - indexed for MEDLINE] 7945. Tex State J Med. 1958 Aug;54(8):594-6. Gamma globulin in the treatment of herpes zoster. LEA WA Jr, TAYLOR WB. PMID: 13580917 [PubMed - indexed for MEDLINE] 7946. J Neurol Neurosurg Psychiatry. 1958 Aug;21(3):210-2. Ophthalmic herpes zoster with contralateral hemiplegia. ANASTASOPOULOS G, ROUTSONIS K, IERODIAKONOU CS. PMCID: PMC497320 PMID: 13576172 [PubMed - OLDMEDLINE] 7947. Wien Z Inn Med. 1958 Jul;39(7):293-9. [Herpes zoster in the gastrointestinal tract.] [Article in German] DOBY T, TOTH J. PMID: 13604279 [PubMed - indexed for MEDLINE] 7948. Z Laryngol Rhinol Otol. 1958 Jul;37(7):436-43. [Catamnestic studies in herpes zoster oticus.] [Article in German] BITTRICH K, WILKE J. PMID: 13581918 [PubMed - indexed for MEDLINE] 7949. Practitioner. 1958 Jul;181(1081):87-90. Two unusual diseases seen in general practice in one week. HORN R. PMID: 13567284 [PubMed - indexed for MEDLINE] 7950. Pol Tyg Lek (Wars). 1958 Jun 23;13(25):959-62. [Herpes zoster after the treatment of breast cancer with x-rays.] [Article in Polish] GIERMANSKI A. PMID: 13591057 [PubMed - indexed for MEDLINE] 7951. Bull Soc Fr Dermatol Syphiligr. 1958 Jun-Jul;65(3):257-8. [Thoracic zona followed by an ascending quadriplegia of fatal development: nosological discussion.] [Article in French] DUPERRAT B, PRINGUET R. PMID: 13608214 [PubMed - OLDMEDLINE] 7952. Friuli Med. 1958 May-Jun;13(3):441-5. [Treatment of herpes zoster with A. T. P.; clinical contribution.] [Article in Italian] BISARO A, CASASOLA M, MILESI C. PMID: 13574315 [PubMed - indexed for MEDLINE] 7953. Pediatriia. 1958 Apr;41(4):59-62. [Epidemiology of herpes zoster.] [Article in Russian] GOLEMBA PI. PMID: 13578563 [PubMed - indexed for MEDLINE] 7954. Bull Soc Fr Dermatol Syphiligr. 1958 Apr-May;65(2):184-5. [Development of a transient positive reaction to the Nelson qualitative test in a former syphilitic with negative serology during an attack of zona.] [Article in French] THIERS H, COLOMB D, FAYOLLE J, MOULIN G. PMID: 13573079 [PubMed - indexed for MEDLINE] 7955. Alger Medicale. 1958 Apr;62(4):451-2 passim. [Not Available] [Article in French] COSSET J, AMIEL JL, LONGCOTE J. PMID: 13559120 [PubMed - indexed for MEDLINE] 7956. Z Haut Geschlechtskr. 1958 Apr 1;24(7):192-7. [Ganglion-blocking agents and vitamin B12 in the treatment of bullous manifestations of herpes zoster.] [Article in German] MATANIC VI. PMID: 13558288 [PubMed - OLDMEDLINE] 7957. Pediatria (Napoli). 1958 Mar-Apr;66(2):250-65. [A case of herpes zoster in a newborn infant.] [Article in Italian] MORMONE V. PMID: 13590801 [PubMed - OLDMEDLINE] 7958. Bull Soc Ophtalmol Fr. 1958 Mar;3:278-81. [Current treatment of ophthalmic zona.] [Article in French] ROUGIER, ROYER. PMID: 13561085 [PubMed - OLDMEDLINE] 7959. S Afr Med J. 1958 Feb 8;32(6):166-8. Cutaneous nerves in herpes zoster. VAN BILJON PJ. PMID: 13529211 [PubMed - indexed for MEDLINE] 7960. Scott Med J. 1958 Feb;3(2):93-4. A note on the Ramsay Hunt syndrome and the place of cortisone in its treatment. McNICOL GP. PMID: 13529052 [PubMed - indexed for MEDLINE] 7961. Dermatol Wochenschr. 1958 Jan 25;137(4):100-3. [Experiences with a sympatholytic in the treatment of herpes zoster.] [Article in German] ROSENKRANZER R. PMID: 13523996 [PubMed - indexed for MEDLINE] 7962. Z Gesamte Inn Med. 1958 Jan 15;13(2):71-6. [Effect of emetine in herpes zoster.] [Article in German] JORDA V, LENFELD J, ROTHSCHILD L. PMID: 13544359 [PubMed - indexed for MEDLINE] 7963. Przegl Epidemiol. 1958;12(2):177-80. [Certain observations on varicella and herpes zoster.] [Article in Polish] STARZECKA B, TOMASIK W, ZASOWSKA K. PMID: 13602006 [PubMed - indexed for MEDLINE] 7964. Otorinolaringol Ital. 1958;26(6):430-73. [Not Available] [Article in Italian] PANEBIANCO G, MANARA E. PMID: 13600845 [PubMed - indexed for MEDLINE] 7965. G Psichiatr Neuropatol. 1958;86(2):655-62. [Brain disease picture in herpes zoster.] [Article in Italian] VOLTERRA V. PMID: 13598158 [PubMed - OLDMEDLINE] 7966. Dtsch Z Nervenheilkd. 1958;178(3):313-29. [Clinical aspects & pathomorphology of a polyradiculomyelitic form of herpes zoster.] [Article in German] STAMMLER A, STRUCK G. PMID: 13597664 [PubMed - OLDMEDLINE] 7967. Arcisp S Anna Ferrara. 1958;11(5):889-903. [Gangrenous zoster & generalized varicella in a man with lymphatic leukemia.] [Article in Italian] MOLINARI R. PMID: 13596202 [PubMed - indexed for MEDLINE] 7968. Klin Monbl Augenheilkd Augenarztl Fortbild. 1958;132(2):252-3. [Ophthalmic herpes zoster.] [Article in German] SCHIRMER R. PMID: 13550766 [PubMed - indexed for MEDLINE] 7969. Z Haut Geschlechtskr. 1958 Jan 1;24(1):9-14. [Zoster with participation of bladder mucosa.] [Article in German] LEHMANN F, FELKL K. PMID: 13531306 [PubMed - OLDMEDLINE] 7970. Ann Otolaryngol Chir Cervicofac. 1957 Dec;74(12):993-5. [Not Available] [Article in French] DECROIX G. PMID: 13509408 [PubMed - OLDMEDLINE] 7971. N Z Med J. 1957 Dec;56(316):668-72. Herpes zoster of the ear. SALAS JR. PMID: 13504531 [PubMed - OLDMEDLINE] 7972. Am J Med. 1957 Dec;23(6):999-1002. Herpes zoster with ileus simulating intestinal obstruction. FIGIEL SJ, FIGIEL LS. PMID: 13487618 [PubMed - indexed for MEDLINE] 7973. Prog Med (Napoli). 1957 Nov 30;13(22):747-51. [Pathological involvement of the sympathetic nerves in herpes zoster.] [Article in Italian] RIZZI D. PMID: 13505927 [PubMed - indexed for MEDLINE] 7974. Bull Soc Fr Dermatol Syphiligr. 1957 Nov-Dec;64(5):768-9. [Not Available] [Article in French] RIMBAUD P, RAVOIRE J, DUNTZE F. PMID: 13536737 [PubMed - indexed for MEDLINE] 7975. Rev Bras Med. 1957 Nov;14(11):830-1. [Ultraviolet ray therapy of zona ophthalmica.] [Article in Portuguese] DE MORAES WR. PMID: 13527868 [PubMed - OLDMEDLINE] 7976. Medizinische. 1957 Oct 19;2(42):1537-9. [Not Available] [Article in German] WILL E. PMID: 13482916 [PubMed - indexed for MEDLINE] 7977. Med Interna (Bucur). 1957 Oct;9(10):1581-6. [Notes on the relation between chickenpox and zona.] [Article in Romanian] PASCU I. PMID: 13516048 [PubMed - indexed for MEDLINE] 7978. AMA Arch Derm. 1957 Oct;76(4):408-12; discussion 412-4. The treatment of herpes zoster. EPSTEIN E, ALLINGTON HV. PMID: 13457421 [PubMed - indexed for MEDLINE] 7979. Br Med J. 1957 Sep 28;2(5047):746-8. Treatment of ophthalmic zoster with prednisone. CARTER AB, ROYDS JE. PMCID: PMC1962246 PMID: 13460373 [PubMed - indexed for MEDLINE] 7980. Minerva Med. 1957 Sep 19;48(75):2954-9. [Not Available] [Article in Italian] MAURO G, PRATO V. PMID: 13483311 [PubMed - indexed for MEDLINE] 7981. Br Med J. 1957 Sep 14;2(5045):616-8. Motor complications of herpes zoster. KENDALL D. PMCID: PMC1962150 PMID: 13460335 [PubMed - OLDMEDLINE] 7982. Sem Med Prof Med Soc. 1957 Sep 6-10;33(32-33):1258-9. Not Available CARRIE J. PMID: 13486138 [PubMed - indexed for MEDLINE] 7983. Tidsskr Nor Laegeforen. 1957 Sep 1;77(17):734-7. [Motor paralysis in zoster; review with reference to a case.] [Article in Norwegian] SKOMEDAL GN. PMID: 13496051 [PubMed - OLDMEDLINE] 7984. Int Rec Med Gen Pract Clin. 1957 Sep;170(9):545-6. Herpes zoster ophthalmicus. CURY D. PMID: 13491167 [PubMed - OLDMEDLINE] 7985. J Med Bord. 1957 Sep;134(9):1135-6. [Not Available] [Article in French] AUBERTIN E. PMID: 13481504 [PubMed - indexed for MEDLINE] 7986. J Med Bord. 1957 Sep;134(9):1133-4. [Not Available] [Article in French] AUBERTIN E. PMID: 13481503 [PubMed - indexed for MEDLINE] 7987. J Med Bord. 1957 Sep;134(9):1131-2. [Not Available] [Article in French] AUBERTIN E. PMID: 13481502 [PubMed - indexed for MEDLINE] 7988. Ann Otolaryngol Chir Cervicofac. 1957 Sep;74(9):710-1. [A special case of deafness during zona of superior maxillary nerve.] [Article in French] MORIN M, PIALOUX P, BOUCHET J. PMID: 13478947 [PubMed - OLDMEDLINE] 7989. Br Med J. 1957 Aug 17;2(5041):384-6. Pneumonia and bronchial vesiculation associated with herpes zoster, with reference to other visceral associations of zoster. ANDREWS RH. PMCID: PMC1962091 PMID: 13446490 [PubMed - indexed for MEDLINE] 7990. Bull Soc Fr Dermatol Syphiligr. 1957 Aug-Oct;39(4):396-7. [Kaposi-Juliusberg's pustolosis of probable herpetic origin.] [Article in French] HADIDA E, BERANGER J, TIMSIT E. PMID: 13511036 [PubMed - indexed for MEDLINE] 7991. Zhonghua Nei Ke Za Zhi. 1957 Aug;5(8):678-9; English abstract 75. [Vitamin B12 in herpes zoster; two case reports.] [Article in Chinese] CHU TY, LU CH. PMID: 13472937 [PubMed - indexed for MEDLINE] 7992. Dia Med. 1957 Jul 11;29(46):1548 passim. [Not Available] [Article in Spanish] BALTER I, BARQUET J, FERNANDEZ C. PMID: 13461701 [PubMed - OLDMEDLINE] 7993. Sov Med. 1957 Jul;21(7):133-4. [Two cases of herpes zoster simulating acute appendicitis.] [Article in Russian] BELEDA RV. PMID: 13506837 [PubMed - indexed for MEDLINE] 7994. Ann Dermatol Syphiligr (Paris). 1957 Jul-Aug;84(4):400-5. [Not Available] [Article in French] VIEGAS LB, VIEGAS LC. PMID: 13458910 [PubMed - indexed for MEDLINE] 7995. R I Med J. 1957 Jul;40(7):387-92; passim. Chickenpox and herpes zoster. WESSELHOEFT C. PMID: 13454474 [PubMed - indexed for MEDLINE] 7996. Praxis. 1957 Jun 27;46(26):581-2. [Irgapyrin in the treatment of herpes zoster.] [Article in German] CAMPELL R. PMID: 13453139 [PubMed - indexed for MEDLINE] 7997. Nord Med. 1957 Jun 13;57(24):858-9. [Not Available] [Article in Norwegian] EIMIND K. PMID: 13452148 [PubMed - OLDMEDLINE] 7998. Nord Med. 1957 Jun 13;57(24):855-8. [Herpes zoster ophthalmicus and its therapy, especially with liver extract.] [Article in Swedish] OKSALA A. PMID: 13452147 [PubMed - OLDMEDLINE] 7999. Nord Med. 1957 Jun 13;57(24):854-5. [Not Available] [Article in Norwegian] HEGGO O, BOROVSKI G. PMID: 13452146 [PubMed - OLDMEDLINE] 8000. Boll Ocul. 1957 May;36(5):293-307. [A case of retrobulbar optic neuritis with cervical herpes zoster.] [Article in Italian] PANNARALE MR. PMID: 13479554 [PubMed - OLDMEDLINE] 8001. Z Haut Geschlechtskr. 1957 Apr 15;22(8):230-41. [Encephalitis in herpes zoster.] [Article in German] MEYER R. PMID: 13434257 [PubMed - OLDMEDLINE] 8002. Z Haut Geschlechtskr. 1957 Apr 1;22(7):202-6. [Herpes zoster as an isomorphous irritant in psoriasis.] [Article in German] BOHNSTEDT RM. PMID: 13434254 [PubMed - indexed for MEDLINE] 8003. Praxis. 1957 Mar 28;46(13):281-4. [A rare complication of herpes zoster: acute urinary retention.] [Article in French] JEANNERET JP, DELACRETAZ J. PMID: 13431636 [PubMed - OLDMEDLINE] 8004. Br Med J. 1957 Mar 23;1(5020):678-81. Visceral lesions in herpes zoster. WYBURN-MASON R. PMCID: PMC1974636 PMID: 13404270 [PubMed - indexed for MEDLINE] 8005. Sem Hop. 1957 Mar 22;33(18):1137-9. [Phenothiazine treatment of herpes zoster & zosteroid pains (including various refractory pains).] [Article in French] SIGWALD J, HEBERT H, QUETIN A. PMID: 13432869 [PubMed - indexed for MEDLINE] 8006. Acta Belg Arte Med Pharm Mil. 1957 Mar;110(1):67-74. [Treatment of herpes zoster by low-frequency currents.] [Article in Dutch] DE DONCKER K, ROSSELLE N. PMID: 13487112 [PubMed - indexed for MEDLINE] 8007. Fulorrgegegyogyaszat. 1957 Mar;(1):10-3. [Not Available] [Article in Hungarian] VARADY-SZABO M. PMID: 13448233 [PubMed - OLDMEDLINE] 8008. Bull Soc Ophtalmol Fr. 1957 Mar;(3):169-81; discussion, 181-2. [A new case of traumatic zona.] [Article in French] DE SAINT-MARTIN R. PMID: 13437083 [PubMed - OLDMEDLINE] 8009. Actas Dermosifiliogr. 1957 Mar;48(3):176-8. [Intercostal herpes zoster in the mother with simultaneous varicella in the three daughters.] [Article in Spanish] LEDO DUNIPE E, LEDO POZUETA A. PMID: 13435025 [PubMed - indexed for MEDLINE] 8010. AMA Arch Derm. 1957 Mar;75(3):397-400. Herpes zoster. LEIDER M, CONTRERAS MA. PMID: 13402213 [PubMed - indexed for MEDLINE] 8011. J Med (Oporto). 1957 Feb 9;32(733):327; passim. [Zona and emetine hydrochlorate.] [Article in Portuguese] VIEGAS LB, VIEGAS LC. PMID: 13415785 [PubMed - indexed for MEDLINE] 8012. AMA Arch Derm. 1957 Feb;75(2):193-6. The outcome of patients with herpes zoster. DE MORAGAS JM, KIERLAND RR. PMID: 13393787 [PubMed - indexed for MEDLINE] 8013. Presse Med. 1957 Jan 23;65(7):140. [A case of pseudoappendicular zona with eosinophilia.] [Article in French] ALAZRAKI H. PMID: 13420030 [PubMed - OLDMEDLINE] 8014. Dtsch Z Nervenheilkd. 1957;177(2):180-93. [Cerebral complications of herpes zoster.] [Article in German] HULTSCH EG. PMID: 13524070 [PubMed - indexed for MEDLINE] 8015. Klin Monbl Augenheilkd Augenarztl Fortbild. 1957;131(1):72-7. [Oculomotor muscle paralysis in ophthalmic herpes zoster.] [Article in German] PRIGGERT W. PMID: 13482164 [PubMed - OLDMEDLINE] 8016. Riv Patol Nerv Ment. 1957;78(1):304-18. [Histopathological changes in the nervous system in herpes zoster; findings on a fatal case with cutaneous onset.] [Article in Italian] BARONTINI F. PMID: 13466952 [PubMed - OLDMEDLINE] 8017. Rev Otoneuroophtalmol. 1957;29(1):28-31. [Not Available] [Article in French] OURGAUD AG, BERARD PV. PMID: 13454326 [PubMed - OLDMEDLINE] 8018. Klin Monbl Augenheilkd Augenarztl Fortbild. 1957;130(2):262-4. [Gangrenous herpes zoster of the first branch of the trigeminal nerve with optic nerve involvement.] [Article in German] SCHIRMER R. PMID: 13439942 [PubMed - OLDMEDLINE] 8019. Arch Ital Dermatol Sifilogr Venereol. 1957;28(4):299-306. [Case of herpes zoster with brachial localization.] [Article in Italian] GIACOMETTI C. PMID: 13436148 [PubMed - OLDMEDLINE] 8020. Br J Clin Pract. 1957 Jan;11(1):41-7. Herpes zoster. JONES AT. PMID: 13396126 [PubMed - indexed for MEDLINE] 8021. Rev Asoc Med Argent. 1956 Dec 15-30;70(833-834):411-4. [Motor disorders in herpes zoster; a case of quadriplegia.] [Article in Spanish] MAGGI AL, MEEROFF M, COSEN JN, HIRSCHMAN B. PMID: 13466226 [PubMed - OLDMEDLINE] 8022. Munch Med Wochenschr. 1956 Dec 7;98(49):1693-4. [Zoster with leukemia, lymphogranulomatosis, lymphosarcoma, and plasmocytoma.] [Article in German] HOFFMANN K. PMID: 13387609 [PubMed - indexed for MEDLINE] 8023. Br J Ophthalmol. 1956 Dec;40(12):762-4. Herpes ophthalmicus. MACLATCHY RS. PMCID: PMC1324742 PMID: 13396165 [PubMed - OLDMEDLINE] 8024. Br J Urol. 1956 Dec;28(4):417-21. A case of herpes zoster with involvement of the urinary bladder. GIBBON N. PMID: 13383174 [PubMed - OLDMEDLINE] 8025. Wis Med J. 1956 Dec;55(12):1319-20. Autohemotherapy; an effective treatment for herpes zoster. ANSFIELD FJ, RENS JL. PMID: 13381143 [PubMed - indexed for MEDLINE] 8026. J Indian Med Assoc. 1956 Nov 16;27(10):356. Treatment of herpes zoster with vitamin B12. SRIVASTAVA JR. PMID: 13385515 [PubMed - indexed for MEDLINE] 8027. Magy Radiol. 1956 Nov;8(4):227-31. [Herpes zoster in the gastrointestinal system.] [Article in Hungarian] DOBY T, TOTH J. PMID: 13417790 [PubMed - OLDMEDLINE] 8028. Can Med Assoc J. 1956 Nov 1;75(9):750-1. Herpes zoster, leukaemia cutis and leukaemic infiltration of the lesions of herpes zoster. ANHALT AW, FORSEY RR. PMCID: PMC1823318 PMID: 13364829 [PubMed - indexed for MEDLINE] 8029. Br Med J. 1956 Oct 13;2(4997):865. Herpes zoster after fractured spine complicating E.C.T. ROITH AI. PMCID: PMC2035653 PMID: 13364348 [PubMed - OLDMEDLINE] 8030. Br Med J. 1956 Oct 13;2(4997):864-5. Herpes zoster. BARFORD LJ. PMCID: PMC2035642 PMID: 13364347 [PubMed - indexed for MEDLINE] 8031. Presse Med. 1956 Oct 6;64(71):1621-2. [Pseudosurgical forms of intercostal zona.] [Article in French] DETRIE P. PMID: 13389256 [PubMed - indexed for MEDLINE] 8032. Mil Med. 1956 Oct;119(4):253-5. Herpes Zoster; etiology, diagnosis, and effective management of a case. YETWIN IJ. PMID: 13369189 [PubMed - indexed for MEDLINE] 8033. J Tn State Med Assoc. 1956 Oct;49(10):350-4. Herpes zoster ophthalmicus and its treatment. BENEDICT WH. PMID: 13368215 [PubMed - indexed for MEDLINE] 8034. Boll Ocul. 1956 Sep-Dec;35(9-12):903-8. [Case of herptic keratitis on a transplanted corneal flap.] [Article in Italian] MIGLIOR M. PMID: 13436641 [PubMed - indexed for MEDLINE] 8035. Rhumatologie. 1956 Sep-Oct;(5):211-3. [Not Available] [Article in French] ISEMEIN L, FOURNIER AM. PMID: 13421357 [PubMed - indexed for MEDLINE] 8036. Circulation. 1956 Sep;14(3):379. Peripheral vascular spasm as a prodrome of herpes zoster. BEHREND A, BLUMBERG L. PMID: 13365049 [PubMed - indexed for MEDLINE] 8037. Alger Medicale. 1956 Sep;60(9):718-9. [Not Available] [Article in French] AUBRY P, FOURRIER A, GUIVARC'H J, SUDAKA P, THIODET J. PMID: 13362036 [PubMed - OLDMEDLINE] 8038. N Y State J Med. 1956 Sep 1;56(17):2684-7. Paravertebral procaine block for the treatment of herpes zoster. ROSENAK SS. PMID: 13358890 [PubMed - indexed for MEDLINE] 8039. Dtsch Med Wochenschr. 1956 Aug 31;81(35):1401-3. [Herpes zoster and liver lesions.] [Article in German] SIEDE W. PMID: 13365419 [PubMed - OLDMEDLINE] 8040. Ugeskr Laeger. 1956 Aug 2;118(31):906-7. [Not Available] [Article in Danish] BECH K. PMID: 13392046 [PubMed - indexed for MEDLINE] 8041. Nord Med. 1956 Aug 2;56(31):1093-5. [Not Available] [Article in Swedish] GRAHNE B, VAHERI E. PMID: 13369833 [PubMed - OLDMEDLINE] 8042. Ideggyogy Sz. 1956 Aug;9(4):102-4. [Polyganglionitis in zoster.] [Article in Hungarian] PALFFY G, BALAZS B. PMID: 13405541 [PubMed - OLDMEDLINE] 8043. Neurology. 1956 Aug;6(8):601-2. Recent advances in neurology and neuropsychiatry. BRAIN R, STRAUSS EB. PMID: 13348823 [PubMed - OLDMEDLINE] 8044. Boll Ocul. 1956 Jul;35(7):479-84. [Unusual combinations of pathological ocular manifestations: neuroretinal lesions caused by Vaquez disease and retrobulbar optic neuritis with oculomotor paralysis caused by herpes zoster ophthalmicus.] [Article in Italian] CAMBIAGGI A. PMID: 13404021 [PubMed - OLDMEDLINE] 8045. Acta Clin Belg. 1956 Jul-Aug;11(4):365-82. [Herpes zoster with Guillain-Barré syndrome and orthostatic hypotension; review of motor complications of herpes zoster.] [Article in French] FRIART J, JEANTY C. PMID: 13372141 [PubMed - indexed for MEDLINE] 8046. Arch Sci Med (Torino). 1956 Jul;102(1):75-85. [Association of scapulohumeral periarthritis (Duplay's disease) with herpes zoster; preventive note.] [Article in Italian] SCALA A, TRINCHIERI P. PMID: 13355575 [PubMed - OLDMEDLINE] 8047. Prensa Med Argent. 1956 Jun 22;43(25):1970-4. [Motor disorders in herpes zoster; a case with quadriplegia.] [Article in Spanish] COSEN JN, HIRSCHMAN B, MAGGI AL, MEEROFF M. PMID: 13379196 [PubMed - OLDMEDLINE] 8048. Z Haut Geschlechtskr. 1956 Jun 15;20(12):389-96. [Generalized gangrenous herpes zoster in aleukemic lymphadenosis.] [Article in German] STOHR H, HOLSCHER-IMMISCH V. PMID: 13353326 [PubMed - indexed for MEDLINE] 8049. J Am Med Assoc. 1956 Jun 9;161(6):511-5. Chronic postherpetic neuralgia. VAN BLARICOM LS, HORRAX G. PMID: 13318953 [PubMed - indexed for MEDLINE] 8050. Br J Urol. 1956 Jun;28(2):198-200. Bladder involvement in a case of herpes zoster. DALES M, WILSON G. PMID: 13342463 [PubMed - indexed for MEDLINE] 8051. AMA Arch Derm. 1956 Jun;73(6):553-5. Treatment of herpes zoster and chicken pox with immune globulin. RODARTE JG, WILLIAMS BH. PMID: 13312652 [PubMed - indexed for MEDLINE] 8052. Actas Dermosifiliogr. 1956 May;47(8):629-35. [Generalized zoster.] [Article in Spanish] CAPDEVILA JM, CARDENAL C, VILANOVA X. PMID: 13354501 [PubMed - indexed for MEDLINE] 8053. Borgyogy Venerol Sz. 1956 May;10(3):132-4. [Case of occupational arsenic poisoning with herpes zoster.] [Article in Hungarian] VINCZE E. PMID: 13342092 [PubMed - indexed for MEDLINE] 8054. AMA Arch Otolaryngol. 1956 Apr;63(4):351-4. Chorda tympan nerve section for postherpetic neuralgia of the tongue. VAHERI E, GRAHNE B. PMID: 13312789 [PubMed - indexed for MEDLINE] 8055. Neurology. 1956 Apr;6(4):262-8. The Ramsay Hunt syndrome, geniculate herpes. SACHS E Jr, HOUSE RK. PMID: 13309605 [PubMed - OLDMEDLINE] 8056. HNO. 1956 Mar 29;5(9):283-5. [Not Available] [Article in German] BOGNER H. PMID: 13318496 [PubMed - indexed for MEDLINE] 8057. N Engl J Med. 1956 Mar 8;254(10):472-4. Disseminated herpes zoster complicating chronic lymphatic leukemia; report of case of electron-microscope study of vesicle fluid. RODNAN GP, RAKE GW. PMID: 13297137 [PubMed - indexed for MEDLINE] 8058. Bull Soc Fr Dermatol Syphiligr. 1956 Mar-Apr;(2):215-6. [Value of early radiotherapy in herpes zoster.] [Article in French] BUREAU Y, JARRY, BARRIERE. PMID: 13342817 [PubMed - indexed for MEDLINE] 8059. Arch Ital Otol Rinol Laringol. 1956 Mar-Apr;67(2):305-10. [Auricular herpes zoster with paralysis of the facial nerve.] [Article in Italian] ZANOTTI G. PMID: 13341339 [PubMed - OLDMEDLINE] 8060. Rev Bras Cir. 1956 Mar;31(3):385-9. [Herpes zoster and lymphoma.] [Article in Portuguese] SANTOS SILVA M. PMID: 13323412 [PubMed - indexed for MEDLINE] 8061. Cyprus Med J. 1956 Mar;8(3):284-5. The use of phenylbutazone in herpes zoster. PARTELIDES G. PMID: 13317496 [PubMed - indexed for MEDLINE] 8062. J Allergy. 1956 Mar;27(2):169. Successful treatment of herpes zoster ophthalmicus with antihistaminic therapy. GLASSER J. PMID: 13294985 [PubMed - OLDMEDLINE] 8063. Concours Med. 1956 Feb 18;78(7):740. [Not Available] [Article in French] DURAND P. PMID: 13305181 [PubMed - indexed for MEDLINE] 8064. Am J Ophthalmol. 1956 Feb;41(2):253-6. Total detachment and reattachment of the retina; in herpes zoster ophthalmicus. LINCOFF HA, WISE GN, ROMAINE HH. PMID: 13292488 [PubMed - OLDMEDLINE] 8065. Calif Med. 1956 Feb;84(2):120-1. Presumptive herpes zoster meningoencephalitis. KOCH R. PMCID: PMC1532845 PMID: 13284645 [PubMed - indexed for MEDLINE] 8066. Dia Med. 1956 Jan 30;28(5):122. [Observations relative to the use of dihydroergotamine.] [Article in Spanish] SAS A. PMID: 13305419 [PubMed - indexed for MEDLINE] 8067. G Psichiatr Neuropatol. 1956;84(4):695-706. [Ramsay-Hunt syndrome, associated with paralysis of several cranial nerves and pyramidal affections.] [Article in Italian] TURINESE A. PMID: 13415420 [PubMed - OLDMEDLINE] 8068. Trans Opthal Soc U K. 1956;76:227-33. A case of left herpes zoster ophthalmicus followed by virus encephalitis with right-sided anaesthesia, paraesthesiae and hemiplegia. MINTON J. PMID: 13409543 [PubMed - OLDMEDLINE] 8069. Trans Opthal Soc U K. 1956;76:187-92. Herpetic infections of the outer eye. GOLDSMITH AJ. PMID: 13409540 [PubMed - indexed for MEDLINE] 8070. Ann Paediatr Fenn. 1956;2(2):142-9. Herpes simplex meningoencephalomyelitis with prolonged course; isolation of the virus, demonstration of intranuclear inclusions, and development of antibodies. HALONEN P, HJELT L, KASSILA E, PENTTINEN K. PMID: 13373121 [PubMed - OLDMEDLINE] 8071. Klin Monbl Augenheilkd Augenarztl Fortbild. 1956;128(6):727-32. [Treatment of herpes zoster ophthalmicus.] [Article in German] ROSSLER H. PMID: 13358176 [PubMed - OLDMEDLINE] 8072. Acta Psychiatr Neurol Scand Suppl. 1956;108:53-9. Herpes zoster in Hodgkin's disease. BICHEL J. PMID: 13354437 [PubMed - indexed for MEDLINE] 8073. Arch Ital Dermatol Sifilogr Venereol. 1956;28(1):56-65. [Case of localized herpes zoster with exclusive localization of the arm and especially of the hand.] [Article in Italian] RANDAZZO SD. PMID: 13341328 [PubMed - OLDMEDLINE] 8074. Arch Ital Dermatol Sifilogr Venereol. 1956;28(1):49-55. [Case of bilateral herpes zoster in a case of chronic myeloid leukemia.] [Article in Italian] ZANCA A. PMID: 13341327 [PubMed - indexed for MEDLINE] 8075. Dermatol Wochenschr. 1956;133(7):161-72. [Radiotherapy and herpes zoster.] [Article in German] KRUCHEN C, SCHMITT T. PMID: 13330412 [PubMed - indexed for MEDLINE] 8076. Minerva Otorinolaringol. 1956 Jan-Feb;6(1):42-4. [Ambramycin in the treatment of the geniculate ganglion zone (Ramsay-Hunt syndrome).] [Article in Italian] COASSOLO M. PMID: 13321681 [PubMed - indexed for MEDLINE] 8077. Boll Ocul. 1956 Jan;35(1):56-64. [Rare concomitant manifestations of ophthalmic herpes zoster and herpes febrilis of the cornea; three personal observations.] [Article in Italian] QUINTIERI C. PMID: 13315637 [PubMed - OLDMEDLINE] 8078. Acta Ophthalmol (Copenh). 1956;34(1):35-44. [Not Available] [Article in French] FRANCOIS J, NEETENS A. PMID: 13301649 [PubMed - OLDMEDLINE] 8079. AMA Arch Derm. 1956 Jan;73(1):69. An interesting case of herpes zoster. KILE RL. PMID: 13275127 [PubMed - indexed for MEDLINE] 8080. Br Med J. 1955 Nov 5;2(4948):1106-9. Malignant change arising in tissues affected by herpes. WYBURN-MASON R. PMCID: PMC1981341 PMID: 13260671 [PubMed - indexed for MEDLINE] 8081. Med Arh. 1955 Nov-Dec;9(6):49-56. [Etiologic and epidemiologic aspects of herpes zoster and its treatment with pure vitamin B12 and liver extracts.] [Article in Undetermined Language] MATANIC V. PMID: 13347696 [PubMed - indexed for MEDLINE] 8082. Vestn Khir Im I I Grek. 1955 Nov;76(10):113-5. [Herpes zoster simulating acute abdomen.] [Article in Russian] MERINA VM. PMID: 13299563 [PubMed - indexed for MEDLINE] 8083. J Albert Einstein Med Cent (Phila). 1955 Nov;4(1):33-7. Generalized herpes zoster; report of an unusual case associated with multiple myeloma. GREENSTEIN RH, CAHN MM. PMID: 13286037 [PubMed - indexed for MEDLINE] 8084. Med World. 1955 Nov;83(5):433-5. Vitamin B12 in the treatment of herpes zoster. JOLLES KE. PMID: 13279389 [PubMed - indexed for MEDLINE] 8085. Northwest Med. 1955 Nov;54(11):1249-52. Clinical evaluation of protamide in sensory nerve root inflammations and allied conditions. LEHRER HW, LEHRER HG, LEHRER DR. PMID: 13272938 [PubMed - OLDMEDLINE] 8086. N Engl J Med. 1955 Oct 20;253(16):693-5. Treatment of herpes zoster with ACTH. APPELMAN DH. PMID: 13266022 [PubMed - indexed for MEDLINE] 8087. Med Interna (Bucur). 1955 Oct-Dec;7(4):122-6. [Dimercaptopropanol therapy of herpes zoster.] [Article in Romanian] D-TRU G, GRIGORESCU C. PMID: 13399601 [PubMed - indexed for MEDLINE] 8088. Maroc Med. 1955 Sep;34(364):1130-2. [Pseudo-occlusive forms of zona; two case reports.] [Article in French] GARIPUY A. PMID: 13308360 [PubMed - indexed for MEDLINE] 8089. J Med Soc N J. 1955 Sep;52(9):474-5. Treatment of herpes zoster with topical application of hydrocortisone. MARSHALL FA. PMID: 13252393 [PubMed - indexed for MEDLINE] 8090. Cas Lek Cesk. 1955 Aug 26;94(34-35):939-42. [Two cases of zoster encephalitis.] [Article in Czech] JEDLICKA P, STYBLOVA V. PMID: 13261111 [PubMed - OLDMEDLINE] 8091. Dtsch Med Wochenschr. 1955 Aug 5;80(31-32):1139-40. [Vitamin B12 treatment in neurology, especially in states of pain.] [Article in German] HAMPP H. PMID: 13250976 [PubMed - indexed for MEDLINE] 8092. Z Laryngol Rhinol Otol. 1955 Aug;34(8):511-20. [Not Available] [Article in German] RAUCH S. PMID: 13257481 [PubMed - OLDMEDLINE] 8093. Stanford Med Bull. 1955 Aug;13(3):357-60. Treatment of postherpetic neuralgia. REICHERT FL. PMID: 13256181 [PubMed - indexed for MEDLINE] 8094. Prakt Lek. 1955 Jul 20;35(14):322-4. [Contribution to the therapy of herpes zoster.] [Article in Czech] PATEJDL Z. PMID: 13254603 [PubMed - indexed for MEDLINE] 8095. Revue Stomatol. 1955 Jul;56(7):516-21. [Localized mandibular necrosis during trigeminal herpes.] [Article in French] DECHAUME, DESCROZAILLES C, GARLOPEAU F, ROBERT J. PMID: 15444869 [PubMed - OLDMEDLINE] 8096. J Mt Sinai Hosp N Y. 1955 Jul-Aug;22(2):79-90. Generalized herpes zoster initiating a minor epidemic of chickenpox. MOSCOVITZ HL. PMID: 14392455 [PubMed - indexed for MEDLINE] 8097. Reumatismo. 1955 Jul-Aug;7(4):263-8. [Multiple myeloma and herpes zoster; a case of myeloma associated with generalized herpes zoster of the varicella type.] [Article in Italian] DANEO V. PMID: 13280927 [PubMed - indexed for MEDLINE] 8098. Acta Med Orient. 1955 Jul-Aug;14(7-8):181-92. Herpes zoster. LYON E. PMID: 13258156 [PubMed - indexed for MEDLINE] 8099. Sem Med. 1955 Jun 30;106(26):974-5. [Localization of herpes zoster still not described.] [Article in Spanish] DE LARA F, GUINEA AI. PMID: 13246721 [PubMed - OLDMEDLINE] 8100. Sem Med. 1955 Jun 16;106(24):875-6. [Not Available] [Article in Spanish] PARPAGLIONE CA. PMID: 13246707 [PubMed - indexed for MEDLINE] 8101. Strahlentherapie. 1955 Jun;97(2):297-304. [Herpes zoster after roentgen irradiation.] [Article in German] RUBE W. PMID: 13256247 [PubMed - indexed for MEDLINE] 8102. J Urol. 1955 May;73(5):836-9. Herpes zoster: a case of acute urinary retention. LERMAN PH, MILLSTEIN G. PMID: 14368730 [PubMed - OLDMEDLINE] 8103. Rev Laryngol Otol Rhinol (Bord). 1955 May-Jun;76(5-6):323-5. [Not Available] [Article in French] GOUBLET. PMID: 13246315 [PubMed - indexed for MEDLINE] 8104. J Am Med Assoc. 1955 Apr 30;157(18):1611. Treatment of herpes zoster with gamma globulin. WEINTRAUB II. PMID: 14367019 [PubMed - indexed for MEDLINE] 8105. Sem Med. 1955 Apr 28;106(17):534-5. [Experiment in the treatment of herpes zoster with phenylbutazone and aminopyrine.] [Article in Spanish] MANZI RO, COLOMBO CV. PMID: 14385986 [PubMed - indexed for MEDLINE] 8106. Nervenarzt. 1955 Apr 20;26(4):170-1. [Periarteriitis nodosa zosterica of the brain with zoster ophthalmicus.] [Article in German] DIETZ H. PMID: 14383919 [PubMed - OLDMEDLINE] 8107. Monatsschr Ohrenheilkd Laryngorhinol. 1955 Apr-Jun;89(2):88-92. [Herpes zoster of the Xth brain nerve.] [Article in German] SCHWETZ F. PMID: 14394008 [PubMed - OLDMEDLINE] 8108. Monatsschr Ohrenheilkd Laryngorhinol. 1955 Apr-Jun;89(2):81-8. [Herpes zoster oticus and a contribution to the determination of localization of the disease focus in the auditory meatus with the aid of audiometry.] [Article in German] GLANINGER J. PMID: 14394007 [PubMed - OLDMEDLINE] 8109. Minerva Dermatol. 1955 Apr;30(4):128-32. [Generalized herpes zoster.] [Article in Italian] DOGLIOTTI M. PMID: 14383432 [PubMed - indexed for MEDLINE] 8110. AMA Arch Derm. 1955 Apr;71(4):488-91. Herpes zoster; treatment of postherpetic neuralgia with cortisone, corticotropin, and placebos. SAUER GC. PMID: 14360764 [PubMed - indexed for MEDLINE] 8111. J Med (Oporto). 1955 Mar 19;26(634):709-10. [Chlorhydrate of emetine in the treatment of herpes zoster.] [Article in Portuguese] OLIVEIRA Ada S. PMID: 14366855 [PubMed - indexed for MEDLINE] 8112. Kinderarztl Prax. 1955 Mar;23(3):107-9. [Herpes zoster and chickenpox.] [Article in German] KROGER U. PMID: 14382294 [PubMed - indexed for MEDLINE] 8113. Bull Soc Fr Dermatol Syphiligr. 1955 Mar-Apr;2:149-50. [Severe zona with generalized vesicular eruption during erythrodermic reticulosis.] [Article in French] BUREAU Y, JARRY A, BARRIERE H. PMID: 13240347 [PubMed - indexed for MEDLINE] 8114. Acta Med Scand. 1955 Feb 23;151(2):131-4. Zoster ophthalmicus; report of a case in a child of 15 months. POULSEN PA. PMID: 14349631 [PubMed - indexed for MEDLINE] 8115. Pediatr Clin North Am. 1955 Feb:41-5. Ramsay Hunt syndrome (geniculate zoster); a rare complication of herpes of the central nervous system, with a note on herpes simplex. SHEV EE. PMID: 13236404 [PubMed - indexed for MEDLINE] 8116. J Pediatr. 1955 Feb;46(2):215-8. Cranial nerve paralysis in herpes zoster encephalitis of childhood; clinical and electroencephalographic observations. SCHMIDT RP, ROSEMAN E, STKIGMAN AJ. PMID: 13234019 [PubMed - OLDMEDLINE] 8117. Conn State Med J. 1955 Feb;19(2):103-5. Herpes zoster of the face and neck, with paralysis, earache, dizziness and nausea (J. Ramsay Hunt syndrome). SHEARD C Jr, FELDER EA. PMID: 13231500 [PubMed - OLDMEDLINE] 8118. Am J Ophthalmol. 1955 Feb;39(2, Part 1):157-61. Herpes zoster as a cause of congenital cataract. DUEHR PA. PMID: 13228523 [PubMed - indexed for MEDLINE] 8119. Presse Med. 1955 Jan 22;63(5):84. [Action of adenosinetriphosphatase on zona.] [Article in French] BROUS M. PMID: 14357258 [PubMed - indexed for MEDLINE] 8120. Mars Med. 1955;92(6):373-7. Not Available MURATORE R. PMID: 14393122 [PubMed - indexed for MEDLINE] 8121. Confin Neurol. 1955;15(2):95-8. [Audiometric comments with reference of a case of herpes zoster of the ear.] [Article in French] ROCHAT R, TERRIER G. PMID: 14390941 [PubMed - OLDMEDLINE] 8122. Ann Otolaryngol Chir Cervicofac. 1955;72(4):324-7. [Audiometric considerations in a case of zoster oticus.] [Article in French] ROCHAT R, TERRIER G. PMID: 14388414 [PubMed - indexed for MEDLINE] 8123. Friuli Med. 1955 Jan-Feb;10(1):91-4. [Herpes zoster and chickenpox in an adult.] [Article in Italian] PETRONIO G. PMID: 14380558 [PubMed - indexed for MEDLINE] 8124. Arch Ital Otol Rinol Laringol. 1955 Jan-Feb;66(1):71-81. [Not Available] [Article in Italian] PIATTI A. PMID: 14377820 [PubMed - OLDMEDLINE] 8125. J Med Bord. 1955 Jan;132(1):61-2. [Treatment of herpes zoster with emetine hydrochloride.] [Article in French] MARTIN C. PMID: 14354389 [PubMed - indexed for MEDLINE] 8126. Bull Soc Belge Ophtalmol. 1955;110:114-25; discussion, 125-6. [Not Available] [Article in French] FRANCOIS J, NEETENS A. PMID: 13413511 [PubMed - OLDMEDLINE] 8127. Rev Otoneuroophtalmol. 1955;27(7):385-91. [Paroxysmal lacrimation and Ramsay-Hunt syndrome.] [Article in French] ALFANDARY MI. PMID: 13390341 [PubMed - indexed for MEDLINE] 8128. Rev Otoneuroophtalmol. 1955;27(6):330-3. [Not Available] [Article in French] DE MORSIER G, FORNI S, FRANCESCHETTI A. PMID: 13371152 [PubMed - OLDMEDLINE] 8129. Otolaryngol Pol. 1955;9(4):343-8. [Not Available] [Article in Polish] GODLEWSKI J. PMID: 13310021 [PubMed - OLDMEDLINE] 8130. Wien Z Nervenheilkd Grenzgeb. 1955;12(1):114-8. [Demonstration of a case of herpes zoster encephalitis.] [Article in German] BECKER G. PMID: 13300106 [PubMed - OLDMEDLINE] 8131. Dermatol Wochenschr. 1955;132(36):937-42. [Hypoprothrombinemia and theoretical basis for liver therapy in herpes zoster.] [Article in German] PASTINSZKY S, KOVACS E, RACZ S, GESZTI O. PMID: 13261631 [PubMed - OLDMEDLINE] 8132. Arch Fr Pediatr. 1955;12(6):573-80. [Curable herpetic encephalitis; virological and immunological study.] [Article in French] THIEFFRY S, MARTIN C, DROUHET V, BOUCHARD J. PMID: 13259705 [PubMed - OLDMEDLINE] 8133. Urol Int. 1955;1(2):139-41. Paralysis of the urinary bladder in herpes zoster. ZACHARIAE F. PMID: 13256830 [PubMed - OLDMEDLINE] 8134. Eye Ear Nose Throat Mon. 1955 Jan;34(1):44-8. Herpes zoster of the cephalic extremity. SABRI JA. PMID: 13220627 [PubMed - OLDMEDLINE] 8135. AMA Arch Ophthalmol. 1955 Jan;53(1):38-44. Treatment of herpes zoster ophthalmicus with cortisone or corticotropin. SCHEIE HG, ALPER MC. PMID: 13217545 [PubMed - indexed for MEDLINE] 8136. Z Haut Geschlechtskr. 1954 Dec 15;17(12):378-81. [The treatment of herpes zoster with hïgh doses of vitamin B12.] [Article in German] JOHNE HO. PMID: 14374879 [PubMed - indexed for MEDLINE] 8137. Harefuah. 1954 Dec 15;47(12):250-1. [Procaine for control of pruritus.] [Article in Hebrew] BERLIN C, MEIROVITZ K, TADJER A. PMID: 14353366 [PubMed - indexed for MEDLINE] 8138. Rev Bras Med. 1954 Dec;11(12):843. [My familial case of herpes zoster and varicella.] [Article in Portuguese] FECURY J. PMID: 14372283 [PubMed - indexed for MEDLINE] 8139. Arch Belg Dermatol Syphiligr. 1954 Nov;10(3):288-95. [Value of therapy of herpes zoster.] [Article in French] LAKAYE G. PMID: 14362561 [PubMed - indexed for MEDLINE] 8140. Arch Belg Dermatol Syphiligr. 1954 Nov;10(3):272. [Nodulare panvasculitis appearing during zona.] [Article in French] VAN DER MEIREN L. PMID: 14362551 [PubMed - OLDMEDLINE] 8141. Stomatologiia (Mosk). 1954 Nov-Dec;6:16. [A case of herpes zoster of mucosa of the mouth.] [Article in Russian] LEIN AA. PMID: 14358995 [PubMed - indexed for MEDLINE] 8142. J Sci Med Lille. 1954 Nov;72(11):513. [Not Available] [Article in French] COUSIN J, DAVID P. PMID: 13234079 [PubMed - indexed for MEDLINE] 8143. Minn Med. 1954 Nov;37(11):815-7. Cat-scratch disease associated with encephalitis and herpes zoster. FRICK PG. PMID: 13213829 [PubMed - indexed for MEDLINE] 8144. J Am Geriatr Soc. 1954 Nov;2(11):726-35. Herpes zoster; review, with preliminary report on new method for treatment of postherpetic neuralgia. SCHILLER F. PMID: 13211194 [PubMed - indexed for MEDLINE] 8145. Lancet. 1954 Oct 30;267(6844):898-9. Hemiplegia complicating ophthalmic zoster. COPE S, JONES AT. PMID: 13213069 [PubMed - OLDMEDLINE] 8146. Minerva Med. 1954 Oct 13;45(82):910-4. [Zosteriform recurrent dermatitis with giant bullae caused by ganglio-radiculitis.] [Article in Italian] RESSA P, APRA A. PMID: 13235393 [PubMed - OLDMEDLINE] 8147. Bull Soc Ophtalmol Fr. 1954 Oct;6:512-3. [The importance of vitamin C in the treatment of herpetic keratitis.] [Article in French] GROSJEAN G. PMID: 14351934 [PubMed - OLDMEDLINE] 8148. Ann Phys Med. 1954 Oct;2(4):132-4. Shoulder-hand syndrome following herpes zoster. RICHARDSON AT. PMID: 13229232 [PubMed - OLDMEDLINE] 8149. Br J Dermatol. 1954 Oct;66(10):357-60. Discoid lupus erythematosus following trauma. SCHIFF BL, KERN AB. PMID: 13208924 [PubMed - OLDMEDLINE] 8150. Am J Nurs. 1954 Oct;54(10):1217-9. Herpes zoster. JEGHERS H. PMID: 13197447 [PubMed - indexed for MEDLINE] 8151. Wien Klin Wochenschr. 1954 Sep 24;66(38):733-5. [Zoster generalisatus in chronic lymphatic leukemia.] [Article in German] MATRAS A. PMID: 14348873 [PubMed - indexed for MEDLINE] 8152. Hautarzt. 1954 Sep;5(9):391-7. [Herpes zoster.] [Article in German] FEYRTER F. PMID: 13221134 [PubMed - indexed for MEDLINE] 8153. Rev Med Nancy. 1954 Sep;79:547-53. [Brachial monoplegia caused by zosterian myelitis.] [Article in French] ARNOULD G, HARTEMANN P, DEBRY G. PMID: 13204947 [PubMed - OLDMEDLINE] 8154. Maroc Med. 1954 Aug;33(351):789. [Two cases of herpes zoster treated by vitamin B12 in doses of 1000 gammas.] [Article in French] DASTE M. PMID: 14369110 [PubMed - indexed for MEDLINE] 8155. Lek List. 1954 Aug 1;9(15-16):368-9. [Ganglion blocking method in the treatment of herpes zoster; preliminary communication.] [Article in Czech] MASEK O. PMID: 13202518 [PubMed - indexed for MEDLINE] 8156. Boll Ocul. 1954 Aug;33(8):491-4. [Not Available] [Article in Italian] MIGLIOR M. PMID: 13199130 [PubMed - OLDMEDLINE] 8157. South Med J. 1954 Aug;47(8):728-32. Bilateral herpes zoster; report of three cases. HAILEY H. PMID: 13186949 [PubMed - indexed for MEDLINE] 8158. Ill Med J. 1954 Aug;106(2):131-3. Treatment of herpes zoster with cortisone. DOENGES JP. PMID: 13183633 [PubMed - indexed for MEDLINE] 8159. Am J Ophthalmol. 1954 Jul;38(1:1):23-33. Argyll Robertson pupil; following herpes zoster ophthalmicus, with remarks on the efferent pupillary pathways. NAQUIN HA. PMID: 13180601 [PubMed - OLDMEDLINE] 8160. N Y State J Med. 1954 Jul 1;54(13):1927-30. The treatment of herpes zoster, neuralgias, and neuritis with thiamine potentiated with neostigmine (thiastigmine). WALDMAN S, PELNER L. PMID: 13176682 [PubMed - indexed for MEDLINE] 8161. Ugeskr Laeger. 1954 Jun 10;116(23):885-6. [Treatment of zoster.] [Article in Undetermined Language] WILKEN JENSEN K. PMID: 13179331 [PubMed - indexed for MEDLINE] 8162. Ann Ocul (Paris). 1954 May;187(5):467-70. Not Available [Article in English, French] REYNON M. PMID: 13189185 [PubMed - OLDMEDLINE] 8163. J Med Bord. 1954 May;131(5):472-5. [Laryngeal herpes zoster and total dysphagia.] [Article in Undetermined Language] PORTMANN M, MALINEAU, CLAVERIE G. PMID: 13184267 [PubMed - OLDMEDLINE] 8164. Proc R Soc Med. 1954 May;47(5):371-84. THE RAMSAY HUNT syndrome. [No authors listed] PMCID: PMC1918846 PMID: 13167057 [PubMed - OLDMEDLINE] 8165. Rev Bras Med. 1954 Apr;11(4):240-3. [Herpes zoster; topographical study of cutaneous lesions in 70 patients.] [Article in Portuguese] MARQUES RJ. PMID: 13194983 [PubMed - indexed for MEDLINE] 8166. Dermatologica. 1954 Apr-Jun;108(4-6):295-9. [Observations of the course and comments on the therapy of herpes zoster.] [Article in German] BURCKHARDT W, VON SZECHY H. PMID: 13190909 [PubMed - indexed for MEDLINE] 8167. Feldsher Akush. 1954 Apr;4:19-21. [Herpes.] [Article in Undetermined Language] SHEKLAKOV ND. PMID: 13183150 [PubMed - indexed for MEDLINE] 8168. Lyon Med. 1954 Mar 14;86(11):240-2. [Effect of emetine on the development of herpes zoster.] [Article in Undetermined Language] GIRARD M, POTTON F, GRIVET A. PMID: 13164469 [PubMed - indexed for MEDLINE] 8169. J Am Med Assoc. 1954 Mar 13;154(11):911-2. Treatment of herpes zoster with cortisone. GELFAND ML. PMID: 13129068 [PubMed - indexed for MEDLINE] 8170. Zentralbl Allg Pathol. 1954 Feb 22;91(6-8):279-301. [Problem of zoster.] [Article in Undetermined Language] FEYRTER F. PMID: 13170522 [PubMed - indexed for MEDLINE] 8171. Orv Hetil. 1954 Feb 7;95(6):154-6. [Clinical aspects and pathogenesis of herpes zoster.] [Article in Undetermined Language] MARTON K, SZEGO L. PMID: 13166250 [PubMed - indexed for MEDLINE] 8172. Rev Bras Med. 1954 Feb;11(2):97-9. [Herpes zoster of prolonged evolution, complicated by cutaneous gangrene during cortisone therapy; varicella in two children of the patient.] [Article in Undetermined Language] DE MACEDO AG, DA S MOREIRA MB. PMID: 13167583 [PubMed - indexed for MEDLINE] 8173. Ann Soc Belg Med Trop (1920). 1954 Jan 28;34(1):5-8. [Bilateral herpetiform zona caused by Loa loa.] [Article in Undetermined Language] BROWNE SG. PMID: 13181226 [PubMed - OLDMEDLINE] 8174. Odontoiatr Rev Iberoam Med Boca. 1954;11(132):724. [Herpes zoster of the tongue and palate and its neurological complications.] [Article in Spanish] STEPAN H. PMID: 14384170 [PubMed - OLDMEDLINE] 8175. Rev Otoneuroophtalmol. 1954;26(4):218-21. [Cochleovestibular disorders with involvement of the trigeminal and mixed nerves of central origin after eruption of zoster.] [Article in French] GREINER GF, PHILIPPIDES D, BERNHARDT C, MENGUS M. PMID: 14372687 [PubMed - OLDMEDLINE] 8176. Przegl Lek. 1954;10(11):295-6. [Considerations on smallpox and herpes zoster.] [Article in Polish] MARCINKOWSKI T. PMID: 14357484 [PubMed - indexed for MEDLINE] 8177. Ther Hung. 1954;1:25-6. Vitamin B12 in the treatment of herpes zoster. LOVEI E, ANTALOCZY Z. PMID: 13247259 [PubMed - indexed for MEDLINE] 8178. Rass Studi Psichiatr. 1954;43(4):673-9. [Homolateral paralysis of the abducent and facial nerves during auricular herpes zoster.] [Article in Italian] CATALANO V, IMBERCIADORI E. PMID: 13224881 [PubMed - OLDMEDLINE] 8179. Arch Kinderheilkd. 1954;148(3):281-4. [Second occurrence of varicella appearing as sequel to herpes zoster.] [Article in German] KIRCHER W. PMID: 13208216 [PubMed - indexed for MEDLINE] 8180. Zdrav Vestn. 1954;23(5-6):102-6. [Not Available] [Article in Undetermined Language] RUS S. PMID: 13188026 [PubMed - indexed for MEDLINE] 8181. Virchows Arch. 1954;325(1):70-89. [Essential features of zoster.] [Article in Undetermined Language] FEYRTER F. PMID: 13179470 [PubMed - indexed for MEDLINE] 8182. Przegl Dermatol. 1954 Jan-Feb;4(1):59-63. [Not Available] [Article in Undetermined Language] KACZOROWSKA H. PMID: 13177744 [PubMed - indexed for MEDLINE] 8183. J Pediatr. 1954 Jan;44(1):116-8. Varicella and herpes zoster. BLATTNER R. PMID: 13131206 [PubMed - indexed for MEDLINE] 8184. Oral Surg Oral Med Oral Pathol. 1954 Jan;7(1):60-3. Herpes zoster; report of a case. STERNLICHT HC. PMID: 13120130 [PubMed - indexed for MEDLINE] 8185. Med J Aust. 1953 Dec 12;2(24):890-1. Motor effects of herpes zoster. PETERSON BH. PMID: 13119047 [PubMed - OLDMEDLINE] 8186. Arch Belg Dermatol Syphiligr. 1953 Dec;9(4):345-7. [Diadynamic currents in therapy of herpes zoster.] [Article in Undetermined Language] FIEVEZ C. PMID: 13139659 [PubMed - indexed for MEDLINE] 8187. Calif Med. 1953 Dec;79(6):444-8. Mandibular herpes zoster; with report on the use of cortisone in a case with geniculate ganglion symptoms. SHEVICK IM. Herpes zoster, an acute specific viral infection, occurs more commonly than is generally supposed. It should be differentiated from other diseases involving the ear and skin; it must be considered as a possible etiologic agent in some palsies of the facial, glossopharyngeal or vagal nerves. The type of cephalic herpes zoster should be carefully differentiated; cases involving the "geniculate zone" may be other than "Ramsay Hunt's syndrome." This syndrome is now defined as a herpes zoster eruption of the external ear at the "geniculate zone" with involvement of the seventh or seventh and eighth nerves. The "topognostic" method is the best for determining the level at which the facial nerve has been affected. It is questioned whether there is a single outstanding therapeutic agent for this disease. Cortisone had no apparent therapeutic effect in a case reported herein. PMCID: PMC1521888 PMID: 13106732 [PubMed - indexed for MEDLINE] 8188. Prakt Lek. 1953 Nov 20;33(22):510. [Studies on the relationship between etiologic agents of herpes zoster and varicella.] [Article in Undetermined Language] NEMEC J. PMID: 13133915 [PubMed - indexed for MEDLINE] 8189. Belg Tijdschr Geneesk. 1953 Nov 15;9(22):1016-23. [Current treatment of herpes zoster.] [Article in Undetermined Language] ROSSELLE N. PMID: 13115331 [PubMed - indexed for MEDLINE] 8190. Riv Neurol. 1953 Nov-Dec;23(6):804-9. [Neurologic complications of herpes zoster.] [Article in Undetermined Language] ZANOCCO G. PMID: 13168150 [PubMed - OLDMEDLINE] 8191. Vie Med. 1953 Nov;34(11):1017-21. [Treatment of herpes zoster.] [Article in Undetermined Language] GUERRE J. PMID: 13136867 [PubMed - indexed for MEDLINE] 8192. Lyon Med. 1953 Oct 25;85(43):270-1. [A case of generalized herpes zoster.] [Article in Undetermined Language] MICHEL PJ, SAINT-PAUL J, MARTIN A. PMID: 13118904 [PubMed - indexed for MEDLINE] 8193. J Med Lyon. 1953 Oct 5;34(810):747-57. [On the so called generalized zona: a personal case.] [Article in Undetermined Language] MICHEL PJ, MARTIN A. PMID: 13109402 [PubMed - indexed for MEDLINE] 8194. Munch Med Wochenschr. 1953 Oct 2;95(40):1074-76. [Herpes zoster in pulmonary tuberculosis.] [Article in Undetermined Language] LINGEMANN O. PMID: 13111146 [PubMed - indexed for MEDLINE] 8195. Arch Pediatr Urug. 1953 Oct;24(10):695-6. [Intercostal herpes zoster in an infant 7 months old.] [Article in Undetermined Language] PELUFFO E, LORENZO Y DEAL J, MOTTA H. PMID: 13125913 [PubMed - indexed for MEDLINE] 8196. Dia Med. 1953 Oct 1;25(66):1849. [Relation between herpes zoster and varicella.] [Article in Undetermined Language] TESORO J. PMID: 13107486 [PubMed - indexed for MEDLINE] 8197. Clin Proc Child Hosp Dist Columbia. 1953 Sep;9(9):199-201. Herpes zoster and varicella simulating poliomyelitis. WOLF SI, PARROTT RH. PMID: 13116474 [PubMed - indexed for MEDLINE] 8198. Arch Belg Dermatol Syphiligr. 1953 Sep;9(2):125-35. [Appearance of a varicelliform herpes zoster in the course of chronic lymphoid leukemia.] [Article in Undetermined Language] VAN STEENACKER G. PMID: 13105374 [PubMed - indexed for MEDLINE] 8199. Tex State J Med. 1953 Sep;49(9):693-5. Inactivated influenza virus vaccine in the therapy of herpes zoster; clinical evaluation. GRISWOLD CM, BOWEN SS. PMID: 13102361 [PubMed - indexed for MEDLINE] 8200. Conn State Med J. 1953 Sep;17(9):771. HERPES zoster in old age. [No authors listed] PMID: 13083006 [PubMed - OLDMEDLINE] 8201. J Sci Med Lille. 1953 Aug 15;71(8):384-5. [Zona and varicella.] [Article in Undetermined Language] LESAGE V, DAVID P. PMID: 13109842 [PubMed - indexed for MEDLINE] 8202. Minerva Dermatol. 1953 Aug;28(8):189-97. [Pathogenesis of complications after zoster.] [Article in Undetermined Language] MORETTI G. PMID: 13110809 [PubMed - OLDMEDLINE] 8203. Reumatismo. 1953 Jul-Aug;5(4):276. [Herpes zoster and periarthritis of the shoulder.] [Article in Undetermined Language] FILOGAMO G, CARTESEGNA F. PMID: 13121378 [PubMed - OLDMEDLINE] 8204. Pediatr Pol. 1953 Jul;28(7):740-2. [Case of herpes zoster with simultaneous symptoms of varicella and meningitis.] [Article in Undetermined Language] GODLEWSKI J, ZEMAN F. PMID: 13120224 [PubMed - indexed for MEDLINE] 8205. Rev Otoneuroophtalmol. 1953 Jul;25(5):273-6. [Otoneuro-ophthalmologic complications following facial zona.] [Article in Undetermined Language] BRONNER A, LOBSTEIN PA. PMID: 13112914 [PubMed - OLDMEDLINE] 8206. Z Haut Geschlechtskr. 1953 Jul 1;15(1):7-8. [Paresis of facial nerve according to Zoster.] MEYER-ROHN J. PMID: 13103257 [PubMed - OLDMEDLINE] 8207. J Lancet. 1953 Jul;73(7):288-92. The treatment of post-herpetic neuralgia. MILLER ZR. PMID: 13096930 [PubMed - indexed for MEDLINE] 8208. Rev Clin Esp. 1953 Jun 30;49(6):397-9. [Paralysis of hemidiaphragm by herpes zoster.] [Article in Undetermined Language] CERVIA T. PMID: 13100878 [PubMed - OLDMEDLINE] 8209. Rev Asoc Med Argent. 1953 Jun 15-30;67(751-2):198-9. [Paralytic mydriasis after zoster ophthalmicus; deductions about the lesion of the ciliary ganglion.] [Article in Undetermined Language] SPOTA BB, BRAGE D. PMID: 13112566 [PubMed - indexed for MEDLINE] 8210. Cesk Otolaryngol. 1953 Jun;2(2):106-10. [Problem of herpes zoster and its therapy with aureomycin.] [Article in Undetermined Language] STRELKA J. PMID: 13116324 [PubMed - indexed for MEDLINE] 8211. Proc Soc Exp Biol Med. 1953 Jun;83(2):340-6. Serial propagation in vitro of agents producing inclusion bodies derived from varicella and herpes zoster. WELLER TH. PMID: 13064265 [PubMed - indexed for MEDLINE] 8212. Wien Med Wochenschr. 1953 May 30;103(22):398. [Sudden occurrence of an epithelial blister on the lower half of the cornea in connection with keratitis herpetica.] [Article in Undetermined Language] PURTSCHER A. PMID: 13078564 [PubMed - indexed for MEDLINE] 8213. Prensa Med Argent. 1953 May 22;40(21):1281-4. [Cephalomotor forms of herpes zoster.] [Article in Undetermined Language] BARDECI CA, KIERMAN HJ. PMID: 13073950 [PubMed - indexed for MEDLINE] 8214. Prensa Med Argent. 1953 May 15;40(20):1220-2. [Herpes zoster and dihydroergotamine.] [Article in Undetermined Language] CANCIO C. PMID: 13073938 [PubMed - indexed for MEDLINE] 8215. Ugeskr Laeger. 1953 May 14;115(20):788-9. [Zoster and chickenpox once again.] [Article in Undetermined Language] DAHL S. PMID: 13077993 [PubMed - indexed for MEDLINE] 8216. Rev Otoneuroophtalmol. 1953 May-Jun;25(4):251-2. [Auricular zona and facial paralysis.] [Article in Undetermined Language] SITBON J, ZERMATI M. PMID: 13112910 [PubMed - OLDMEDLINE] 8217. Neurol Psychiatr Ceskoslov. 1953 May;16(1-2):54-60. [Herpes zoster palatinus.] [Article in Undetermined Language] VOJIR R. PMID: 13087566 [PubMed - OLDMEDLINE] 8218. Med Monatsschr. 1953 May;7(5):316-7. [Zoster with aberrant small vesicles in spondylitis tuberculosa; problem of segmental disposition.] [Article in Undetermined Language] HAUSNER W. PMID: 13086528 [PubMed - indexed for MEDLINE] 8219. N Y State J Med. 1953 May 1;53(9):1118-9. A case of Bell's palsy followed by herpes zoster oticus. MCSWEENY AJ. PMID: 13063729 [PubMed - OLDMEDLINE] 8220. AMA Arch Derm Syphilol. 1953 May;67(5):512-3. Improving the recovery time of herpes zoster. BERG GO. PMID: 13050161 [PubMed - indexed for MEDLINE] 8221. Lyon Med. 1953 Apr 19;188(16):319-20. [An interesting treatment for zona.] [Article in Undetermined Language] GRIVEAUD, ACHARD, MORIN. PMID: 13070795 [PubMed - indexed for MEDLINE] 8222. Riforma Med. 1953 Apr 11;67(15):411-4. [A case of cutaneous gangrene following herpes zoster.] [Article in Undetermined Language] RANDAZZO SD. PMID: 13075732 [PubMed - indexed for MEDLINE] 8223. Wien Med Wochenschr. 1953 Apr 4;103(14):258-60. [Neurological complications in herpes zoster of tongue and palate.] [Article in Undetermined Language] STEPAN H. PMID: 13078510 [PubMed - OLDMEDLINE] 8224. Pediatr Pol. 1953 Apr;28(4):407-9. [Problem of herpes zoster and chickenpox.] [Article in Undetermined Language] MISIUREWICZ M. PMID: 13088146 [PubMed - indexed for MEDLINE] 8225. Northwest Med. 1953 Apr;52(4):291-2. Vitamin B12 in massive dosages for herpetic lesions. LEITCH GB. PMID: 13055119 [PubMed - indexed for MEDLINE] 8226. J Med Assoc State Ala. 1953 Apr;22(10):267-8. Hypersensitivity to protamide; report of case. ZDANIS AS. PMID: 13053111 [PubMed - indexed for MEDLINE] 8227. Ugeskr Laeger. 1953 Mar 19;115(12):459-62. [Chickenpox, zoster; concluding remarks.] [Article in Undetermined Language] DAHL S. PMID: 13077899 [PubMed - indexed for MEDLINE] 8228. Z Haut Geschlechtskr. 1953 Mar 15;14(6):190-3. [Zoster and leukemia (leukemia cutis in zostere.] [Article in Undetermined Language] KEYENBURG GW. PMID: 13078922 [PubMed - indexed for MEDLINE] 8229. Sem Hop. 1953 Mar 10;29(17):845-50. [The skeleton in herpes zoster.] [Article in Undetermined Language] ISEMEIN L, FOURNIER A. PMID: 13076327 [PubMed - indexed for MEDLINE] 8230. Bull Soc Ophtalmol Fr. 1953 Mar;3:231-3. [Zona ophthalmica and sulfarsenol.] [Article in Undetermined Language] HERVOUET F, CHEVANNES. PMID: 13106624 [PubMed - indexed for MEDLINE] 8231. Bull New Engl Med Cent. 1953 Mar;15(1):23-31. Coagulation defects due to acquired anticoagulants and fibrinolysis; their detection and treatment. [Article in English, Undetermined Language] STEFANINI M, CAMPBELL EW, PLITMAN GI, SALOMON L. PMID: 13032681 [PubMed - indexed for MEDLINE] 8232. Resen Clin Cient. 1953 Feb;22(2):44-8. [Herpes zoster.] [Article in Undetermined Language] BAILEY P. PMID: 13074625 [PubMed - indexed for MEDLINE] 8233. Lattante. 1953 Feb;24(2):99-100. [Relations between herpes zoster and chickenpox.] [Article in Undetermined Language] BULLA G. PMID: 13070641 [PubMed - indexed for MEDLINE] 8234. J Nerv Ment Dis. 1953 Feb;117(2):157-8. Herpes zoster with muscular involvement report of three cases. FREIMAN IS, LADERMAN P. PMID: 13061962 [PubMed - indexed for MEDLINE] 8235. Minn Med. 1953 Feb;36(2):152; passim. Herpes zoster with motor paralysis. BLANSHARD TP. PMID: 13025256 [PubMed - OLDMEDLINE] 8236. Med Klin (Munich). 1953 Jan 23;48(4):106-8. [Zoster and trauma.] [Article in Undetermined Language] LAUSECKER H. PMID: 13119256 [PubMed - indexed for MEDLINE] 8237. Manedsskr Prakt Laegegern. 1953 Jan;31(1):33-9. [Not Available] [Article in Danish] DAHL S. PMID: 13202574 [PubMed - indexed for MEDLINE] 8238. Ann Otolaryngol Chir Cervicofac. 1953;70(11-12):798-801. [Zonas of the face.] [Article in Undetermined Language] CAMBRELIN MG. PMID: 13148908 [PubMed - OLDMEDLINE] 8239. J Radiol Electrol Arch Electr Medicale. 1953;34(5-6):379-80. [Herpes zoster and antihistaminic ionization.] [Article in Undetermined Language] DANO R. PMID: 13097492 [PubMed - indexed for MEDLINE] 8240. Rev Otoneuroophtalmol. 1953 Jan;25(1):12-5. [Pharyngo-otic zona.] [Article in Undetermined Language] MONTANDON A. PMID: 13075409 [PubMed - indexed for MEDLINE] 8241. Bull Soc Fr Dermatol Syphiligr. 1953 Jan-Feb;60(1):106-7. [Interesting therapy of zona.] [Article in Undetermined Language] GRIVEAUD, ACHARD, MORIN. PMID: 13066915 [PubMed - indexed for MEDLINE] 8242. Bull Soc Fr Dermatol Syphiligr. 1953 Jan-Feb;60(1):102-3. [Cervico-scapular zona and generalized varicella.] [Article in Undetermined Language] DUVERNE J, BONNAYME R, MONTAGNON. PMID: 13066911 [PubMed - indexed for MEDLINE] 8243. J Pathol Bacteriol. 1953 Jan;65(1):221-7. The pathology of acute herpes zoster ophthalmicus. GOODBODY RA. PMID: 13035615 [PubMed - indexed for MEDLINE] 8244. J Indian Med Assoc. 1953 Jan;22(4):158-62. Treatment of herpes zoster ophthalmicus with methanesulphonate of hydrogenated ergotamine. AGARWAL LP, ADHAULIA HN, MEHRA KS, SHURMA CK. PMID: 13035143 [PubMed - indexed for MEDLINE] 8245. Antiseptic. 1953 Jan;50(1):59-60. A case of mumps following herpes zoster. ROY SK. PMID: 13017572 [PubMed - indexed for MEDLINE] 8246. N Y State J Med. 1952 Dec 15;52(24):3033-4. Herpes zoster and varicella. GLOTZER S. PMID: 13013556 [PubMed - indexed for MEDLINE] 8247. Med J Aust. 1952 Dec 6;2(23):810-5. Facial paralysis, a clinical review with an autopsy report of the histo-pathology in a case of infection of the geniculate ganglion by the virus of cephalic herpes zoster. FINDLAY JP. PMID: 13012431 [PubMed - OLDMEDLINE] 8248. Nord Med. 1952 Nov 28;48(48):1661. [Ophthalmic zoster with cranial nerve complication.] [Article in Undetermined Language] PETERSEN J. PMID: 13025946 [PubMed - OLDMEDLINE] 8249. Nord Med. 1952 Nov 14;48(46):1589-90. [Chloromycetin allergy with joint & cardiac symptoms and psychic reaction.] [Article in Undetermined Language] GULLBERG S. PMID: 13025911 [PubMed - indexed for MEDLINE] 8250. Arch Belg Dermatol Syphiligr. 1952 Nov 3;8(3):307-10. [Zona with multiple localizations in hemolytic jaundice.] [Article in Undetermined Language] LEGROS A. PMID: 13031591 [PubMed - OLDMEDLINE] 8251. Rass Medica. 1952 Nov;29(11):264-6. [Herpes zoster and chickenpox.] [Article in Undetermined Language] VERGA G. PMID: 13047595 [PubMed - indexed for MEDLINE] 8252. Acta Physiother Rheumatol Belg. 1952 Nov-Dec;7(6):354-6. [Treatment of herpes zoster by ultrasound.] [Article in Undetermined Language] FORMIGAL LUZES F. PMID: 13040043 [PubMed - indexed for MEDLINE] 8253. Z Laryngol Rhinol Otol. 1952 Nov;31(11):545-57. [Differential diagnosis and clinical observation in zoster oticus.] [Article in Undetermined Language] PELLNITZ D. PMID: 13039391 [PubMed - indexed for MEDLINE] 8254. Hautarzt. 1952 Nov;3(11):483-8. [Applications of electron microscopy in dermatology.] [Article in Undetermined Language] NASEMANN T. PMID: 13021710 [PubMed - indexed for MEDLINE] 8255. Miss Valley Med J. 1952 Nov;74(6):186-7. Herpes zoster; treatment with x-radiation. WEST T, MAN M, DALTON C. PMID: 13013142 [PubMed - indexed for MEDLINE] 8256. N C Med J. 1952 Nov;13(11):632-5. HERPES zoster; presentation of a case. [No authors listed] PMID: 13003002 [PubMed - indexed for MEDLINE] 8257. Med Ann Dist Columbia. 1952 Nov;21(11):606-7. Herpes zoster and varicella occurring simultaneously in the same case. JONES BC Jr. PMID: 12992053 [PubMed - indexed for MEDLINE] 8258. Sem Med. 1952 Oct 26;28(39):659. [Serum of convalescent subjects of herpes zoster and chickenpox in therapy of herpes zoster.] [Article in Undetermined Language] TZANCK A, HERZOG F, GAIFFE M. PMID: 13028544 [PubMed - indexed for MEDLINE] 8259. Rev Med Liege. 1952 Oct 15;7(20):653-5. [Presentation of otorhinolaryngological cases.] [Article in Undetermined Language] VANDAM J. PMID: 13027882 [PubMed - OLDMEDLINE] 8260. Rev Medica Hosp Esp. 1952 Oct-Dec;22(10-12):165-70. [Teleroentgenotherapy of neuralgia following zona.] [Article in Undetermined Language] MATEOS MB. PMID: 13064523 [PubMed - indexed for MEDLINE] 8261. Hopital. 1952 Oct;40(615):305-6. [Not Available] [Article in Undetermined Language] VIDAL J. PMID: 13021861 [PubMed - indexed for MEDLINE] 8262. Minerva Med. 1952 Oct 1;43(79):545-7. [Relations between herpes zoster, herpes simplex and varicella manifestations.] [Article in Undetermined Language] ZANROSSO G. PMID: 13013018 [PubMed - OLDMEDLINE] 8263. Minn Med. 1952 Oct;35(10):961. Herpes zoster; report of a case occurring in an infant eight months old. MADDEN JF. PMID: 13002213 [PubMed - indexed for MEDLINE] 8264. Am Pract Dig Treat. 1952 Oct;3(10):797-8. Treatment of herpes zoster with chloromycetin. WRIGHT CS, ROXBY JB Jr. PMID: 12986161 [PubMed - indexed for MEDLINE] 8265. Praxis. 1952 Sep 11;41(37):805-6. [Neurosurgical therapy of intolerable post-zona neuralgia.] [Article in Undetermined Language] WERNER A. PMID: 13026708 [PubMed - indexed for MEDLINE] 8266. Prensa Med Argent. 1952 Sep 5;39(36):2090-2. [Paralytic mydriasis following zona ophthalmica; considerations on a lesion of the ciliary ganglion.] [Article in Undetermined Language] SPOTA BB, BRAGE D. PMID: 12993676 [PubMed - OLDMEDLINE] 8267. Dtsch Med Wochenschr. 1952 Sep 5;77(36):1074-6. [Therapy of herpes zoster with human globulin.] [Article in Undetermined Language] GROS H. PMID: 12979748 [PubMed - indexed for MEDLINE] 8268. AMA Arch Neurol Psychiatry. 1952 Sep;68(3):314-7. Pain of herpes zoster ophthalmicus. DOLAN RA, BUCY PC. PMID: 14952068 [PubMed - indexed for MEDLINE] 8269. Bibl Laeger. 1952 Sep-Oct;144:222-4. [Modes of transmission in zoster.] [Article in Undetermined Language] DAHL S. PMID: 13159866 [PubMed - indexed for MEDLINE] 8270. Bibl Laeger. 1952 Sep-Oct;144:217-21. [Not Available] [Article in Undetermined Language] DAHL S. PMID: 13159865 [PubMed - indexed for MEDLINE] 8271. Bibl Laeger. 1952 Sep-Oct;144:213-6. [Not Available] [Article in Undetermined Language] DAHL S. PMID: 13159864 [PubMed - indexed for MEDLINE] 8272. Archivos Soc Oftalmol Hisp Am. 1952 Sep;12(9):1106-21. [Chemotherapy of herpetic infections in ophthalmology.] [Article in Undetermined Language] DIAZ FERRON E. PMID: 13017993 [PubMed - indexed for MEDLINE] 8273. Rev Med Chil. 1952 Sep;80(9):568. [Treatment of herpes zoster with terramycin.] [Article in Undetermined Language] LOPEZ N. PMID: 13014616 [PubMed - indexed for MEDLINE] 8274. Calcutta Med J. 1952 Sep;49(9):367-70. Herpes zoster with eye complications. GHOSH CK. PMID: 13009453 [PubMed - indexed for MEDLINE] 8275. J Maine Med Assoc. 1952 Sep;43(9):301-3. The value of adrenocorticotropic hormone in herpes zoster ophthalmacus. POULIN JE. PMID: 12990927 [PubMed - indexed for MEDLINE] 8276. Med Klin (Munich). 1952 Aug 15;47(33):1053-4. [Primary generalized herpes zoster causing death in chronic lymphogranulomatosis.] [Article in Undetermined Language] HAUSNER W. PMID: 13012791 [PubMed - indexed for MEDLINE] 8277. Ugeskr Laeger. 1952 Aug 14;114(33):1109-10. [Pituitrin preparations in therapy of herpes zoster.] [Article in Undetermined Language] SECHER K. PMID: 13015713 [PubMed - OLDMEDLINE] 8278. Dia Med. 1952 Aug 11;24(50):1303-4. [Chloromycetin in therapy of zoster ophthalmicus.] [Article in Undetermined Language] TELLO EE. PMID: 13020712 [PubMed - OLDMEDLINE] 8279. Postgrad Med. 1952 Aug;12(2):127-32. Herpes zoster. BAILEY P. PMID: 14957687 [PubMed - indexed for MEDLINE] 8280. Minerva Dermatol. 1952 Aug;27(8):187-90. [Chloramphenicol therapy of herpes zoster.] [Article in Undetermined Language] GIULIANI V. PMID: 13012918 [PubMed - indexed for MEDLINE] 8281. Antiseptic. 1952 Aug;49(8):587-94. Herpes zoster and varicella. SUBBA RAO KV. PMID: 12986712 [PubMed - indexed for MEDLINE] 8282. Prensa Med Argent. 1952 Jul 25;39(30):1723-6. [Treatment of herpes zoster with chloramphenicol.] [Article in Undetermined Language] TELLO EE. PMID: 14957748 [PubMed - indexed for MEDLINE] 8283. Rev Bras Med. 1952 Jul;9(7):455-62. [Generalized herpes zoster and lymphoma.] [Article in Undetermined Language] SILVA MS. PMID: 13064469 [PubMed - indexed for MEDLINE] 8284. Arch Dermatol Syph. 1952 Jul;194(4):366-75. [A clinically and pathologically unusual case of herpes zoster multiplex with peculiar ileitis.] [Article in Undetermined Language] SCHIRDUAN M, DIETZE HH. PMID: 12996985 [PubMed - indexed for MEDLINE] 8285. Orv Hetil. 1952 Jun 15;93(24):708-10. [A case of atypic zoster oticus.] [Article in Undetermined Language] GAL P. PMID: 13003324 [PubMed - indexed for MEDLINE] 8286. Montp Med. 1952 Jun;41-42(4):414-6. [Trophic disorders and osteoporosis after herpes zoster of the upper extremity.] [Article in Undetermined Language] MARGAROT J, RIMBAUD P, IZARN P, BERTRAND A. PMID: 13013182 [PubMed - OLDMEDLINE] 8287. Sem Med. 1952 May 2;100(18):554-6. [Now concept on physiopathology of nerve fibers.] [Article in Undetermined Language] ARETA T. PMID: 14950318 [PubMed - indexed for MEDLINE] 8288. Rev Med Chil. 1952 May;80(5):266-9. [Treatment of herpes zoster with ACTH and cortisone.] [Article in Undetermined Language] WEINSTEIN M, LAMAS R. PMID: 14949663 [PubMed - indexed for MEDLINE] 8289. Va Med Mon (1918). 1952 May;79(5):250-3. Herpes zoster of the cranial nerves. McGOVERN FH, FITZ-HUGH GS. PMID: 14943005 [PubMed - indexed for MEDLINE] 8290. Practitioner. 1952 May;168(1007):513-4. A plan for the non-specific treatment of herpes zoster. ROGERS SC. PMID: 14941724 [PubMed - indexed for MEDLINE] 8291. Bull Soc Fr Dermatol Syphiligr. 1952 May-Jun;59(3):215-6. [Case of hemiplegic zona.] [Article in Undetermined Language] TZANCK A, MELKI GR, ARNAULT P. PMID: 12987950 [PubMed - indexed for MEDLINE] 8292. Arch Dis Child. 1952 Apr;27(132):126-7. Herpes zoster neonatorum. FELDMAN GV. PMCID: PMC1988768 PMID: 14924677 [PubMed - OLDMEDLINE] 8293. Rass Medica. 1952 Apr;29(4):74-5. [Case of herpes zoster treated with synthomycetin ointment.] [Article in Undetermined Language] URBANO P. PMID: 12994060 [PubMed - indexed for MEDLINE] 8294. Rass Medica. 1952 Apr;29(4):70-1. [Therapeutic action of chloramphenicol in herpes zoster.] [Article in Undetermined Language] AVOLIO W. PMID: 12994056 [PubMed - indexed for MEDLINE] 8295. N Y State J Med. 1952 Mar 15;52(6):706-8. Herpes zoster; its treatment with protamide. COMBES FC, CANIZARES O. PMID: 14910892 [PubMed - OLDMEDLINE] 8296. Br Med J. 1952 Mar 8;1(4757):533. Parkinson's syndrome following severe herpes ophthalmicus. STRONG G. PMCID: PMC2022964 PMID: 14904972 [PubMed - OLDMEDLINE] 8297. Br Med J. 1952 Mar 8;1(4757):520-3. Herpes zoster varicellosus. McCALLUM DI. PMCID: PMC2022927 PMID: 14904966 [PubMed - indexed for MEDLINE] 8298. AMA Arch Otolaryngol. 1952 Mar;55(3):307-20. Herpes zoster of the cephalic extremity. McGOVERN FH, FITZ-HUGH GS. PMID: 14902214 [PubMed - indexed for MEDLINE] 8299. Bull Soc Fr Dermatol Syphiligr. 1952 Mar-Apr;59(2):153-5. [Zona adenitis; histological study.] [Article in Undetermined Language] MARGAROT J, RIMBAUD P, IZARN P. PMID: 12978820 [PubMed - OLDMEDLINE] 8300. Medicina (Madr). 1952 Feb;20(2):152-7. [Epidemic outbreak of chickenpox following a case of herpes zoster in a ward for tuberculous meningitis.] [Article in Undetermined Language] CROS CAMPILLO T. PMID: 14928931 [PubMed - indexed for MEDLINE] 8301. Rev Otoneuroophtalmol. 1952 Feb-Mar;24(2):114-6. [Genicular zoster syndrome; pre-eruptive facial paralysis, and late meningitis.] [Article in Undetermined Language] AYMES G, MOUSSION VH. PMID: 14921426 [PubMed - OLDMEDLINE] 8302. Med Klin (Munich). 1952 Feb 1;47(5):149-51. [Rare forms of herpes zoster.] [Article in Undetermined Language] LAUSECKER H. PMID: 14918974 [PubMed - indexed for MEDLINE] 8303. Practitioner. 1952 Feb;168(1004):191-4. The treatment of herpes zoster. KINMONT PD. PMID: 14911512 [PubMed - indexed for MEDLINE] 8304. J Neurol Neurosurg Psychiatry. 1952 Feb;15(1):45-9. Herpes zoster ophthalmicus and post-herpetic neuralgia. TATLOW WF. PMCID: PMC499557 PMID: 14908614 [PubMed - indexed for MEDLINE] 8305. N Engl J Med. 1952 Jan 31;246(5):200-1. ELUSIVE virus. [No authors listed] PMID: 14890836 [PubMed - indexed for MEDLINE] 8306. N Engl J Med. 1952 Jan 31;246(5):167-72. Clinical evaluation of aureomycin and chloramphenicol in herpes zoster. KASS EH, AYCOCK RR, FINLAND M. PMID: 14890830 [PubMed - indexed for MEDLINE] 8307. Riv Patol Nerv Ment. 1952;73(1):151-65. [Zosterian encephalitis.] [Article in Undetermined Language] CAVALCA GG. PMID: 14950048 [PubMed - indexed for MEDLINE] 8308. Klin Monbl Augenheilkd Augenarztl Fortbild. 1952;120(6):636-9. [Diseases of the optic nerve in herpes zoster ophthalmicus.] [Article in Undetermined Language] BORNER R. PMID: 14939607 [PubMed - OLDMEDLINE] 8309. Acta Derm Venereol. 1952;32(1):20-6. Herpes zoster following bilateral supranuclear sympathicotomy. SVENDSEN IB. PMID: 14932665 [PubMed - indexed for MEDLINE] 8310. Acta Derm Venereol. 1952;32(2):184-9. Aureomycin and chloromycetin in the treatment of herpes zoster. SCHAFFER G, SVENDSEN IB. PMID: 14923195 [PubMed - indexed for MEDLINE] 8311. South Med J. 1952 Jan;45(1):76. Simultaneous herpes zoster and chickenpox; report of two cases. AUSTIN SD, BRANDON WH, McGEE RR. PMID: 14892981 [PubMed - indexed for MEDLINE] 8312. Arch Ital Dermatol Sifilogr Venereol. 1952-1953;25(6):453-6. [Cocarboxylase in the treatment of neuritis in herpes zoster.] [Article in Undetermined Language] BOTTOLI A. PMID: 13115086 [PubMed - indexed for MEDLINE] 8313. Stomatologiia (Mosk). 1952;6(4):21-2. [Herpes zoster of the oral mucosa and of facial skin.] RABINOVICH MV, SOTOVA AM. PMID: 13076952 [PubMed - OLDMEDLINE] 8314. Cesk Otolaryngol. 1952;1(2):62-9. [Not Available] [Article in Undetermined Language] CHYTIL S. PMID: 13033013 [PubMed - indexed for MEDLINE] 8315. Bull Mem Soc Med Hop Paris. 1952;68(30-31):1119-21. [Zona and malignant lymphogranulomatosis.] [Article in Undetermined Language] PUIG R. PMID: 13019580 [PubMed - indexed for MEDLINE] 8316. Mars Med. 1952;89(4):242-3. [Zona and dysenteric syndrome.] [Article in Undetermined Language] MONGES A, MARTIN J. PMID: 12991973 [PubMed - indexed for MEDLINE] 8317. Cesk Oftalmol. 1952;8(4):248-51. [Relation of focal infection to herpes corneae.] [Article in Undetermined Language] SIMKOVA M. PMID: 12979029 [PubMed - OLDMEDLINE] 8318. Cesk Oftalmol. 1952;8(4):245-7. [Review of herpetic diseases of the cornea treated since 1921 in the ophthalmologic clinic in Pilzen.] [Article in Undetermined Language] MOSINGEROVA D. PMID: 12979028 [PubMed - OLDMEDLINE] 8319. Ned Tijdschr Geneeskd. 1951 Dec 15;95(50):3732-7. [A case of herpes zoster encephalitis.] [Article in Undetermined Language] BRIET W, VAN DER MOLEN HR. PMID: 14919711 [PubMed - OLDMEDLINE] 8320. Ned Tijdschr Geneeskd. 1951 Dec 8;95(49):3687-90. [Herpes zoster after smallpox revaccination and certain conclusions based on this.] [Article in Undetermined Language] BOS CH, BOS GJ. PMID: 14919705 [PubMed - indexed for MEDLINE] 8321. Borgyogy Venerol Sz. 1951 Dec;5(6):165-8. [Hypoprothrombinemia in herpes zoster.] [Article in Undetermined Language] PASTINSZKY I, KOVACS E, GESZTI O. PMID: 14895755 [PubMed - indexed for MEDLINE] 8322. Ugeskr Laeger. 1951 Nov 15;113(46):1537-40. [Aureomycin and chloromycetin therapy of zoster.] [Article in Undetermined Language] SCHAFFER G, SVENDSEN IB. PMID: 14922547 [PubMed - indexed for MEDLINE] 8323. Rev Otoneuroophtalmol. 1951 Nov-Dec;23(8):477-80. [Pains from zona ophthalmica; sympathalgias; treatment by posterior pituitary hormone.] [Article in Undetermined Language] BELZ, BOUCHEL. PMID: 14930605 [PubMed - OLDMEDLINE] 8324. Rass Medica. 1951 Nov;28(11):195-6. [Therapy of herpes zoster with chloramphenicol pomade.] [Article in Undetermined Language] CADORE L. PMID: 14920766 [PubMed - indexed for MEDLINE] 8325. Med J Aust. 1951 Sep 29;2(13):425-6. Further revision of the dermatomes. YOUNG JH. PMID: 14890169 [PubMed - indexed for MEDLINE] 8326. Br Med J. 1951 Sep 22;2(4733):716-7. Herpes zoster with involvement of anterior horn cells. McINTYRE JH. PMCID: PMC2069778 PMID: 14869702 [PubMed - indexed for MEDLINE] 8327. Dtsch Med Wochenschr. 1951 Aug 31;76(35):1066-9. [Herpes zoster therapy with ganglia blocking preparation pendiomid (9295 Ciba).] [Article in Undetermined Language] NORPOTH L, DRUGEMOLLER P, FLOSSDORF T. PMID: 14879578 [PubMed - indexed for MEDLINE] 8328. Orv Hetil. 1951 Aug 12;92(32):1041-2. [Polyganglionic radiculitis in a case of herpes zoster.] [Article in Undetermined Language] PALFFY G. PMID: 14863905 [PubMed - indexed for MEDLINE] 8329. J Am Med Assoc. 1951 Aug 11;146(15):1410-2. Cytologic smears in diagnosis of herpes simplex, herpes zoster, and varicella. BLANK H, BURGOON CF, BALDRIDGE GD, McCARTHY PL, URBACH F. PMID: 14850308 [PubMed - indexed for MEDLINE] 8330. Prensa Med Argent. 1951 Aug 3;38(31):1942-4. [Herpes zoster, D. H. E. 45 therapy.] [Article in Undetermined Language] CAPORALETTI A. PMID: 14864358 [PubMed - indexed for MEDLINE] 8331. Rev Med Chir Mal Foie. 1951 Aug-Sep;26(8-9):14-5. [Alternation of hepato-biliary crises with zona.] [Article in Undetermined Language] CORSET P. PMID: 14900791 [PubMed - indexed for MEDLINE] 8332. Acta Otolaryngol. 1951 Aug;39(4):291-5. Disturbances of smell in course of herpes zoster cephalicus. LASKIEWICZ A. PMID: 14868478 [PubMed - indexed for MEDLINE] 8333. AMA Arch Derm Syphilol. 1951 Aug;64(2):192-4. Generalized herpes zoster encephalitis and lymphatic leukemia. a case report. FRANK L. PMID: 14856409 [PubMed - indexed for MEDLINE] 8334. Vie Med. 1951 Jul;32(7):29-30. [Management of herpes zoster. Conclusion of the inquiry.] [Article in Undetermined Language] LE GOARANT de TROMELIN. PMID: 14867196 [PubMed - indexed for MEDLINE] 8335. Vie Med. 1951 Jul;32(7):22-6. [Management of herpes zoster and its complications. Radiotherapy should be early, at the beginning of the disease.] [Article in Undetermined Language] GUGLIEMI M. PMID: 14867195 [PubMed - indexed for MEDLINE] 8336. Vie Med. 1951 Jul;32(7):21-2. [Management of herpes zoster and its complications. Various treatments must frequently be combined from the start.] [Article in Undetermined Language] LAUGIER P. PMID: 14867194 [PubMed - indexed for MEDLINE] 8337. Vie Med. 1951 Jul;32(7):16-9. [Management of herpes zoster and its complications. Early, energetic treatment is the best preventive of post-eruptive pain.] [Article in Undetermined Language] FOURNIER A. PMID: 14867193 [PubMed - indexed for MEDLINE] 8338. Vie Med. 1951 Jul;32(7):8-15. [The management of herpes zoster and its complications: ocular complications; symptomatic treatment.] [Article in Undetermined Language] BEAUVIEUX J, JULIEN RG. PMID: 14867192 [PubMed - indexed for MEDLINE] 8339. Am J Ophthalmol. 1951 Jul;34(7):1035-7. Herpes zoster ophthalmicus. AHL BN, NADBATH RP. PMID: 14846877 [PubMed - indexed for MEDLINE] 8340. Paris Med. 1951 Jun 2-9;41(21-22):299. [Syndrome of hepato-biliary tract and herpes zoster.] [Article in Undetermined Language] PARTURIER G, CORSET P. PMID: 14853588 [PubMed - indexed for MEDLINE] 8341. South Med J. 1951 Jun;45(6):529-33. Attenuated virus in autogenous blood serum as a therapeutic agent in herpes zoster. BONDURANT CP. PMID: 14931027 [PubMed - indexed for MEDLINE] 8342. Acta Otolaryngol. 1951 Jun;39(2-3):172-5. A case of lingual herpes zoster with homolateral facial paralysis. JEPSEN O. PMID: 14868461 [PubMed - OLDMEDLINE] 8343. Gazz Med Ital. 1951 Jun;110(6):204-6. [A modern therapeutic application in herpes zoster; experimental contribution.] [Article in Undetermined Language] SACINO G. PMID: 14860432 [PubMed - indexed for MEDLINE] 8344. Alger Medicale. 1951 Jun-Jul;55(6):965-7. [Herpes zoster of the cornea and aureomycin.] [Article in Undetermined Language] FABREGOULE M, LARMANDE A. PMID: 14856925 [PubMed - indexed for MEDLINE] 8345. Mil Surg. 1951 Jun;108(6):491-4. Herpes zoster ophthalmicus successfully treated with aureomycin. BENEDEK T. PMID: 14852620 [PubMed - indexed for MEDLINE] 8346. Laval Med. 1951 Jun;16(6):763-9. [Present-day treatment of zona.] [Article in Undetermined Language] BEAUDRY M. PMID: 14851762 [PubMed - indexed for MEDLINE] 8347. Northwest Med. 1951 Jun;50(6):432. Banthine in herpes zoster. BROWN HS, REEKIE RD, SINCLAIR WJ. PMID: 14843589 [PubMed - indexed for MEDLINE] 8348. Am J Ophthalmol. 1951 Jun;34(6):893-4. Herpes zoster ophthalmicus. Report of a case successfully treated with aureomycin. PRITIKIN RI, DUCHON ML. PMID: 14838072 [PubMed - indexed for MEDLINE] 8349. AMA Arch Derm Syphilol. 1951 Jun;63(6):772-6. Generalized herpes zoster: report of a case following roentgen ray therapy, associated with chronic lymphatic leukemia, leukemia cutis and Mikulicz's syndrome. BOSWORTH EL. PMID: 14829061 [PubMed - indexed for MEDLINE] 8350. Br Med J. 1951 May 5;1(4713):987-91. Investigation into the effects of aureomycin and chloramphenicol in herpes zoster. CARTER AB. PMCID: PMC2068787 PMID: 14830825 [PubMed - indexed for MEDLINE] 8351. Bull Soc Fr Dermatol Syphiligr. 1951 May-Jun;58(3):334-5. [Zona and cancer of the breast.] [Article in Undetermined Language] GROS CM, VEILLON A. PMID: 14869996 [PubMed - indexed for MEDLINE] 8352. Riv Ital Stomatol. 1951 May;6(5):522-31. [Contribution to the knowledge of the relationship between trauma and herpes zoster (case following the alcoholization of the gasserian ganglion).] [Article in Undetermined Language] RUSCONI L. PMID: 14865789 [PubMed - indexed for MEDLINE] 8353. Rev Laryngol Otol Rhinol (Bord). 1951 May-Jun;72(5-6):461-4. [Auricular and trigeminal zoster.] [Article in Undetermined Language] MESNAGE J, RABECHAULT R. PMID: 14865416 [PubMed - indexed for MEDLINE] 8354. Alger Medicale. 1951 May;55(5):918-22. [Neuralgia following zoster cured by ACTH (325 milligr.).] [Article in Undetermined Language] LACROIX A, ANTOINE G, TIMSIT E. PMID: 14856914 [PubMed - indexed for MEDLINE] 8355. Med Gen Fr. 1951 May;11(5):102-3. [Therapy of zona by vitamin B12.] [Article in Undetermined Language] HEYBLON R. PMID: 14852012 [PubMed - indexed for MEDLINE] 8356. Ann West Med Surg. 1951 May;5(5):487. Herpes zoster appearing during cortisone therapy: case report. FISHMAN HC. PMID: 14838569 [PubMed - indexed for MEDLINE] 8357. Postgrad Med. 1951 May;9(5):433-5. Treatment of herpes zoster. EBERT MH. PMID: 14833955 [PubMed - indexed for MEDLINE] 8358. J Lancet. 1951 May;71(5):184. Herpes zoster with motor involvement. TUDOR RB. PMID: 14824718 [PubMed - indexed for MEDLINE] 8359. S Afr Med J. 1951 Apr 21;25(16):271-2. Herpes zoster of the lower extremity. SHEDROW A. PMID: 14855020 [PubMed - indexed for MEDLINE] 8360. Presse Med. 1951 Apr 21;59(27):544. [Zoster osteoporosis of the hand.] [Article in Undetermined Language] PIZON P. PMID: 14844173 [PubMed - indexed for MEDLINE] 8361. Conn State Med J. 1951 Apr;15(4):334-5. Herpes zoster. BLUMER G. PMID: 14887264 [PubMed - indexed for MEDLINE] 8362. Accad Medica. 1951 Apr;66(4):121-3. [Efficacy of para-aminobenzoic acid (so-called vitamin H1) in the treatment of herpes zoster.] [Article in Undetermined Language] ACCORNERO SR. PMID: 14877432 [PubMed - indexed for MEDLINE] 8363. Medicina (Madr). 1951 Apr;19(4):297-9. [Aureomycin in herpes zoster.] [Article in Undetermined Language] DIEZ APARICIO JL. PMID: 14852363 [PubMed - indexed for MEDLINE] 8364. Am J Ophthalmol. 1951 Apr;34(4):623-5. Herpes zoster ophthalmicus treated with chloromycetin. BEIL WC, KEITH F, MIMS JL Jr. PMID: 14819197 [PubMed - indexed for MEDLINE] 8365. Sven Lakartidn. 1951 Mar 30;48(13):760-6. [Treatment of herpes zoster with aureomycin.] [Article in Undetermined Language] BLUMENTHAL B. PMID: 14835369 [PubMed - indexed for MEDLINE] 8366. Orv Hetil. 1951 Mar 25;92(12):388-9. [Aureomycin therapy.] [Article in Undetermined Language] VARKONYI G. PMID: 13046844 [PubMed - indexed for MEDLINE] 8367. Sven Lakartidn. 1951 Mar 22;48(12):721-2. [Aureomycin and herpes zoster.] [Article in Undetermined Language] LINDBERG G. PMID: 14835359 [PubMed - indexed for MEDLINE] 8368. Nervenarzt. 1951 Mar 20;22(3):110. [Transverse myelitis in herpes zoster.] [Article in Undetermined Language] BIRKMAYER W. PMID: 14833498 [PubMed - indexed for MEDLINE] 8369. Sven Lakartidn. 1951 Mar 9;48(10):583-8. [Case of herpes zoster treated with aureomycin.] [Article in Undetermined Language] SCHERSTEN B. PMID: 14835342 [PubMed - indexed for MEDLINE] 8370. Cas Lek Cesk. 1951 Mar 9;90(10):299-302. [Significance of pathology of the intervertebral disks in herpes zoster.] [Article in Undetermined Language] VRANESIC Z. PMID: 14821999 [PubMed - indexed for MEDLINE] 8371. Med J Aust. 1951 Mar 3;1(9):339. Report of two cases of herpes zoster treated with "chloromycetin". BABBAGE NF. PMID: 14826185 [PubMed - indexed for MEDLINE] 8372. Z Haut Geschlechtskr. 1951 Mar 1;10(5):186-8. [Herpes zoster following calcification of a nucleus pulposus in the same region.] [Article in Undetermined Language] KRIEGK HJ. PMID: 14836926 [PubMed - indexed for MEDLINE] 8373. Neurology. 1951 Mar-Apr;1(2):167-9. Herpes zoster of the right trigeminal nerve with left hemiplegia. HUGHES WN. PMID: 14827069 [PubMed - indexed for MEDLINE] 8374. Conn State Med J. 1951 Mar;15(3):199-200. Herpes zoster encephalitis; report of a case with recovery. FOSTER JH, JACKSON AH. PMID: 14822525 [PubMed - indexed for MEDLINE] 8375. Ann Ottalmol Clin Ocul. 1951 Mar;77(3):101-14. [Zosteriform eruption and ocular hypertension.] [Article in Undetermined Language] ROSSETTI D. PMID: 14819834 [PubMed - indexed for MEDLINE] 8376. J Am Med Assoc. 1951 Feb 24;145(8):560-1. Herpes zoster with a varicelliform eruption and parotitis in chronic leukemia. GELFAND ML. PMID: 14794487 [PubMed - indexed for MEDLINE] 8377. Pediatrics. 1951 Feb;7(2):200-5. Neurologic complications of herpes zoster. NACHMAN AR. PMID: 14827622 [PubMed - indexed for MEDLINE] 8378. G Clin Med. 1951 Feb;32(2):235. [Herpes zoster and the new antibiotics.] [Article in Undetermined Language] TELO W. PMID: 14823372 [PubMed - indexed for MEDLINE] 8379. AMA Arch Neurol Psychiatry. 1951 Feb;65(2):131-45. Postherpetic trigeminal neuralgia. SUGAR O, BUCY PC. PMID: 14798991 [PubMed - indexed for MEDLINE] 8380. South Med J. 1951 Feb;44(2):137-40. Herpes laryngis: herpes zoster of the vagus nerve. McGOVERN FH. PMID: 14798555 [PubMed - indexed for MEDLINE] 8381. Minerva Med. 1951 Jan 27;42(5):157-9. [Herpes zoster and motor paralysis of the muscles of the abdominal wall.] [Article in Undetermined Language] DE DOMINICIS G. PMID: 14826588 [PubMed - OLDMEDLINE] 8382. Izv Meditsinskite Inst Bulg Akad Naukite Sofia Otd Biol Meditsinski Nauki. 1951;4-5:275-80. [Case of simultaneous pulmonary tuberculosis and herpes zoster ophthalmicus; cure; preliminary communication.] [Article in Undetermined Language] MINCHEV S. PMID: 14937918 [PubMed - OLDMEDLINE] 8383. Dermatologica. 1951;103(2):109-16. Some climatological and other particulars on herpes zoster from the northern and southern hemisphere; contribution to dermatology in the tropics. SIMONS RD. PMID: 14872645 [PubMed - indexed for MEDLINE] 8384. Klin Monbl Augenheilkd Augenarztl Fortbild. 1951;118(6):620-9. [Scleral staphyloma following ophthalmic herpes zoster.] [Article in Undetermined Language] ADELUNG JC. PMID: 14862075 [PubMed - indexed for MEDLINE] 8385. Acta Derm Venereol. 1951;31(4):486-8. Case of herpes zoster generalisatus. LECZINSKY CG. PMID: 14856598 [PubMed - indexed for MEDLINE] 8386. Confin Neurol. 1951;11(4):227-40. Bactifebrin therapy of acute encephalo-radiculo-neuritis and myelo-radiculo-neuritis. ROSENZWEIG A. PMID: 14849142 [PubMed - indexed for MEDLINE] 8387. Acta Ophthalmol (Copenh). 1951;29(2):227-31. Increased intraocular pressure associated with herpes zoster ophthalmicus without any signs of iritis. SALOMAA S. PMID: 14846578 [PubMed - indexed for MEDLINE] 8388. Rev Neurol (Paris). 1951 Jan;84(1):59-60. [Recurrent zosteriform eruption following disk compression with retrolisthesis.] [Article in Undetermined Language] TARDIEU G, LIQUIER A, CAROIT M. PMID: 14845360 [PubMed - OLDMEDLINE] 8389. Bull Soc Fr Dermatol Syphiligr. 1951 Jan-Feb;58(1):62-3. [Coexistence of ophthalmic zona and chickenpox in the same patient; aureomycin therapy.] [Article in Undetermined Language] VERNIER L, FOUCHE G. PMID: 14839440 [PubMed - indexed for MEDLINE] 8390. Bull Soc Fr Dermatol Syphiligr. 1951 Jan-Feb;58(1):54-5. [Cervical zona in a newborn evolving from birth.] [Article in Undetermined Language] CLEISZ L, BOLGERT M, LE SOURD M, HABIB G, DEVENY P. PMID: 14839435 [PubMed - indexed for MEDLINE] 8391. Acta Derm Venereol. 1951;31(3):275-7. Trauma and herpes zoster. TOTTIE M. PMID: 14837651 [PubMed - indexed for MEDLINE] 8392. Arch Ital Dermatol Sifilogr Venereol. 1951;24(1):27-32. [Zoster and chickenpox.] [Article in Undetermined Language] TORCHI M. PMID: 14820512 [PubMed - indexed for MEDLINE] 8393. Actas Dermosifiliogr. 1951 Jan;42(4):412-4. [Rare localization of herpes zoster (femoral region).] [Article in Undetermined Language] AGUILERA MARURI C. PMID: 14818849 [PubMed - indexed for MEDLINE] 8394. Z Haut Geschlechtskr. 1951 Jan 1;10(1):16-9. [Atypical herpes zoster or epizoonosis (trombidiosis)?] [Article in Undetermined Language] WESENER G. PMID: 14818250 [PubMed - indexed for MEDLINE] 8395. Am J Ophthalmol. 1951 Jan;34(1):45-8. Herpes zoster ophthalmicus with bilateral hemorrhagic retinopathy. BARTLETT RE, MUMMA CS, IRVINE AR. PMID: 14799578 [PubMed - indexed for MEDLINE] 8396. Calif Med. 1951 Jan;74(1):41-2. Anal herpes with generalized varicelliform eruption. Report of a case. HAMILTON CI Jr, PERKINS EK. PMCID: PMC1520796 PMID: 14792379 [PubMed - indexed for MEDLINE] 8397. AMA Arch Derm Syphilol. 1951 Jan;63(1):134-5. Treatment of herpes zoster ophthalmicus with aureomycin. ROSENBERG WA. PMID: 14789217 [PubMed - indexed for MEDLINE] 8398. Ann Otolaryngol Chir Cervicofac. 1951;68(8-9):745-7. [Case of herpes zoster of the facial, cochlear and vestibular nerves.] [Article in Undetermined Language] MADURO R. PMID: 12986477 [PubMed - OLDMEDLINE] 8399. Br Med J. 1950 Dec 23;2(4694):1424-5. Herpes zoster provoked by smallpox vaccination. GREENWOOD K. PMCID: PMC2039602 PMID: 14792047 [PubMed - indexed for MEDLINE] 8400. Sem Hop. 1950 Dec 10;26(91):4717-8. [Vasomotor and trophic sequels of zona.] [Article in Undetermined Language] ISEMEIN, PERDRIX, REDON. PMID: 14809321 [PubMed - indexed for MEDLINE] 8401. Prensa Med Argent. 1950 Dec 8;37(49):2978-81. [Herpes zoster.] [Article in Undetermined Language] STEINBERG IR, MARZETTI AA. PMID: 14797605 [PubMed - indexed for MEDLINE] 8402. Neurol Psychiatr Ceskoslov. 1950 Dec;13(6):350-4. [The viruses of herpes zoster, choriomeningitis and rabies.] [Article in Undetermined Language] LEPINE P. PMID: 14833524 [PubMed - indexed for MEDLINE] 8403. Boll Ocul. 1950 Dec;29(12):788-94. [Lysozymic rate of aqueous humor in induced herpetic keratitis.] [Article in Undetermined Language] MARSICO V. PMID: 14821077 [PubMed - indexed for MEDLINE] 8404. Boll Ocul. 1950 Dec;29(12):745-50. [Case of simultaneous bilateral herpetic keratitis.] [Article in Undetermined Language] PANZARDI D. PMID: 14821075 [PubMed - indexed for MEDLINE] 8405. Ann Ocul (Paris). 1950 Dec;183(12):1034-9. [The treatment of zona ophthalmica.] [Article in Undetermined Language] MAGITOT A. PMID: 14800052 [PubMed - indexed for MEDLINE] 8406. N Y State J Med. 1950 Dec 1;50(23):2825-6. A further report on the use of ether in the treatment of herpetic keratitis. KRONENBERG B. PMID: 14796849 [PubMed - indexed for MEDLINE] 8407. Am J Ophthalmol. 1950 Dec;33(12):1921-2. Epidemic herpes zoster ophthalmicus. Report of a case treated with aureomycin. SHIER JM, PROVISOR B. PMID: 14789945 [PubMed - indexed for MEDLINE] 8408. U S Armed Forces Med J. 1950 Dec;1(12):1499-1502. Herpes zoster concurrent with varicelliform eruption. Report of 5 cases. HENDERSON AT, YOUNG DC. PMID: 14788438 [PubMed - indexed for MEDLINE] 8409. J Prat Rev Gen Clin Ther. 1950 Nov 30;64(48):586. [Therapy of herpes and herpes zoster with intravenous vitamin C.] [Article in Undetermined Language] ZUREICK M. PMID: 14908970 [PubMed - indexed for MEDLINE] 8410. Ugeskr Laeger. 1950 Nov 23;112(47):1640-1. [Aureomycin therapy of herpes zoster.] [Article in Undetermined Language] HVID-HANSEN N. PMID: 14855664 [PubMed - indexed for MEDLINE] 8411. Wis Med J. 1950 Nov;49(11):1025. Additional thoughts about herpes zoster. TATUM AL. PMID: 14788856 [PubMed - indexed for MEDLINE] 8412. Nurs Mirror Midwives J. 1950 Oct 27;92(Emergency News Letter):3-4. Cause, treatment, prognosis of shingles. ROBERTS A. PMID: 14807124 [PubMed - indexed for MEDLINE] 8413. Ugeskr Laeger. 1950 Oct 5;112(40):1391-3. [Aureomycin in the treatment of ophthalmic herpes zoster.] [Article in Undetermined Language] JESSEN H, MOSEGAARD KE. PMID: 14788371 [PubMed - indexed for MEDLINE] 8414. N Z Med J. 1950 Oct;49(273):569-71. Herpes zoster with involvement of anterior horn cells. McINTYRE JH. PMID: 14806884 [PubMed - indexed for MEDLINE] 8415. Riforma Med. 1950 Sep 16;64(37):1015-8. [Treatment of herpes zoster with liver extracts.] [Article in Undetermined Language] GOBBO A. PMID: 14787166 [PubMed - indexed for MEDLINE] 8416. Nord Med. 1950 Sep 15;44(37):1475-8. [Herpes zoster and leukemia.] [Article in Undetermined Language] HALLGREN BE. PMID: 14806941 [PubMed - indexed for MEDLINE] 8417. Sem Hop. 1950 Sep 10;26(67):3572-9. [Viral neuralgias (herpes zoster encephalitis); amputation stump pains.] [Article in Undetermined Language] DURUPT L. PMID: 14781922 [PubMed - indexed for MEDLINE] 8418. Arztl Wochensch. 1950 Sep 1;5(34):657-9. [Treatment of herpes zoster, with a note on the effect of aureomycin.] [Article in Undetermined Language] HOFFMEISTER W. PMID: 14789634 [PubMed - indexed for MEDLINE] 8419. Laryngoscope. 1950 Sep;60(9):939-44. Aureomycin in treatment of otitic and ophthalmic herpes zoster. GANS EW. PMID: 14779416 [PubMed - indexed for MEDLINE] 8420. U S Armed Forces Med J. 1950 Sep;1(9):1045-7. Treatment of herpes zoster with protamide. MARSH WC. PMID: 14776843 [PubMed - indexed for MEDLINE] 8421. Arch Pediatr. 1950 Sep;67(9):397-9. Herpes zoster in the newborn associated with congenital blindness; report of case. COUNTER CE, KORN BJ. PMID: 14771967 [PubMed - indexed for MEDLINE] 8422. Dtsch Med Wochenschr. 1950 Aug 11;75(31-32):1033-5. [Treatment of pain following herpes zoster.] [Article in Undetermined Language] SCHMITT W. PMID: 14773285 [PubMed - indexed for MEDLINE] 8423. Rev Neurol (Paris). 1950 Jul;83(1):30-1. [Virus of herpes, herpes zoster choriomeningitis & rabies.] [Article in Undetermined Language] LEPINE P. PMID: 14787026 [PubMed - indexed for MEDLINE] 8424. Rev Bras Med. 1950 Jul;7(7):457-60. [Recapitulation of herpes zoster.] [Article in Undetermined Language] GARCIA DE LIMA E. PMID: 14781477 [PubMed - indexed for MEDLINE] 8425. Bull Mem Soc Med Hop Paris. 1950 Jun 30-Jul 7;66(23-24):1218-21. [Zona and aureomycin.] [Article in Undetermined Language] TZANCK A, ALBAHARY C, CALDERA R. PMID: 14777974 [PubMed - indexed for MEDLINE] 8426. Cyprus Med J. 1950 Mar;3(5):360-1. One case of rare manifestation of herpes zoster. SPANOPOULOS GJ. PMID: 14773206 [PubMed - indexed for MEDLINE] 8427. J Radiol Electrol Arch Electr Medicale. 1950;31(11-12):772-4. [Herpes zoster and cancer of the breast.] [Article in Undetermined Language] GROS CM, VEILLON A. PMID: 14825362 [PubMed - indexed for MEDLINE] 8428. Acta Anat (Basel). 1950;10(4):363-76. [Morphologic investigations on the pathogenesis of Zoster.] [Article in Undetermined Language] von HEILBORN F. PMID: 14810404 [PubMed - indexed for MEDLINE] 8429. Arch Ital Dermatol Sifilogr Venereol. 1950;23(4):300-4. [Bismuth camphocarbonate in the treatment of herpes zoster.] [Article in Undetermined Language] LOT G. PMID: 14772021 [PubMed - indexed for MEDLINE] 8430. J Okla State Med Assoc. 1949 Oct;42(10):429-32. The treatment of herpes zoster. DOYLE WH. PMID: 18148123 [PubMed - indexed for MEDLINE] 8431. Am J Clin Pathol. 1949 Oct;19(10):981-4. Reticulo-epithelioid cell granulomas in bone marrow in herpes zoster; report of case. SCHLEICHER EM. PMID: 18147963 [PubMed - indexed for MEDLINE] 8432. Union Med Can. 1949 Oct;78(10):1237. [Not Available.] [Article in Undetermined Language] GOBEIL LJ. PMID: 18143821 [PubMed - indexed for MEDLINE] 8433. Ann Surg. 1949 Oct;130(4):622-36. Herpes zoster; a surgical procedure for the treatment of post-herpetic neuralgia. BROWDER J, DeVEER JA. PMID: 18143173 [PubMed - indexed for MEDLINE] 8434. Arch Derm Syphilol. 1949 Oct;60(4):636-8. Autohemotherapy of herpex zoster; results in 154 cases. POTH DO. PMID: 18140385 [PubMed - OLDMEDLINE] 8435. Arch Derm Syphilol. 1949 Oct;60(4):558-69. Paralysis of cranial nerves complicating herpes zoster. COSTELLO MJ, SCOTT MJ. PMID: 18140378 [PubMed - OLDMEDLINE] 8436. Med J Aust. 1949 Sep 10;2(11):380-2. Herpes zoster of the nervus chorda tympani with facial paralysis. FINDLAY JP. PMID: 18143632 [PubMed - indexed for MEDLINE] 8437. Calif Med. 1949 Sep;71(3):214. Aureomycin in the treatment of herpes zoster. CASE RB. PMCID: PMC1520183 PMID: 18229036 [PubMed - indexed for MEDLINE] 8438. Br Med J. 1949 Aug 13;2(4623):386. Strains of Bact. coli. BRAY J. PMCID: PMC2050796 PMID: 18229034 [PubMed - OLDMEDLINE] 8439. J Med Lyon. 1949 Aug 5;30(710):604. [Not Available.] [Article in Undetermined Language] FERRARI AV. PMID: 18146939 [PubMed - OLDMEDLINE] 8440. Rev Bras Med. 1949 Aug;6(8):537-9. [Not Available.] [Article in Undetermined Language] LACORTE JG. PMID: 18143744 [PubMed - indexed for MEDLINE] 8441. South Med J. 1949 Aug;42(8):696. Herpes zoster; treatment with chloramphenicol. DAWSON LM, SIMON HE. PMID: 18137594 [PubMed - indexed for MEDLINE] 8442. Rev Asoc Med Argent. 1949 Jul 15-30;63(657-658):326-30. [Not Available.] [Article in Undetermined Language] BARDECI CA. PMID: 18147593 [PubMed - indexed for MEDLINE] 8443. Arch Otolaryngol. 1949 Jul;48(1):1-8. Herpes zoster oticus; Ramsay Hunt syndrome; report of a case. JOHNSON L, ZONDERMAN B. PMID: 18113035 [PubMed - indexed for MEDLINE] 8444. Br Med J. 1949 Jun 11;1(4614):1037. Treatment of herpes zoster with liver extract. GASKELL HS. PMCID: PMC2050271 PMID: 18131644 [PubMed - OLDMEDLINE] 8445. Proc Soc Exp Biol Med. 1949 Jun;71(2):283-6. Electron microscope studies of the vesicle and spinal fluids from a case of herpes zoster. EVANS AS, MELNICK JL. PMID: 18134038 [PubMed - indexed for MEDLINE] 8446. Am J Med Sci. 1949 Jun;217(6):674-80. On the occurrence of herpes zoster in carcinoma of the breast. PENDERGRASS EP, KIRSH D. PMID: 18129793 [PubMed - indexed for MEDLINE] 8447. Urol Cutaneous Rev. 1949 Jun;53(6):321-4. Neurogenic bladder associated with herpes zoster. SHULLENBERGER WA, WISHARD WN Jr. PMID: 18121286 [PubMed - OLDMEDLINE] 8448. Minerva Med. 1949 May 26;40(25):754-8. [Not Available.] [Article in Undetermined Language] DE LUCA R. PMID: 18152475 [PubMed - indexed for MEDLINE] 8449. Med Press. 1949 May 25;221(21):510-2. Ophthalmic herpes zoster with contralateral pontine lesions. WORSTER-DROUGHT C, SARGENT F. PMID: 18129950 [PubMed - OLDMEDLINE] 8450. Schweiz Med Wochenschr. 1949 May 14;79(19):436-8. [Not Available.] [Article in Undetermined Language] DAHL S. PMID: 18150479 [PubMed - indexed for MEDLINE] 8451. Arch Intern Med (Chic). 1949 May;83(5):502-4. Concurrent herpes zoster and chickenpox; report of a case. FETTER F, SCHNABEL TG. PMID: 18129805 [PubMed - indexed for MEDLINE] 8452. J Neurol Neurosurg Psychiatry. 1949 May;12(2):152-4. Some unusual complications of herpes zoster. WHITTY CW, COOKE AM. PMCID: PMC497124 PMID: 18127085 [PubMed - indexed for MEDLINE] 8453. Lyon Med. 1949 Apr 10;181(15):234. [Not Available.] [Article in Undetermined Language] FERRARI AV. PMID: 18126872 [PubMed - OLDMEDLINE] 8454. J Invest Dermatol. 1949 Mar;12(3):153-5. Treatment of herpes zoster with moccasin venom. DENNIE CC, MORGAN DB, COOMBS FP. PMID: 18117760 [PubMed - indexed for MEDLINE] 8455. N Y State J Med. 1949 Mar 1;49(5):531. Ramsay Hunt's syndrome. MELANT JH. PMID: 18111011 [PubMed - indexed for MEDLINE] 8456. W V Med J. 1949 Mar;45(3):53-6. Herpes zoster ophthalmicus; sodium iodide therapy. MOORE TW. PMID: 18109872 [PubMed - indexed for MEDLINE] 8457. Arch Neurol Psychiatry. 1949 Feb;61(2):194-8. Tetraethylammonium chloride in treatment of herpes zoster and intercostal neuralgia. FISHER RL, ZUKERMAN M, SWEENY DN Jr. PMID: 18152784 [PubMed - OLDMEDLINE] 8458. New Orleans Med Surg J. 1949 Feb;101(8):378-80. Herpes zoster therapy; pain relief by simple procedure. FASTING GF. PMID: 18109623 [PubMed - indexed for MEDLINE] 8459. Cesk Dermatol. 1949;24(2):73. [Not Available.] [Article in Undetermined Language] WOHLSTEIN E. PMID: 18236542 [PubMed - OLDMEDLINE] 8460. Am J Ophthalmol. 1949 Jan;32(1):130-4. Herpes zoster ophthalmicus; a case with manifold complications. PINCUS MH. PMID: 18122920 [PubMed - OLDMEDLINE] 8461. Dtsch Z Nervenheilkd. 1949;160(1-2):43-8. [Not Available.] [Article in Undetermined Language] SCHILF E. PMID: 18117484 [PubMed - indexed for MEDLINE] 8462. Pediatriia. 1949 Jan-Feb;4(1):27-31. [Interrelation of herpes zoster and chicken-pox.] [Article in Undetermined Language] VERCNER VN. PMID: 18111417 [PubMed - indexed for MEDLINE] 8463. Br Med J. 1948 Dec 11;2(4588):1035. Herpes zoster treated by anthisan. HONIGSBERGER M. PMCID: PMC2092231 PMID: 18100447 [PubMed - indexed for MEDLINE] 8464. Univ Hosp Bull. 1948 Dec;14(12):125-8. Herpes zoster; review of the literature and report of a case. HALEY RR. PMID: 18109868 [PubMed - indexed for MEDLINE] 8465. Actas Dermosifiliogr. 1948 Dec;40(3):312-6. [Not Available.] [Article in Undetermined Language] SICILIA, JAQUETI DEL POZO. PMID: 18109062 [PubMed - OLDMEDLINE] 8466. Physiotherapy. 1948 Dec;34(12):205. Treatment of ophthalmic herpes. CUTNER M, STUTTARD M. PMID: 18107282 [PubMed - OLDMEDLINE] 8467. J Prat Rev Gen Clin Ther. 1948 Nov 4;62(45):555-7. [Not Available.] [Article in Undetermined Language] BRU P. PMID: 18099181 [PubMed - indexed for MEDLINE] 8468. Philipp Med World. 1948 Nov;3(11):341-6. Thiamine therapy of herpes zoster. ORTIZ AL. PMID: 18106593 [PubMed - indexed for MEDLINE] 8469. Ned Tijdschr Geneeskd. 1948 Oct 9;92(41):3195-3200. [Not Available.] [Article in Undetermined Language] LORENTZ DE HAAS AM. PMID: 18100650 [PubMed - OLDMEDLINE] 8470. Wien Klin Wochenschr. 1948 Oct 8;60(40):652-5. [Not Available.] [Article in Undetermined Language] SCHNEIDER H. PMID: 18102366 [PubMed - indexed for MEDLINE] 8471. J R Nav Med Serv. 1948 Oct;34(4):152. Zoster lymphadenitis. MALLOWS HR. PMID: 18100829 [PubMed - indexed for MEDLINE] 8472. Prog Med (Paris). 1948 Sep 24;76(18):443-5. [Not Available.] [Article in Undetermined Language] CHAVANY JA, GODLEWSKI S, et al. PMID: 18887104 [PubMed - indexed for MEDLINE] 8473. U S Nav Med Bull. 1948 Sep-Oct;48(5):742-9. Herpes zoster following exposure to varicella; treatment of herpes zoster with cowpox vaccine. HORTON SH Jr. PMID: 18883807 [PubMed - indexed for MEDLINE] 8474. J Bacteriol. 1948 Sep;56(3):293-303. The relationship of varicella and herpes zoster; electron microscope studies. RAKE G, BLANK H, et al. PMID: 18880570 [PubMed - indexed for MEDLINE] 8475. Arch Derm Syphilol. 1948 Sep;58(3):265-75. Herpes zoster ophthalmicus; results of treatment with transfusions of convalescent blood. BECKER FT. PMID: 18117049 [PubMed - indexed for MEDLINE] 8476. Cas Lek Cesk. 1948 Aug 20;87(32):887-9. [Not Available.] [Article in Undetermined Language] PECHA J. PMID: 18881349 [PubMed - OLDMEDLINE] 8477. Med J Aust. 1948 Jul 31;2(5):126. Severe zoster associated with leuchaemia. ANDERSON D. PMID: 18881612 [PubMed - OLDMEDLINE] 8478. Br Med J. 1948 Jun 19;1(4563):1206. Gastric herpes zoster. FITZPATRICK PE. PMCID: PMC2089869 PMID: 18865978 [PubMed - indexed for MEDLINE] 8479. Med Gen Fr. 1948 Jun 10;8(11):153. [Not Available.] [Article in Undetermined Language] HALBRON P. PMID: 18875932 [PubMed - indexed for MEDLINE] 8480. Dtsch Med Wochenschr. 1948 May 14;73(17-20):195-8. [Not Available.] [Article in Undetermined Language] ZUR G. PMID: 18869945 [PubMed - indexed for MEDLINE] 8481. Surgery. 1948 May;23(5):773-7. Herpes zoster and the surgical abdomen. BOSHER LH Jr, WILLIAMS C Jr. PMID: 18915494 [PubMed - indexed for MEDLINE] 8482. Am J Syph Gonorrhea Vener Dis. 1948 May;32(3):286-8. Simultaneous herpes zoster and lymphogranuloma venereum. GARDNER L. PMID: 18912218 [PubMed - indexed for MEDLINE] 8483. Med J Aust. 1948 Apr 17;1(16):542. Herpes zoster with lymphocytic meningitis. SHERWOOD J. PMID: 18934583 [PubMed - indexed for MEDLINE] 8484. Arch Derm Syphilol. 1948 Apr;57(4):782. Leukemic infiltration in scars of herpes zoster generalisatus. NETHERTON EW. PMID: 18886313 [PubMed - indexed for MEDLINE] 8485. Portland Clin Bull. 1948 Apr;1(4):75-82. Relationship of trauma and herpes zoster; report of three cases. SELLING L. PMID: 18862789 [PubMed - indexed for MEDLINE] 8486. Ned Tijdschr Geneeskd. 1948 Mar 27;92(13):928. [Not Available.] [Article in Undetermined Language] KORTMANN W. PMID: 18870292 [PubMed - indexed for MEDLINE] 8487. Br Med J. 1948 Mar 13;1(4549):521. Rarer manifestations of herpes zoster. GUTHANER E. PMCID: PMC2089791 PMID: 18933736 [PubMed - indexed for MEDLINE] 8488. Dtsch Med Wochenschr. 1948 Mar 12;73(9-12):119. [Not Available.] [Article in Undetermined Language] FRANK A. PMID: 18914563 [PubMed - indexed for MEDLINE] 8489. Arch Derm Syphilol. 1948 Mar;57(3):319-27. Herpes zoster associated with monocytic leukemia. BLUEFARB SM. PMID: 18871393 [PubMed - OLDMEDLINE] 8490. Arch Derm Syphilol. 1948 Mar;57(3 Pt. 2):568. Causalgic state secondary to brachial herpes zoster. AYRES S Jr. PMID: 18098716 [PubMed - indexed for MEDLINE] 8491. Br Med J. 1948 Feb 21;1(4546):365. Herpes zoster and varicella. DICKSON JW, BLAIR G. PMCID: PMC2089508 PMID: 18933247 [PubMed - indexed for MEDLINE] 8492. Bras Med. 1948 Feb 7-14;62(6-7):39. [Not Available.] [Article in Undetermined Language] FERRARI A. PMID: 18908110 [PubMed - indexed for MEDLINE] 8493. Klin Med Osterr Z Wiss Prakt Med. 1948 Jan 15;3(2):73. [Not Available.] [Article in Undetermined Language] TAPPEINER. PMID: 18933781 [PubMed - indexed for MEDLINE] 8494. Klin Med Osterr Z Wiss Prakt Med. 1948 Jan 15;3(2):73. [Not Available.] [Article in Undetermined Language] TAPPEINER. PMID: 18906751 [PubMed - indexed for MEDLINE] 8495. Br Med J. 1948 Jan 3;1(4539):8-10. Rarer manifestations of herpes zoster; a report on three cases. PARKINSON T. PMCID: PMC2089174 PMID: 18920007 [PubMed - indexed for MEDLINE] 8496. J Neuropathol Exp Neurol. 1948 Jan;7(1):100. Pathologic changes in early herpes zoster. RIGGS HE, RUPP C. PMID: 18917339 [PubMed - indexed for MEDLINE] 8497. Vestn Otorinolaringol. 1948 Jan-Feb;58(1):81. [Herpes zoster oticus.] [Article in Undetermined Language] IAZYKOV SA. PMID: 18887457 [PubMed - indexed for MEDLINE] 8498. Acta Psychiatr Neurol. 1948;23(1-2):69-77. Pathogenesis of cranial nerve lesions, notably ophthalmoplegias, complicating herpes zoster ophthalmicus. GODTFREDSEN E. PMID: 18881892 [PubMed - OLDMEDLINE] 8499. Acta Psychiatr Neurol. 1948;23(1-2):13-48. Herpes zoster following operations for facial pain; a clinical investigation of 830 cases. EPSTEIN L. PMID: 18881889 [PubMed - indexed for MEDLINE] 8500. Dermatologica. 1948;96(5):373-6. [Not Available.] [Article in Undetermined Language] FELLNER M. PMID: 18880899 [PubMed - indexed for MEDLINE] 8501. Dermatologica. 1948;97(1-3):78-80. [Not Available.] [Article in Undetermined Language] PICARD H. PMID: 18100135 [PubMed - indexed for MEDLINE] 8502. Lancet. 1947 Dec 20;2(6486):910. Bilateral zoster; report of a case. THOMAS EW. PMID: 18896092 [PubMed - indexed for MEDLINE] 8503. J Philipp Med Assoc. 1947 Dec;23(12):593-9. Treatment of herpes zoster with cobra venom and sulfanilamide; report of 5 cases. TAN MG, INES-TAN AR. PMID: 18902799 [PubMed - indexed for MEDLINE] 8504. J Med Lyon. 1947 Nov 5;28(668):795-806. [Not Available.] [Article in Undetermined Language] GIRARD PF, GARDE A. PMID: 18899139 [PubMed - indexed for MEDLINE] 8505. Bol Veracruz Mexico. 1947 Nov-Dec;8(5-6):3-5. [Not Available.] [Article in Undetermined Language] SAINZ TREJO. PMID: 18909476 [PubMed - indexed for MEDLINE] 8506. Concours Med. 1947 Sep 20;69(38):1569. [Not Available.] [Article in Undetermined Language] GAILLARD P. PMID: 18898087 [PubMed - indexed for MEDLINE] 8507. Ann Dermatol Syphiligr (Paris). 1947 Jun;7(6):202. [Not Available.] [Article in Undetermined Language] FLANDIN C. PMID: 18900222 [PubMed - indexed for MEDLINE] 8508. Dtsch Zahnarztl Z. 1947;2(19-20):701. [Not Available.] [Article in Undetermined Language] WENZEL H. PMID: 18935669 [PubMed - indexed for MEDLINE] 8509. Actas Dermosifiliogr. 1947-1948;39(1):87-93. [Not Available.] [Article in Undetermined Language] DE LAS OBRAS Y LOSCERTALES JM. PMID: 18903793 [PubMed - indexed for MEDLINE]