1. Korean Journal Anesthesiol. 2010 Mar;58(3):311-7. Epub 2010 Mar 29.

The effect of Gunn's intramuscular stimulation for postherpetic neuralgia -A
report of 4 cases-.

Jung W, Lee BJ, Kim SS, Lee YJ.

Department of Anesthesiology and Pain Medicine, Donkang Hospital, Ulsan, Korea.

Herpes zoster is the consequence of reactivation of latent varicella zoster virus
from dorsal root ganglia. Postherpetic neuralgia (PHN) may be diagnosed when pain
persists in a dermatomal pattern long after the vesicular erruption has healed.
PHN is a kind of neuropathic pain. The pathophysiology of PHN is uncertain, but
neuropathic pain due to denervation supersensitivity may be important to
understand the pathophysiology of PHN. Numerous treatment have been introduced
for the management of PHN, but no methods that results in complete remission.
Gunn's intramuscular stimulation (IMS) is one of the best treatment of chronic
pain, especially neuropathic pain. We tried Gunn's IMS for treatment of PHN
patients affecting thoracic dermatomes. As a result, the visual analogue scale
(VAS) was decreased from 7-8 to 2-3 and the result were satisfactory. The purpose
of this case report is to introduce the Gunn's IMS and review our experience for 
the treatment of PHN.

PMID: 20498785 [PubMed - in process]


2. Zhongguo Zhen Jiu. 2010 Mar;30(3):218-20.

[Operating rules of cotton-pave moxibustion and its samples for clinical
application in dermatopathy]

[Article in Chinese]

Li XW, Zuo J, Huang WL, Yang YK.

Acupuncture and Massage College, Chengdu University of TCM, Chengdu 610075,
China.

In clinical researches, the authors find that cotton-pave moxibustion has obvious
effect for treatment of common dermatopathy, such as herpes zoster. This therapy 
has some advantages such as easy operation, obvious clinical effect, slight and
short burning pain and easy to be accepted by patients. The purpose of this paper
is to make the operation of cotton-pave moxibustion standardized, spread and
popularize the application of this therapy in dermatopathy through detailed
description to the operation method and points for attention of cotton-pave
moxibustion and its typical cases.

PMID: 20496738 [PubMed - in process]


3. Mycoses. 2010 May 19. [Epub ahead of print]

Tinea corporis mimicking herpes zoster.

Aste N, Pau M, Aste N, Atzori L.

Dermatology Department, University of Cagliari, Cagliari, Italy.

PMID: 20492537 [PubMed - as supplied by publisher]


4. Eur J Ophthalmol. 2010 Apr 22. pii: 2B713D61-60C6-4697-BA1E-3877C9364E89. [Epub
ahead of print]

Focal posterior pole viral retinitis.

Hazirolan D, Sungur G, Demir N, Kasim R, Duman S.

1st Ophthalmology Department, Ankara Training and Research Hospital, Ministry of 
Health, Ankara - Turkey.

Purpose. To describe the clinical features of an atypical form of viral retinitis
in immunocompetent patients. Methods. This was a retrospective noncomparative
case series. The charts of 8 patients diagnosed with and treated for focal
posterior viral retinitis were reviewed. Clinical and demographic features were
evaluated. All the patients had extensive laboratory tests, fundus fluorescein
angiography, optical coherence tomography of macula, and polymerase chain
reaction of vitreous. Results. All the patients were referred to our Uveitis
Service from other hospitals, as their uveitis symptoms deteriorated in spite of 
treatment. The mean age of 4 male and 4 female patients was 32.1 years (range,
22-42 years). The mean follow-up period was 10 months (range, 6-18 months). All
of the patients had unilateral disease. Polymerase chain reaction analysis of
vitreous specimen was positive for herpes simplex virus-1 in 5 patients and
varicella zoster virus in 3 patients. Retinitis resolved after systemic acyclovir
treatment in all patients. Conclusions. Viral etiology must be borne in mind in
the differential diagnosis of atypical retinitis. It can be a milder form of
viral retinitis like focal viral retinitis, as mentioned in this study. The
prognosis of this disease is better than the other forms of necrotizing
retinopathies involving a larger area of retina.

PMID: 20491048 [PubMed - as supplied by publisher]


5. Klin Monbl Augenheilkd. 2010 May;227(5):400-6. Epub 2010 May 20.

[Penetrating keratoplasty in corneal infections with herpes simplex virus and
varicella zoster virus]

[Article in German]

Birnbaum F, Reinhard T.

Universitäts-Augenklinik Freiburg, Freiburg, Germany.
florian.birnbaum@uniklinik-freiburg.de

Penetrating keratoplasties due to herpetic corneal scars are more often performed
compared to persisting Varicella zoster virus infections, which are quite seldom.
Penetrating keratoplasties in herpetic corneas are risk keratoplasties due to the
vascularisation and the risk of recurrent virus replication. The prognosis in
these corneal transplantations has been improved in recent years due to better
postoperative medical treatment with virustatics and systemic immunosuppression. 
Indications for and treatment following penetrating keratoplasty in herpetic eyes
are the topics of this review.

PMID: 20490994 [PubMed - in process]


6. Klin Monbl Augenheilkd. 2010 May;227(5):393-9. Epub 2010 May 20.

[Amniotic membrane transplantation in herpetic corneal infections]

[Article in German]

Meller D, Thomasen H, Steuhl K.

Zentrum für Augenheilkunde, Klinik für Erkrankungen des vorderen Augenabschnitts,
Universität Duisburg-Essen, Essen, Germany. Daniel.Meller@uk-essen.de

Severe infectious corneal ulceration such as herpetic stromal keratitis commonly 
causes loss of vision and may lead to blindness. Treatment depending on the
underlying disease includes antimicrobial medication and the development of
surgical strategies to restore the integrity of the corneal ocular surface.
Ulcerative herpetic stromal keratitis and/or neurotrophic keratopathy with the
risk of corneal perforation are still clinically challenging conditions in
ophthalmic surgery of the ocular surface. Since the introduction of newly
developed preservation methods, amniotic membrane (AM) functioning as a basement 
membrane substitute has gained widespread popularity in ocular surface
reconstruction. Various ways of clinical application such as the use of AM as a
graft, patch or culture substrate and carrier system to expand ocular surface
epithelia have been recently reported. In this article, the basis and clinical
application of amniotic membrane transplantation for the management of corneal
infections with Herpes simplex and Herpes zoster virus are reviewed.

PMID: 20490993 [PubMed - in process]


7. Klin Monbl Augenheilkd. 2010 May;227(5):384-7. Epub 2010 May 20.

[Zoster vaccine]

[Article in German]

Wutzler P.

Institut für Virologie und Antivirale Therapie, Universitätsklinikum Jena, Jena, 
Germany. Peter.Wutzler@med.uni-jena.de

In Germany, a vaccine (Zostavax) to prevent herpes zoster and postherpetic
neuralgia (PHN) in adults aged 50 years and older has been available since
October 2009. The efficacy of this attenuated high-dose live vaccine was
evaluated in a double-blind randomised, placebo-controlled trial involving more
than 38,000 immunocompetent adults aged >or= 60 years. Compared to placebo the
vaccine reduced the frequency of herpes zoster by 51 % and the incidence of PHN
by 67 %. Overall, the burden of illness was reduced by 61 %. The course of
diseases occurring among the vaccine recipients was clearly milder and the risk
for complications was lower than among the placebo recipients. Although the
vaccine efficacy against herpes zoster declined with advancing age of the
vaccinees, subjects older than 70 years also benefited from vaccination because
the burden of illness was considerably reduced. To the best of our present
knowledge the protective effect of zoster vaccine persists for at least 7 years
post-vaccination. The need for, or timing of, revaccination has not yet been
determined. Zostavax has been well tolerated. It can be concomitantly
administered with inactivated influenza vaccine at separate sites. Zoster and
pneumococcal vaccines should not be given concomitantly.

PMID: 20490991 [PubMed - in process]


8. Klin Monbl Augenheilkd. 2010 May;227(5):379-83. Epub 2010 May 20.

[Postherpetic neuralgia]

[Article in German]

Mahn F, Baron R.

Sektion für Neurologische Schmerzforschung und -therapie, Universitätsklinikum
Schleswig-Holstein, Campus Kiel, Kiel, Germany.

BACKGROUND: In the last years, new findings from the research on pain diseases
and the enhancement of therapeutic options have drastically changed the treatment
of postherpetic neuralgia (PHN). This disease, belonging to the neuropathic pain 
syndromes, needs an adequate pain therapy at an early stage to prevent pain
chronicity. DEFINITION AND CLINICAL ATTRIBUTES OF PHN: In 20 % of all cases of
herpes zoster, the innervation territory of the trigeminal nerve is affected. A
PHN exists by definition in the case of persisting pain in the zoster-affected
area 6 months after healing of the zoster eruptions. The incidence of PHN depends
on the patient's age: 50 - 75 % of patients in the seventh decade develop PHN
after an infection with herpes zoster. The clinical appearance of PHN is
characteristic. Three different pain types can be distinguished: 1. spontaneous, 
constant, burning pain, 2. intermittent sharp, lancinating pain and 3. pain in
response to a normally non-painful stimulus (mechanical allodynia). Other
phenomena which can be observed are hyp- or anaesthesia, hypalgesia and par- or
dysaesthesia. PATHOPHYSIOLOGY OF NEUROPATHIC PAIN: In the last few years,
pathomechanisms of individual pain symptoms occurring in PHN have been
identified. These include peripheral and central sensitisation as well as
spontaneous activity of damaged afferent nociceptive fibres as the consequence of
changes in channels on the neuron's membrane. TREATMENT OF PHN: A basic rule in
the treatment of neuropathic pain syndromes is that the medication should be
taken for at least 2 - 4 weeks before making a final evaluation. Systematic
reviews of data from clinical trials of drug therapy for PHN have given distinct 
indications for antidepressants, antiepileptics, opioid analgesics and topically 
acting agents. Tricyclic antidepressants act on CNS pain-modulating descending
pathways. The antiepileptics gabapentin and pregabalin act on calcium channels on
presynaptic terminals of afferent nociceptive neurons in the central nervous
system. Carbamazepine and oxcarbazepine may be helpful for some patients, but
there is still a lack of controlled trials demonstrating efficacy in the
treatment of PHN. Oral oxycodone and tramadol are verifiable effective drugs in
PHN. Topically acting agents with verifiable efficacy in PHN are capsaicin and
lidocaine, both available in the form of patches for local use.

PMID: 20490990 [PubMed - in process]


9. Klin Monbl Augenheilkd. 2010 May;227(5):369. Epub 2010 May 20.

[Inflammations of the eye due to herpes simplex virus and varicella/zoster virus]

[Article in German]

Behrens-Baumann W, Heiligenhaus A.

PMID: 20490987 [PubMed - in process]


10. Curr Top Microbiol Immunol. 2010 May 4. [Epub ahead of print]

Roles of Cellular Transcription Factors in VZV Replication.

Ruyechan WT.

Department of Microbiology and Immunology, Witebsky Center for Microbial
Pathogenesis and Immunology, University at Buffalo SUNY, 138 Farber Hall,
Buffalo, NY, 14214, USA, ruyechan@buffalo.edu.

Varicella zoster virus (VZV) is the causative agent of chickenpox and shingles.
During productive infection the complete VZV proteome consisting of some 68
unique gene products is expressed through interaction of a small number of viral 
transcriptional activators with the general transcription apparatus of the host
cell. Recent work has shown that the major viral transactivator, commonly
designated the IE62 protein, interacts with the human Mediator of transcription. 
This interaction requires direct contact between the MED25 subunit of Mediator
and the acidic N-terminal transactivation domain of IE62. A second cellular
factor, host cell factor-1, has been shown to be the common element in two
mechanisms of activation of the promoter driving expression of the gene encoding 
IE62. Finally, the ubiquitous cellular transcription factors Sp1, Sp3, and YY1
have been shown to interact with sequences near the VZV origin of DNA replication
and in the case of Sp1/Sp3 to influence replication efficiency.

PMID: 20490778 [PubMed - as supplied by publisher]


11. Med Trop (Mars). 2010 Apr;70(2):137-40.

[Ocular manifestations in HIV/AIDS patients undergoing highly active
antiretroviral treatment (HAART) in Togo]

[Article in French]

Ayena KD, Amedome KM, Agbo AR, Kpetessou-Ayivon AL, Dzidzinyo BK, Djagnikpo PA,
Banla M, Balo KP.

Service d'ophtalmologie CHU Tokoin, Lomé, Togo.

AIM: The twofold purpose of this study in people living with human
immunodeficiency virus (PLHIV/AIDS) and undergoing highly active antiretroviral
treatment (HAART) was to determine the prevalence of ocular manifestations and
its correlation with CD4 T-cell count. PATIENTS AND METHODS: All patients who
attended 2 NGO care centers that manage PLHIV/AIDS in Lomé, Togo between August
and October 2005 were recruited. CD4 T-cell counts and use of antiretroviral
treatment was noted. A thorough eye examination was performed in all cases.
RESULTS: A total of 422 PLHIV/SIDA were recruited including 281 who were
undergoing HAART. The sex-ratio was 2 female/1 male. Mean age was 34 +/- 2294
years. Involvement of the anterior segment was observed in 36.3% of patients and 
involvement of the posterior segment in 54.1%. The second most common ocular
manifestation was ophthalmic herpes zoster of the anterior segment (19.6%)
secondary to conjunctivitis (57.8%). One case of palpebral and conjunctival
Kaposi's sarcoma was noted. The most common type of posterior segment involvement
was cotton-wool nodules (35.5%). Five cases of CMV retinitis were observed.
CONCLUSION: A longitudinal study in PLHIV/AIDS will be needed to better evaluate 
the correlation between ocular manifestations and CD4 T-cell count.

PMID: 20486347 [PubMed - in process]


12. Arch Dermatol. 2010 May;146(5):569-70.

Permanent localized hair repigmentation following herpes zoster infection.

Adiga GU, Rehman KL, Wiernik PH.

PMID: 20479318 [PubMed - in process]


13. Curr Top Microbiol Immunol. 2010 May 7. [Epub ahead of print]

VZV T Cell-Mediated Immunity.

Weinberg A, Levin MJ.

University of Colorado Denver, Research Complex 2, Mail Stop 8604, 12700 E. 19th 
Ave., Aurora, CO, 80045, USA, Adriana.Weinberg@ucdenver.edu.

Primary varicella-zoster virus (VZV) infection (varicella) induces VZV-specific
antibody and VZV-specific T cell-mediated immunity. T cell-mediated immunity,
which is detected within 1-2 weeks after appearance of rash, and consists of both
CD4 and CD8 effector and memory T cells, is essential for recovery from
varicella. Administration of a varicella vaccine also generates VZV-specific
humoral and cellular immune responses. The memory cell responses that develop
during varicella or after vaccination contribute to protection following
re-exposure to VZV. These responses are subsequently boosted either by endogenous
re-exposure (silent reactivation of latent virus) or exogenous re-exposure
(environmental). VZV-specific T cell-mediated immunity is also necessary to
maintain latent VZV in a subclinical state in sensory ganglia. When these
responses decline, as occurs with aging or iatrogenic immune suppression,
reactivation of VZV leads to herpes zoster. Similarly, the magnitude of these
responses early after the onset of herpes zoster correlates with the extent of
zoster-associated pain. These essential immune responses are boosted by the VZV
vaccine developed to prevent herpes zoster.

PMID: 20473790 [PubMed - as supplied by publisher]


14. Infect Dis Clin North Am. 2010 Jun;24(2):373-93.

Herpes viruses in transplant recipients: HSV, VZV, human herpes viruses, and EBV.

Shiley K, Blumberg E.

Division of Infectious Diseases, Hospital of the University of Pennsylvania, 3rd 
Floor Silverstein Pavilion, Suite E, 3400 Spruce Street, Philadelphia, PA 19104, 
USA. shileyk@uphs.upenn.edu

The herpes viruses are responsible for a wide range of diseases in patients
following transplant, resulting from direct viral effects and indirect effects,
including tumor promotion. Effective treatments and prophylaxis exist for the
neurotropic herpes viruses HSV-1, HSV-2, varicella zoster virus, and possibly
HHV-6. Antivirals seem to be less effective at prevention of the tumor-promoting 
effects of Epstein-Barr virus and HHV-8. Reduction in immunosuppression is the
cornerstone to treatment of many diseases associated with herpes virus
infections. Copyright (c) 2010 Elsevier Inc. All rights reserved.

PMID: 20466275 [PubMed - in process]


15. Int J Dermatol. 2010 Feb;49(2):234-5.

Wolf's isotopic response--lichen planus at the site of healed herpes zoster in an
Indian woman.

Ghorpade A.

PMID: 20465656 [PubMed - in process]


16. Int J Dermatol. 2010 Jan;49(1):105-7.

Wolf's isotopic response--furuncles at the site of healed herpes zoster in an
Indian male.

Ghorpade A.

PMID: 20465628 [PubMed - in process]


17. Br J Neurosurg. 2010 Jun;24(3):298-300.

Carotico-cavernous fistula secondary to Varicella zoster?

Amato-Watkins A, St George EJ, Saxena A, Bhattacharya J.

Department of Neurosurgery, Institute of Neurological Sciences, Southern General 
Hospital, Glasgow, United Kingdom.

We describe the case of a previously well, 73-year-old male patient who presented
with a spontaneous high flow, carotico-cavernous fistula, 1 month following an
attack of herpes zoster. We postulate that the zoster virus was the underlying
cause, given the history and time frame between the preceding shingles and the
subsequent development of the fistula. The literature supporting this hypothesis 
is reviewed.

PMID: 20465460 [PubMed - in process]


18. S Afr Med J. 2010 Mar 8;100(3):172-4.

Hutchinson's sign as a marker of ocular involvement in HIV-positive patients with
herpes zoster ophthalmicus.

Van Dyk M, Meyer D.

Stellenbosch University, Tygerberg, W Cape. mariusvandyk@hotmail.com

BACKGROUND: A positive Hutchinson's sign indicates an increased risk of ocular
involvement in herpes zoster ophthalmicus (HZO). We examined the sensitivity of
Hutchinson's sign as an indicator of ocular involvement in a consecutive series
of patients presenting with HZO. METHODS: We conducted a descriptive
observational prospective study of patients > or =18 years old presenting with
HZO and consenting to pre-and post-test counselling and HIV and CD4 testing. A
full ophthalmological examination focused on the extent of ocular involvement,
and the presence of Hutchinson's sign was confirmed by two clinicians. RESULTS:
Thirty-three patients were enrolled; 29 were HIV positive, of whom 18 (62%) had
not been diagnosed with HIV prior to enrollment. Of the 29 HIV-positive patients,
21 (72%) were Hutchinson's sign positive (HSP), all of whom had intra-ocular
involvement (95% confidence interval 88 - 100%). Of the 8 HIV-positive,
Hutchinson's sign-negative (HSN) patients, 4 did and 4 did not display
intra-ocular involvement. Neither the mean CD4 count nor the average age in the
HSP group differed significantly from the HSN group. CONCLUSION: We confirmed
that a Hutchinson's sign- and HIV-positive patient with HZO has a very high
positive predictive value for intra-ocular involvement. Neither age nor CD4 count
had predictive value for ocular involvement. Young adults presenting with HZO
should be suspected of having HIV, and HIV-positive patients with HZO but HSN may
still have ocular involvement. All patients with HZO should be seen by an
ophthalmologist.

PMID: 20459942 [PubMed - in process]


19. BMC Fam Pract. 2010 May 6;11:33.

Epidemiology of herpes zoster infection among patients treated in primary care
centres in the Valencian community (Spain).

Cebrián-Cuenca AM, Díez-Domingo J, Rodríguez MS, Puig-Barberá J, Navarro-Pérez J;
'Herpes Zoster Research Group of the Valencian Community'.

Collaborators: Momparler-Martínez C, Navarrete-Villalta JM, García-García C,
Guillem-Miralles JF, Pereiró-Berenguer I, Ruiz-Varea N, Vives-Rebollar L,
Feliú-Morte C, Alvarez-Martínez M, Cañada-Blasco J, Picón-García E, Pla-García
JA, Robles-Pastor E, Fillols FC, Cervera-Pérez I, Colomer-Paché M, López-De los
Mozos AR, Mir-Mora JE, Latorre-Atienza MA, Matoses-Nácher D, Pascual-López L,
Gorgues-Comás R, i Espert FJ.

Centro Superior de Investigaciones en Salud Pública de Valencia (CSISP), Av,
Cataluña 21, 46020, Valencia, Spain.

BACKGROUND: There is little available data regarding the epidemiology of herpes
zoster (HZ) in Spain. This study's main goal was to estimate the annual incidence
of HZ in the Autonomous Community of Valencia. METHODS: From December 1st 2006 to
December 1st 2007, a prospective study was carried out in 24 primary health care 
centres that together provide care for a population of 36,030 persons aged >14
years. We included all adult patients with a clinical diagnosis of HZ who were
seen at these centres during the one-year study period. Demographic (i.e., age,
gender, and area of residence) and clinical data were also collected from these
patients. RESULTS: A total of 146 cases of HZ were identified during the study
period. The annual incidence of HZ was 4.1/1,000 individuals >14 years of age
(95% confidence interval [CI]: 3.4-4.7). Cases of HZ were predominantly
unilateral and most commonly affected women and people living in rural areas. The
most frequently reported symptoms were pain, dysesthesia and itching. A total of 
46% of patients also had underlying illnesses (e.g., chronic diseases and/or
malignancy) and 24% of patients experienced complications, which were mostly
ocular in nature. A total of 91% of patients were treated with antiviral drugs.
The median time from symptoms onset to diagnosis was 6.3 days (range: 2.0-8.3).
CONCLUSIONS: HZ is a common illness in our region (especially in the older
population) that causes a significant clinical burden on primary care providers.

PMCID: PMC2874789
PMID: 20459608 [PubMed - in process]


20. Arch Neurol. 2010 May;67(5):640-1.

Laser scanning in vivo confocal microscopy demonstrating significant alteration
of human corneal nerves following herpes zoster ophthalmicus.

Patel DV, McGhee CN.

Department of Ophthalmology, University of Auckland, Auckland, New Zealand.

PMID: 20457969 [PubMed - in process]